Journal of the International AIDS Society最新文献

{"title":"Systematic review and meta-analysis of retention and disengagement after initiation on antiretroviral therapy in low- and middle-income countries after the introduction of Universal Test and Treat policies","authors":"Amy Zheng, Emma M. Kileel, Alana T. Brennan, David B. Flynn, Sydney Rosen, Matthew P. Fox","doi":"10.1002/jia2.70026","DOIUrl":"https://doi.org/10.1002/jia2.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>We previously published a systematic review evaluating retention in care after antiretroviral therapy initiation among adults in low- and middle-income countries from 2008 to 2013. This review evaluates retention after the implementation of Universal Test and Treat (UTT) in 2015.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched PubMed, ISI Web of Science, Cochrane Database of Systematic Reviews and EMBASE for studies published 1 January 2017, through 31 December 2024 and searched conference abstract repositories from AIDS, IAS and CROI from 2015 to 2024. Retention for each study was estimated using (1) simple averages and (2) interpolated for missing time points through the last reported time point. Our outcomes were all-cause attrition and retention. We estimated retention rates using a generalized linear mixed model (GLMM) with a logit distribution using interpolated data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy studies met our inclusion criteria. Most studies came from Africa, with very few from Europe and Asia. Few studies reported retention past the first 12 months following treatment initiation. Across all studies, we estimated simple average retention without interpolation of missing time points to be 72.6% at 12 months, 75.2% at 24 months, 67.7% at 36 months and 64.8% at 48 months. Utilizing a GLMM model, we estimated retention to be 79.6% at 12 months, 81.2% at 24 months, 75.6% at 36 months and 72.8% at 48 months. Whereas in our prior 2015 review, we estimated retention rates to be 86.0% at 12 months, 79.0% at 24 months, 75.0% at 36 months, and 69.0% at 48 months. These results generally reflect retention at the initiating facility and omit the effect of unreported transfers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Retention in care at 36 months was estimated to be between 67% and 75%. Compared to results from our prior review, retention is largely similar in the post-UTT era. Further research evaluating retention in other geographic areas (i.e. Latin America and the Caribbean, Europe, and Asia) is needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Attrition after the first 2 years in treatment remains a concern, and concerted efforts should be made to ensure patients remain engaged in care over their lifetime. The impact of PEPFAR's recent cuts needs to be evaluated further to understand the effect it may have on long-term retention.</p>\u0000 </sect","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144998716","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":"Effects of Stop-Work orders on HIV testing, treatment and programmes for prevention of vertical transmission in four sub-Saharan African countries","authors":"Suzue Saito, Mansoor Farahani, Salaza Kunda, Lievain Maluantesa, Agnaldo Guambe, Habtamu Ayalneh Worku, Eugenie Poirot, Nyikadzino Mahachi, Lucille Bonaventure, Stéphania Koblavi, Tafadzwa Dzinamarira, Wafaa M. El-Sadr","doi":"10.1002/jia2.70034","DOIUrl":"https://doi.org/10.1002/jia2.70034","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Beginning in late January 2025, Stop-Work orders and contract cancellations have disrupted HIV programmes supported by the President's Emergency Plan for AIDS Relief (PEPFAR). We assessed the effects on HIV service delivery in four African countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Weekly aggregate HIV services data from a convenience sample of 165 Center for Disease Control and Prevention (CDC)-funded, ICAP-supported facilities—22 in Angola, 75 in the Democratic Republic of the Congo (DRC), 20 in South Sudan and 48 in Zambia—were analysed. We compared data from pre-Stop-Work (7 October 2024–23 January 2025), Stop-Work (24 January 2025–11 February 2025) and post-resumption (12 February 2025–31 March 2025) phases. We examined the number of individuals: (1) who tested for HIV; (2) receiving index testing; (3) had HIV-positive results/yield; (4) initiated antiretroviral therapy (ART); as well as (5) number of pregnant women with known HIV status; and (6) number of HIV-exposed infants who received early infant diagnosis (EID) testing. We used phase-specific weekly averages, relative percentage changes across phases and linear trend tests to measure the magnitude of disruptions and recovery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In Angola, DRC and Zambia, significant declines in number of HIV-positive tests (−58%, −34%, −17%) and ART initiations (−16%, −32%, −17%) were observed across the three phases with limited recovery in number of positive tests in Zambia and ART initiations in Angola. In DRC and Zambia, HIV testing (−33%, −35%), including index testing (−37%, −72%), significantly declined; additionally, HIV testing of pregnant women significantly declined (−28%) in DRC. In Angola and Zambia, EID testing declined (−12%, −18%) with limited recovery. In Angola, HIV testing (2476→2205→2519), including testing for pregnant women (280→ 233→ 287), rebounded in the post-resumption phase; in DRC, EID (6.5→6.3→7.9) rebounded. There were increases in HIV testing yield in Zambia (2.8%→3.1%→4.0%) and index testing (20→24→36) in Angola. No reductions were observed in South Sudan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Stop-Work orders and award terminations have resulted in substantial short-term reductions in the delivery of HIV testing and treatment services. Long-term funding disruptions necessitate careful planning, realistic timelines and investment in cost-effective service models to sustain the gains and maintain the momentum in the global HIV response.</p>\u0000 </sectio","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934970","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":"Bone health in a U.K. cohort of youth living with perinatally acquired HIV-1: a longitudinal study","authors":"Merle Henderson,&nbsp;Alexandra Blenkinsop,&nbsp;Oliver Ratmann,&nbsp;Moira Cheung,&nbsp;Hermione Lyall,&nbsp;Sarah Fidler,&nbsp;Caroline Foster,&nbsp;the BONDY study group","doi":"10.1002/jia2.70029","DOIUrl":"https://doi.org/10.1002/jia2.70029","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Low bone mineral density (BMD) has been described in children and young people with perinatally acquired HIV (PHIV), which may be related to both traditional (e.g. low body mass index and malnutrition) and HIV-related risk factors (e.g. longstanding exposure to HIV and antiretroviral therapy [ART], with immune suppression, chronic immune activation and inflammation). Here, we evaluate BMD in a U.K. cohort of young people with PHIV by age and ART.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This longitudinal, observational study was conducted at a U.K. tertiary PHIV service between November 2018 and March 2022. Bone health was assessed in 130 individuals aged 15–19 (<i>n</i> = 50), 20−24 (<i>n</i> = 50) and 25 years and older (<i>n</i> = 30) by dual-energy X-ray absorptiometry, bone mineralization and turnover markers. Low BMD was defined as lumbar spine (LS) and/or femur-BMD z-score below −2, relative to age, sex and ethnicity-matched U.K. population-based normative controls. Two-year follow-up evaluation was performed in those aged 15−19 (<i>n</i> = 42) and 20−24 years (<i>n</i> = 43) at enrolment, which included a group who switched from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) ART at baseline. Bayesian logistic regression models examined predictors of low BMD and the effect of ART-backbone on BMD accrual.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>At baseline, 57% were female and 82% of black ethnicity, with 31 (24%) on TDF-ART. Sixteen (12%) had low baseline BMD. Over a median follow-up duration of 26 (interquartile range [IQR] 25–29) months, BMD accrual was lower-than-expected in those aged 15−19 years (mean change LS-BMD z-score −0.15 (standard deviation [SD] 0.44)), when compared to normative controls. No associations were seen with HIV parameters or the ART regimen. Participants who switched to TAF-ART had similar BMD accrual 26 (IQR 24–32) months post switch, when compared to those on non-TAF/TDF-ART (mean change LS-BMD z-score TAF −0.01 [SD 0.41] vs. non-TAF/TDF −0.03 [SD 0.54]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While rates of low BMD were reassuringly low in this cohort, lower-than-expected BMD accrual was observed in younger individuals, relative to normative controls. Overall, BMD accrual on TAF-ART was non-inferior to non-TAF/TDF-ART.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144934971","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":"Integrating HIV and primary healthcare for key populations: community-led models from Vietnam, Nigeria and Eswatini","authors":"Megan Coleman,&nbsp;Christopher Akolo,&nbsp;Acapel Mbanusi,&nbsp;Bhekizitha Sithole,&nbsp;George K. Siberry,&nbsp;Ryan Schowen,&nbsp;Deborah Goldstein","doi":"10.1002/jia2.70027","DOIUrl":"https://doi.org/10.1002/jia2.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Key populations (KP), including men who have sex with men, people who inject drugs, sex workers, transgender people and people in closed settings, are disproportionately affected by HIV and face structural and legal barriers to care. While community-led responses are central to reaching KP, services are often disease-specific and disconnected from national primary healthcare (PHC) systems. PHC, defined by WHO as a whole-of-society approach to delivering integrated and person-centred services, is rarely designed to meet the broader health needs of KP, who also experience high burdens of non-communicable diseases, mental health conditions and violence. This paper describes three service delivery models, supported by PEPFAR, that integrate HIV and PHC services for KP in Vietnam, Nigeria and Eswatini.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The three models are community-led, client-centred, and tailored to KP health and social needs. Each integrates HIV services—including testing, antiretroviral therapy, viral load monitoring, pre-exposure prophylaxis (PrEP) and advanced HIV disease management—alongside broader PHC services such as mental healthcare, sexual and reproductive health, non-communicable disease screening and tuberculosis services. All models include structural and community-based interventions such as gender-based violence support, stigma reduction, peer navigation and economic empowerment. These services are delivered in safe, trusted spaces by multidisciplinary teams including peer and clinical providers. While the models demonstrate alignment with PHC principles (accessibility, cultural competence, continuity and community empowerment), challenges remain related to integration within national health systems, financing and provider training. Recent U.S. global health policy shifts, including reductions in funding for KP-specific programming and limited PrEP access, pose additional threats to programme sustainability and client trust.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrated models of HIV and PHC for KP can improve access, engagement and health outcomes across a range of services. They represent promising approaches for addressing intersecting health and structural needs, particularly in settings where stigma and criminalization persist. Sustained progress will require inclusion of KP in PHC policies and planning, protection of community-led services and domestic financing strategies that ensure continuity in the face of shifting donor priorities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935052","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":"Combining HIV prevention Options with Mental health service delivery for Adolescent girls and young women (CHOMA): results of a pilot hybrid effectiveness-implementation randomized trial in South Africa","authors":"Jennifer Velloza,&nbsp;Nomhle Ndimande-Khoza,&nbsp;Lisa Mills,&nbsp;Nicole Poovan,&nbsp;Aliza Adler,&nbsp;Elizabeth B. Sherwin,&nbsp;Carrie Mathew,&nbsp;Zinhle Sokhela,&nbsp;Ruth Verhey,&nbsp;Dixon Chibanda,&nbsp;Monica Gandhi,&nbsp;Connie Celum,&nbsp;Sinead Delany-Moretlwe","doi":"10.1002/jia2.70037","DOIUrl":"https://doi.org/10.1002/jia2.70037","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;Adolescent girls and young women (AGYW) at risk of HIV frequently have symptoms of common mental disorders (CMDs), which are associated with lower pre-exposure prophylaxis (PrEP) adherence. We conducted a pilot hybrid effectiveness-implementation trial (CHOMA) to evaluate whether an evidence-based mental health intervention adapted for PrEP delivery (“Youth Friendship Bench SA”) could address CMD and PrEP adherence among South African AGYW.&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;CHOMA was conducted in Johannesburg from April 2023 to February 2024. We enrolled AGYW (18−25 years) who were already on or willing to initiate PrEP and had CMD symptoms (Self-Reporting Questionnaire 20-item [SRQ-20]≥7). Participants were randomized to our Youth Friendship Bench SA intervention (five problem-solving sessions with a lay counsellor, one group session) or standard-of-care CMD services (brief CMD assessment, referral). Counselling sessions occurred at enrolment and Weeks 2, 4, 8 and 12. Co-primary outcomes were PrEP adherence (positive result on a urine tenofovir assay) and reduced CMD symptoms (SRQ-20&lt;7) at Week 12 and, secondarily, Week 4. We used Poisson regression to assess intervention effects and summarized responses to three validated scales assessing intervention acceptability, appropriateness and feasibility (ranges: 1–4).&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 116 AGYW enrolled, the median SRQ-20 score was 9. We retained 69% through Week 12. Of 57 intervention participants, 64.9% (&lt;i&gt;N&lt;/i&gt; = 37) received four or more sessions. At Week 4, 29/36 (80.6%) participants in the intervention and 25/41 (61.0%) in the standard-of-care had recent PrEP use (RR = 1.40; 95% CI = 1.03−1.89; &lt;i&gt;p&lt;/i&gt; = 0.03), but this was not sustained through Week 12 (RR = 0.88; 95% CI = 0.64−1.22; &lt;i&gt;p&lt;/i&gt; = 0.44). Enrolment SRQ-20 score was not associated with Week 12 PrEP adherence or retention. CMD symptoms did not differ by arm at Week 4 or 12, although the proportion with SRQ-20 scores &gt;7 decreased overall between Weeks 4 (54.5%, 42/77) and 12 (35.0%, 28/80; &lt;i&gt;p&lt;/i&gt; = 0.02). Median acceptability, appropriateness and feasibility scores were 3.50, 3.75 and 3.25, 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;The intervention improved PrEP adherence at Week 4, although the effect was not durable to Week 12, possibly due to retention challenges. Reductions in CMD symptoms were seen in both arms. Findings suggest different mental health and PrEP support interventions may be needed to improve integrat","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935053","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High syphilis incidence among PrEP-adherent men who have sex with men and transgender women in Peru","authors":"Silver K. Vargas,&nbsp;Kelika A. Konda,&nbsp;Ronaldo I. Moreira,&nbsp;Iuri C. Leite,&nbsp;Marcelo Cunha,&nbsp;Brenda Hoagland,&nbsp;Juan V. Guanira,&nbsp;Marcos Benedetti,&nbsp;Cristina Pimenta,&nbsp;Beatriz Grinztejn,&nbsp;Valdiléa G. Veloso,&nbsp;Carlos F. Caceres","doi":"10.1002/jia2.70002","DOIUrl":"https://doi.org/10.1002/jia2.70002","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;Syphilis remains a public health concern in Peru. Pre-exposure prophylaxis (PrEP) implementation programmes in Latin America need to assess their impact on sexually transmitted infections (STIs), along with their feasibility. We assessed the relationship between PrEP adherence and syphilis incidence among men who have sex with men (MSM) and transgender women (TW) enrolled in ImPrEP, a multi-country PrEP demonstration project; however, this analysis focuses on Peru.&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;Between April 2018 and June 2021, 2292 HIV-negative MSM/TW attending Peruvian STI clinics were enrolled and followed in ImPrEP. Participants had to be aged ≥18 years and report recent condomless anal sex (CAS), sex with a partner living with HIV, STI history (diagnosis/symptoms) and/or transactional sex. Quarterly follow-up visits included PrEP dispensing, behavioural assessment, HIV and syphilis screening (treponemal test and Rapid Plasma Reagin [RPR] if syphilis negative at enrolment; RPR only if reactive-treponemal test at baseline). PrEP adherence was assessed using the medication possession ratio (MPR: #pills prescribed / #days between visits). Generalized estimating equation (GEE) Poisson regression models were used to evaluate factors related to syphilis incidence and also assessed syphilis incidence during two periods: pre-COVID-19 lockdown (up to 16 March 2020) and during COVID-19-lockdown (17 March 2020−June 2021).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We enrolled 2039 cisgender-MSM and 253 TW, with a median follow-up time of 514 days; 205 incident syphilis cases were identified among 185 individuals. Overall syphilis incidence was 9.1 cases/100 person-years (p.y.) (95% CI: 7.9−10.4), 14.7/100 p.y. (95% CI: 10.5−20.1) among TW and 8.3/100 p.y (95% CI: 7.1−10.0) among cisgender-MSM. During the COVID-19 pre-lockdown period, syphilis incidence was 10.0/100 p.y. (95% CI: 8.3−12.1) and 8.1/100 p.y. (95% CI: 6.6−10.0) during-lockdown. Multivariate GEE analysis showed higher syphilis incidence among PrEP-adherent participants (MPR≥0.6) (adjusted incidence rate ratio [aIRR]: 1.46 [95% CI: 1.08−1.99]), those reporting receptive CAS (aIRR: 1.53 [95% CI: 1.11−2.11]) and TW (aIRR: 1.64 [95% CI: 1.08−2.51]). Syphilis incidence pre-lockdown was higher for participants reporting receptive CAS (aIRR: 2.35 [95% CI: 1.43−3.86]); during-lockdown, syphilis incidence was higher among those diagnosed with syphilis at enrolment (aIRR: 2.70 [95% CI: 1.67−4.36]).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cross-sectional study evaluating the frequency of HIV drug resistance mutations among individuals diagnosed with HIV-1 in tenofovir disoproxil fumarate-based pre-exposure prophylaxis rollout programmes in Kenya, Zimbabwe, Eswatini and South Africa","authors":"Urvi M. Parikh,&nbsp;Lauren D. Kudrick,&nbsp;Lisa Levy,&nbsp;Everline Bosek,&nbsp;Bhavna H. Chohan,&nbsp;Irene Mukui,&nbsp;Sarah Masyuko,&nbsp;Nonhlanhla Ndlovu,&nbsp;Imelda Mahaka,&nbsp;Owen Mugurungi,&nbsp;Gertrude Ncube,&nbsp;Anita Hettema,&nbsp;Sindy N. Matse,&nbsp;Saiqa Mullick,&nbsp;Carole L. Wallis,&nbsp;Amy L. Heaps,&nbsp;Kerri J. Penrose,&nbsp;Kevin D. McCormick,&nbsp;Lubbe Wiesner,&nbsp;Peter L. Anderson,&nbsp;Jill M. Peterson,&nbsp;Connie Celum,&nbsp;Barbra A. Richardson,&nbsp;Delivette Castor,&nbsp;Shannon Allen,&nbsp;Kristine Torjesen,&nbsp;John W. Mellors,&nbsp;Global Evaluation of Microbicide Sensitivity (GEMS) Project","doi":"10.1002/jia2.70011","DOIUrl":"https://doi.org/10.1002/jia2.70011","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 ongoing rollout of oral tenofovir-based pre-exposure prophylaxis (PrEP) has the potential to reduce HIV-1 incidence, but HIV drug resistance (HIVDR) in individuals who acquire HIV-1 on PrEP could threaten the treatment effectiveness of overlapping antiretrovirals (tenofovir/emtricitabine), contribute to development of resistance, and undermine HIV control efforts. Accordingly, the Global Evaluation of Microbicide Sensitivity (GEMS) project was established to monitor HIVDR in PrEP rollout programmes in Southern and Eastern 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;GEMS monitored resistance in &gt;100,000 estimated persons who accessed PrEP through national programmes or implementation projects in Southern/Eastern Africa. Participants self-reported demographics and PrEP adherence. HIV-1 RNA and tenofovir-diphosphate levels were measured in blood samples collected at the time of study enrolment from consenting participants diagnosed with HIV who had received PrEP. HIVDR mutations were detected by population genotyping.&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 283 reported seroconversions on PrEP from December 2017 through September 2023, 255 (90%) individuals enrolled in GEMS, of which 81 (32%) were from Kenya, 77 (30%) from South Africa, 69 (27%) from Zimbabwe and 28 (11%) from Eswatini. Half (130; 51%) were 15–24 years of age at seroconversion, and three-quarters (193; 76%) were female. Thirty-four seroconversions occurred within 30 days of PrEP initiation. Tenofovir-diphosphate levels were consistent with moderate to high levels (≥350 femtomoles per punch) in 53% (120 of 226) individuals with drug-level data. Of 154 samples successfully genotyped, 34 (22%; 95% CI [16%, 30%]) had PrEP-associated mutations; these included 27 samples with M184I/V, one sample with K65KR, and six samples with both K65R and M184I/V.&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 frequency of HIVDR mutations associated with tenofovir or emtricitabine among individuals diagnosed with HIV who had received PrEP (22%) exceeded background levels of transmitted nucleoside &lt;i&gt;reverse transcriptase&lt;/i&gt; inhibitor resistance in Southern and Eastern Africa (≤5%) but people with PrEP-associated mutations are likely to achieve virologic suppression with current first-line antiretroviral therapy (ART). Improved screening for acute infection before initiating PrEP, surveillance of HIVDR with the introduction of new PrEP programmes and the monitoring of longer-term ART outcomes in individuals who acquire HIV-1 on Pr","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preferences for HIV pre-exposure prophylaxis among men who have sex with men and trans women in 15 countries and territories in Asia and Australia: a discrete choice experiment","authors":"Warittha Tieosapjaroen,&nbsp;Benjamin R. Bavinton,&nbsp;Heather-Marie A. Schmidt,&nbsp;Curtis Chan,&nbsp;Kim E. Green,&nbsp;Nittaya Phanuphak,&nbsp;Midnight Poonkasetwattana,&nbsp;Nicky S. Suwandi,&nbsp;Doug Fraser,&nbsp;Hua Boonyapisomparn,&nbsp;Michael Cassell,&nbsp;Lei Zhang,&nbsp;Weiming Tang,&nbsp;Jason J. Ong","doi":"10.1002/jia2.70025","DOIUrl":"https://doi.org/10.1002/jia2.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Scaling up pre-exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM) and transgender women (TGW) in the Asia-Pacific region has been slow. We identified the drivers of PrEP use and forecasted PrEP uptake given different PrEP programmes for MSM and TGW living in 15 countries and territories in Asia and Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Separate online discrete choice experiment surveys for MSM and TGW were distributed in 15 Asian countries and territories and Australia between May and November 2022. We used random parameters logit models to estimate the relative importance of service attributes and predicted PrEP uptake for different programme configurations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 21,943 participants included in the MSM survey and 1522 in the TGW survey, the mean age was 31.7 (±9.5) years and 28.1 (±7.0) years, respectively. Cost emerged as the primary driver of PrEP use for MSM and TGW across countries, followed by the type of PrEP. When switching from the least preferred PrEP programme (i.e. very high service fee, PrEP implant, rare kidney problems as side effects of PrEP and a 2-monthly clinic visit) to an optimal programme (i.e. free access to PrEP via peer-led community clinics which offered sexually transmitted infection [STI] testing, and a 6–12 monthly visit), the predicted PrEP uptake could improve by over 50% for MSM in Australia, China, Hong Kong SAR China, Japan, the Philippines, Taiwan (China) and Thailand, and 37% for TGW. Compared to those at lower risk of HIV, free access was more preferred by MSM at a higher risk of HIV, while telehealth was more preferred by TGW at a substantial risk of HIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Tailoring services to local contexts, including ensuring affordability, preferred type of PrEP and providing differentiated services, could accelerate the uptake of PrEP among MSM and TGW in Asia and Australia. Novel innovations, such as STI and HIV self-testing, should be explored as alternatives to conventional testing, given that most MSM and TGW prefer less frequent clinic visits and long-acting PrEP options.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881370","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":"Life-years lost associated with mental disorders in people with HIV: a cohort study in South Africa, Canada and the United States","authors":"Yann Ruffieux,&nbsp;John A. Joska,&nbsp;Raynell Lang,&nbsp;Chunyan Zheng,&nbsp;Naomi Folb,&nbsp;Gregory D. Kirk,&nbsp;Angela M. Parcesepe,&nbsp;Michael J. Silverberg,&nbsp;Sonia Napravnik,&nbsp;Kelly Gebo,&nbsp;Joseph J. Eron Jr,&nbsp;Brenna C. Hogan,&nbsp;Keri N. Althoff,&nbsp;Mpho Tlali,&nbsp;David J. Grelotti,&nbsp;Mona Loutfy,&nbsp;Peter F. Rebeiro,&nbsp;Mary-Ann Davies,&nbsp;Matthias Egger,&nbsp;Gary Maartens,&nbsp;Andreas D. Haas","doi":"10.1002/jia2.70023","DOIUrl":"https://doi.org/10.1002/jia2.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>People with HIV (PWH) have a high burden of mental health disorders, which contribute to increased mortality due to elevated rates of physical illness, suicide or fatal accidents. Additionally, mental health disorders can adversely affect antiretroviral therapy (ART) adherence, leading to increased HIV-related mortality. This study aims to quantify the difference in mortality between PWH who have a mental health disorder and PWH without mental health disorders in South Africa (SA) and North America (NA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cohort study includes PWH aged 18 years or older who initiated ART between 2000 and 2021 at a national private-sector HIV programme in SA and 13 programmes in the United States and Canada. Mental health disorders were diagnosed according to ICD-10 codes F10-F99, which include psychotic disorders, bipolar disorders, depression, anxiety and substance use disorders. We estimated life-years lost (LYL) associated with mental health disorders, quantifying the average difference in remaining life expectancy between individuals diagnosed with a mental health disorder and those without such diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 119,785 participants from SA (57.4% female, median age 39 years) and 142,044 from NA (85.0% male, median age 43 years). In SA, 57,999 (48.4%) were diagnosed with a mental health disorder, compared with 93,518 (65.8%) in NA. In SA, the LYL associated with any mental health disorder were 3.42 years (95% CI 2.42−4.28) in males and 2.95 years (0.67−5.95) in females. Corresponding figures for NA were 4.16 years (3.71−4.59) in males and 4.64 years (2.93−6.05) in females. In both regions, LYL were higher for psychotic and substance use disorders than for depression and anxiety. Losses were primarily due to natural deaths at CD4 counts ≥200 cells/µl, with considerable contributions at CD4 counts &lt;200 cells/µl. Unnatural causes also contributed to the loss of life-years in males from SA and males and females from NA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PWH affected by mental health disorders experience higher mortality, primarily from natural causes. LYL were associated with both immunosuppression and higher CD4 levels. Improved management of HIV and physical comorbidities among PWH affected by mental health disorders may enhance their prognosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869376","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":"Socio-demographic and geographic disparities in HIV prevalence, HIV testing and treatment coverage: An analysis of 108 national household surveys in 33 African countries","authors":"Adrien Allorant,&nbsp;Salome Kuchukhidze,&nbsp;James Stannah,&nbsp;Yiqing Xia,&nbsp;Sanele S. Masuku,&nbsp;Gatien K. Ekanmian,&nbsp;Jeffrey W. Imai-Eaton,&nbsp;Mathieu Maheu-Giroux","doi":"10.1002/jia2.70024","DOIUrl":"https://doi.org/10.1002/jia2.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Socio-demographic and geographic disparities in HIV prevalence, uptake of HIV testing and access to antiretroviral therapy (ART) persist in high HIV burden countries. Understanding demographic, spatial and temporal factors can guide interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed 108 geo-referenced population-based surveys conducted over 2000–2023 across 33 African countries, involving 2.3 million respondents. Multilevel Bayesian logistic regression models assessed associations between HIV outcomes (HIV prevalence, recent HIV testing and ART coverage) and socio-demographic characteristics (age, education, place of residence, relative wealth), geographic location (country, district) and time trends. Separate models were estimated for men and women in central, eastern, southern and western Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Inequalities in HIV risk and access to testing and treatment services were driven by differences in educational attainment and within-country variations. In southern Africa, women with tertiary education had a 12%-point lower HIV prevalence (95% Credible Interval [CrI]: −27% to −2%) than those with less than primary education. In eastern Africa, they had a 13%-points (95% CrI: 2−22%) higher probability of recent HIV testing. Associations with relative wealth were weaker and more heterogeneous: in southern Africa, HIV prevalence shifted over time from higher to lower wealth quintiles, and adolescent girls and young women became the most frequently tested age group. In central Africa, wealthier men maintained higher recent testing and ART coverage levels. District-level variations accounted for disparities in HIV outcomes. In western Africa, the expected difference in ART coverage between individuals with similar socio-demographic characteristics living in different districts was 14%-points (95% CrI: 3−32%) for men and 10%-points (95% CrI: 3−27%) for women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Disparities in HIV outcomes are strongly associated with differences in education, and across districts of the same country. Higher education levels are associated with lower HIV prevalence, greater testing and higher ART coverage, while districts with limited services sustain higher population viraemia. Despite the scale-up of HIV prevention and treatment programmes, important disparities remain, and renewed education-centred and geographically targeted efforts are needed to close gaps.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833152","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}