The Lancet regional health. Southeast Asia最新文献

{"title":"Exome sequencing facilitates personalized treatment in developmental and epileptic encephalopathy patients: transforming current clinical practice in Indonesia","authors":"Agung Triono , Kristy Iskandar , Auliya S.B. Sumpono , Tyas I. Hikmawan , Gunadi , Elisabeth S. Herini","doi":"10.1016/j.lansea.2025.100638","DOIUrl":"10.1016/j.lansea.2025.100638","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100638"},"PeriodicalIF":5.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testing the Geoffrey Rose's assumption of uniform population change for body mass index distribution in India","authors":"Janny Liao , Meekang Sung , Rockli Kim , S.V. Subramanian","doi":"10.1016/j.lansea.2025.100639","DOIUrl":"10.1016/j.lansea.2025.100639","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100639"},"PeriodicalIF":5.0,"publicationDate":"2025-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144663357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantification of regional variation in ultra-processed food consumption and its sociodemographic correlates across Bangladesh, India, Pakistan, and Sri Lanka: insights from the South Asia Biobank","authors":"Divya Bhagtani ,&nbsp;Jean Adams ,&nbsp;Fumiaki Imamura ,&nbsp;Anwesha Lahiri ,&nbsp;Rajendra Pradeepa ,&nbsp;Sara Mahmood ,&nbsp;Abu Ahmed Shamim ,&nbsp;Fahmida Akter ,&nbsp;Menka Loomba ,&nbsp;Lathika Athauda ,&nbsp;Laksara De Silva ,&nbsp;Khadija I. Khawaja ,&nbsp;Sajjad Ahmad ,&nbsp;Vinitaa Jha ,&nbsp;Anuradhani Kasturiratne ,&nbsp;Prasad Katulanda ,&nbsp;Malay K. Mridha ,&nbsp;Ranjit M. Anjana ,&nbsp;John C. Chambers ,&nbsp;Nita G. Forouhi","doi":"10.1016/j.lansea.2025.100633","DOIUrl":"10.1016/j.lansea.2025.100633","url":null,"abstract":"<div><h3>Background</h3><div>Sales of ultra-processed foods (UPFs) are rising in South Asia, yet UPF consumption and its sociodemographic determinants remain largely unknown. We aimed to quantify UPF consumption and investigate its sociodemographic correlates in four countries of South Asia.</div></div><div><h3>Methods</h3><div>Between January 2020 and September 2022, the South Asia Biobank recruited 63,914 participants aged 18 years or older who were resident in Bangladesh, Pakistan, Sri Lanka, and North and South India, and self-reported as being of South Asian ethnicity. We analysed data from 60,714 eligible adults. Dietary consumption was assessed using interviewer-led 24-h recalls. Foods were classified by their degree of processing using the NOVA classification. Two-part multivariable-adjusted regression models examined associations of sociodemographic factors with the likelihood and quantity of UPF consumption.</div></div><div><h3>Findings</h3><div>In Bangladesh, Sri Lanka, and North India, ∼75% of participants reported consuming UPFs during the previous day, versus 41% in South India and Pakistan. Among consumers, UPFs contributed 13–17% of total energy intake, with biscuits being a common source across regions. Other UPFs included sweetened beverages in Pakistan, packaged salty snacks in South India, and breakfast cereals in Bangladesh. Younger age was associated with UPF consumption in Pakistan and Sri Lanka whereas in Bangladesh and North India, older age was. Women were more likely to consume UPFs in all regions except Bangladesh. In Bangladesh, Pakistan, and North India, any level of education above none (i.e., primary, secondary, or higher) was associated with UPF consumption. Among consumers, UPF consumption was lower in married or cohabiting than single people, in all regions. UPF consumption was higher in rural versus urban residents in Bangladesh and Sri Lanka but lower in Pakistan.</div></div><div><h3>Interpretation</h3><div>UPF consumption varied across South Asia by sociodemographic factors including age, gender, and education. Understanding this heterogeneity is crucial when designing interventions aimed at reducing UPF consumption. Our findings of regional variations in the types of UPFs consumed provide valuable insights for targeted interventions.</div></div><div><h3>Funding</h3><div>The South Asia Biobank is funded by the <span>National Institute for Health Research</span>.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100633"},"PeriodicalIF":5.0,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adolopment of clinical practice guidelines and creation of referral pathways for dermatological conditions in Pakistan","authors":"Alina Pervez ,&nbsp;Javeria Nizam ,&nbsp;Meryum Ishrat Baig ,&nbsp;Areesha Ahmer ,&nbsp;Unzela Ghulam ,&nbsp;Russell Seth Martins ,&nbsp;Areej Khawaja ,&nbsp;Nashia Ali Rizvi ,&nbsp;Alina Abdul Rehman ,&nbsp;Mohsin Ali Mustafa ,&nbsp;Bushra Ayub ,&nbsp;Salima Saleem Aamdani ,&nbsp;Sabeika Raza ,&nbsp;Shayana Rukhsar ,&nbsp;Saadia Tabassum ,&nbsp;Tazein Amber ,&nbsp;Syeda Fatima Shariq ,&nbsp;Sarah Nadeem ,&nbsp;Shaheen Naveed ,&nbsp;Adil H. Haider ,&nbsp;Sadia Masood","doi":"10.1016/j.lansea.2025.100635","DOIUrl":"10.1016/j.lansea.2025.100635","url":null,"abstract":"<div><div>This Health Policy discusses the development of evidence-based clinical practice guidelines (CPGs) and referral pathways tailored for dermatological conditions in Pakistan's primary care setting. Recognising the high burden of skin diseases among primary care consultations, a panel of dermatology experts reviewed sixteen high-quality source CPGs using the GRADE-ADOLOPMENT process to adapt, adopt, or exclude recommendations for local relevance. Management and referral algorithms were designed to guide general physicians, with additional recommendations provided to address identified gaps, such as the safe use of steroids. The final output comprised CPGs and referral pathways for ten common skin disorders, ensuring local relevance by excluding unsuitable recommendations. This initiative aims to standardise dermatological care, improve patient outcomes, and streamline referrals within Pakistan's healthcare system.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100635"},"PeriodicalIF":5.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ISOT position statement on the feasibility of an organ for transplantation from brain-dead deceased donors: a Delphi consensus","authors":"Manish R. Balwani ,&nbsp;Vivek B. Kute ,&nbsp;Jigar Shrimali ,&nbsp;Bharat G. Jagiasi ,&nbsp;Pradip Kumar Bhattacharya ,&nbsp;Amit Pasari ,&nbsp;Manoj Gumber ,&nbsp;Sanjeev Gulati ,&nbsp;Raj Kanwar Yadav ,&nbsp;Shankar Prasad Nagaraju ,&nbsp;Gomathy Narasimhan ,&nbsp;Natarajan Gopalkrishnan ,&nbsp;Divyesh Engineer ,&nbsp;Tushar Dighe ,&nbsp;Jamal Rizvi ,&nbsp;Sanjay P. Kolte ,&nbsp;Vishal Vasant Ramteke ,&nbsp;Nishant Shantanu Deshpande ,&nbsp;Priyanka Tolani ,&nbsp;Georgi Abraham ,&nbsp;Aneesh Srivastava","doi":"10.1016/j.lansea.2025.100628","DOIUrl":"10.1016/j.lansea.2025.100628","url":null,"abstract":"<div><div>Organ shortage remains a critical challenge in India’s transplant landscape, despite established deceased donor organ transplantation (DDOT) programmes. Many potentially viable organs from brain-dead deceased donors (DBDs) are discarded due to uncertainties surrounding donor suitability in specific clinical scenarios. To address this gap, the Indian Society of Organ Transplantation (ISOT) convened a panel of national experts to develop a Delphi consensus statement aimed at guiding transplant professionals on the feasibility of organ donation from DBDs, particularly in complex or marginal donor situations. This position statement presents 19 consensus recommendations based on real-world clinical contexts such as extremes of age, acute kidney injury, infections (including HCV, HBV, HIV, tuberculosis, and tropical diseases), malignancy, diabetes, hypertension, and various surgical anomalies. The guidance is grounded in available literature, registry data, and extensive clinical experience, with the aim of expanding the DBD donor pool across Asia and improving access to transplantation for patients with end-stage organ failure. The consensus does not function as a formal clinical guideline but rather as a practical reference tool, acknowledging the limitations in India-specific data and the contextual differences from Western transplant settings. It encourages critical care and transplant teams to perform structured assessments of organ viability, apply ethical principles, and pursue informed consent in line with local regulations.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100628"},"PeriodicalIF":5.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144634534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health insurance coverage among men and women in six countries within the Southeast Asia Region (2015–2022): a multilevel analysis of Demographic and Health Surveys","authors":"Nishikant Singh ,&nbsp;Pratheeba John ,&nbsp;Sudheer Kumar Shukla ,&nbsp;Rimjhim Bajpai ,&nbsp;Rituparna Sengupta ,&nbsp;Rajeev Sadanandan ,&nbsp;Navin Singh","doi":"10.1016/j.lansea.2025.100634","DOIUrl":"10.1016/j.lansea.2025.100634","url":null,"abstract":"<div><h3>Background</h3><div>Equitable access to quality healthcare without financial hardship is key to achieving Universal Health Coverage (UHC), especially in low- and middle-income countries in the WHO Southeast Asia Region (SEAR). Despite health insurance programmes, high out-of-pocket expenditures remain a barrier. This study evaluates health insurance coverage in SEAR, analysing socioeconomic and demographic factors.</div></div><div><h3>Methods</h3><div>This cross-sectional study used data from Demographic and Health Surveys (2015–2022) conducted in countries within the SEAR (data from six countries for women and five for men). Our analysis separately examined women and men aged 15–49 years using data from their respective individual Demographic and Health Survey datasets. Pooled estimates of health insurance coverage were calculated with 95% CI. Multilevel logistic regression quantified variations at the country and community-levels and identified factors influencing health insurance uptake.</div></div><div><h3>Findings</h3><div>Health insurance coverage varied across SEAR, with Indonesia reporting highest for women (58.2%; 95% CI: 57.65–58.72) and men (56.6%; 95% CI: 55.31–57.88), while lowest in Bangladesh for women (0.3%; 95% CI: 0.22–0.39) and Myanmar for men (1.4%; 95% CI: 1.04–1.83). Indonesia also had highest social security health insurance (women: 31.0%; 95% CI: 30.49–31.49, men: 27.9%; 95% CI: 26.74–29.03). Private insurance was lowest in Myanmar (women: 0.6%; 95% CI: 0.42–0.72, men: 0.9%; 95% CI: 0.60–1.27) and highest in Indonesia (women: 28.0%; 95% CI: 27.54–28.5, men: 30.0%; 95% CI: 28.81–31.14). Health insurance coverage was higher among individuals with higher education, greater exposure to mass media, rural residence, and older age. Insurance uptake was influenced by contextual factors beyond individual characteristics. India had highest community-attributable variation in health insurance uptake [women (53.1%; 95% CI: 52.56–53.62); men (56.3%; 95% CI: 55.17–57.46)], while lowest in Indonesia among women (17.7%; 95% CI: 16.40–18.99) and Maldives among men (10.8%; 95% CI: 6.71–16.84), after adjusting for demographic and socioeconomic factors.</div></div><div><h3>Interpretation</h3><div>With an ageing population, healthcare demand and costs in SEAR will rise. Context-specific health insurance policies and targeted interventions are crucial for bridging coverage gaps and achieving UHC.</div></div><div><h3>Funding</h3><div>There is no specific funding for this study.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100634"},"PeriodicalIF":5.0,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144597159","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health insurance coverage, healthcare use, and financial protection amongst people with disabilities in Indonesia: analysis of the 2021 National Socioeconomic Survey","authors":"Luthfi Azizatunnisa’ ,&nbsp;Ari Probandari ,&nbsp;Hannah Kuper ,&nbsp;Lena Morgon Banks","doi":"10.1016/j.lansea.2025.100631","DOIUrl":"10.1016/j.lansea.2025.100631","url":null,"abstract":"<div><h3>Background</h3><div><em>Jaminan Kesehatan Nasional</em> (JKN), Indonesia’s mandatory national health insurance scheme and the world’s largest single-payer system, has not been rigorously evaluated for its reach and effectiveness amongst people with disabilities, who often have greater healthcare needs. This study evaluates JKN coverage and its association with healthcare use and financial protection for people with disabilities in Indonesia.</div></div><div><h3>Methods</h3><div>This cross-sectional study analysed the Indonesia National Socioeconomic Survey (Susenas) March 2021 dataset (n = 1,277,497). Disability was measured using the Washington Group Short Set (WG-SS). We used multivariate logistic regression to examine associations between disability and health insurance coverage, and between insurance coverage and healthcare utilization, out-of-pocket payments (OOP), and catastrophic health expenditure (CHE).</div></div><div><h3>Findings</h3><div>Around 30% of people with disabilities were uninsured, and 35% were not enrolled in JKN, with coverage lower in the lowest socioeconomic groups, living in rural areas, or self-employment. Among JKN-enrolees, they were more likely to be in the subsidised group (vs. contributory) compared to those without disabilities. Overall, people with disabilities utilised healthcare services more frequently and incurred higher OOP and CHE than those without disabilities. These disparities were not mitigated by insurance coverage. Indeed, people with disabilities, even with JKN coverage, were more likely to experience high OOP and CHE, with those in the contributory group facing a higher likelihood of CHE than the subsidised group.</div></div><div><h3>Interpretation</h3><div>There are large gaps in health insurance coverage for people with disabilities in Indonesia. Additionally, there is an urgent need to enhance the financial protection of people with disabilities, ensuring equitable and comprehensive care.</div></div><div><h3>Funding</h3><div>This study is part of the first author’s PhD project, funded by the <span>Indonesia Endowment Fund for Education</span> (LPDP).</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100631"},"PeriodicalIF":5.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144579602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FTIR-based molecular fingerprinting for the rapid classification of dengue and chikungunya from human sera using machine learning: an observational study","authors":"Souvik Das ,&nbsp;Subhanita Roy ,&nbsp;Aritri Bir ,&nbsp;Arindam Ghosh ,&nbsp;Tarun Kanti Bhattacharyya ,&nbsp;Pooja Lahiri ,&nbsp;Basudev Lahiri","doi":"10.1016/j.lansea.2025.100630","DOIUrl":"10.1016/j.lansea.2025.100630","url":null,"abstract":"<div><h3>Background</h3><div>Dengue and chikungunya are arboviral diseases transmitted by <em>Aedes</em> mosquitoes, co-endemic in southeast Asia and India. Accurate and rapid diagnosis is crucial for effective outbreak management, but conventional diagnostic methods (ELISA, RT-PCR) are limited by cross-reactivity and the need for specialized infrastructure. Vibrational spectroscopy offers a novel, label-free alternative for detecting host molecular changes directly from serum.</div></div><div><h3>Methods</h3><div>We conducted an observational study to evaluate the diagnostic potential of Fourier Transform Infrared (FTIR) and Raman micro-spectroscopy combined with machine learning for the classification of dengue and chikungunya from human serum. Serum samples from confirmed dengue (N = 142), chikungunya (N = 120), and healthy controls (N = 40) were analysed. Vibrational spectra were acquired using FTIR and Raman techniques, followed by spectral deconvolution and machine learning-based classification using Support Vector Machine (SVM), Neural Network (NN), and Random Forest (RF) models.</div></div><div><h3>Findings</h3><div>FTIR analysis revealed distinctive group-specific vibrational signatures, particularly in the Amide I and III regions, where dengue-infected sera exhibited a marked increase in β-sheet content and loss of α-helical structures. Raman spectroscopy further identified differences in nucleic acid backbone vibrations and protein conformations. The SVM, RF, and NN models, trained on FTIR data, achieved near-perfect classification (AUC = 1.000; CA-score ≥0.989), outperforming traditional diagnostic methods. Additionally, t-SNE and Silhouette analyses demonstrated superior clustering performance with FTIR, with clear separation of Chikungunya samples (average Silhouette score 0.385) compared to Raman, where clustering was less distinct.</div></div><div><h3>Interpretation</h3><div>Vibrational spectroscopy, particularly FTIR integrated with machine learning, offers a robust, rapid, and scalable diagnostic platform for distinguishing arboviral infections in regions with high co-infection rates. By capturing host biomolecular changes directly from serum, this method minimizes cross-reactivity and enhances diagnostic speed compared to ELISA and RT-PCR. Its deployment in point-of-care settings could significantly improve arboviral surveillance and clinical management, especially in resource-limited regions.</div></div><div><h3>Funding</h3><div>This study was funded by the Department of Health Research- <span>Indian Council of Medical Research</span> (DHR-ICMR) Grant-In-Aid grant number <span><span>GIA/2020/000346</span></span> and <span>CoEs Phase II</span>, IIT/SRIC/IDK-PHASE-II/2024/01.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"40 ","pages":"Article 100630"},"PeriodicalIF":5.0,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144581378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"49th Annual Meeting of the Indian Society of Human Genetics and International Conclave on Neurogenetics (ISHG-2025): India’s march towards low-cost rare disease therapeutics","authors":"Mathivanan Jothi ,&nbsp;B.K. Thelma ,&nbsp;Monojit Debnath","doi":"10.1016/j.lansea.2025.100632","DOIUrl":"10.1016/j.lansea.2025.100632","url":null,"abstract":"","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"39 ","pages":"Article 100632"},"PeriodicalIF":5.0,"publicationDate":"2025-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144563306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug resistance mutations among people living with HIV and ART failure in Bangladesh: a cross-sectional study","authors":"Sezanur Rahman ,&nbsp;Md Safiullah Sarker ,&nbsp;Md Mobarok Hossain ,&nbsp;Md Abir Hossain ,&nbsp;Mohammad Fakhruddin ,&nbsp;Rubel Howlader ,&nbsp;Golam Sarwar ,&nbsp;Sharful Islam Khan ,&nbsp;Mustafizur Rahman","doi":"10.1016/j.lansea.2025.100629","DOIUrl":"10.1016/j.lansea.2025.100629","url":null,"abstract":"<div><h3>Background</h3><div>While maintaining a low HIV prevalence among the general population, Bangladesh is among the few countries in the Asia–Pacific region where the incidence of people living with HIV (PLWH) continues to increase. The National Anti-Retroviral Therapy Program still relies on a ‘Test and Treat’ strategy and faces challenges in treating drug-resistant HIV. This study aims to assess the HIV viral load and drug resistance mutations among key populations (KPs) under anti-retroviral therapy (ART) in Bangladesh.</div></div><div><h3>Methods</h3><div>A total of 110 KPs from 20 drop-in-centers across 11 districts in Bangladesh were enrolled from March 2019 to November 2020 for viral load (VL) testing using Xpert® HIV-1 Viral Load kits. Samples with high VL (≥1000 copies/mL) underwent pol gene sequencing to identify drug resistance mutations.</div></div><div><h3>Findings</h3><div>Most of the participants were men who have sex with men (MSM, 49.1%) followed by men sex workers (MSW, 34.5%), and transgender women (TGW, 13.6%). The median age of the participants was 28 years (IQR: 24–35) and 80% of them were from the capital city, Dhaka. The median time for ART was 11.5 months (IQR: 4.5–29.1), where 15 participants were naïve to ART. Overall, high VL was observed in 23.8%, and virologic failure was in 17.9% among PLWH who were treated for &gt;30 days. HIV-1 subtype C was predominant (43.8%), followed by A1 (25%), CRF01_AE (25%), and CRF02_AG (6.2%). Seven participants showed resistance against Efavirenz, the common drug received from ART centres, and three of them were additionally resistant against Tenofovir Disoproxil Fumarate. Other drugs supplied by ART centres were also found resistant for participants; i.e. 6 against Emtricitabine, 6 against Lamivudine, and 1 against Etravirine. The spatial distribution indicated HIV transmission occurred within and between KPs and drop-in-centers. Additionally, samples that received different ART also clustered together.</div></div><div><h3>Interpretation</h3><div>Evidence suggests that KPs are at a higher risk of virologic failure in Bangladesh, emphasizing the need for routine VL and drug resistance mutation tests as part of the national ART program. This study also advocates for exploring barriers to ART adherence and implementing personalized ART strategies in national ART programs.</div></div><div><h3>Funding</h3><div>The Global Fund.</div></div>","PeriodicalId":75136,"journal":{"name":"The Lancet regional health. Southeast Asia","volume":"40 ","pages":"Article 100629"},"PeriodicalIF":5.0,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144557068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}