Journal of the International AIDS Society最新文献

{"title":"Medical-Legal Partnerships as Structural Interventions: Integrating Implementation Science and Community-Engaged Research to Advance HIV Care","authors":"Omar Martinez, Edda Santiago Rodriguez, Guillermo Prado, Kathryn M. Nowotny, Robin Davison, Cui Yang, Samantha Morton, Ashley French, Souhail Malave-Rivera, Carlos E. Rodriguez-Diaz, Florence Momplaisir, Elena Cyrus, Mallory O. Johnson, Miguel Munoz-Laboy","doi":"10.1002/jia2.70191","DOIUrl":"https://doi.org/10.1002/jia2.70191","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>People living with HIV (PLWH) often face health-harming legal needs (HHLNs), including housing instability, discrimination, immigration concerns, benefit denials and interpersonal violence, which can undermine engagement in care and health outcomes. Medical-legal partnerships (MLPs) integrate legal services into healthcare settings to address these drivers of health inequities and improve access to HIV prevention and care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study presents mixed-methods implementation findings from three federally funded MLP initiatives serving PLWH in New York City, Philadelphia, Orlando and San Juan. Implementation was evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and the Consolidated Framework for Implementation Research (CFIR), with guidance from Community and Scientific Advisory Boards. Quantitative data were derived from standardized HHLN screening tools, while qualitative interviews with clients, healthcare providers and legal professionals explored implementation experiences, contextual factors and perceived impacts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Across the three initiatives, 928 participants were enrolled between 2022 and 2026. Core intervention components included: (1) workforce training on HHLNs and legal-health integration; (2) routine legal screening; (3) referral to community-based legal services; and (4) co-located legal clinics and preventive legal education. Common HHLNs included housing instability, benefit denials, immigration concerns, criminal record expungement, advance care planning and discrimination. Implementation demonstrated strong feasibility, acceptability, adoption and cultural responsiveness across sites. Participants described reductions in anxiety, improved confidence, greater trust in healthcare systems and improved engagement in HIV care following legal support. Trainings co-developed with community stakeholders enhanced providers’ understanding of structural determinants and legal remedies, while interdisciplinary collaboration reduced provider burden and strengthened care coordination. RE-AIM findings demonstrated broad reach and organizational adoption, and CFIR analyses identified leadership engagement, organizational readiness and client-provider trust as key implementation facilitators. Cross-study findings informed development of the equity-centred implementation framework for MLP in HIV care, integrating implementation science, health equity and community engagement principles to guide future adaptation and scale-up.</p>\u0000 </section>\u0000 \u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70191","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125777","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":"Cutting Out Stigma: Findings From a Pilot Implementation Trial of a Barbershop-Based HIV Stigma Reduction and Health Promotion Intervention in the Southern United States","authors":"Jessica M. Perkins, Ruitian Xeno Hu, Madison Humphrey, Shawnika J. Hull, Konor von Kraut, Nathaniel King, Steven Nelson, Carolyn M. Audet, Zhihong Xeno Yu, Bryan E. Shepherd, Sharon Hurt, Aima A. Ahonkhai","doi":"10.1002/jia2.70195","DOIUrl":"https://doi.org/10.1002/jia2.70195","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Black Americans and individuals in the Southern United States bear a disproportionate burden of HIV. To address stigma, a key contributor to these inequities, we developed <i>Cutting Out Stigma</i> (<i>COS</i>), a barbershop-based education and multimedia intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We recruited and trained Tennessee (U.S.) barbers as <i>COS</i> Men's Health Ambassadors and invited them to participate in a 6-month <i>COS</i> pilot implementation trial from September 2024 to March 2025. <i>COS</i> barbers provided sexual health education, referrals to HIV (and other ancillary) services for barbershop clients and shared relevant study and barber-created social media posts. Using the RE-AIM framework, we assessed reach (social media and barbershop-based), preliminary effectiveness (barber-level HIV knowledge improvement, role effectiveness and resource connection), intervention adoption and implementation (feasibility, acceptability, appropriateness at baseline and endline). Data sources included validated pre- and post-implementation surveys, social media analytics, weekly self-report forms and in-depth interviews (IDIs). Quantitative data were summarized descriptively, with mixed-effects models estimating change over time; IDI analyses helped interpret effectiveness outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-seven barbers completed COS training. Among 57 successfully contacted post-training, 50 barbers (87.7%) enrolled in the pilot trial across 26 barbershops. The pilot reached an estimated 4464 barbershop client encounters, with 62.0% of barbers engaging ≥6 clients weekly. Estimated social media reach averaged 57,462 users monthly. Implementation outcomes remained high: baseline/endline scores were 4.8/4.8 for feasibility, 4.9/4.9 for acceptability and 4.8/4.9 for appropriateness (each out of 5). HIV knowledge improved following training, and barbers reported high effectiveness as health ambassadors (median effectiveness 8 of 10; IQR: 7–9). Barbers facilitated an estimated 3096 referrals, primarily for HIV testing (71.0%) and pre-exposure prophylaxis (PrEP) (70.0%). IDIs helped explain these patterns: barbers described moving from transmission myths towards actionable understanding of HIV prevention, reported shifts in personal attitudes as they grew in their new role, and perceived normalizing HIV discussion and making resource referrals as “shop talk” that could reduce community stigma. Barbers also described client-level early prevention behaviours (e.g. condom uptake, PrEP inquiries), though they felt fear of judgement created intention−behaviour gaps f","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70195","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125778","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":"Cross-Cutting Implementation Strategies to Integrate Hypertension Care Into HIV Care in Africa: Results From Six Country Studies in the HLB-SIMPLe Alliance","authors":"Angela Aifah, Emmanuel K. Tetteh, Karla I. Galaviz, Michael E. Herce, Norberto Lumbandali, Martin Muddu, Lisa R. Hirschhorn","doi":"10.1002/jia2.70162","DOIUrl":"https://doi.org/10.1002/jia2.70162","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The National Heart, Lung and Blood Institute (NHLBI), in 2020, funded six implementation research trials in Africa (Botswana, Mozambique, Nigeria, South Africa, Uganda and Zambia) to test implementation strategies for integrating evidence-based cardiovascular disease (CVD) care into primary care for people living with HIV. We identified cross-site implementation strategies used by the six trials to integrate CVD care for people living with HIV in these diverse settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between December 2022 and September 2023, we reviewed protocols for each trial and followed up with study teams from the six studies to identify implementation strategies targeting the individual (healthcare worker [HCW] and patient), facility and system levels. Guided by the Expert Recommendations for Implementing Change (ERIC) taxonomy of implementation strategies, we grouped and defined strategies used for each study. We then specified each strategy (i.e. actor, the action, action targets, temporality, dose, implementation outcomes addressed and theoretical justification) to understand similarities and differences in how cross-cutting implementation strategies were operationalized.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten implementation strategies were identified across the six trials for integrating hypertension (six studies) and diabetes (one study) care into existing HIV primary healthcare platforms. Three strategies, HCW training, audit and feedback, and practice facilitation or coaching, were implemented in all trials. Function and form synthesis showed that while these strategies shared the common goal of improving provider capacity and quality of care, their delivery varied across settings. HCW training was adapted in duration, frequency and trainer type; audit and feedback processes differed in how data were used and integrated with district quality improvement structures; and practice facilitation approaches ranged from study-led to health system-led models. These adaptations reflected contextual differences in health system capacity and available resources while maintaining a shared focus on strengthening HIV-CVD service integration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>With the increasing burden of CVD among people living with HIV, identifying implementation strategies for integrating CVD care into HIV primary healthcare is critical. Our study provides contextually relevant information on cross-site implementation strategies aimed at achieving this in six Afric","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70162","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125867","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 Fidelity to HIV Index Case Testing Protocols in Malawian Clinical Settings: Results From a Cluster Randomized Controlled Trial","authors":"Tapiwa A. Tembo, Nora E. Rosenberg, Katie R. Mollan, Mike J. Chitani, Mtisunge Mphande, Jiayu Wang, Victor Mwapasa, Katherine Simon, Saeed Ahmed, Maria H. Kim, Linda-Gail Bekker","doi":"10.1002/jia2.70185","DOIUrl":"https://doi.org/10.1002/jia2.70185","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>HIV index case testing is an evidence-based practice in which health care workers (HCWs) counsel people living with HIV (index clients) to offer HIV testing services to their sexual partners and biological children (contacts). For index case testing to be effective, it is important that index- and contact-client counselling protocols are implemented as intended (fidelity). We evaluated whether a digital training implementation strategy improved HCWs’ fidelity to these counselling protocols.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cluster-randomized controlled trial at health facilities (clusters) in Southeastern Malawi. Primary study follow-up was from October 2022 to September 2023. Thirty-three clusters were randomized 1:2 to the Enhanced (<i>n</i> = 11) and Standard (<i>n</i> = 22) arms. HCWs in both arms received brief centralized in-person training on processes and protocols for index case testing. HCWs in the Enhanced arm also received decentralized tablet-guided digital training through 20 synchronous and asynchronous sessions. In all 33 clusters, a selection of index and contact client encounters were audio-recorded in the year after the digital training. We applied a 15-item fidelity checklist to assess counselling quality and adherence to index case testing protocols. Audio recordings were coded independently by two assessors blinded to the study arm. Fidelity scores ranged from 0% to 100%; higher scores indicate better protocol compliance. To compare fidelity scores between the Enhanced and Standard arms, we estimated a mean difference and 95% confidence interval (CI), using generalized estimating equations to account for clustered data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We audio-recorded 341 index client-HCW and 194 contact client-HCW encounters. The mean fidelity score for index client-HCW encounters was 66.3% (CI: 62.8%−69.7%) in the Enhanced arm and 45.7% (CI: 42.7%−48.6%) in the Standard arm (Mean Difference 20.6%; CI: 16.1%, 25.2%, <i>p</i><0.001). The mean fidelity score for contact client-HCW encounters was 69.0% (CI: 63.8%−74.1%) in the Enhanced arm and 57.4% (CI: 55.5%−59.3%) in the Standard arm (Mean Difference 11.5%; CI: 6.1%, 17.1%, <i>p</i><0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The digital training substantially improved HCW fidelity to index and contact client protocols. A decentralized digital training can be used to improve HCW counselling behaviour. Future research should explore the methods of assessing fidelity in tria","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70185","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125869","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":"Metabolic Dysfunction-Associated Steatohepatitis and the Progression of Cognitive Decline in Older Thai People With HIV","authors":"Katekarn Porkaew,&nbsp;Akarin Hiransuthikul,&nbsp;Win Min Han,&nbsp;Tanakorn Apornpong,&nbsp;Sasiwimol Ubolyam,&nbsp;Stephen Kerr,&nbsp;Anchalee Avihingsanon,&nbsp;HIV-NAT 006 and 207 study team","doi":"10.1002/jia2.70215","DOIUrl":"10.1002/jia2.70215","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Metabolic dysfunction-associated steatohepatitis (MASH) is more common in people with HIV and associated with systemic inflammation and extrahepatic complications, including cognitive impairment. While cross-sectional studies suggest an association between MASH and worse cognitive outcomes, its impact on longitudinal cognitive trajectories in people with HIV remains unclear.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective study included people with HIV aged≥50 years from HIV-NAT, Bangkok, Thailand, between 2015 and 2024. MASLD and MASH were identified at baseline using the FibroScan-AST (FAST) score. Cognitive function was assessed using the Thai-validated Montreal Cognitive Assessment (MoCA) at baseline and a follow-up visit. A multivariate linear mixed model was used to determine the difference in changes in MoCA scores between participants with and without baseline MASH.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 291 participants (60.5% male; median age 54.4 years), 60 (20.6%) met criteria for MASH at baseline. Over a median follow-up of 5.9 years, baseline MASLD was not associated with cognitive decline, whereas participants with baseline MASH showed a significantly greater cognitive decline between ages 50 and 80 years, after adjusting for age, sex, body mass index, education level, employment status, smoking, alcohol consumption, diabetes, hypertension, duration of HIV acquisition and exposure to efavirenz. Participants with MASH showed a mean MoCA decline of –4.79 (95% CI –7.49 to –2.09), compared with –0.94 (95% CI –2.20 to –0.32) among those without MASH (<i>p</i>-interaction = 0.007).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>MASH is a significant predictor of steeper cognitive decline in older people with HIV, independent of traditional metabolic and HIV-related risk factors. These findings suggest that early identification and management of MASH may help mitigate cognitive decline in ageing HIV care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70215","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126101","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 State of HIV-Related Implementation Research in 2026: Lessons Learned and Future Directions","authors":"Stefan Baral,&nbsp;Tonderai Mabuto,&nbsp;Sheree Schwartz","doi":"10.1002/jia2.70213","DOIUrl":"https://doi.org/10.1002/jia2.70213","url":null,"abstract":"&lt;p&gt;The quality and quantity of HIV-related implementation research have continued to accelerate over the past 15 years [&lt;span&gt;1-3&lt;/span&gt;]. As a field, we have dramatically increased funding opportunities related to implementation science, while simultaneously increasing academic productivity [&lt;span&gt;2&lt;/span&gt;]. During recent years, the rigour of implementation science-related work has also increased, with expectations of use of implementation research theories, models and frameworks, as well as increased reporting of implementation outcomes [&lt;span&gt;2&lt;/span&gt;]. Despite these successes, there is also recognition of areas for progress [&lt;span&gt;4&lt;/span&gt;]. Reporting implementation outcomes beyond acceptability, appropriateness and feasibility is a critical area for expansion as the field moves down the translational pathway beyond pre and/or early implementation work, to increasing focus on adoption, fidelity and maintenance [&lt;span&gt;5&lt;/span&gt;]. Unpacking mechanisms and linking implementation outcomes more directly to health outcomes is similarly in need of increased attention. Increased specificity of implementation strategies and study of those strategies through research focused on enhancing implementation outcomes, such as through hybrid type 2 and 3 effectiveness-implementation studies, represent other growth opportunities for HIV-related implementation research. Further, including organizational readiness, culture and other inner setting service delivery level features as targets for implementation strategies and change, alongside consideration of outer setting context such as varying healthcare financing models or policy contexts are critical areas for analysis [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;This special issue seeks to advance science through addressing gaps in the HIV-related implementation research space. The collection of articles spanning multiple regions around the world, a number of which are multi-site studies, provides best practice examples of moving beyond barriers and facilitators to advancing implementation. Together, this work demonstrates opportunities to impact health at scale through increased focus on the behaviour of the health ecosystems and not just the individual patients or clients within those systems. Multiple cross-cutting themes emerge across the collection, including the importance of specifying implementation strategies, defining the mechanisms through which those strategies shape real-world impact and measuring implementation outcomes as predictors of programme effectiveness. The papers also underscore the central role of community engagement and culturally grounded approaches in addressing structural determinants of HIV prevention and care. Finally, the issue highlights HIV-related implementation research as a growing but still underdeveloped funding priority, with continued opportunities to expand the methodological rigour, scale and policy relevance of the field.&lt;/p&gt;&lt;p&gt;Methodological innovation must keep pace with programme comp","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S5","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70213","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125858","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":"PrEP Use and Willingness Cascades Among Transgender Women in 11 Asian Countries: Findings From the PrEP APPEAL Cross-Sectional Online Survey","authors":"Alegra Wolter,&nbsp;Gede Benny Setia Wirawan,&nbsp;Curtis Chan,&nbsp;Rena Janamnuaysook,&nbsp;Warittha Tieosapjaroen,&nbsp;Hua Boonyapisomparn,&nbsp;Michael M. Cassell,&nbsp;Lei Zhang,&nbsp;Heather-Marie Ann Schmidt,&nbsp;Jason J. Ong,&nbsp;Nittaya Phanuphak,&nbsp;Benjamin R. Bavinton","doi":"10.1002/jia2.70209","DOIUrl":"10.1002/jia2.70209","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;Transgender women in Asia face a high HIV burden, yet remain underrepresented in pre-exposure prophylaxis (PrEP) research. Despite increases in PrEP availability, uptake among trans women remains low. This study examines PrEP awareness, use, and willingness among trans women across 11 Asian 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;Data were drawn from the 2022 PrEP Product Awareness, Preferences, and Past Experiences Among Transgender Women and Men Who Have Sex with Men (PrEP APPEAL) study, a multi-country cross-sectional online survey. Two PrEP cascades were constructed: one assessing use (awareness, lifetime use, current use) and the other assessing willingness (risk, interest, and willingness to pay). Logistic regression models were used to identify factors associated with lifetime PrEP use and willingness to use PrEP.&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 1178 trans women participants, 80.0% (&lt;i&gt;n&lt;/i&gt; = 942) had heard of PrEP. Among those who were PrEP-aware, 62.6% (&lt;i&gt;n&lt;/i&gt; = 590/942) reported ever using it, and of these, 78.1% (&lt;i&gt;n&lt;/i&gt; = 461/590) were current users. Among PrEP-naïve participants classified as at risk of HIV (&lt;i&gt;n&lt;/i&gt; = 265), 60.0% (&lt;i&gt;n&lt;/i&gt; = 159/265) were willing to initiate PrEP, yet only 34.0% (&lt;i&gt;n&lt;/i&gt; = 54/159) were also willing to pay. Lifetime PrEP use was positively associated with wider country-level PrEP access (aOR = 4.34; 95% CI: 3.03–6.21), genital surgery (aOR = 1.54; 1.03–2.31), current romantic relationship (aOR = 1.65; 1.19–2.29), as well as reporting sex work (aOR = 1.51; 1.05–2.18), condomless sex (aOR = 1.76; 1.28–2.42), chemsex (aOR = 1.98; 1.36–2.87), and a recent sexually transmitted infection diagnosis (aOR = 2.28; 1.45–3.59) within the past 6 months. Negative associations included older age (aOR per year = 0.94; 0.92–0.96) and discrimination from healthcare workers (aOR = 0.66; 0.47–0.93). Willingness to use PrEP was lower among older participants (aOR per year = 0.97; 0.94–0.99) and those in countries with wider PrEP access (aOR = 0.53; 0.29–0.97), with no significant associations observed for behavioural risks.&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;PrEP awareness was high among trans women in Asia. PrEP use and willingness were influenced by structural barriers (e.g. country-level PrEP access), healthcare discrimination, and personal factors (e.g. behavioural risks). Scaling up PrEP for trans women requires rights-based approaches and commitment to achieve equitable HIV prevention in the region.&lt;/p&gt;\u0000 &lt;/se","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70209","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126049","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":"Natural Language Processing Analysis of WhatsApp Messages to Identify Unrecognized HIV Prevention Needs Among Young Women in Kenya","authors":"Jessica E. Haberer,&nbsp;Bernard Rono,&nbsp;Rakesh Ravi,&nbsp;Vinal Bagaria,&nbsp;Sinchana Shetty,&nbsp;Shanmukh Moparthi,&nbsp;Kevin Oware,&nbsp;Josephine B. Odoyo,&nbsp;Lindsey Garrison,&nbsp;William Rand,&nbsp;Elizabeth A. Bukusi","doi":"10.1002/jia2.70214","DOIUrl":"10.1002/jia2.70214","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;Identifying HIV prevention needs is challenging. Common approaches (e.g. public health campaigns, HIV risk scores) have limited sensitivity. Natural language processing techniques, such as topic modelling and computational linguistics, can extract meaning and subjective information from text. This study used these techniques with WhatsApp messages to identify unrecognized HIV prevention needs among young women in Kenya.&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;Prior work established key ethical protections (e.g. privacy, confidentiality). Between July and December 2024, women (18−24 years) who used WhatsApp were enrolled from four clinical sites in Kisumu, Kenya. After completing a socio-demographic questionnaire, participants securely transferred all WhatsApp messages from the prior 6 months and provided anonymized relationship types (e.g. friend, sexual partner) for their 20 most frequent contacts. Data were de-identified, and only outgoing messages were retained; all photos and incoming messages were deleted. WhatsApp data were pre-processed using a downloaded large language model to translate Swahili and Dholuo to English and account for slang linguistic patterns. We explored multiple approaches to topic modelling in the WhatsApp data using latent Dirichlet allocation. Non-negative matrix factorization and uniform manifold approximation and projection allowed for comparison of participant word topics with the VOICE HIV risk score (range 0–8, 8 indicating high risk).&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 413 eligible young women, 13 (3%) declined to provide WhatsApp data, and 22 had insufficient data for analysis. Participants had a mean age of 22 years and a VOICE risk score of 5.7. The remaining 378 women provided a median of 14 chats per individual. Participants most commonly chatted with friends (62.4%), followed by sexual partners (18.1%). The median VOICE risk score was 7 for women whose most messaged relationship was a sexual partner versus 5 for those messaging a friend most often. Topic models had differential correlation with the VOICE risk score that was most strongly positive (0.12) when indicating romance/affection and most strongly negative (−0.09) when describing faith/transactions. Dimensional analysis of linguistic similarity identified discrete participant populations with distinct VOICE risk scores.&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;This study provides proof-of-concept that natural language processing of routine WhatsApp messages can yield meaningful ind","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13639533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149101904","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":"Predictors of Liver Steatosis Progression Among People Living With HIV in Low- and Middle-Income Countries: A Multicentre Longitudinal Study","authors":"Marie K. Plaisy,&nbsp;Thierry Tiendrebeogo,&nbsp;Carlotta Mondoka,&nbsp;Mark H. Kuniholm,&nbsp;Rodrigo de Carvalho Moreira,&nbsp;Aggrey Semeere,&nbsp;Rohidas T. Borse,&nbsp;Albert Minga,&nbsp;Gilles Wandeler,&nbsp;Gad Murenzi,&nbsp;Brenda E. Crabtree-Ramírez,&nbsp;Niharika Samala,&nbsp;Jeremy Ross,&nbsp;Ephrem Mensah,&nbsp;Ardele Mandiriri,&nbsp;Sandra W. Cardoso,&nbsp;Jean Paul Mivumbi,&nbsp;Lameck Diero,&nbsp;Haridas Prasad,&nbsp;Paola Alarcón Murra,&nbsp;Belinda V. Chihota,&nbsp;Suzanne Goodrich,&nbsp;Thida Chanyachukul,&nbsp;Ellen Brazier,&nbsp;Stephany N. Duda,&nbsp;Hugo Perazzo,&nbsp;Antoine Jaquet,&nbsp;the International epidemiology Databases to Evaluate AIDS (IeDEA)","doi":"10.1002/jia2.70184","DOIUrl":"https://doi.org/10.1002/jia2.70184","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Liver steatosis is increasingly recognized as a major comorbidity in people living with HIV (PLWH), with growing evidence suggesting an increased risk of progression to advanced liver disease. We assessed predictors of liver steatosis progression over 36 months in PLWH from low- and middle-income countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between 2020 and 2023, we enrolled PLWH aged ≥40 years who had been on antiretroviral therapy (ART) for ≥6 months at nine HIV clinics in the IeDEA Sentinel Research Network (SRN) across the Asia-Pacific, the Americas and African IeDEA regions, and followed them prospectively for 36 months. Participants with available and reliable controlled attenuation parameter (CAP) measurements at both enrolment and the 36-month visits were included in the analysis. Steatosis progression was defined as incident steatosis (CAP ≥248 dB/m) or a transition to a higher steatosis grade (moderate ≥268 dB/m; severe ≥280 dB/m) among those with a lower steatosis grade at enrolment. Logistic regression was used to assess predictors of progression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 923 participants (63% female; median age 50 years, interquartile range 45–55) in this analysis. At enrolment, 51% were overweight or obese, 10% had type 2 diabetes mellitus (T2DM), 94% had HIV RNA &lt;1000 copies/mL and 72% were on integrase strand inhibitor (INSTI)-based ART. During the 36-month follow-up, 190 (20%) participants showed steatosis progression, including 147 (74%) with incident steatosis and 49 (26%) with worsening of steatosis grades. The progression rate was significantly higher in Asia-Pacific (33% [95% CI, 24−44]) and the Americas (36% [95% CI, 26−46]) compared to the African regions (17% [95% CI, 14−20]). Independent predictors of steatosis progression were overweight/obesity (aOR: 2.97, 95% CI: 2.03−4.40), T2DM (aOR: 2.41, 95% CI: 1.45−3.96) and dyslipidaemia (aOR: 1.46, 95% CI: 1.01−2.12). In females, INSTI use for ≥2 years at enrolment was additionally associated (aOR 3.19, 95% CI: 1.35−8.01).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Metabolic disorders—including T2DM, overweight/obesity and dyslipidaemia—were associated with steatosis progression in PLWH in our cohort. These findings underscore the need for targeted monitoring and prevention strategies to address this significant public health issue.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 10","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70184","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149072562","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":"Neurodevelopment of Children Exposed to HIV But Uninfected in Zambia: Outcomes From Prospective Birth Cohort Study","authors":"Ethan M. Zulu,&nbsp;Peter C. Rockers,&nbsp;Leah Forman,&nbsp;Namwiya Musonda,&nbsp;Charles Nthele,&nbsp;Frazer Shimaingwa,&nbsp;Megan Bartrum,&nbsp;Ngosa Kawama,&nbsp;Carol B. Masempela,&nbsp;Donald M. Thea,&nbsp;Julie M. Herlihy","doi":"10.1002/jia2.70202","DOIUrl":"10.1002/jia2.70202","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Children exposed to HIV but uninfected (CHEU) number approximately 15.7 million globally. In Zambia, an estimated 56,000 CHEU are born annually, representing a substantial proportion of the national birth cohort. CHEU experience a higher risk of neurodevelopmental delay compared to their peers born HIV-unexposed. It is unknown whether the increased neurodevelopment delay burden of CHEU has been diminished by maternal combination antiretroviral therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This prospective observational study analysed a subset of participants from the Zambian Infant Cohort Study (ZICS), which included 1500 pregnant women–infant dyads enrolled at a peri-urban hospital in Zambia. Infants aged 6−24 months were enrolled in a 1:1 ratio of CHEU to CHU and were followed for 18 months. Neurodevelopment was evaluated using the Malawi Developmental Assessment Tool (MDAT) at 6- and 18-month follow-ups. Anthropometrics, Caregiver-Reported Early Development Instruments assessments, eye-tracking and additional assessments were conducted at 6-, 12- and 18-month follow-ups. The primary outcomes were MDAT domain-specific Z-scores for gross motor, fine motor, language and social-adaptive. A series of regression models were fitted with MDAT domain-specific Z-scores as dependent variables, and CHEU versus CHU status as the primary independent variable. All models were adjusted for child birth year, age at assessment, sex, mother's age, education, household size and socioeconomic status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between March 2022 and October 2024, a total of 316 mother−infant pairs were enrolled in the study (CHEU, <i>n</i> = 155; CHU, <i>n</i> = 161). MDAT assessments at the 18-month follow-up were done for a total of 286 infants (139 CHEU [89.7%] and 147 CHU [91.3%]). The mean age at 18-month follow-up was comparable between CHEU and CHU (29.1 vs. 28.0 months, respectively). Mean MDAT Z-scores were comparable between CHEU and CHU for all domains, with adjusted mean differences in Z-scores of 0.00 (95% CI: −0.23, 0.23) for gross motor, 0.00 (95% CI: −0.28, 0.27) for fine motor, −0.10 (95% CI: −0.48, 0.28) for language and −0.01 (95% CI: −0.32, 0.30) for social-adaptive.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Neurodevelopmental outcomes at endline were comparable between CHEU and CHU across all the MDAT domains in this peri-urban Zambian cohort.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 9","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70202","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149035789","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}