Journal of the International AIDS Society最新文献

{"title":"Scale of differentiated service delivery implementation in HIV care facilities in low- and middle-income countries: a global facility survey","authors":"Nathalie Verónica Fernández Villalobos, Fabrice Helfenstein, Vohith Khol, Christella Twizere, Mayara Secco, Barbara Castelnuovo, Jacqueline Huwa, Thierry Tiendredbeogo, C. William Wester, Siew Moy Fong, Gad Murenzi, Yanink Caro-Vega, Rita Elias Lyamuya, Idiovinio Rafael, Djimon Marcel Zannou, Kathy Petoumenos, Dominique Mahambou Nsonde, Jorge Pinto, Kara Wools-Kaloustian, Carolyn Bolton Moore, Ounoo Elom Takassi, Sasisopin Kiertiburanakul, Rogers Ajeh Awoh, Shamim M. Ali, Geoffrey Fatti, Karen Malateste, Elizabeth Zaniewski, Marie Ballif, the International epidemiology Databases to Evaluate AIDS","doi":"10.1002/jia2.26477","DOIUrl":"https://doi.org/10.1002/jia2.26477","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In 2016, the World Health Organization recommended differentiated service delivery (DSD) as a client-centred approach to simplify HIV care in frequency and intensity, thus reducing the clinic visit burden on individuals and HIV programmes. We describe the scale of DSD implementation among HIV facilities in low- and middle-income countries (LMICs) in Latin America, Africa and the Asia-Pacific before the COVID-19 pandemic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed facility-level survey data from HIV care facilities participating in the International epidemiology Databases to Evaluate AIDS consortium in 2019. We used descriptive statistics to summarise the availability of DSD, multi-month dispensing (MMD) and DSD for HIV treatment models. We explored factors associated with DSD implementation using multivariable models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 175 facilities in the Asia-Pacific (<i>n</i> = 30), Latin America (<i>n</i> = 8), Central Africa (<i>n</i> = 21), East Africa (<i>n</i> = 74), Southern Africa (<i>n</i> = 28) and West Africa (<i>n</i> = 14). Overall, 133 facilities (76%) reported implementing DSD. Of these, 91% offered DSD for HIV treatment, 61% for HIV testing and 59% for antiretroviral therapy (ART) initiation. The most common duration of ART refills for clinically stable clients was 3MMD, (70%), followed by monthly (14%) and 6MMD (10%). Facility-based individual models were the most frequently available DSD for the HIV treatment model (82%), followed by client-managed group models (60%). Out-of-facility individual models were available at 48% of facilities. Facility-based individual models were particularly common among facilities in East (92%) and Southern Africa (96%). Facilities in medium and high HIV prevalence countries, and those with 3MMD, were more likely to implement DSD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In 2019, DSD was available in most HIV care facilities globally but was not evenly implemented across regions and HIV services. Most offered facility-based DSD for HIV treatment models and 3MMD for clinically stable clients. Efforts to expand DSD for HIV testing and ART initiation and to offer longer MMD can improve long-term retention in care of people living with HIV in LMICs, while further alleviating the operational burden on healthcare services. These findings from the pre-COVID-19 era underline the need for strengthening DSD in HIV care, which remains at the centre of current efforts towards client-centred care.</p>\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26477","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574129","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 TB treatment and support delivery models among people living with TB in Eastern Cape, South Africa: a discrete choice experiment","authors":"Michael Strauss, Gavin George, Emma Lansdell, Kuhle Fiphaza, Andrew Medina-Marino, Joseph Daniels","doi":"10.1002/jia2.26506","DOIUrl":"https://doi.org/10.1002/jia2.26506","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>South Africa has one of the highest incidence rates of notified tuberculosis (TB) in the world. Achieving TB control requires strengthening treatment and support services. The implementation of differentiated delivery models can be used to improve service quality and enhance retention in care. This study aimed to identify treatment and support delivery preferences among people on TB treatment, specifically examining gender differences, to inform the development of differentiated care models for improving engagement and retention in TB treatment services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A binary, unlabelled, fractional factorial design discrete choice experiment (DCE) was used to investigate preferences for TB treatment adherence support and service delivery. Attributes included who provides the support, how and where support is delivered, medication collection location and frequency of clinic visits. The DCE was administered to individuals who were currently on or recently completed TB treatment, and to those at-risk for being lost-to-care. Data from 284 individuals for the DCE were collected from March to August 2022. Mixed effects logistic regression models were used as primary analysis tools. Latent class analysis (LCA) was used to explore heterogeneity in preference structures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Compared to standard clinic-based treatment collection, participants preferred collecting their treatment from a mobile community-based location (ß = 0.231; 95% CI: 0.08–0.39), clinic-based fast-tracked pick-ups (ß = 0.539; 95% CI: 0.38–0.70) or home delivery (ß = 0.563; 95% CI: 0.37–0.75). Participants also significantly preferred support offered monthly compared to once-off (ß = 0.167; 95% CI: 0.01–0.32). Furthermore, participants preferred face-to-face support over group (ß = –0.142; 95% CI: –0.27 to –0.02) or phone-based (ß = –0.222; 95% CI: –0.36 to –0.09) support models. LCA revealed three classes with statistically similar preference structures; Class 1 (62%) preferred community-based treatment delivery and support services; Class 2 (28%) preferred clinic-based support and treatment delivery services; and Class 3 (10%), preferred self-selected peer navigator or nurse delivered, and group models of support and prioritised the location of medication pickups, with a preference for any model other than standard clinic collection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Though preference structures did not differ by gender, respondents revealed strong prefere","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26506","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573987","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":"Build, do not dismantle: leveraging a differentiated service delivery approach for broader health impact amidst funding changes","authors":"Anna Grimsrud, Charles B. Holmes, Linda Sande","doi":"10.1002/jia2.26514","DOIUrl":"https://doi.org/10.1002/jia2.26514","url":null,"abstract":"<p>“<i>It is so easy to break down and destroy. The heroes are those who make peace and build</i>.”—Nelson Mandela</p><p>We received over 100 abstracts in response to this supplement's call for evidence to advance the scale-up of differentiated service delivery (DSD) beyond HIV treatment. However, since January 2025, the global context for HIV service delivery has shifted dramatically.</p><p>A steep, sudden reduction in United States government funding has jeopardised HIV services in many high-burden countries [<span>1</span>]. The closure of United States Agency for International Development (USAID) and termination of President's Emergency Plan for AIDS Relief (PEPFAR) programming delivered through USAID partners [<span>2</span>] marks more than a bureaucratic reshuffle—it signals the potential unravelling of critical components of the global HIV response.</p><p>While a State Department waiver was intended to provide clarification to allow for life-saving humanitarian assistance, it failed to deliver, resulting in widespread disruption of HIV services, including life-saving treatment [<span>3</span>]. The punative choices reflected in the waiver also reveal a fundamental shift in the scope of U.S. support going forward. The cessation of most pre-exposure prophylaxis (PrEP) programmes (except for pregnant and breastfeeding women), removal of earmarked funding for key populations and orphans and vulnerable children, and the elimination of HIV survey, surveillance and community-led monitoring activities underscore the magnitude of the shift. These changes threaten to dismantle the very structures built to make HIV care more efficient, client-centred and resilient. Among them is DSD—an approach that has transformed HIV services and remains key to sustaining and expanding access amid shrinking resources.</p><p>Prior to 20 January 2025, DSD had been scaled and integrated into national guidance, especially in Eastern and Southern Africa. Data from the Coverage, Quality and Impact Network (CQUIN) network of 21 countries in Sub-Saharan Africa show that by 2023, a median of 76% of people on antiretroviral therapy (ART) accessed treatment through a less-intensive DSD model [<span>4</span>]. Multi-month dispensing (MMD) of ART, which expanded during COVID-19 [<span>5</span>], is an enabler of DSD. Scale-up of MMD has continued, with 45% of people on ART supported by PEPFAR outside of South Africa, or 6.67 million people, receiving 6MMD in July−September 2023 (personal communication, Lauren Bailey). The potential savings from DSD include cost and resource savings from less frequent clinic visits, both for clients and the health system [<span>6, 7</span>], and can increase human resource capacity [<span>8</span>].</p><p>During COVID-19, the World Health Organization (WHO) recommended DSD components to support uninterrupted access to services: MMD of ART, MMD and prescribing of PrEP, scaled provision of HIV self-testing and ART distribution through community d","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26514","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"“A cure might help, but it won't erase it all”: a qualitative study of policy challenges and priorities for long-term survivors of HIV in the United States","authors":"Ali Ahmed, Jeff Taylor, Rachel Lau, Joyce Ching-Jung Lai, Sithara Deshan Diunugala, Michael Louella, Thomas J. Villa, William Freshwater, Dawn Averitt, Maile Karris, Jeff Berry, Lynda Dee, Karine Dubé","doi":"10.1002/jia2.70006","DOIUrl":"https://doi.org/10.1002/jia2.70006","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Long-term survivors (LTS) of HIV, including individuals diagnosed before the availability of effective antiretroviral therapy (ART), have played a pivotal role in shaping the HIV response. Despite an increase in their number in the United States, their unique medical, social and economic challenges remain underrepresented in HIV policy and research, particularly in the context of HIV cure advancements. While an HIV cure may alleviate ART-related burdens, LTS fear unintended consequences, including the potential loss of critical social benefits, economic support and healthcare access. This study explores the policy priorities of LTS, addressing their current unmet needs and the broader implications of an HIV cure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted qualitative interviews with 32 LTS across diverse racial, gender and geographic backgrounds, recruited through community-based organizations and research networks from 2023 to 2024. Using inductive thematic analysis, we identified key policy concerns and recommendations based on participants’ lived experiences. Data collection continued until thematic saturation was reached.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>LTS emphasized four pressing policy domains: (1) Persistent Healthcare Disparities: Participants reported fragmented Medicare and Medicaid coverage, limited access to essential services (e.g. dental, vision and mental healthcare), and ongoing stigma and discrimination in healthcare settings. (2) Social and Economic Precarity: Housing instability, financial insecurity and employment barriers disproportionately affect LTS, many of whom face systemic barriers to re-entering the workforce. (3) Policy Implications of an HIV Cure: Participants voiced concerns that an HIV cure, while promising, could result in disqualification from disability and social assistance programmes, exacerbating socio-economic vulnerabilities. (4) Structural Reforms for LTS Inclusion: LTS underscored the urgent need for their direct involvement in HIV research, policy development and decision-making to ensure equitable, community-driven solutions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Policymakers must address comprehensive healthcare access, economic stability and social protections for LTS of HIV. HIV cure research must not undermine existing benefits or widen disparities. Ensuring LTS representation in decision-making is critical to developing equitable policies that safeguard their wellbeing before and after a cure.</p>\u0000 </se","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144550940","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 preferences and early acceptability of injectable cabotegravir among pregnant and lactating people in Cape Town, South Africa: findings from the PrEPared to Choose study","authors":"Nafisa Wara, Carey Pike, Elzette Rousseau, Pippa Macdonald, Pakama Mapukata, Bryan Leonard, Keitumetse Lebelo, Risa Hoffman, Catherine Orrell, Linda-Gail Bekker, Dvora Joseph Davey","doi":"10.1002/jia2.26492","DOIUrl":"https://doi.org/10.1002/jia2.26492","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Providing pregnant and lactating people (PLP) with choice in HIV pre-exposure prophylaxis (PrEP) methods, including long-acting injectable cabotegravir (CAB-LA), may mitigate barriers to effective PrEP use. We evaluated PrEP preferences and acceptability among PLP offered CAB-LA versus oral PrEP in South Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The PrEPared to Choose study in Cape Town, South Africa, enrolled young people ages 15–29 at one public clinic and one community-based mobile clinic. Using informed choice counselling, participants were offered oral PrEP or CAB-LA, with the option to switch methods at follow-up visits over 18 months. We report baseline CAB-LA and oral PrEP initiations among PLP in the study, acceptability of their initial choice within 3 months of enrolment and theoretical preferences regarding PrEP methods that may become available to PLP. We report descriptive statistics and use Chi-square and Fisher's exact to compare responses by initiated PrEP method and pregnancy status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From February to August 2024, we enrolled 58 PLP (<i>n</i> = 30 pregnant, <i>n</i> = 28 breastfeeding). Median age 23 years (IQR 19.5−26). Of 30 pregnant participants, 23 (77%) initiated CAB-LA and seven (23%) oral PrEP; among 28 breastfeeding participants, 25 (89%) initiated CAB-LA and three (11%) oral PrEP. Of enrolled PLP, 36 (62%, <i>n</i> = 13 pregnant, <i>n</i> = 23 breastfeeding) completed the acceptability survey. Of these, 83% (<i>n</i> = 12/13 pregnant, <i>n</i> = 20/23 breastfeeding) chose and received CAB-LA, and the remaining (<i>n</i> = 4) chose and received oral PrEP. PLP who received CAB-LA reported liking its ease of use (69%; <i>n</i> = 22/32) and long-acting protection (44%; <i>n</i> = 14/32). Half of CAB-LA users disliked side effects (e.g. injection site pain), although 41% of PLP (<i>n</i> = 13/32) described no CAB-LA dislikes. Almost all (97%; <i>n</i> = 31/32) PLP currently using CAB-LA were interested in continuing CAB-LA, and all PLP using oral PrEP reported interest in trying CAB-LA in the future. Eighty-six percent of surveyed PLP (<i>n</i> = 31/36) did not want to try the dapivirine vaginal ring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PLP in South Africa had a strong preference for CAB-LA over oral PrEP, and CAB-LA was found to be highly acceptable. Further research is needed to evaluate the effect of offering choice of PrEP methods, including CAB-LA, on PrEP continuation among PLP.</p>\u0000 </section>\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26492","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524761","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":"Strategies for implementing long-acting cabotegravir for PrEP in US clinics serving Black women: interim healthcare provider findings from the EBONI study","authors":"Katherine L. Nelson, Tammeka Evans Cooper, Yolanda Lawson, Dylan Baker, Satish Mocherla, Megan Dieterich, Theo Hodge, Alftan Dyson, Denise Sutherland-Philips, Heidi Swygard, Lisa Petty, Peter Jeffery, Kenneth Sutton, Courtney Peasant Bonner, Sara M. Andrews, Samantha Chang, Piotr Budnik, Kimberly Smith, Annemiek de Ruiter, Maggie Czarnogorski, Nanlesta Pilgrim","doi":"10.1002/jia2.26497","DOIUrl":"https://doi.org/10.1002/jia2.26497","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Long-acting cabotegravir (CAB LA) is the first LA agent approved for HIV pre-exposure prophylaxis. EBONI (NCT05514509) is a Phase 4 implementation study evaluating the implementation of CAB LA delivery to Black cis- and transgender (cis-and-trans) women in clinics located in the United States, including infectious disease (ID), primary care (PC) and women's health (WH) clinics. We present interim perspectives, considerations and strategies from healthcare professionals’ (HCPs’) experiences during the initial implementation stages of administering CAB LA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From August 2022 to June 2024, through quantitative surveys (prior to implementation [baseline] and Month 4 [M4]) and/or structured qualitative interviews (M4), HCPs provided their perceptions and experiences of integrating CAB LA in their clinical settings that served Black cis-and-trans women. Monthly implementation monitoring (IM) calls were also conducted. Survey data were analysed using descriptive statistics. Qualitative and IM data were coded and analysed using a Framework Analysis approach grounded in the Consolidated Framework for Implementation Research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ninety-two HCPs across 20 sites completed baseline and M4 surveys; 57% were cisgender female and 43% were Black. HCPs across clinic types developed innovative approaches to support CAB LA implementation, with few HCPs (< 10%) reporting concerns about practice preparation. Initial HCP considerations related to patient adherence, insurance verification and patient identification reduced by M4 (absolute % reduction: 5–14%; 5–9%; and 4–12%, respectively). HCPs across clinic types serving Black women reported successful implementation strategies, including addressing medical mistrust and patient miseducation, staff training and reminder or tracking systems. Useful implementation strategies unique to clinic types included using electronic medical records to document whether patients were offered CAB LA (PC), designating specific days for administering injections (WH) and creating time for discussion with patients (ID).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A range of strategies across clinics that routinely serve Black cis-and-trans women were used to support CAB LA implementation. Implementing CAB LA in clinical settings can be bolstered by addressing population-specific concerns, increasing staff/patient education about CAB LA and modifying clinical flows. Lessons learned in EBONI can help suppor","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26497","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524763","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":"Finally, PrEP choices! But will clients ever have a choice?","authors":"Kimberly E. Green, Kenneth Ngure, Robyn Eakle, Nittaya Phanuphak, Jason Reed","doi":"10.1002/jia2.26505","DOIUrl":"https://doi.org/10.1002/jia2.26505","url":null,"abstract":"<p>Ten years after the World Health Organization (WHO) recommended tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis (PrEP) as an additional HIV prevention option, the world is, or rather should be, on the cusp of a biomedical HIV prevention choice revolution. Although oral PrEP scale-up started slow, particularly in low- and middle-income countries, uptake grew exponentially in Africa and elsewhere to 3.5 million people by 2023 [<span>1</span>]. The end of 2024 represented a convergence of excellence in HIV prevention science, large-scale country and community leadership in designing and delivering differentiated PrEP services, and visionary financing and programmatic commitment by the President's Emergency Fund for AIDS Relief (PEPFAR) and the Global Fund for AIDS, TB and Malaria (GFATM). By December 2024, two additional products, the dapivirine vaginal ring and long-acting injectable cabotegravir (CAB-LA), were newly available in 10 and 12 countries, respectively, and the PURPOSE-1 and -2 trials on a longer-acting injectable, lenacapavir (LEN), reported astounding near-perfect efficacy in preventing HIV [<span>2</span>].</p><p>Why is choice in PrEP products so anticipated? Several studies have measured substantial unmet PrEP need across populations and geographies when oral PrEP was the only option available. Unmet need is inclusive of those that report intention to start PrEP and/or who report risk factors but who remain PrEP naïve; those that discontinue PrEP but report continued need for PrEP; and individuals using oral PrEP but who prefer a different PrEP product type (e.g. a longer-acting option). These studies—such as PrEP APPEAL in the Asia-Pacific and a discrete choice study among women and girls in Kenya, Eswatini and South Africa—measured substantial unmet PrEP need among populations surveyed and preference for a long-acting product over oral PrEP [<span>3-5</span>]. Their authors theorized that where a choice in PrEP products was on offer, unmet need would be reduced, PrEP uptake and continuation would be increased, and HIV incidence would fall.</p><p>As CAB-LA and the ring were introduced into the PrEP method mix in countries like Brazil, South Africa and the United States, fairly consistent real-world PrEP uptake trends emerged indicating a pattern of strong preference for long-acting injectable PrEP (from 68% to 83% of individuals), and more modest preferences for oral PrEP (17–26%), and the ring (under 5% where included as a PrEP option) [<span>6-8</span>]. The Dynamic Choice HIV Prevention study in Kenya and Uganda found when services were optimized to provide product choice and service flexibility, PrEP uptake more than doubled. Offering a choice of both CAB-LA and oral PrEP resulted in 70% of participants opting for any biomedical HIV prevention compared to 13% in the standard of care arm—a 56% difference [<span>9</span>]. While in Brazil, 83% of participants opted for CAB-LA over oral PrEP as part of the ImPr","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26505","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524835","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":"“People have options”: a qualitative study of experiences and influences of PrEP choice among women in South Africa","authors":"Siphokazi Dada, Faith Mary Musvipwa, Fatima Abegail Cholo, Melanie Pleaner, Alison Kutywayo, Vusile Butler, Catherine Elizabeth Martin, Saiqa Mullick","doi":"10.1002/jia2.26462","DOIUrl":"https://doi.org/10.1002/jia2.26462","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Long-acting injectable cabotegravir and dapivirine vaginal ring were recently introduced in South Africa through demonstration projects, providing additional HIV prevention options to oral pre-exposure prophylaxis (PrEP). PrEP choice marks a pivotal moment in HIV prevention, potentially increasing PrEP uptake and use by offering women a choice of methods best suited to their individual needs. Understanding experiences of PrEP choice in real-world settings is critical to informing the introduction of PrEP choice at scale. This study, embedded within an implementation science study introducing new PrEP methods, explores women's experiences of PrEP choice counselling, and factors influencing PrEP choice.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between April and May 2024, we conducted 12 focus group discussions with a sub-set of 126 women (18–57 years) enrolled in a parent cohort study delivering PrEP choice at six fixed and three roving mobile clinics in three areas of South Africa. Cohort participants are HIV-negative men and women ≥ 15 years interested in HIV prevention services. At the time of data collection, non-pregnant and lactating women ≥ 18 years enrolled in the cohort were provided PrEP choice counselling and offered a choice of oral PrEP or dapivirine vaginal ring. Discussions explored women's experiences of PrEP choice counselling and influences of PrEP choice. They were audio recorded, transcribed verbatim and translated into English for thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Women reported positive choice counselling experiences, particularly when it was supplemented by pamphlets, demonstration rings and pelvic models. Participants valued learning about alternative PrEP methods and appreciated friendly healthcare providers who answered their questions. Privacy and emotional support were also crucial. However, negative experiences included the use of complex scientific jargon and insufficient information on PrEP's potential drawbacks. PrEP choices were mainly influenced by concerns about intravaginal products, distrust of new methods, prior oral PrEP experiences, and partner and family opinions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings will guide strategies for PrEP delivery, emphasizing provider training, effective counselling tools and tailored communication. Women valued clear, jargon-free information, visual aids and a welcoming environment, which supported open dialogue. The influence of prior oral PrEP experiences on PrEP choice highli","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26462","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525022","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-1 testing in the context of expanding PrEP modalities","authors":"Urvi M. Parikh,&nbsp;Jana L. Jacobs,&nbsp;Njambi Njuguna,&nbsp;Kristine Torjesen,&nbsp;John W. Mellors","doi":"10.1002/jia2.26491","DOIUrl":"https://doi.org/10.1002/jia2.26491","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Multiple effective antiretroviral-based pre-exposure prophylaxis (PrEP) modalities for HIV-1 prevention are now available or under investigation but their safe rollout requires implementable HIV-1 testing strategies that accurately identify rare cases of HIV-1 acquisition. Current PrEP testing guidelines and testing algorithms in PrEP studies are varied, using single or combinations of rapid antibody-based diagnostic testing, qualitative or quantitative nucleic acid testing, and/or sample collection for retrospective analyses with sensitive research assays for HIV-1 nucleic acid detection. The objective of this commentary is to summarize current and alternative HIV testing approaches for PrEP implementation to guide best practices for individual programmes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Diagnosing HIV-1 in PrEP users is challenging because (1) rarity of breakthrough HIV-1 in individuals on PrEP that increases the risk of a false-positive test; (2) modification of acute HIV infection by PrEP; and (3) PrEP delivery in community settings with inadequate testing infrastructure. Current best practices indicate the use of rapid diagnostic tests or self-testing as recommended by national testing algorithms and the World Health Organization (WHO). The use of nucleic acid testing such as plasma HIV-1 RNA polymerase chain reaction may allow earlier detection of HIV-1 but feasibility and risk of false positive are downsides. Sensitive tests to detect single-copy HIV-1 RNA in plasma and integrated proviral DNA in blood mononuclear cells may be important methods to resolve ambiguous HIV-1 diagnosis in research settings. Delayed diagnoses could lead to drug resistance emergence under long-acting PrEP selection, whereas single unconfirmed false-positive tests could create diagnostic challenges in users of long-acting PrEP. The cost, feasibility and positive predictive value of HIV tests are important considerations for PrEP programmes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Optimal strategies to detect HIV-1 acquisition among users of different PrEP modalities are evolving. While new guidance from the WHO recommends HIV-1 testing by serological assays or self-testing with PrEP use, feasible plans for clinical management of rare cases of breakthrough on PrEP and ambiguous diagnoses are still needed. The data from PrEP studies and scale-up will help us assess the value of different tests and testing approaches for their inclusion in HIV detection algorithms across PrEP modalities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26491","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524834","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":"Expanding access to a choice-based multi-method PrEP market for HIV prevention","authors":"Nicolette P. Naidoo,&nbsp;James Ayieko,&nbsp;Virginia A. Fonner","doi":"10.1002/jia2.26512","DOIUrl":"https://doi.org/10.1002/jia2.26512","url":null,"abstract":"&lt;p&gt;In the last decade, pre-exposure prophylaxis (PrEP) has revolutionized HIV prevention. The World Health Organization first recommended daily oral PrEP containing tenofovir as an additional prevention option for all populations at substantial risk of HIV in 2015 [&lt;span&gt;1&lt;/span&gt;], then added a recommendation for event-driven or “on-demand” PrEP for men in 2019 [&lt;span&gt;2&lt;/span&gt;], the monthly dapivirine vaginal ring for women in 2021 [&lt;span&gt;3&lt;/span&gt;] and long-acting injectable cabotegravir (CAB-LA) in 2022 [&lt;span&gt;4&lt;/span&gt;]. More PrEP options are becoming available, such as lenacapavir, which is administered as a sub-cutaneous injection. Recent clinical trial results suggest lenacapavir injections every 6 months are highly efficacious [&lt;span&gt;5, 6&lt;/span&gt;], and early safety and pharmacokinetic data show potential for once-yearly dosing [&lt;span&gt;7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Despite the promise of PrEP and the recent proliferation of products, the programmatic rollout of PrEP has been challenging, as system-level constraints (e.g. cost, policy, operational barriers), social-level factors (e.g. stigma and lack of normalization of HIV prevention) and individual behaviours (e.g. adherence) have all contributed to limiting overall impact [&lt;span&gt;8-10&lt;/span&gt;]. However, more countries have recently adopted PrEP into national guidelines, and global use of PrEP has increased substantially over the last several years [&lt;span&gt;11&lt;/span&gt;]. Research suggests that expanding the menu of PrEP options to better meet the diverse needs and preferences of end users could improve uptake and use [&lt;span&gt;12&lt;/span&gt;]. The advent of PrEP methods with different administration routes, discreet formulations and less frequent dosing will potentially enable easier access, more effective use, reduce stigma and, in some cases, allow for the implementation of more flexible delivery channels.&lt;/p&gt;&lt;p&gt;To collate early evidence related to expanding access to a choice-based HIV prevention market, we invited investigators and research teams across the globe to submit multidisciplinary articles for this supplement, designed to speak to the evaluation and delivery of PrEP choice in diverse settings and for varied populations. After careful consideration, the editorial team selected 15 contributions that illustrate current evidence, implementation learnings and challenges associated with the introduction, uptake and continued use of PrEP within the context of an expanded HIV prevention method-mix.&lt;/p&gt;&lt;p&gt;Choice in PrEP methods and service delivery approaches have the potential to improve prevention coverage. In a commentary by Schmidt et al. [&lt;span&gt;13&lt;/span&gt;], the authors highlight that despite the significant strides made in accelerating oral PrEP scale-up, it is unlikely that global PrEP targets will be met. In the era of PrEP choice, the authors remind readers that choice is not only about PrEP methods, but also service delivery approaches that have the potential to transform global HIV prevention efforts and m","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26512","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144525020","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}