Journal of the International AIDS Society最新文献

{"title":"HIV incidence and prevalence among adults in Mozambique: estimates from the Population-based HIV Impact Assessment Survey (INSIDA 2021) and district-level modelling","authors":"Eduardo Samo Gudo, K. Carter McCabe, Erika Fazito, Daniel Catano, Orrin Tiberi, Makini Boothe, Jordan McOwen, Jeffrey W. Imai-Eaton, Oliver Stevens, Lourena Manembe, Wafaa M. El-Sadr","doi":"10.1002/jia2.70008","DOIUrl":"https://doi.org/10.1002/jia2.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Accurate information is needed to prioritize programmes and resources that address gaps in the HIV response. We examined findings from the 2021 Mozambique Population-based HIV Impact Assessment (INSIDA) survey, complemented with subnational model-based estimates of the number of new infections and district-level incidence to gauge progress in the HIV response and guide future priorities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>INSIDA 2021, a nationally representative cross-sectional household survey, measured national HIV incidence, national and provincial HIV prevalence, and factors associated with HIV. Consenting adults aged 15 years and older were interviewed and tested for HIV using the national diagnostic algorithm, followed by laboratory-based confirmation of HIV status. Testing for viral load, limiting antigen avidity and the presence of antiretrovirals were used to estimate HIV incidence. The Naomi model, a Bayesian small-area estimation model combining the INSIDA 2021 survey and routine HIV service delivery data, estimated provincial and district-level HIV incidence and district-level prevalence. Weighted HIV prevalence estimates, stratified by sex, are reported and factors associated with HIV infection modelled via multivariate logistic regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>National HIV prevalence was 12.5% (95% CI: 11.5−13.4) among adults 15 years and older, and national HIV incidence was 4.3 (95% CI: 2.3−6.3) per 1000 HIV-negative adults in 2021. Per model estimates, there were 84,000 (95% CI: 80,000−89,000) new infections per year, 55,000 among women (95% CI: 52,000−58,000) and 30,000 (95% CI: 28,000−31,000) among men. In 2023, an estimated 2.2 million (95% CI: 2,200,000−2,300,000) adults (15+ years) with HIV were living in Mozambique. District-level estimates highlighted areas of higher adult HIV prevalence and incidence in urban areas of key cities and ports, in the south, and along coastal districts in central Mozambique. Compared to men the same age, the distribution of HIV infections remains concentrated among women, particularly young women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Mozambique continues to face a high burden HIV epidemic, with high HIV incidence associated with spatial heterogeneity. Prevention of new infections through women and young women-centred prevention programmes, treatment for men, and focusing interventions in urban areas, port cities, and coastal areas in central and southern Mozambique could contribute to reducing the HIV burd","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 11","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375372","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":"Cognitive and mental health significantly contribute to disability in people ageing with HIV in Asia: an observational case-control study","authors":"Grace Lui,&nbsp;Yaokai Chen,&nbsp;Chien-Ching Hung,&nbsp;Pui Li Wong,&nbsp;Chen Seong Wong,&nbsp;Jason Leung,&nbsp;Xiaolei Xu,&nbsp;Catherine Cheung,&nbsp;Guanlin Li,&nbsp;Vivian Wong,&nbsp;Shui Shan Lee,&nbsp;Timothy Kwok,&nbsp;Reena Rajasuriar","doi":"10.1002/jia2.70052","DOIUrl":"https://doi.org/10.1002/jia2.70052","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Disability disproportionally impacts people living with HIV (PLWH). The burden and determinants of disability among PLWH in Asia have not been well studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a multi-country observational cross-sectional study in five cities in Asia involving PLWH and age- and sex-matched controls living without HIV from March 2020 to November 2023. We compared the prevalence of disability (measured by World Health Organization Disability Assessment Schedule 2.0, WHODAS 2.0) between PLWH and controls, and determined the association between living with HIV and disability using multivariable logistic regression and mediation analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1004 PLWH and 416 age- and sex-matched controls were enrolled. PLWH (mean age 53.6 ± 10.3 years, 84.4% male, 72.2% ≥1 comorbidities) had a higher Charlson Comorbidity Index, more depression, anxiety, stress, social isolation and loneliness, and poorer cognitive performance.</p>\u0000 \u0000 <p>The prevalence of disability was 50.9% among PLWH and 40.6% among controls (<i>p</i>&lt;0.001). PLWH had significantly higher WHODAS 2.0 complex score, and significantly more PLWH had impairments in all of the six domains of disability. The presence of disability correlated with living with HIV after adjusting for demographic characteristics, physical health parameters and cognition, but not after adjusting for socio-behavioural variables and mental health parameters. Mediation analysis showed that living with HIV had a significant indirect effect on disability mediated by social isolation, mental health disorders and poor cognitive performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PLWH in Asia had a higher burden of disability as compared with matched controls. The effect of living with HIV on disability was mediated by social isolation, mental health disorders and impaired cognition. Future work should be directed to developing interventions that mitigate these conditions with the goal of reducing disability among PLWH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 11","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70052","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145375373","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 rates of viral suppression in pregnancy drop postpartum in South African women on tenofovir-lamivudine-dolutegravir: a prospective cohort study","authors":"Elaine J. Abrams,&nbsp;Jennifer Jao,&nbsp;Elton Mukonda,&nbsp;Hlengiwe P. Madlala,&nbsp;Sandisiwe Matyseni,&nbsp;Allison Zerbe,&nbsp;Justine Legbedze,&nbsp;Landon Myer","doi":"10.1002/jia2.70044","DOIUrl":"10.1002/jia2.70044","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Achieving and maintaining viral suppression (VS) during pregnancy and breastfeeding is central to preventing vertical transmission and optimizing maternal health. High rates of VS have been demonstrated among adult and paediatric populations receiving tenofovir-lamivudine-dolutegravir (TLD), but VS and viraemia among pregnant and postpartum women with HIV (WHIV) in high-burden settings have not been well-documented.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between September 2021 and December 2023, pregnant WHIV, ≤18 weeks gestation, were enrolled in antenatal care (ANC) and followed postpartum in Cape Town, South Africa. WHIV received HIV care in routine health services and continued, switched to or initiated TLD at ANC entry. VS was defined as viral load (VL) &lt;50 copies/ml; viraemic episodes (VEs) were categorized as major (&gt;1000 copies/ml) or minor (50−1000 copies/ml). Mixed-effects Poisson regression models were fit to assess factors associated with major VE risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 763 WHIV with ≥1 VL, median age was 30 years (interquartile range [IQR] 25−34) and median gestation was 14 weeks at enrolment (IQR 11−17); 89% were on antiretroviral therapy, including 74% on TLD. Overall 99% achieved ≥1 VL&lt;50 copies/ml: 73% sustained VS through 48 weeks postpartum, with 16% having ≥1 minor VE and 15% ≥1 major VE. At enrolment, 77% of VL measures were &lt;50 copies/ml, increasing to &gt;90% during pregnancy through 12 weeks postpartum and declining to 81% by 24 weeks postpartum. In multivariable analysis, each additional year of age conferred a 6% (95% confidence interval [CI] 0.89, 0.98, <i>p</i> = 0.006) lower risk of subsequent major VE after achieving VS. WHIV with viraemia (50−1000 copies/ml) at enrolment were 3.6 (95% CI 1.94, 6.70, <i>p</i>&lt;0.001) times more likely to have a subsequent major VE, whereas CD4+&gt;500 cells/mm lowered major VE risk by 53% (95% CI 0.32, 0.89, <i>p</i> = 0.016).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>High rates of VS were maintained during pregnancy and early postpartum, but substantial viraemia emerged by 24 weeks postpartum, jeopardizing maternal and child health outcomes. These unique data provide further impetus to explore innovative approaches to supporting adherence among WHIV during the postpartum period.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145353258","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 in a low-resource, high-burden South African cohort on antiretroviral therapy: Retrospective, longitudinal analysis comparing six measures of retention","authors":"Claire M. Keene,&nbsp;Jonathan Euvrard,&nbsp;Tamsin K. Phillips,&nbsp;Mike English,&nbsp;Jacob McKnight,&nbsp;Catherine Orrell","doi":"10.1002/jia2.70046","DOIUrl":"10.1002/jia2.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Retention on antiretroviral therapy (ART) is a prerequisite for adherence and subsequent treatment success. Measuring retention is also easily implementable at facility and population levels, making it pragmatic to monitor ART programme success. However, despite its ubiquitous global use, there is little consistency in the measurement of retention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study retrospectively applied six measures of retention to one cohort of adults (initiating ART after 01-09-2016, with ≥1 year of observation time to database closure on 30-09-2022), in a low-resource, high HIV-burden setting in South Africa. Using routine healthcare data from the Western Cape's Provincial Health Data Centre, loss to follow-up (LTFU), fixed-point retention, visit constancy, visit gaps, treatment interruptions and medication possession ratio (MPR) were described over 5 years from initiation. Individuals were considered “continuously retained” if they did not experience attrition throughout their observed follow-up. Measures were compared using the proportion misassigned and Cohen's Kappa statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age of the cohort (<i>n</i> = 68,888) was 31 years (interquartile range [IQR] 26–38) at initiation, with 69% (47,631/68,888) female, and a median observed follow-up of 4 years (IQR 3–5). Across different measures, retention was low, and declined over time. There was variable overlap; the proportion continuously retained throughout their observed follow-up ranged from 60% (41,268/68,888 not LTFU) to 32% (22,381/68,888 MPR ≥80%). Retention by all measures was strongly associated with viral suppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By all measures, large proportions of people in this setting were considered out of ART care during 5 years of observed follow-up time from initiation. This makes retention a critical target for intervention to improve population-level viral suppression and achieve epidemic control. Measuring longitudinal retention revealed that most people disengaged from ART care at some point after initiation. Certain measures of retention (e.g. treatment interruptions) identified people in and out of care with more granularity, whereas blunter measures (e.g. LTFU) misassigned individuals’ retention status and missed patterns of retention over time as people cycled in and out of care between points of measurement. Ultimately, the choice of measure depends on the purpose of the evaluation and on the data available, b","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285187","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":"Incidence and outcomes of anal and cervical cancer among adults with HIV in Latin America: a retrospective cohort study","authors":"Rachael A. Pellegrino,&nbsp;Shengxin Tu,&nbsp;Rodrigo Ville-Benavides,&nbsp;Emilia M. Jalil,&nbsp;Staci L. Sudenga,&nbsp;Brenda Crabtree-Ramírez,&nbsp;Claudia P. Cortes,&nbsp;Diana Varela,&nbsp;Genevieve Hilaire,&nbsp;Cynthia Riviere,&nbsp;Eduardo Gotuzzo,&nbsp;Bryan E. Shepherd,&nbsp;Valeria Fink,&nbsp;Jessica L. Castilho,&nbsp;the Caribbean, Central and South America network for HIV Epidemiology","doi":"10.1002/jia2.70050","DOIUrl":"https://doi.org/10.1002/jia2.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Human papillomavirus (HPV)-associated cervical and anal cancers disproportionately affect people with HIV (PWH). This study aimed to determine the incidence trends of and risk factors for these malignancies in PWH in Latin America.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included PWH from the Caribbean, Central and South America network for HIV epidemiology (CCASAnet) who contributed person-time between 2000 and 2019. We calculated crude and age-standardized incidence rates, examining trends over time with Poisson regression. Adjusted hazard ratios were calculated using Cox proportional hazard models with propensity score adjustment. We calculated the probability of survival after cancer diagnosis using Kaplan−Meier curves. To understand factors that influence our results, we surveyed all adult CCASAnet sites on current practices of cervical and anal cancer screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 5739 females with HIV (43,417 person-years) were included in cervical cancer analyses. There were 27 incident cervical cancers: crude incidence rate of 62.2 (95% confidence interval [CI]: 34.9−89.4) per 100,000 person years. In the anal cancer analysis, 12,489 males who have sex with men (MSM), 7324 males other than MSM and 5739 females were included for a total of 25,552 PWH, contributing 157,166 person-years. Anal cancer was diagnosed in 56 individuals: crude incidence rates of 59.1 [95% CI: 33.2−85.0], 20.7 [95% CI: 11.6−29.7] and 15.2 [95% CI: 8.6−21.9] per 100,000 person-years in MSM, females and males other than MSM, respectively. Age-standardized incidence rates did not significantly change over time. Anal cancer risk decreased significantly with higher time-updated CD4 cell count. The predicted probability of 5-year survival after cancer diagnosis was 72.6% (95% CI: 48.4−86.8) for cervical cancer and 58.5% (95% CI: 44.0−70.5) for anal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In one of the few reports outside the United States or Europe, we did not observe a decrease in age-standardized incidence rates for anal and cervical cancer between 2000 and 2019. These data support continued efforts for cancer prevention through access to gender-neutral HPV vaccination and cancer screening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272818","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 efficacy of community-led monitoring: successes, lessons learnt and opportunities for improvement from the Zimbabwean context","authors":"Morgen Chinoona,&nbsp;Jephias Matunhu,&nbsp;Donald Denis Tobaiwa,&nbsp;Kudzaishe Mutungamiri,&nbsp;Melody Musendo,&nbsp;Tinashe Marange,&nbsp;Tinashe Chidede","doi":"10.1002/jia2.70053","DOIUrl":"https://doi.org/10.1002/jia2.70053","url":null,"abstract":"&lt;p&gt;Community-led monitoring (CLM) is vital in the global HIV response as it enables community participation and evidence-based advocacy for improved health service delivery. CLM is “an accountability mechanism for HIV responses at different levels, led and implemented by community-led organizations of people living with HIV (PLHIV), networks of key populations (KP), other affected groups” [&lt;span&gt;1&lt;/span&gt;]. It is a form of social accountability, where citizens hold duty bearers accountable for the services they provide. Evidence highlights its effectiveness in bridging gaps between healthcare providers and communities, addressing systemic inequities and strengthening accountability [&lt;span&gt;2&lt;/span&gt;]. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) supported CLM coordinated by Family AIDS Caring Trust (FACT) commenced in 2021, driving community-led action to improve services at 246 health facilities in 21 districts of Zimbabwe. It was initiated by civil society organizations in collaboration with PLHIV and KP communities, who determined its scope and priorities. Districts were consultatively selected with consideration of epidemiological burden and CLM coverage. CLM targets PLHIV, adolescent girls and young women and KP, including sex workers, men who have sex with men and sexual minorities. It involves 718 community health monitors (CHMs) selected by communities based on representation and levels of their literacy and commitment. CHMs utilize Kobo Collect surveys and community score cards to monitor availability, accessibility, acceptability, appropriateness and quality of HIV-health services. Data are collected and synchronized from various tools, drawing insights that are disseminated and actioned on a quarterly basis at the facility and district levels.&lt;/p&gt;&lt;p&gt;CLM recognizes that, while HIV prevalence declined from 12.6% in 2019 to 10.5% in 2023 in Zimbabwe, some subpopulations remain behind [&lt;span&gt;3&lt;/span&gt;]. Stigma and discrimination remain high, with the 2022 PLHIV Stigma Index noting 77.7% of sex workers reporting HIV status-related stigma and 17.9% PLHIV discontinuing Antiretroviral Therapy (ART) in the preceding year due to stigma [&lt;span&gt;4&lt;/span&gt;]. Stigma and legal barriers disproportionately hinder KP's access to equitable HIV services owing to Zimbabwe's socio-cultural landscape dominated by Christian (85.3%) and traditional beliefs [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In this context, this article aims to (1) highlight CLM's achievements in improving access and uptake of HIV and sexual and reproductive health services, and (2) share experiences from CLM implementation in Zimbabwe, highlighting lessons and opportunities for improvement.&lt;/p&gt;&lt;p&gt;As highlighted in Table 1, between 2023 and 2025, CLM improved access to HIV/AIDS services, enhanced healthcare staff attitudes and strengthened linkages between healthcare facilities and communities. CLM has been instrumental in resolving stock-outs and promoting differentiated service delivery. Neve","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272817","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":"Put rights at the centre of person- and people-centred HIV prevention","authors":"Megan McLemore,&nbsp;Joseph J. Amon","doi":"10.1002/jia2.70028","DOIUrl":"https://doi.org/10.1002/jia2.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>“Person-centred” and “people-centred” HIV prevention programmes both seek to scale up access to HIV prevention services. A “person-centred” approach presents a vision of a client with agency in decision-making, engaged and empowered, working with providers in a process that is not disease-centric but focused on addressing, holistically, a client's needs. A “people-centred” approach recognizes the broader role of family and community, as well as the influence of the political and legal environment as barriers or facilitators to HIV services. In both cases, human rights are a critical determinant of positive or negative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>In 2017, the Global Fund's <i>Breaking Down Barriers</i> initiative funded baseline assessments in 20 countries examining key human rights barriers to HIV services. Subsequent evaluations in 2019–2021 and 2022–2024 focused on the scale-up of community-led human rights interventions and the impact of these programmes on access to HIV prevention and care. Results from the latest assessment describe a range of strategies and impact across diverse countries, settings and populations. For example, in Indonesia, transgender-led organizations catalysed a national drive to allow transgender persons to receive gender-matched identity cards, allowing thousands of individuals to access HIV prevention and treatment and broader social benefits. In Mozambique, peer-led paralegals and community advocates promoted legal literacy and assisted clients with claims of human rights violations, preventing access to HIV services. In Jamaica, lesbian, gay, bisexual and transgender led organizations sponsored trainings that advanced community activism for HIV prevention, education and advocacy. Despite facing stigma and challenging legal environments, in each case, human rights-based programmes removed structural and legal barriers to HIV prevention services, strengthening accountability and increasing uptake and retention in HIV services, especially among marginalized and criminalized populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Community mobilization led by key populations is a long-term undertaking that requires partnership and support from a wide range of stakeholders to ensure sustainability. A growing body of evidence across a range of diverse countries and settings demonstrates the impact of rights-based and people-centred programmes on access to, and retention in, HIV prevention and treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237104","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":"Oral pre-exposure prophylaxis initiation, continuation and adherence among pregnant and postpartum women receiving antenatal and postnatal care: a systematic review","authors":"Anke Rotsaert,&nbsp;Zaynab Essack,&nbsp;Shannon Bosman,&nbsp;Dvora Joseph Davey,&nbsp;Bernadette Hensen","doi":"10.1002/jia2.70035","DOIUrl":"https://doi.org/10.1002/jia2.70035","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 2023, one-fourth of new HIV acquisitions in children globally resulted from vertical transmission following incident HIV during pregnancy or breastfeeding. Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil and emtricitabine is safe and effective in pregnancy and postpartum, with long-acting options emerging. Integrating PrEP into antenatal and postnatal care (ANC/PNC) is a crucial person-centred approach to prevent maternal HIV acquisition and vertical transmission. This review summarizes oral PrEP initiation, continuation and adherence among pregnant and postpartum women receiving ANC/PNC.&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 systematically searched three databases for English-language quantitative studies published between 1 January 2015 and 28 March 2024. Eligible studies focused on pregnant and/or postpartum women accessing PrEP through ANC/PNC, and reported on initiation (receipt of prescription or self-reported use), continuation (persistent use over time) and/or adherence (self-reported and/or objective).&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 identified 481 articles; 12 studies from Kenya, Lesotho, Malawi and South Africa met our inclusion criteria. Study heterogeneity (e.g. definitions used, population included, follow-up time) precluded meta-analysis. All studies enrolled pregnant women; three also enrolled postpartum women. Median gestational age at enrolment ranged from 20 to 26 weeks, and follow-up periods from 1 month post-enrolment to 12 months postpartum. Oral PrEP initiation ranged from 14% to 84%. Continuation at 3 months ranged from 22% to 90% and declined postpartum in all studies. Self-reported adherence (daily use) ranged from 11% to 81% in the past 7 or 30 days at 1 month (four studies) and from 54% to 81% at 3 months (two studies). Objectively measured adherence ranged from 34% to 62% for detectable tenofovir or tenofovir diphosphate levels at 1 month (three studies). One Kenyan trial demonstrated that universal versus risk-based offers of oral PrEP resulted in similar PrEP use and HIV incidence. Two-way SMS communication (Kenya) and real-time adherence biofeedback counselling using urine tenofovir testing (South Africa) enhanced PrEP continuation/adherence compared to standard-of-care.&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;Integrating oral PrEP into ANC/PNC showed high initiation among pregnant/postpartum women; however, continuation and adherence were suboptimal.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237232","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":"Laser hair removal to antiretrovirals: findings from a person-centred care model for transgender people in India","authors":"Simran Shaikh,&nbsp;Parthasarathy Mugundu Ramien,&nbsp;Jade Bell,&nbsp;Kanchan Pawar,&nbsp;Allison M. McFall,&nbsp;Saya Okram,&nbsp;Ajay Enugu,&nbsp;Lakshmi Ganapathi,&nbsp;Maria Salvat Ballester,&nbsp;Viswanathan Arumugam,&nbsp;Rose Pollard Kaptchuk,&nbsp;Aditya Singh,&nbsp;Shantanu Kumar Purohit,&nbsp;Alex Keuroghlian,&nbsp;Kevin Ard,&nbsp;Shruti H. Mehta,&nbsp;Sukhvinder Kaur,&nbsp;Kenneth H. Mayer,&nbsp;Sunil Suhas Solomon","doi":"10.1002/jia2.70041","DOIUrl":"https://doi.org/10.1002/jia2.70041","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;Transgender women (TGW) in India continue to bear disproportionate HIV burden and face persistent social, legal and structural barriers to receive gender-affirming 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;Since 2021, we established three “&lt;i&gt;Mitr&lt;/i&gt;” (meaning: friend) clinics in Hyderabad, Pune and Thane, India, for transgender people with staffing primarily from the community. &lt;i&gt;Mitr&lt;/i&gt; clinics provide free HIV testing and pre-exposure prophylaxis (PrEP) on site with linkage to government antiretroviral therapy (ART) centres. They also provide free consultation for gender-affirming hormone therapy (GAHT), subsidized laser hair removal and legal assistance. Client service utilization data were analysed using summary statistics to evaluate uptake of HIV and gender-affirming services; correlates of HIV testing were examined using logistic regression. Semi-structured interviews conducted at one site were used to understand barriers/facilitators of HIV testing.&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 5223 unique clients registered between March 2021 and September 2024; median age was 26 years. Most (86%) self-identified as TGW, and 35% reported transactional sex. Most clients (70%) had not previously accessed public sector HIV services. The majority (75%) accessed &lt;i&gt;Mitr&lt;/i&gt; clinics for gender-affirming care, including laser hair removal (53%), GAHT consultations (34%) and surgical referral (26%). Over half (62%) of clients eligible for HIV testing underwent screening, of whom 6% were newly diagnosed. Accessing &lt;i&gt;Mitr&lt;/i&gt; clinics for gender-affirming surgical services was significantly associated with HIV testing receipt (aOR: 1.51; 95% CI: 1.02, 2.25). Services provided by staff from the community were a prominent facilitator for HIV testing, while stigma and disclosure concerns were notable barriers. Among 585 clients interested in and eligible for PrEP, 576 (98%) initiated PrEP, and 378 (66%) were PrEP persistent at 3 months. Of 454 clients with HIV (newly diagnosed or previously known), 392 (86%) initiated ART. As of 30 September 2024, 233 (59%) were still receiving &lt;i&gt;Mitr&lt;/i&gt; clinic services and retained in HIV care; viral suppression was 98% among the 156 clients with data.&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 &lt;i&gt;Mitr&lt;/i&gt; model highlights the importance of aligning programme and community priorities. The provision of gender-affirming care attracted many clients who might not otherwise have accessed HIV services; indeed, laser hair removal served as the ke","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sustaining HIV prevention success in Australia through person-centred approaches","authors":"Benjamin R. Bavinton,&nbsp;James Gray,&nbsp;Andrew E. Grulich","doi":"10.1002/jia2.70007","DOIUrl":"https://doi.org/10.1002/jia2.70007","url":null,"abstract":"&lt;p&gt;Person-centred care is a critical element of HIV care. Global and country-level consensus statements, including from Australia, have emphasized holistic, rights-based approaches centring the autonomy, dignity, experiences, diverse needs, preferences and wellbeing of people living with HIV (PLHIV) [&lt;span&gt;1&lt;/span&gt;]. However, the focus has been on HIV care with less focus on person-centred prevention, despite its recent integration into the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal that 95% of individuals at risk of HIV will utilize “appropriate, person-centred, prioritised, and effective combination prevention options” by 2025 [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Drawing on the concept of person-centred care, person-centred HIV prevention [&lt;span&gt;3&lt;/span&gt;] prioritizes individuals – their autonomy, dignity, rights, decisions and experiences – over interventions or risk categories. It recognizes that individuals are best placed to determine suitable prevention methods, respecting their personal choice and agency. This approach acknowledges the dynamic nature of needs and choices, shaped by personal, contextual and structural factors, such as stigma, discrimination, criminalization and socio-economic conditions. It requires services to be appropriate, responsive and accessible, particularly for marginalized communities facing barriers to care.&lt;/p&gt;&lt;p&gt;Australia has achieved considerable success in HIV prevention, and has an ambitious goal to virtually eliminate HIV transmission by 2030 [&lt;span&gt;4&lt;/span&gt;]. In gay, bisexual and other men who have sex with men (GBMSM) in certain urban areas, reductions in HIV diagnoses are approaching the UNAIDS 2030 goal of a 90% reduction from a 2010 baseline [&lt;span&gt;5&lt;/span&gt;]. Nonetheless, disparities are evident, particularly among overseas-born GBMSM and those residing outside inner-city suburbs. While nationwide HIV diagnoses decreased by 54% in Australian-born GBMSM between 2010 and 2023, there was a 55% increase in migrant GBMSM, and by 2023, 59% of all GBMSM diagnoses were in migrants [&lt;span&gt;6&lt;/span&gt;]. Diagnoses among sex workers and people who use drugs are very low, and HIV rates are also very low among heterosexuals, though those born overseas are at higher risk [&lt;span&gt;6&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Community and community-based organizations (CBOs) have long been integral to HIV prevention, and play an essential role in understanding, articulating and advocating for the needs and preferences of communities affected by HIV [&lt;span&gt;7&lt;/span&gt;]. Referred to in Australia as the “partnership approach” [&lt;span&gt;8&lt;/span&gt;], collaboration between community, government, policymakers, clinicians and researchers has ensured that communities affected by HIV are key players in decision-making. Despite occasional fluctuations, there has been sustained investment in Australia's HIV-focused CBOs, including support to diversify their remit to encompass broader elements of LGBTQ+ health, other blood-borne viruses and/or sexually transmitted infec","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237384","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}