Journal of the International AIDS Society最新文献

{"title":"Comparative effectiveness of dolutegravir + lamivudine versus three-drug regimens in Swedish clinical practice: a nationwide study","authors":"Erik Sörstedt,&nbsp;George Nduva,&nbsp;Fredrik Månsson,&nbsp;Åsa Mellgren,&nbsp;Johanna Repits,&nbsp;Eva Fernvik,&nbsp;Adam Stubbs,&nbsp;Melanie Schroeder,&nbsp;Johanna Brännström,&nbsp;Christina Carlander","doi":"10.1002/jia2.70054","DOIUrl":"10.1002/jia2.70054","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>HIV guidelines recommend switching from a three-drug regimen (3DR) to dolutegravir + lamivudine (DTG+3TC) for eligible individuals. This retrospective national cohort study used Swedish InfCareHIV registry data to evaluate long-term outcomes of adults with HIV RNA &lt;50 copies/ml who switched to DTG+3TC or a guideline-recommended 3DR between July 2019 and May 2023 in routine clinical care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Demographic and clinical data were obtained from InfCareHIV at baseline, 6, 12, 24, 36 and 42 months post-switch. The primary endpoint was virologic failure (VF) rates at each time point; secondary endpoints included VF rates in prespecified subgroups, time to VF, and incidence of viral blips and treatment-emergent resistance. Generalized estimating equations modelling was used to assess the effects of clinical predictors on VF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1125 individuals (46%) switched to DTG+3TC, and 1336 (54%) switched to 3DR. Adjusted VF rates post-switch were 0.1–2.9% in the DTG+3TC group and 0.3–2.2% in the 3DR group in the intent-to-treat analysis (0–0.4% and 0.3–2.3% in the on-treatment [OT] analysis, respectively). In the OT set, the odds of VF were significantly lower for DTG+3TC versus 3DR at 24, 36 and 42 months (<i>p</i>&lt;0.001). Treatment-emergent resistance rates were low in both groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In this long-term, real-world, national cohort, switching to DTG+3TC was associated with low rates of VF and antiretroviral therapy resistance, indicating that eligible individuals can be switched to DTG+3TC without increased risk of VF.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 3","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12946511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147300396","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":"Role of pharmacists in HIV prophylaxis: a scoping review of pharmacists’ services, interventions and outcomes","authors":"Gustavo Magno Baldin Tiguman,&nbsp;Amanda Veiga Barbosa das Dores,&nbsp;Patricia Melo Aguiar","doi":"10.1002/jia2.70090","DOIUrl":"10.1002/jia2.70090","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;HIV remains a major global public health challenge, with nearly 1.3 million new HIV acquisitions annually. Despite the effectiveness of pre-exposure (PrEP) and post-exposure prophylaxis (PEP), barriers to access, initiation and adherence persist. Pharmacists, as accessible healthcare providers with medication expertise, are increasingly involved in HIV prevention. However, the scope and impact of pharmacist-led prophylaxis services have not been comprehensively synthesized. This study aimed to map and characterize the existing evidence on pharmacists’ services, interventions and outcomes in HIV prophylaxis.&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 scoping review was conducted with searches in Medline (PubMed), Embase, Scopus and LILACS, supplemented by grey literature (Google Scholar) until May 2025. Eligible studies included original research describing pharmacist-led clinical activities or interventions related to HIV prophylaxis. Two independent reviewers conducted study selection and data extraction. Pharmacists’ roles were categorized based on the International Pharmaceutical Federation (FIP) and the Descriptive Elements of Pharmacist Intervention Characterization Tool (DEPICT) Version 2. The impacts of pharmacists on outcomes of care were categorized considering economic, clinical, humanistic and process-related outcomes.&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;Out of 2736 records retrieved from searches, 26 studies published between 2014 and 2025 were included, which were conducted predominantly in the United States (&lt;i&gt;n&lt;/i&gt; = 21). Pharmacists commonly performed direct patient care (e.g. patient counselling, PrEP/PEP prescribing, adherence monitoring, laboratory tests ordering), facilitated medication access and collaborated with other healthcare professionals via different communication methods (face-to-face, telephone, written, videoconference), especially in primary care and community pharmacies. Pharmacists’ autonomy to prescribe and order laboratory tests was observed in several studies under both independent and collaborative practice models. Twenty studies reported positive process outcomes, such as increased PrEP initiation, adherence and retention, while fewer assessed clinical (&lt;i&gt;n&lt;/i&gt; = 8), economic (&lt;i&gt;n&lt;/i&gt; = 2) or humanistic (&lt;i&gt;n&lt;/i&gt; = 1) outcomes.&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;Expanding pharmacist-led services, particularly in underserved regions, represents a promising strategy to improve access, initiation and adherence to HIV prevention. Future res","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12930320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147281600","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":"HIV low-level viraemia: considerations for prevention and treatment in an era of highly effective and durable antiretroviral therapy regimens","authors":"Lara Vojnov,&nbsp;Linda-Gail Bekker,&nbsp;Myron S. Cohen,&nbsp;Andreas Jahn,&nbsp;Diane Havlir,&nbsp;Debrah Boeras,&nbsp;Nathan Ford,&nbsp;Nagalingesawaran Kumarasamy,&nbsp;Laura N. Broyles","doi":"10.1002/jia2.70085","DOIUrl":"10.1002/jia2.70085","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite increasingly widespread acceptance of the (undetectable = untransmittable) U = U concept, uncertainty remains about the implications of suppressed viral loads (detected but ≤1000 copies/ml, also often referred to as low-level viraemia) for both sexual HIV transmission and individual patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>There has been no documented evidence of a transmission event when the index partner had a viral load &lt;200 copies/ml, suggesting zero risk of sexual transmission. Additionally, the risk of sexual transmission when the index partner is taking medication as prescribed and has a viral load that is detectable but suppressed (<i>≤</i>1000 copies/ml) is negligible. The clinical implications, including drug resistance development, of persistent low-level viraemia in people with HIV (PWH) taking dolutegravir-containing antiretroviral therapy remains limited and relatively unknown; ongoing research and surveillance will be critical to monitor expanded scale-up of optimized treatment. To support widespread access to treatment monitoring for all PWH, viral load testing should be expanded using any combination of available viral load technologies and sample types, as they can all support the primary objectives of understanding the viral load of PWH, for both prevention and treatment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PWH who have an undetectable or suppressed viral load should be celebrated and encouraged to maintain their treatment adherence and engagement in care, while ensuring that no remaining barriers exist for them to do so.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12930288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147281561","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 HIV/AIDS response as we knew it is over: Where do we go from here?","authors":"Chris Beyrer,&nbsp;Jirair Ratevosian,&nbsp;Tom Carpino,&nbsp;Nora E. Rosenberg,&nbsp;Huub C. Gelderblom,&nbsp;Patrick S. Sullivan,&nbsp;Steve G. Deeks,&nbsp;Glenda Gray","doi":"10.1002/jia2.70077","DOIUrl":"10.1002/jia2.70077","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The global HIV response, once a model of progress and innovation, faces a profound moment. Despite four decades of pivotal scientific and programmatic advances—most notably in antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP)—the world remains off track to meet the 2025 and 2030 targets for ending AIDS as a public health threat. New acquisitions and AIDS-related deaths remain unacceptably high, particularly among key populations and in low- and middle-income countries. The abrupt U.S. funding reversals in 2025 have severely disrupted support for HIV efforts. Cuts to U.S. and international institutions have compromised HIV prevention, treatment and surveillance systems worldwide, and may already have begun reversing two decades of progress.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>To avert this crisis, the HIV and public health community, together with governments and global funders, must urgently invest in scaling long-acting treatment and prevention tools, rebuild disaggregated data systems and strengthen implementation science rooted in community-led approaches. Digital health technologies offer promise to enhance service delivery, surveillance, monitoring and evaluation, especially in resource-constrained settings, but demand ethical governance and infrastructure investment. The global research ecosystem must become more evenly distributed and inclusive, with a shift towards country-led partnerships, national data sovereignty and regional co-operation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Looking to 2030 and beyond, the strategy to end HIV should include expanded access to long-acting ART and PrEP, sustained investments in HIV vaccine and cure research, and robust monitoring and evaluation systems. Achieving epidemic control—and ultimately ending the HIV pandemic—will require not only biomedical tools but also political will, community leadership and equitable financing. The lessons of the past underscore that sustained progress is possible, but only if we meet this moment with urgency, imagination and solidarity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12922781/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146256901","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 postal HIV testing into the HIV care cascade in Japan: a public health centre model","authors":"Kota Iwahashi,&nbsp;Keisuke Ejima,&nbsp;Naho Tsuchiya,&nbsp;Nittaya Phanuphak,&nbsp;Akifumi Imamura","doi":"10.1002/jia2.70086","DOIUrl":"10.1002/jia2.70086","url":null,"abstract":"&lt;p&gt;HIV testing is delivered through three principal modalities: facility-based testing; remote self-sampling/postal testing (samples mailed to a laboratory); and self-testing (HIVST). By July 2024, 107 countries had policies supporting HIVST, of which 71 reported routine implementation, while the remaining 38 had supportive policies but had not yet reported routine implementation [&lt;span&gt;1-3&lt;/span&gt;]. In Japan, however, HIVST for at-home use has not yet been approved by the government, partly due to concerns about follow-up and linkage to care after users had reactive results.&lt;/p&gt;&lt;p&gt;Japan's HIV epidemic remains concentrated among men who have sex with men (MSM): in 2023, 71% of new HIV acquisitions were attributed to male-to-male sexual contact [&lt;span&gt;4&lt;/span&gt;]. Accordingly, MSM-focused interventions are pivotal for prevention and case-finding, and close collaboration between public health services and community-based organizations (CBOs)—particularly those serving lesbian, gay, bisexual, transgender and queer (LGBTQ) communities—is essential to expand access, provide accurate information about testing options and reduce stigma.&lt;/p&gt;&lt;p&gt;Within this context, Public Health Centres (PHCs) have long anchored Japan's HIV response. They are widely established nationwide and, as publicly funded institutions operated by local governments with national subsidies, offer free, anonymous HIV testing, pre- and post-test counselling, and referral to care (Figure 1) [&lt;span&gt;4&lt;/span&gt;]. In 2023, municipalities conducted 106,137 HIV tests and provided 86,088 consultations through PHCs; 316 people screened positive, which represents one-third of the 983 people with newly reported HIV infections nationwide that year. PHCs have also worked with CBOs across the country to widen access to their services, including PHC-led collaborations in which CBOs support community outreach, testing promotion at LGBTQ venues and events, training of PHC staff, and navigation from community-based activities to PHC-provided HIV testing and follow-up [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Since the early 2000s, access to and uptake of postal HIV testing has expanded in Japan [&lt;span&gt;6&lt;/span&gt;]. In recent years, CBOs and their clinical/academic partners started pilot projects to extend the reach of postal testing among MSM and evaluate the feasibility and acceptability of self-sampling using finger-prick and dried blood spots (DBS; e.g. the HIVcheck programme [&lt;span&gt;7&lt;/span&gt;]). Japan's Ministry of Health, Labor and Welfare research group has surveyed postal testing vendors annually since 2005, quantifying testing volumes, HIV positivity and linkage indicators [&lt;span&gt;6&lt;/span&gt;]. In 2023, vendors reported 153,037 postal tests—figures that exceeded PHC-site testing volumes that year [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The contrast in testing cascades helps explain such dynamics: PHC-led testing is provider-delivered and labour-intensive, whereas the postal testing pathway offers more limited services than PHCs (Figure 1). Th","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12906993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146199762","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":"Optimizing the patient journey: Insights from early implementation of long-acting cabotegravir and rilpivirine in four urban Ryan White-funded clinics in the United States","authors":"Xavier A. Erguera,&nbsp;Mollie B. Smith,&nbsp;Priyasha Pareek,&nbsp;Alicia Dawdani,&nbsp;Kaylin V. Dance,&nbsp;Ryan S. Walker,&nbsp;Janet Grochowski,&nbsp;Jon Oskarsson,&nbsp;Matthew D. Hickey,&nbsp;Mallory O. Johnson,&nbsp;John Sauceda,&nbsp;Jose I. Gutierrez Jr.,&nbsp;Elizabeth T. Montgomery,&nbsp;Jonathan A. Colasanti,&nbsp;Lauren F. Collins,&nbsp;Moira C. McNulty,&nbsp;Kimberly A. Koester,&nbsp;Katerina A. Christopoulos","doi":"10.1002/jia2.70082","DOIUrl":"10.1002/jia2.70082","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) represents a breakthrough in HIV treatment. However, understanding how to optimize real-world service delivery and user experiences among people with HIV (PWH) remains limited.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between August 2022 and December 2024, we conducted semi-structured interviews with PWH at four academic Ryan White-funded HIV clinics in Atlanta, Chicago and San Francisco. Eligibility criteria were current LAI-CAB/RPV use with ≥3 injections or having discontinued. Interviews were analysed using thematic analysis grounded in descriptive phenomenology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 69 participants, 48 of whom were receiving LAI-CAB/RPV and 21 who had discontinued, we identified three themes that highlighted opportunities to enhance patient-centred service delivery of LAI-CAB/RPV: (1) enhancing knowledge and self-efficacy in using oral antiretroviral therapy (ART) in cases of missed or late injections; (2) improving patient comfort and confidence, particularly regarding injection anxiety, pain management and blood draws; (3) attending to the potential evolution of patient-provider relationships, as in most cases injection visits outnumber primary care visits. In addition, PWH may experience depressive feelings upon discontinuation, even if they view it as the right decision.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Optimizing the LAI-CAB/RPV patient journey requires developing a specialized support framework that is distinct from oral ART protocols. This new treatment modality requires a tailored approach that addresses unique challenges, including facilitating candid discussions about adherence contingencies, managing the physical and psychological aspects of injection experiences, ensuring meaningful and consistent provider relationships amid changing care patterns and providing enhanced support during treatment transitions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12900896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146176761","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":"Sustaining Rwanda's HIV response after elimination of PEPFAR funding: a modelling analysis of HIV epidemic and care continuum outcomes","authors":"April D. Kimmel,&nbsp;Zhongzhe Pan,&nbsp;Gad Murenzi,&nbsp;Ellen Brazier,&nbsp;Batya Elul,&nbsp;Benjamin Muhoza,&nbsp;Marcel Yotebieng,&nbsp;Kathryn Anastos,&nbsp;Denis Nash,&nbsp;and on behalf of the Central Africa International epidemiology Databases to Evaluate AIDS (CA-IeDEA)","doi":"10.1002/jia2.70078","DOIUrl":"10.1002/jia2.70078","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;HIV prevention and treatment supported by the United States President's Emergency Plan for AIDS Relief (PEPFAR) have saved millions of lives. Rwanda is among the most successful countries worldwide in achieving global targets with PEPFAR support. Abrupt PEPFAR funding uncertainty raises concerns about continued HIV epidemic control. We projected the impact of the Government of Rwanda's (GoR's) capacity to offset PEPFAR funding elimination on adult HIV epidemic and care continuum outcomes over 10 years.&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;Using an HIV policy model calibrated to Rwanda, we assessed capacity to sustain HIV services at: 50% (with no capacity by GoR to cover the PEPFAR funding gap), 75%, 90% and 100% (with full capacity by GoR to cover the gap). Scenarios involved reducing the number on antiretroviral therapy (ART), immediately discontinuing ART and proportionally decreasing HIV diagnosis, ART initiation, and care re-engagement. We projected epidemic outcomes (HIV prevalence, HIV incidence, number with HIV, new HIV infections, deaths) and care continuum outcomes (percentage diagnosed, percentage on ART among those diagnosed, percentage virally suppressed among those on ART). We calculated differences in projected outcomes for partial or no capacity versus full capacity. Secondary analyses assessed the timing of the GoR's response.&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;Compared to full capacity at 10 years, the model projected a 13.9%–38.7% increase in HIV prevalence and 69.0%–246.7% increase in HIV incidence across coverage capacity scenarios. This translated to 29,000–64,000 additional adults with HIV and 20,000–92,000 cumulative new adult HIV infections. Cumulative projected deaths increased by 10,000–51,200. The model projected continual reductions in percentage diagnosed at 10 years; percentage virally suppressed among those on ART was similar across scenarios. Higher, and more delayed, coverage capacity had projected outcomes similar to lower, and less delayed, coverage capacity. Outcomes for gradual increases in coverage capacity were generally similar to or better than full, but delayed, coverage capacity.&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;Even in countries like Rwanda that have achieved epidemic control, abrupt and persistent elimination of PEPFAR funding could drastically reverse critical gains. Evidence quantifying the consequences of different capacities to sustain HIV services underscores the high stakes of rapid and sufficient action.&lt;/p&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12894777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146163192","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":"Consequences of United States funding suspensions on community-led HIV services in Latin America and the Caribbean: findings of a rapid service provider survey","authors":"José Rafael Guillén,&nbsp;Megan Stevenson,&nbsp;Miguel Ángel Barriga Talero,&nbsp;Mary Ann Torres,&nbsp;Andrea L. Wirtz","doi":"10.1002/jia2.70081","DOIUrl":"10.1002/jia2.70081","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Foreign aid provided by the United States government (USG), including support for HIV services, has been suspended or dismantled since January 2025. Early research and modelling projections have suggested significant impacts globally and in sub-Saharan Africa. We aimed to evaluate the consequences of USG funding suspensions on community-led HIV services in Latin America and the Caribbean (LAC).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We surveyed community-led organizations providing HIV services in LAC in February−March 2025. Organization leaders were recruited through a network of HIV service organizations. Survey items measured USG funding (past 12 months) and funding sources; experiences of funding suspensions; and programmes, beneficiaries and workforce affected by funding suspensions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 40 respondent organizations, 24 (60%) had received USG funding in the past 12 months. Of the 24, 21 (87%) organizations representing 10 countries reported that they had experienced a funding suspension. These included direct and indirect funding from PEPFAR (62%), USAID (48%) and, less frequently, other USG agencies. Programmes most frequently affected by the funding freeze included sexual prevention programmes, HIV testing services, psychosocial support and humanitarian services. An estimated 156,164 beneficiaries had been receiving HIV services across respondent organizations that were affected by funding suspensions. Populations commonly served included (but were not limited to) people living with HIV, transgender people, people engaged in sex work, men who have sex with men, migrant populations and women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>LAC HIV programmes have had comparatively less reliance on USG funding than other regions; however, they are still likely to be significantly affected by funding suspensions and the dismantling of USAID. Achievement of global HIV goals in LAC will require support from government and foreign donors, as well as collaboration with pharmaceutical companies to ensure access to biomedical HIV prevention and treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148516","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":"Intentions and attitudes of caregivers towards enrolment of their children and adolescents living with HIV into remission trials involving analytic treatment interruption","authors":"Holly L. Peay,&nbsp;Kennedy Otwombe,&nbsp;Shaun Barnabas,&nbsp;Ana Barrios-Tascon,&nbsp;Maria Grazia Lain,&nbsp;Tacilta Nhampossa,&nbsp;Diana Rutebarika,&nbsp;Thidarat Jupimai,&nbsp;Moherndran Archary,&nbsp;Almoustapha-Issiaka Maiga,&nbsp;Avy Violari,&nbsp;Moira J. Spyer,&nbsp;Kavidha Reddy,&nbsp;Paolo Palma,&nbsp;Savita Pahwa,&nbsp;Mathias Lichterfeld,&nbsp;Mark Cotton,&nbsp;Louise Kuhn","doi":"10.1002/jia2.70084","DOIUrl":"10.1002/jia2.70084","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The development of approaches and interventions to achieve HIV remission continues to accelerate. Children living with HIV who started antiretroviral therapy (ART) at a young age and sustain viral suppression are an ideal clinical trial population. Trials may require analytic treatment interruptions (ATIs). Paediatric trials depend on the willingness of guardians to consent to child participation, yet there are few data about guardian willingness or attitudes. Here, we investigated the opinions of guardians of children likely to be eligible for ATI trials.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Children and youth who started ART ≤ 3 months of age, and who remained well-controlled on ART older than 7 years, were recruited in South Africa, Mozambique, Uganda, Mali and Thailand. A survey was conducted among guardians of these paediatric participants. The survey utilized a vignette describing a trial with ATI and assessed attitudes and intentions (measured on 7-point scales) of the guardians regarding their children's participation in a hypothetical trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Guardians of 99 children were recruited. Guardians’ median age was 45 years (range 24–73) and most (89.9%) were female. The median age of the child or youth with HIV was 13.2 years (range 7–18.5 years). Most respondents endorsed a positive intention to enrol their child in a future HIV remission trial (mean 6.5 [SD:1.3] on a 7-point scale), with significant variation across the sites (<i>p</i> = 0.0024). Most respondents strongly endorsed a range of trial benefits, including better future HIV treatments (93.8%) and access to better care (88.0%). Some endorsed concern about the trial burden to themselves (33.3%) and the child (35.4%). Almost half strongly believed that the trial would result in the child no longer needing ART (48%) and the child being cured of HIV (46.5%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Across multiple countries, guardians of children and youth who were treated early were positive about participation in trials with ATI. Only a third expressed some concern about trial burden, while almost half had unrealistic expectations about potential benefits. Recruitment into trials involving ATI will need to include effective communication strategies to ensure that participants and caregivers are adequately informed about burden, potential risks and the likelihood of personal benefit.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70084","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148559","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":"Age, sex—and what else? Rethinking priorities to close gaps in the HIV care cascade","authors":"Lise Jamieson,&nbsp;Sydney Rosen,&nbsp;Gesine Meyer-Rath,&nbsp;Idah Mokhele,&nbsp;Nozipho Musakwa,&nbsp;Jeffrey W. Imai-Eaton,&nbsp;Domonique M. Reed,&nbsp;Tsitsi Apollo,&nbsp;Dorlim Moiana Uetela,&nbsp;Daniel Shodell,&nbsp;Peter Ehrenkranz,&nbsp;Matthew P. Fox,&nbsp;the Closing The Gap Working Group","doi":"10.1002/jia2.70080","DOIUrl":"10.1002/jia2.70080","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Many countries with high HIV burden have made substantial progress towards UNAIDS 95-95-95 targets and ending AIDS, but gaps in some sub-populations hinder overall achievement, even as programmes face potentially diminished resources. While certain broad groups defined by age, sex or large geographic regions are commonly labelled as “high-risk” for being out of care, most individuals within these groups are in care and virally suppressed. Characteristics beyond age and sex (e.g. behavioural, socio-economic, smaller geographic areas) may differentiate those requiring targeted intervention strategies. Our <i>Closing The Gap</i> project aims to characterize unreached and disengaged sub-populations for targeted HIV interventions across Mozambique, South Africa and Zimbabwe, countries selected for their varied target achievement and diverse populations. We discuss overarching themes from the first <i>Closing The Gap</i> workshop, convening government stakeholders, implementers, researchers and community representatives in February 2025.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Key themes emerged from the workshop: (1) the importance of considering absolute sub-population size, alongside percentages, when assessing service gaps; (2) limitations of existing data and analytic paradigms beyond age-and-sex categories, highlighting the need for richer, contextual data linked to care cascade outcomes (e.g. clinical markers, mobility, socio-economic circumstances) and analyses incorporating additional factors for identifying more granular sub-populations; (3) need to identify individuals who do not require differentiated care to better prioritize resources to those not served by existing models; and (4) in the context of decreasing funding, the need to balance the cost and complexity of differentiated interventions with the feasibility and cost-effectiveness of standardized approaches, including self-selection strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>It is critically important to generate more efficient strategies to close HIV care cascade gaps and sustain positive progress amidst potentially reduced future resources towards HIV. This may need a paradigm shift in service differentiation that specifically identifies sub-populations most-at-risk of suboptimal outcomes, beyond age/sex categories, while efficiently balancing sub-population size and proportionate risk. Data-driven prioritization of cost-effective interventions targeting the unreached and underserved is essential for sustaining progress in the evolving HIV response.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 2","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12886747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146148506","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}