Journal of the International AIDS Society最新文献

{"title":"Innovating healthcare: Tangerine Clinic's role in implementing inclusive and equitable HIV care for transgender people in Thailand.","authors":"Rena Janamnuaysook, Ratee Taesombat, Joe Wong, Ravipa Vannakit, Stephen Mills, Maarten Schim van der Loeff, Peter Reiss, Frits van Griensven","doi":"10.1002/jia2.26405","DOIUrl":"10.1002/jia2.26405","url":null,"abstract":"","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":"e26405"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A global review of national guidelines of post-exposure prophylaxis for the prevention of HIV.","authors":"Marcus Maisano, Daniel Tran, Virginia Macdonald, Rachel C Baggaley, Nathan Ford, Cheryl C Johnson, Ying Zhang, Jason J Ong","doi":"10.1002/jia2.26333","DOIUrl":"10.1002/jia2.26333","url":null,"abstract":"<p><strong>Introduction: </strong>The World Health Organization (WHO) recommends the use of antiretroviral drugs as post-exposure prophylaxis (PEP) for preventing HIV acquisition for occupational and non-occupational exposures. To inform the development of global WHO recommendations on PEP, we reviewed national guidelines of PEP for their recommendations.</p><p><strong>Methods: </strong>Policies addressing PEP from 38 WHO HIV priority countries were obtained by searching governmental and non-governmental websites and consulting country and regional experts; these countries were selected based on HIV burden, new HIV acquisitions and the number of HIV-associated deaths. We reviewed national guidelines to collate data on where PEP can be offered, who can prescribe PEP, PEP eligibility, recommended drug regime, linkage to other interventions, recommended investigations prescribed with PEP, HIV self-test recommendation related to PEP and stopping rules for PEP.</p><p><strong>Results: </strong>In total, 46 guidelines from January 2010 to May 2023 across 36 countries were included, with 70% of documents published during or after 2020. There was significant variation across national guidelines regarding where PEP can be accessed and who can provide or prescribe PEP. Six countries (17%) described being able to access PEP from a primary care facility, four countries (11%) from hospitals and two (6%) from community-based services. Only three countries (8%) specifically considered dispensing PEP by professionals other than doctors (e.g. nurses). None mentioned pharmacists as prescribers. We found a lack of consistency across countries regarding who is eligible for PEP, regimens used, interventions integrated into PEP provision and recommended investigations for PEP users. No country guidance provided considerations on using HIV self-tests for starting or stopping PEP.</p><p><strong>Discussion: </strong>Despite PEP being recommended for more than three decades, many national policies were lacking in terms of PEP guidance. There are opportunities for countries to update and optimize guidance to consider ways to improve the accessibility of PEP. Greater efforts are needed to support the development of global consensus on how best to implement and integrate PEP, as well as how to include decentralization and task-sharing to achieve sufficient scale for impact.</p><p><strong>Conclusions: </strong>Improving timely access to PEP and promoting PEP adherence could help contribute to reducing the incidence of HIV globally.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":"e26333"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755062/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143021435","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Updated guidelines on HIV post-exposure prophylaxis: continued efforts towards increased accessibility\".","authors":"","doi":"10.1002/jia2.26409","DOIUrl":"10.1002/jia2.26409","url":null,"abstract":"","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":"e26409"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11710929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142941980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing populations prioritized for PrEP in 19 African countries: a review of national guidance.","authors":"Lauren A Graybill, Caroline N McKay, Jiayu Wang, Nadia A Sam-Agudu, Marcel Yotebieng, Friday Saidi, Linda-Gail Bekker, Bonnie E Shook-Sa, Benjamin H Chi, Nora E Rosenberg","doi":"10.1002/jia2.26407","DOIUrl":"https://doi.org/10.1002/jia2.26407","url":null,"abstract":"<p><strong>Introduction: </strong>While African countries have expanded access to HIV pre-exposure prophylaxis (PrEP) since 2015, regional targets for PrEP uptake remain unmet. Understanding which populations are prioritized for PrEP at the policy level is an important step in determining the scope of PrEP distribution across Africa and identifying gaps in programme implementation. We reviewed national guidance to characterize populations prioritized for PrEP in Africa.</p><p><strong>Methods: </strong>Between January and June 2023, we searched for current National HIV Treatment and Prevention Guidelines, National HIV Strategic Plans, and the United States President's Emergency Plan for AIDS Relief (PEPFAR) Country Operational Plans (COPs) for all African countries implementing PrEP programmes supported by PEPFAR in 2022. From each document, we summarize the populations prioritized for PrEP within a country and describe PrEP eligibility.</p><p><strong>Results: </strong>In 2022, 19 African countries implemented PrEP programmes supported by PEPFAR. Eighteen of these countries contributed National Guidelines (2016-2022), 18 contributed National Strategic Plans (2017-2023) and 19 contributed COPs (2022) to this review. Twenty-nine population groups were prioritized for PrEP in these documents. All countries prioritized HIV-serodifferent couples, female sex workers (FSWs), adolescent girls and young women (AGYW), pregnant and breastfeeding women (PBFW) and people who inject drugs (PWID), and most prioritized men who have sex with men (MSM; n = 18), transgender people (n = 18) and people in prisons (n = 17). The remaining 21 populations were prioritized in fewer than two-thirds of countries.</p><p><strong>Discussion: </strong>FSWs, MSM, PWID, transgender people and people in prisons were typically prioritized for PrEP with no eligibility restrictions. In contrast, most countries had at least one document indicating that HIV-serodifferent couples, AGYW and PBFW were only eligible for PrEP if classified as high risk. Few documents specified how risk was determined, and no document included validated HIV risk assessment tools to guide implementation. We observed similarities in priority populations across countries with different HIV epidemics and inconsistencies in who was prioritized for PrEP within a country's own set of policy documents.</p><p><strong>Conclusions: </strong>Understanding how PrEP prioritization policies impact HIV incidence in different epidemiologic settings is critical for strengthening PrEP implementation across the continent.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":"e26407"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142930139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of same-day and rapid ART initiation under the Universal Health Coverage programme on HIV outcomes in Thailand: a retrospective real-life cohort study.","authors":"Sirinya Teeraananchai, David C Boettiger, Cheewanan Lertpiriyasuwat, Rattaphon Triamwichanon, Patchara Benjarattanaporn, Nittaya Phanuphak","doi":"10.1002/jia2.26406","DOIUrl":"10.1002/jia2.26406","url":null,"abstract":"<p><strong>Introduction: </strong>Antiretroviral therapy (ART) initiation, regardless of CD4 count, has been recommended in Thailand since 2014, with same-day initiation recommended since 2021. We assessed HIV treatment outcomes among Thai people living with HIV (PLHIV) by the time from HIV diagnosis to ART initiation under the Universal Health Coverage (UHC) programme and identified factors associated with virological failure (VF).</p><p><strong>Methods: </strong>PLHIV aged ≥15 years initiating ART between 2014 and 2022 were included from the UHC database. We categorized participants into four groups using the duration from HIV diagnosis to ART initiation: (1) ≤ 7 days (same-day ART); (2) 8 days to <1 month; (3) 1-3 months; and (4) >3 months. Viral load (VL) was measured 6 months after starting ART, and annually thereafter. VF was defined as VL ≥1000 copies/ml. Factors associated with VF were analysed using competing risk models considering death and loss to follow-up (LTFU) as competing events.</p><p><strong>Results: </strong>Among 252,239 PLHIV who started ART, the median age at initiation was 34 years (interquartile range [IQR]: 26-43 years). The median (IQR) pre-ART CD4 count was 233 (76-420) cells/mm³. ART initiation occurred within 7 days for 25% (17% on the same day, 8% in 2-7 days), 24% in 8 days to <1 month, 23% in 1-3 months and 28% in >3 months. ART initiation within 7 days increased from 20% (2014-2016) to 32% (2021-2022). VF occurred with a rate of 3.11 (95% CI 3.07-3.159) per 100 person-years (PYs). PLHIV initiating ART 8 days to 1 month were at lower risk of VF (aSHR 0.52, 95% CI 0.50-0.54) when compared to ART initiation >3 months. ART initiation within 7 days resulted in the lowest mortality (6%: 1.28 [95% CI 1.24-1.32] per 100 PYs), but the highest rate of LTFU (12%: 2.69 [95% CI 2.63-2.75] per 100 PYs) when compared to other ART initiation groups.</p><p><strong>Conclusions: </strong>Although ART initiation within 7 days has increased in Thailand, the overall rate of early initiation remains low. ART initiation within 1 month significantly lowered the risk of VF. ART initiation within 7 days significantly reduced mortality. To further optimize health outcomes, innovative strategies are urgently needed to promote earlier ART initiation in Thailand.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":"e26406"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of long-acting cabotegravir safety and pharmacokinetics in pregnant women in eastern and southern Africa: a secondary analysis of HPTN 084.","authors":"Sinead Delany-Moretlwe, Brett Hanscom, Xu Guo, Clemensia Nkabiito, Patricia Mandima, Patricia Ntege Nahirya, Juliet Mpendo, Muchaneta Bhondai-Mhuri, Nyaradzo Mgodi, Rebecca Berhanu, Jennifer Farrior, Estelle Piwowar-Manning, Susan L Ford, Craig W Hendrix, Alex R Rinehart, James F Rooney, Adeola Adeyeye, Raphael J Landovitz, Myron S Cohen, Mina C Hosseinipour, Mark A Marzinke","doi":"10.1002/jia2.26401","DOIUrl":"10.1002/jia2.26401","url":null,"abstract":"<p><strong>Introduction: </strong>Long-acting injectable cabotegravir (CAB-LA) for pre-exposure prophylaxis significantly reduced HIV acquisition in HPTN 084. We report on the safety and CAB-LA pharmacokinetics in pregnant women during the blinded period of HPTN 084.</p><p><strong>Methods: </strong>Participants were randomized 1:1 to either active cabotegravir (CAB) plus tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) placebo or active TDF/FTC plus CAB placebo. Pregnancy testing was performed at each visit; participants with a positive test had study product withheld and were offered open-label TDF/FTC. Pregnancies were confirmed on two tests at least 4 weeks apart. All participants with a positive pregnancy test prior to November 5, 2020 are included in this analysis. Pregnancy incidence, maternal adverse event (AE) incidence, pregnancy outcomes (including composite outcome of spontaneous abortion <20 weeks, intrauterine foetal death or stillbirth ≥20 weeks, premature birth <37 weeks, or small for gestational age) were assessed. The apparent terminal phase half-life (t_1/2app) of CAB-LA in pregnant women in HPTN 084 was compared to non-pregnant women from the phase 2a HPTN 077 trial. Multivariable models assessed associations with t_1/2app. RESULTS: Fifty-seven pregnancies (30 CAB-LA, 27 TDF/FTC) were confirmed over 3845 person-years [py] (incidence 1.5/100 py, 95% CI 1.1-1.9). CAB-LA group participants had a median 342 days (IQR 192, 497) of CAB-LA exposure prior to pregnancy detection. Grade 2 or higher maternal AE incidence did not differ by study arm (CAB 157, 95% CI 91-271 per 100 py vs. TDF/FTC 217, 95% CI 124-380 per 100 py; p = 0.256). Most pregnancies (81%) resulted in live births (25 CAB-LA, 22 TDF/FTC). Composite poor pregnancy outcomes did not differ significantly by group (CAB 6/30 vs. TDF/FTC 4/27; p = 0.476). No congenital anomalies were observed. The CAB t_1/2app geometric mean was 52.8 days (95% CI 40.7-68.4) in pregnant women compared to 60.3 days (95% CI 47.7-76.3; p = 0.66) in non-pregnant women; neither pregnancy nor body mass index were significantly associated with t_1/2app.</p><p><strong>Conclusions: </strong>CAB-LA concentrations post-cessation of injections were generally well tolerated in pregnant women. The t_1/2app was comparable between pregnant and non-pregnant women. Ongoing studies will examine the safety and pharmacology of CAB-LA in women who choose to continue CAB-LA through pregnancy and lactation.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":"e26401"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing intrinsic capacity for person-centred HIV care: a cross-sectional study in ageing populations in Malaysia and Hong Kong.","authors":"Reena Rajasuriar, Syaza Hisham, John Son Lim, Jean Yi Cheong, Wen Ying Ho, Siew Hwei Yap, Nurul Syuhada Zulhaimi, Malinee Neelamegam, Catherine Cheung, Vivian Wong, Ruhana Che Yusof, Kejal Hasmukharay, Shahrul Bahyah Kamaruzzaman, Sharifah Faridah Syed Omar, Meng Li Chong, Pui Li Wong, Grace Chung-Yan Lui","doi":"10.1002/jia2.26404","DOIUrl":"10.1002/jia2.26404","url":null,"abstract":"<p><strong>Introduction: </strong>WHO's Integrated Care for Older People (ICOPE) proposes we measure the functional construct of intrinsic capacity (IC) to monitor and identify individuals with age-associated vulnerabilities. Assessments of IC may be useful to address the evolving, non-HV care needs of ageing people with HIV (PWH). However, to date, its utility within the context of HIV has not been assessed.</p><p><strong>Methods: </strong>Participants included 200 PWH attending out-patient care (2021-2023) in Universiti Malaya Medical Centre, Malaysia and 101 community controls aged 35 years and above. The ICOPE framework was adapted to derive aggregate IC scores (ranging 0-6) encompassing the five domains of cognition, sensory (hearing and vision), mobility, mood and vitality. Multivariable analyses were used to explore the association of IC scores in PWH with multiple health outcomes including frailty, difficulties performing instrumental activities of daily living (IADL) and inflammatory markers. Area under the receiver operator characteristic (AUC-ROC) was calculated to predict frailty and IADL deficits in the current cohort and an independent cohort of 275 PWH from Hong Kong (HK).</p><p><strong>Results: </strong>Median (interquartile range, IQR) age among PWH and controls were 50 (42-56) and 50 (39-59) years, respectively. There were more males among PWH (83% vs. 56%, p<0.001). All PWH received antiretroviral therapy (ART) for a median duration of 11 (8-14) years. Aggregate IC scores were lower in PWH but not significantly different compared to controls, (5.4 vs. 5.6, p = 0.093) and PWH performed significantly worse than controls only in the cognitive domain. Aggregate IC scores in PWH was independently associated with frailty (OR 0.17 95% CI 0.07-0.42, p<0.001), IADL deficits (OR 0.25 95% CI 0.14-0.46, p<0.001) and all other patient-reported outcomes assessed. Aggregate IC scores correlated with IL-6 but not sCD14 and sCD163 levels. IC scores performed well in identifying PWH with frailty (AUC-ROC ≥ 0.80) in the HK and Malaysian cohorts but more modestly (AUC-ROC ≥ 0.64) for IADL deficits.</p><p><strong>Conclusions: </strong>IC is a good composite measure to monitor non-HIV, age-associated physical and social vulnerabilities in PWH on ART and should complement disease-based monitoring in routine HIV care. Assessments of IC should be validated in larger, longitudinal cohorts of PWH from diverse settings.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":"e26404"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11670474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of the National Syphilis Prevention Program on the prevalence of syphilis among people living with HIV in China: a systematic review and meta-analysis.","authors":"Qingling Zeng, Yuhui Yang, Limin Zhang, Jiangyu Yan, Jian Wang, Jingmin Nie, Qingmei Wang, Yu Luo, Gaoming Li","doi":"10.1002/jia2.26408","DOIUrl":"https://doi.org/10.1002/jia2.26408","url":null,"abstract":"<p><strong>Introduction: </strong>In 2010, China launched the 10-year National Syphilis Prevention and Control Program to curb the spread of syphilis by integrating syphilis screening and treatment with HIV services. Herein, we aimed to evaluate changes in the prevalence of syphilis among people living with HIV (PLHIV) in China.</p><p><strong>Methods: </strong>We conducted this systematic review and meta-analysis by searching the PubMed, Embase, Web of Science, China Biomedical Literature, China National Knowledge Infrastructure, Wanfang and CQVIP databases from inception to 1 June 2024 to obtain relevant articles. A total of 75 studies were ultimately included. We used a DerSimonian‒Laird random effects model to estimate the prevalence and 95% confidence interval of syphilis among PLHIV.</p><p><strong>Results: </strong>The overall prevalence of syphilis among PLHIV in China was 18.6% (95% CI 16.5-21.0). Regional differences (R² = 15.29%) were observed in the prevalence rates: 22.2% (18.9-25.8) in the eastern region, 19.0% (15.1-23.8) in the central region and 14.0% (11.1-17.5) in the western region. The prevalence decreased from 22.8% (18.4-27.9) before 2010 to 17.0% (14.6-19.6) in 2010 and thereafter (R² = 5.82%). Among PLHIV via homosexual transmission, the prevalence of syphilis was 24.9% (21.3-28.9), which significantly declined from 33.8% (27.5-40.8) to 21.4% (18.3-24.9) in 2010 and thereafter (R² = 22.35%). The prevalence of syphilis was significantly higher in men living with HIV than in women living with HIV (pooled odds ratio 1.67, 95% CI 1.29-2.15), with the highest prevalence in the eastern region (2.55, 95% CI 1.80-3.59).</p><p><strong>Discussion: </strong>The prevalence of syphilis among PLHIV, particularly in cases of homosexual transmission, has declined. There was a correlation between the prevalence of syphilis and regional economic conditions, with a greater burden in developed eastern coastal areas. Additionally, the risk of syphilis differed across sexes, with men living with HIV having a higher risk.</p><p><strong>Conclusions: </strong>There has been preliminary success in the control of syphilis among PLHIV, but there is still a long way to go to meet the WHO's 2030 syphilis prevention and control goal. Syphilis prevention measures should be integrated into broader health policies and development plans, particularly in high-burden regions and populations.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":"e26408"},"PeriodicalIF":4.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11705538/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142941982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Men who have sex with men perceiving that sex with women carries the greatest risk of HIV acquisition: results from a mixed-methods systematic review in sub-Saharan Africa","authors":"Marion Fiorentino,&nbsp;Marie Dos Santos,&nbsp;August Eubanks,&nbsp;Nathan Yanwou,&nbsp;Christian Laurent,&nbsp;Perrine Roux,&nbsp;Bruno Spire","doi":"10.1002/jia2.26402","DOIUrl":"10.1002/jia2.26402","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In sub-Saharan Africa (SSA), men who have sex with men (MSM) often have female sexual partners. Their overall risk of acquiring HIV is higher with male partners. Risk perception is associated with HIV knowledge, sexual risk and preventive behaviours. This synthesis aimed to summarize existing data about HIV knowledge and perceived HIV acquisition risk regarding sex with men and with women in MSM in SSA.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a systematic literature review of MSM's relationships with women in SSA (PROSPERO-CRD42021237836). Quantitative and qualitative data related to MSM's perceived risk from sex with men and with women and HIV knowledge (published up to 2021) were selected and synthesized.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Twenty studies were selected. More MSM perceived that the greatest risk of HIV acquisition came from heterosexual/vaginal sex than from homosexual/anal sex (53% vs. 15%; 51% vs. 39%; 42% vs. 8%; 27% vs. 25%; 43% vs. 11%; 23% vs. 13%; 35% vs. 16%, cumulative sample &lt;i&gt;n&lt;/i&gt; = 4396, six countries). A higher proportion of MSM received preventive information on heterosexual HIV transmission than on homosexual transmission (79% vs. 22%; 94% vs. 67%; 54% vs. 19%; cumulative sample &lt;i&gt;n&lt;/i&gt; = 1199, four countries). The qualitative synthesis (eight studies) highlighted biology- and behaviour-based misconceptions leading MSM to perceive lower or negligible HIV risk from sex with men, compared to sex with women. These misconceptions were partly fuelled by the predominant focus on heterosexual and vaginal HIV transmission in HIV prevention information.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Common misconceptions regarding sexual risk between men remain unaddressed by the heteronormative messaging of HIV prevention. Underestimation by MSM of their HIV acquisition risk with male partners can pose significant barriers to effective HIV preventive behaviours and strengthen the transmission risk from MSM to their female partners.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Improving access of MSM to tailored HIV prevention information and tools that address their practices with male and female partners is crucial. Integrating messages about anal sex into broader public health initiatives, including sexual health programmes targeting the general population, is essential. Further research in diverse settings in SSA is necessary to gain a great","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Linkage to care and prevention after HIV self-testing: a systematic review and meta-analysis","authors":"Ying Zhang,&nbsp;Su Mei Goh,&nbsp;James Tapa,&nbsp;Cheryl C. Johnson,&nbsp;Eric P. F. Chow,&nbsp;Lei Zhang,&nbsp;Tiffany Phillips,&nbsp;Christopher K. Fairley,&nbsp;Jason J. Ong","doi":"10.1002/jia2.26388","DOIUrl":"10.1002/jia2.26388","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Effective linkage to prevention and care is a crucial step following HIV testing services. This systematic review aimed to determine the proportion of individuals linked to prevention and care after HIV self-testing (HIVST) and describe factors associated with linkage.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Following PRISMA guidelines, a comprehensive search across eight databases (2010–October 2023) identified studies on linkage to care after HIVST, defined as receiving a confirmatory test or initiating antiretroviral therapy (ART) if the self-test was reactive, and/or pre-exposure prophylaxis (PrEP) if the self-test was non-reactive. A random-effects meta-analysis summarized the findings and meta-regression explored study-level covariates, such as world region, population type and service delivery model, that might explain the between-study heterogeneity.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;From 10,071 screened studies, 173 were included in the meta-analysis. The majority of studies focused on key populations in Africa using unassisted, oral fluid-based HIVST kits. Among those with reactive HIVST results, 92% (95% confidence interval [CI]: 88–95) were linked to confirmatory testing (&lt;i&gt;n&lt;/i&gt; = 124 studies), and 89% (95% CI: 84–93) of newly diagnosed individuals initiated ART (&lt;i&gt;n&lt;/i&gt; = 88 studies). Overall, 84% (95% CI: 74–93) of self-testers were linked to care (&lt;i&gt;n&lt;/i&gt; = 69 studies). However, only 9% (95% CI: 2–19) of individuals with non-reactive HIVST results were linked to PrEP services (&lt;i&gt;n&lt;/i&gt; = 9 studies). Assisted HIVST was associated with higher linkage rates to confirmatory testing and ART initiation compared to unassisted testing. Meta-regression revealed that the type of delivery model for the HIVST kits influenced linkage and that individuals who obtained their HIVST kits through a social network-based approach (SNA) were more likely to be linked to confirmatory testing (adjusted odds ratio = 1.28 [95% CI: 1.10–1.50], &lt;i&gt;p&lt;/i&gt; = 0.001) compared to non-SNA service delivery model.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;In the context of expanding HIVST services globally, we found that linkage to confirmatory testing and ART initiation after HIVST is generally high, particularly when assisted HIVST or SNA-based distribution is used.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Strengthening timely linkage is vital for improving health outcomes, reducing HIV tr","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811707","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}