Oral HIV pre-exposure prophylaxis (PrEP) is highly effective, yet various barriers limit its potential as a HIV prevention strategy. This scoping review aimed to identify and quantify determinants of oral PrEP initiation...Oral HIV pre-exposure prophylaxis (PrEP) is highly effective, yet various barriers limit its potential as a HIV prevention strategy. This scoping review aimed to identify and quantify determinants of oral PrEP initiation and continuation among community members, and provision by healthcare providers in Australia and comparable countries (UK, Canada, and New Zealand). Three databases were searched in January 2025 for original studies published between January 2018 and December 2024. We considered papers published in English from the four countries that contained primary research exploring determinants of PrEP initiation, continuation, and provision. Determinant codes were extracted, the number of times they appeared were counted, and were mapped to the updated Consolidated Framework for Implementation Science (CFIR 2.0). We identified 142 articles reporting 70 unique barriers (appearing 444 times in the 142 articles) and 49 unique facilitators (appearing 256 times in the 142 articles). Frequently identified PrEP initiation and continuation determinants-including cost, risk perception, stigma, and varying levels of PrEP knowledge and awareness-may substantially impact PrEP use and warrant further investigation. PrEP provision determinants highlighted opportunities for service innovation, such as through task-shifting and telehealth integration. Determinants absent from Australian literature suggest research opportunities in PrEP importation, telehealth delivery, task-shifting to other healthcare workers and peer workers, and PrEP use in the context of STI prophylaxis use. Research predominantly focused on gay, bisexual, and other men who have sex with men, indicating opportunities for more nuanced examination of diversity within this population, alongside further research with other key populations.
This study examined PrEP uptake and the role of gender-affirming care among Black and Latina women of transgender experience and transfeminine people (WTE/TFP) in Los Angeles County from 2019 to 2020 and 2023-2024. PrEP...This study examined PrEP uptake and the role of gender-affirming care among Black and Latina women of transgender experience and transfeminine people (WTE/TFP) in Los Angeles County from 2019 to 2020 and 2023-2024. PrEP use increased substantially among Latinas (28% to 49%) but declined among Black participants (32% to 21%). PrEP uptake was more prevalent among participants using hormones or reporting methamphetamine use. Having trusted gender-affirming providers increased PrEP use more for Black than Latina participants. Our findings highlight the importance of integrating HIV prevention within gender-affirming care and align with calls for community-led approaches, particularly to mobilize Black WTE/TFP and rebuild trust.
Children and adolescents with HIV receiving antiretroviral therapy (ART) often experience poorer treatment outcomes than adults due to inconsistent adherence, leading to poor viral suppression, increased morbidity, and h...Children and adolescents with HIV receiving antiretroviral therapy (ART) often experience poorer treatment outcomes than adults due to inconsistent adherence, leading to poor viral suppression, increased morbidity, and higher mortality. While studies in Sub-Saharan Africa have shown that peer group support can improve adherence among adolescents, its effectiveness in Asian populations remains unclear. This study evaluated the impact of peer group support on reducing virological failure among adolescents with HIV receiving ART. A multicenter pragmatic randomized controlled trial was conducted from July 2020 to January 2022 across four cities in Vietnam: Hanoi, Ho Chi Minh City, Ha Long, and Hai Phong. A total of 630 children and adolescents aged 10-16 years were randomized to either an intervention or control group. Both groups received standard HIV care according to Vietnamese national guidelines, while the intervention group additionally participated in peer support sessions. Virological failure was assessed through viral load measurements at study completion. Primary analyses followed an intention-to-treat approach using multivariable logistic regression adjusted for baseline viral status and study site. After 18 months, virological failure rates were similar between groups, with no statistically significant difference observed (adjusted OR: 1.03; 95% CI: 0.50-3.37; p > 0.05). Findings were consistent in per-protocol analyses. The limited impact may reflect already low virological failure rates and strong adolescent HIV care systems in Vietnam. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov NCT02035969.
Public health vending machines (PHVMs) are a recent innovation in the delivery of health promoting supplies in the United States (US). However, there are significant gaps in our understanding of their potential impacts o...Public health vending machines (PHVMs) are a recent innovation in the delivery of health promoting supplies in the United States (US). However, there are significant gaps in our understanding of their potential impacts on American Indian reservations. This study explores perspectives about PHVM implementation through semi-structured interviews among a sample of persons (N = 12) who used a PHVM on an American Indian reservation. Participants were asked to describe their perceptions about the PHVMs, including how they affected infectious disease and overdose prevention. Participants reported that PHVMs enhanced access to a variety of health-promoting supplies (e.g., HIV tests, sterile injection equipment, naloxone). Participants explained that the PHVMs offered HIV and overdose prevention supplies in a low-threshold manner that minimized stigma. Future work should explore associations between PHVM implementation and shifts in infectious disease transmission and overdose morbidity and mortality on American Indian reservation lands.
Adolescent girls and young women (AGYW) living with HIV face heightened risks of mental distress, which may be compounded by exposure to violence and socioeconomic vulnerabilities. This study examined whether social prot...Adolescent girls and young women (AGYW) living with HIV face heightened risks of mental distress, which may be compounded by exposure to violence and socioeconomic vulnerabilities. This study examined whether social protection moderates the relationship between violence exposure and mental distress among AGYW living with HIV in Eswatini, Lesotho, and Namibia. Using data from the Violence Against Children and Youth Surveys (VACS), we analysed 1,006 AGYW aged 15-24. Mental distress was measured using the Kessler Psychological Distress Scale (K6), with scores ≥ 5 indicating moderate-to-severe distress. Correlates included lifetime sexual, physical, or emotional violence and access to social protection from government or non-governmental programs. Findings showed that sexual (aOR = 1.84, 95% CI: 1.13-2.99, p = 0.014) and physical violence (aOR = 1.95, 95% CI: 1.18-3.23, p = 0.010) were associated with mental distress. Social protection showed no protective effect (aOR = 0.65, 95% CI: 0.41-1.03; p = 0.067) against mental distress and did not moderate the relationship between violence and distress. Predicted probabilities indicated that AGYW not exposed to violence had lower mental health distress (27.64%) compared to those exposed to all forms (77.81%). Findings suggest that integrated trauma-informed mental health and targeted social protection interventions are urgently needed for AGYW living with HIV in resource-constrained settings.
OBJECTIVE: To explore the association of pre-exposure prophylaxis (PrEP) use with condomless sex and sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (MSM) in Washington, DC...OBJECTIVE: To explore the association of pre-exposure prophylaxis (PrEP) use with condomless sex and sexually transmitted infections (STIs) among gay, bisexual, and other men who have sex with men (MSM) in Washington, DC. DESIGN: Multivariate analysis of cross-sectional weighted survey data from 2014, 2017, and 2023 among MSM. METHODS: This analysis used venue-based, time-space sampling to survey MSM about HIV-related behavioral risk factors, HIV testing, and use of prevention services. Chi-square tests and logistic regression were conducted to calculate adjusted prevalence ratios (aPR) and ascertain the association between the use of PrEP with condomless sex and having a bacterial STI in the past 12 months RESULTS: 774 MSM were surveyed during the three cycles in 2014, 2017, and 2023. The proportion of MSM reporting PrEP use, having a STI in the past 12 months, and condomless sex in the past 12 months increased over time from 2014 to 2023. MSM that used PrEP were more likely to report condomless sex (aPR = 1.33, 95% CI: 1.11-1.55) and having a STI in the past 12 months (aPR = 2.97, 95% CI: 1.35-4.59). CONCLUSIONS: There is a significant association of PrEP use with both condomless sex and having a STI in the past 12 months among MSM in Washington, DC. As a result, this population may benefit from doxycycline post-exposure prophylaxis (doxy PEP) and other STI prevention methods, but further research is needed to understand the relationship between PrEP, condomless sex, and STIs.
Latino men who have sex with men (LMSM) are disproportionately affected by HIV in the United States. Despite advances in HIV prevention options, LMSM have inequitably low access to knowledge about HIV, HIV testing, and p...Latino men who have sex with men (LMSM) are disproportionately affected by HIV in the United States. Despite advances in HIV prevention options, LMSM have inequitably low access to knowledge about HIV, HIV testing, and pre-exposure prophylaxis (PrEP), contributing to disparities in prevention service use. We first identified subgroups of LMSM (N = 290) based on their patterns of knowledge related to HIV prevention by using latent class analysis. Secondly, following a three-step logistic regression procedure, we examined differences in class composition by demographics. Lastly, we evaluated the relationship between class membership and HIV prevention behaviors (e.g., PrEP engagement, HIV testing, and sexual behavior that could lead to HIV acquisition), using Lanza's method to estimate the probability of class membership. We identified three classes among LMSM based on HIV knowledge: Class 1: HIV/PrEP Experts (n = 112), Class 2: Moderate HIV/PrEP Knowledge (n = 140), and Class 3: HIV Knowledge Only (n = 38). We found no significant association between class membership and demographics (education, income, race, nativity). Class membership was associated with prevention behaviors: HIV testing (χ(2) = 27.107, p <.001), PrEP use (χ(2) = 137.672, p < .001), and sexual behavior that can lead to HIV (χ(2) = 11.659, p < .05). Among HIV/PrEP Experts, 83% of LMSM tested recently, 57% were on PrEP, and 3% reported sexual behavior that could lead to HIV. By comparison, in the Moderate HIV/PrEP Knowledge class, a smaller proportion of participants tested recently (53%) and were on PrEP (8%), whereas more (17%) reported sexual behavior that could lead to HIV. In the HIV Knowledge Only class, the smallest proportion (compared to the other two classes) were recently tested (20%) and on PrEP (< 1%), although there were also relatively few (5%) who reported sexual behavior that could lead to HIV acquisition. Several class differences were statistically significant. This study identifies subgroups of LMSM with respect to the specific types of knowledge they do and do not have, which builds on prior research that traditionally only examines the absence or presence of PrEP/HIV knowledge. Further, the findings demonstrate that the type of knowledge LMSM have and do not have is associated with their HIV-prevention behaviors. Findings may inform future programs that address knowledge gaps to support HIV-prevention uptake among LMSM.
Our study aimed to describe the HIV care continuum and explore factors related to viral suppression among people on methadone maintenance treatment (MMT) who use methamphetamine (meth) in Vietnam. We used baseline data o...Our study aimed to describe the HIV care continuum and explore factors related to viral suppression among people on methadone maintenance treatment (MMT) who use methamphetamine (meth) in Vietnam. We used baseline data of participants living with HIV (PLWH) from a clinical trial in Vietnam. Among 132 PLWH, 95.5% knew their HIV status, 91.7% were on antiretroviral therapy (ART), and 79.5% achieved viral suppression (< 20 copies/mL). Being currently on ART and not early meth use were associated with viral suppression. The findings highlight the importance of enhancing ART engagement among meth-using PLWH on MMT, especially those who began meth use early in life.
Vietnam has committed to ending the AIDS epidemic by 2030 through the 95-95-95 targets. Men who have sex with men (MSM) remain a key population driving new infections. This study assessed progress toward national HIV tar...Vietnam has committed to ending the AIDS epidemic by 2030 through the 95-95-95 targets. Men who have sex with men (MSM) remain a key population driving new infections. This study assessed progress toward national HIV targets among MSM and identified factors associated with HIV status awareness. Data were obtained from the HIV Sentinel Surveillance Plus Behavioral Surveys (HSS+) conducted from 2015 to 2020 in six provinces. Proportions of HIV-positive MSM who knew their HIV status, received antiretroviral therapy (ART), and achieved viral suppression were estimated. Temporal trends were analyzed using the Cochran-Armitage trend test, and correlates of HIV status awareness were examined using multivariable logistic regression. Among 4712 MSM, 471 (10.0%) tested HIV-positive. Awareness of HIV status increased from 16.7% in 2015 to 47.8% in 2020 (p-trend < 0.001). ART uptake among those aware of their status rose from 63.6 to 97.7% (p-trend < 0.001). Viral suppression among those on ART remained high (97.0% in 2018 to 98.8% in 2020). MSM who knew an HIV testing site (AOR = 6.0, 95% CI 2.7-13.1) had health insurance (AOR = 2.2, 95% CI 1.0-4.9), or had ever engaged in group sex (AOR = 2.3, 95% CI 1.1-5.0) were more likely to know their HIV status. Substantial improvements were observed in ART coverage and viral suppression among MSM with HIV in Vietnam from 2015 to 2020. However, more than half remained undiagnosed, underscoring the need to expand HIV testing improve insurance access, and strengthen community-based services to accelerate progress toward the 95-95-95 goals.
Timely engagement in healthcare is crucial for effective management of HIV, comorbidities, and disease prevention among older people living with HIV (PLHIV). Healthcare acceptability may be especially important for older...Timely engagement in healthcare is crucial for effective management of HIV, comorbidities, and disease prevention among older people living with HIV (PLHIV). Healthcare acceptability may be especially important for older PLHIV who have experienced long-standing stigma, medical mistrust, and culturally insensitive care. This study examined healthcare acceptability and its association with delayed care among older (≥ 50 years) PLHIV and assessed whether demographic characteristics moderated this relationship. Using data from the All of Us Research Program collected between May 2017 and July 2022, we conducted a cross-sectional analysis of 920 participants across the United States. Descriptive statistics and logistic regression were used to analyze the data. Majority of the sample identified as White (47.4%), gay or lesbian (47.1%), and publicly insured (55.2%). A one-point increase in healthcare acceptability was associated with lower odds of delayed care (aOR=0.762, 95% CI [0.691, 0.838]). Compared to White participants, the association between valuing a provider with a similar background and delayed care was stronger among Black participants, with greater importance of provider similarity associated with lower odds of delayed care (aOR=0.265, 95% CI [0.096, 0.723]). Higher comorbidity was associated with greater odds of delayed care; however, these odds were lower among participants who felt they were always treated with respect (aOR=0.514, 95% CI [0.264, 0.990]). There were no significant interactions observed between healthcare acceptability and demographic characteristics. Healthcare systems should prioritize patient-centered care, an inclusive workforce, and integration of healthcare acceptability measures into quality improvement to enhance timely care and reduce disparities among older PLHIV.
Unhealthy alcohol use is linked to several adverse health outcomes among people with HIV (PWH). HIV-related stigma (HRS) has been identified as a potential risk factor for unhealthy drinking, but research has been limite...Unhealthy alcohol use is linked to several adverse health outcomes among people with HIV (PWH). HIV-related stigma (HRS) has been identified as a potential risk factor for unhealthy drinking, but research has been limited, and findings have been equivocal. This cross-sectional study examined associations between HRS and alcohol-related indices in a national sample of PWH with unhealthy alcohol use enrolled in an intervention trial for one of two common comorbidities that impact functioning among PWH (i.e., chronic pain or physical inactivity; n = 331). Generalized structural equation modeling tested whether depressive symptoms mediated HRS-alcohol involvement associations, and model invariance was assessed across trials. Participants had a mean age of 47.9 (SD = 11.4) years (16.6% identified as female, 29.6% were White, 51.4% were African American). HRS was directly and indirectly associated with greater alcohol use risk severity (as measured by the AUDIT) and mean drinks per day via depressive symptoms only among participants in the chronic pain trial. In the combined sample, HRS was associated with greater alcohol-related consequences, with significant indirect effects through depressive symptoms, although no trial-specific effects emerged. Depressive symptoms may be a pathway through which HRS influences alcohol involvement among PWH. Clinical comorbidities, such as chronic pain, may amplify HRS-alcohol use associations.
Eremin A, Grunemwald T, Palich R
… +12 more, Morel S, Elisa A, Pataut D, Jedrzejewski T, Dudoit Y, Agher R, Costa M, Michels D, Velter A, Sagaon-Teyssier L, Ohayon M, Katlama C
Despite free access in France, uptake of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) remains insufficient, particularly among younger and migrant subpopulations. This study describes a commu...Despite free access in France, uptake of HIV pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) remains insufficient, particularly among younger and migrant subpopulations. This study describes a community-based program linking outreach via geosocial/sexual networking applications and community venues to same-day PrEP access at a sexual health center in Paris. MSM and transgender individuals aged ≥ 18 years were recruited and referred to the Le 190/Le SPOT sexual health center. At baseline, they received HIV/STI testing and, depending on results, initiation of PrEP, post-exposure prophylaxis (PEP), or antiretroviral therapy. Sociodemographic, behavioral, and clinical data were collected at baseline and follow-up (months 1, 3, 6). The primary outcome was PrEP uptake among eligible participants (HIV-negative, not on PrEP, without PEP indication); associated factors were assessed using Firth's penalized logistic regression. Between July 2023 and December 2024, 209 individuals were enrolled; 86% were recruited via apps, the median age was 31 years (IQR 26-41), and 47% were born outside France. Participants reported a median of six sexual partners (IQR 3-15) in the past three months; 73% had been tested for HIV/STI in the past year. Fourteen participants (7%) were living with HIV, including five newly diagnosed individuals. Among 164 PrEP-eligible participants, 118 (72%) initiated PrEP at baseline; 82/118 (70%) were retained at month 6. In multivariable analysis, uptake was associated with reporting ≥ 6 partners in the past three months and HIV/STI testing in the past year. These findings indicate high PrEP uptake among individuals presenting to care after community outreach, including younger and foreign-born MSM typically underrepresented in PrEP programs.
HIV disparities among U.S. Latino men who have sex with men (LMSM) persist alongside lower PrEP use. We examined correlates of PrEP cascade outcomes among 287 cisgender immigrant LMSM. PrEP conspiracy beliefs were negati...HIV disparities among U.S. Latino men who have sex with men (LMSM) persist alongside lower PrEP use. We examined correlates of PrEP cascade outcomes among 287 cisgender immigrant LMSM. PrEP conspiracy beliefs were negatively associated with HIV testing (OR = 0.77, 95% CI: 0.59-0.99, p=.04); knowing a PrEP user was positively associated (OR = 3.09, CI: 1.81-5.28, p<.0001). PrEP readiness was associated with positive PrEP attitudes (belief: OR = 2.23, CI: 1.51-3.30, p<.0001; plan: OR = 1.86, CI: 1.13-3.06, p=.02), multiple sexual partners (belief: OR = 2.06, CI: 1.02-4.16, p=.04; plan: OR = 2.25, CI: 1.04-4.87, p=.04), knowing a PrEP user (belief: OR = 4.18, CI: 2.10-8.32, p<.0001; plan: OR = 3.78, CI: 1.43-10.03, p=.008), and internalized sexual orientation stigma (plan: OR = 1.78, CI: 1.11-2.85, p=.02). Positive PrEP attitudes (OR = 1.59, CI: 1.17-2.18, p=.004) and lower barriers (OR = 0.70, CI: 0.52-0.95, p=.02) were associated with increased PrEP use, and medical mistrust (OR = 2.95, CI: 1.32-6.58, p=.008) with nonadherence.
Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV, but out-of-pocket costs represent a critical barrier to uptake. We conducted an online survey from May 2020 to October 2021. Gay and bisexual men wh...Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV, but out-of-pocket costs represent a critical barrier to uptake. We conducted an online survey from May 2020 to October 2021. Gay and bisexual men who have sex with men (GBMSM) in New England recruited through social networking apps were randomly assigned to view different monthly PrEP costs ($0-$105) and asked about their willingness to pay. Among 612 participants, each $10 increase in monthly costs was associated with a 6.0% point decrease in willingness to pay (p < 0.001). In logistic regression, each $1 increase reduced the odds of willingness to pay by 4% (odds ratio, 0.960; 95% CI, 0.952-0.968; p < 0.001). At $40 per month, 68% were willing to pay. Lower-income participants (<$75,000 annually) showed greater cost sensitivity (8.0% point decrease per $10 increase; p < 0.001). Participants at higher HIV acquisition risk (HIRI-MSM ≥ 10) were more willing to pay (β = 0.119; p = 0.001), as were those perceiving they definitely needed PrEP (β=-0.134 for those who may not or definitely did not need it; p = 0.005). These findings support policies that minimize or eliminate cost-sharing for PrEP to achieve HIV prevention goals.
Van Huizen R, Annequin M, Mora M
… +17 more, Faye A, Fiorentino M, Bourrelly M, Maradan G, Berenger C, Michard F, Yazdanpanah Y, Maresca AF, Rouveix E, Balhan L, Costa M, Michels D, Blanquart L, Rincon G, Spire B, Protiere C, and the ANRS-Trans&HIV study group
Understanding the drivers of depression among transgender women living with HIV (TWLH) is essential to developing appropriate interventions. Using data from ANRS-Trans&HIV (2020-2022), multivariable modified Poisson regr...Understanding the drivers of depression among transgender women living with HIV (TWLH) is essential to developing appropriate interventions. Using data from ANRS-Trans&HIV (2020-2022), multivariable modified Poisson regressions were used to identify individual, social, and structural determinants of depression (PHQ-9 ≥ 8) among TWLH. Of 493 participants, one-third (31%) had moderate-to-severe depression. In multivariable analyses, lifetime violence, declaring harassment by strangers in public spaces because of their transgender identity, financial difficulty, and a long delay between HIV diagnosis and treatment initiation were risk factors for depression. Receiving emotional support and declaring very attentive HIV healthcare providers were protective against depression. We identified a concerning prevalence of depression among TWLH. Findings suggest that the primary determinants are social and structural, rather than individual, underscoring the need to reduce systemic transphobia and structural inequities, and improve access to gender-affirming care. ANRS-Trans&HIV is registered at ClinicalTrials.gov (NCT04849767, 2021-04-19).
Golin CE, Hill LM, Ayangeakaa SD
… +19 more, Allison O, Keshishian TH, Michel T, Pulliam A, Woodley A, Amola K, Harding C, Hall N, Jacobs T, Jones M, Parrish T, Wiggins D, Riggins L, Lightfoot AF, Choi Y, Navarro I, Frye J, Burns CM, McKellar MS
Black women in the Southeastern United States face disproportionate HIV risk yet have low pre-exposure prophylaxis (PrEP) utilization. This pilot study evaluated the feasibility and acceptability of I'm Fully Empowered (...Black women in the Southeastern United States face disproportionate HIV risk yet have low pre-exposure prophylaxis (PrEP) utilization. This pilot study evaluated the feasibility and acceptability of I'm Fully Empowered (IFE4Her), a community-based intervention combining peer-led culturally-tailored messaging with mobile medical unit (MMU) services alongside complementary health screenings to enhance PrEP awareness and access among cis-gender women in four low-income communities. Over eight months of weekly half-day sessions, 78 women approached the MMU, 31 underwent services, 24 (77%) underwent a PrEP consultation, and 8 (33%) expressed interest in initiating. Field-based logistical challenges (blood draw difficulties, equipment malfunctions, and transportation to off-site laboratories) prevented PrEP initiation but highlighted modifiable implementation gaps. Satisfaction was high, with 80-85% reporting positive experiences with convenience, scheduling, and consultation quality. Over 95% utilized additional health screenings. Mobile, community-based PrEP access appears feasible and acceptable, supporting optimized mobile models to expand PrEP access for underserved women.ClinicalTrials.gov identifier: NCT05644834.
Thoughts of death or self-injury and the clinical implications of such thoughts remain largely underassessed among people with HIV (PWH) in Africa. As strong predictors of suicidal ideation and death by suicide, it is pa...Thoughts of death or self-injury and the clinical implications of such thoughts remain largely underassessed among people with HIV (PWH) in Africa. As strong predictors of suicidal ideation and death by suicide, it is paramount to understand these risk indicators, particularly in populations with heightened susceptibility to poor mental health. We aimed to characterize thoughts of death or self-injury (i.e., self-injurious thoughts) and their relationship with non-same-day (i.e., delayed) anti-retroviral treatment (ART) initiation and longitudinal disengagement from clinic in a cohort of PWH newly entering HIV care in Cameroon. We conducted structured interviews with PWH aged 21 + initiating clinical care between June 2019 and March 2020. Clinical records were used to ascertain ART initiation date and disengagement from the clinic across two years following care initiation. Log binomial regression was used to estimate the association between self-injurious thoughts at care initiation and delayed ART initiation. A Fine and Gray sub-distribution proportional hazards model was used to quantify the cumulative incidence of disengagement from the clinic (i.e., a gap in clinic visits > 183 days) and differences in these estimates across groups. Of 426 enrolled individuals, seventy-one (16.7%) endorsed self-injurious thoughts at entry into care, 24 (33.8%) of whom had active thoughts of self-injury. Self-injurious thoughts at entry into care were positively associated with delayed ART initiation (adjusted prevalence ratio = 1.8; 95% CI: 1.2, 2.9) and cumulative incidence of disengagement from clinic, though differences in disengagement were statistically non-significant. Interventions are urgently needed to support the mental health and well-being of PWH entering care and improve down-stream HIV treatment outcomes.
About two-thirds of all HIV infections in 2024 were in sub-Saharan Africa, where adolescent girls and young women (AGYW) bear a disproportionate burden. Daily oral pre-exposure prophylaxis (PrEP) offers an HIV prevention...About two-thirds of all HIV infections in 2024 were in sub-Saharan Africa, where adolescent girls and young women (AGYW) bear a disproportionate burden. Daily oral pre-exposure prophylaxis (PrEP) offers an HIV prevention option for AGYW at high risk who are unable to negotiate safer sex with male partners. Primary health care clinics (PHCCs) staffed by nurses are an important access point for health services, including antiretroviral treatment, family planning, and antenatal care. Effective delivery of new and existing services depends on the preparedness and acceptability of interventions among health care workers (HCWs). This study explored the preparedness of rural PHCC HCWs in South Africa to deliver PrEP to AGYW, in anticipation that PrEP would become widely available at PHCCs in 2020. Twelve in-depth interviews were conducted with HCWs from all six PHCCs in a rural sub-district. Knowledge, attitudes, and experiences in delivering PrEP to AGYW were explored to identify key facilitators and barriers to implementation, in anticipation of widescale oral PrEP roll-out in public-sector facilities. Providers recognised AGYW's elevated HIV risk and viewed PHCCs as suitable PrEP distribution sites, noting opportunities to leverage existing contraceptive service infrastructure. However, several barriers emerged, including limited PrEP knowledge, inexperience in PrEP provision, and concerns about logistics for additional service delivery within existing staff and infrastructure constraints. This study highlights the need for targeted HCW training and simplified PrEP guidelines to support PrEP provision by HCWs in PHCCs to AGYW in this rural sub-district.
There is scarcity of evidence on the changes over time of adherence to oral HIV pre-exposure prophylaxis (PrEP) among female sex workers. Therefore, we assessed the changes of adherence to PrEP over 12 months and influen...There is scarcity of evidence on the changes over time of adherence to oral HIV pre-exposure prophylaxis (PrEP) among female sex workers. Therefore, we assessed the changes of adherence to PrEP over 12 months and influencing factors for suboptimal adherence and explored strategies to optimize adherence to oral PrEP among female sex workers in Tanzania. Convergence analysis was conducted involving 313 respondent driven sampled participants in the city of Tanga. Adherence was assessed at months 1, 6, and 12. In month 12 we conducted 26 in-depth interviews in parallel with quantitative interviews. A modified Poisson regression and thematic analysis was conducted for quantitative and qualitative data respectively. The prevalence of suboptimal adherence at month 1 was 19.5% (95% CI 14.1-26.3), with a significant increase to 91.8% (95% CI 87-94.9) at month 6 and 94.7% (95% CI 90.3-97.1) at month 12. Sub-optimal adherence was influenced by: Medical and medication related barriers, mobility and travel, limited access and availability of PrEP pills, lifestyle-related factors, inadequate PrEP knowledge and low perceived benefits of PrEP, non-disclosure PrEP use and, low perceived HIV risk. Participants recommended modifying PrEP dosing, introducing multiple dosing options at the PrEP care clinic, enhancing counselling sessions, and ensuring continuous availability of PrEP pills. The prevalence of suboptimal PrEP adherence is high among female sex workers in Tanzania. The study underscores the need for implementation research on the introduction of multiple dosing modalities, coupled with improved availability and accessible PrEP services and tailored counselling programs.
Frndak S, Dear N, Burns N
… +12 more, Kibuuka H, Owuoth J, Sing'oei V, Maswai J, Bahemana E, Parker Z, Shah N, Crowell TA, Valcour V, Ake JA, Tsoy E, AFRICOS Study Group
Cognitive development in young adulthood among people living with HIV (PLWH) is not well understood, especially in the context of food insecurity (FI). Nutrient-based interventions may have unique cognitive benefits depe...Cognitive development in young adulthood among people living with HIV (PLWH) is not well understood, especially in the context of food insecurity (FI). Nutrient-based interventions may have unique cognitive benefits dependent on age and HIV status. Our analysis included participants enrolled in the African Cohort Study (AFRICOS). AFRICOS enrolls PLWH and without HIV (PLWoH) across 12 PEPFAR-supported facilities in Kenya, Nigeria, Tanzania, and Uganda. All participants were 15-27 years old and on antiretroviral therapy (ART) ≥ 6 months if PLWH. Annual neuropsychological assessments included the WHO Auditory Verbal Learning Test (AVLT; learning and memory), Trail Making Test Part A (TMT-A; processing speed), Color Trails 1 (CT1; processing speed), Color Trails 2 (CT2; executive functions), and Verbal Fluency (VF; language generativity). FI was determined by self-reporting not enough to eat or having < 3 meals per day. Linear mixed models assessed independent and interactive effects of age, HIV status, and time-varying FI on longitudinal cognitive outcomes. From 2013 to 2023 we collected data from 1,012 participants, of whom 575 (56.8%) were female and 476 (47.0%) ever FI. Overall, increasing age was associated with better cognitive performance. Despite ART experience, PLWH performed worse than PLWoH on language generativity (VF; β=-0.47, p = 0.032) and executive functions (CT2; β = 8.10, p = 0.004). FI was associated with worse memory performance at younger ages (β = 0.17 [95%CI: 0.07, 0.27], p=0.001) and poorer executive functions at older age (β = 1.63 [95%CI: 0.56, 2.70], p=0.003). Additional cognitive interventions may be needed for young PLWH including nutrient-based interventions that are developmentally tailored to unique cognitive domains.