Journal of the International AIDS Society最新文献

{"title":"A modified pharmacy provider-led delivery model of oral HIV pre- and post-exposure prophylaxis in Kenya: a pilot study extension","authors":"Stephanie D. Roche, Victor Omollo, Peter Mogere, Magdaline Asewe, Stephen Gakuo, Preetika Banerjee, Kendall Harkey, Monisha Sharma, Jillian Pintye, Melissa Latigo Mugambi, Parth Shah, Josephine Odoyo, Patricia Ong'wen, Daniel Were, Elizabeth A. Bukusi, Kenneth Ngure, Katrina F. Ortblad","doi":"10.1002/jia2.26467","DOIUrl":"https://doi.org/10.1002/jia2.26467","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Private pharmacies in Africa reach individuals with ongoing and periodic HIV risk, yet few countries currently leverage pharmacies as an HIV service delivery platform. We conducted a 6-month pilot to evaluate a model for pharmacy provider-led delivery of HIV pre- and post-exposure prophylaxis (PrEP and PEP) in Kenya.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>At 12 private pharmacies in Kisumu and Kiambu Counties, licensed pharmacy providers initiated and managed eligible clients ≥18 years on PrEP and PEP under remote clinician supervision (NCT04558554); four of these pharmacies additionally offered sextually transmitted infection (STI) testing. PrEP/PEP clients were scheduled for follow-up 1 month later and then quarterly (PrEP clients only). Primary outcomes included PrEP and PEP initiation and continuation during the pilot period. Client and providers rated the model across multiple constructs of acceptability and feasibility from established frameworks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From January to July 2022, 1028 clients interested in PrEP, PEP and/or STI testing were screened and 829 initiated one or more service: 661 PrEP, 162 PEP and 52 STI testing. About half of clients (48%, 398/829) were male, most were unmarried (78%, 644/829) and PrEP-naïve (89%, 737/829), and the median age was 25 years (IQR 22–31). Most PrEP clients reported inconsistent condom use (88%, 581/661) or sex with partners of unknown HIV status (70%, 460/661) in the past 6 months. Most PEP clients reported condomless sex (48%, 78/162) or a condom break (46%, 75/162) in the past 72 hours; 4% (6/162) reported sexual assault. Among PrEP clients eligible for a refill, 73% (479/658) refilled at least once and 60% (197/328) twice. Among PEP clients eligible for follow-up, 44% (65/148) completed follow-up HIV testing and 20% (30/148) transitioned to PrEP. Among STI clients, 19% (10/52) tested positive for gonorrhoea (<i>n</i> = 7) and/or chlamydia (<i>n</i> = 5). Most clients and providers (≥92%) found the delivery model and its implementation strategies acceptable. All providers (<i>n</i> = 12) thought it was possible to deliver PrEP and PEP at pharmacies in Kenya.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pharmacy PrEP/PEP delivery achieved high uptake, continuation and acceptability among eligible clients that could benefit, highlighting the potential of pharmacies to expand HIV prevention service coverage in Kenya, particularly to individuals not accessing these services at clinics.</p>\u0000 </sect","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S1","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26467","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144492584","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":"Age-specific all-cause mortality rates among adolescents and youth living with and without HIV: Evidence from a cohort study in South Africa","authors":"Siyanai Zhou,&nbsp;Elona Toska,&nbsp;Bulelani Gwampi,&nbsp;Leigh F. Johnson,&nbsp;Janke Tolmay,&nbsp;Wylene Saal,&nbsp;Zea Leon,&nbsp;Lucia Knight,&nbsp;Lucie Cluver","doi":"10.1002/jia2.26522","DOIUrl":"https://doi.org/10.1002/jia2.26522","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Mortality among adolescents living with HIV (ALHIV) remains a global health problem. We lack granular (age- and sex-disaggregated) data on mortality among ALHIV, hence, this study aims to assess all-cause mortality among ALHIV in a low-resource setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All adolescents ever initiated on antiretroviral treatment (ART, <i>N</i> = 1107) and their HIV-negative peers (<i>N</i> = 456) aged 10–19 years, recruited as part of the Mzantsi Wakho study cohort, were followed up between 2014 and 2022 (yielding 12,427.7 person-years of follow-up). First, we assessed the proportion of deaths and estimated crude mortality incidence rates per 100 person-years of follow-up and their 95% confidence intervals, stratified by HIV status, sex and mode of HIV acquisition (vertical vs. sexual). We then estimated adjusted incidence rate ratios (IRRs) using Poisson regression adjusted for time-varying age, sex and time on ART. Last, we used the Cox proportional hazards regression model to estimate the risk of death by ART adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1563 adolescents and young people were included in this analysis, 70.8% ALHIV and 57% female. More deaths occurred in ALHIV compared to their HIV-negative peers (8.3% vs. 0.4%, <i>p</i>&lt;0.001). Among ALHIV, we observed a significantly higher proportion of deaths among males compared to females (10.7% vs. 7.1%, <i>p</i> = 0.036). Overall, mortality increased significantly with age, and males had a higher risk of mortality compared to females. Adolescents and youth living with vertically acquired HIV had a higher risk of mortality than those living with sexually acquired HIV. Comparing mortality rates by mode of HIV acquisition stratified by age and sex, mortality risk was higher among females aged 20+ years with vertically acquired HIV (IRR: 3.61, 95% CI 1.48–8.82) compared to females with sexually acquired HIV of the same age group. In a sub-sample analysis, sustained ART adherence was associated with a lower risk of death (aHR: 0.44, 95% CI 0.23–0.85).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>ALHIV experience higher all-cause mortality than their HIV-negative peers, despite having initiated ART. Among ALHIV, mortality risk was higher among males and adolescents who acquired HIV vertically. Strategies to improve survival among ALHIV, including adolescent-tailored care and support for adherence to ART, are urgently needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26522","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144473117","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 unintended outcome: a retrospective cross-sectional study using a urine lateral flow assay to detect ART use reveals non-disclosure of taking ART in South Africa's public health system","authors":"Nsika Sithole,&nbsp;Indira Govender,&nbsp;Matthew Spinelli,&nbsp;Theresa Smit,&nbsp;Siyabonga Cibane,&nbsp;Mlungisi Zwane,&nbsp;Njabulo Phakathi,&nbsp;Meighan Krows,&nbsp;Busisiwe Nkosi,&nbsp;Janet Seeley,&nbsp;Ruanne V. Barnabas,&nbsp;Mark J. Siedner,&nbsp;Mosa Moshabela,&nbsp;Connie Celum,&nbsp;Alison Grant,&nbsp;Monica Gandhi,&nbsp;Adrienne E. Shapiro","doi":"10.1002/jia2.26515","DOIUrl":"https://doi.org/10.1002/jia2.26515","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Differentiated service delivery (DSD) models for HIV and tuberculosis (TB) care prioritize efficient resource allocation and targeted interventions, and benefit from accurate assessment of patients’ antiretroviral therapy (ART) pill-taking status. Accurate ART use identification is essential for ensuring proper care transition services rather than unnecessary initiation. A point-of-care urine tenofovir (TFV) assay may identify undisclosed ART use in settings with high rates of TB and HIV coinfection.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A cohort of people living with HIV (PWH) presenting for routine care, including newly diagnosed and those returning to care, and reporting no ART use within 90 days, was enrolled in a clinic-based cross-sectional study of TB prevalence which tested for TB using sputum and urine-based TB tests in two clinics in KwaZulu-Natal, South Africa. CD4 counts were determined at the time of ART initiation, per national guidelines. A novel urine-based lateral flow assay (LFA) which detects TFV ingested within the past 4–7 days was used to assess ART use from thawed urine samples, which were collected concurrently with the self-report assessment. Conditional logistic regression models assessed predictors of ART non-disclosure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 12/2021 and 5/2024, 404 PWH (40% male) reporting no recent ART use presented for ART initiation. TB testing identified 14 (3%) PWH with undiagnosed TB. Seventy-nine (20%) had detectable TFV in urine indicating undisclosed ART use, with a median CD4 count of 466 cells/mm³ (IQR 277–625) compared to 322 cells/mm³ (IQR 175–490, <i>p</i> = 0.001) in those without undisclosed ART use. In a multivariable model, undisclosed ART use was associated with older age, rural clinic site, higher CD4 count and having active TB, but not with gender, education or employment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Among people presenting for HIV treatment initiation, 20% had evidence of ART use within 4–7 days by TFV urine LFA testing. Integration of point-of-care urine TFV assays into DSD models of HIV care may support providers to engage PWH about treatment challenges, address potential barriers to disclosure and facilitate seamless transfers between clinics. If successful, this strategy may reduce duplicative care entries and promote more efficient use of resources.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26515","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144367411","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":"Effectiveness of islatravir post-exposure prophylaxis after intravenous challenge with simian immunodeficiency virus in rhesus macaques","authors":"Martin Markowitz,&nbsp;Agegnehu Gettie,&nbsp;Leslie St. Bernard,&nbsp;Brooke Grasperge,&nbsp;Ryan Vargo,&nbsp;Michelle Pham,&nbsp;Kerry Fillgrove,&nbsp;Neal Dube,&nbsp;Tracy L. Diamond,&nbsp;Daria J. Hazuda,&nbsp;Jay A. Grobler","doi":"10.1002/jia2.26507","DOIUrl":"https://doi.org/10.1002/jia2.26507","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Islatravir (ISL) is a nucleoside reverse transcriptase translocation inhibitor (NRTTI) with robust antiretroviral activity. The efficacy of ISL administered for post-exposure prophylaxis (PEP) was evaluated in a simian immunodeficiency virus (SIV) rhesus macaque intravenous (IV) challenge model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twelve rhesus macaques were challenged with SIVmac251 via IV administration. After 24 hours, six animals received ISL 3.9 mg/kg (the minimum effective dose that gives maximal protection) and six animals were untreated controls. In stage 1, treated animals received 4 weekly oral doses of ISL and were monitored for SIV infection for 7 weeks after the last dose. In stage 2, uninfected, treated animals from stage 1 were challenged similarly; 24 hours after challenge, 3 weekly oral doses of ISL 3.9 mg/kg were initiated. The treated animals were monitored for 7 weeks, as in stage 1. Uninfected, treated animals (from stage 2) entered stage 3. In stage 3, the animals were challenged as in stage 2; 24 hours after challenge, 2 weekly oral doses of ISL 3.9 mg/kg were initiated. The treated animals were monitored for 7 weeks, as before. Finally, in stage 4, uninfected, treated animals were challenged using IV administration and 24 hours later were treated with a single oral dose of ISL 3.9 mg/kg and monitored for 7 weeks. Infection was monitored through plasma viral RNA and proviral DNA amplification. Virus-specific antibody responses were measured using a commercial assay. ISL concentrations in plasma and ISL triphosphate (ISL-TP) levels in peripheral blood mononuclear cells were measured longitudinally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All untreated controls were viraemic 7 days after SIVmac251 IV challenge. All six ISL-treated animals were completely protected in stages 1–3 (Fisher exact test <i>p</i> = 0.0022). In stage 4, two of six ISL-treated animals became infected with wild-type SIVmac251: viraemia was observed at days 14 and 49 in the two animals (Fisher exact test <i>p</i> = 0.06). Both animals had unquantifiable ISL-TP on the day viraemia was observed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Two weekly oral doses of ISL 3.9 mg/kg, administered 24 hours post IV SIV exposure, prevents infection of rhesus macaques. These results support further investigation of a long-acting oral NRTTI for PEP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26507","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315261","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":"Factors associated with awareness of and willingness to use PrEP among stable, heterosexual HIV-serodifferent couples in seven African countries, 2019–2022","authors":"J. Danielle Sharpe,&nbsp;Rebecca L. Laws,&nbsp;Christine A. West,&nbsp;Gaston Djomand,&nbsp;Jared Omolo,&nbsp;Dinah Ramaabya,&nbsp;Michelle Li,&nbsp;Sindisiwe Dlamini,&nbsp;Maletsatsi Motebang,&nbsp;Nthuseng Marake,&nbsp;Victor Singano,&nbsp;Washington Ozituosauka,&nbsp;Carter McCabe,&nbsp;Isabel Sathane,&nbsp;Nzali Kancheya,&nbsp;Tina Chisenga,&nbsp;Rickie Malaba,&nbsp;Getrude Ncube,&nbsp;Neena M. Philip,&nbsp;Samuel Biraro,&nbsp;Man E. Charurat,&nbsp;Italia Rolle,&nbsp;Andrew C. Voetsch","doi":"10.1002/jia2.26446","DOIUrl":"https://doi.org/10.1002/jia2.26446","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;HIV pre-exposure prophylaxis (PrEP) is an effective biomedical intervention for preventing HIV; however, PrEP adoption initially lagged across sub-Saharan Africa (SSA) and may have been affected by barriers to engagement in PrEP care. Stable, heterosexual HIV-serodifferent couples are a priority population of PrEP expansion efforts. We assessed factors associated with PrEP awareness and willingness among HIV-serodifferent couples in SSA to guide PrEP interventions for this population.&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 cross-sectional analysis using pooled data from nationally representative, two-stage cluster sampling, HIV-focused household surveys completed during 2019–2022 in seven African countries. We analysed data from 1738 persons without HIV aged ≥15 years in stable, heterosexual HIV-serodifferent couples and included clinical information from their partners with HIV. Higher HIV risk was defined by unawareness of a partner's HIV-positive status or having a partner with an unsuppressed viral load (≥200 copies/ml). Lower HIV risk was defined by awareness of a partner's HIV-positive status and having a partner with a suppressed viral load (&lt;200 copies/ml). We conducted multivariable logistic regression using survey weights and jackknife variance estimation to assess factors associated with PrEP awareness and willingness.&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, 18.1% were aware of PrEP, 69.1% were willing to use PrEP and 5.1% had ever used PrEP. Forty-four percent had higher HIV risk. Higher odds of PrEP awareness were associated with being female (adjusted odds ratio [aOR]: 1.73; 95% confidence interval [CI]: 1.15–2.59), secondary education or higher (aOR: 6.42; 95% CI: 2.97–13.91) and lower HIV risk (aOR: 1.58; 95% CI: 1.00–2.48). Higher odds of PrEP willingness were associated with employment in the past year (aOR: 1.55; 95% CI: 1.01–2.37), previous PrEP awareness (aOR: 2.44; 95% CI: 1.36–4.36) and lower HIV risk (aOR: 1.70; 95% CI: 1.07–2.70).&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;Persons in stable, heterosexual HIV-serodifferent couples with lower HIV risk were more aware of and willing to use PrEP than those with higher risk. Our findings highlight the importance of encouraging HIV status disclosure, educating about HIV-serodifference and PrEP, and providing PrEP linkage during HIV testing and prevention counselling to increase PrEP awareness, willingness and use among HIV-serodifferent couples in SSA.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26446","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144315260","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":"Characterizing the HIV care continuum among children and adolescents with HIV in eastern and southern Africa in the era of “Universal Test and Treat”: A systematic review and meta-analysis","authors":"Nel Jason L. Haw,&nbsp;Marcela Banegas,&nbsp;Sita Lujintanon,&nbsp;Lee Fairlie,&nbsp;Mutsa Bwakura-Dangarembizi,&nbsp;Allison Agwu,&nbsp;Derek K. Ng,&nbsp;Catherine R. Lesko","doi":"10.1002/jia2.26526","DOIUrl":"https://doi.org/10.1002/jia2.26526","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 “Universal Test and Treat” (UTT) era for antiretroviral therapy (ART) increased HIV service delivery to children and adolescents aged 0–19 with HIV. The goal is to reach ≥95% of people with HIV diagnosed, receiving ART and virally suppressed. We conducted a systematic review and meta-analysis to describe the care continuum among children and adolescents with HIV during the UTT era in the UNAIDS eastern and southern African region.&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 searched PubMed, EMBASE and African Index Medicus databases for peer-reviewed articles published from 1 January 2010 to 1 June 2023. We included studies reporting ≥1 care continuum proportion in ≥1 country in the study region during the country's UTT implementation. We extracted summary proportions and pooled them using random-effects logistic regression.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of 10,281 studies screened, 190 met the inclusion criteria. Studies came from 16 countries; many from South Africa (&lt;i&gt;n&lt;/i&gt; = 37) and Ethiopia (&lt;i&gt;n&lt;/i&gt; = 32). The meta-analysis pooled proportions (95% confidence intervals) for children aged 0–14 were: 72% (60%, 81%) aware of HIV diagnosis; 95% (89%, 97%) on ART among diagnosed; 88% (76%, 95%) retained in HIV care after 12 months on ART; 77% (68%, 84%) self-/caregiver-reported ART adherence; 90% (79%, 95%) had a viral load test after ART initiation; and 76% (72%, 79%) viral suppression (&lt;1000 copies/ml) while on ART with a viral load test. Similar proportions were estimated among adolescents aged 15–19: 73% (66%, 79%) diagnosed; 93% (92%, 94%) on ART; 80% (54%, 93%) retained; 74% (63%, 83%) adherent; 90% (79%, 95%) viral load test; and 78% (74%, 81%) viral suppression.&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;Estimates from this study on diagnosis, ART initiation and viral suppression were consistent with UNAIDS official estimates. Estimates on retention, adherence and viral suppression were similar to previous meta-analyses conducted before UTT.&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;Consistent with UTT expectations, most children and adolescents with HIV in eastern and southern Africa have initiated ART, but challenges remain on other care continuum indicators. Future planning for HIV programmes should consider locally informed, community-supported approaches to consistently support children and adolescents with HIV throughout the HIV care continuum.&lt;/p&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144281376","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":"REPRIEVE final results: What does it mean for guidelines in low- and middle-income countries?","authors":"Simiso Sokhela,&nbsp;Jennifer M. Manne-Goehler,&nbsp;Samanta Lalla-Edward,&nbsp;Mark J. Siedner,&nbsp;Mohammed K. Ali,&nbsp;Andrew Hill,&nbsp;Aaloke Mody,&nbsp;Anton Pozniak,&nbsp;Jeremy Nel,&nbsp;W. D. Francois Venter","doi":"10.1002/jia2.26525","DOIUrl":"https://doi.org/10.1002/jia2.26525","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The REPRIEVE study demonstrated significant reductions in major adverse cardiovascular events (MACE) with pitavastatin among people living with HIV (PWH) with low to moderate cardiovascular risk. Most MACE events occurred in higher-income countries, raising important considerations for similar primary prevention interventions within HIV programmes in low- and middle-income countries (LMICs) as antiretrovirals become safer and as PWH age.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Limited data from Africa and within REPRIEVE suggests that MACE may not be as prevalent among PWH as within other geographies. Consequently, there remain questions about the appropriateness of extrapolating REPRIEVE data to the region and whether it should motivate programmatic implementation on the continent. Moreover, glucose and lipid screening used in REPRIEVE raise concerns about additional resources for similar screening, where there is little existing infrastructure and subsequent treatment. Similarly, questions around funding priorities, and health worker resource allocation for MACE prevention, particularly in the context of competing health priorities and limited health financing, need to be addressed. Newer cardiovascular medications, with cardiac, renal, hepatic, diabetes and weight loss benefits, may have greater promise, although cost remains a major concern. Finally, successful implementation with statins or other proven interventions will be unlikely, unless systemic change within non-communicable disease health system delivery programmes occurs first. However, HIV programmes and public health systems more generally have shown themselves to be poor at screening and treating other cardiovascular risk factors, including aspects as simple as raised blood pressure, even in high-income countries, and statins remain grossly under-prescribed for primary and secondary prevention internationally.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>REPRIEVE turned a spotlight on how ill-prepared current HIV programmes are to implement the simplest and safest primary care prevention interventions for cardiometabolic disease within LMICs. As data for existing and new interventions become available, HIV delivery systems will need to raise their standard beyond simply prescribing antiretrovirals and taking viral loads.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26525","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144256010","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":"Correction to PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: An analysis of the PrEP APPEAL survey","authors":"","doi":"10.1002/jia2.26520","DOIUrl":"https://doi.org/10.1002/jia2.26520","url":null,"abstract":"<p>Wirawan GBS, Schmidt HM, Chan C, Fraser D, Ong JJ, Cassell M, et al. PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: an analysis of the PrEP APPEAL survey. J Int AIDS Soc. 2025;28(1):e26438. https://doi.org/10.1002/jia2.26438</p><p>In the article, the middle initial of one of the authors was incorrect and should be changed to Kimberly E. Green from Kimberly A. Green.</p><p>The online version of the article was corrected.</p><p>We apologize for this error.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26520","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144256009","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 drug resistance, early treatment outcomes and impact of guidelines compliance after protease inhibitor-based second-line failure in a dedicated resistance clinic in western Kenya: a retrospective cohort study","authors":"John M. Humphrey,&nbsp;Shamim M. Ali,&nbsp;Allison DeLong,&nbsp;Vlad Novitsky,&nbsp;Edwin Sang,&nbsp;Bilal Jawed,&nbsp;Emmanuel Kemboi,&nbsp;Celia Ngetich,&nbsp;Suzanne Goodrich,&nbsp;Adrian Gardner,&nbsp;Joseph W. Hogan,&nbsp;Rami Kantor","doi":"10.1002/jia2.26523","DOIUrl":"https://doi.org/10.1002/jia2.26523","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;Data on drug resistance, viral outcomes and guidelines compliance following protease inhibitor (PI)-based second-line failure in low- and middle-income countries are limited, particularly in the era of dolutegravir-containing antiretroviral therapy (ART).&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 retrospective cohort study of people living with HIV (PLWH) ≥3 years old with second-line viral failure (VF, ≥1000 copies/ml) at the Academic Model Providing Access to Healthcare from 2011 to 2021. We assessed resistance prevalence and patterns at second-line VF, stratified by PI (atazanavir/ritonavir or lopinavir/ritonavir), and examined correlations of resistance and treatment strategies with VF at 6–18 months post-genotype. Analyses employed inverse probability weighting, adjusting for calendar year, age, gender, ART duration, PI at genotyping and class-specific resistance, and considered guidelines-supported versus unsupported strategies.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of 187 participants (median age 41 years, 54% female, 41% on atazanavir/ritonavir, 59% on lopinavir/ritonavir-based ART), 91% had any resistance (NRTI 79%, NNRTI 80%, major PI 37%, dual-class 36%, triple-class 37%). Predicted resistance to third-line options was 67% for etravirine or rilpivirine and 10% for darunavir/ritonavir. Despite higher resistance detected on atazanavir/ritonavir versus lopinavir/ritonavir, predicted darunavir/ritonavir resistance was similar. At median 9 months post-genotype, 95% of 173 participants with available data were on a guidelines-supported regimen (55% second-line; 45% third-line, 86% dolutegravir-based), of whom 28% had post-genotype VF. Of the 5% not on guidelines-supported regimens, 71% had post-genotype VF. Adjusted odds of VF were higher for guidelines-unsupported versus supported regimens (OR = 4.52; 95% CI 1.02−26.24), and odds of VF were 97% lower for those on third-line versus second-line (OR = 0.07; 95% CI 0.02−0.20).&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;We found high levels of drug resistance and early VF following PI-based second-line failure in Kenya. Treatment guidelines compliance and switches to third-line, even within guidelines recommendations, improved early viral outcomes. Findings highlight the vulnerability of PLWH with advanced ART experience and resistance profiles, and the importance of following guidelines and improving access to third-line and drug resistance testing, particularly in the new ART era.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26523","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144244599","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":"Household economic impact of HIV-associated cryptococcal meningitis in five countries in Southern and Eastern Africa","authors":"David S. Lawrence,&nbsp;Charles Muthoga,&nbsp;Jack Adams,&nbsp;Antoinette Buhle Ndweni,&nbsp;David R. Boulware,&nbsp;Chimwemwe Chawinga,&nbsp;Kyla Comins,&nbsp;Eltas N. Dziwani,&nbsp;Admire Hlupeni,&nbsp;Mina C. Hosseinipour,&nbsp;Samuel Jjunju,&nbsp;Cecilia Kanyama,&nbsp;Tshepo B. Leeme,&nbsp;Graeme Meintjes,&nbsp;David B. Meya,&nbsp;Mosepele Mosepele,&nbsp;Melanie Moyo,&nbsp;Henry C. Mwandumba,&nbsp;Conrad Muzoora,&nbsp;Chiratidzo E. Ndhlovu,&nbsp;Edwin Nuwagira,&nbsp;Charlotte Schutz,&nbsp;Lillian Tugume,&nbsp;Darlisha Williams,&nbsp;Síle F. Molloy,&nbsp;Timothée Boyer-Chammard,&nbsp;Nabila Youssouf,&nbsp;Shabbar Jaffar,&nbsp;Louis W. Niessen,&nbsp;Thomas S. Harrison,&nbsp;Lucy Cunnama,&nbsp;Joseph N. Jarvis,&nbsp;the AMBITION Study Group","doi":"10.1002/jia2.26441","DOIUrl":"https://doi.org/10.1002/jia2.26441","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;HIV-associated cryptococcal meningitis is the second leading cause of AIDS-related mortality. Cryptococcal meningitis is a poverty-related disease and the majority of cases occur in settings where resources are limited and access to quality care is often linked to an individual's ability to pay for services. We have previously demonstrated the efficacy, safety and cost-effectiveness of a single, high-dose liposomal amphotericin-based treatment regimen within the AMBITION-cm trial. Here, we present a five-country, within-trial analysis exploring the household economic impact of cryptococcal meningitis.&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;Eight hundred and ten participants were recruited into this sub-study in Botswana, Malawi, South Africa, Uganda and Zimbabwe between January 2018 and February 2021. We collected data on annual household expenditure, direct costs and indirect costs incurred prior to enrolment and during the 10-week trial period. Costs were inflated and converted to 2022 USD. We calculated out-of-pocket expenditure, lost income and catastrophic healthcare expenditure, defined as costs exceeding 20% of annual household expenditure.&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 average total out-of-pocket expenditure plus lost income prior to enrolment was $132 and 17.9% (145/810, 95% CI 15.3–20.5) of participant households had already experienced catastrophic healthcare expenditure. Among the 592 surviving participants, when combining out-of-pocket expenditure and lost income, the average cost was $516 and 29.1% of annual household expenditure across all countries, ranging from $230 (7.6%) in South Africa to $592 (64.2%) in Zimbabwe. More than half (296/581, 51.0%, 95% CI 46.9–55.0) of households experienced catastrophic healthcare expenditure by the end of the trial, ranging from 16.0% (13/81, 95% CI 7.9–24.2) in South Africa to 68.1% (156/229, 95% CI 62.0–74.2) in Uganda.&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;This is the first study exploring the household economic impact experienced by those diagnosed with cryptococcal meningitis. The household economic impact of cryptococcal meningitis is high and more than half of households of individuals who survive experience catastrophic healthcare expenditure. It is likely these figures are higher outside of the research setting. This highlights the profound financial impact of this devastating infection and provides a rationale to offer financial and social protection to those affected.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26441","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144220123","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}