Journal of the International AIDS Society最新文献

{"title":"Correlates of Poor Quality of Life Among Older People Living With HIV: A Cross-Sectional Analysis of the Tanzania HIV and Aging Cohort Study","authors":"Theresia A. Ottaru, Christopher Mbotwa, Dannielle Grayer, Joan Rugemalila, Lisa R. Hirschhorn, Sylvia Kaaya, Grayson Nyamsogoro, Rosemary Kiboma, Herieth Mboya, Irene Mageni, Pilly Chillo, Edith Tarimo, Mary Clare Masters, Bethann Conover, Claudia Hawkins","doi":"10.1002/jia2.70163","DOIUrl":"https://doi.org/10.1002/jia2.70163","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Older people living with HIV (PLH) have a high multimorbidity burden that may impair quality of life (QOL). This study assessed the burden of geriatric syndromes and medical comorbidities and their association with QOL among older PLH in urban Tanzania. These results are important to understand the growing complexities of care needs in this population and inform future strategies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional analysis of baseline data from the Tanzania HIV and Aging Longitudinal Cohort Study (THALCS). Eligible participants (age ≥50 years, on anti-retroviral therapy [ART] for ≥3 years) were recruited between April and July 2024 from seven HIV care and treatment centres. Participants were excluded if pregnant or unable to consent. QOL was assessed using the WHOQOL-HIV-BREF, a 31-item tool in six domains. Domain scores were converted to a 0–100 scale, and the overall QOL score was calculated. Geriatric syndromes and medical comorbidities were assessed using standard tools. Multivariable linear regression examined the associations, adjusting for sociodemographic and HIV-related factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 400 participants (median age: 57 [IQR: 53−63] years; 50% females; ART duration: 10−19 years [60.3%]), the majority were on first-line dolutegravir-based ART (83.5%) with undetectable viral load (78.5%). The most common medical comorbidities were dyslipidaemia (80.2%), hypertension (54.5%) and overweight/obese (50.8%). Frailty (13.8%) and pre-frailty (48.3%) were observed. Median QOL score was 75.4 (IQR: 66.3−83.5), highest in physical health and spirituality domains (87.5 [IQR: 75−100] and 87.5 [IQR: 68.7−93.7]) and lowest in environmental domain 62.5 (IQR: 50−75). Males had a higher median overall QOL score than females (76.8 [IQR: 67.9−83.7] vs. 72.9 [IQR: 65.2−83.4], <i>p</i> = 0.036). Pre-frailty (β = −3.41, 95% CI: −5.64, −1.18, <i>p</i> = 0.003), mild depression (β = −7.88, 95% CI: −11.17, −4.60, <i>p</i><0.001) and moderate/severe depression (β = −19.25, 95% CI: −24.67, −13.83, <i>p</i><0.001) were associated with poorer QOL. Functional impairment showed a dose–response relationship with QOL. Increasing age (β = 0.18, 95% CI: 0.02, 0.34; <i>p</i> = 0.026) and higher income (>500,000 TZS) (β = 7.16, 95% CI: 3.10, 11.21; <i>p</i> = 0.001) were associated with better QOL.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A high prevalence of geriatric syndromes and medical comorbidities was observed among older PL","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 7","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70163","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148467531","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":"What Tools Do We Have to End the US HIV Epidemic? A Review of Structural, Biomedical and Implementation Interventions and Their Potential Population Impact","authors":"Micah Piske,&nbsp;Brenda Carolina Guerra-Alejos,&nbsp;Minh Tri Van,&nbsp;Benjamin Enns,&nbsp;Melanie G. Medina,&nbsp;Xiao Zang,&nbsp;Wendy S. Armstrong,&nbsp;Czarina Behrends,&nbsp;Carlos del Rio,&nbsp;Eva Enns,&nbsp;Elvin H. Geng,&nbsp;Matthew R. Golden,&nbsp;Brandon D. L. Marshall,&nbsp;Shruti H. Mehta,&nbsp;Lisa R. Metsch,&nbsp;Bruce R. Schackman,&nbsp;Steffanie A. Strathdee,&nbsp;Hansel E. Tookes,&nbsp;Bohdan Nosyk,&nbsp;the Localized Economic Modeling group","doi":"10.1002/jia2.70146","DOIUrl":"10.1002/jia2.70146","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The United States Ending the HIV Epidemic (EHE) initiative was always challenged by structural and implementation barriers to HIV care. On top of that, since 2025, there are additional political and policy barriers that make this goal seem increasingly difficult to achieve. This review identified evidence-based structural, implementation and biomedical interventions available to support each of the EHE pillars and estimated their potential population-level impact, accounting for potential barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a targeted literature review of US studies presenting data on efficacy or effectiveness of interventions pertaining to the EHE pillars—prevention, diagnosis, treatment and response—published as of September 2025. We searched interventions included in the US Centers for Disease Control and Prevention HIV Compendium and Response Evidence Brief, all publicly available EHE jurisdictional plans, and the peer-reviewed literature. Potential population impact of an intervention was determined as the product of its effectiveness and scale of delivery. Scale was the product of population reach, provider adoption and structural barriers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 570 studies identified, 57 met the inclusion criteria. We estimated that pre-exposure prophylaxis (PrEP) uptake could increase as much as nearly two-fold (risk ratio [RR]: 1.93, 95% CI: 1.30, 1.96) through pharmacies integrated in primary care clinics. Online HIV self-testing kits were among the most promising interventions to increase testing uptake by two-fold (RR: 1.99, 95% CI: 1.56, 2.57) Finally, a clinic-based education app offering tailored health education could result in a 45% absolute increase (RR: 1.45, 95% CI: 1.29, 1.70) in viral suppression among people living with HIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Interventions that address barriers to PrEP, HIV testing and adherence to treatment have substantial population-level impact on HIV care outcomes across EHE pillars through changing the context of how care is offered, understood and delivered.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 7","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70146","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417128","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":"Trends in Incidence and Risk Factors of HIV-Associated Disseminated Histoplasmosis in the Americas: An Observational Cohort Study","authors":"Ashley Zeoli,&nbsp;Paridhi Ranadive,&nbsp;Rodrigo Ville,&nbsp;Gabriel Castillo-Rozas,&nbsp;Pablo F. Belaunzarán-Zamudio,&nbsp;Valdiléa G. Veloso,&nbsp;Daisy M. Machado,&nbsp;Marco Tulio Luque,&nbsp;Eduardo Gotuzzo,&nbsp;Julián Garcia,&nbsp;Timothy R. Sterling,&nbsp;Bryan E. Shepherd,&nbsp;Jessica L. Castilho,&nbsp;the Caribbean, Central and South America network for HIV epidemiology (CCASAnet)","doi":"10.1002/jia2.70160","DOIUrl":"10.1002/jia2.70160","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Histoplasmosis remains a significant cause of morbidity and mortality in people with HIV . We examined disseminated histoplasmosis incidence, risk factors, and outcomes from North and South American HIV clinical sites.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Cohorts from Brazil, Chile, Honduras, Mexico, Peru and the United States (Tennessee) contributed data on PLWH ≥18 years old from 2000 to 2021. Stratifying by US and Latin American cohorts, we examined diagnosed disseminated histoplasmosis incidence and risk factors with modified Poisson regression models. Cox proportional hazard models examined factors associated with mortality after histoplasmosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 26,672 people with HIV (Latin America <i>n</i> = 19,836; United States <i>n</i> = 6836), 214 had incident histoplasmosis(Latin America <i>n</i> = 140; United States <i>n</i> = 74). From 2000 to 2021, histoplasmosis incidence decreased from 16.08 to 0.93 in Latin America and 13.4 to 0.67 per 1000 person-years in the United States. In Latin America, histoplasmosis risk was higher for males (aRR = 2.50 [95% CI: 1.62−3.86]), pre-antiretroviral therapy initiation (aRR = 7.76 [95% CI: 5.05−11.90]) and those who had migrated from a histoplasma-endemic country (aRR = 6.12 [95% CI: 1.81−20.69]). Risk was also higher for older people with HIV, those with low CD4, earlier calendar year and differed by site. In the United States, risk was higher in people with HIV with low CD4, higher HIV viral load, earlier calendar year and pre-antiretroviral therapy initiation (aRR = 2.65 [95% CI: 1.11−6.36]). Mortality after histoplasmosis was higher in people with HIV with an earlier year of histoplasmosis 2000 versus 2010 (aHR = 2.00 [95% CI: 1.26−3.17]) and among those who developed histoplasmosis after antiretroviral therapy initiation compared to before antiretroviral therapy (aHR = 2.66 [95% CI: 1.43−4.95]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite concern for underdiagnosis of disseminated histoplasmosis in Latin America, its incidence in people with HIV decreased, as it did in the United States. Low CD4 cell count and time before antiretroviral therapy initiation remain strongly associated with histoplasmosis risk. Further attention to early HIV diagnosis and treatment is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 7","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70160","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148417145","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":"Integrated Care Models for HIV, Diabetes and Hypertension in Sub-Saharan Africa: A Systematic Review of Effectiveness, Implementation and Real-World Applicability","authors":"Charuai Suwanbamrung,&nbsp;Esayas Aydiko Amele,&nbsp;Dereje Haile,&nbsp;Hien Thi Nguyen,&nbsp;Temesgen Anjulo Ageru","doi":"10.1002/jia2.70159","DOIUrl":"10.1002/jia2.70159","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Sub-Saharan Africa faces a syndemic of HIV and non-communicable diseases (NCDs), particularly diabetes and hypertension. Integrated care models have been promoted to improve service efficiency and patient outcomes; however, evidence on their effectiveness, implementation and real-world applicability remains fragmented.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Objective&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This systematic review aimed to assess the clinical and service delivery effectiveness of integrated HIV-diabetes-hypertension care models in sub-Saharan Africa and to identify key implementation barriers and facilitators, and sustainability considerations.&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 review of studies published between January 2016 and June 2026 following PRISMA 2020 guidelines. PubMed, Scopus and African Index Medicus were searched. Eligible studies included randomized controlled trials, observational, qualitative and mixed-method studies evaluating integrated care models for HIV and NCDs in sub-Saharan Africa. Data were synthesized narratively, guided by implementation science frameworks.&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;Sixteen studies from eight sub-Saharan African countries were included. Integrated care models, such as one-stop clinics, nurse-led service, adherence clubs and decentralized drug distribution, were consistently associated with high retention in care for people living with HIV (generally &gt;80%) and sustained viral suppression (&gt; 90%). Retention for diabetes and hypertension care was lower (70%–78%), and improvements in blood pressure and glycaemic control were reported but remained inconsistent and frequently suboptimal. Integrated care models improved service delivery outcomes, including appointment adherence, continuity of care and patient acceptability. Key implementation facilitators included task-shifting, co-located services, leadership support and leveraging existing HIV infrastructure. Common barriers were drug stockouts for NCDs, workforce shortages, fragmented data systems, stigma and confidentiality concerns, and long waiting times. Limited economic evidence indicates that personnel costs constituted the largest share of programme expenditure. While integrated care models were feasible and acceptable in routine settings, scalability and long-term sustainability were constrained by donor dependence, supply chain weaknesses and variable health system readiness.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 7","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70159","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148389576","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":"“It Reduces Stigma Now That the Service Is Under One Roof” Women and Provider Experiences on Factors Influencing Effective Integration of Oral PrEP Delivery in Family Planning Clinics in Kenya: A Qualitative Study","authors":"Vallery Ogello,&nbsp;Kenneth Ngure,&nbsp;Sharon Mutai,&nbsp;Mercy Awuor,&nbsp;Winnie Atieno,&nbsp;Annabell Dollah,&nbsp;Cynthia Wandera,&nbsp;Daniel Matemo,&nbsp;Jennifer F. Morton,&nbsp;John Kinuthia,&nbsp;Kenneth K. Mugwanya","doi":"10.1002/jia2.70150","DOIUrl":"10.1002/jia2.70150","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;Women of childbearing age in sub-Saharan Africa continue to face a disproportionately high risk of HIV acquisition. Integrating pre-exposure prophylaxis (PrEP) into existing care platforms such as family planning (FP) services may offer a strategic opportunity to reach women at heightened risk for HIV. However, limited evidence exists on the factors influencing effective PrEP integration in FP settings.&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 November 2021 to November 2023, we conducted a qualitative study nested within a programmatic stepped-wedge implementation project to integrate oral PrEP delivery in 12 real-world public health FP clinics in Kenya (the FP-Plus Project, Clinical Trials.gov: NCT04666792). Prior to the implementation phase of the FP-Plus project, FP providers received facility-based training and mentorship to build their capacity to deliver oral PrEP as part of routine care in FP clinics. We conducted in-depth interviews with providers and women accessing FP services using semi-structured interview guides informed by the consolidated framework of implementation research. Interviews were audio-recorded with permission, transcribed and translated. We analysed data using inductive and deductive thematic analysis approaches.&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, we interviewed 48 providers offering PrEP in the FP clinics and 64 women accessing FP services. Women had a median age of 24 years (IQR, 23−30), and providers were 87% female. Overall, integration of PrEP in FP clinics was highly acceptable as it provided efficient service delivery, minimized missed opportunities, improved access to PrEP, saved time, improved privacy and reduced stigma by providing a discreet and trusted platform to access HIV prevention services. Women also expressed strong trust and confidence in FP providers to deliver PrEP services. Key reported barriers to integrating PrEP services included increased workload, physical space, frequent staff turnover, inefficient workflows, and occasional stockouts for both PrEP and FP commodities.&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;Integration of PrEP in public FP clinics in Kenya is highly acceptable to both women and providers. Women expressed high confidence and trust in FP providers to provide adequate HIV prevention care. Targeted strategies to overcome systemic barriers, such as inefficient workflows, workload and data systems, need to be defined to improve the efficiency of integrated FP and PrEP services provision.&lt;/p&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 7","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70150","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366236","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 Intersection of Human Rights, HIV and Sex Work: Implications for Ending AIDS in Thailand by 2030","authors":"Ravipa Vannakit,&nbsp;David Clarke,&nbsp;Surang Janyam,&nbsp;Chamrong Phaengnongyang,&nbsp;Chomnad Manopaiboon,&nbsp;Inthira Suya,&nbsp;Philippe Girault,&nbsp;Jintanat Ananworanich,&nbsp;Michael Cassell,&nbsp;R. Cameron Wolf","doi":"10.1002/jia2.70140","DOIUrl":"10.1002/jia2.70140","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;Sex work significantly shapes the Thai economy and the HIV epidemic, yet its criminalization restricts access to health services and exacerbates human rights violations. This study examines experiences of stigma, discrimination, gender-based violence (GBV) and incarceration among sex workers (SWs), exploring how these factors intersect with HIV services. This research is a component of a larger study investigating factors associated with pre-exposure prophylaxis (PrEP) uptake among SWs in Thailand.&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 post hoc analysis of a cross-sectional survey (September–December 2023) of 1511 Thai SWs recruited through convenience and quota sampling in seven provinces. Eligible participants were adults who self-reported HIV-negative or unknown status and had exchanged sex in the past 3 months. Trained peers administered anonymous face-to-face questionnaires covering demographics, work characteristics, HIV service utilization, stigma and discrimination, GBV, and PrEP. Descriptive statistics and bivariable and multivariable logistic regression were used to examine factors associated with past-year human rights violations.&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;41.3% of SW participants reported experiencing at least one human rights violation, including stigma, discrimination, GBV and incarceration. Specifically, 18.1% experienced stigma and 35.8% reported GBV within the past year. Male sex workers (MSWs), transgender women sex workers (TGSWs), younger individuals, people who use drugs and those with a history of incarceration were the most affected groups. Geographical location was strongly correlated with these violations. A lack of human rights protections contributed to low uptake of HIV testing and sexually transmitted infection (STI) screening. PrEP uptake was critically low across all SW sub-populations: 14.8% for TGSWs, 13.9% for MSWs and only 1.3% for female sex workers (FSWs).&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;A human rights approach to HIV and sex work is indispensable to ending AIDS. Criminalization, stigma, discrimination and GBV intersect to produce layered vulnerability among different SW populations in Thailand, with TGSWs particularly affected. These structural conditions negatively shape access to HIV testing, STI screening and HIV prevention services, including PrEP. The findings reinforce that punitive legal environments and social stigma directly undermine HIV prevention efforts. Addressing the stigmatisation and human rig","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 7","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70140","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148366254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"HIV Care Retention and Cost Analysis in Multi-Month ART Dispensing: A Randomized Controlled Trial in China","authors":"Wenqi Shang,&nbsp;Yanyan Zhu,&nbsp;Ying He,&nbsp;Xiaolin Li,&nbsp;Qinghai Hu,&nbsp;Hong Sun,&nbsp;Wenqing Geng,&nbsp;Hong Shang,&nbsp;Haibo Ding","doi":"10.1002/jia2.70151","DOIUrl":"https://doi.org/10.1002/jia2.70151","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;Multi-month dispensing (MMD), as a differentiated service delivery model, can reduce the frequency of clinic visits, waiting time and travel costs for clinically stable people living with HIV. This study aimed to evaluate the impact of 6-month MMD of antiretroviral therapy (ART) on retention and conduct a cost analysis in China.&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 randomized, non-blind, non-inferiority study from December 2022 to March 2023 at The First Hospital of China Medical University. Eligible participants were randomly assigned to a 3-month dispensing group (&lt;i&gt;n&lt;/i&gt; = 789) or a 6-month dispensing group (&lt;i&gt;n&lt;/i&gt; = 799) and followed up for 18 months. The proportion of patients continuing ART after 18 months, virological suppression rate (&lt;50 copies/mL) and average treatment cost per patient were evaluated. Cox regression analysis was used to compare treatment retention rates and virological suppression rates between groups, while descriptive statistical analysis was applied to assess cost differences. Cost metrics comprised the average cost per clinic visit and the price of ART medications, among other factors. This trial is registered with ChiCTR2200066438.&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 1588 participants were included (median age 40.0 years, IQR 34.0–50.0; 94.8% male), with no significant between-group differences in demographic and clinical characteristics (all &lt;i&gt;p&lt;/i&gt;&gt;0.05). In the intention-to-treat analysis, treatment retention rates at 18 months were 94.9% (749/789) in the 3-month dispensing group and 94.2% (753/799) in the 6-month dispensing group. The risk difference (6-month minus 3-month) was −0.7% (95% CI −2.9% to 1.5%); non-inferiority was demonstrated as the lower bound of the 95% CI (−2.9%) exceeded the pre-specified margin of −5%. Viral suppression rates (&lt;50 copies/mL) were similarly high in both groups in intent-to-treat analysis: 94.9% (3-month) versus 94.2% (6-month), with no statistically significant difference. Per-protocol analysis confirmed these findings (viral suppression 97.59% vs. 97.75%; χ&lt;sup&gt;2&lt;/sup&gt; = 0.0421, &lt;i&gt;p&lt;/i&gt; = 0.8375). In terms of cost, the 6-month dispensing group had two fewer annual outpatient visits (3 vs. 5), with total treatment costs reduced by 27.7% (¥931.82 vs. ¥1288.85) and work value loss decreased by 16.7% (¥174.20 vs. ¥209.04 yearly).&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;Six-month MMD of ART did not reduce treatment retention; instead, it decreased patients’ clinic visit cos","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 7","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70151","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148306115","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":"Drivers of Vertical HIV Transmission in Sub-Saharan Africa and the Impact and Cost-Effectiveness of Targeted and Universal Lenacapavir Pre-Exposure Prophylaxis","authors":"Anna Yakusik,&nbsp;Magdalene K. Walters,&nbsp;Deepak Mattur,&nbsp;Savvy Brar,&nbsp;Leigh F. Johnson,&nbsp;Gesine Meyer-Rath,&nbsp;Lise Jamieson,&nbsp;Angela Mushavi,&nbsp;John Stover,&nbsp;Mary Mahy","doi":"10.1002/jia2.70127","DOIUrl":"https://doi.org/10.1002/jia2.70127","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;Eliminating vertical HIV transmission remains a major public health priority, particularly in sub-Saharan Africa (SSA), which accounted for 83% of global paediatric HIV acquistions in 2024. Despite expanded antiretroviral therapy (ART) coverage, gaps in maternal ART access, retention and HIV acquisition during pregnancy and breastfeeding continue to drive paediatric HIV acquisitions. Long-acting injectable (LAI) lenacapavir pre-exposure prophylaxis (PrEP) may reduce paediatric HIV acquisitions by preventing maternal HIV acquisition. We evaluated drivers of vertical transmission in SSA and assessed the impact and cost-effectiveness of LAI lenacapavir PrEP among pregnant and breastfeeding women (PBW) without HIV.&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;Using 2025 UNAIDS estimates, Spectrum AIM and Naomi model outputs, we decomposed vertical HIV transmission pathways by maternal HIV acquisition timing and ART status. We modelled universal and geographically targeted rollout strategies using district-level HIV incidence thresholds among women aged 15–49 years (≥0.7%, ≥0.5% and ≥0.3%). Base-case assumptions included 65% uptake, 70% retention over 2.2 years, drug costs of US$40 per person-year plus a US$17 loading dose and service delivery costs of US$50 per person-year. Upper-bound scenarios and deterministic sensitivity analyses evaluated implementation uncertainty.&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;In 2024, an estimated 98,000 new paediatric HIV acquisitions occurred in SSA. Lack of maternal ART access accounted for 46% of vertical transmissions, while ART discontinuation during pregnancy or breastfeeding contributed 19%. Maternal HIV acquisition during pregnancy or breastfeeding accounted for 25% of paediatric HIV acquisitions, reaching 59% in South Africa and 46% in Zambia. Under base-case assumptions, universal LAI lenacapavir PrEP rollout averted approximately 56,100 HIV acquisitions at a net cost of US$85,200 per HIV acqusition averted. Geographic targeting at ≥0.7% incidence was more cost-effective, averting approximately 8450 acquisitions at a net cost of US$8530 per acquisition averted. Retention and service delivery costs were the primary determinants of cost-effectiveness.&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;Gaps in maternal ART access and retention remain the dominant drivers of vertical HIV transmission in SSA, while maternal HIV acquisition contributes substantially in high-incidence settings. Targeted LAI lenacapavir PrEP rollout among PBW without HIV could reduce ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70127","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274766","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":"Optimizing Identification and Care of Pregnant/Breastfeeding Women Living With HIV in Resource-Limited Settings","authors":"Mary Glenn Fowler,&nbsp;Victoria B. Chou,&nbsp;Philippa Musoke","doi":"10.1002/jia2.70126","DOIUrl":"https://doi.org/10.1002/jia2.70126","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;Since the mid-1990s, there have been major advances in diagnosing and providing antiretroviral therapy (ART) for pregnant women living with HIV (WLWH) in both resource-rich and resource-limited settings. Initial progress was based on the 1994 landmark perinatal trial, which showed 67% reduction in vertical transmission among infants born to non-breastfeeding mothers in the United States when zidovudine was given during pregnancy, at labour/delivery and for 6 weeks after birth.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;International perinatal trials began testing “short-course” zidovudine regimens during late pregnancy and at labour/delivery to develop cost-effective, feasible and deliverable interventions for low-resource environments. More recent research has focused on the delivery of cost-effective combination triple ART during pregnancy and breastfeeding for WLWH. The latest trial results indicate that providing lifetime maternal ART at the time of antenatal diagnosis improves overall survival and decreases morbidity, while reducing vertical transmission to &lt;1%.&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;Translation of clinical trial results into successful widescale programme implementation remains a major challenge, particularly in low- and middle-income countries with high HIV seroprevalence and weak maternal and child health infrastructure. Interventions recommended earlier in the global epidemic are no longer adequate, but key points of the perinatal cascade of services remain crucial to both ensure successful HIV care for WLWH and maximize reductions in vertical transmission. Notable progress made in Botswana and Uganda is valuable to highlight country-led successes. Rapid HIV testing for pregnant women whose status is unknown, followed by immediate implementation of lifetime maternal ART, and linkage to long-term HIV care/treatment are essential. Counselling on adherence, as well as the use of long-acting ART regimens and holistic support for women's care, including psychosocial support, are also needed. A current major challenge has been the sudden reduction in international donor funding, which has had a significant negative impact on continuity and effective delivery of HIV care/treatment services.&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;Much progress has been made in advancing HIV interventions and programmes for WLWH and pregnant and breastfeeding mothers. However, several challenges persist, which compromise delivery of effective interventions on the path to eliminate perinatal HIV transmission, and care/treatment remains suboptimal for WLWH, especially in resource-limited se","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70126","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reimagining Paediatric HIV Care: Centering Infants and Young Children in Optimized, Integrated Models of Care","authors":"Fatima Tsiouris,&nbsp;Catharina Alons,&nbsp;Madeline Maurice,&nbsp;Nilesh Bhatt,&nbsp;Natella Rakhmanina,&nbsp;Michelle M. Gill,&nbsp;Anja Giphart,&nbsp;Appolinaire Tiam","doi":"10.1002/jia2.70103","DOIUrl":"https://doi.org/10.1002/jia2.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite substantial gains in the global HIV response, infants and young children continue to experience poorer outcomes across the HIV testing and care cascade. Rates of early infant diagnosis, timely antiretroviral therapy (ART) initiation, retention in care and viral suppression remain unacceptably low in paediatric populations. These disparities are compounded by systemic challenges, including fragmented service delivery, limited availability of child-friendly ART and other drug formulations, and health systems that fail to integrate HIV services within broader maternal and child health platforms. As a result, many children living with HIV are diagnosed and start treatment late and face high risks of mortality and morbidity, particularly in the first 2 years of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>In this commentary, we advocate for the urgent reimagining of paediatric HIV service delivery, emphasizing the need to centre infants and young children within models of care. We highlight four promising approaches: (1) Integrated mother−infant follow-up models that ensure continuity of care from pregnancy through the postpartum period and infancy until the infant's final HIV status is determined; (2) Family-centred models that treat the household as the unit of care; (3) Advanced HIV care strategies tailored to the needs of children with late presentation or treatment failure, including paediatric tailored ART regimens and diagnostics; and (4) Community-based interventions that leverage peer support, lay health workers, and provide stigma-free entry points to expand access and retention to care and treatment. These approaches have demonstrated that when services are designed to reflect the developmental, clinical and social needs of children and their caregivers, outcomes significantly improve. However, many of these models remain underutilized, fragmented or inadequately resourced.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>To close the paediatric HIV treatment gap, we must move beyond pilot projects towards national, integrated and adequately funded child-centred systems. This requires political will, strategic investment and prioritization of children in HIV policy, innovation and implementation research. A sustained and equitable HIV response must include infants and young children not as an afterthought, but as a core priority. Epidemic control cannot be achieved if the youngest children are left behind.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274717","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}