Journal of the International AIDS Society最新文献

{"title":"“From an HCV and HIV point of view, it's been remarkable”: A qualitative study about using prescribed safer supply to support people who use drugs along the HIV and HCV prevention and treatment cascades in Ontario, Canada","authors":"Adrian Guta,&nbsp;Katherine Rudzinski,&nbsp;Marilou Gagnon,&nbsp;Rose A. Schmidt,&nbsp;Gillian Kolla,&nbsp;Danielle German,&nbsp;David Kryszajtys,&nbsp;Melissa Perri,&nbsp;Andrea Sereda,&nbsp;Christopher Sterling-Murphy,&nbsp;Carol Strike","doi":"10.1002/jia2.70038","DOIUrl":"https://doi.org/10.1002/jia2.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite advances in HIV and hepatitis C virus (HCV) treatment, people who use drugs (PWUD) face significant barriers along prevention and treatment cascades. Safer supply programmes (SSPs) providing prescribed pharmaceutical alternatives to the unregulated drug supply may create opportunities for enhanced healthcare engagement and person-centred care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a qualitative study examining four SSPs in Ontario, Canada between February and October 2021. Semi-structured interviews were conducted with 52 patients and 21 providers (including physicians, registered nurse practitioners, nurses and allied health professionals). Interviews explored experiences with safer supply and HIV/HCV care. Analysis used thematic techniques guided by the Consolidated Framework for Implementation Research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SSPs supported HIV/HCV care by first addressing patients’ substance use needs, which created subsequent opportunities for building trust for broader health engagement. Providers identified the safer supply model as giving PWUD something they wanted, which then opened opportunities to discuss HIV, HCV, and other sexually transmitted and blood-borne infections. SSPs provided opportunities to support patients with HIV and HCV testing and treatment initiation, and safer supply medications were bundled with HIV and HCV medications to support adherence. Non-punitive approaches helped overcome previous negative healthcare experiences by prioritizing patient autonomy. Implementation challenges included balancing flexible, patient-directed care with programme requirements and coordinating comprehensive services around individual needs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SSPs may improve HIV/HCV care delivery for PWUD by building services around their priorities and lived realities. The integration of safer supply with HIV/HCV care through daily dispensing and wraparound services showed promise for engaging people previously disconnected from care. While findings suggested improved treatment outcomes, limitations included data collection during COVID-19, limited representation of some populations and a focus on opioid-only programmes. Research examining long-term outcomes and programme sustainability is needed as SSPs face growing scrutiny and closure in Canada.</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/jia2.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237105","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":"Person-centred HIV prevention in an era of innovation and uncertainties","authors":"Andrew Mujugira,&nbsp;Iskandar Azwa,&nbsp;Marie-Claude Lavoie","doi":"10.1002/jia2.70043","DOIUrl":"https://doi.org/10.1002/jia2.70043","url":null,"abstract":"&lt;p&gt;Person-centred care (PCC) is a healthcare approach that focuses on understanding and respecting clients’ preferences, values and beliefs. It aims to empower clients by actively involving them in their own care and highlighting the importance of effective communication and relationships between providers and clients [&lt;span&gt;1-3&lt;/span&gt;]. Person-centred health systems are widely endorsed in political and policy statements as essential for addressing health system challenges, promoting equity in access, delivering quality and effective care, and ensuring that no one is left behind [&lt;span&gt;4&lt;/span&gt;]. Despite widespread recognition of these PCC principles, current healthcare delivery models often fall short of these ideals because they tend to be disease-focused, fragmented and siloed, emphasising specific programmatic outputs, putting pressure on health workers and jeopardising client-centred care delivery [&lt;span&gt;5&lt;/span&gt;]. There is an urgent need to transition from disease-focused health systems to those centred on individuals because nearly half of the global population lacks equitable access to essential healthcare services.&lt;/p&gt;&lt;p&gt;This transformation requires innovative solutions that meet client needs while maintaining accessibility and continuity of care. Recent advances in HIV prevention, including long-acting injectables for pre-exposure prophylaxis (LAI-PrEP), create unprecedented opportunities for PCC. In 2024, the ground-breaking PURPOSE 1 trial reported 100% efficacy among young women receiving twice-yearly lenacapavir​ [&lt;span&gt;6&lt;/span&gt;]. Similarly, the PURPOSE 2 trial demonstrated that HIV incidence was 96% lower with lenacapavir compared to the background incidence [&lt;span&gt;7&lt;/span&gt;]. For the first time, individuals can choose from multiple PrEP options—pills, rings or injectables—that align with their sexual behaviours, needs, preferences and life circumstances. Health providers need to educate and counsel individuals about these options, providing evidence-based information about their effectiveness, side effects and requirements (such as adherence to daily dosing or injection schedule) to facilitate autonomous and informed decision-making.&lt;/p&gt;&lt;p&gt;HIV self-testing (HIVST) utilisation can be improved through PCC approaches and complement PrEP. A meta-analysis of 33 studies from around the globe found that HIVST kit distribution by sexual partners, peers or through online platforms achieved higher testing rates than facility-based testing [&lt;span&gt;8&lt;/span&gt;]. Significantly, it expanded testing coverage in key populations without reducing test accuracy or safety. Recent evidence suggests that HIVST streamlines HIV screening for people on PrEP and promotes PrEP uptake by individuals not accessing care. It can be leveraged to support PrEP initiation, continuation and re-engagement in care [&lt;span&gt;9&lt;/span&gt;]. Technological innovations, such as LAI-PrEP and HIVST, represent only one component of effective prevention. To maximise their effectiveness, i","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/jia2.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237235","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":"Person-centred HIV care and prevention for youth in rural South Africa: preliminary implementation findings from Thetha Nami ngithethe nawe stepped-wedge trial of peer-navigator mobilization into mobile sexual health services","authors":"Jacob Busang,&nbsp;Nqobile Ngoma,&nbsp;Thembelihle Zuma,&nbsp;Carina Herbst,&nbsp;Nonhlanhla Okesola,&nbsp;Natsayi Chimbindi,&nbsp;Jaco Dreyer,&nbsp;Theresa Smit,&nbsp;Kristien Bird,&nbsp;Lucky Mtolo,&nbsp;Osee Behuhuma,&nbsp;Willem Hanekom,&nbsp;Kobus Herbst,&nbsp;Limakatso Lebina,&nbsp;Janet Seeley,&nbsp;Andrew Copas,&nbsp;Kathy Baisley,&nbsp;Maryam Shahmanesh","doi":"10.1002/jia2.70032","DOIUrl":"https://doi.org/10.1002/jia2.70032","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;Despite the efficacy of antiretroviral therapy (ART)-based prevention, population-level impact remains limited because those at high risk of HIV acquisition are not reached by conventional services. We investigated whether youth-centred and tailored HIV prevention, delivered by community-based peer navigators alongside sexual and reproductive health (SRH) services, can mobilize demand for HIV pre-exposure prophylaxis (PrEP) and ART among adolescents and young adults (AYA) in KwaZulu-Natal, South Africa.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;&lt;i&gt;Thetha Nami ngithethe nawe&lt;/i&gt; is a cluster-randomized stepped-wedge trial (SWT) in 40 clusters within a rural health and demographic surveillance site. Clusters were randomized to receive the intervention in period 1 (early) or period 2 (delayed). Trained area-based peer navigators conducted needs assessments with youth aged 15–30 years to tailor health promotion, psychosocial support and referrals into nurse-led mobile SRH clinics that also provided HIV testing, and status-neutral ART and oral PrEP. Standard of care was PrEP delivered through primary health clinics. We report SRH service uptake from the 20 intervention clusters during the first period of the SWT (NCT05405582).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Between June 2022 and September 2023, peer-navigators reached 9742 (74.9%) of the 13,000 youth in the target population, 46.8% males. Among 9576 individuals with needs assessment, peer-navigators identified 141 (1.5%) with social needs, and 4138 (43.5%) had medium to high health needs. These individuals were referred to mobile clinics, with 2269 (54.8%) attending, including 959 (42.3%) males. HIV testing uptake was high (92.7%; 2103/2269), with 10.1% (212/2103) testing positive for HIV, 62 (29.2%) of whom started ART for the first time. The prevalence of HIV was higher among females compared to males (15.1% vs. 3.3%; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Among clinic attendees, 96.8% were screened for PrEP eligibility, with 38.5% deemed eligible and offered PrEP. Of the 1433 (63.2%) individuals tested for sexually transmitted infections (STIs), 418 (29.2%) tested positive, with females having higher STI prevalence (37.2% vs. 17.9%; &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Of these, 385 (92.1%) received STI treatment. Among 1310 females, 769 (58.7%) reported not using any contraception at their initial visit, and 275/769 (35.8%) started contraception during the trial.&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;Community-based and person-centred approaches delivered thr","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/jia2.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237385","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":"Harnessing digital health data for person-centred HIV prevention monitoring: a survey of national health information systems","authors":"Shona Dalal,&nbsp;Bradley Mathers,&nbsp;Dominik Stelzle,&nbsp;Lilly M. Nyagah,&nbsp;Francis Agbo,&nbsp;Dennis Annang,&nbsp;Saiprasad Prabhakar Bhavsar,&nbsp;Stone Mbiriyawanda,&nbsp;Bongiwe Mhlanga,&nbsp;Tshepo Molapo,&nbsp;Lowrence Moro,&nbsp;Peter Mudiope,&nbsp;Linea Ngwali,&nbsp;Mwiche Siame Nyirenda,&nbsp;Isabel Sathane,&nbsp;Rajatashuvra Adhikary,&nbsp;Monica Alonso Gonzalez,&nbsp;Polin Chan,&nbsp;Annette Gerritsen,&nbsp;Kiyohiko Izumi,&nbsp;Giorgi Kuchukhidze,&nbsp;Antons Mozalevskis,&nbsp;Georges Perrin,&nbsp;Ahmed S. Alaama,&nbsp;Madidimalo Tebogo,&nbsp;Annette Verster,&nbsp;Daniel Low-Beer","doi":"10.1002/jia2.70039","DOIUrl":"https://doi.org/10.1002/jia2.70039","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Measuring HIV prevention impact is challenging because prevention is started and stopped as needed, and individual-level data availability has been suboptimal or not collected. WHO's 2022 <i>Consolidated guidelines on person-centred HIV strategic information</i> aim to bridge this gap by recommending a minimum dataset for HIV prevention monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We surveyed the availability of 42 HIV prevention data elements collected on an individual from WHO's recommended minimum dataset in 21 countries’ national health information systems during a Prevention Outcome Monitoring Workshop held in September 2024 in Gaborone, Botswana. Over 150 participants representing ministries of health and programme implementers from 21 countries in Africa and Asia, as well as representatives from global organizations, attended. National HIV prevention managers completed the survey covering: registration (client demographics, use of unique identification, key population status), HIV testing, HIV prevention and vertical transmission. Data element availability determined which prevention indicators each country could calculate. Additionally, we describe global data on the use of unique identification for key populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 21 attending countries, 18 completed the survey. Fifteen countries (83%) used unique identification in their national health information systems. All 18 countries collected HIV testing data elements, while 14–18 countries (78–100%) collected those for vertical transmission. However, prevention data availability varied widely. Different data elements on pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) were collected by 13–17 (72–94%) countries, condoms by 15 (83%) and voluntary medical male circumcision by 11 (61%) countries. Data elements on harm reduction were available in 4–6 countries among 8–10 countries providing services. While all countries could calculate HIV testing indicators, around 90% could for vertical transmission, 50–94% for PrEP/PEP and 40–75% for harm reduction. Only two countries could calculate linkage to prevention, which incorporates all prevention interventions. Kenya was the only country that collected all recommended person-centred data elements. Overall, up to 37 of 105 reporting countries had a nationally harmonized personal unique identification method for key populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Data building blocks for HIV prevention exist in most n","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/jia2.70039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237237","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":"Empowering at-risk Thai adolescents and young adults: an observational study of “Stand By You” – a person-centred online service model for HIV self-screening, text-based counselling and linkage to care","authors":"Kantarida Sripanidkulchai,&nbsp;Supattra Rungmaitree,&nbsp;Yuitiang Durier,&nbsp;Theppharit Thiamprasert,&nbsp;Vitharon Boon-Yasidhi,&nbsp;Peerawong Werarak,&nbsp;Yenjit Somphoh,&nbsp;Pornvilai Urujchutchairut,&nbsp;Pichapun Pongsakul,&nbsp;Benjawan Khumcha,&nbsp;Alan Maleesatharn,&nbsp;Kulkanya Chokephaibulkit","doi":"10.1002/jia2.70040","DOIUrl":"https://doi.org/10.1002/jia2.70040","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;Adolescents and young adults (AYA) are disproportionately at risk of HIV acquisition. Person-centred online platforms could effectively reach AYA with HIV testing services. We assessed the effectiveness of Stand By You, a mobile application, in delivering HIV-related services to at-risk Thai AYAs.&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;Deidentified data from clients who accessed Stand By You services between August 2022 and February 2024 were analysed. HIV self-testing (HIVST) services were promoted through TikTok influencers to target AYAs vulnerable to HIV. An automated chatbot provided real-time responses to client inquiries, and trained counsellors provided confidential, text-based counselling daily. Clients who completed risk assessments received personalized recommendations for HIVST based on their risk profile. Clients who submitted their HIVST results received post-test counselling and linkage to care and prophylactic treatment. Multivariable logistic regression was used to assess risk factors for reactive HIVST kit results. The per unit direct cost of the programme's performance metrics were assessed.&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 8863 clients provided 11,536 risk assessments. The majority were male (76.3%), under the age of 30 (76.0%), identified as members of key populations (60.4%) and first-time testers (56.1%). Additionally, 27.8% had a history of sexually transmitted infections (3,202/11,536), 16.5% reported receiving money or incentives for sex (1908/11,536) and clients indicated an average of 2.6 sexual partners in the past month (SD 3.4). Out of 7585 submitted HIVST results, 3.6% were reactive (&lt;i&gt;n&lt;/i&gt; = 274); 60.2% were linked to care (&lt;i&gt;n&lt;/i&gt; = 165/274) and 10.4% are in the process of linkage (&lt;i&gt;n&lt;/i&gt; = 23/274). Of the 5.3% invalid results reported (&lt;i&gt;n&lt;/i&gt; = 401/7585), nearly all were non-reactive by the second HIVST (117/187). A history of testing HIV negative (adjusted odds ratio [aOR] 0.54 [95% CI 0.40–0.72], &lt;i&gt;p&lt;/i&gt; &lt; 0.001) and receiving pre-exposure prophylaxis (aOR 0.20 [95% CI 0.06–0.64], &lt;i&gt;p&lt;/i&gt; = 0.007) were independently associated with reduced odds of a reactive result. Average direct cost was $18.7, $40.3 and $1100 USD per distributed HIVST kit, first-time tester and new client linked to care, respectively.&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;AYA populations at risk for HIV can be effectively reached through mobile phone applications that provide services anonymously. Online strategies for HIVST delivery and supportiv","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/jia2.70040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237236","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":"Enhancing PrEP adherence through person-centred mobile app interventions: a real-world data and machine learning approach using UPrEPU among gay, bisexual and other men who have sex with men in Taiwan","authors":"Jay Chiehen Liao,&nbsp;Huei-Jiuan Wu,&nbsp;Tsan-Tse Chuang,&nbsp;Tsai-Wei Chen,&nbsp;Carol Strong","doi":"10.1002/jia2.70033","DOIUrl":"https://doi.org/10.1002/jia2.70033","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool that relies on good adherence in high-risk scenarios. To understand the factors that predict adherence, technology such as mobile applications like UPrEPU—allowing for logging users’ daily behaviours at close to the time they have sex or PrEP intake—can be used as a person-centred, self-care intervention. This study aims to develop a machine learning model using logs of sexual activities and user attributes recorded in the UPrEPU mobile application in Taiwan to predict whether a sexual event was protected by oral PrEP among gay, bisexual and other men who have sex with men (GBMSM).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used data from the UPrEPU app collected between January 2022 and May 2023 in Taiwan. The dataset included information on users’ sex events, such as the timing and users’ sex roles (e.g. versatile, receptive or insertive partner), and the dynamic user-based attributes related to sexual behaviours and PrEP use. Various subsets of these features were employed in CatBoost models to predict whether the sex events were associated with correct PrEP use. We evaluated the models’ performance using five-fold cross-validation. The influential features were identified through feature importance analysis and Shapley Additive Explanations (SHAP) values to explain the models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 198 users recorded 2356 anal sex events on UPrEPU. The model with dynamic user-based attributes outperformed those without them. The most parsimonious model had a good prediction performance (accuracy = 75%, precision = 78%, recall = 90%, F1-score = 83%) and identified the key features of PrEP protection. The model with five dynamic user-based attributes—age, cumulative PrEP use, condom use and the proportion of anal sex events with HIV-negative partners not on PrEP—significantly outperformed the model based on event-level attributes alone.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Behavioural patterns significantly influence PrEP adherence among GBMSM. Person-centred mobile applications such as UPrEPU provide valuable data for tailored, just-in-time interventions, enhancing adherence. Recognizing these patterns can guide person-centred interventions. Incorporating these insights into clinical care or digital tools may improve consultations and support timely, informed HIV prevention decisions.</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/jia2.70033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237103","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":"Prevalence and risk factors of hypertension and diabetes among persons living with HIV in Zambia: results of a national facility-based cross-sectional survey","authors":"Chomba Mandyata,&nbsp;Sivile Suilanji,&nbsp;Samuel Bosomprah,&nbsp;Paul Somwe,&nbsp;Cosmas Zyambo,&nbsp;Mwiche Musukuma,&nbsp;Aggrey Mweemba,&nbsp;Malizgani Paul Chavula,&nbsp;Chipefwe Sichilima,&nbsp;Phoebe Bwembya,&nbsp;Mpanji Siwingwa,&nbsp;Richard Chibale,&nbsp;Henry Phiri,&nbsp;Joseph Zulu,&nbsp;Halwindi Hikabasa,&nbsp;Wilbroad Mutale","doi":"10.1002/jia2.70051","DOIUrl":"10.1002/jia2.70051","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;Despite growing evidence on the rising burden of non-communicable diseases (NCDs) in sub-Saharan Africa, the national prevalence of hypertension, prediabetes and diabetes among persons living with HIV (PLHIV) in Zambia is largely unknown. This study aimed to determine the national prevalence of hypertension and diabetes mellitus and their associated risk factors among adult PLHIV in Zambia.&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 study in 149 antiretroviral therapy (ART) clinics located in 52 rural and urban districts in Zambia based on the adapted World Health Organization (WHO) STEPwise approach to NCD risk factor Surveillance (STEPS) and the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) questionnaire. We used proportional to size sampling to select districts and clinics, targeting 5775 PLHIV. Data was collected from 1 October 2023 to 30 November 2023. We estimated the prevalence of hypertension and diabetes mellitus and used robust Poisson regression to analyse associations with socio-demographic, behavioural and HIV-related risk factors, and reported prevalence ratios (PR).&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 the final analysis, we included a total of 5204 participants from 52 districts and 149 ART clinics countrywide: 67.2% were female, and 71.3% were from urban areas. The prevalence of hypertension, prediabetes and diabetes was 22.5% (95% confidence interval [CI]: 21.3−23.6), 26.7% (CI: 25.5−27.9) and 12.5% (CI: 11.6−13.4), respectively. In the multivariable model, being 30–44 (PR = 2.1; CI: 1.5−2.9), 45–49 (PR = 3.3; CI: 2.4−4.7) and 60 years or older (PR = 4.7; CI: 3.3−6.8) compared to those aged 18–29; widowed, divorced or separated individuals compared to those never married; being overweight (PR = 1.4; CI: 1.2−1.5) and obese (PR = 1.9; CI: 1.6−2.1) compared to normal weight PLHIV was associated with hypertension. College or university-educated PLHIV (PR = 2.1; CI: 1.3−3.4), compared to those with no formal education; and those with high total cholesterol ≥6.2 mmol/l (PR = 2.2; CI: 1.4−3.6), versus desirable total cholesterol (&lt;5.2 mmol/l); being overweight (PR = 1.4; CI: 1.1−1.6) and obese (PR = 1.6; CI: 1.3−2.0), compared to those with normal weight, showed a significant association with diabetes mellitus.&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 prevalence of hypertension and diabetes mellitus among PLHIV in Zambia was notably high. This underscores the need for immediate and robust intervention strategies to mitigate t","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12501770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237491","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":"Traditional healers can help facilitate HIV serostatus disclosure: results from a qualitative study in rural Uganda","authors":"Srija Gogineni,&nbsp;Gabriel Nuwagaba,&nbsp;Misha Hooda,&nbsp;Sylvia Natukunda,&nbsp;Constance Birungi,&nbsp;William Bugeza,&nbsp;Maureen Tushabe,&nbsp;Denis Nansera,&nbsp;Winnie Muyindike,&nbsp;Carolyn Marie Audet,&nbsp;Juliet Mwanga-Amumpaire,&nbsp;Radhika Sundararajan","doi":"10.1002/jia2.70031","DOIUrl":"https://doi.org/10.1002/jia2.70031","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 Uganda, HIV-related stigma and discrimination remain major barriers to HIV care engagement and serostatus disclosure. While serostatus disclosure can improve access to, engagement with and retention in HIV care, many people living with HIV (PLWH) hesitate to disclose due to fear of negative consequences. Traditional healers (THs) are trusted community members offering accessible and confidential psychosocial support. This study explores the role of THs in facilitating HIV status disclosure among PLWH disengaged from clinical care in southwestern Uganda.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This qualitative sub-study was nested within a cluster-randomized trial evaluating the effectiveness of THs supporting PLWH to engage with HIV care in southwestern Uganda. In-depth semi-structured individual interviews were conducted with 22 healers (14 female) and 16 PLWH (10 female) from August 2023 to June 2024. Interviews explored experiences with HIV care and healer-facilitated support to engage with and remain in HIV care. Data was analysed thematically, with particular attention to serostatus disclosure practices.&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;Four key themes emerged: (1) PLWH, who receive care from TH practices, preferred THs over healthcare workers to disclose their HIV serostatus due to perceived trust, confidentiality and personalized care; (2) HIV-related stigma and fear of domestic violence hindered disclosure within families, but disclosure to healers offered a safer alternative; (3) in some cases, THs were the first individuals to whom PLWH disclosed their status; and (4) THs actively encouraged and facilitated serostatus disclosure by PLWH to family members, offering guidance and mediating difficult conversations. These findings highlight the critical role of THs in reducing barriers to disclosure and fostering supportive networks to improve the quality of life for PLWH.&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;THs provide a culturally sensitive and trusted avenue for HIV status disclosure in rural Uganda. Their unique position within the community allows them to address stigma, build trust and facilitate safe disclosure practices. Integrating healers into HIV care through training and collaboration with formal healthcare systems could enhance linkage, adherence, retention and overall care outcomes for PLWH. Future research should explore scalable models to leverage the positive influence and potential of THs to improve HIV care delivery.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70031","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145146479","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":"Artificial intelligence for HIV care: a global systematic review of current studies and emerging trends","authors":"Sanele Ngcobo,&nbsp;Edith Madela Mntla,&nbsp;Jonathan Shock,&nbsp;Murray Louw,&nbsp;Linda Mbonambi,&nbsp;Thato Serite,&nbsp;Theresa Rossouw","doi":"10.1002/jia2.70045","DOIUrl":"https://doi.org/10.1002/jia2.70045","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;Artificial intelligence (AI) and, in particular, machine learning (ML) have emerged as transformative tools in HIV care, driving advancements in diagnostics, treatment monitoring and patient management. The present review aimed to systematically identify, map and synthesize studies on the use of AI methods across the HIV care continuum, including applications in HIV testing and linkage to care, treatment monitoring, retention in care, and management of clinical and immunological outcomes.&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;A comprehensive literature search was conducted across databases, including PubMed and ProQuest Central, Scopus and Web of Science, covering studies published between 2014 and 2024. The review followed PRISMA guidelines, screening 3185 records, of which 47 studies were included in the final analysis.&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;Forty-seven studies were grouped into four thematic areas: (1) HIV testing, AI models improved diagnostic accuracy, with ML achieving up to 100% sensitivity and 98.8% specificity in self-testing and outperforming human interpretation of rapid tests; (2) Retention in care and virological response, ML predicted clinic attendance, viral suppression and virological failure (72–97% accuracy; area under the curve up to 0.76), enabling early identification of high-risk patients; (3) Clinical and immunological outcomes, AI predicted disease progression, immune recovery, comorbidities and HIV complications, achieving up to 97% CD4 status accuracy and outperforming clinicians in tuberculosis diagnosis; (4) Testing and treatment support, AI chatbots improved self-testing uptake, linkage to care and adherence support. Methods included random forests, neural networks, support vector machines, deep learning and many others.&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;AI has the potential to transform HIV care by improving early diagnosis, treatment adherence and retention in care. However, challenges such as data quality, infrastructure limitations and ethical considerations must be addressed to ensure successful implementation.&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;AI has demonstrated immense potential to address gaps in HIV care, improving diagnostic accuracy, enhancing retention strategies and supporting effective treatment monitoring. These advancements contribute towards achieving the UNAIDS 95-95-95 targets. However, challenges","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70045","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145122640","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":"Impact of the Anti-Homosexuality Act on HIV service delivery in Uganda: Evidence from community-led monitoring","authors":"Allan Nsubuga,&nbsp;Frank Mugisha,&nbsp;Beatrice Ajonye,&nbsp;Kenneth Mwehonge,&nbsp;Elise Lankiewicz,&nbsp;Patrick Drake,&nbsp;Esther Joan Kilande,&nbsp;Alice Kayongo,&nbsp;Alana R. Sharp","doi":"10.1002/jia2.70030","DOIUrl":"https://doi.org/10.1002/jia2.70030","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, the Ugandan government enacted the Anti-Homosexuality Act (AHA), which included expanded and intensified criminal penalties for consensual same-sex relations. While arrests, harassment and violence have been reported, evidence of the AHA's impact on HIV healthcare delivery is limited. Community-led monitoring (CLM) is an accountability mechanism that uses community-gathered evidence to advocate for improved healthcare quality and is well-positioned to describe changes in access and quality of 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;Data from the CLM programme in Uganda were used to identify changes in healthcare delivery and use related to the AHA. As part of the CLM programme, routine survey data were collected from clients and managers in 320 public health facilities and 50 drop-in centres (DICs) from 2022 to 2024. Survey data were analysed using a difference-in-differences logistic model to measure changes in indicator measures before and after the AHA was signed into law. Seven semi-structured individual interviews were conducted with DIC facility managers, deductively coded and thematically analysed.&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 public health facilities and DICs, the proportion of respondents identified as men who have sex with men (MSM) declined significantly after AHA. In facilities, all categories of key populations (KPs) reported high levels of discrimination. After the AHA, MSM reported significant reductions in key HIV-related services compared to other populations, including lower rates of pre-exposure prophylaxis (PrEP) counselling, lower participation in support groups and having fewer friendly staff interactions. In DICs, all types of clients were less likely to be referred to health facilities, receive PrEP and find the DIC easy to access after the AHA was signed. DIC managers described experiencing harassment, violence and staffing challenges due to AHA, which they responded to by leveraging partnerships with local and global allies, providing virtual services, and seeking registration as full-service clinics.&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;Data from the Uganda CLM programme provide an early view of the impact of the AHA on service delivery in public health facilities and DICs. While DICs and health facilities developed strategies to build resiliency and adapt, the AHA created significant barriers to care. These findings provide empirical warnings of the barriers experienced by KPs when accessing healthcare services in a criminaliz","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145038438","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}