Journal of the International AIDS Society最新文献

{"title":"Prevalence and risk factors of hypertension and diabetes among persons living with HIV in Zambia: results of a national facility-based cross-sectional survey.","authors":"Chomba Mandyata, Sivile Suilanji, Samuel Bosomprah, Paul Somwe, Cosmas Zyambo, Mwiche Musukuma, Aggrey Mweemba, Malizgani Paul Chavula, Chipefwe Sichilima, Phoebe Bwembya, Mpanji Siwingwa, Richard Chibale, Henry Phiri, Joseph Zulu, Halwindi Hikabasa, Wilbroad Mutale","doi":"10.1002/jia2.70051","DOIUrl":"https://doi.org/10.1002/jia2.70051","url":null,"abstract":"<p><strong>Introduction: </strong>Despite growing evidence on the rising burden of non-communicable diseases (NCDs) in sub-Saharan Africa, the national prevalence of hypertension, prediabetes and diabetes among persons living with HIV (PLHIV) in Zambia is largely unknown. This study aimed to determine the national prevalence of hypertension and diabetes mellitus and their associated risk factors among adult PLHIV in Zambia.</p><p><strong>Methods: </strong>We conducted a cross-sectional study in 149 antiretroviral therapy (ART) clinics located in 52 rural and urban districts in Zambia based on the adapted World Health Organization (WHO) STEPwise approach to NCD risk factor Surveillance (STEPS) and the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) questionnaire. We used proportional to size sampling to select districts and clinics, targeting 5775 PLHIV. Data was collected from 1 October 2023 to 30 November 2023. We estimated the prevalence of hypertension and diabetes mellitus and used robust Poisson regression to analyse associations with socio-demographic, behavioural and HIV-related risk factors, and reported prevalence ratios (PR).</p><p><strong>Results: </strong>In the final analysis, we included a total of 5204 participants from 52 districts and 149 ART clinics countrywide: 67.2% were female, and 71.3% were from urban areas. The prevalence of hypertension, prediabetes and diabetes was 22.5% (95% confidence interval [CI]: 21.3-23.6), 26.7% (CI: 25.5-27.9) and 12.5% (CI: 11.6-13.4), respectively. In the multivariable model, being 30-44 (PR = 2.1; CI: 1.5-2.9), 45-49 (PR = 3.3; CI: 2.4-4.7) and 60 years or older (PR = 4.7; CI: 3.3-6.8) compared to those aged 18-29; widowed, divorced or separated individuals compared to those never married; being overweight (PR = 1.4; CI: 1.2-1.5) and obese (PR = 1.9; CI: 1.6-2.1) compared to normal weight PLHIV was associated with hypertension. College or university-educated PLHIV (PR = 2.1; CI: 1.3-3.4), compared to those with no formal education; and those with high total cholesterol ≥6.2 mmol/l (PR = 2.2; CI: 1.4-3.6), versus desirable total cholesterol (<5.2 mmol/l); being overweight (PR = 1.4; CI: 1.1-1.6) and obese (PR = 1.6; CI: 1.3-2.0), compared to those with normal weight, showed a significant association with diabetes mellitus.</p><p><strong>Conclusions: </strong>The prevalence of hypertension and diabetes mellitus among PLHIV in Zambia was notably high. This underscores the need for immediate and robust intervention strategies to mitigate the high prevalence of hypertension and diabetes mellitus, along with their associated risk factors, particularly within this vulnerable demographic.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":"e70051"},"PeriodicalIF":4.9,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237491","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":"Traditional healers can help facilitate HIV serostatus disclosure: results from a qualitative study in rural Uganda","authors":"Srija Gogineni,&nbsp;Gabriel Nuwagaba,&nbsp;Misha Hooda,&nbsp;Sylvia Natukunda,&nbsp;Constance Birungi,&nbsp;William Bugeza,&nbsp;Maureen Tushabe,&nbsp;Denis Nansera,&nbsp;Winnie Muyindike,&nbsp;Carolyn Marie Audet,&nbsp;Juliet Mwanga-Amumpaire,&nbsp;Radhika Sundararajan","doi":"10.1002/jia2.70031","DOIUrl":"https://doi.org/10.1002/jia2.70031","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 Uganda, HIV-related stigma and discrimination remain major barriers to HIV care engagement and serostatus disclosure. While serostatus disclosure can improve access to, engagement with and retention in HIV care, many people living with HIV (PLWH) hesitate to disclose due to fear of negative consequences. Traditional healers (THs) are trusted community members offering accessible and confidential psychosocial support. This study explores the role of THs in facilitating HIV status disclosure among PLWH disengaged from clinical care in southwestern Uganda.&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;This qualitative sub-study was nested within a cluster-randomized trial evaluating the effectiveness of THs supporting PLWH to engage with HIV care in southwestern Uganda. In-depth semi-structured individual interviews were conducted with 22 healers (14 female) and 16 PLWH (10 female) from August 2023 to June 2024. Interviews explored experiences with HIV care and healer-facilitated support to engage with and remain in HIV care. Data was analysed thematically, with particular attention to serostatus disclosure practices.&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;Four key themes emerged: (1) PLWH, who receive care from TH practices, preferred THs over healthcare workers to disclose their HIV serostatus due to perceived trust, confidentiality and personalized care; (2) HIV-related stigma and fear of domestic violence hindered disclosure within families, but disclosure to healers offered a safer alternative; (3) in some cases, THs were the first individuals to whom PLWH disclosed their status; and (4) THs actively encouraged and facilitated serostatus disclosure by PLWH to family members, offering guidance and mediating difficult conversations. These findings highlight the critical role of THs in reducing barriers to disclosure and fostering supportive networks to improve the quality of life for PLWH.&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;THs provide a culturally sensitive and trusted avenue for HIV status disclosure in rural Uganda. Their unique position within the community allows them to address stigma, build trust and facilitate safe disclosure practices. Integrating healers into HIV care through training and collaboration with formal healthcare systems could enhance linkage, adherence, retention and overall care outcomes for PLWH. Future research should explore scalable models to leverage the positive influence and potential of THs to improve HIV care delivery.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146479","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":"Artificial intelligence for HIV care: a global systematic review of current studies and emerging trends","authors":"Sanele Ngcobo,&nbsp;Edith Madela Mntla,&nbsp;Jonathan Shock,&nbsp;Murray Louw,&nbsp;Linda Mbonambi,&nbsp;Thato Serite,&nbsp;Theresa Rossouw","doi":"10.1002/jia2.70045","DOIUrl":"https://doi.org/10.1002/jia2.70045","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;Artificial intelligence (AI) and, in particular, machine learning (ML) have emerged as transformative tools in HIV care, driving advancements in diagnostics, treatment monitoring and patient management. The present review aimed to systematically identify, map and synthesize studies on the use of AI methods across the HIV care continuum, including applications in HIV testing and linkage to care, treatment monitoring, retention in care, and management of clinical and immunological outcomes.&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;A comprehensive literature search was conducted across databases, including PubMed and ProQuest Central, Scopus and Web of Science, covering studies published between 2014 and 2024. The review followed PRISMA guidelines, screening 3185 records, of which 47 studies were included in the final analysis.&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;Forty-seven studies were grouped into four thematic areas: (1) HIV testing, AI models improved diagnostic accuracy, with ML achieving up to 100% sensitivity and 98.8% specificity in self-testing and outperforming human interpretation of rapid tests; (2) Retention in care and virological response, ML predicted clinic attendance, viral suppression and virological failure (72–97% accuracy; area under the curve up to 0.76), enabling early identification of high-risk patients; (3) Clinical and immunological outcomes, AI predicted disease progression, immune recovery, comorbidities and HIV complications, achieving up to 97% CD4 status accuracy and outperforming clinicians in tuberculosis diagnosis; (4) Testing and treatment support, AI chatbots improved self-testing uptake, linkage to care and adherence support. Methods included random forests, neural networks, support vector machines, deep learning and many others.&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;AI has the potential to transform HIV care by improving early diagnosis, treatment adherence and retention in care. However, challenges such as data quality, infrastructure limitations and ethical considerations must be addressed to ensure successful implementation.&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;AI has demonstrated immense potential to address gaps in HIV care, improving diagnostic accuracy, enhancing retention strategies and supporting effective treatment monitoring. These advancements contribute towards achieving the UNAIDS 95-95-95 targets. However, challenges","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145122640","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":"Impact of the Anti-Homosexuality Act on HIV service delivery in Uganda: Evidence from community-led monitoring","authors":"Allan Nsubuga,&nbsp;Frank Mugisha,&nbsp;Beatrice Ajonye,&nbsp;Kenneth Mwehonge,&nbsp;Elise Lankiewicz,&nbsp;Patrick Drake,&nbsp;Esther Joan Kilande,&nbsp;Alice Kayongo,&nbsp;Alana R. Sharp","doi":"10.1002/jia2.70030","DOIUrl":"https://doi.org/10.1002/jia2.70030","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 2023, the Ugandan government enacted the Anti-Homosexuality Act (AHA), which included expanded and intensified criminal penalties for consensual same-sex relations. While arrests, harassment and violence have been reported, evidence of the AHA's impact on HIV healthcare delivery is limited. Community-led monitoring (CLM) is an accountability mechanism that uses community-gathered evidence to advocate for improved healthcare quality and is well-positioned to describe changes in access and quality of care.&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;Data from the CLM programme in Uganda were used to identify changes in healthcare delivery and use related to the AHA. As part of the CLM programme, routine survey data were collected from clients and managers in 320 public health facilities and 50 drop-in centres (DICs) from 2022 to 2024. Survey data were analysed using a difference-in-differences logistic model to measure changes in indicator measures before and after the AHA was signed into law. Seven semi-structured individual interviews were conducted with DIC facility managers, deductively coded and thematically analysed.&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;In public health facilities and DICs, the proportion of respondents identified as men who have sex with men (MSM) declined significantly after AHA. In facilities, all categories of key populations (KPs) reported high levels of discrimination. After the AHA, MSM reported significant reductions in key HIV-related services compared to other populations, including lower rates of pre-exposure prophylaxis (PrEP) counselling, lower participation in support groups and having fewer friendly staff interactions. In DICs, all types of clients were less likely to be referred to health facilities, receive PrEP and find the DIC easy to access after the AHA was signed. DIC managers described experiencing harassment, violence and staffing challenges due to AHA, which they responded to by leveraging partnerships with local and global allies, providing virtual services, and seeking registration as full-service clinics.&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;Data from the Uganda CLM programme provide an early view of the impact of the AHA on service delivery in public health facilities and DICs. While DICs and health facilities developed strategies to build resiliency and adapt, the AHA created significant barriers to care. These findings provide empirical warnings of the barriers experienced by KPs when accessing healthcare services in a criminaliz","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038438","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":"Systematic review and meta-analysis of retention and disengagement after initiation on antiretroviral therapy in low- and middle-income countries after the introduction of Universal Test and Treat policies","authors":"Amy Zheng,&nbsp;Emma M. Kileel,&nbsp;Alana T. Brennan,&nbsp;David B. Flynn,&nbsp;Sydney Rosen,&nbsp;Matthew P. Fox","doi":"10.1002/jia2.70026","DOIUrl":"https://doi.org/10.1002/jia2.70026","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;We previously published a systematic review evaluating retention in care after antiretroviral therapy initiation among adults in low- and middle-income countries from 2008 to 2013. This review evaluates retention after the implementation of Universal Test and Treat (UTT) in 2015.&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 searched PubMed, ISI Web of Science, Cochrane Database of Systematic Reviews and EMBASE for studies published 1 January 2017, through 31 December 2024 and searched conference abstract repositories from AIDS, IAS and CROI from 2015 to 2024. Retention for each study was estimated using (1) simple averages and (2) interpolated for missing time points through the last reported time point. Our outcomes were all-cause attrition and retention. We estimated retention rates using a generalized linear mixed model (GLMM) with a logit distribution using interpolated data.&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;Seventy studies met our inclusion criteria. Most studies came from Africa, with very few from Europe and Asia. Few studies reported retention past the first 12 months following treatment initiation. Across all studies, we estimated simple average retention without interpolation of missing time points to be 72.6% at 12 months, 75.2% at 24 months, 67.7% at 36 months and 64.8% at 48 months. Utilizing a GLMM model, we estimated retention to be 79.6% at 12 months, 81.2% at 24 months, 75.6% at 36 months and 72.8% at 48 months. Whereas in our prior 2015 review, we estimated retention rates to be 86.0% at 12 months, 79.0% at 24 months, 75.0% at 36 months, and 69.0% at 48 months. These results generally reflect retention at the initiating facility and omit the effect of unreported transfers.&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;Retention in care at 36 months was estimated to be between 67% and 75%. Compared to results from our prior review, retention is largely similar in the post-UTT era. Further research evaluating retention in other geographic areas (i.e. Latin America and the Caribbean, Europe, and Asia) is needed.&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;Attrition after the first 2 years in treatment remains a concern, and concerted efforts should be made to ensure patients remain engaged in care over their lifetime. The impact of PEPFAR's recent cuts needs to be evaluated further to understand the effect it may have on long-term retention.&lt;/p&gt;\u0000 &lt;/sect","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144998716","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":"Effects of Stop-Work orders on HIV testing, treatment and programmes for prevention of vertical transmission in four sub-Saharan African countries","authors":"Suzue Saito,&nbsp;Mansoor Farahani,&nbsp;Salaza Kunda,&nbsp;Lievain Maluantesa,&nbsp;Agnaldo Guambe,&nbsp;Habtamu Ayalneh Worku,&nbsp;Eugenie Poirot,&nbsp;Nyikadzino Mahachi,&nbsp;Lucille Bonaventure,&nbsp;Stéphania Koblavi,&nbsp;Tafadzwa Dzinamarira,&nbsp;Wafaa M. El-Sadr","doi":"10.1002/jia2.70034","DOIUrl":"https://doi.org/10.1002/jia2.70034","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;Beginning in late January 2025, Stop-Work orders and contract cancellations have disrupted HIV programmes supported by the President's Emergency Plan for AIDS Relief (PEPFAR). We assessed the effects on HIV service delivery in four African countries.&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;Weekly aggregate HIV services data from a convenience sample of 165 Center for Disease Control and Prevention (CDC)-funded, ICAP-supported facilities—22 in Angola, 75 in the Democratic Republic of the Congo (DRC), 20 in South Sudan and 48 in Zambia—were analysed. We compared data from pre-Stop-Work (7 October 2024–23 January 2025), Stop-Work (24 January 2025–11 February 2025) and post-resumption (12 February 2025–31 March 2025) phases. We examined the number of individuals: (1) who tested for HIV; (2) receiving index testing; (3) had HIV-positive results/yield; (4) initiated antiretroviral therapy (ART); as well as (5) number of pregnant women with known HIV status; and (6) number of HIV-exposed infants who received early infant diagnosis (EID) testing. We used phase-specific weekly averages, relative percentage changes across phases and linear trend tests to measure the magnitude of disruptions and recovery.&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;In Angola, DRC and Zambia, significant declines in number of HIV-positive tests (−58%, −34%, −17%) and ART initiations (−16%, −32%, −17%) were observed across the three phases with limited recovery in number of positive tests in Zambia and ART initiations in Angola. In DRC and Zambia, HIV testing (−33%, −35%), including index testing (−37%, −72%), significantly declined; additionally, HIV testing of pregnant women significantly declined (−28%) in DRC. In Angola and Zambia, EID testing declined (−12%, −18%) with limited recovery. In Angola, HIV testing (2476→2205→2519), including testing for pregnant women (280→ 233→ 287), rebounded in the post-resumption phase; in DRC, EID (6.5→6.3→7.9) rebounded. There were increases in HIV testing yield in Zambia (2.8%→3.1%→4.0%) and index testing (20→24→36) in Angola. No reductions were observed in South Sudan.&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;Stop-Work orders and award terminations have resulted in substantial short-term reductions in the delivery of HIV testing and treatment services. Long-term funding disruptions necessitate careful planning, realistic timelines and investment in cost-effective service models to sustain the gains and maintain the momentum in the global HIV response.&lt;/p&gt;\u0000 &lt;/sectio","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934970","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":"Bone health in a U.K. cohort of youth living with perinatally acquired HIV-1: a longitudinal study","authors":"Merle Henderson,&nbsp;Alexandra Blenkinsop,&nbsp;Oliver Ratmann,&nbsp;Moira Cheung,&nbsp;Hermione Lyall,&nbsp;Sarah Fidler,&nbsp;Caroline Foster,&nbsp;the BONDY study group","doi":"10.1002/jia2.70029","DOIUrl":"https://doi.org/10.1002/jia2.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Low bone mineral density (BMD) has been described in children and young people with perinatally acquired HIV (PHIV), which may be related to both traditional (e.g. low body mass index and malnutrition) and HIV-related risk factors (e.g. longstanding exposure to HIV and antiretroviral therapy [ART], with immune suppression, chronic immune activation and inflammation). Here, we evaluate BMD in a U.K. cohort of young people with PHIV by age and ART.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This longitudinal, observational study was conducted at a U.K. tertiary PHIV service between November 2018 and March 2022. Bone health was assessed in 130 individuals aged 15–19 (<i>n</i> = 50), 20−24 (<i>n</i> = 50) and 25 years and older (<i>n</i> = 30) by dual-energy X-ray absorptiometry, bone mineralization and turnover markers. Low BMD was defined as lumbar spine (LS) and/or femur-BMD z-score below −2, relative to age, sex and ethnicity-matched U.K. population-based normative controls. Two-year follow-up evaluation was performed in those aged 15−19 (<i>n</i> = 42) and 20−24 years (<i>n</i> = 43) at enrolment, which included a group who switched from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) ART at baseline. Bayesian logistic regression models examined predictors of low BMD and the effect of ART-backbone on BMD accrual.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, 57% were female and 82% of black ethnicity, with 31 (24%) on TDF-ART. Sixteen (12%) had low baseline BMD. Over a median follow-up duration of 26 (interquartile range [IQR] 25–29) months, BMD accrual was lower-than-expected in those aged 15−19 years (mean change LS-BMD z-score −0.15 (standard deviation [SD] 0.44)), when compared to normative controls. No associations were seen with HIV parameters or the ART regimen. Participants who switched to TAF-ART had similar BMD accrual 26 (IQR 24–32) months post switch, when compared to those on non-TAF/TDF-ART (mean change LS-BMD z-score TAF −0.01 [SD 0.41] vs. non-TAF/TDF −0.03 [SD 0.54]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While rates of low BMD were reassuringly low in this cohort, lower-than-expected BMD accrual was observed in younger individuals, relative to normative controls. Overall, BMD accrual on TAF-ART was non-inferior to non-TAF/TDF-ART.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934971","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":"Integrating HIV and primary healthcare for key populations: community-led models from Vietnam, Nigeria and Eswatini","authors":"Megan Coleman,&nbsp;Christopher Akolo,&nbsp;Acapel Mbanusi,&nbsp;Bhekizitha Sithole,&nbsp;George K. Siberry,&nbsp;Ryan Schowen,&nbsp;Deborah Goldstein","doi":"10.1002/jia2.70027","DOIUrl":"https://doi.org/10.1002/jia2.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Key populations (KP), including men who have sex with men, people who inject drugs, sex workers, transgender people and people in closed settings, are disproportionately affected by HIV and face structural and legal barriers to care. While community-led responses are central to reaching KP, services are often disease-specific and disconnected from national primary healthcare (PHC) systems. PHC, defined by WHO as a whole-of-society approach to delivering integrated and person-centred services, is rarely designed to meet the broader health needs of KP, who also experience high burdens of non-communicable diseases, mental health conditions and violence. This paper describes three service delivery models, supported by PEPFAR, that integrate HIV and PHC services for KP in Vietnam, Nigeria and Eswatini.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The three models are community-led, client-centred, and tailored to KP health and social needs. Each integrates HIV services—including testing, antiretroviral therapy, viral load monitoring, pre-exposure prophylaxis (PrEP) and advanced HIV disease management—alongside broader PHC services such as mental healthcare, sexual and reproductive health, non-communicable disease screening and tuberculosis services. All models include structural and community-based interventions such as gender-based violence support, stigma reduction, peer navigation and economic empowerment. These services are delivered in safe, trusted spaces by multidisciplinary teams including peer and clinical providers. While the models demonstrate alignment with PHC principles (accessibility, cultural competence, continuity and community empowerment), challenges remain related to integration within national health systems, financing and provider training. Recent U.S. global health policy shifts, including reductions in funding for KP-specific programming and limited PrEP access, pose additional threats to programme sustainability and client trust.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrated models of HIV and PHC for KP can improve access, engagement and health outcomes across a range of services. They represent promising approaches for addressing intersecting health and structural needs, particularly in settings where stigma and criminalization persist. Sustained progress will require inclusion of KP in PHC policies and planning, protection of community-led services and domestic financing strategies that ensure continuity in the face of shifting donor priorities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935052","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":"Combining HIV prevention Options with Mental health service delivery for Adolescent girls and young women (CHOMA): results of a pilot hybrid effectiveness-implementation randomized trial in South Africa","authors":"Jennifer Velloza,&nbsp;Nomhle Ndimande-Khoza,&nbsp;Lisa Mills,&nbsp;Nicole Poovan,&nbsp;Aliza Adler,&nbsp;Elizabeth B. Sherwin,&nbsp;Carrie Mathew,&nbsp;Zinhle Sokhela,&nbsp;Ruth Verhey,&nbsp;Dixon Chibanda,&nbsp;Monica Gandhi,&nbsp;Connie Celum,&nbsp;Sinead Delany-Moretlwe","doi":"10.1002/jia2.70037","DOIUrl":"https://doi.org/10.1002/jia2.70037","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;Adolescent girls and young women (AGYW) at risk of HIV frequently have symptoms of common mental disorders (CMDs), which are associated with lower pre-exposure prophylaxis (PrEP) adherence. We conducted a pilot hybrid effectiveness-implementation trial (CHOMA) to evaluate whether an evidence-based mental health intervention adapted for PrEP delivery (“Youth Friendship Bench SA”) could address CMD and PrEP adherence among South African AGYW.&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;CHOMA was conducted in Johannesburg from April 2023 to February 2024. We enrolled AGYW (18−25 years) who were already on or willing to initiate PrEP and had CMD symptoms (Self-Reporting Questionnaire 20-item [SRQ-20]≥7). Participants were randomized to our Youth Friendship Bench SA intervention (five problem-solving sessions with a lay counsellor, one group session) or standard-of-care CMD services (brief CMD assessment, referral). Counselling sessions occurred at enrolment and Weeks 2, 4, 8 and 12. Co-primary outcomes were PrEP adherence (positive result on a urine tenofovir assay) and reduced CMD symptoms (SRQ-20&lt;7) at Week 12 and, secondarily, Week 4. We used Poisson regression to assess intervention effects and summarized responses to three validated scales assessing intervention acceptability, appropriateness and feasibility (ranges: 1–4).&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;Of 116 AGYW enrolled, the median SRQ-20 score was 9. We retained 69% through Week 12. Of 57 intervention participants, 64.9% (&lt;i&gt;N&lt;/i&gt; = 37) received four or more sessions. At Week 4, 29/36 (80.6%) participants in the intervention and 25/41 (61.0%) in the standard-of-care had recent PrEP use (RR = 1.40; 95% CI = 1.03−1.89; &lt;i&gt;p&lt;/i&gt; = 0.03), but this was not sustained through Week 12 (RR = 0.88; 95% CI = 0.64−1.22; &lt;i&gt;p&lt;/i&gt; = 0.44). Enrolment SRQ-20 score was not associated with Week 12 PrEP adherence or retention. CMD symptoms did not differ by arm at Week 4 or 12, although the proportion with SRQ-20 scores &gt;7 decreased overall between Weeks 4 (54.5%, 42/77) and 12 (35.0%, 28/80; &lt;i&gt;p&lt;/i&gt; = 0.02). Median acceptability, appropriateness and feasibility scores were 3.50, 3.75 and 3.25, respectively.&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;The intervention improved PrEP adherence at Week 4, although the effect was not durable to Week 12, possibly due to retention challenges. Reductions in CMD symptoms were seen in both arms. Findings suggest different mental health and PrEP support interventions may be needed to improve integrat","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935053","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":"High syphilis incidence among PrEP-adherent men who have sex with men and transgender women in Peru","authors":"Silver K. Vargas,&nbsp;Kelika A. Konda,&nbsp;Ronaldo I. Moreira,&nbsp;Iuri C. Leite,&nbsp;Marcelo Cunha,&nbsp;Brenda Hoagland,&nbsp;Juan V. Guanira,&nbsp;Marcos Benedetti,&nbsp;Cristina Pimenta,&nbsp;Beatriz Grinztejn,&nbsp;Valdiléa G. Veloso,&nbsp;Carlos F. Caceres","doi":"10.1002/jia2.70002","DOIUrl":"https://doi.org/10.1002/jia2.70002","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;Syphilis remains a public health concern in Peru. Pre-exposure prophylaxis (PrEP) implementation programmes in Latin America need to assess their impact on sexually transmitted infections (STIs), along with their feasibility. We assessed the relationship between PrEP adherence and syphilis incidence among men who have sex with men (MSM) and transgender women (TW) enrolled in ImPrEP, a multi-country PrEP demonstration project; however, this analysis focuses on Peru.&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;Between April 2018 and June 2021, 2292 HIV-negative MSM/TW attending Peruvian STI clinics were enrolled and followed in ImPrEP. Participants had to be aged ≥18 years and report recent condomless anal sex (CAS), sex with a partner living with HIV, STI history (diagnosis/symptoms) and/or transactional sex. Quarterly follow-up visits included PrEP dispensing, behavioural assessment, HIV and syphilis screening (treponemal test and Rapid Plasma Reagin [RPR] if syphilis negative at enrolment; RPR only if reactive-treponemal test at baseline). PrEP adherence was assessed using the medication possession ratio (MPR: #pills prescribed / #days between visits). Generalized estimating equation (GEE) Poisson regression models were used to evaluate factors related to syphilis incidence and also assessed syphilis incidence during two periods: pre-COVID-19 lockdown (up to 16 March 2020) and during COVID-19-lockdown (17 March 2020−June 2021).&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;We enrolled 2039 cisgender-MSM and 253 TW, with a median follow-up time of 514 days; 205 incident syphilis cases were identified among 185 individuals. Overall syphilis incidence was 9.1 cases/100 person-years (p.y.) (95% CI: 7.9−10.4), 14.7/100 p.y. (95% CI: 10.5−20.1) among TW and 8.3/100 p.y (95% CI: 7.1−10.0) among cisgender-MSM. During the COVID-19 pre-lockdown period, syphilis incidence was 10.0/100 p.y. (95% CI: 8.3−12.1) and 8.1/100 p.y. (95% CI: 6.6−10.0) during-lockdown. Multivariate GEE analysis showed higher syphilis incidence among PrEP-adherent participants (MPR≥0.6) (adjusted incidence rate ratio [aIRR]: 1.46 [95% CI: 1.08−1.99]), those reporting receptive CAS (aIRR: 1.53 [95% CI: 1.11−2.11]) and TW (aIRR: 1.64 [95% CI: 1.08−2.51]). Syphilis incidence pre-lockdown was higher for participants reporting receptive CAS (aIRR: 2.35 [95% CI: 1.43−3.86]); during-lockdown, syphilis incidence was higher among those diagnosed with syphilis at enrolment (aIRR: 2.70 [95% CI: 1.67−4.36]).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910036","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}