HIV AIDS-Research and Palliative Care最新文献

{"title":"The Future of Newly Diagnosed HIV Cases in Iran Through 2030: A Mixed-Methods Trend Impact Analysis.","authors":"AliAkbar Haghdoost, Mostafa Hosseini Golkar, Hamid Sharifi, Farid Najafi, Alireza Alikhani","doi":"10.2147/HIV.S631256","DOIUrl":"https://doi.org/10.2147/HIV.S631256","url":null,"abstract":"<p><strong>Introduction: </strong>Despite substantial progress in the global HIV response, the MENA region continues to face important challenges in HIV prevention and control. In Iran, fluctuations in the number of newly diagnosed HIV cases indicate an ongoing public health challenge and underscore the need to anticipate factors that may shape future diagnosis patterns.</p><p><strong>Methods: </strong>This study applied Trend Impact Analysis (TIA) to develop conditional projections of newly diagnosed HIV cases in Iran through 2030. Monthly surveillance data from 1998 to 2023 were modeled using an ARIMA(2,0,2) to establish a baseline trend which was subsequently modified through TIA based on expert-informed estimates of the timing and magnitude of key drivers. A panel of 30 experts in HIV/AIDS, epidemiology, public health, and health policy identified and assessed key drivers that could influence future trends. Expert- informed estimates of the timing, magnitude, and persistence of impacts, were then incorporated into the baseline projection to construct alternative future scenarios.</p><p><strong>Results: </strong>Expert panels identified 13 key drivers: eight adverse influences, including conflict risk, increased sex work, new stimulant drug use, online sexual platforms, socioeconomic crises, emerging epidemics, developing sex tourism, and HIV drug resistance, expected to increase the future number of newly diagnosed HIV cases. Conversely, five positive influences, including AI healthcare, effective vaccination access, efficient surveillance toward the 95-95-95 objectives, PEP/PrEP implementation, and advanced therapies, expected to reduce the future number of newly diagnosed HIV cases. Quantitative estimates project 1698 new cases if current trends persist. Under optimistic scenarios, cases may decline by 51%, whereas pessimistic scenarios suggest an increase of 102%. The integrated TIA scenario projected an approximately 51% increase in newly diagnosed HIV cases by 2030, reaching 2558 cases by 2030, with an approximate 95% uncertainty interval of 2120-2996 (±2 SD).</p><p><strong>Conclusion: </strong>The scenario projections represent conditional future trajectories based on specified assumptions about the impact of different key drivers, The scenarios illustrate substantial uncertainty in the future number of newly diagnosed HIV cases in Iran, with scenario estimates ranging from approximately a 50% decrease to a 100% increase relative to the baseline projection.</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":"18 ","pages":"631256"},"PeriodicalIF":2.4,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13660510/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149184344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Predictors of Hyperglycemia Among Adults Receiving Dolutegravir-Based Antiretroviral Therapy at Mbarara Regional Referral Hospital HIV Clinic, Uganda: A Retrospective Cohort Study.","authors":"Arinaitwe Medard, Mwesigwa Geoffrey, Asiimwe Derrick, Ikiriza Anthony, Muyindike Winnie, Stephen Asiimwe","doi":"10.2147/HIV.S637953","DOIUrl":"10.2147/HIV.S637953","url":null,"abstract":"<p><strong>Background: </strong>Dolutegravir (DTG)-based antiretroviral therapy is widely used in sub-Saharan Africa, but routine-care evidence on incident hyperglycemia after DTG initiation or substitution remains limited in southwestern Uganda.</p><p><strong>Purpose: </strong>To determine the incidence and predictors of documented hyperglycemia among adults receiving DTG-based antiretroviral therapy at Mbarara Regional Referral Hospital.</p><p><strong>Patients and methods: </strong>We conducted a retrospective cohort study using routine clinical records of adults who initiated or switched to DTG-based ART between 1 January 2019 and 31 December 2023. Documented incident hyperglycemia was defined as fasting glucose ≥7.0 mmol/L or random glucose ≥11.1 mmol/L with documented classic symptoms. Cox proportional hazards regression estimated adjusted hazard ratios (aHRs); age was modeled per 10-year increase. The proportional-hazards assumption was assessed using Schoenfeld residuals.</p><p><strong>Results: </strong>Of 8,859 adults in the descriptive cohort, 8,856 contributed positive follow-up time. Seventy-four documented hyperglycemia events occurred over 29,157.74 person-years, an incidence rate of 2.54 per 1,000 person-years (95% CI 1.99-3.19). The smoothed hazard increased after DTG initiation/substitution, peaked at approximately 1.1 years, and declined thereafter. Higher hazard was associated with older age (per 10 years: aHR 1.70, 95% CI 1.33-2.18), prior thymidine analogue NRTI exposure (aHR 3.27, 95% CI 1.20-8.89), and ≥15 years of ART before DTG (aHR 5.63, 95% CI 1.39-22.77). The global proportional-hazards test was not significant (p=0.70).</p><p><strong>Conclusion: </strong>Documented hyperglycemia was uncommon but was associated with older age and markers of long-term ART exposure. Risk-stratified glucose monitoring should be considered, particularly during the first year after DTG initiation/substitution and among higher-risk patients.</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":"18 ","pages":"637953"},"PeriodicalIF":2.4,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149116591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-Test Fear and Confidentiality in Premarital HIV Screening in Somalia.","authors":"Abdullahi Hassan Mohamud","doi":"10.2147/HIV.S635922","DOIUrl":"https://doi.org/10.2147/HIV.S635922","url":null,"abstract":"<p><p>Somalia has a low-level HIV epidemic, but low prevalence does not necessarily mean that HIV testing is socially or psychologically low risk. This commentary examines \"pre-test fear\", defined here as anticipatory concern before HIV testing about possible health, relational, social, or confidentiality consequences of being tested or receiving a reactive result. Somalia-specific evidence documents HIV-related stigma, non-consented disclosure, misinformation, and confidentiality concerns, but direct evidence on pre-test fear and the prevalence or regulation of premarital HIV testing remains limited. Accordingly, the article distinguishes local evidence from contextual evidence drawn from other settings and does not present new patient-level data. It proposes a conceptual privacy-first framework for routine and premarital HIV screening built around voluntary informed consent, brief culturally appropriate pre-test information, confidential laboratory workflows, confirmatory testing, linkage to care, and community health literacy. The framework is intended to generate testable implementation questions rather than to represent an empirically validated intervention. For Somalia, the principal implication is that diagnostic quality should include not only analytical accuracy but also the conditions that make people willing to test, receive results, and continue into confirmatory testing and care. Prospective mixed-methods and implementation studies are needed to measure pre-test fear, characterize premarital testing practices, assess confidentiality, and evaluate whether privacy-centered counseling improves acceptability and linkage.</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":"18 ","pages":"635922"},"PeriodicalIF":2.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13578596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991330","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Role Expansion: Building Prepared, Empowered and Accountable Nurse Leaders for the HIV Response.","authors":"Emmanuel Ndahiro Manirafasha","doi":"10.2147/HIV.S640931","DOIUrl":"10.2147/HIV.S640931","url":null,"abstract":"<p><p>Nurses are central to HIV testing, treatment, prevention, differentiated service delivery, and increasingly integrated care. However, expanding their clinical responsibilities without corresponding leadership preparation, decision-making authority, and institutional support risks creating symbolic rather than effective leadership. This Viewpoint argues that the next phase of the HIV response requires prepared and accountable nurse leaders who can use program data, redesign workflows, strengthen referral systems, support quality improvement, and contribute to policy and resource decisions. Accountability must be reciprocal: nurse leaders should be responsible for quality, equity, patient experience, and workforce well-being, while institutions must provide adequate staffing, mentorship, reliable supplies, usable data, and enabling scopes of practice. Ministries, regulators, implementing partners, and HIV governance bodies should establish competency-based leadership preparation, align authority with responsibility, include nurses in decision-making, and involve communities in service design. Nursing leadership should be treated as essential HIV program infrastructure, not optional professional development.</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":"18 ","pages":"640931"},"PeriodicalIF":2.4,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13577171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148978292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Affecting Changes in CD4+ T-cell Count Among People Living with HIV (PLWH): A Retrospective Cohort Study in Kermanshah, Iran.","authors":"Ayda Mohammadnezamian, Keyghobad Ghadiri, Mosayeb Rostamian, Leila Solouki, Manizheh Azadian, Bahare Andayeshgar, Shahla Shahbazi, Roya Chegene Lorestani, Etrat Javadirad","doi":"10.2147/HIV.S589685","DOIUrl":"10.2147/HIV.S589685","url":null,"abstract":"<p><strong>Background and objective: </strong>Considering the crucial role of CD4+ T-cell counts in disease control and management, the present study aimed to investigate changes in CD4+ T-cell counts among People Living with HIV (PLWH) at the Behavioral Diseases Counseling Center in Kermanshah Province. The study also assessed the impact of demographic and clinical factors, including age, gender, duration of infection, duration of antiretroviral therapy (ART), and CD4+ T-cell count, on changes in CD4+ T-cell counts during ART among PLWH.</p><p><strong>Methods: </strong>In this retrospective study, the medical records of 2909 PLWH who had attended the Kermanshah Behavioral Diseases Counseling Center between 2012 and 2023 were reviewed. Demographic, behavioral, and clinical data were extracted from the records. Ultimately, 728 individuals whose CD4+ T-cell counts were documented both at diagnosis and after treatment were included in the analysis. Data were analyzed using SPSS version 21. As CD4+ T- cell count changes were not normally distributed, robust linear regression was employed. Collinearity among independent variables and autocorrelation of errors were assessed and confirmed. The assumption of homoscedasticity of errors was also evaluated and satisfied.</p><p><strong>Results: </strong>Among the 728 PLWH, 519 (71.3%) were male and 209 (28.7%) were female. The mean age of the PLWH was 37.2 ± 11.5 years. The mean CD4+ T-cell count at diagnosis was 336.4 cells/µL, which increased to 526.4 cells/µL after treatment. The average duration of treatment was 57.8 months (SD = 34.5), and the average number of follow-up visits was 48.6 (SD = 36.9). Robust linear regression, with ART duration entered as a four-level category, showed that longer ART duration (1-5 years: B=111.9; 5-10 years: B=267.5; >10 years: B=527.3, all vs <1 year, p<0.001), higher education (B=302.6, 95% CI: 171.5-433.7), older age (B=5.3, 95% CI: 2.4-8.3), and sexual transmission (B=101.6, 95% CI: 18.0-185.2) were significantly associated with improved CD4+ T-cell recovery (p<0.05). Female sex, more advanced clinical stage (III-IV), and certain occupational categories were also significantly associated with CD4+ T-cell recovery, while a longer duration of infection was associated with lower CD4+ T-cell recovery (all p<0.05).</p><p><strong>Conclusion: </strong>Consistent with the well-established effect of antiretroviral therapy on CD4+ T-cell recovery, this study suggests that immune recovery is influenced by both treatment duration and patients' demographic and clinical characteristics. These findings emphasize the importance of individualized HIV care, with closer monitoring and adherence support for patients at risk of poorer immune recovery.</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":"18 ","pages":"589685"},"PeriodicalIF":2.4,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148956893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the \"Missing Middle\" in Advanced HIV Disease Care for Adolescents in Sub-Saharan Africa: Early Identification, Integrated Care, and Continuity After Discharge.","authors":"Emmanuel Ndahiro Manirafasha","doi":"10.2147/HIV.S632486","DOIUrl":"10.2147/HIV.S632486","url":null,"abstract":"<p><p>Adolescents remain insufficiently addressed in the response to advanced HIV disease (AHD) in sub-Saharan Africa. Despite progress in HIV testing and antiretroviral therapy, gaps remain in early identification, integrated care, and continuity of care for adolescents at risk of severe disease. This commentary describes adolescents as a \"missing middle\" between pediatric and adult HIV services. It highlights how treatment interruption, fragmented services, psychosocial challenges, and weak follow-up can increase their vulnerability. We propose an adolescent-responsive AHD pathway focused on three priorities: early identification of adolescents at risk, integration of clinical and psychosocial care, and continuity after hospitalization or treatment interruption. The approach should be adapted to the available workforce, financing, technology, and health-system capacity. Strengthening these areas may help reduce preventable illness and deaths and improve retention and recovery among adolescents living with HIV in sub-Saharan Africa.</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":"18 ","pages":"632486"},"PeriodicalIF":2.4,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13557019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148921224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune Dysregulation and Viral Persistence in HPV-HIV Coinfection: Oncogenic and Clinical Implications.","authors":"Mitra Sadrkhanlou, Hossein Nasouti Aghjehroud, Zahra Nikkhooy, Zahra Sadat Mousavian Hiagh, Sobhan Aboulhassanzadeh, Hamed Aghazadeh","doi":"10.2147/HIV.S616942","DOIUrl":"10.2147/HIV.S616942","url":null,"abstract":"<p><strong>Introduction: </strong>Human papillomavirus (HPV) associated cancers constitute a major global health concern, particularly among people living with human immunodeficiency virus (HIV). Accumulating evidence suggests that HPV-HIV co-infection substantially increases the risk of genital, cervical, and oral cancers; however, the molecular and immunological mechanisms underlying this association remain incompletely elucidated.</p><p><strong>Objective: </strong>To critically review the current evidence regarding HPV-HIV interactions, focusing on immunological synthesis, translation, clinical implications, and development of a comprehensive prevention strategy for viral persistence and carcinogenesis.</p><p><strong>Research methods: </strong>The research methods employed were a narrative review of the literature through the use of major scientific databases such as PubMed, Scopus, and Web of Science, searching for articles up to the end of December 2024. Narrative synthesis of relevant studies on HPV-HIV coinfection, immune dysregulation, viral persistence, and cancer development focused on molecular, immunological, and clinical mechanisms. Limitations of this narrative review are that it may suffer from selection bias and does not include a quantitative meta-analysis.</p><p><strong>Results: </strong>There is epidemiological evidence that HPV-related genital, cervical, and oral cancers occur earlier, are more aggressive, and are much more common in HIV-infected persons. Specifically, clinical data have shown up to a six-fold increase in HPV persistence and an eighteen-fold increase in risk of infection among people who have low levels of CD4⁺ T-cells. Moreover, the prevalence of oral HPV is 2-6 times greater, reaching up to 32% in HIV positive cohorts and 16% in HIV negative controls. This quantitatively greater burden of persistent high-risk HPV infection is associated with immune dysfunction, which includes the depletion and dysfunction of CD4⁺ T cells and dendritic cells, resulting in impaired mucosal immune surveillance. Persistent HPV infection promotes oncogenic transformation through E6/E7-mediated inactivation of tumor suppressor pathways, including p53 and retinoblastoma protein. Chronic inflammation, epithelial barrier disruption, and altered cytokine signaling further contribute to a pro-oncogenic microenvironment.</p><p><strong>Conclusion: </strong>HPV-HIV coinfection is a biologically synergistic disease condition, which greatly increases the risk of oral, genital, and cervical cancers. A better understanding of this interaction on a mechanistic basis is crucial for optimizing prevention strategies. For HIV-positive populations, the practical recommendations include increased screening for cervical and anal HPV, strict implementation of HPV vaccination, and monitoring of the oral/oropharyngeal HPV in high-risk groups.</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":"18 ","pages":"616942"},"PeriodicalIF":2.4,"publicationDate":"2026-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13511458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148833459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From Denial to Near Blindness: Overcoming Herpes Zoster Ophthalmicus in a Rural Ugandan Man with HIV and Alcoholism.","authors":"Benson Okongo, Gladys Amuge, Ruth Lucy Adong, Anthony O Okengo, Enoch Muwanguzi","doi":"10.2147/HIV.S626441","DOIUrl":"10.2147/HIV.S626441","url":null,"abstract":"<p><strong>Introduction: </strong>In remote Ugandan settings, HIV care retention remains poor among men and pastoralists. Despite progress toward UNAIDS 95-95-95 targets, structural barriers, geographic isolation and stigma continue to undermine long-term retention.</p><p><strong>Case presentation: </strong>In 2022, a male pastoralist in his early forties with heavy alcohol use presented to a rural health center in Karamoja with fever and weight loss, and was diagnosed with HIV. He declined antiretroviral therapy (ART) believing the drugs were \"poisonous\" and was lost to follow-up for 48 months. He re-presented in March 2026 with a one-year history of a scaly, pruritic lesion on his right hand extending to the face and neck, unresponsive to antifungal creams. Two days prior, he developed an acutely painful vesicular eruption in the right V1 trigeminal distribution, along with oropharyngeal candidiasis. CD4 count was 120 cells/μL and urine TB LAM was positive, indicating disseminated tuberculosis. While LAM is highly suggestive and warrants immediate empirical treatment, definitive diagnosis of dissemination ideally requires clinical and radiological correlation. He was treated with oral acyclovir (800 mg five times daily for 10 days), topical acyclovir, ibuprofen, intensive-phase anti-TB therapy, and fluconazole (200 mg daily for 14 days). ART was deferred for two weeks to manage acute opportunistic infections and monitor for IRIS. At two weeks, the zoster lesions had crusted, oral candidiasis cleared, and pain reduced to 2/10. ART was initiated on day 14 with village health team support. At three months, he remained adherent with no new opportunistic infections.</p><p><strong>Conclusion: </strong>Delayed ART initiation caused years of preventable suffering. This case highlights the urgent need in low-income settings for community re-engagement strategies, integrated HIV/co-infection screening, point-of-care diagnostics, and culturally tailored care. As the patient stated: \"I was sick, and now I am well. The science of HIV treatment is a miracle, and I am living proof.\".</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":"18 ","pages":"626441"},"PeriodicalIF":2.4,"publicationDate":"2026-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436550/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148674010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Efficacy: The Access, Delivery Systems, Acceptability, Persistence, and Transition Management \"ADAPT\" Framework for Long-Acting Injectable PrEP in Sub-Saharan Africa.","authors":"Eric Nzirakaindi Ikoona, Lucy Namulemo, Ronald Kaluya, Rebecca Ikoona, Foday Sahr","doi":"10.2147/HIV.S616392","DOIUrl":"10.2147/HIV.S616392","url":null,"abstract":"<p><strong>Introduction: </strong>Long-acting injectable pre-exposure prophylaxis (LA-PrEP) is a major biomedical advance for HIV prevention, but efficacy alone does not deliver population-level impact. Oral PrEP performed well in trials yet persisted poorly in practice, including among young women in KwaZulu-Natal, South Africa. LA-PrEP reduces daily pill burden and improves discretion, but introduces implementation demands that oral PrEP did not: appointment-based adherence, product-specific delivery needs, workforce and task-shifting limits, financing vulnerability, HIV testing requirements and pharmacokinetic-tail management.</p><p><strong>Purpose: </strong>This paper develops the Access, Delivery Systems, Acceptability, Persistence and Transition Management (ADAPT) framework as a conceptual, practice-oriented model for LA-PrEP implementation in sub-Saharan Africa.</p><p><strong>Approach: </strong>ADAPT was developed through structured narrative synthesis of peer-reviewed and grey literature on oral PrEP scale-up, cabotegravir long-acting (CAB-LA) and lenacapavir (LEN) efficacy, HIV service delivery, task shifting and implementation frameworks, combined with non-research program experience from facility-facing implementation support in Uganda and Sierra Leone. The model is not empirically validated and should be tested through Delphi consensus, stakeholder consultation, prospective implementation studies and program evaluation.</p><p><strong>Discussion: </strong>ADAPT complements CFIR, RE-AIM, BLUPrInt and WHO guidance. Its contribution is product awareness, planner orientation and explicit recognition of Transition Management as a safety domain. It asks planners to align regulatory access, procurement and affordability; product-specific delivery systems; choice-based acceptability; appointment persistence; and protocols for stopping, switching and restarting.</p><p><strong>Conclusion: </strong>For sub-Saharan Africa, safer and more equitable LA-PrEP rollout requires deliberate design across financing, service delivery, community governance, persistence systems and transition protocols. ADAPT offers a testable organizing model for this work.</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":"18 ","pages":"616392"},"PeriodicalIF":2.4,"publicationDate":"2026-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13381110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148608585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Facilitators and Barriers to Implementation of WHO HEARTS Strategy for Hypertension and Diabetes Among People Living with HIV in Eastern Uganda: A COM-B Analysis.","authors":"Richard Katuramu, Yueyun Li, Maureen Namugaya, Steven Nsereko Muwanga, Ronald Kibuuka, Francis Mawejje, Samuel Baker Obakiro, Andrew Marvin Kanyike, Zhihui Li","doi":"10.2147/HIV.S611133","DOIUrl":"10.2147/HIV.S611133","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization's HEARTS technical package aims to improve the management of hypertension (HTN) and diabetes (DM) in primary health care at the population level. This study explored the barriers and facilitators of implementing this strategy among People Living with HIV (PLHIV) with Hypertension and/or Diabetes in Eastern Uganda.</p><p><strong>Methods: </strong>This was a descriptive qualitative study that used a semi-structured interview guide. We conducted in-depth interviews with healthcare workers (HCWs). We adopted the Capability, Opportunity, and Motivation (COM-B) model of behavior change to guide both study design and data analysis.</p><p><strong>Results: </strong>Twelve HCWs with a mean age of 36 years were interviewed. Within the capability domain, inadequate training on HTN and DM management was identified as a barrier, while existing skills in blood pressure measurement and management served as a facilitator. Social opportunity barriers included the absence of community-based support groups for integrated HIV-NCD co-management and the inability to track outcomes for patients on concurrent ART and NCD medications. Physical opportunity barriers encompassed frequent stock-outs of essential antihypertensive and antidiabetic medications, shortages of glucometer test strips and blood pressure machines, and understaffing at HIV clinics. Conversely, opportunity facilitators included collaboration with implementing partners for material support, adherence to standard treatment guidelines, and availability of lifestyle counselling sessions. Within the motivation domain, patient-centred follow-up and strong therapeutic rapport between healthcare workers and patients were identified as facilitators, with no motivational barriers reported.</p><p><strong>Conclusion: </strong>Implementation of the WHO HEARTS strategy in HIV clinics is influenced by some of the COM-B domains. Building on these findings, a stakeholder-informed foundation can support the design of contextually appropriate, behaviorally targeted interventions to improve outcomes in similar settings.</p>","PeriodicalId":46555,"journal":{"name":"HIV AIDS-Research and Palliative Care","volume":"18 ","pages":"611133"},"PeriodicalIF":2.4,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13361403/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}