Journal of the International AIDS Society最新文献

{"title":"From Policy to Practice: Brazil's Pathway to Eliminating Vertical Transmission of HIV as a Public Health Milestone","authors":"Pâmela Cristina Gaspar,&nbsp;Angélica Espinosa Miranda,&nbsp;Leonor Henriette de Lannoy,&nbsp;Ana Roberta Pati Pascon,&nbsp;Carmen Silvia Bruniera Domingues,&nbsp;Ítalo Vinicius Albuquerque Diniz,&nbsp;Amanda Krummenauer,&nbsp;Ana Paula Betaressi da Silva,&nbsp;Alisson Bigolin,&nbsp;Ariane Tiago Bernardo de Matos,&nbsp;Márcia Rejane Colombo,&nbsp;Claudia Gonçalves Siqueira,&nbsp;Angela Gasperin Martinazzo,&nbsp;Adele Schwartz Benzaken,&nbsp;Draurio Barreira,&nbsp;Mariângela Batista Galvão Simão,&nbsp;Brazilian Elimination Vertical Transmission Group (Brazilian EVT Group)","doi":"10.1002/jia2.70123","DOIUrl":"https://doi.org/10.1002/jia2.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The elimination of vertical transmission of HIV is a global health priority endorsed by the Pan American Health Organization (PAHO) and the World Health Organization (WHO), aligned with the Sustainable Development Goals (SDGs). Brazil has made substantial progress towards this goal through sustained investment in universal health policies and a rights-based approach to healthcare.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Brazil's national HIV response is anchored in the Unified Health System (Sistema Único de Saúde—SUS), a universal, decentralized and participatory health system that ensures access to prevention, diagnosis, treatment and monitoring. Tripartite governance—across federal, state and municipal levels—combined with strong community engagement, has enabled coordinated policy implementation at scale. This framework has supported high coverage of antenatal care (&gt;98%), HIV testing (&gt;95%) and antiretroviral therapy among pregnant women living with HIV (&gt;95%) in recent years. Vertical transmission rates of HIV declined from 3.73% in 2015 to 1.78% in 2023, remaining below the elimination threshold. The annual rate of new paediatric HIV acquisitions also declined to low levels, being 5.99 per 100,000 live births in 2023, far below the PAHO/WHO targets. A certification for states and municipalities strategy further accelerated progress toward the elimination by strengthening accountability, improving data quality and engaging local health systems.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Brazil's experience demonstrates that HIV vertical transmission elimination is feasible in large and unequal settings when supported by strong governance, integrated health systems and sustained political commitment. The certification of vertical transmission elimination of HIV by PAHO/WHO in 2025 represents a major milestone and offers valuable lessons for global health. Brazil remains committed to sustaining stainability of this certification and to advancing efforts for the elimination of other vertically transmitted infections, including syphilis, hepatitis B, Human T-cell lymphotropic virus (HTLV) and Chagas disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274770","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":"Getting Back on the Path to Eliminating HIV in Children","authors":"George K. Siberry","doi":"10.1002/jia2.70102","DOIUrl":"https://doi.org/10.1002/jia2.70102","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The global community proved remarkably resilient in protecting the progress in and commitment to eliminating HIV in children in the face of the COVID-19 pandemic. However, sudden disruptions in 2025 in donor support for HIV assistance have posed new and existential threats to the hard-fought gains in global paediatric HIV control.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Since the early 2000s, the reductions in paediatric HIV acquisitions, in deaths in children with HIV and in the number of children orphaned by HIV/AIDS have been breathtaking, but in recent years, progress has stalled, and gaps remain. The disruptions in political and financial support from the U.S. government obligate us to reframe our plans for ending HIV as a threat to children and also enable us to implement overdue changes in strategy to overcome barriers to success. Pillars for success include: robust integration of HIV into strengthened general healthcare systems; reassertion of national government leadership; prioritizing reduced donor funding for research and innovation; stronger partnership between private sectors and public health programmes; amplified community voices; and bold determination and creative solutions from global paediatric HIV stakeholders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The time is right for the global paediatric HIV community to consider the key factors that have enabled the tremendous progress towards ending the threat of HIV in children, the critical barriers to overcoming remaining gaps and a framework no longer so dependent on donor support for getting back on the path to eliminating HIV in children. The diverse and talented global HIV stakeholder coalition will find the opportunities for transformation and innovation in paediatric HIV care and boldly chart a lasting, evidence-based, person-centred, community-informed, national health system-aligned path to ending HIV as a threat to children.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70102","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274771","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":"Acceptability of a Dolutegravir Oral Dispersible Film in Term Neonates Born to Mothers Living With HIV","authors":"Lario Viljoen,&nbsp;Charlene Purdy,&nbsp;Verah Luke,&nbsp;Samantha du Toit,&nbsp;Marisa Groenewald,&nbsp;Lindee Ganger,&nbsp;Anneke C. Hesseling,&nbsp;Anthony J. Garcia-Prats,&nbsp;Tim R. Cressey,&nbsp;Adrie Bekker","doi":"10.1002/jia2.70104","DOIUrl":"https://doi.org/10.1002/jia2.70104","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;Dolutegravir (DTG) is a key antiretroviral (ARV) drug for children living with HIV, but no specific formulation is available for neonates (&lt;28 days old). One of the DTG formulations evaluated in the PETITE-DTG trial was a novel 5 mg oral DTG dispersible film (DTG-Film). Acceptability to end-users is essential when introducing new ARV drugs. We report on the experiences of mothers and health workers related to the DTG-Film.&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;PETITE-DTG was a phase I/II, open-label two-stage study evaluating the pharmacokinetics, safety and acceptability of two paediatric DTG formulations in term neonates in South Africa. In the multi-dose stage, 43 term neonates born to women with HIV were randomized to receive either the 5 mg DTG-Film or half of a 10 mg DTG dispersible tablet, in addition to zidovudine syrup prophylaxis, for 28 days. In-depth interviews were conducted in a sub-set of mothers whose neonates received DTG-Film (at three time points) and with health workers (at two time points). Thematic analysis was employed.&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;Data were collected (September 2023–October 2024) from 16 virologically suppressed mothers (median age: 38 years) whose neonates received DTG-Film and six female health workers (median age: 47 years) involved in the study. Usability was described positively—with participants highlighting ease of administration, quick dissolution, accurate dosing with no spillage and convenient packaging. Some mothers were initially hesitant due to unfamiliarity with the film, but after 1–2 doses, most reported liking or preferring the DTG-Film above other known ARV formulations. The film integrated well into households, was supported by family members and was considered discreet, helping to avoid unintentional HIV-status disclosure. Previous experience with neonatal ARV drugs and trust in health workers supported acceptability. Health workers noted DTG-Film was potentially fit for use in public health settings, where other formulations require manipulation prior to administration. Health workers played a key role in reassuring mothers that the “paper” was indeed medicine.&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;Mothers and health workers found the new DTG-Film acceptable for neonatal use. While initial hesitancy was noted, acceptability increased with use. Targeted peer support and engagement with mothers and health workers will be essential to familiarize end-users with the novel DTG-Film.&lt;/p&gt;\u0000 &lt;/section&gt;","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70104","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274716","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 Delivery Disconnect: Why We Could Not Model the Impact of Foreign Aid Reductions on Vertical HIV Transmission and What Remains Evident About Strategic Priorities","authors":"Alyssa Bilinski,&nbsp;Andrea Ciaranello,&nbsp;Amrutha Ramaswamy,&nbsp;Magdalene Walters,&nbsp;Karen Webb,&nbsp;Jeffrey W. Imai-Eaton","doi":"10.1002/jia2.70129","DOIUrl":"https://doi.org/10.1002/jia2.70129","url":null,"abstract":"&lt;p&gt;Preventing HIV acquisitions in children has been one of the most impactful achievements in human health. Over the past two decades, global HIV incidence among children has fallen about 75%, from approximately 490,000 in 2005 to 120,000 in 2024, as antiretroviral therapy (ART) coverage among pregnant women with HIV rose from 10% to 84% [&lt;span&gt;1, 2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In 2025, upheaval to US foreign assistance for health threatened this progress. Early model-based analyses projected that interruptions of HIV services previously supported by PEPFAR could substantially increase HIV transmission and AIDS-related deaths [&lt;span&gt;3-6&lt;/span&gt;]. These models sought to illustrate potential implications of drastic cuts, in part to support funding waivers for “life-saving HIV services,” but were limited to simplified “what if” scenarios amidst policy uncertainty. We initially sought to conduct a model-based analysis of the impact of discontinuing foreign assistance for reproductive, maternal, newborn, and child health (RMNCH)—beyond direct HIV-related services—on vertical HIV transmission. However, limited data on both service interruptions and the flow of HIV versus non-HIV investment dollars left us uncomfortable generating quantitative projections as planned.&lt;/p&gt;&lt;p&gt;Nevertheless, precise projections are not the only output models offer. Amidst uncertainty, modelling can identify generalizable insights: which factors most shape outcomes and which conclusions are robust across scenarios. In what follows, we first review uncertainties that prevented us from generating quantitative projections and then highlight two qualitative conclusions that hold across plausible scenarios: (1) systems investment remains critical for prevention of vertical transmission (pVT); and (2) the impact of lenacapavir-based pre-exposure prophylaxis (PrEP) depends on this infrastructure.&lt;/p&gt;&lt;p&gt;What didn't we know? We encountered two data limitations. The first was the interruption of routine reporting. PEPFAR's progress on pVT has historically been documented in national health management information systems. Similar aggregate results reported directly to PEPFAR have been publicly shared on a quarterly basis. However, in 2025, the US government stopped routine reporting, releasing only limited quarter 3 2025 data in April 2026 [&lt;span&gt;7&lt;/span&gt;]. This rendered it challenging to understand how policy shifts affected care.&lt;/p&gt;&lt;p&gt;Second, we struggled to characterize the relationship between funding and services, as national governments, PEPFAR (for HIV-related services), USAID (for myriad non-HIV-related services, including reproductive and maternal health), the Global Fund and other donors funded closely related services at the same delivery sites. For example, at an antenatal clinic, staff may have been paid through one mechanism, supplies purchased through another and overhead or specific services funded through a third. We could not determine who paid for what, which components were at ris","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70129","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274732","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":"Timely and Efficient Infant Diagnosis Is Required to End AIDS in Children","authors":"Lara Vojnov,&nbsp;Ilesh V. Jani","doi":"10.1002/jia2.70113","DOIUrl":"https://doi.org/10.1002/jia2.70113","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Though considerable effort and investment has significantly increased the proportion of pregnant women living with HIV accessing lifesaving antiretroviral therapy and lowered the prevalence of vertical HIV transmission, more than 70,000 children die each year due to AIDS-related deaths, and nearly half of the 1.4 million children living with HIV are not receiving antiretroviral treatment (ART). Improving case-finding and identification of children acquiring HIV and accelerating linkage to ART will be fundamental to end AIDS in children.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>A variety of existing infant and child case-finding strategies could be tailored by countries to complement testing within vertical HIV transmission programmes, including establishing the HIV exposure status of sick infants and children attending malnutrition and inpatient wards and children accessing vaccines, as well as out-of-facility strategies such as community and family-based testing. Because the risk of HIV acquisition is persistent throughout pregnancy, delivery and breastfeeding, repeated testing throughout the exposure period and especially after cessation of breastfeeding will be critical in capturing HIV acquisitions as early as possible. Immediate or rapid linkage to ART is now possible through using same-day point-of-care testing technologies.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>As countries aim to end AIDS in children, adapted and nuanced strategies for case-finding, test timing and the technologies used should be leveraged to meet the needs of each setting and country. Several countries have shown us that it is possible to end AIDS; however, it requires political will, strategic thinking, funding, prioritization and creative innovations.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70113","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274769","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":"From the “Dark Days” to Golden Days: Lessons From the Botswana National Validation Committee's Journey on the Path to Elimination of Vertical Transmission of HIV","authors":"Mogomotsi Matshaba,&nbsp;Queen Nthusang,&nbsp;Jessica Setswalo,&nbsp;Tebogo Madidimalo,&nbsp;Bornapate Nkomo,&nbsp;Mooketsi Molefi","doi":"10.1002/jia2.70105","DOIUrl":"https://doi.org/10.1002/jia2.70105","url":null,"abstract":"&lt;p&gt;The global HIV epidemic is now mature, potentially getting closer to elimination targets set by UNAIDS and the path set by the World Health Organization (WHO) [&lt;span&gt;1&lt;/span&gt;]. In parallel, WHO has advanced the concept of triple elimination of mother-to-child-transmission (MTCT) of HIV, syphilis and hepatitis B, recognizing the shared service delivery platforms, health system enablers and human rights principles to eliminate these infections among pregnant women and infants. Lessons from Botswana demonstrate that elimination is achievable when key ingredients are in place, including adequate resource allocation, political will, community and stakeholder engagement, and evidence-based programming, among others [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;The first country to be validated by WHO for eliminating MTCT of HIV was Cuba in 2015, followed by Thailand, Armenia and Moldova in 2016 [&lt;span&gt;3&lt;/span&gt;]. These early validations occurred in countries with low HIV burden. In contrast, countries with a high burden of HIV—and overlapping burdens of syphilis and hepatitis B—face substantially greater barriers to achieving elimination. These challenges include large populations of people living with HIV, persistent structural and developmental constraints, competing national priorities and limitations in health systems capacity, financing, and programme implementation [&lt;span&gt;4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Given these challenges facing countries with a high burden of HIV, the WHO developed a path to elimination (PTE) of transmission of HIV, making it possible for these countries to celebrate each step of the process [&lt;span&gt;1&lt;/span&gt;]. The process is overseen by local, regional and global committees that work together to ensure progress. The achievement of elimination of MTCT of HIV requires the Ministry of Health (MoH) ownership, rigorous data analysis and intensive programme assessment. This involves a set of impact and process indicators looking at data quality, programme strength, laboratory quality and human rights, gender equality and community engagement. see Figure 1.&lt;/p&gt;&lt;p&gt;Botswana has made remarkable progress since the period in which Former President Festus Mogae warned at the 2001 UN General Assembly that the nation faced the threat of extinction [&lt;span&gt;6&lt;/span&gt;]. This was followed by significant government investments in the nation's health and an outpouring of solidarity and support from the international community, and subsequently led to Botswana being one of the first high HIV-prevalence countries to achieve the WHO silver-tier validation for the PTE of HIV in 2021 [&lt;span&gt;7&lt;/span&gt;]. Sustaining this progress and advancing to gold-tier status in 2025 required strengthening health systems, optimizing service delivery and addressing residual programmatic gaps.&lt;/p&gt;&lt;p&gt;WHO first established National Validation Committees (NVC) to assess each country's progress towards elimination targets. In response, the MoH HIV Department, with support from partners, constituted Botswana's ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274797","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":"Progress and Challenges in Elimination of Vertical HIV Transmission","authors":"Lynne M. Mofenson,&nbsp;Jorge Pinto,&nbsp;Angela Mushavi","doi":"10.1002/jia2.70131","DOIUrl":"https://doi.org/10.1002/jia2.70131","url":null,"abstract":"&lt;p&gt;There has been tremendous progress in the prevention and treatment of vertical HIV transmission in children over the last three decades. In the early 1990s, vertical transmission from a mother living with HIV to her infant was approximately 15%–30% in high-resource settings and 30%–45% in breastfeeding populations in lower-resource settings, and almost 50% of children living with HIV died by the age of 2 years [&lt;span&gt;1-3&lt;/span&gt;]. Research in maternal and paediatric HIV has been incremental over the years, with each study building on previous data, resulting in the current era of universal treatment with potent antiretroviral treatment (ART). With current regimens, vertical transmission rates from pregnant mothers living with HIV who achieve and maintain viral suppression are less than 1%–2%, and children with HIV are living into adolescence and young adulthood and having children of their own [&lt;span&gt;4-6&lt;/span&gt;]. Thus, the tools to eliminate vertical transmission and end paediatric AIDS are available [&lt;span&gt;7&lt;/span&gt;], and the goal of global elimination of new paediatric HIV acquisitions has been thought to be imminent [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;However, while 84% of pregnant women living with HIV are currently receiving ART, overall coverage has been unchanged since 2019 [&lt;span&gt;9&lt;/span&gt;]. Although globally there has been a 56% decrease in new vertical transmissions since 2010, more than one in every 10 HIV-exposed infants acquired HIV in 2024. Almost half of the 120,000 new infant HIV acquisitions globally can be attributed to pregnant and breastfeeding mothers not knowing their HIV status and hence not receiving ART, and another quarter to new maternal acquisition of HIV during pregnancy or breastfeeding. While scale-up of infant HIV diagnosis and treatment has improved over the years, the proportion of children undergoing early infant diagnostic testing was only 65% in 2024. Additionally, just over half of children living with HIV were receiving ART. This reflects a consistent gap between adults and children with HIV in achieving the UNAIDS 95-95-95 targets of knowing their HIV status, and being on treatment and virally suppressed [&lt;span&gt;9, 10&lt;/span&gt;]. The stalling in prevention of paediatric HIV acquisition has several potential causes, including gaps in HIV testing for pregnant women; gaps in provision of and adherence to pre-exposure HIV prophylaxis (PrEP) in women at risk of HIV; difficulties in adherence to ART and retention in care for women, particularly during the postpartum period; and limitations in formulations and availability of antiretroviral drugs for neonates.&lt;/p&gt;&lt;p&gt;Additionally, the global context for HIV prevention and care has dramatically changed since January 2025, with sudden and unexpected reductions in United States funding for the President's Emergency Plan for AIDS Relief (PEPFAR) and closure of the United States Agency for International Development. Although waivers for resumption of “urgent life-saving” HIV services w","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274765","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":"Baseline Data on Viral Suppression, Treatment Adherence and Mental Health in Peripartum Girls and Young Women With HIV in Zimbabwe","authors":"Tariro D. Chawana-Mutingwende,&nbsp;Bernard Ngara,&nbsp;Leon-Say Mudadi,&nbsp;Thelma T. Tauya,&nbsp;Marvelous Sibanda,&nbsp;Mercy Mutambanengwe-Jacob,&nbsp;Precious Andifasi,&nbsp;Bernadette Malunda,&nbsp;Tinashe Chidemo,&nbsp;Annie Mapfunde,&nbsp;Sandra Nyakudya,&nbsp;Anna Z. Mufumisi,&nbsp;Thandiwe H. Chirenda,&nbsp;Tobias Chitambo,&nbsp;Walter T. S. Nderecha,&nbsp;Constance Murandu,&nbsp;Miriam Gwande,&nbsp;Kudakwashe Muringayi,&nbsp;Rhoda Micah Bongo,&nbsp;Hideaki Okochi,&nbsp;Karen Kuncze,&nbsp;Angela Mushavi,&nbsp;Nicola Willis,&nbsp;Karen Webb,&nbsp;Monica Gandhi,&nbsp;Lynda Stranix-Chibanda","doi":"10.1002/jia2.70117","DOIUrl":"https://doi.org/10.1002/jia2.70117","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;Peripartum adolescent girls and young women (AGYW) with HIV have lower viral suppression compared to older women. But the recently introduced dolutegravir-based regimens and psychosocial peer motivation may improve viral control. We assessed viral suppression, adherence, drug exposure and mental health in a cohort of peripartum AGYW with HIV.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We present baseline data from an ongoing randomized controlled and observational cohort study. Peripartum (conception to 24 months postpartum) AGYW 15- to 24-year-old with HIV and &lt;span&gt;&gt;&lt;/span&gt;3 months on tenofovir-based antiretroviral therapy were enrolled between September 2024 and July 2025. Point-of-care viral load and urine tenofovir assays were performed at entry, as well as data on sociodemographic, HIV, treatment and mental health characteristics. Anxiety was assessed using the Generalized Anxiety Disorder-7, depression using the Patient Health Questionnaire-9, stigma using the Modified HIV Stigma Scale and post-traumatic stress disorder using the Primary Care Post Traumatic Stress Disorder 5 tools.&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 151 participants. Mean age was 21.1 years. All participants were receiving tenofovir, lamivudine and dolutegravir. Baseline mean viral load was 1133 copies/mL (cpm); 135 (89.4%) were virally suppressed (viral load &lt;span&gt;&lt;&lt;/span&gt;40 cpm). Mean self-reported adherence over the past 1 month was 97.5%. Tenofovir was detected in 141 (93.4%) participants at baseline. The following were significantly associated baseline with viral suppression (mean [SD]; 95% CI) or (&lt;i&gt;n&lt;/i&gt; [%]): higher self-reported adherence (99.5 [1.7]; 99.2−99.8, &lt;i&gt;p&lt;/i&gt;&lt;0.001), detectable urine tenofovir (133 [94.3]; &lt;i&gt;p&lt;/i&gt;&lt;0.001), being married (79 [92.9]; &lt;i&gt;p&lt;/i&gt; = 0.03), having food security (86 [95.6]; &lt;i&gt;p&lt;/i&gt; = 0.004) and being financially secure (74 [96.1]; &lt;i&gt;p&lt;/i&gt; = 0.02). Seven (4.6%) experienced post-traumatic stress disorder, 132 (88.0%) had minimal or no depression; 137 (92.0%) had minimal anxiety and 81 (53.6%) experienced moderate stigma. Participants without detectable tenofovir in urine were 0.05 times less likely to have baseline viral suppression, adjusted odds ratio (95% CI) (0.05 [0.006−0.4]; &lt;i&gt;p&lt;/i&gt; = 0.004). Participants with higher self-reported adherence were 1.3 times more likely to have viral suppression (1.3 [1.1−1.6]; &lt;i&gt;p&lt;/i&gt; = 0.008).&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 viral suppression at enrolment into a cohort study in ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 S1","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70117","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148274768","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 Urine Tenofovir Point-of-Care Assay Facilitates Positive Antiretroviral Therapy Adherence Discussions Among People Living With HIV and Healthcare Providers—A Mixed-Methods Evaluation in Cape Town, South Africa","authors":"Abenathi Mcinziba,&nbsp;Dillon T. Wademan,&nbsp;Lario Viljoen,&nbsp;Hanlie Myburgh,&nbsp;Lauren Jennings,&nbsp;Zukiswa Nkantsu,&nbsp;Marije van Schalkwyk,&nbsp;Eric Decloedt,&nbsp;Monica Gandhi,&nbsp;Catherine Orrell,&nbsp;Gert van Zyl,&nbsp;Graeme Hoddinott","doi":"10.1002/jia2.70141","DOIUrl":"10.1002/jia2.70141","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 South Africa, antiretroviral therapy adherence monitoring relies on self-reported adherence, which is prone to recall error, and only verified annually during blood viral load measurement. A novel urine tenofovir rapid assay (UTRA) is a low-cost point-of-care adherence support tool for people living with HIV (PLHIV). Nested in an effectiveness randomized trial, we aimed to understand the relative acceptability of adherence support experiences among PLHIV receiving the UTRA point-of-care adherence intervention versus standard 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;All trial participants (&lt;i&gt;n&lt;/i&gt; = 199) completed a brief, repeat-measures, quantitative acceptability questionnaire at months 3, 6 and 12. We also conducted longitudinal in-depth interviews with 25 PLHIV with three interactions per participant over 52 weeks—a total of 75 interviews. Interviewed PLHIV were purposively sampled for balance by arm, diversity in age and gender, rich-case sampling, and saturation. We also conducted once-off in-depth interviews with five healthcare providers administering the UTRA intervention. Data were collected between May 2022 and June 2024. Qualitative data analysis involved descriptive summaries of key emergent themes with illustrative case examples augmented by descriptive statistics from the questionnaires.&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;Participants in the intervention arm reported that being tested and informed about their adherence levels in real-time served as a reminder to take treatment consistently. The UTRA facilitated conversations between PLHIV and healthcare providers on how to overcome barriers to adherence. Participants in the control arm reported that they relied on relatives for adherence support and accountability because there is limited time for adherence discussions with healthcare providers. Healthcare providers reported that providing adherence counselling to PLHIV receiving standard of care was challenging because they relied on voluntary disclosure of adherence interruptions. PLHIV in the intervention arm reported more positive experiences of adherence support compared to those in the control arm, regardless of their adherence practices.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A point-of-care adherence tool like the UTRA provides a much-needed platform for PLHIV and healthcare providers to discuss adherence practices and challenges. PLHIV preferred this style of adherence support compared to the standard of care.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 6","pages":""},"PeriodicalIF":5.2,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70141","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148275284","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":"Facilitators and Barriers to Implementing Peer-Led Neurocognitive Screening for Older Adults Living With HIV at a Community Hospital in Thailand: A Multiple-Methods Study","authors":"Linda Aurpibul,&nbsp;Rattika Thammalangka,&nbsp;Pramual Threeyakul,&nbsp;Arunrat Tangmunkongvorakul,&nbsp;Nittaya Phanuphak,&nbsp;Morgan M. Philbin,&nbsp;Claude A. Mellins","doi":"10.1002/jia2.70135","DOIUrl":"10.1002/jia2.70135","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Neurocognitive impairment (NCI) is increasingly prevalent among older adults living with HIV (OALHIV). HIV clinics in low- and middle-income countries often do not routinely screen for NCI. Task-shifting screening to peer educators might be an alternative approach. We explored facilitators and barriers to implementing a peer-led NCI screening tool in an HIV clinic in Thailand.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study took place at a community hospital HIV clinic in suburban Chiang Mai. Peer educators were trained to screen OALHIV ≥50 years for NCI using the International HIV-Dementia Scale for global cognition, the Trail-Making Test for psychomotor speed and the General Practitioner Assessment of Cognition. We interviewed OALHIV who participated in the peer-led NCI screening during and after a 12-week implementation phase, peer educators and healthcare professionals to identify individual and intervention characteristics categorized according to the Consolidated Framework for Implementation Research. Transcribed and imported digital materials were used for thematic analysis in Dedoose (version 9.2.12).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From March to June 2023, 162 eligible OALHIV were recruited. Among the 144 (89%) screened, the median age was 58 (IQR 54−62) years, and 93 (65%) were female. On at least one measure, 40 (28%) matched the study-defined referral criteria for NCI, of whom 20 (50%) were diagnosed with mild NCI, representing 14% of all those screened. We conducted 39 interviews with OALHIV (<i>n</i> = 26) and clinic-based staff (<i>n</i> = 12; five peer educators, eight healthcare professionals). The perceived benefits of neurocognitive screening, the empowerment of peer educators, the reliance on established links between peers and clinic clients, and OALHIV acceptance of screening were facilitators of the intervention. The main reported barriers were a lack of perceived necessity among OALHIV, clinic staff concerns about screening quality and comprehensiveness, and a lack of supportive national policies to integrate screening into routine HIV care for OALHIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We demonstrated that a peer-led NCI screening intervention was feasible and acceptable in our setting. Raising awareness of the benefits of NCI screening among OALHIV and improved training and coordination in the healthcare setting would facilitate more effective implementation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 6","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70135","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148222256","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}