Journal of the International AIDS Society最新文献

{"title":"Cost-Effectiveness and Impact of Depression Treatment Implementation on HIV Outcomes in Western Kenya: A Mathematical Modelling Study","authors":"Daniel T. Citron, Hae-Young Kim, Roscoe Kasujja, Khamisi Musanje, Samuel M. Mwalili, Duncan Kioi Gathungu, Peris Wambui, Chikumbi Chambwe, Ingrida Platais, Frey B. Assefa, Mellesia Jeetoo, R. Scott Braithwaite, Anna Bershteyn","doi":"10.1002/jia2.70186","DOIUrl":"https://doi.org/10.1002/jia2.70186","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In eastern, central and southern Africa, HIV is a leading cause of mortality, and both HIV and depression contribute substantially to morbidity. Depression can impede effective HIV treatment and prevention, yet access to depression treatment remains limited. We estimated the impact and cost-effectiveness of scaling up depression screening and treatment to different population segments in western Kenya\u0000.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We adapted a previously validated HIV transmission model for western Kenya (EMOD-HIV) to include age- and sex-specific depression incidence, remission and recurrence. The model incorporated depression's effects on HIV risk; HIV testing and linkage to care; antiretroviral therapy (ART) adherence; and ART retention. We evaluated four depression screening and treatment scale-up strategies for adults aged 15+ years: (1) universal screening/treatment for all adults; (2) co-administering depression and HIV screening; (3) screening ART recipients; and (4) screening ART recipients with unsuppressed viral load. We assumed 62% depression treatment efficacy and calculated costs from the provider perspective, including US$3.35 for depression screening and US$20.32 per person for psychotherapy; future costs were discounted at 3%, and costs were varied in sensitivity analyses. We calculated incremental cost-effectiveness ratios as the cost (2024 USD) of depression screening and treatment per overall and HIV-related disability-adjusted life-year (DALY) averted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Without depression treatment, we projected 129,000 new HIV infections, 95,900 HIV-related deaths and 1.83 M depression episodes between 2025 and 2035. Universal screening had the highest impact, averting 29.3% (95% CI 29.2%–29.3%) of person-years lived with depression, 2.8% (95% CI 2.6%–3.1%) of HIV acquisitions and 1.4% (95% CI 1.3%–1.6%) of HIV deaths. The cost-effectiveness of universal screening and treatment was US$1291 per DALY averted (95% CI: $1288–1296). Screening ART clients was most cost-effective at $744 per DALY averted (95% CI: $730–760), followed by screening ART clients with unsuppressed viral load at $752 per DALY averted (95% CI: $710–799). Co-administering HIV and depression was dominated by other strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrating depression interventions into HIV care could substantially reduce both depression and HIV burden. Cost-effective scale-up could initially focus on individuals with unsuppressed viral load, t","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 9","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70186","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148862179","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 Impact of Behavioural Economics-Informed Interventions on the Care Cascade for Sexually Transmitted and Blood-Borne Infections: A Systematic Review of Randomized Controlled Trials","authors":"Min Zhao, Zhengcheng Tu, Xiang Zhao, Chunyan Li, Jiajun Sun, Ye Zhang, Warittha Tieosapjaroen, Fanpu Ji, Jason J. Ong, Lei Zhang","doi":"10.1002/jia2.70136","DOIUrl":"10.1002/jia2.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While behavioural economics principles are widely used for public health interventions, a comprehensive understanding of their impact across the sexually transmitted and blood-borne infections (STBBIs) care cascade remains limited. We systematically evaluated the effectiveness of behavioural economics-informed interventions for an STBBI care cascade.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched five major literature databases from their inception to 25 April 2024, with the search updated on 22 March 2025. We included randomized controlled trials (RCTs) evaluating behavioural economics-informed interventions, that is strategies such as incentives, defaults, framing and reminders designed to influence health-related decision-making, at any stage of the care cascade for STBBIs. The cascade included three domains: prevention, care engagement and treatment adherence. Two reviewers independently extracted data and assessed the risk of bias using the Cochrane RoB-2 tool. Due to significant heterogeneity, findings were synthesized narratively using a three-stage care cascade framework.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our search identified 2546 records, of which 40 RCTs met the inclusion criteria and evaluated 12 distinct behavioural economics-informed intervention types. Incentives were the most common intervention, including monetary, lottery and voucher-based incentives (25/40; 63%). Monetary and voucher incentives effectively improved outcomes across multiple cascade stages, including prevention (such as safer sex, male medical circumcision), care engagement (testing for HIV, HBV and HCV) and treatment adherence (such as retention in care, viral suppression). Opt-out defaults showed strong, sustained effects on HIV/HCV screening. Pay-it-forward strategies significantly increased dual STBBI testing and often demonstrated cost-effectiveness. A substantial proportion of studies (27/40; 67.5%) reported a high risk of bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Behavioural economics-informed interventions showed stage-specific effects across the STBBI care cascade. Monetary incentives were the most consistently effective, especially for prevention, testing and some adherence outcomes. Defaults and pay-it-forward were promising for screening uptake, whereas crowdsourcing appeared more useful for intervention design. Overall, effectiveness depended on intervention design and context.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 8","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70136","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148704810","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":"Modelling the 5-Year Impact of Twice-Yearly Injectable Lenacapavir for HIV Pre-Exposure Prophylaxis in the United States","authors":"Mia Moore,&nbsp;Serin Lee,&nbsp;Laura Matrajt,&nbsp;Sarah E. Stansfield,&nbsp;Li Tao,&nbsp;Juan Yang,&nbsp;Dylan Mezzio,&nbsp;James Jarrett,&nbsp;JeanPierre Coaquira Castro,&nbsp;Alice Hsiao,&nbsp;Woodie Zachry,&nbsp;Dobromir Dimitrov","doi":"10.1002/jia2.70188","DOIUrl":"10.1002/jia2.70188","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The impact of pre-exposure prophylaxis (PrEP) on the US HIV-1 epidemic has not been fully maximized, potentially due to challenges in uptake, coverage, adherence and consistent use. Following the FDA (Food and Drug Adminstration) approval of twice-yearly lenacapavir, epidemiological projections are needed to understand the potential role of lenacapavir in overcoming PrEP barriers. The objective of this analysis was to estimate the impact of lenacapavir on HIV-1 incidence in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a static cohort model representing the US population aged 15 or older to predict the number of HIV-1 cases averted between 2026 and 2030 under different lenacapavir uptake scenarios (S1–S5) versus projected status quo 2025 PrEP use with no lenacapavir (S0). In S0 and S3, we assumed 2025 levels of PrEP use (652K total PrEP users with no lenacapavir use) for 2026–2030. In all other scenarios, we assumed PrEP use increases to 1.1 million PrEP users with 0%−100% using lenacapavir. Oral and injectable PrEP effectiveness were based on clinical trials adjusted by percent days covered in real-world use. Oral PrEP use was assumed to be zero among people who inject drugs in all scenarios.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In S1, moderate lenacapavir uptake (37% of PrEP users by 2030) averted 13,700 (95% credible interval: 10,800–18,300) new HIV-1 cases, an 8% (6%–10%) reduction in cumulative cases between 2026 and 2030 relative to S0. In S2, more rapid lenacapavir uptake (85% of PrEP users by 2030) averted 23,800 (19,100–33,700) cases. Switching all PrEP users to lenacapavir averted 22,400 (12,200–47,200) and 37,400 (26,800–61,200) cases without (S3) and with (S4) an increase in PrEP use, respectively. In S5, 9400 (4600–11,500) cases were averted if PrEP use increased but lenacapavir was not introduced. This analysis was limited as only reductions in primary acquisitions were considered in the static cohort model and the model did not account for potential future demographic or behavioural shifts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Twice-yearly lenacapavir may impact the US HIV-1 epidemic by improving adherence and increasing the duration of protection relative to oral PrEP, leading to more consistent protection over time and reducing HIV-1 incidence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 8","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13455683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700177","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":"Sex Differences in Advanced HIV Disease at Presentation in Care Among People Living With HIV in Latin America and the Caribbean","authors":"Yanink Caro-Vega,&nbsp;Jessica Mejía-Castrejón,&nbsp;Lorena Guerrero-Torres,&nbsp;Carina Cesar,&nbsp;Claudia P. Cortes,&nbsp;Daisy Maria Machado,&nbsp;Paula M. Luz,&nbsp;Jorge Andrade-Pinto,&nbsp;Marco Tulio Luque,&nbsp;Eduardo Gotuzzo,&nbsp;Vanessa Rouzier,&nbsp;Jessica L. Castilho,&nbsp;Peter F. Rebeiro,&nbsp;Brenda Crabtree-Ramírez,&nbsp;for the Caribbean, Central & South American Network for HIV Epidemiology (CCASAnet)","doi":"10.1002/jia2.70161","DOIUrl":"10.1002/jia2.70161","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite an overall recent decline of 28% in the region, AIDS-related deaths have increased among women in some Latin American countries. Low HIV risk perception among women may contribute to late diagnosis. We compared advanced HIV disease (AHD) at care enrolment between males and females in Latin America and the Caribbean.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults (≥18 years old) from clinical sites in the Central and South America network for HIV epidemiology who enrolled between 2003 and 2022 were stratified by sex-at-birth/HIV acquisition group as females, males with male-to-male sexual contact and heterosexual males (HMs). We classified location as within a generalized epidemic (GE: Haiti) or a concentrated epidemic (CE: Argentina, Brazil, Chile, Honduras and Mexico). We estimated the probability of AHD (AIDS diagnosis or CD4&lt;200 cells/µL) at enrolment in care using logistic regression models, stratifying by sex-at-birth/acquisition group and CE/GE setting, adjusting for age, education level and calendar year of enrolment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 47,548 people living with HIV, 51% were from GE sites (58% females), and 49% were from CE sites (20% females, 22% HMs and 58% males with male-to-male sexual contact). In GE, 27.7% of persons presented with AHD (23.5% of females; 33.3% of males), while in CE, 44.9% of persons presented with AHD (37.4% of males with male-to-male sexual contact, 47.8% of females and 61.8% of HMs). Males in GE had higher odds of AHD compared with females (aOR: 1.48 [95% CI: 1.40–1.57]). The odds of AHD decreased from 2003 to 2022 (aOR: 0.29 [95% CI: 0.26–0.33] in GE and aOR: 0.32 [95% CI: 0.29–0.36] in CE). In sex-at-birth/acquisition stratified models, in CE sites, odds decreased more in males with male-to-male sexual contact (aOR: 0.22 [95% CI: 0.19–0.25]) than in females (aOR: 0.57 [95% CI: 0.46–0.79]) and HMs (aOR: 0.47 [95% CI: 0.38–0.58]) in 2022 versus 2003.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In CE sites, the slight decreasing trend of AHD at enrolment among females and HMs contrasts with the steeper decline among males with male-to-male sexual contact. In the GE site, risk of AHD at enrolment decreased in both males and females over time. Interventions to increase awareness, improve HIV testing, and hasten linkage to care among females and HMs are needed in CE settings in addition to addressing structural and social barriers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 8","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13454556/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148700207","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":"Reimagining Hepatitis C Elimination: Time for Actions, Not Targets","authors":"Marina B. Klein,&nbsp;Nadine Kronfli,&nbsp;Jim Young","doi":"10.1002/jia2.70183","DOIUrl":"10.1002/jia2.70183","url":null,"abstract":"&lt;p&gt;Global progress towards the World Health Organization's (WHO) 2030 hepatitis C virus (HCV) elimination targets has stalled. Only 13 countries are on track to achieve either relative (80% reduction in new acquisitions, 65% in deaths) or absolute (&lt;5 new acquisitions/100,000, &lt;2 deaths/100,000) targets, with only two of the 20 highest-burden countries among them (China and Egypt) [&lt;span&gt;1&lt;/span&gt;]. In 2024, 0.9 million people newly acquired HCV, a decline of only 8% from 2015; including nearly 10% of people who inject drugs (PWID) [&lt;span&gt;2&lt;/span&gt;]. That year, the number of new acquisitions was about the same as the number cured [&lt;span&gt;1&lt;/span&gt;]. Deaths from HCV-related cirrhosis and cancer remained high at 240,000, a reduction of a disappointing 12% from 2015 [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;HCV elimination is contingent on political will and adequate financing of national elimination programmes [&lt;span&gt;1&lt;/span&gt;], with countries such as Spain, Australia and Egypt leading the way. Progress has been seen in low- and middle-income countries (LMICs) such as Rwanda, Myanmar and Pakistan, but high-burden countries such as Russia and the United States lag behind.&lt;/p&gt;&lt;p&gt;At this stage of the epidemic, continuing to do the same will not be enough. It is unrealistic to expect that countries which have endorsed targets but have failed to commit to or finance a national strategy will suddenly change course. We advocate for advancing specific concrete actions focused on key remaining challenges along the care cascade.&lt;/p&gt;&lt;p&gt;Step 1: Prevention. Transmissions associated with injection drug use continue to drive incident HCV. PWID are disproportionately concentrated in prisons and injection-related risk-taking increases following incarceration, due primarily to the scarcity of sterile injecting material. Expansion of opioid agonist therapy (OAT) and prison needle and syringe programmes (PNSPs) is critical, with the potential to have broader population-level impacts [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;&lt;i&gt;Challenge&lt;/i&gt;: Many factors have undermined adoption and sustainability of OAT and PNSPs, including political and ideological opposition, security and confidentiality concerns, stigma, and chronic underfunding [&lt;span&gt;4&lt;/span&gt;]. Even where available, these services are accessed by few, hampering their effectiveness [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;&lt;i&gt;Action&lt;/i&gt;: Where neither exists, OAT should be prioritized given its greater impact on reducing HCV transmission [&lt;span&gt;3&lt;/span&gt;]. However, with a global shift in drug use towards non-opiates [&lt;span&gt;5&lt;/span&gt;], PNSPs will become increasingly crucial.&lt;/p&gt;&lt;p&gt;&lt;i&gt;Benefits&lt;/i&gt;: By addressing multiple, interacting drivers of harm simultaneously, OAT and PNSPs interrupt the syndemic of substance use, infectious diseases, overdose and structural disadvantages that perpetuate poor health among incarcerated PWID, with health benefits extending beyond prison walls.&lt;/p&gt;&lt;p&gt;Step 2: Testing. As an increasing proportion of people who have been diagnosed are t","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 8","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70183","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597101","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 Impact of the Common Elements Treatment Approach on HIV Treatment Outcomes Among Women Experiencing Intimate Partner Violence in South Africa: A Randomized Trial","authors":"Matthew P. Fox,&nbsp;Jeremy C. Kane,&nbsp;Sithabile Mngadi-Ncube,&nbsp;Amy Zheng,&nbsp;Kristina Metz,&nbsp;Pertunia Manganye,&nbsp;Lawrence Long,&nbsp;Ross Greener,&nbsp;Srishti Sardana,&nbsp;Taylor Allen,&nbsp;Donald M. Thea,&nbsp;Bridgette Goeieman,&nbsp;Marnie Vujovic,&nbsp;Laura K. Murray,&nbsp;Sophie Pascoe","doi":"10.1002/jia2.70172","DOIUrl":"10.1002/jia2.70172","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In South Africa, which has the world's highest prevalence of HIV, intimate partner violence (IPV) and common mental health conditions are barriers to retention in HIV treatment and achieving viral suppression. The Common Elements Treatment Approach (CETA), a cognitive-behavioural-therapy-based intervention designed for lay healthcare worker delivery, is effective in reducing mental and behavioural health problems but has not been trialled for effectiveness in improving HIV outcomes. We conducted a randomized control trial to evaluate the effectiveness of CETA in improving HIV treatment outcomes among women experiencing IPV in South Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a single-blind trial conducted among women living with HIV on antiretroviral therapy (ART) who experienced sexual and/or physical IPV in the last 12 months and had either an unsuppressed viral load or were at risk for poor medication adherence in the past year (e.g. defaulted on treatment, late or missed clinic visit). Women were randomized 1:1 to receive either 8–12 CETA counselling sessions or weekly safety text messages. The primary outcome was viral suppression (<span>≤</span>50 copies/mL) (which requires retention) at 12 months after baseline, which was evaluated using routinely collected medical records. A linear regression model was estimated to calculate risk differences and 95% confidence intervals (CI).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants were enrolled from 11 November 2021 to 19 July 2023, with 202 women randomized to CETA and 197 randomized to the control arm. Median age was 41.0 years (interquartile range [IQR]: 34.0, 47.0) with a median time on ART of 8.2 years (IQR: 4.3, 12.5). Receiving CETA was associated with a 1-percentage point (95% CI: −0.11, 0.09) decrease in retention and viral suppression compared to the control. When restricted to individuals who completed CETA (<i>N</i> = 144) compared to all controls, we observed a 7-percentage point (95% CI: −0.03, 0.18) increase in retention and viral suppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our estimates suggest overall there was no meaningful difference in retention and viral suppression at 12 months between individuals who received CETA compared to individuals who received the active safety control. Future work should seek to determine if CETA can be effective among those who complete the intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 8","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13402931/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148589331","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":"Abstracts From AIDS 2026, the 26th International AIDS Conference, 26 – 31 July 2026 Rio de Janeiro, Brazil & virtual","authors":"","doi":"10.1002/jia2.70125","DOIUrl":"10.1002/jia2.70125","url":null,"abstract":"&lt;p&gt;&lt;span&gt;L. Bertoni Giron&lt;/span&gt;&lt;sup&gt;1&lt;/sup&gt;, M. W. Shaikh&lt;sup&gt;2&lt;/sup&gt;, T. M. Cantu Jungles&lt;sup&gt;3&lt;/sup&gt;, P. A. Engen&lt;sup&gt;2&lt;/sup&gt;, S. Shankaran&lt;sup&gt;4&lt;/sup&gt;, M. Villanueva&lt;sup&gt;2&lt;/sup&gt;, A. Landay&lt;sup&gt;5&lt;/sup&gt;, F. J. Palella&lt;sup&gt;1&lt;/sup&gt;, M. Corley&lt;sup&gt;6&lt;/sup&gt;, B. Hamaker&lt;sup&gt;3&lt;/sup&gt;, R. Lorenzo Redondo&lt;sup&gt;1&lt;/sup&gt;, A. Keshavarzian&lt;sup&gt;2,4&lt;/sup&gt;, M. Abdel-Mohsen&lt;sup&gt;1&lt;/sup&gt;&lt;/p&gt;&lt;p&gt;&lt;sup&gt;1&lt;/sup&gt;Northwestern University, Medicine, Chicago, United States; &lt;sup&gt;2&lt;/sup&gt;Rush University Medical Center, Rush Center for Integrated Microbiome and Chronobiology Research, Chicago, United States; &lt;sup&gt;3&lt;/sup&gt;Purdue University, West Lafayette, United States; &lt;sup&gt;4&lt;/sup&gt;Rush University Medical Center, Department of Internal Medicine, Chicago, United States; &lt;sup&gt;5&lt;/sup&gt;University of Texas Medical Branch, Galveston, United States; &lt;sup&gt;6&lt;/sup&gt;University of California San Diego, San Diego, United States&lt;/p&gt;&lt;p&gt;&lt;b&gt;Background&lt;/b&gt;: Despite antiretroviral therapy (ART), people with HIV (PWH) exhibit persistent microbial dysbiosis, including depletion of bacteria that produce short-chain fatty acids (SCFAs), metabolites essential for intestinal barrier integrity and resilience to stress. Loss of epithelial α1,2-fucose has recently emerged as a potentially targetable upstream mechanism driving the depletion of SCFA-producing bacteria during disease. This host-intrinsic prebiotic glycan fuels commensals to produce SCFAs. When α1,2-fucose is degraded by glycan-degrading enzymes (α-L-fucosidases) released by senescent cells, the microbiota is deprived of this substrate, causing dysbiosis with reduced SCFA output. We tested whether α1,2-fucose depletion contributes to HIV-associated SCFA depletion and intestinal dysfunction.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Methods&lt;/b&gt;: Ileal and colonic biopsies were obtained from PWH on ART (&lt;i&gt;n&lt;/i&gt; = 25) and matched people without HIV (PWoH; &lt;i&gt;n&lt;/i&gt; = 23). Epithelial α1,2-fucosylation was quantified by lectin-based glycomic profiling. α-L-fucosidase expression and senescence/stress signatures were evaluated by spatial transcriptomics. Mucosal microbiota was profiled by 16S rRNA gene-amplicon sequencing. Plasma microbial translocation and inflammation markers were quantified using MesoScale multiplex assays. Biological ageing was assessed using epigenetic clocks. To test functional microbiome consequences of differential α1,2-fucose levels, anaerobic stool fermentations from PWH and PWoH were performed with or without exogenous α1,2-fucose provided as a clinically safe supplement (2′-fucosyllactose; 2′FL). SCFAs were quantified by mass-spectrometry in fermentation supernatants, which were applied to 3D intestinal organoids during stress challenge.&lt;/p&gt;&lt;p&gt;&lt;b&gt;Results&lt;/b&gt;: Intestinal tissues from PWH exhibited significantly lower α1,2-fucosylation than PWoH (&lt;i&gt;p&lt;/i&gt; &lt; 0.05; Figure 1). This reduction correlated with increased expression of α-L-fucosidase (&lt;i&gt;p&lt;/i&gt; = 9.3e-08) and increased senescence (&lt;i&gt;p&lt;/i&gt; &lt; 0.0001) and stress-response (&lt;i&gt;p&lt;/i&gt; &lt; 0.05) progra","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S4","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148589813","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 Impact of the United States Foreign Aid Freeze on HIV Service Delivery in PEPFAR-Supported Countries: A Facility-Level Analysis of 2024–2025 Programme Data","authors":"Brian Honermann,&nbsp;Anna Grimsrud,&nbsp;Elise Lankiewicz,&nbsp;Jennifer Sherwood,&nbsp;Greg Millett","doi":"10.1002/jia2.70182","DOIUrl":"10.1002/jia2.70182","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;On 24 January 2025, the U.S. government issued a stop-work order freezing foreign assistance, including support for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), although a limited waiver for selected “life-saving” interventions was subsequently granted. PEPFAR's official 2025 monitoring results, released 17 April 2026, included only fourth-quarter data, whereas an earlier inadvertent release contained data for all four quarters of 2025. Using both datasets, we conducted a systematic facility-level assessment of HIV programme performance while accounting for reporting disruptions.&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;Facilities were categorized by reporting between Q1 2024 and Q4 2025 (continuous, intermittent, dropped, new). We assessed changes in HIV treatment, testing, prevention of mother-to-child transmission (PMTCT) and HIV prevention across facility categories. We additionally analyse changes in human resources for health (HRH) reported by PEPFAR.&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 dataset included 31,628 facilities and community service sites. Most sites reported continuously (71.5%), while 16.7% reported intermittently, 3.9% stopped reporting, 3.1% were new in 2025 and 2.5% were community service sites. Between Q4 2024 and Q4 2025, the total number of people receiving HIV treatment declined by −1%. People on treatment increased 0.3% at continuously reporting facilities but declined −6.0% at intermittently reporting facilities. HIV testing declined by −18% overall. HIV diagnoses decreased by −13% at continuously reporting facilities, −32% in intermittently reporting facilities and −36% in community services sites. PMTCT infant testing declined by −6% at continuously reporting facilities and −60% at intermittently reporting facilities, while infant HIV diagnoses declined by −12% and −31%, respectively. Pre-exposure prophylaxis initiations declined by −33%, and the number of direct service delivery healthcare workers declined by −62,541 (−24%).&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;Although HIV treatment remained relatively stable at continuously reporting facilities, substantial declines were observed in HIV testing, HIV diagnoses, treatment initiation, prevention services and the PEPFAR-supported workforce. These findings suggest that treatment coverage alone is an insufficient indicator of programme resilience. As countries assume greater responsibility for HIV programmes, sustained investment across the entire HIV care cascade coupled with transp","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 8","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70182","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148597083","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":"Latin America and the Caribbean: Socioeconomic Realities and Implications for Health and HIV Responses","authors":"Claudia P. Cortes,&nbsp;Carmen Pérez Casas,&nbsp;Pedro Cahn","doi":"10.1002/jia2.70174","DOIUrl":"10.1002/jia2.70174","url":null,"abstract":"&lt;p&gt;Latin America and the Caribbean (LAC) is a region of remarkable diversity, encompassing more than 650 million people across countries and territories with different levels of economic development, political stability, health-system capacity and social cohesion. This diversity is one of the region's strengths. Several countries have built robust public health infrastructures, expanded access to antiretroviral therapy (ART), promoted human-rights-based approaches to HIV and supported meaningful community participation in health policymaking. These achievements, however, coexist with profound and persistent inequities.&lt;/p&gt;&lt;p&gt;Although almost 70% of countries in the region are currently classified by the World Bank as middle-income economies, this classification often obscures more than it clarifies [&lt;span&gt;1&lt;/span&gt;]. Income levels illustrate this heterogeneity: in 2024, Atlas-method gross domestic product per capita ranged from approximately US$2142 in Haiti (living on less than US$3.00/day) to more than US$23,900 in Uruguay, while several Caribbean economies were classified as high-income [&lt;span&gt;1, 2&lt;/span&gt;]. Yet, national averages can conceal deep within-country inequalities. LAC remains one of the most unequal regions in the world, with wealth, opportunities and access to services concentrated among relatively small segments of the population [&lt;span&gt;3&lt;/span&gt;]. Regional economic growth in the first decade of the twenty-first century was real, but its gains were uneven and fragile. In addition, while poverty declined before the COVID-19 pandemic, subsequent economic disruption, inflationary pressures, high levels of economic and employment informality and growing public debt have limited the capacity of governments to expand social protection and strengthen health systems.&lt;/p&gt;&lt;p&gt;Urbanization and migration further shape regional HIV responses. More than 80% of the population lives in urban settings, making LAC one of the most urbanized regions globally. Cities can improve access to education and health services, but they also concentrate poverty, overcrowding, violence and exclusion. Informal settlements and marginalized urban communities often face barriers to HIV prevention, testing and treatment. At the same time, migration has required health systems to adapt, as these mobile populations present with documentation barriers, interrupted care pathways and changing patterns of vulnerability.&lt;/p&gt;&lt;p&gt;These structural realities intersect with persistent discrimination affecting gay men and other men who have sex with men, transgender people, sex workers, people who use drugs, migrants, Indigenous communities, people of African descent and people living in poverty. These inequities are visible in the epidemic itself: in Latin America, estimated adult HIV prevalence is 0.6%, yet median prevalence among reporting countries is 8.2% among gay men and other men who have sex with men and 9.5% among transgender people; high prevalence has also been reported a","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S3","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148589565","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":"Using Tenofovir Diphosphate Levels to Evaluate Factors Associated With PrEP Non-Adherence and Performance of Indirect Adherence Measures in Latin America: A Prospective, Single-Arm, Open-Label, Multicentre Implementation Study (ImPrEP)","authors":"Thiago S. Torres,&nbsp;Mayara Secco Torres Silva,&nbsp;Brenda Hoagland,&nbsp;Luana Monteiro Spindola Marins,&nbsp;Carolina Coutinho,&nbsp;Emilia M. Jalil,&nbsp;Pedro Leite,&nbsp;Marcelo Cunha,&nbsp;Ronaldo Moreira,&nbsp;Iuri C. Leite,&nbsp;Kelika Konda,&nbsp;Juan Guanira,&nbsp;Marcos Benedetti,&nbsp;Cristina Pimenta,&nbsp;Hamid Vega-Ramirez,&nbsp;Sandra W. Cardoso,&nbsp;Carlos F. Caceres,&nbsp;Peter L. Anderson,&nbsp;Beatriz Grinsztejn,&nbsp;Valdilea G. Veloso,&nbsp;for ImPrEP Study Group","doi":"10.1002/jia2.70154","DOIUrl":"10.1002/jia2.70154","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;Tenofovir-based oral pre-exposure prophylaxis (PrEP) is pivotal for HIV prevention in Latin America. Monitoring PrEP adherence is crucial for maximizing its impact and identifying individuals who may benefit from additional support. We evaluated the performance of indirect adherence measures and factors associated with PrEP non-adherence in Brazil, Mexico and Peru.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;ImPrEP was a prospective, multicentre, PrEP implementation study which enrolled 9509 persons from 6 February 2018 to 30 June 2021. For this analysis, we included men who have sex with men (MSM) aged 18–24 years and transgender women aged 18+ years with at least one dried blood spot (DBS) sample collected. Adherence was assessed objectively (tenofovir diphosphate [TFV-DP] levels in DBS) and indirectly (medication possession rate [MPR] and self-report). We estimated area under the curve (AUC) to evaluate the performance of each indirect adherence measure, and the optimal cut-off points for discriminating protective TFV-DP levels based on the Youden index. We used generalized estimating equations to identify factors associated with PrEP non-adherence (TFV-DP&lt;900 fmol/punch).&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 included 2096 participants (1692 young MSM and 404 transgender women) with 4257 DBS samples. Overall, 62.3% DBS samples showed protective TFV-DP levels, which declined over time (68.8% at week 4 to 33.8% at week 124). Both MPR and self-report demonstrated moderate concordance (AUC: 0.74) with no difference between them (&lt;i&gt;p&lt;/i&gt; = 0.79). Optimal cut-offs were 97.6% for MPR and 93.3% for self-report; self-report showed higher sensitivity (84.6%), while MPR had higher specificity (62.9%). Among young adults, PrEP non-adherence was higher among transgender women, participants with lower education and from Peru. Among transgender women, PrEP non-adherence was higher among those with younger age, lower education, and from Peru and Mexico. Self-reported sexual behaviours conveying elevated HIV exposure were associated with lower PrEP non-adherence.&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;MPR and self-report are pragmatic and clinically useful adherence monitoring tools for PrEP programmes in Latin America. Social determinants of health, particularly education, emerged as major drivers of PrEP non-adherence among transgender women and young MSM. To maximize impact, PrEP programmes must prioritize person-centred interventions that address stigma within health services, remove barr","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S3","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13401721/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148589787","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}