Journal of the International AIDS Society最新文献

{"title":"Community-led monitoring of HIV and viral hepatitis services: lessons learned and impacts from India and Indonesia","authors":"Giten Khwairakpam,&nbsp;Rajkumar Nalinikanta,&nbsp;Caroline Thomas,&nbsp;Solange L. Baptiste,&nbsp;Elise Lankiewicz","doi":"10.1002/jia2.26373","DOIUrl":"10.1002/jia2.26373","url":null,"abstract":"<p>Community-led monitoring (CLM) assesses healthcare services and improves health outcomes. It provides insights about the state of local or national HIV responses, assisting managers and policymakers to improve services under the framework of availability, accessibility, acceptability and quality (AAAQ) [<span>1</span>]. Interest in CLM is growing, with support from the International AIDS Society, the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Global Fund to Fight AIDS, TB, and Malaria, and the United States President's Emergency Plan for AIDS Relief (PEPFAR) [<span>2-5</span>].</p><p>The Community-led Monitoring Project in Asia [<span>6</span>] was initiated in 2021 by the Community Network for Empowerment (CoNE) in Manipur, India, Yayasan Peduli Hati Bangsa in Indonesia, the International Treatment Preparedness Coalition—Global (ITPC) and amfAR's TREAT Asia programme. CoNE and Peduli Hati are monitoring 12 health facilities from local districts to referral hospitals that provide public services for HIV and viral hepatitis. CLM indicators are based on national guidelines and policies and target essential components of the AAAQ framework covering HIV, hepatitis B (HBV) and hepatitis C (HCV).</p><p>CLM is a mechanism where care recipients’ perceptions of the essential components of healthcare are captured and leveraged to advocate for changes in service delivery. Our observations indicate that CLM can also play a critical role in addressing urgent individual-level human rights and care access issues in a more rapid timeframe through effective co-problem-solving and advocacy.</p><p>The project is funded by ViiV Healthcare. The authors otherwise have no competing interests to declare.</p><p>GK led the drafting and writing of the manuscript. EL reviewed the draft and final manuscript. RN, CT and SLB provided inputs and edits. All authors approved the final version of the manuscript.</p><p>The CLM in Asia project is supported by ViiV Healthcare and amfAR.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 10","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11447636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142363628","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":"Persistently high HIV incidence among men who have sex with men and people who inject drugs attending integrated care centres in India: a longitudinal assessment of clinic-based data","authors":"Allison M. McFall,&nbsp;Mihili P. Gunaratne,&nbsp;Lakshmi Ganapathi,&nbsp;A. K. Srikrishnan,&nbsp;C. K. Vasudevan,&nbsp;Santhanam Anand,&nbsp;David D. Celentano,&nbsp;Sunil S. Solomon,&nbsp;Shruti H. Mehta,&nbsp;Gregory M. Lucas","doi":"10.1002/jia2.26361","DOIUrl":"https://doi.org/10.1002/jia2.26361","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Globally, there have been significant declines in HIV incidence over the past two decades, but this decline is slowing, and in some settings, declines have stalled or are growing—particularly where epidemics are concentrated in key populations (KPs). Understanding temporal changes in HIV incidence among KP is critical yet, due to logistical constraints, there are few sources of longitudinal incidence data, particularly among KP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We present HIV incidence rates from June 2014 to December 2022 among cisgender men who have sex with men (MSM) and people who inject drugs (PWID) attending community-based integrated care centres (ICCs) in 15 Indian cities. ICCs, established between 2014 and 2017, provide HIV testing and other services to MSM (eight sites) or PWID (eight sites). Client HIV testing data were included in the analysis if they had ≥2 tests and were not positive on the first test. We calculated incidence rates per 100 person-years (PY), stratified by KP, city/site and year. Poisson regression explored associations of incidence with time, age, gender (PWID only) and ICC use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From June 2014 to December 2022, 13,501 clients (5722 MSM, 7779 PWID) had ≥2 HIV tests over a median of 1.8 years. There were a total of 1093 incident HIV acquisitions. Overall incidence rates for MSM and PWID were 1.9/100 PY (95% CI: 1.7−2.2) and 4.1 (3.9−4.4), respectively. Among MSM sites, incidence ranged from 0.4 to 3.5 and in PWID sites from 0.6 to 17.9. From adjusted models, incidence increased by 17% annually among MSM. Among PWID, incidence increased by 11% annually up until 2020 and then decreased by 29% after 2020; when excluding the outlier of New Delhi, incidence was stable among PWID. MSM and PWID 21−25 years old had the highest risk of HIV and among PWID, those more consistently engaged in medication for opioid use disorder were at the lowest risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>While there was substantial geographic variability, MSM and PWID engaged in a free community-based clinic experienced persistently high HIV incidence (&gt;2/100 PY). KP in low- and middle-income countries should be a focus when considering novel strategies such as long-acting pre-exposure prophylaxis to curtail incidence.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26361","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273233","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":"Risk of dyslipidaemia in people living with HIV who are taking tenofovir alafenamide: a systematic review and meta-analysis","authors":"Jeong-Ju Yoo,&nbsp;Eun Ae Jung,&nbsp;Sang Gyune Kim,&nbsp;Young Seok Kim,&nbsp;Min Jae Kim","doi":"10.1002/jia2.26358","DOIUrl":"https://doi.org/10.1002/jia2.26358","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Among many antiretroviral drugs, tenofovir alafenamide is used extensively in combination regimens of tenofovir/emtricitabine or tenofovir/emtricitabine/bictegravir. However, concerns have arisen about the potential of tenofovir alafenamide to exacerbate hyperlipidaemia. This meta-analysis evaluates the relationship between tenofovir alafenamide use and lipid-profile alterations in people living with HIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched PubMed, Ovid MEDLINE, EMBASE and the Cochrane Library to identify studies on changes in cholesterol levels (e.g. total cholesterol, low-density and high-density lipoprotein cholesterol, and triglycerides) in people living with HIV who received treatment with a regimen containing tenofovir alafenamide (data collected 31 March 2023, review completed 30 July 2023). Potential risk factors for worsening lipid profile during treatment with tenofovir alafenamide were also evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty-five studies involving 39,713 people living with HIV were selected. Significant increases in total cholesterol, low-density and high-density lipoprotein cholesterol, and triglycerides were observed after treatment with tenofovir alafenamide. Specifically, low-density lipoprotein cholesterol (+12.31 mg/dl) and total cholesterol (+18.86 mg/dl) increased markedly from the third month of tenofovir alafenamide use, with significant elevations observed across all time points up to 36 months. Comparatively, tenofovir alafenamide regimens resulted in higher lipid levels than tenofovir disoproxil fumarate regimens at 12 months of use. Notably, discontinuation of the tenofovir alafenamide regimen led to significant decreases in low-density lipoprotein cholesterol (–9.31 mg/dl) and total cholesterol (–8.91 mg/dl). Additionally, tenofovir alafenamide use was associated with increased bodyweight (+1.38 kg; 95% confidence interval: 0.92–1.84), which became more pronounced over time. Meta-regression analysis identified young age, male sex and low body mass index as risk factors for worsening cholesterol levels in individuals treated with tenofovir alafenamide.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Tenofovir alafenamide use in people living with HIV is associated with significant alterations in lipid profile.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26358","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273234","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 rate of uncontrolled hypertension among adults receiving integrated HIV and hypertension care with aligned multi-month dispensing in Malawi: results from a cross-sectional survey and retrospective chart review","authors":"Hannah S. Whitehead,&nbsp;Khumbo Phiri,&nbsp;Pericles Kalande,&nbsp;Joep J. van Oosterhout,&nbsp;George Talama,&nbsp;Sam Phiri,&nbsp;Corrina Moucheraud,&nbsp;Agnes Moses,&nbsp;Risa M. Hoffman","doi":"10.1002/jia2.26354","DOIUrl":"10.1002/jia2.26354","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;People living with HIV have high rates of hypertension. Integrated HIV and hypertension care with aligned multi-month dispensing of medications (MMD) could decrease the burden of care for individuals and health systems. We sought to describe hypertension control and evaluate its association with different durations of MMD among Malawian adults receiving integrated care with aligned dispensing of antiretroviral therapy (ART) and antihypertensive medication.&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 survey and retrospective chart review of adults (≥18 years) receiving integrated HIV and hypertension care on medications for both conditions for at least 1 year, with aligned MMD at seven clinics in Malawi. Data were collected from July 2021 to April 2022 and included socio-demographics, clinical characteristics, antihypertensive medications and up to the three most recent blood pressure measurements. Bivariate analyses were used to characterize associations with hypertension control. Uncontrolled hypertension was defined as ≥2 measurements ≥140 and/or ≥90 mmHg. Chart reviews were conducted for a random subset of participants with uncontrolled hypertension to describe antihypertensive medication adjustments in the prior year.&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 surveyed 459 adults receiving integrated care with aligned dispensing (58% female; median age 54 years). Individuals most commonly received a 3-month aligned dispensing of ART and antihypertensive medications (63%), followed by every 6 months (16%) and every 4 months (15%). Hypertension control was assessed in 359 respondents, of whom only 23% had controlled hypertension; 90% of individuals in this group reported high adherence to blood pressure medications (0−1 missed days/week). Control was more common among those with longer aligned medication dispensing intervals (20% among those with 1- to 3-month dispensing vs. 28% with 4-month dispensing vs. 40% with 6-month dispensing, &lt;i&gt;p&lt;/i&gt; = 0.011). Chart reviews were conducted for 147 individuals with uncontrolled hypertension. Most had high self-reported adherence to blood pressure medications (89% missing 0−1 days/week); however, only 10% had their antihypertensive medication regimen changed in the prior year.&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;Uncontrolled hypertension was common among Malawian adults receiving integrated care with aligned MMD and was associated with shorter refill intervals and few antihypertensive medication escalations. Inte","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26354","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251359","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":"Courier delivery of antiretroviral therapy: a cohort study of a South African private-sector HIV programme","authors":"Yann Ruffieux,&nbsp;Naomi Folb,&nbsp;Anna Grimsrud,&nbsp;Michael Hislop,&nbsp;Liezl Dunn,&nbsp;Eliane Rohner,&nbsp;Anne Maria Namubiru,&nbsp;Chido Chinogurei,&nbsp;Morna Cornell,&nbsp;Mary-Ann Davies,&nbsp;Matthias Egger,&nbsp;Gary Maartens,&nbsp;Andreas D. Haas","doi":"10.1002/jia2.26360","DOIUrl":"10.1002/jia2.26360","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Courier delivery has become a popular antiretroviral therapy (ART) distribution method in some HIV care settings, yet data on ART courier delivery and how it relates to ART outcomes are scarce. We studied the differences in viral suppression rates between individuals from a South African private sector HIV programme receiving ART by courier delivery and those receiving ART through traditional retail dispensing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Individuals aged 15 years or older who were actively enrolled in the Aid for AIDS programme between January 2011 and July 2022 were eligible for the analysis. The outcome of interest was viral suppression defined as a viral load (VL) &lt;400 copies per ml. We calculated adjusted odds ratios (OR) for the association between the ART distribution method and viral suppression, comparing those receiving refills through courier pharmacies versus retail dispensing at the time of the VL testing. We used generalized estimating equations to account for repeated VL testing of the same individual. The models were adjusted for age, sex, calendar year, ART regimen, history of mental illness and medical insurance scheme. We computed adjusted ORs for the calendar periods 2011−2013, 2014−2016, 2017−2019, 2020−2022 and overall.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We extracted 442,619 VL measurements from 68,720 eligible individuals, 39,406 (57.3%) were women. The median number of VL measurements per individual was 6 (IQR 3−10). VL suppression was detected in 398,901 (90.1%) tests, and 185,701 (42.0%) of the tests were taken while the individual was receiving ART by courier delivery. Overall, courier delivery was associated with 5% higher odds of viral suppression than retail dispensing (adjusted OR 1.05, 95% CI 1.02−1.08). The strength and direction of this association varied by calendar period, with an adjusted OR of 1.37 (95% CI 1.27−1.48) in 2011−2013 and 1.02 (95% CI 0.97−1.07) in 2020−2022.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Courier delivery of ART is a viable alternative to retail dispensing in the South African private sector, as it was associated with higher viral suppression until 2016 and similar suppression rates in recent years. Further research is needed to investigate the potential benefits and drawbacks of courier delivery of ART in both private and public healthcare settings.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26360","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142251296","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":"Improving access to integrated community-based HIV, HCV and harm reduction services for people who inject drugs in Putao district, North Myanmar","authors":"Nini Tun,&nbsp;Cho Lwin Oo,&nbsp;Cho Myat Nwe,&nbsp;Lutgarde Lynen,&nbsp;Tom Decroo,&nbsp;Frank Smithuis,&nbsp;Tinne Gils","doi":"10.1002/jia2.26355","DOIUrl":"https://doi.org/10.1002/jia2.26355","url":null,"abstract":"&lt;p&gt;People who inject drugs (PWID) are disproportionally affected by HIV acquisition [&lt;span&gt;1&lt;/span&gt;]. Myanmar, a large producer of opium, has an estimated 116,000 PWID, among whom an estimated 26.4% are people living with HIV [&lt;span&gt;2, 3&lt;/span&gt;]. Needle sharing contributed to one-third of the national HIV incidence in 2018 [&lt;span&gt;4&lt;/span&gt;]. The national harm reduction programme includes prevention and care for HIV, viral hepatitis C (HCV), other sexually transmittable infections and tuberculosis (TB), needle and syringe exchange (NSE), and opiate substitution therapy (OST) for PWID [&lt;span&gt;4&lt;/span&gt;]. Yet, nationally, only 24.0% of PWID were tested for HIV, and 47.8% of HIV-positive PWID were on antiretroviral treatment (ART) [&lt;span&gt;3&lt;/span&gt;]. Even in Yangon, PWID experience barriers to access NSE and OST [&lt;span&gt;5&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Putao is a remote sparsely populated district on the slopes of the Himalayas in the far North of Myanmar [&lt;span&gt;6&lt;/span&gt;]. Sources of income include agriculture, and gold mines operated by increasing numbers of migrant workers. Opioid cultivation sites exist [&lt;span&gt;6&lt;/span&gt;]. Heroin injecting is common in Putao, among miners, and in rural communities [&lt;span&gt;7&lt;/span&gt;]. Access to health services for PWID is tremendously challenging. Poor road infrastructure, lack of public transport and extreme remoteness of the villages hamper physical access. OST is restricted to government hospitals. Like elsewhere, PWID are insufficiently aware about the risks of heroin use, associated blood-borne infections, and available care [&lt;span&gt;5&lt;/span&gt;] and often stigmatized by community members [&lt;span&gt;8&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Before 2012, no PWID-specific harm reduction services existed in Putao. HIV testing and ART initiation were provided at a public hospital, where only seven ART patients were registered as PWID before 2012.&lt;/p&gt;&lt;p&gt;Medical Action Myanmar (MAM), a medical organization, is present in Putao since 2012. In a first phase, MAM provided clinic-based primary care services, following a request by a local organization and because no other non-governmental organizations were present. Due to a lack of key population data and PWID-specific services, and a suspicion of PWID presenting with advanced HIV, MAM started clinic-based HIV testing and treatment, while referring TB patients to a local organization for treatment and care. The high incidence of malaria and TB and difficulties with linkage to care prompted MAM to set up a network of community health workers (CHWs) providing malaria, TB and primary healthcare services in remote communities in 2014. CHWs were selected by MAM and village leaders among community volunteers, trained by MAM, and incentivized per diagnosis, referral, and treated malaria or TB patient. Trained CHWs received a joint certificate from the Ministry of Health and MAM. Due to the remoteness of the Putao district, clinic-based HIV services were insufficient to reach most PWID. Between 2012 and 2017, only 144 PWID were initiat","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26355","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142231090","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":"Social network-based approaches to HIV testing: a systematic review and meta-analysis","authors":"Annabelle Choong,&nbsp;Yi Ming Lyu,&nbsp;Cheryl C. Johnson,&nbsp;Rachel Baggaley,&nbsp;Magdalena Barr-DiChiara,&nbsp;Muhammad S. Jamil,&nbsp;Nandi L. Siegfried,&nbsp;Christopher K. Fairley,&nbsp;Eric P. F. Chow,&nbsp;Virginia Macdonald,&nbsp;Jason J. Ong","doi":"10.1002/jia2.26353","DOIUrl":"https://doi.org/10.1002/jia2.26353","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;Social network-based testing approaches (SNAs) encourage individuals (“test promoters”) to motivate sexual partners and/or those in their social networks to test for HIV. We conducted a systematic review to examine the effectiveness, acceptability and cost-effectiveness of SNA.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We searched five databases from January 2010 to May 2023, and included studies that compared SNA with non-SNA. We used random-effects meta-analysis to combine effect estimates. Certainty was assessed using the GRADE approach.&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 identified 47 studies. SNA may increase uptake of HIV testing compared to non-SNA (RR 2.04, 95% CI: 1.06–3.95, Low certainty). The proportion of first-time testers was probably higher among partners or social contacts of test promoters using SNA compared to non-SNA (RR 1.49, 95% CI: 1.22–1.81, Moderate certainty). The proportion of people who tested positive for HIV may be higher among partners or social contacts of test promoters using SNA compared to non-SNA (RR 1.84, 95% CI: 1.01–3.35, Low certainty). There were no reports of any adverse events or harms associated with SNA. Based on six cost-effectiveness studies, SNA was generally cheaper per person tested and per person diagnosed compared to non-SNA. Based on 23 qualitative studies, SNA is likely to be acceptable to a variety of populations.&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;Our review collated evidence for SNA to HIV testing covering the key populations and the general population who may benefit from HIV testing. We summarized evidence for the effectiveness, acceptability and cost-effectiveness of different models of SNA. While we did not identify an ideal model of SNA that could be immediately scaled up, for each setting and population targeted, we recommend various implementation considerations as our meta-analysis showed the effectiveness might differ due to factors which include the testing modality (i.e. use of HIV self-testing), type of test promoters, long or short duration of recruitment and use of financial incentives.&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;Social network-based approaches may enhance HIV testing uptake, increase the proportion of first-time testers and those testing positive for HIV. Heterogeneity among studies highlights the need for context-specific adaptations, but the overall positive impact of SNA on HIV te","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 9","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26353","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142165474","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":"Persistent low-level viraemia is associated with non-infectious comorbidities in an observational cohort in four African countries","authors":"Allahna L. Esber,&nbsp;Suze Colt,&nbsp;Ningbo Jian,&nbsp;Nicole Dear,&nbsp;Bonnie Slike,&nbsp;Valentine Sing'oei,&nbsp;Jonah Maswai,&nbsp;Michael Iroezindu,&nbsp;Emmanuel Bahemana,&nbsp;Hannah Kibuuka,&nbsp;Christina S. Polyak,&nbsp;Hendrik Streeck,&nbsp;Neha Shah,&nbsp;Trevor A. Crowell,&nbsp;Julie A. Ake,&nbsp;the AFRICOS Study Group","doi":"10.1002/jia2.26316","DOIUrl":"10.1002/jia2.26316","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>People living with HIV (PLWH) have higher rates of non-infectious comorbid diseases (NCDs) than individuals without HIV. We characterized the risk of NCDs among PLWH with undetectable viral load and persistent low-level viraemia (pLLV) in the African Cohort Study (AFRICOS). We secondarily quantified the role of immune activation in the association between LLV and NCDs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>AFRICOS enrols participants in 12 clinics in Uganda, Kenya, Tanzania and Nigeria. Participants on antiretroviral therapy ≥ 6 months without an NCD at enrolment were included. PLLV was defined as at least two consecutive visits with a detectable viral load &lt;1000 copies/ml. We examined elevated blood pressure, hypercholesterolemia, hyperglycaemia, renal insufficiency and a composite variable of any NCD. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard modelling. Among a subset of participants with biomarker data, we assessed the interaction between viral load and 13 biomarkers in the association with any NCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From 23 January 2013 to 1 December 2022, 1755 participants met the inclusion criteria for these analyses. At the first eligible visit, the majority of participants had an undetectable viral load (<i>n</i> = 1375, 78.35%). Participants with pLLV had an increased rate of developing any NCD (aHR: 1.22, 95% CI: 1.02−1.47) compared to participants with an undetectable viral load. There was a statistically significant interaction between LLV and TNF-α, CCL2/MCP-1 and TNF-RII in the association with any NCD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PLLV was significantly associated with NCDs and immune inflammation in this population. Aggressive management of LLV may positively impact NCDs in PLWH.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26316","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142071602","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":"Occupational post-exposure prophylaxis among healthcare workers: a scoping review of factors affecting optimal utilization","authors":"Judith D. Auerbach,&nbsp;Siobhan Malone,&nbsp;Andrew D. Forsyth","doi":"10.1002/jia2.26341","DOIUrl":"10.1002/jia2.26341","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;Post-exposure prophylaxis (PEP) is an efficacious prevention method when initiated promptly after an HIV exposure. Yet, PEP has been underutilized, even among healthcare workers (HCWs) with occupational exposure in sites with PEP policies and procedures and access to PEP medications. It is important to understand the dynamics of uneven PEP use in what appears to be an optimal context to better protect the health and wellbeing of HCWs.&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 scoping review to elucidate factors influencing HCWs’ use of PEP after occupational exposure. We searched PubMed, PsychInfo and Google Scholar for peer-reviewed literature published in English from 2014 to 2022 using the terms &lt;i&gt;HIV, postexposure/post-exposure prophylaxis, acceptability&lt;/i&gt;, &lt;i&gt;healthcare workers&lt;/i&gt;, and &lt;i&gt;values and preferences&lt;/i&gt;. An inductive narrative review of the resulting 53 studies identified core themes.&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;Nearly all studies (96%) with various HCW types and settings occurred in low- and middle-income countries (LMICs) in Africa and Asia. Identified themes arrayed along a trajectory of PEP use experience: awareness/knowledge; acceptability; availability/access; uptake/use; adherence/completion. Across studies, awareness of PEP for HIV prevention was high, knowledge about drug regimens and healthcare facility policies was moderate to low; acceptability of PEP was moderate to high; PEP's perceived accessibility/availability was inconsistent and varied by geographic location and setting; HCWs’ uptake of PEP was low, affected by not knowing how to report an exposure and being unaware of PEP availability; and adherence/completion of PEP regimens was moderate to low, impeded by side effects and a belief that completing regimens was unnecessary to avert seroconversion. HCWs consistently expressed concern about HIV stigma.&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;Findings are limited by the inconsistent use of constructs across studies and a lack of clarity about reporting exposure events. Multi-level approaches are needed to address the interplay of individual, social and structural barriers that diminish HCWs’ PEP use. Improved training, incident reporting, 24-hour access to non-stigmatizing PEP services and monitoring of adherence/completion are essential to optimizing HCWs’ PEP use.&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;Lessons f","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26341","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999080","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 impact of analytical treatment interruptions and trial interventions on time to viral re-suppression in people living with HIV restarting ART in cure-related clinical studies: a systematic review and meta-analysis","authors":"Ming Jie Lee,&nbsp;Miles Eason,&nbsp;Antonella Castagna,&nbsp;Galli Laura,&nbsp;Marie-Angelique De Scheerder,&nbsp;James Riley,&nbsp;Pablo Tebas,&nbsp;Jesper Gunst,&nbsp;Ole Søgaard,&nbsp;Eric Florence,&nbsp;Eugene Kroon,&nbsp;Mark De Souza,&nbsp;Beatriz Mothe,&nbsp;Marina Caskey,&nbsp;Sarah Fidler","doi":"10.1002/jia2.26349","DOIUrl":"10.1002/jia2.26349","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;To assess the effectiveness of novel HIV curative strategies, “cure” trials require periods of closely monitored antiretroviral therapy (ART) analytical treatment interruptions (ATIs). We performed a systematic review and meta-analysis to identify the impact of ATI with or without novel therapeutics in cure-related studies on the time to viral re-suppression following ART restart.&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;Medline, Embase and Web of Science databases were searched for human studies involving ATIs from 1 January 2015 till 22 April 2024. The primary outcome was time to first viral re-suppression (plasma HIV viral load [VL] &lt;50 copies/ml) stratified by receipt of interventional drug with ATI (IA) or ATI-only groups. Random-effects proportional meta-analysis and multivariable Cox proportional hazards analysis were performed using R.&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 1073 studies screened, 13 were included that met the inclusion criteria with VL data available after restarting ART (&lt;i&gt;n&lt;/i&gt; = 213 participants). There was no difference between time to viral suppression in IA or ATI-only cohorts (&lt;i&gt;p&lt;/i&gt; = 0.22). For 87% of participants, viral suppression within 12 weeks of ART restart was achieved, and all eventually had at least one VL &lt;50 copies/ml during follow-up. After adjusting for covariables, while participants in the IA cohort were associated with less rapid suppression (adjusted hazard ratio [aHR] 0.61, 95% CI 0.40–0.94, &lt;i&gt;p&lt;/i&gt; = 0.026), other factors include greater log VL at ART restart (aHR 0.56, 95% CI 0.46–0.68, &lt;i&gt;p&lt;/i&gt;&lt;0.001), duration since HIV diagnosis (aHR 0.93, 95% CI 0.89–0.96) and longer intervals between HIV VL monitoring (aHR 0.66, 95% CI 0.59–0.74, &lt;i&gt;p&lt;/i&gt;&lt;0.001). However, the use of integrase inhibitors was associated with more rapid viral suppression (aHR 1.74, 95% CI 1.16–2.59).&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;When designing studies involving ATIs, information on time to viral re-suppression after restarting ART is important to share with participants, and should be regularly monitored and reported, to assess the impact and safety of specific trial interventions in ATI studies.&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 majority of participants achieved viral suppression after restarting ART in ATI studies. ART regimens containing integrase inhibitors and frequent VL monitoring should be offered for people","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26349","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141999082","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}