Journal of the International AIDS Society最新文献

{"title":"By executive order: The likely deadly consequences associated with a 90-day pause in PEPFAR funding","authors":"Khai Hoan Tram, Jirair Ratevosian, Chris Beyrer","doi":"10.1002/jia2.26431","DOIUrl":"https://doi.org/10.1002/jia2.26431","url":null,"abstract":"<p>On 20 January 2025, the first day of his second term in office, President Donald Trump issued an executive order instating a 90-day pause on new U.S. foreign assistance, pending a review for alignment with U.S. foreign policy. Four days later, the U.S. State Department issued a “stop order” directive, expanding the pause to include a freeze on all foreign aid programmes, including the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) [<span>1</span>]. By 1 February, PEPFAR received a limited waiver for life-saving HIV care and treatment services and prevention programmes to prevent vertical transmission [<span>2</span>]. While this waiver signalled hope to millions, it did not release immediate funding to implementing partners, prolonging confusion and disruption on the ground [<span>3, 4</span>]. Ongoing uncertainty around PEPFAR funding has interfered with critical HIV programmes that rely on long-term planning, making it impossible to operate effectively and sustain life-saving services.</p><p>First announced under President George W. Bush in 2003 and reauthorized regularly since with bipartisan support in Congress, PEPFAR has been critical not only in the global response against the HIV epidemic but also in strengthening overall health systems in over 50 countries worldwide [<span>5</span>]. Over the past 21 years, PEPFAR has supported antiretroviral treatment (ART) for over 20 million people living with HIV (PLWH), including 566,000 children; reached 2.3 million adolescent girls and young women with comprehensive HIV prevention services; supported 6.6 million orphans, vulnerable children and caregivers; enrolled 2.5 million people on HIV pre-exposure prophylaxis; provided 83.8 million people with HIV testing services; and directly supported 342,000 health workers [<span>5</span>]. Since its inception, PEPFAR is estimated to have saved 26 million lives and prevented 7.8 million infants from being born with HIV [<span>5</span>]. Additionally, in PEPFAR-supported countries, new HIV infections have been reduced by half since 2010 [<span>5</span>].</p><p>The deadly consequences of even brief pauses in foreign aid cannot be overstated. At stake with the stoppage of U.S. foreign aid is PEPFAR's ability to continue its indispensable work of delivering life-saving HIV treatment to millions of people and supporting local health system capacity. HIV treatment interruption leads to not only loss of virological control but also reversal of immune recovery for PLWH, the potential for viral resistance, the emergence of opportunistic infections, increased risk of tuberculosis and other co-infections, and ultimately increased morbidity, mortality and onward transmission [<span>6</span>]. Based on previously described mathematical models of HIV epidemiology and intervention programmes in sub-Saharan Africa, a 90-day disruption of HIV treatment and care programmes modelled as discontinuation of ART to 50% of people is expected to lead to a median inc","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26431","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481373","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":"Cost thresholds for anticipated long-acting HIV pre-exposure prophylaxis products in Eastern and Southern Africa: a mathematical modelling study","authors":"David Kaftan,&nbsp;Monisha Sharma,&nbsp;Danielle Resar,&nbsp;Masabho Milali,&nbsp;Edinah Mudimu,&nbsp;Linxuan Wu,&nbsp;Cory Arrouzet,&nbsp;Ingrida Platais,&nbsp;Hae-Young Kim,&nbsp;Sarah Jenkins,&nbsp;Anna Bershteyn","doi":"10.1002/jia2.26427","DOIUrl":"https://doi.org/10.1002/jia2.26427","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Affordable HIV prevention tools are needed in Eastern and Southern Africa (ESA). Several promising long-acting pre-exposure prophylaxis (LA-PrEP) products are available or in development. However, ESA settings face severe healthcare resource constraints. We aimed to estimate the threshold price at which LA-PrEP products could be cost-effective in three ESA settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We adapted an agent-based model, EMOD-HIV, to simulate LA-PrEP (monthly oral, 2- and 6-monthly injectable) rollout in South Africa, Zimbabwe and Kenya. Due to uncertainties about LA-PrEP use, we examined a range of coverages (5%−20% of HIV-negative sexually active adults) and extents to which LA-PrEP use will be concentrated among those most at risk (prioritized rollout from higher- to lower-risk groups vs. uniform rollout among sexually active adults). To evaluate a 20-year commitment to LA-PrEP delivery, we assumed LA-PrEP was scaled up to target coverage from 2025 to 2030 and maintained at target levels before ending in 2045. We estimated maximum per-dose and per-year LA-PrEP costs that achieve cost-effectiveness (&lt;US$500 per disability-adjusted life-year averted) over 35 years (until 2060), compared to a scenario of daily oral PrEP only. Sensitivity analyses varied PrEP scale-up speeds and eligible populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Risk-prioritized LA-PrEP for 5% of adults was projected to avert 11–21% of HIV acquisitions across settings, with 3–5 times more HIV acquisitions averted and 3–5 times higher maximum cost compared to non-prioritized rollout. Six-monthly injectable PrEP supported the highest per-dose cost: in the scenario with the most cost-effective LA-PrEP use (5% risk-prioritized rollout), the maximum per-dose price in South Africa was $52.99 (95% CI: $48.82–$57.21), in Zimbabwe $14.64 (95% CI: $12.04–$17.38) and in western Kenya $7.50 (95% CI: $6.73–$8.27). For monthly oral PrEP, corresponding per-dose costs were $5.02 (95% CI: $4.67–$5.37), $1.45 (95% CI: $1.10–$1.79) and $0.87 (95% CI: $0.80–$0.93). Results were sensitive to eligible population and prioritization, and moderately sensitive to scale-up speed and product effectiveness.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LA-PrEP is likely to require reduced pricing and/or risk-prioritized rollout to be cost-effective in ESA.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26427","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143481314","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 HIV seroconversions among a cohort of oral PrEP users in South Africa","authors":"Catherine E. Martin,&nbsp;Hlologelo Ramatsoma,&nbsp;Glory Chidumwa,&nbsp;Laura Ashleigh Cox,&nbsp;Saiqa Mullick","doi":"10.1002/jia2.26421","DOIUrl":"https://doi.org/10.1002/jia2.26421","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>There has been significant progress in the rollout of oral pre-exposure prophylaxis (PrEP) for the prevention of HIV. The introduction of long-acting prevention methods holds the potential to improve HIV prevention uptake and use, however, presents unique complexities regarding HIV diagnosis and potential for resistance. Quantifying and understanding the scenarios within which seroconversions occur may help to inform approaches to identifying acute HIV in programmes delivering PrEP at scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This paper documents ctra series of seroconversions within a large implementation study conducted in eight Department of Health facilities and four linked mobile clinics in four areas of South Africa. Using routinely collected data, we conducted a descriptive analysis of clients who seroconverted after initiating oral PrEP and determined the distribution of time from oral PrEP initiation to seroconversion as well as the proportion of days covered by oral PrEP. A seroconversion was defined as any HIV-positive diagnosis after initiation of PrEP. Time to seroconversion was calculated as the number of days between the first PrEP initiation and the date of HIV diagnosis. The proportion of days covered by PrEP was calculated as the number of days of PrEP prescribed over the number of days between PrEP initiation and HIV seroconversion. We conducted a logistic regression to determine factors associated with seroconversion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 11,882 clients initiated on PrEP between January 2019 and October 2022 who attended at least one follow-up visit, 112 (0.9%) seroconverted after PrEP initiation. Among those who seroconverted, the median proportion of days covered by PrEP between initiation and seroconversion was 33%. In the period between PrEP initiation and seroconversion, almost all (<i>n</i> = 93, 83.0%) had not used PrEP consistently, with only 19 (17.0%) having consistent PrEP use, all of whom were identified at the 1-month follow-up visit and were likely missed acute acquisitions. Younger age and geographical area were associated with seroconversion.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study reports a low number of seroconversions among a large cohort of PrEP users in a real-world implementation study, the majority of which occurred among clients who had interrupted or discontinued PrEP use.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26421","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143466101","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":"Acceptability of an annual tenofovir alafenamide implant for HIV prevention in South African women: findings from the CAPRISA 018 Phase I clinical trial","authors":"Tanuja N. Gengiah,&nbsp;Craig J. Heck,&nbsp;Lara Lewis,&nbsp;Leila E. Mansoor,&nbsp;Ishana Harkoo,&nbsp;Nqobile Myeni,&nbsp;Marc M. Baum,&nbsp;John A. Moss,&nbsp;James F. Rooney,&nbsp;Catherine Hankins,&nbsp;Bruno Pozzetto,&nbsp;Salim S. Abdool Karim,&nbsp;Quarraisha Abdool Karim","doi":"10.1002/jia2.26426","DOIUrl":"https://doi.org/10.1002/jia2.26426","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;Long-acting HIV pre-exposure prophylaxis promises to improve uptake, adherence and persistence challenges experienced with daily oral tablets. We assessed the acceptability of an annual tenofovir alafenamide (TAF) implant in South African women enrolled from 9 July 2020 until 31 May 2022 in a Phase I trial.&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;Six women received one TAF implant for 4 weeks (Group 1), after which 30 women were randomized (4:1, TAF to placebo ratio) to receive 1 or 2 TAF or placebo implants for 48 weeks (Group 2), before trial discontinuation. Acceptability assessments were conducted pre- and post-implant removal. Implant attributes (size, quantity, insertion site, palpability, visibility) and physical experiences (insertion/removal procedures, implant site reactions [ISRs]) were rated on a scale of 1 (highly unacceptable) to 6 (highly acceptable), with 4 being the acceptability threshold. The mean (range) of the mean acceptability scores across all pre-removal visits were calculated, including stratification by removal timing (early vs. scheduled). Implant likes and dislikes were also assessed.&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;The median participant age was 26 years. Prior to implant removal, the mean (range) acceptability scores were 5.4 (3.6–6.0) for product attributes and 5.1 (1.7–6.0) for physical experiences. Eleven (31%) participants had early implant removals, occurring on average 19 weeks (range 2–27 weeks) after insertion. The proportion of study visits reporting adherence measure as unacceptable in early versus scheduled removals: ISRs (50% vs. 19%), visibility (30% vs. 15%), palpability (14% vs. 8%), pain (16% vs. 4%) and implant quantity (13% vs. 1%). Pre-removal acceptability scores for ISRs (&lt;i&gt;p&lt;/i&gt; = 0.003) and physical experiences (&lt;i&gt;p&lt;/i&gt; = 0.05) were significantly associated with early removal. Overall, mean (range) acceptability scores were 5.8 (4.0–6.0) and 5.9 (4.7–6.0) for lifestyle compatibility and likelihood of recommendation, respectively. After removal, 39% of participants found ISRs unacceptable, followed by 22% citing implant visibility. Potential for long-term HIV protection, followed by discreet and convenient use, were most liked, while ISRs were the most disliked aspect.&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;While implant attributes, physical experiences and insertion/removal procedures were largely acceptable, local ISRs significantly reduced tolerability and acceptability, resulting in higher-than-expected early removals.","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26426","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143455863","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":"Early impacts of the PEPFAR stop-work order: a rapid assessment","authors":"Elise Lankiewicz,&nbsp;Alana Sharp,&nbsp;Patrick Drake,&nbsp;Jennifer Sherwood,&nbsp;Brian Macharia,&nbsp;Michael Ighodaro,&nbsp;Brian Honermann,&nbsp;Asia Russell","doi":"10.1002/jia2.26423","DOIUrl":"https://doi.org/10.1002/jia2.26423","url":null,"abstract":"&lt;p&gt;On 20 January, the Trump Administration issued an Executive Order freezing all foreign assistance funds for 90 days, to assess their alignment with the Administration's foreign policy priorities [&lt;span&gt;1&lt;/span&gt;]. The freeze included funds disbursed under the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), a historically bipartisan programme that has provided lifesaving HIV services since 2003. PEPFAR programmes are implemented primarily by the U.S. Centers for Disease Control and Prevention (CDC) and the United States Agency for International Development (USAID) and delivered by more than 450 prime implementing partners and around 850 sub-recipients in 55 countries. Following this order, all U.S. embassies were ordered to immediately suspend all foreign assistance, with only limited exceptions for emergency food assistance and military financing for Egypt and Israel, as well as some administrative costs [&lt;span&gt;2&lt;/span&gt;]. This sudden cessation of services, including HIV treatment, put millions of people at risk. Estimates predict that each day of the freeze about 220,000 people, including over 7000 children, will be unable to access their needed treatment [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;On 1 February, a waiver was granted to PEPFAR, allowing the resumption of life-saving humanitarian assistance during the review period [&lt;span&gt;4&lt;/span&gt;]. The exemption was limited to diagnostics, treatment, management of opportunistic infections, supply chain support and certain human resources [&lt;span&gt;4&lt;/span&gt;]. All HIV prevention activities, including the provision of pre-exposure prophylaxis, were excluded from the waiver, except for those aimed at preventing mother-to-child transmission [&lt;span&gt;4&lt;/span&gt;]. Further details on activities covered by the waiver were outlined in a Global Health Security and Diplomacy memo on 6 February [&lt;span&gt;5&lt;/span&gt;]. However, the process for resuming services under the waiver still requires notification from a contracting or agreement officer and approval of a modified workplan and budget. As of 21 January, the CDC has been under orders not to communicate with external partners, and as of 8 February, almost all USAID staff were put on administrative leave [&lt;span&gt;6, 7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Measuring and urgently addressing the disruption to PEPFAR-supported programmes is critical to save lives and mitigate the impact of the funding freeze, particularly given PEPFAR's own data systems have been shut down, eliminating their ability to track impacts on services [&lt;span&gt;3, 8&lt;/span&gt;]. We surveyed PEPFAR funding recipients the week immediately following the funding freeze and stop-work order (24 January−28 January 2025) using a web-based survey tool available in English, French, Spanish, Portuguese, Russian and Thai. Respondents were recruited via listservs and WhatsApp groups relevant to the global HIV response. All individuals employed by a PEPFAR prime implementing partner or sub-recipients were eligible to participate. Respondents were ask","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26423","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143431587","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":"Preferences for HIV pre-exposure prophylaxis formulations and delivery among young African women: results of a discrete choice experiment","authors":"Wendy W. Dlamini,&nbsp;Brenda G. Mirembe,&nbsp;Meighan L. Krows,&nbsp;Sue Peacock,&nbsp;Philip L. Kotze,&nbsp;Pearl Selepe,&nbsp;Jenni Smit,&nbsp;Nelly Mandona,&nbsp;Cheryl Louw,&nbsp;Harriet Nuwagaba-Biribonwoha,&nbsp;Victor O. Omollo,&nbsp;Zinhle Zwane,&nbsp;Ravindre Panchia,&nbsp;Noluthando Mwelase,&nbsp;Melissa Senne,&nbsp;Logashvari Naidoo,&nbsp;Rachel Chihana,&nbsp;Sinead Delany-Moretlwe,&nbsp;Katherine Gill,&nbsp;Pippa MacDonald,&nbsp;Alastair van Heerden,&nbsp;Shannon Bosman,&nbsp;Remco P. H. Peters,&nbsp;Philip du Preez,&nbsp;Amy Ward,&nbsp;Connie Celum,&nbsp;Renee Heffron,&nbsp;Jennifer Velloza,&nbsp;for the INSIGHT Study Team","doi":"10.1002/jia2.26422","DOIUrl":"https://doi.org/10.1002/jia2.26422","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;Oral HIV pre-exposure prophylaxis (PrEP) is highly effective, but adherence is challenging for young women. Products centred around women's preferences could address adherence barriers. Using a longitudinal discrete choice experiment (DCE), we examined young African women's preferences around PrEP product formulation and delivery attributes before and after initiating oral PrEP.&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 enrolled HIV-negative women from six African countries in a prospective cohort from August 2022 to June 2023. Women completed two DCEs on PrEP products and PrEP delivery. At enrolment and month 1, participants completed the DCE about PrEP products with 16 randomly assorted choice sets assessing product form and dosing, dose forgiveness, drug reversibility, weight change and antiretroviral or immune-based mechanism attributes. At month 3, participants completed the DCE about PrEP delivery evaluating preferences related to location to collect doses, packaging, product storage, type of HIV test and costs. Preference weights (PW) were estimated with a hierarchical Bayesian model; higher positive numbers indicate greater preference for an attribute. Importance scores compare relative importance across the five attributes; higher scores indicate greater importance.&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;Two thousand eight hundred and forty-seven women completed enrolment and month 1 DCEs; the median age was 24 years (range: 16–30) and 92.8% initiated daily oral PrEP. Product form and dosing was the most important attribute at enrolment and month 1. At enrolment, women preferred small oral pills taken monthly (preference weight [PW]: 0.67; 95% confidence interval [CI]: 0.58−0.77), and at month 1, they preferred a 6-monthly injection (PW: 0.56; 95% CI: 0.46−0.65). In the month 3 DCE, location was the most important PrEP delivery attribute with a strong preference for a youth-friendly or non-governmental organization (PW: 0.25; 95% CI: 0.19−0.30) or health facility (PW: 0.21; 95% CI: 0.17−0.25); mobile clinic or van was least preferred. The cost of the product was the second most important product delivery attribute.&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;Young African women preferred discreet, less frequently administered PrEP formulations, particularly after 1 month of taking daily oral PrEP. Long-acting formulations are needed to meet women's preferences. Coupled with the preferred PrEP delivery location and cost, the highlighted PrEP product characteristics have the poten","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26422","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143423599","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":"Integrated multi-month dispensing for HIV and hypertension in South Africa: A model of epidemiological impact and cost-effectiveness","authors":"Youngji Jo,&nbsp;Sydney Rosen,&nbsp;Brooke E. Nichols,&nbsp;Lise Jamieson,&nbsp;Nkgomeleng Lekodeba,&nbsp;Robert Horsburgh Jr.","doi":"10.1002/jia2.26413","DOIUrl":"https://doi.org/10.1002/jia2.26413","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In the current era of universal antiretroviral treatment (ART), health systems have the dual challenge of a growing number of people living with HIV and on ART who are also receiving chronic, life-long treatment for non-communicable diseases. Current evidence suggests that 6-month multi-month dispensing (6MMD) can maintain at least equivalent clinical outcomes to conventional care and reduce costs, but little is known when integrating 6MMD for multiple conditions. We examined the cost-effectiveness of integrated multi-month drug dispensing for people living with HIV and hypertension.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using an age- and sex-specific hybrid decision tree and Markov state-transition model, we constructed a 100,000-person simulated population cohort who may develop HIV and hypertension and initiate treatment at clinics in South Africa over a 10-year time horizon. We assessed the incremental costs and effectiveness of 6MMD versus conventional care from a health system perspective under different conditions of care-seeking, eligibility and uptake of 6MMD for clinically stable patients. Model inputs were sourced from previously published literature. 6MMD was defined as reducing the frequency of clinic visits by increasing the number of medications dispensed to stable patients at each visit from 3 to 6 months. For the integrated 6MMD, we assumed that comorbid patients receive both HIV and hypertension drugs at the same facility on the same day.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our study demonstrates that integrated 6MMD for HIV and hypertension in South Africa can avert between 0.8 and 1 DALYs and increase health systems costs between $24 and $49 per patient per year, compared to the status quo. One-way sensitivity analysis showed that HTN drug cost and prevalence of HIVHTN and HIV were key drivers in the cost per DALYs averted. Overall, integrated 6MMD with a greater proportion of well-controlled patients and lower mortality rates led to greater cost savings or better cost-effectiveness (less than $50 per DALY averted) across a wide range of loss-to-follow-up (LTFU) factor variation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By better controlling disease among patients already in care, integrated 6MMD can be more beneficial than the status quo treatment by resulting in fewer cases of LTFU and fewer deaths through high-quality care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26413","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396987","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 hepatitis C testing and treatment into routine HIV care in Cameroon is feasible","authors":"Mathurin Pierre Kowo,&nbsp;Liza Coyer,&nbsp;Victor Sini,&nbsp;Carole Assontsa Kafack,&nbsp;Gabriella Yelheen Metomo,&nbsp;Guy S. Wafeu,&nbsp;Richard Njouom,&nbsp;Alexander Boers,&nbsp;Roel Coutinho,&nbsp;Oudou Njoya,&nbsp;Charles Kouanfack,&nbsp;the DHEPC project team","doi":"10.1002/jia2.26417","DOIUrl":"https://doi.org/10.1002/jia2.26417","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Hepatitis C virus (HCV) prevalence and adverse outcomes are higher among people with human immunodeficiency virus (HIV) than people without HIV. Yet, HCV prevalence among people with HIV in Cameroon remains unknown, with HCV diagnosis and treatment largely inaccessible due to care centralization by specialists with high out-of-pocket costs. Integration of HCV services into routine HIV care by general practitioners could improve diagnosis and treatment coverage. We aimed to examine HCV prevalence and treatment cure rate among people with HIV attending 11 HIV clinics in the Centre Region of Cameroon.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We offered HCV rapid antibody testing, and, if positive, RNA testing to all persons ≥21 years, on HIV ART for ≥6 months and with suppressed HIV RNA (&lt;1000 copies) who attended HIV counselling and treatment appointments between 20 April 2021 and 31 May 2022. Participants with an HCV RNA positive test received 12 weeks of pangenotypic sofosbuvir/velpatasvir. We calculated the cure rate as the proportion of participants with a sustained virological response 12 weeks after treatment completion (SVR12) among all starting and completing treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We tested 8266 persons for HCV antibodies, 316 (3.8%, 95% CI = 3.4−4.3%) of whom were anti-HCV positive. Of these, 286 (90.5%) were sampled for HCV RNA, 20 (6.3%) ineligible, 5 (1.6%) declined, 4 (1.3%) left before sampling and 1 (0.3%) had an unknown reason. Among 286 sampled, 251 (87.8%) had detectable HCV RNA. Of these, 173 (68.9%) enrolled for treatment, 55 (21.9%) were eligible but not enrolled (49 lost-to-follow-up, 6 denied) and 23 (9.2%) were ineligible. Of 173 enrolled, 165 completed treatment, 6 were lost-to-follow-up and 2 were excluded due to treatment interruption. SVR12 was achieved in 93.6% (<i>n</i> = 162; 95% CI: 88.9–96.8%) of those enrolled and 98.2% (95% CI: 94.8–99.6%) of treatment completers. All three initially not achieving SVR12 were cured with second-line treatment (sofosbuvir/velpatasvir/voxilaprevir).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our study demonstrates the viability of integrating HCV testing and treatment into routine HIV care in Cameroon, yielding new HCV diagnoses and high cure rates. Cameroon can use this strategy to achieve HCV elimination goals, although improvements in testing uptake, diagnosis and treatment access, and laboratory capacity are needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26417","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143396988","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":"Early initiation of fast-track care for persons living with HIV initiating dolutegravir-based regimens during a period of severe civil unrest in Port-au-Prince, Haiti: a pilot randomized trial","authors":"Jean Bernard Marc,&nbsp;Samuel Pierre,&nbsp;Othnia Ducatel,&nbsp;Fabienne Homeus,&nbsp;Abigail Zion,&nbsp;Vanessa R. Rivera,&nbsp;Nancy Dorvil,&nbsp;Patrice Severe,&nbsp;Colette Guiteau,&nbsp;Vanessa Rouzier,&nbsp;Ingrid T. Katz,&nbsp;Carl Frederic Duchatelier,&nbsp;Guyrlaine Pierre Louis Forestal,&nbsp;Josette Jean,&nbsp;Guirlaine Bernadin,&nbsp;Emelyne Droit Dumont,&nbsp;Rose Cardelle B. Riche,&nbsp;Jean William Pape,&nbsp;Serena P. Koenig","doi":"10.1002/jia2.26419","DOIUrl":"https://doi.org/10.1002/jia2.26419","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;Differentiated service delivery (DSD) models have been widely implemented for patients in stable HIV care. However, DSD has rarely been offered to newly diagnosed patients. We assessed the effectiveness of early fast-track care during a period of severe civil unrest in Port-au-Prince, Haiti.&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 pilot randomized trial among adults presenting with early HIV disease to determine whether early fast-track care (8−12 weeks after same-day HIV testing and antiretroviral therapy [ART] initiation) was associated with superior outcomes compared with standard (deferred eligibility for fast-track care). All participants received tenofovir/lamivudine/dolutegravir (TLD), and HIV-1 RNA &lt;200 copies/ml was required prior to initiating fast-track care. The primary outcome was 48-week HIV-1 RNA &lt;200 copies/ml, with intention-to-treat 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;From December 2020 to August 2022, 245 participants were randomized to standard (&lt;i&gt;n&lt;/i&gt; = 116) and early fast-track (&lt;i&gt;n&lt;/i&gt; = 129) groups. All initiated TLD on the day of HIV diagnosis. In the early fast-track group, one (0.8%) died, 12 (9.3%) were internally displaced/emigrated, five (3.9%) were lost-to-follow-up (LTFU), two (1.6%) had a gap in care/later return, one (0.8%) was transferred and 108 (83.7%) were retained; 88 (68.2%) received 48-week viral load testing and 80 (90.9% of tested; 62.0% of randomized) had HIV-1 RNA &lt;200 copies/ml. In the standard group, two (1.7%) died, six (5.2%) were internally displaced/emigrated, three (2.6%) were LTFU, one (0.9%) had a gap in care/later return, one (0.9%) was transferred and 103 (88.8%) were retained; 78 (67.2%) received 48-week viral load testing and 66 (84.6% of tested; 56.9% of randomized) had HIV-1 RNA &lt;200 copies/ml. By design, the sample size of this pilot study was too small to provide definitive evidence of treatment effect, but the primary outcome was numerically higher in the early fast-track group (62.0% vs. 56.9%; RD: 0.051: 95% CI: −0.072, 0.174).&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;Early fast-track care was associated with high levels of viral suppression among adults initiating same-day TLD, despite severe civil unrest in Haiti. Completion of 48-week viral load testing was suboptimal, due to the need for participants to leave Port-au-Prince during peak periods of gang-related violence, and the lack of availability of viral load testing for those receiving non-facility-based ART.&lt;/p&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26419","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143380084","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":"Global prevalence of advanced HIV disease in healthcare settings: a rapid review","authors":"Nathan Ford,&nbsp;Reshma Kassanjee,&nbsp;Dominik Stelzle,&nbsp;Joseph N Jarvis,&nbsp;Omar Sued,&nbsp;Georges Perrin,&nbsp;Meg Doherty,&nbsp;Ajay Rangaraj","doi":"10.1002/jia2.26415","DOIUrl":"https://doi.org/10.1002/jia2.26415","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;Recent studies have indicated a high enduring burden of advanced HIV disease, but estimates across regions and settings are lacking. The aim of this study was to estimate the prevalence of advanced HIV disease since 2015 among those people with CD4 measured in healthcare settings, disaggregated by age group, level of healthcare and region.&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 MedLine via Pubmed and Hinari for studies that reported the proportion of individuals with advanced HIV disease (defined as CD4 cell count &lt;200 cells/mm&lt;sup&gt;3&lt;/sup&gt;) in healthcare settings since 2015; this search was complemented by conference abstracts and data from the International epidemiology Databases to Evaluate AIDS Consortium (IeDEA). We estimated pooled prevalence of advanced HIV disease using random-effects models and performed subgroup and sensitivity analyses to explore 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;We obtained data from 117 cohorts, representing 1,814,362 individuals from 52 countries across all six World Health Organization regions. The majority of studies (&lt;i&gt;n&lt;/i&gt; = 83) were conducted among adults and recorded CD4 cell count among treatment naïve individuals at antiretroviral therapy start (&lt;i&gt;n&lt;/i&gt; = 86). Studies included data reported up to 2023. The proportion of individuals with advanced HIV disease was higher in inpatient settings (44.3%, 95% CI 39.1−49.6%) compared to outpatient settings (33.5%, 95% CI 31.5−35.4%). Prevalence was similar across age groups, time since HIV diagnosis and treatment status, and highest in West and Central Africa, South-East Asia and the Eastern Mediterranean region.&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;This review finds that at least a third of people presenting to healthcare settings have advanced HIV disease, with no evidence that this has changed in recent years. Screening for advanced HIV remains important to be able to direct appropriate preventive, diagnostic and therapeutic interventions to prevent progression to severe illness and death.&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 review summarizes recent evidence of the continued high proportion of individuals who (re)present to care with advanced HIV disease. These findings underscore the urgent need to reinforce programme capacity to diagnose, prevent and treat advanced HIV disease as an essential pillar of the global AIDS response.&lt;/p&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143362670","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}