Journal of the International AIDS Society最新文献

{"title":"Improving PrEP access for adolescent girls and young women: a descriptive analysis of community-based PrEP delivery in the DREAMS programme in Zambia","authors":"Maurice Musheke,&nbsp;Jake M. Pry,&nbsp;Izukanji Sikazwe,&nbsp;Walusiku J. Muyunda,&nbsp;Kanema Chiyenu,&nbsp;Charity M. Siame,&nbsp;Winfred K. Khondowe,&nbsp;Bwalya Mushiki,&nbsp;Martha M. Mwaba,&nbsp;Pelile Zulu,&nbsp;Flavia Mwape,&nbsp;Bridget Siamasuku,&nbsp;Davies Shula,&nbsp;Mable B. Mweemba,&nbsp;Cuthbert Kanene,&nbsp;Arlene Phiri,&nbsp;Michael E. Herce","doi":"10.1002/jia2.26484","DOIUrl":"https://doi.org/10.1002/jia2.26484","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite being at high risk of HIV acquisition, access to pre-exposure prophylaxis (PrEP) among adolescent girls and young women (AGYW) is low in Zambia because PrEP is traditionally delivered in clinical settings. We describe the effects of community centres supported by the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative on PrEP outcomes in Zambia and examine factors associated with PrEP continuation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We collected individual-level PrEP data for AGYW aged 15–24 years at risk of HIV acquisition and enrolled in DREAMS in seven districts of Zambia between August 2022 and August 2024. We used Pearson's Chi-squared test to examine differences in beneficiary characteristics between clients with a PrEP initiation visit and ≥ 2 PrEP visits (i.e. an initiation plus ≥ 1 return visit), and mixed effects Poisson regression modelling to estimate the association between DREAMS enrolment criteria and PrEP continuation (defined as ≥ 1 PrEP visit within 180 days of initiation). We also estimated the marginal probability of PrEP continuation by number of DREAMS enrolment criteria and used Kaplan-Meier methods to estimate the time to the first PrEP return visit by client age band.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 11 August 2022 and 23 August 2024, 15,502 AGYW aged 15–24 years were screened for PrEP eligibility, of whom 15,072 (97.2%) initiated PrEP per national guidelines. Of those initiating PrEP, 9807 (65.1%) had sufficient follow-up time to allow for observation of a PrEP return visit. The proportion of AGYW who had ≥ 1 PrEP return visit within 180 days of initiation was 59.0% (<i>n</i>/<i>N</i> = 5706/9675). Across age bands, the percent probability of having a PrEP return visit within 180 days of initiation was highest among clients who reported ≥ 4 DREAMS enrolment criteria at 91.7% (95% CI: 70.7, 112.7%) for clients aged 15–19 years and 83.6% (95% CI: 61.1, 106.2%) for clients aged 20–24 years. Overall, 41.5% of clients had a first PrEP return visit between 21 and 42 days of PrEP initiation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The high number and proportion of AGYW initiated on PrEP suggests that decentralising PrEP services to DREAMS community centres has the potential to improve PrEP access among AGYW. Increasing HIV risk perception among AGYW may improve PrEP continuation.</p>\u0000 </section>\u0000 </div>","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/jia2.26484","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574072","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early findings from the integration of hypertension care into differentiated service delivery models for HIV in Uganda: a mixed-method study","authors":"John Baptist Kiggundu,&nbsp;Fred C. Semitala,&nbsp;Chelsea Faith Lipoto,&nbsp;Lilian Giibwa,&nbsp;Robert Twine,&nbsp;Savio Mwaka,&nbsp;Florence Ayebare,&nbsp;Christine Kiwala,&nbsp;Evelyn N. Magambo,&nbsp;Gerald Mutungi,&nbsp;Isaac Ssinabulya,&nbsp;Donna Spiegelman,&nbsp;James Kayima,&nbsp;Martin Muddu,&nbsp;Jeremy I. Schwartz,&nbsp;Anne R. Katahoire,&nbsp;Chris T. Longenecker","doi":"10.1002/jia2.26499","DOIUrl":"https://doi.org/10.1002/jia2.26499","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;Uganda's national guidelines recommend integrated HIV and hypertension care; however, integration of hypertension care into HIV differentiated service delivery (DSD) models has not been extensively described. We aimed to describe trends in DSD models for people living with HIV (PLHIV) with hypertension and to qualitatively describe the experiences of healthcare providers (HCPs) and PLHIV with hypertension after implementing integrated care.&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 parallel convergent mixed methods study nested in an ongoing stepped wedge cluster randomised trial in Kampala and Wakiso districts. Quantitative data (age, sex, blood pressure, DSD model, medication prescriptions) were collected from routine medical records at eight clinics implementing the enhanced care package between March 2023 and July 2024. Additionally, structured interviews were conducted at two clinics with HCPs (&lt;i&gt;n&lt;/i&gt; = 6, 3 per clinic) and PLHIV with hypertension (&lt;i&gt;n&lt;/i&gt; = 8, 4 per clinic). Our quantitative outcome variable was enrolment in intensive DSD models (facility-based individual and group models) versus other DSDs. A generalised estimation equation was used to account for within clinic correlation and repeated measures within participants over time. Inductive thematic analysis was applied to the qualitative data using the Consolidated Framework for Implementation Research.&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;Overall, 3164 PLHIV with hypertension accessed care at the eight clinics. Median age was 46 years (IQR 38–56); more than two-thirds were female. There was considerable heterogeneity across clinics in the use of DSD models during the study period. Overall, use of intensive models increased over time (OR 1.127 [1.059−1.199] per month). However, two clinics showed significant time interaction effects (Wald test χ&lt;sup&gt;2&lt;/sup&gt; (7) = 69.94, &lt;i&gt;p&lt;/i&gt; &lt; 0.001), with a decrease in the intensive models over time. HCPs and PLHIV observed that integrating hypertension care was easily adaptable in some models, while more challenging in others. The availability of resources and synchronisation of HIV and hypertension visits facilitated the integration of hypertension care within the HIV DSD models.&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;The integration of hypertension management into HIV DSD models is both feasible and adaptable; however, it requires transitioning PLHIV between various models based on clinical needs. To facilitate this process, comprehensive client educati","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/jia2.26499","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness analysis of a community-based model for delivery of antiretroviral therapy to people with clinically stable HIV in Cambodia","authors":"Lo Yan Esabelle Yam,&nbsp;Pheak Chhoun,&nbsp;Ziya Tian,&nbsp;Michiko Nagashima-Hayashi,&nbsp;Marina Zahari,&nbsp;Sovannary Tuot,&nbsp;Sovannarith Samreth,&nbsp;Bora Ngauv,&nbsp;Vichea Ouk,&nbsp;Kiesha Prem,&nbsp;Siyan Yi","doi":"10.1002/jia2.26476","DOIUrl":"https://doi.org/10.1002/jia2.26476","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 Cambodia, of all people living with HIV, 89% knew their status, 89% were receiving antiretroviral therapy (ART) and 87% had their viral load suppressed in 2023. In 2017, the national HIV programme introduced the multi-month dispensing (MMD) model to reduce visits to ART clinics, thereby reducing the burden on people living with HIV and health facilities. A quasi-experimental study introduced the community ART delivery (CAD) model, where community action workers (CAWs) delivered pre-packaged antiretrovirals to their peers in the community. This study examined the cost-effectiveness of the CAD compared to the MMD model.&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;This study was conducted between 2021 and 2023 and involved 2040 stable people living with HIV in the CAD arm and 2049 in the MMD arm. Baseline and endline surveys included self-reported ART adherence, quality of life, and medical and non-medical expenses. Intention-to-treat analyses (ITTs) were conducted based on participants’ original treatment assignment, with multiple imputations performed for participants lost to follow-up at the endline. Incremental cost-effectiveness ratios (ICERs) on ART adherence and quality of life were generated using health system and societal perspectives. Cost-effectiveness thresholds (CETs) were one-time gross domestic product (GDP) per capita and opportunity cost.&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;Both arms observed a decline in ART adherence and good physical health, with a decline in CAD less than in the MMD (&lt;i&gt;p&lt;/i&gt;-value &lt; 0.001). Similarly, a reduced proportion of participants reported good mental health across both arms; however, the difference was statistically insignificant. The ICERs for good physical health at the health system and societal levels were below the one-time GDP per capita (Incremental Net Benefit = 77.49−83.03) but exceeded the opportunity cost CET. The ICERs for ART adherence at the health system and societal levels were above both CETs.&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;The results showed that the CAD model was cost-effective in reducing the decline in the physical health of people living with HIV during the COVID-19 pandemic in Cambodia when a less stringent threshold was used. Further investigations are required to ascertain the cost-effectiveness of the CAD model by factoring in the productivity gains within the health system.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Clinical Trial Number&lt;/h3&gt;\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/jia2.26476","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573916","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":"Exploring healthcare experiences of transgender people in the Jabula Uzibone study, South Africa: a longitudinal implementation science study","authors":"Rutendo Bothma,&nbsp;Audrey Pettifor,&nbsp;Innocent Maphosa,&nbsp;Philisiwe Ndlovu,&nbsp;John Imrie,&nbsp;Tonia Poteat","doi":"10.1002/jia2.26503","DOIUrl":"https://doi.org/10.1002/jia2.26503","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;The World Health Organization promotes a transgender-differentiated service delivery (TG-DSD) model to overcome barriers to HIV service engagement among transgender people (TGP). For TGP, an essential element of DSD includes gender-affirming care which is non-stigmatising, free from discrimination and celebrates their gender identity. The &lt;i&gt;Jabula Uzibone&lt;/i&gt; Study, launched in November 2023, assesses the cost and effectiveness of TG-DSD on HIV outcomes. In this paper, we describe the baseline characteristics of TGP in our study and explore whether there are differences in healthcare experiences among those seeking care at TG-DSD clinics versus standard service delivery (SSD) clinics at baseline.&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;This observational, mixed-method, prospective implementation study compares models of care at four TG-DSD and four SSD facilities using standardised observation checklists, in-depth and key informant interviews. For this paper, we asked participants about healthcare experiences and experiences of stigma through a structured, interviewer-administered quantitative survey. We assessed the sections of the quantitative survey which ask about self-reported experiences of stigma.&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 study enrolled 422 TGP with HIV (217 TG-DSD and 205 SSD) and 248 TGP without HIV (128 TG-DSD and 120 SSD); 15% (102/670) gender non-conforming, 15% (91/670) TG men and 70% (477/670) TG women. Participants’ median age was 29 years, interquartile range: 24−35 years. SSD participants at baseline were 46% more likely to experience stigma compared to their TG-DSD counterparts (aOR = 1.46, 95% CI: 1.06, 2.01). SSD participants were more likely to encounter a healthcare provider who is unwilling to provide care for them (aOR = 1.55, 95% CI: 1.09, 2.21) and to report that healthcare workers are unable to provide the same quality care to TGP as they do other people (aOR = 1.46, 95% CI: 1.00, 1.91) compared to their TG-DSD counterparts.&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;TGP from TG-DSD facilities were less likely to report experiences of facility-based enacted stigma at baseline, compared to the TGP from SSD facilities. Our study highlights the importance of provider training in tailored transgender healthcare to provide gender-affirming healthcare services. Results from the &lt;i&gt;Jabula Uzibone&lt;/i&gt; study will provide further evidence of the effectiveness of TG-DSD models in sub-Saharan Africa, and the role of stigma and discrimination in HIV outco","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/jia2.26503","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573992","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":"Data-informed Stepped Care (DiSC) to improve adolescent and young adult HIV care outcomes in Kenya: a cluster randomized trial","authors":"Pamela Kohler,&nbsp;Wenwen Jiang,&nbsp;Jacinta Badia,&nbsp;James Kibugi,&nbsp;Jessica Dyer,&nbsp;Julie Kadima,&nbsp;Dorothy Oketch,&nbsp;Kristin Beima-Sofie,&nbsp;Sarah Hicks,&nbsp;Barbra A. Richardson,&nbsp;Irene Inwani,&nbsp;Seema K. Shah,&nbsp;Kawango Agot,&nbsp;Grace John-Stewart","doi":"10.1002/jia2.26501","DOIUrl":"https://doi.org/10.1002/jia2.26501","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;Systematic use of data-driven tools to allocate care services based on needs, including differentiated care for stable individuals and intensive care for those with higher risk, may improve retention and viral suppression in adolescents and young adults living with HIV (AYLHIV).&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;This cluster randomised trial in western Kenya tested a data-informed stepped care intervention that assigned AYLHIV to four intensities of care according to need. AYLHIV at 12 intervention facilities underwent step assignment at each visit; those at lowest risk were offered differentiated models of service delivery (DSD), and those with risk factors more intensive services. AYLHIV at control sites received standard care. AYLHIV were followed for 12 months. Clinical and viral load data were abstracted from medical records. The primary outcome was the proportion of missed visits (defined as &gt; 30 days late for scheduled visit). Secondary outcomes included loss to follow-up, viral non-suppression and assignment to DSD (multi-month refills or pharmacy fast-track visits). Mixed effects regression was clustered by individual and facility and adjusted for outcomes during the pre-enrolment period and baseline variables that differed by arm.&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;Between April and July 2022, 1911 AYLHIV ages 10–24 were enrolled (control: 1016, intervention: 895, 1708.8 person-years). Median age was 17, and 1512 (79.5%) were in school. Characteristics were balanced by arm, except for a higher proportion coming to the clinic alone in control arm (68.5% vs. 61.1%, &lt;i&gt;p&lt;/i&gt; = 0.04). At intervention facilities, using the DiSC tool, 574 (64.6%) AYLHIV were assigned to DSD, 122 (13.7%) to standard care, 100 (11.3%) to mental health and retention counselling, and 92 (10.4%) to intensive case management. Missed visits were 8.5% in intervention versus 8.3% in control (adjusted risk ratio [aRR]: 1.04, 95% CI: 0.89−1.20); viral non-suppression (7.7% vs. 9.7%, aRR 0.79 95% CI: 0.54−1.16) and antiretroviral therapy adherence (92.8% vs. 94.6%, aRR 0.98 95% CI: 0.94−1.02) were similar between arms. AYLHIV in the intervention arm received more fast-track visits (aRR 1.21, 95% CI: 1.01−1.46). Intervention facilities experienced fewer scheduled appointments compared to control (aRR: 0.95, 95% CI: 0.91−0.98, &lt;i&gt;p&lt;/i&gt; = 0.004).&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;Overall, missed visits and non-suppression were infrequent (&lt; 10%) and did not decrease with the DiSC interventi","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/jia2.26501","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573991","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":"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,&nbsp;Fabrice Helfenstein,&nbsp;Vohith Khol,&nbsp;Christella Twizere,&nbsp;Mayara Secco,&nbsp;Barbara Castelnuovo,&nbsp;Jacqueline Huwa,&nbsp;Thierry Tiendredbeogo,&nbsp;C. William Wester,&nbsp;Siew Moy Fong,&nbsp;Gad Murenzi,&nbsp;Yanink Caro-Vega,&nbsp;Rita Elias Lyamuya,&nbsp;Idiovinio Rafael,&nbsp;Djimon Marcel Zannou,&nbsp;Kathy Petoumenos,&nbsp;Dominique Mahambou Nsonde,&nbsp;Jorge Pinto,&nbsp;Kara Wools-Kaloustian,&nbsp;Carolyn Bolton Moore,&nbsp;Ounoo Elom Takassi,&nbsp;Sasisopin Kiertiburanakul,&nbsp;Rogers Ajeh Awoh,&nbsp;Shamim M. Ali,&nbsp;Geoffrey Fatti,&nbsp;Karen Malateste,&nbsp;Elizabeth Zaniewski,&nbsp;Marie Ballif,&nbsp;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,&nbsp;Gavin George,&nbsp;Emma Lansdell,&nbsp;Kuhle Fiphaza,&nbsp;Andrew Medina-Marino,&nbsp;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,&nbsp;Charles B. Holmes,&nbsp;Linda Sande","doi":"10.1002/jia2.26514","DOIUrl":"https://doi.org/10.1002/jia2.26514","url":null,"abstract":"&lt;p&gt;“&lt;i&gt;It is so easy to break down and destroy. The heroes are those who make peace and build&lt;/i&gt;.”—Nelson Mandela&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;A steep, sudden reduction in United States government funding has jeopardised HIV services in many high-burden countries [&lt;span&gt;1&lt;/span&gt;]. 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 [&lt;span&gt;2&lt;/span&gt;] marks more than a bureaucratic reshuffle—it signals the potential unravelling of critical components of the global HIV response.&lt;/p&gt;&lt;p&gt;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 [&lt;span&gt;3&lt;/span&gt;]. 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.&lt;/p&gt;&lt;p&gt;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 [&lt;span&gt;4&lt;/span&gt;]. Multi-month dispensing (MMD) of ART, which expanded during COVID-19 [&lt;span&gt;5&lt;/span&gt;], 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 [&lt;span&gt;6, 7&lt;/span&gt;], and can increase human resource capacity [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;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,&nbsp;Jeff Taylor,&nbsp;Rachel Lau,&nbsp;Joyce Ching-Jung Lai,&nbsp;Sithara Deshan Diunugala,&nbsp;Michael Louella,&nbsp;Thomas J. Villa,&nbsp;William Freshwater,&nbsp;Dawn Averitt,&nbsp;Maile Karris,&nbsp;Jeff Berry,&nbsp;Lynda Dee,&nbsp;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,&nbsp;Carey Pike,&nbsp;Elzette Rousseau,&nbsp;Pippa Macdonald,&nbsp;Pakama Mapukata,&nbsp;Bryan Leonard,&nbsp;Keitumetse Lebelo,&nbsp;Risa Hoffman,&nbsp;Catherine Orrell,&nbsp;Linda-Gail Bekker,&nbsp;Dvora Joseph Davey","doi":"10.1002/jia2.26492","DOIUrl":"https://doi.org/10.1002/jia2.26492","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;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.&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;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.&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 February to August 2024, we enrolled 58 PLP (&lt;i&gt;n&lt;/i&gt; = 30 pregnant, &lt;i&gt;n&lt;/i&gt; = 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%, &lt;i&gt;n&lt;/i&gt; = 13 pregnant, &lt;i&gt;n&lt;/i&gt; = 23 breastfeeding) completed the acceptability survey. Of these, 83% (&lt;i&gt;n&lt;/i&gt; = 12/13 pregnant, &lt;i&gt;n&lt;/i&gt; = 20/23 breastfeeding) chose and received CAB-LA, and the remaining (&lt;i&gt;n&lt;/i&gt; = 4) chose and received oral PrEP. PLP who received CAB-LA reported liking its ease of use (69%; &lt;i&gt;n&lt;/i&gt; = 22/32) and long-acting protection (44%; &lt;i&gt;n&lt;/i&gt; = 14/32). Half of CAB-LA users disliked side effects (e.g. injection site pain), although 41% of PLP (&lt;i&gt;n&lt;/i&gt; = 13/32) described no CAB-LA dislikes. Almost all (97%; &lt;i&gt;n&lt;/i&gt; = 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 (&lt;i&gt;n&lt;/i&gt; = 31/36) did not want to try the dapivirine vaginal ring.&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;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.&lt;/p&gt;\u0000 &lt;/section&gt;\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}