Lancet Hiv最新文献

{"title":"Screening for chlamydia and incidence of symptomatic infections.","authors":"Thibaut Vanbaelen, Achilleas Tsoumanis, Chris Kenyon","doi":"10.1016/S2352-3018(24)00270-4","DOIUrl":"10.1016/S2352-3018(24)00270-4","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e9"},"PeriodicalIF":12.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of a multicomponent, person-centred care intervention on client experience and HIV treatment outcomes in Zambia: a stepped-wedge, cluster-randomised trial.","authors":"Kombatende Sikombe, Aaloke Mody, Charles W Goss, Sandra Simbeza, Laura K Beres, Jake M Pry, Ingrid Eshun-Wilson, Anjali Sharma, Njekwa Mukamba, Lloyd B Mulenga, Brian Rice, Jacob Mutale, Alida Zulu Dube, Musunge Mulabe, James Hargreaves, Carolyn Bolton Moore, Charles B Holmes, Izukanji Sikazwe, Elvin H Geng","doi":"10.1016/S2352-3018(24)00264-9","DOIUrl":"10.1016/S2352-3018(24)00264-9","url":null,"abstract":"<p><strong>Background: </strong>Recipients of health services value not only convenience but also respectful, kind, and helpful providers. To date, research to improve person-centred HIV treatment has focused on making services easier to access (eg, differentiated service delivery) rather than the interpersonal experience of care. We developed and evaluated a person-centred care (PCC) intervention targeting practices of health-care workers.</p><p><strong>Methods: </strong>Using a stepped-wedge, cluster-randomised design, we randomly allocated 24 HIV clinics stratified by size in Zambia into four groups and introduced a PCC intervention that targeted caring aspects of the behaviour of health-care workers in one group every 6 months. The intervention entailed training and coaching for health-care workers on PCC practices (to capacitate), client experience assessment with feedback to facilities (to create opportunities), and small performance-based incentives (to motivate). In a probability sample of clients who were pre-trained on a client experience exit survey and masked to facility intervention status, we evaluated effects on client experience by use of mean score change and also proportion with poor encounters (ie, score of ≤8 on a 12-point survey instrument). We examined effects on missed visits (ie, >30 days late for next scheduled encounter) in all groups and retention in care at 15 months in group 1 and group 4 by use of electronic health records. We assessed effects on treatment success at 15 months (ie, HIV RNA concentration <400 copies per mL or adjudicated care status) in a prospectively enrolled subset of clients from group 1 and group 4. We estimated treatment effects with mixed-effects logistic regression, adjusting for sex, age, and baseline care status. This trial is registered at the Pan-African Clinical Trials Registry (202101847907585), and is completed.</p><p><strong>Findings: </strong>Between Aug 12, 2019, and Nov 30, 2021, 177 543 unique clients living with HIV made at least one visit to one of the 24 study clinics. The PCC intervention reduced the proportion of poor visits based on exit surveys from 147 (23·3%) of 632 during control periods to 33 (13·3%) of 249 during the first 6 months of intervention, and then to eight (3·5%) of 230 at 6 months or later (adjusted risk difference [aRD] for control vs ≥6 months intervention -16·9 percentage points, 95% CI -24·8 to -8·9). Among all adult scheduled appointments, the PCC intervention reduced the proportion of missed visits from 90 593 (25·3%) of 358 741 during control periods to 40 380 (22·6%) of 178 523 in the first 6 months, and then 52 288 (21·5%) of 243 350 at 6 months or later (aRD for control vs the intervention -4·2 percentage points, 95% CI -4·8 to -3·7). 15-month retention improved from 33 668 (80·2%) of 41 998 in control to 35 959 (83·6%) of 43 005 during intervention (aRD 5·9 percentage points, 95% CI 0·6 to 11·2), with larger effects in clients newly starting treatm","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e26-e39"},"PeriodicalIF":12.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142796571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fostering healthy cognitive ageing in people living with HIV.","authors":"Lucette A Cysique, Jules Levin, Chris Howard, Jeff Taylor, John Rule, Jane Costello, Jane Bruning, Priscilla Njeri, Amy B Mullens, Edwina Wright, Hetta Gouse, Kirstie Daken, Mattia Trunfio, Htein Linn Aung, Reuben N Robbins, Christopher M Ferraris, Jose A Muñoz-Moreno, Steven P Woods, David J Moore, Christopher Power, Pui Li Wong, Kejal Hasmukharay, Primrose Nyamayaro, Jaime Vera, Reena Rajasuriar, Robert K Heaton, Karl Goodkin, Scott Letendre, Ronald J Ellis, Bruce J Brew, Sean B Rourke","doi":"10.1016/S2352-3018(24)00248-0","DOIUrl":"10.1016/S2352-3018(24)00248-0","url":null,"abstract":"<p><p>Prevalence and incidence of HIV among people aged 50 years and older continue to rise worldwide, generating increasing awareness among care providers, scientists, and the HIV community about the importance of brain health in older adults with HIV. Many age-related factors that adversely affect brain health can occur earlier and more often among people with HIV, including epigenetic ageing, chronic medical conditions (eg, cardiovascular disease), and age-related syndromes (eg, frailty). Extensive dialogue between HIV community leaders, health-care providers, and scientists has led to the development of a multidimensional response strategy to protect and enhance brain health in people ageing with HIV that spans across public health, clinical spaces, and research spaces. This response strategy was informed by integrated ageing care frameworks and is centred on prevention, early detection, and management of brain health issues associated with HIV (eg, neurocognitive disorders), with specific considerations for low-resource or middle-resource countries. A collaborative, international, and data-informed update of the diagnostic criteria for HIV-associated neurocognitive disorders is a cornerstone of the proposed response strategy. The proposed response strategy includes a dynamic, international, online knowledge hub that will provide a crucial community resource for emerging evidence on the brain health of people ageing with HIV.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e71-e80"},"PeriodicalIF":12.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142773979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex as a biological variable in HIV-1 and schistosome co-infection.","authors":"Jane K Maganga, Khanh Pham, John M Changalucha, Jennifer A Downs","doi":"10.1016/S2352-3018(24)00234-0","DOIUrl":"10.1016/S2352-3018(24)00234-0","url":null,"abstract":"<p><p>The sex of people living with HIV-1 infection, schistosome infection, or both, is a fundamental determinant of their clinical outcomes and of how these two infections interact in the host. Data from longitudinal and cross-sectional human studies and animal models indicate that males with HIV-1 and schistosome co-infection excrete fewer schistosome eggs and might have higher HIV-1 RNA viral loads and greater liver damage. Females with schistosome infection appear to have higher risk of HIV-1 acquisition than females without, particularly in Schistosoma haematobium infection, and a greater risk of death in HIV-1 and schistosome co-infection. Greater transmission of HIV-1 to partners has been shown in both sexes in those with schistosome infection. Biological sex is a consequential factor affecting pathophysiological and clinical responses in HIV-1 and schistosome co-infection. Designing future analyses to incorporate sex is vital to optimise research and care for people living with HIV-1, schistosomes, and HIV-1 and schistosome co-infection.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e60-e70"},"PeriodicalIF":12.8,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11710965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570253","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":"Global, regional, and national burden of HIV/AIDS, 1990-2021, and forecasts to 2050, for 204 countries and territories: the Global Burden of Disease Study 2021.","authors":"","doi":"10.1016/S2352-3018(24)00212-1","DOIUrl":"10.1016/S2352-3018(24)00212-1","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;As set out in Sustainable Development Goal 3.3, the target date for ending the HIV epidemic as a public health threat is 2030. Therefore, there is a crucial need to evaluate current epidemiological trends and monitor global progress towards HIV incidence and mortality reduction goals. In this analysis, we assess the current burden of HIV in 204 countries and territories and forecast HIV incidence, prevalence, and mortality up to 2050 to allow countries to plan for a sustained response with an increasing number of people living with HIV globally.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 analytical framework to compute age-sex-specific HIV mortality, incidence, and prevalence estimates for 204 countries and territories (1990-2021). We aimed to analyse all available data sources, including data on the provision of HIV programmes reported to UNAIDS, published literature on mortality among people on antiretroviral therapy (ART) identified by a systematic review, household surveys, sentinel surveillance antenatal care clinic data, vital registration data, and country-level case report data. We calibrated a mechanistic simulation of HIV infection and natural history to available data to estimate HIV burden from 1990 to 2021 and generated forecasts to 2050 through projection of all simulation inputs into the future. Historical outcomes (1990-2021) were simulated at the 1000-draw level to support propagation of uncertainty and reporting of uncertainty intervals (UIs). Our approach to forecasting utilised the transmission rate as the basis for projection, along with new rate-of-change projections of ART coverage. Additionally, we introduced two new metrics to our reporting: prevalence of unsuppressed viraemia (PUV), which represents the proportion of the population without a suppressed level of HIV (viral load &lt;1000 copies per mL), and period lifetime probability of HIV acquisition, which quantifies the hypothetical probability of acquiring HIV for a synthetic cohort, a simulated population that is aged from birth to death through the set of age-specific incidence rates of a given time period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Global new HIV infections decreased by 21·9% (95% UI 13·1-28·8) between 2010 and 2021, from 2·11 million (2·02-2·25) in 2010 to 1·65 million (1·48-1·82) in 2021. HIV-related deaths decreased by 39·7% (33·7-44·5), from 1·19 million (1·07-1·37) in 2010 to 718 000 (669 000-785 000) in 2021. The largest declines in both HIV incidence and mortality were in sub-Saharan Africa and south Asia. However, super-regions including central Europe, eastern Europe, and central Asia, and north Africa and the Middle East experienced increasing HIV incidence and mortality rates. The number of people living with HIV reached 40·0 million (38·0-42·4) in 2021, an increase from 29·5 million (28·1-31·0) in 2010. The lifetime probability of HIV acquisition","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e807-e822"},"PeriodicalIF":12.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11612058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142751643","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":"Addressing HIV prevention and the PrEP gap among migrants.","authors":"Christiana Nöstlinger","doi":"10.1016/S2352-3018(24)00272-8","DOIUrl":"10.1016/S2352-3018(24)00272-8","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e798-e800"},"PeriodicalIF":12.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights of the 5th HIVR4P Conference.","authors":"Adrian Gonzalez-Lopez","doi":"10.1016/S2352-3018(24)00307-2","DOIUrl":"10.1016/S2352-3018(24)00307-2","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e806"},"PeriodicalIF":12.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to Lancet HIV 2024; 11: e64-65.","authors":"","doi":"10.1016/S2352-3018(24)00091-2","DOIUrl":"10.1016/S2352-3018(24)00091-2","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e804"},"PeriodicalIF":12.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332206","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antiretrovirals and obesity.","authors":"Nikos Pantazis, Kholoud Porter, Caroline A Sabin, Fiona Burns, Giota Touloumi","doi":"10.1016/S2352-3018(24)00298-4","DOIUrl":"10.1016/S2352-3018(24)00298-4","url":null,"abstract":"","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e802-e803"},"PeriodicalIF":12.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extreme weather events and disruptions to HIV services: a systematic review.","authors":"Collins C Iwuji, Celia McMichael, Euphemia Sibanda, Kingsley S Orievulu, Kelly Austin, Kristie L Ebi","doi":"10.1016/S2352-3018(24)00186-3","DOIUrl":"10.1016/S2352-3018(24)00186-3","url":null,"abstract":"<p><strong>Background: </strong>Extreme weather events pose a risk to health and disproportionately affect vulnerable groups, such as people living with HIV. We aimed to investigate the effects of extreme weather events on HIV testing uptake, HIV treatment and care, and HIV transmission.</p><p><strong>Methods: </strong>For this systematic review, we searched PubMed, Web of Science, and PsycINFO for peer-reviewed studies published between database inception and Aug 31, 2023. Eligible studies were English-language qualitative, quantitative observational (retrospective, prospective, cross-sectional, longitudinal, case-control, and cohort), and mixed-method studies, and randomised controlled trials related to HIV and extreme weather events. We excluded reviews, mathematical models, and case reports. After exporting the search results, two authors independently screened the titles and abstracts of identified articles, reviewing the full text of those that met the inclusion criteria. We used systems thinking to develop a framework linking extreme weather events and HIV and summarised the results using thematic narrative synthesis.</p><p><strong>Findings: </strong>Of the 6126 studies identified by the search, 27 met the inclusion criteria and were eligible for analysis, of which 19 were quantitative, six were qualitative, and two were mixed-method studies. We identified five main themes linking extreme weather events to HIV: economic and livelihood conditions (12 studies), psychosocial factors (19 studies), infrastructure damage and operational challenges (17 studies), migration and displacement (ten studies), and associated medical conditions and health-care needs (12 studies). We showed how these themes interact in complex ways, resulting in a reduction in uptake of HIV testing, interruption of HIV care and subsequent disease progression, altered risk behaviours, and an increased prevalence of HIV.</p><p><strong>Interpretation: </strong>Extreme weather events are associated with disruptions to HIV services. Owing to the design of the included studies, we could not establish a causal relationship between extreme weather events and HIV incidence, highlighting a research gap. Appropriate adaptations and mitigation policies that protect the health and wellbeing of people living with HIV during and after extreme weather events are warranted. Such actions will be crucial to achieving the UNAIDS goal of ending HIV as a public health threat by 2030.</p><p><strong>Funding: </strong>None.</p>","PeriodicalId":48725,"journal":{"name":"Lancet Hiv","volume":" ","pages":"e843-e860"},"PeriodicalIF":12.8,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}