Journal of the International AIDS Society最新文献

{"title":"The impact of same-day and rapid ART initiation under the Universal Health Coverage programme on HIV outcomes in Thailand: a retrospective real-life cohort study","authors":"Sirinya Teeraananchai,&nbsp;David C. Boettiger,&nbsp;Cheewanan Lertpiriyasuwat,&nbsp;Rattaphon Triamwichanon,&nbsp;Patchara Benjarattanaporn,&nbsp;Nittaya Phanuphak","doi":"10.1002/jia2.26406","DOIUrl":"10.1002/jia2.26406","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Antiretroviral therapy (ART) initiation, regardless of CD4 count, has been recommended in Thailand since 2014, with same-day initiation recommended since 2021. We assessed HIV treatment outcomes among Thai people living with HIV (PLHIV) by the time from HIV diagnosis to ART initiation under the Universal Health Coverage (UHC) programme and identified factors associated with virological failure (VF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>PLHIV aged ≥15 years initiating ART between 2014 and 2022 were included from the UHC database. We categorized participants into four groups using the duration from HIV diagnosis to ART initiation: (1) ≤ 7 days (same-day ART); (2) 8 days to &lt;1 month; (3) 1–3 months; and (4) &gt;3 months. Viral load (VL) was measured 6 months after starting ART, and annually thereafter. VF was defined as VL ≥1000 copies/ml. Factors associated with VF were analysed using competing risk models considering death and loss to follow-up (LTFU) as competing events.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 252,239 PLHIV who started ART, the median age at initiation was 34 years (interquartile range [IQR]: 26–43 years). The median (IQR) pre-ART CD4 count was 233 (76–420) cells/mm³. ART initiation occurred within 7 days for 25% (17% on the same day, 8% in 2–7 days), 24% in 8 days to &lt;1 month, 23% in 1–3 months and 28% in &gt;3 months. ART initiation within 7 days increased from 20% (2014–2016) to 32% (2021–2022). VF occurred with a rate of 3.11 (95% CI 3.07–3.159) per 100 person-years (PYs). PLHIV initiating ART 8 days to 1 month were at lower risk of VF (aSHR 0.52, 95% CI 0.50–0.54) when compared to ART initiation &gt;3 months. ART initiation within 7 days resulted in the lowest mortality (6%: 1.28 [95% CI 1.24–1.32] per 100 PYs), but the highest rate of LTFU (12%: 2.69 [95% CI 2.63–2.75] per 100 PYs) when compared to other ART initiation groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although ART initiation within 7 days has increased in Thailand, the overall rate of early initiation remains low. ART initiation within 1 month significantly lowered the risk of VF. ART initiation within 7 days significantly reduced mortality. To further optimize health outcomes, innovative strategies are urgently needed to promote earlier ART initiation in Thailand.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918840","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":"Evaluation of long-acting cabotegravir safety and pharmacokinetics in pregnant women in eastern and southern Africa: a secondary analysis of HPTN 084","authors":"Sinead Delany-Moretlwe,&nbsp;Brett Hanscom,&nbsp;Xu Guo,&nbsp;Clemensia Nkabiito,&nbsp;Patricia Mandima,&nbsp;Patricia Ntege Nahirya,&nbsp;Juliet Mpendo,&nbsp;Muchaneta Bhondai-Mhuri,&nbsp;Nyaradzo Mgodi,&nbsp;Rebecca Berhanu,&nbsp;Jennifer Farrior,&nbsp;Estelle Piwowar-Manning,&nbsp;Susan L. Ford,&nbsp;Craig W. Hendrix,&nbsp;Alex R. Rinehart,&nbsp;James F. Rooney,&nbsp;Adeola Adeyeye,&nbsp;Raphael J. Landovitz,&nbsp;Myron S. Cohen,&nbsp;Mina C. Hosseinipour,&nbsp;Mark A. Marzinke,&nbsp;the HPTN 084 Study Team","doi":"10.1002/jia2.26401","DOIUrl":"10.1002/jia2.26401","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Long-acting injectable cabotegravir (CAB-LA) for pre-exposure prophylaxis significantly reduced HIV acquisition in HPTN 084. We report on the safety and CAB-LA pharmacokinetics in pregnant women during the blinded period of HPTN 084.&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;Participants were randomized 1:1 to either active cabotegravir (CAB) plus tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) placebo or active TDF/FTC plus CAB placebo. Pregnancy testing was performed at each visit; participants with a positive test had study product withheld and were offered open-label TDF/FTC. Pregnancies were confirmed on two tests at least 4 weeks apart. All participants with a positive pregnancy test prior to November 5, 2020 are included in this analysis. Pregnancy incidence, maternal adverse event (AE) incidence, pregnancy outcomes (including composite outcome of spontaneous abortion &lt;20 weeks, intrauterine foetal death or stillbirth ≥20 weeks, premature birth &lt;37 weeks, or small for gestational age) were assessed. The apparent terminal phase half-life (t&lt;sub&gt;1/2app&lt;/sub&gt;) of CAB-LA in pregnant women in HPTN 084 was compared to non-pregnant women from the phase 2a HPTN 077 trial. Multivariable models assessed associations with t&lt;sub&gt;1/2app.&lt;/sub&gt;&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;Fifty-seven pregnancies (30 CAB-LA, 27 TDF/FTC) were confirmed over 3845 person-years [py] (incidence 1.5/100 py, 95% CI 1.1−1.9). CAB-LA group participants had a median 342 days (IQR 192, 497) of CAB-LA exposure prior to pregnancy detection. Grade 2 or higher maternal AE incidence did not differ by study arm (CAB 157, 95% CI 91−271 per 100 py vs. TDF/FTC 217, 95% CI 124–380 per 100 py; &lt;i&gt;p&lt;/i&gt; = 0.256). Most pregnancies (81%) resulted in live births (25 CAB-LA, 22 TDF/FTC). Composite poor pregnancy outcomes did not differ significantly by group (CAB 6/30 vs. TDF/FTC 4/27; &lt;i&gt;p&lt;/i&gt; = 0.476). No congenital anomalies were observed. The CAB t&lt;sub&gt;1/2app&lt;/sub&gt; geometric mean was 52.8 days (95% CI 40.7−68.4) in pregnant women compared to 60.3 days (95% CI 47.7−76.3; &lt;i&gt;p&lt;/i&gt; = 0.66) in non-pregnant women; neither pregnancy nor body mass index were significantly associated with t&lt;sub&gt;1/2app&lt;/sub&gt;.&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;CAB-LA concentrations post-cessation of injections were generally well tolerated in pregnant women. The t&lt;sub&gt;1/2app&lt;/sub&gt; was comparable between pregnant and non-pregnant women. Ongoing studies will examine the safety and pharmacology of CAB-LA in women who choose to continu","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11695207/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142918839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing intrinsic capacity for person-centred HIV care: a cross-sectional study in ageing populations in Malaysia and Hong Kong","authors":"Reena Rajasuriar,&nbsp;Syaza Hisham,&nbsp;John Son Lim,&nbsp;Jean Yi Cheong,&nbsp;Wen Ying Ho,&nbsp;Siew Hwei Yap,&nbsp;Nurul Syuhada Zulhaimi,&nbsp;Malinee Neelamegam,&nbsp;Catherine Cheung,&nbsp;Vivian Wong,&nbsp;Ruhana Che Yusof,&nbsp;Kejal Hasmukharay,&nbsp;Shahrul Bahyah Kamaruzzaman,&nbsp;Sharifah Faridah Syed Omar,&nbsp;Meng Li Chong,&nbsp;Pui Li Wong,&nbsp;Grace Chung-Yan Lui","doi":"10.1002/jia2.26404","DOIUrl":"10.1002/jia2.26404","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>WHO's Integrated Care for Older People (ICOPE) proposes we measure the functional construct of intrinsic capacity (IC) to monitor and identify individuals with age-associated vulnerabilities. Assessments of IC may be useful to address the evolving, non-HV care needs of ageing people with HIV (PWH). However, to date, its utility within the context of HIV has not been assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants included 200 PWH attending out-patient care (2021−2023) in Universiti Malaya Medical Centre, Malaysia and 101 community controls aged 35 years and above. The ICOPE framework was adapted to derive aggregate IC scores (ranging 0–6) encompassing the five domains of cognition, sensory (hearing and vision), mobility, mood and vitality. Multivariable analyses were used to explore the association of IC scores in PWH with multiple health outcomes including frailty, difficulties performing instrumental activities of daily living (IADL) and inflammatory markers. Area under the receiver operator characteristic (AUC-ROC) was calculated to predict frailty and IADL deficits in the current cohort and an independent cohort of 275 PWH from Hong Kong (HK).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Median (interquartile range, IQR) age among PWH and controls were 50 (42−56) and 50 (39−59) years, respectively. There were more males among PWH (83% vs. 56%, <i>p</i>&lt;0.001). All PWH received antiretroviral therapy (ART) for a median duration of 11 (8−14) years. Aggregate IC scores were lower in PWH but not significantly different compared to controls, (5.4 vs. 5.6, <i>p</i> = 0.093) and PWH performed significantly worse than controls only in the cognitive domain. Aggregate IC scores in PWH was independently associated with frailty (OR 0.17 95% CI 0.07−0.42, <i>p</i>&lt;0.001), IADL deficits (OR 0.25 95% CI 0.14−0.46, <i>p</i>&lt;0.001) and all other patient-reported outcomes assessed. Aggregate IC scores correlated with IL-6 but not sCD14 and sCD163 levels. IC scores performed well in identifying PWH with frailty (AUC-ROC ≥ 0.80) in the HK and Malaysian cohorts but more modestly (AUC-ROC ≥ 0.64) for IADL deficits.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>IC is a good composite measure to monitor non-HIV, age-associated physical and social vulnerabilities in PWH on ART and should complement disease-based monitoring in routine HIV care. Assessments of IC should be validated in larger, longitudinal cohorts of PWH from diverse settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11670474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142891095","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":"Innovating healthcare: Tangerine Clinic's role in implementing inclusive and equitable HIV care for transgender people in Thailand","authors":"Rena Janamnuaysook,&nbsp;Ratee Taesombat,&nbsp;Joe Wong,&nbsp;Ravipa Vannakit,&nbsp;Stephen Mills,&nbsp;Maarten Schim van der Loeff,&nbsp;Peter Reiss,&nbsp;Frits van Griensven","doi":"10.1002/jia2.26405","DOIUrl":"10.1002/jia2.26405","url":null,"abstract":"&lt;p&gt;Globally, anticipated and experienced stigma and discrimination against people with transgender and intersecting social identities in healthcare settings are barriers to HIV service uptake across the continuum of services [&lt;span&gt;1&lt;/span&gt;]. This involves a lack of awareness, knowledge and understanding of transgender-competent care among service providers. A consequence of this is low uptake of HIV services including adherence to antiretroviral treatment (ART) [&lt;span&gt;2&lt;/span&gt;]. Also reported is arbitrary advice from healthcare providers involving a choice between ART and gender-affirming hormone treatment (GAHT). Thus, there is a compelling case for establishing a transgender-responsive health package across the HIV prevention, care and treatment cascade to meet their unmet health needs.&lt;/p&gt;&lt;p&gt;Despite the known high HIV prevalence in this population since 2010 [&lt;span&gt;3&lt;/span&gt;], transgender women were not included as a distinct key population in Thailand's National AIDS Program. Categorized under men who have sex with men, they faced challenges accessing HIV services due to the lack of transgender-inclusive care in public health facilities. In response, the Institute of HIV Research and Innovation (IHRI) established the Tangerine Clinic in Bangkok in November 2015—the country's first clinic to offer transgender-competent HIV services.&lt;/p&gt;&lt;p&gt;In this Field Note, we share our experience implementing transgender-competent HIV care at the Tangerine Clinic.&lt;/p&gt;&lt;p&gt;Our process involves four key components, illustrated in Figure 1.&lt;/p&gt;&lt;p&gt;To promote transgender leadership in service design and delivery, IHRI facilitated a consensus meeting with the transgender community in Bangkok (September 2015). The consultation aimed to pilot a transgender-competent HIV care model through community-driven implementation research. Participants included a diverse range of transgender individuals, for example transgender women and men, sex workers, youth, persons with HIV, healthcare providers, academics and entrepreneurs.&lt;/p&gt;&lt;p&gt;Three key areas were identified: (i) &lt;i&gt;Health priorities&lt;/i&gt; (GAHT, neovaginal care, HIV); (ii) &lt;i&gt;Essential service factors&lt;/i&gt; (sensitive intake forms, stigma-free providers, transgender-inclusive healthcare team, confidentiality, safe space); and (iii) &lt;i&gt;Potential challenges&lt;/i&gt; (lack of transgender-competent physicians, invisibility of transgender men).&lt;/p&gt;&lt;p&gt;Dialogue between transgender delegates, providers and academics ensured the programme would be grounded in lived experience, scientific evidence and practicality. The consultation concluded with a consensus to establish Thailand's first transgender-dedicated clinic, named “&lt;i&gt;Tangerine&lt;/i&gt;” with the slogan “&lt;i&gt;where transition fulfills identities&lt;/i&gt;.”&lt;/p&gt;&lt;p&gt;Reflecting the consensus achieved at the consultation regarding transgender health priorities, a protocol to deliver GAHT at Tangerine Clinic was developed. In parallel, the healthcare team undertook gender sensitization training a","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11666330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881080","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":"Men who have sex with men perceiving that sex with women carries the greatest risk of HIV acquisition: results from a mixed-methods systematic review in sub-Saharan Africa","authors":"Marion Fiorentino,&nbsp;Marie Dos Santos,&nbsp;August Eubanks,&nbsp;Nathan Yanwou,&nbsp;Christian Laurent,&nbsp;Perrine Roux,&nbsp;Bruno Spire","doi":"10.1002/jia2.26402","DOIUrl":"10.1002/jia2.26402","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;In sub-Saharan Africa (SSA), men who have sex with men (MSM) often have female sexual partners. Their overall risk of acquiring HIV is higher with male partners. Risk perception is associated with HIV knowledge, sexual risk and preventive behaviours. This synthesis aimed to summarize existing data about HIV knowledge and perceived HIV acquisition risk regarding sex with men and with women in MSM in SSA.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a systematic literature review of MSM's relationships with women in SSA (PROSPERO-CRD42021237836). Quantitative and qualitative data related to MSM's perceived risk from sex with men and with women and HIV knowledge (published up to 2021) were selected and synthesized.&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;Twenty studies were selected. More MSM perceived that the greatest risk of HIV acquisition came from heterosexual/vaginal sex than from homosexual/anal sex (53% vs. 15%; 51% vs. 39%; 42% vs. 8%; 27% vs. 25%; 43% vs. 11%; 23% vs. 13%; 35% vs. 16%, cumulative sample &lt;i&gt;n&lt;/i&gt; = 4396, six countries). A higher proportion of MSM received preventive information on heterosexual HIV transmission than on homosexual transmission (79% vs. 22%; 94% vs. 67%; 54% vs. 19%; cumulative sample &lt;i&gt;n&lt;/i&gt; = 1199, four countries). The qualitative synthesis (eight studies) highlighted biology- and behaviour-based misconceptions leading MSM to perceive lower or negligible HIV risk from sex with men, compared to sex with women. These misconceptions were partly fuelled by the predominant focus on heterosexual and vaginal HIV transmission in HIV prevention information.&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;Common misconceptions regarding sexual risk between men remain unaddressed by the heteronormative messaging of HIV prevention. Underestimation by MSM of their HIV acquisition risk with male partners can pose significant barriers to effective HIV preventive behaviours and strengthen the transmission risk from MSM to their female partners.&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;Improving access of MSM to tailored HIV prevention information and tools that address their practices with male and female partners is crucial. Integrating messages about anal sex into broader public health initiatives, including sexual health programmes targeting the general population, is essential. Further research in diverse settings in SSA is necessary to gain a great","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26402","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142845423","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":"Linkage to care and prevention after HIV self-testing: a systematic review and meta-analysis","authors":"Ying Zhang,&nbsp;Su Mei Goh,&nbsp;James Tapa,&nbsp;Cheryl C. Johnson,&nbsp;Eric P. F. Chow,&nbsp;Lei Zhang,&nbsp;Tiffany Phillips,&nbsp;Christopher K. Fairley,&nbsp;Jason J. Ong","doi":"10.1002/jia2.26388","DOIUrl":"10.1002/jia2.26388","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;Effective linkage to prevention and care is a crucial step following HIV testing services. This systematic review aimed to determine the proportion of individuals linked to prevention and care after HIV self-testing (HIVST) and describe factors associated with linkage.&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;Following PRISMA guidelines, a comprehensive search across eight databases (2010–October 2023) identified studies on linkage to care after HIVST, defined as receiving a confirmatory test or initiating antiretroviral therapy (ART) if the self-test was reactive, and/or pre-exposure prophylaxis (PrEP) if the self-test was non-reactive. A random-effects meta-analysis summarized the findings and meta-regression explored study-level covariates, such as world region, population type and service delivery model, that might explain the between-study heterogeneity.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;From 10,071 screened studies, 173 were included in the meta-analysis. The majority of studies focused on key populations in Africa using unassisted, oral fluid-based HIVST kits. Among those with reactive HIVST results, 92% (95% confidence interval [CI]: 88–95) were linked to confirmatory testing (&lt;i&gt;n&lt;/i&gt; = 124 studies), and 89% (95% CI: 84–93) of newly diagnosed individuals initiated ART (&lt;i&gt;n&lt;/i&gt; = 88 studies). Overall, 84% (95% CI: 74–93) of self-testers were linked to care (&lt;i&gt;n&lt;/i&gt; = 69 studies). However, only 9% (95% CI: 2–19) of individuals with non-reactive HIVST results were linked to PrEP services (&lt;i&gt;n&lt;/i&gt; = 9 studies). Assisted HIVST was associated with higher linkage rates to confirmatory testing and ART initiation compared to unassisted testing. Meta-regression revealed that the type of delivery model for the HIVST kits influenced linkage and that individuals who obtained their HIVST kits through a social network-based approach (SNA) were more likely to be linked to confirmatory testing (adjusted odds ratio = 1.28 [95% CI: 1.10–1.50], &lt;i&gt;p&lt;/i&gt; = 0.001) compared to non-SNA service delivery model.&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;In the context of expanding HIVST services globally, we found that linkage to confirmatory testing and ART initiation after HIVST is generally high, particularly when assisted HIVST or SNA-based distribution is used.&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;Strengthening timely linkage is vital for improving health outcomes, reducing HIV tr","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11634545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142811707","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":"High recent PrEP adherence with point-of-care urine tenofovir testing and adherence counselling among young African women: results from the INSIGHT cohort","authors":"Brenda Gati Mirembe,&nbsp;Deborah Donnell,&nbsp;Meighan Krows,&nbsp;Zinhle Zwane,&nbsp;Elizabeth Bukusi,&nbsp;Ravindre Panchia,&nbsp;Cheryl Louw,&nbsp;Noluthando Mwelase,&nbsp;Pearl Selepe,&nbsp;Melissa Senne,&nbsp;Logashvari Naidoo,&nbsp;Rachel Chihana,&nbsp;Margaret Kasaro,&nbsp;Harriet Nuwagaba-Biribonwoha,&nbsp;Philip Kotze,&nbsp;Katherine Gill,&nbsp;Pippa MacDonald,&nbsp;Alastair vanHeerden,&nbsp;Shannon Bosman,&nbsp;Manjeetha Jaggernath,&nbsp;Phillip du Preez,&nbsp;Amy Ward,&nbsp;Remco P. H. Peters,&nbsp;Sinead Delany-Moretlwe,&nbsp;Sue Peacock,&nbsp;Rachel Johnson,&nbsp;Jason Caucutt,&nbsp;Susan Morrison,&nbsp;Guohong Wang,&nbsp;Monica Gandhi,&nbsp;Jennifer Velloza,&nbsp;Renee Heffron,&nbsp;Connie Celum,&nbsp;the INSIGHT Study Team","doi":"10.1002/jia2.26389","DOIUrl":"10.1002/jia2.26389","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;Adolescent girls and young women (AGYW) account for two-thirds of new HIV infections in Africa. African AGYW have had high uptake of oral HIV pre-exposure prophylaxis (PrEP) but low adherence, which might be improved by point-of-care adherence monitoring with tailored counselling.&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;From August 2022 to July 2023, we conducted a PrEP demonstration project with sexually active AGYW ages 16−30 years from 20 sites in South Africa, Eswatini, Kenya, Malawi, Uganda and Zambia. Participants were offered oral tenofovir-based PrEP at enrolment and followed up at 1, 3 and 6 months. PrEP adherence was assessed by a point-of-care qualitative lateral flow urine tenofovir (TFV) assay indicating PrEP use in the prior 4 days, which accompanied real-time adherence counselling that incorporated urine TFV results when testing was available (70.8% of month 1, 35.3% of month 3 and 83.9% of month 6 visits). We estimated overall adherence, correcting for missing test results, and analysed the association of having received urine TFV results at month 1 or 3 with subsequent urine TFV test positivity, using modified Poisson regression.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of the 3087 AGYW enrolled, the median age was 24 years (interquartile range 21−27), 75.7% were from South Africa, 2878 (93.2%) initiated PrEP at enrolment and 107 (3.5%) after enrolment. Visit retention was 92.0−96.2% for months 1, 3 and 6, and 2518 (90.1%) exited the study with a PrEP refill. Adherence, based on the point-of-care urine tenofovir test positivity rate, was estimated as 72%, 71% and 65% at months 1, 3 and 6, respectively. Women who received one prior urine TFV test had a 42% higher likelihood of a subsequent positive urine TFV test (adjusted odds ratio, OR = 1.42, 95% confidence interval, CI 1.27−1.60), and those having received two prior tests had a 67% higher likelihood (adjusted OR = 1.67; 95% CI 1.41−1.98). Observed HIV incidence was 1.38/100 person-years (95% CI 0.97−2.08).&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;Oral PrEP uptake, recent adherence and persistence were high in a multisite cohort of young African women over 6 months of follow-up. The use of a novel point-of-care tenofovir assay with tailored real-time adherence counselling was associated with increased adherence to PrEP at subsequent visits, warranting further study.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Clinical trials registration&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11628190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142798781","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 heterogeneity among people re-engaging in antiretroviral therapy highlights the need for a differentiated approach: results from a cross-sectional study in Johannesburg, South Africa","authors":"Chipo Mutyambizi,&nbsp;Kate Rees,&nbsp;Anna Grimsrud,&nbsp;Rendani Ndou,&nbsp;Lynne S. Wilkinson","doi":"10.1002/jia2.26395","DOIUrl":"10.1002/jia2.26395","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;Disengagement and re-engagement with antiretroviral therapy (ART) are common in South Africa, but routine monitoring is insufficient to inform policy development. To address this gap, Anova implemented the 2020 National Adherence Guidelines’ re-engagement standard operating procedure (re-engagement SOP) and collected additional data to describe the characteristics of re-engagement visits to inform HIV programmes.&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;Between July and December 2022, we conducted a study at nine primary healthcare facilities in Johannesburg. Staff were trained on the re-engagement SOP and provided with job aides to support implementation. Administration clerks categorized visits based on the time elapsed since the missed appointment: ≤14days and &gt;14 days, with the latter identified as re-engaging. For these clients, clinicians filled out “re-engagement clinical assessment forms” that included visit dates, both clinician-assessed and self-reported treatment interruptions, and clinical details. Data on missed appointments and previous viral loads were extracted from medical records. The information was entered into REDCap. We present data from three out of the nine facilities, selected for their comprehensive data collection and high coverage of all re-engaging clients.&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;A total of 2342 clients returned following a missed scheduled appointment. The majority, 1523 (65%), missed their appointments by ≤ 14 days, while 819 (35%) were &gt;14 days late (re-engaging). Among those re-engaging, 635 (78%) re-engagement clinical assessment forms were completed. A missed appointment date was available for 623 with 25% (&lt;i&gt;n&lt;/i&gt; = 161) returning 2–4 weeks late, 47% (&lt;i&gt;n&lt;/i&gt; = 298) 4–12 weeks and 26% (&lt;i&gt;n&lt;/i&gt; = 164) &gt;12 weeks late. Self-reported ART interruption, available for 89% (567/635), indicated the majority (54%, &lt;i&gt;n&lt;/i&gt; = 304) experienced no interruption. Clinical concerns were identified in 65 (10%) cases. A majority (79%, 504/635) had prior viral load results, with 73% (370/504) below 50 copies/ml.&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;Clients frequently return to care shortly after missed appointments. Despite missing scheduled ART refill dates, many report not interrupting treatment, either having treatment on hand or sourcing ART elsewhere. Most re-engaging clients were adherent prior to disengagement, and clinical concerns are rare. A differentiated service delivery approach, prioritizing flexibility and reduced healthcar","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-12-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11625505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142793952","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":"Retention on antiretroviral therapy and drivers of lost-to-follow up in the Central African Republic: a longitudinal analysis","authors":"Gaspard Tekpa,&nbsp;Jules Inikoutiyo,&nbsp;Christian Yonli,&nbsp;Celia Noguera,&nbsp;Pierre Prince Lujwiro,&nbsp;Laure Gigout,&nbsp;Aboubacar Hachimou,&nbsp;Sydney Romaric,&nbsp;Raphaël Mabaïlao,&nbsp;Marie Charlotte Banthas,&nbsp;Larissa Bertille Mbia,&nbsp;Paulette Rose Mbay,&nbsp;Kevin Romuald,&nbsp;Alain Sana,&nbsp;Florida Roberte,&nbsp;Laura Moretó-Planas,&nbsp;Eric Goemaere,&nbsp;Calorine Mekiedje,&nbsp;Stella Ouanekpone,&nbsp;Maria Amparo Núñez-Andrés,&nbsp;Sarah Hoibak,&nbsp;Xavier Vallès","doi":"10.1002/jia2.26387","DOIUrl":"10.1002/jia2.26387","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The retention in care of patients undergoing antiretroviral therapy (ART) is a cornerstone for preventing AIDS-associated morbidity and mortality, as well as further transmission of HIV. Adherence to ART poses particular challenges in conflict-affected settings like the Central African Republic (CAR). The study objective was to estimate the rate of lost-to-follow-up (LTFU) and determine factors associated with LTFU among patients living with HIV under ART in CAR.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort analysis was conducted using data from patients being managed at 42 representative ART dispensing sites (i.e. management of ≥200 patients) in the seven health regions of CAR which started ART between January 2019 to September 2021 and followed up to December 2021. The outcome of LTFU was defined as a failure of a patient to attend a scheduled ART refill appointment for at least 90 days from the last appointment. Patients were censored at the first LTFU event.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 6844 patients enrolled in ART care were included in the analysis, of whom 67.5% were females. The mean age (standard deviation) was 35.3 years (10.5). Forty-two per cent (<i>n</i> = 2874/6844) had an LTFU event during the follow-up period. However, 23.2% (<i>n</i> = 666/2874) returned to care after LTFU. Overall retention in antiretroviral care at 12 months was 64.2% (CI 63.0−65.5), which ranged from 76.1% in the capital to 48.2% in the inner country region. Risk factors related to LTFU were being male (adjusted hazard ratio [aHR] 1.33; CI 1.1−1.5), age &lt; 25 (aHR 1.46; CI 1.1−1.9), living in regions outside the capital (aHR 1.83; CI 1.6−2.3) and undernutrition (aHR 1.13; CI 1.0−1.3).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Retention to care in CAR is suboptimal, especially in the inner country. Our results underline the difficulties involved in retaining patients in ART in complex settings, the interplay between poor retention, social unrest, stigma, food insecurity and HIV epidemic control, and the need for tailored programming and interventions like differentiated treatment strategies and complementary food provision.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11621234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783570","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":"Applying population-specific incidence prevalence ratio benchmarks to monitor the Australian HIV epidemic: an epidemiological analysis","authors":"Jonathan M. King,&nbsp;Hamish McManus,&nbsp;Richard T. Gray,&nbsp;Steven J. Nigro,&nbsp;Jana Sisnowski,&nbsp;Timothy Dobbins,&nbsp;Benjamin R. Bavinton,&nbsp;Andrew E. Grulich,&nbsp;Kathy Petoumenos,&nbsp;Jane Costello,&nbsp;Skye McGregor","doi":"10.1002/jia2.26399","DOIUrl":"https://doi.org/10.1002/jia2.26399","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Due to a lack of robust population denominators, Australia is unable to accurately monitor changes in the HIV epidemic for some populations. The ratio of HIV transmission relative to the number of people with HIV (an incidence prevalence ratio, or IPR) can measure such changes. The IPR is measured against an IPR benchmark derived from post-HIV acquisition life expectancy, to indicate whether an HIV epidemic is shrinking or growing. Using IPRs and Australia-specific IPR benchmarks, this study aims to describe the Australian HIV epidemic among three groups: men with HIV attributed to male-to-male sex, women with HIV and people with HIV attributed to injection drug use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using mathematical modelling derived from HIV notifications, cohort and administrative data, IPRs were generated for each of the three groups. These IPRs were compared with IPR benchmarks derived from post-HIV acquisition mortality estimates using abridged life tables for men, women and people who inject drugs. The IPR benchmark for men was applied to people with HIV attributed to male-to-male sex. Trends in the IPR over time were described for each reported population from 2015 to 2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, the IPR fell by 80%, from 0.040 (range: 0.034−0.045) in 2015 to 0.008 (range: 0.003−0.013) in 2022 and fell below the benchmark (0.022) in 2020. Among people with HIV attributed to male-to-male sex, the IPR fell by 85%, from 0.041 (range: 0.034−0.047) in 2015 to 0.006 (range: 0.003−0.024) in 2022 and fell below the benchmark (0.022) in 2020. Among women with HIV, the IPR fell by 56%, from 0.032 (range: 0.026−0.039) in 2015 to 0.014 (range: 0.003−0.029) in 2022 and fell below the benchmark (0.022) in 2019. Among people with HIV attributed to injection drug use, the IPR fell by 61%, from 0.036 (range: 0.022−0.047) in 2015 to 0.014 (range: 0.002−0.057) in 2022 and fell below the benchmark (0.028) in 2019.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Australian IPRs in all populations examined have dropped below the level required to sustain the HIV epidemic at current levels. By applying this method in other contexts, the changing scale of HIV epidemics may be better described for populations lacking robust population denominators.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 12","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26399","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142764290","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}