Journal Of The International AIDS Society[JOURNAL]
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200 papers
"It Reduces Stigma Now That the Service Is Under One Roof" Women and Provider Experiences on Factors Influencing Effective Integration of Oral PrEP Delivery in Family Planning Clinics in Kenya: A Qualitative Study.
Ogello V, Ngure K, Mutai S … +8 more , Awuor M, Atieno W, Dollah A, Wandera C, Matemo D, Morton JF, Kinuthia J, Mugwanya KK
J Int AIDS Soc · 2026 Jul · PMID 42387908 · Full text
INTRODUCTION: Women of childbearing age in sub-Saharan Africa continue to face a disproportionately high risk of HIV acquisition. Integrating pre-exposure prophylaxis (PrEP) into existing care platforms such as family pl...
INTRODUCTION: Women of childbearing age in sub-Saharan Africa continue to face a disproportionately high risk of HIV acquisition. Integrating pre-exposure prophylaxis (PrEP) into existing care platforms such as family planning (FP) services may offer a strategic opportunity to reach women at heightened risk for HIV. However, limited evidence exists on the factors influencing effective PrEP integration in FP settings. METHODS: From November 2021 to November 2023, we conducted a qualitative study nested within a programmatic stepped-wedge implementation project to integrate oral PrEP delivery in 12 real-world public health FP clinics in Kenya (the FP-Plus Project, Clinical Trials.gov: NCT04666792). Prior to the implementation phase of the FP-Plus project, FP providers received facility-based training and mentorship to build their capacity to deliver oral PrEP as part of routine care in FP clinics. We conducted in-depth interviews with providers and women accessing FP services using semi-structured interview guides informed by the consolidated framework of implementation research. Interviews were audio-recorded with permission, transcribed and translated. We analysed data using inductive and deductive thematic analysis approaches. RESULTS: Overall, we interviewed 48 providers offering PrEP in the FP clinics and 64 women accessing FP services. Women had a median age of 24 years (IQR, 23-30), and providers were 87% female. Overall, integration of PrEP in FP clinics was highly acceptable as it provided efficient service delivery, minimized missed opportunities, improved access to PrEP, saved time, improved privacy and reduced stigma by providing a discreet and trusted platform to access HIV prevention services. Women also expressed strong trust and confidence in FP providers to deliver PrEP services. Key reported barriers to integrating PrEP services included increased workload, physical space, frequent staff turnover, inefficient workflows, and occasional stockouts for both PrEP and FP commodities. CONCLUSIONS: Integration of PrEP in public FP clinics in Kenya is highly acceptable to both women and providers. Women expressed high confidence and trust in FP providers to provide adequate HIV prevention care. Targeted strategies to overcome systemic barriers, such as inefficient workflows, workload and data systems, need to be defined to improve the efficiency of integrated FP and PrEP services provision.
The Intersection of Human Rights, HIV and Sex Work: Implications for Ending AIDS in Thailand by 2030.
Vannakit R, Clarke D, Janyam S … +7 more , Phaengnongyang C, Manopaiboon C, Suya I, Girault P, Ananworanich J, Cassell M, Wolf RC
J Int AIDS Soc · 2026 Jul · PMID 42387895 · Full text
INTRODUCTION: Sex work significantly shapes the Thai economy and the HIV epidemic, yet its criminalization restricts access to health services and exacerbates human rights violations. This study examines experiences of s...
INTRODUCTION: Sex work significantly shapes the Thai economy and the HIV epidemic, yet its criminalization restricts access to health services and exacerbates human rights violations. This study examines experiences of stigma, discrimination, gender-based violence (GBV) and incarceration among sex workers (SWs), exploring how these factors intersect with HIV services. This research is a component of a larger study investigating factors associated with pre-exposure prophylaxis (PrEP) uptake among SWs in Thailand. METHODS: We conducted a post hoc analysis of a cross-sectional survey (September-December 2023) of 1511 Thai SWs recruited through convenience and quota sampling in seven provinces. Eligible participants were adults who self-reported HIV-negative or unknown status and had exchanged sex in the past 3 months. Trained peers administered anonymous face-to-face questionnaires covering demographics, work characteristics, HIV service utilization, stigma and discrimination, GBV, and PrEP. Descriptive statistics and bivariable and multivariable logistic regression were used to examine factors associated with past-year human rights violations. RESULTS: 41.3% of SW participants reported experiencing at least one human rights violation, including stigma, discrimination, GBV and incarceration. Specifically, 18.1% experienced stigma and 35.8% reported GBV within the past year. Male sex workers (MSWs), transgender women sex workers (TGSWs), younger individuals, people who use drugs and those with a history of incarceration were the most affected groups. Geographical location was strongly correlated with these violations. A lack of human rights protections contributed to low uptake of HIV testing and sexually transmitted infection (STI) screening. PrEP uptake was critically low across all SW sub-populations: 14.8% for TGSWs, 13.9% for MSWs and only 1.3% for female sex workers (FSWs). CONCLUSIONS: A human rights approach to HIV and sex work is indispensable to ending AIDS. Criminalization, stigma, discrimination and GBV intersect to produce layered vulnerability among different SW populations in Thailand, with TGSWs particularly affected. These structural conditions negatively shape access to HIV testing, STI screening and HIV prevention services, including PrEP. The findings reinforce that punitive legal environments and social stigma directly undermine HIV prevention efforts. Addressing the stigmatisation and human rights violations of sex workers are essential to ending AIDS in Thailand.
HIV Care Retention and Cost Analysis in Multi-Month ART Dispensing: A Randomized Controlled Trial in China.
Shang W, Zhu Y, He Y … +6 more , Li X, Hu Q, Sun H, Geng W, Shang H, Ding H
J Int AIDS Soc · 2026 Jul · PMID 42339560 · Full text
INTRODUCTION: Multi-month dispensing (MMD), as a differentiated service delivery model, can reduce the frequency of clinic visits, waiting time and travel costs for clinically stable people living with HIV. This study ai...
INTRODUCTION: Multi-month dispensing (MMD), as a differentiated service delivery model, can reduce the frequency of clinic visits, waiting time and travel costs for clinically stable people living with HIV. This study aimed to evaluate the impact of 6-month MMD of antiretroviral therapy (ART) on retention and conduct a cost analysis in China. METHODS: We conducted a randomized, non-blind, non-inferiority study from December 2022 to March 2023 at The First Hospital of China Medical University. Eligible participants were randomly assigned to a 3-month dispensing group (n = 789) or a 6-month dispensing group (n = 799) and followed up for 18 months. The proportion of patients continuing ART after 18 months, virological suppression rate (<50 copies/mL) and average treatment cost per patient were evaluated. Cox regression analysis was used to compare treatment retention rates and virological suppression rates between groups, while descriptive statistical analysis was applied to assess cost differences. Cost metrics comprised the average cost per clinic visit and the price of ART medications, among other factors. This trial is registered with ChiCTR2200066438. RESULTS: A total of 1588 participants were included (median age 40.0 years, IQR 34.0-50.0; 94.8% male), with no significant between-group differences in demographic and clinical characteristics (all p>0.05). In the intention-to-treat analysis, treatment retention rates at 18 months were 94.9% (749/789) in the 3-month dispensing group and 94.2% (753/799) in the 6-month dispensing group. The risk difference (6-month minus 3-month) was -0.7% (95% CI -2.9% to 1.5%); non-inferiority was demonstrated as the lower bound of the 95% CI (-2.9%) exceeded the pre-specified margin of -5%. Viral suppression rates (<50 copies/mL) were similarly high in both groups in intent-to-treat analysis: 94.9% (3-month) versus 94.2% (6-month), with no statistically significant difference. Per-protocol analysis confirmed these findings (viral suppression 97.59% vs. 97.75%; χ = 0.0421, p = 0.8375). In terms of cost, the 6-month dispensing group had two fewer annual outpatient visits (3 vs. 5), with total treatment costs reduced by 27.7% (¥931.82 vs. ¥1288.85) and work value loss decreased by 16.7% (¥174.20 vs. ¥209.04 yearly). CONCLUSIONS: Six-month MMD of ART did not reduce treatment retention; instead, it decreased patients' clinic visit costs, thereby meeting cost-effectiveness criteria. CLINICAL TRIAL NUMBER: ChiCTR2200066438.
Drivers of Vertical HIV Transmission in Sub-Saharan Africa and the Impact and Cost-Effectiveness of Targeted and Universal Lenacapavir Pre-Exposure Prophylaxis.
Yakusik A, Walters MK, Mattur D … +7 more , Brar S, Johnson LF, Meyer-Rath G, Jamieson L, Mushavi A, Stover J, Mahy M
J Int AIDS Soc · 2026 Jun · PMID 42319257 · Full text
INTRODUCTION: Eliminating vertical HIV transmission remains a major public health priority, particularly in sub-Saharan Africa (SSA), which accounted for 83% of global paediatric HIV acquistions in 2024. Despite expanded...
INTRODUCTION: Eliminating vertical HIV transmission remains a major public health priority, particularly in sub-Saharan Africa (SSA), which accounted for 83% of global paediatric HIV acquistions in 2024. Despite expanded antiretroviral therapy (ART) coverage, gaps in maternal ART access, retention and HIV acquisition during pregnancy and breastfeeding continue to drive paediatric HIV acquisitions. Long-acting injectable (LAI) lenacapavir pre-exposure prophylaxis (PrEP) may reduce paediatric HIV acquisitions by preventing maternal HIV acquisition. We evaluated drivers of vertical transmission in SSA and assessed the impact and cost-effectiveness of LAI lenacapavir PrEP among pregnant and breastfeeding women (PBW) without HIV. METHODS: Using 2025 UNAIDS estimates, Spectrum AIM and Naomi model outputs, we decomposed vertical HIV transmission pathways by maternal HIV acquisition timing and ART status. We modelled universal and geographically targeted rollout strategies using district-level HIV incidence thresholds among women aged 15-49 years (≥0.7%, ≥0.5% and ≥0.3%). Base-case assumptions included 65% uptake, 70% retention over 2.2 years, drug costs of US$40 per person-year plus a US$17 loading dose and service delivery costs of US$50 per person-year. Upper-bound scenarios and deterministic sensitivity analyses evaluated implementation uncertainty. RESULTS: In 2024, an estimated 98,000 new paediatric HIV acquisitions occurred in SSA. Lack of maternal ART access accounted for 46% of vertical transmissions, while ART discontinuation during pregnancy or breastfeeding contributed 19%. Maternal HIV acquisition during pregnancy or breastfeeding accounted for 25% of paediatric HIV acquisitions, reaching 59% in South Africa and 46% in Zambia. Under base-case assumptions, universal LAI lenacapavir PrEP rollout averted approximately 56,100 HIV acquisitions at a net cost of US$85,200 per HIV acqusition averted. Geographic targeting at ≥0.7% incidence was more cost-effective, averting approximately 8450 acquisitions at a net cost of US$8530 per acquisition averted. Retention and service delivery costs were the primary determinants of cost-effectiveness. CONCLUSIONS: Gaps in maternal ART access and retention remain the dominant drivers of vertical HIV transmission in SSA, while maternal HIV acquisition contributes substantially in high-incidence settings. Targeted LAI lenacapavir PrEP rollout among PBW without HIV could reduce maternal and paediatric HIV acquistions more efficiently than universal rollout, although outcomes remain highly sensitive to implementation conditions. LAI lenacapavir PrEP should complement strengthened maternal ART programmes, not replace them.
From Policy to Practice: Brazil's Pathway to Eliminating Vertical Transmission of HIV as a Public Health Milestone.
Gaspar PC, Miranda AE, Lannoy LH … +14 more , Pascon ARP, Domingues CSB, Diniz ÍVA, Krummenauer A, da Silva APB, Bigolin A, Matos ATB, Colombo MR, Siqueira CG, Martinazzo AG, Benzaken AS, Barreira D, Simão MBG, Brazilian Elimination Vertical Transmission Group (Brazilian EVT Group)
J Int AIDS Soc · 2026 Jun · PMID 42319248 · Full text
INTRODUCTION: The elimination of vertical transmission of HIV is a global health priority endorsed by the Pan American Health Organization (PAHO) and the World Health Organization (WHO), aligned with the Sustainable Deve...
INTRODUCTION: The elimination of vertical transmission of HIV is a global health priority endorsed by the Pan American Health Organization (PAHO) and the World Health Organization (WHO), aligned with the Sustainable Development Goals (SDGs). Brazil has made substantial progress towards this goal through sustained investment in universal health policies and a rights-based approach to healthcare. DISCUSSION: Brazil's national HIV response is anchored in the Unified Health System (Sistema Único de Saúde-SUS), a universal, decentralized and participatory health system that ensures access to prevention, diagnosis, treatment and monitoring. Tripartite governance-across federal, state and municipal levels-combined with strong community engagement, has enabled coordinated policy implementation at scale. This framework has supported high coverage of antenatal care (>98%), HIV testing (>95%) and antiretroviral therapy among pregnant women living with HIV (>95%) in recent years. Vertical transmission rates of HIV declined from 3.73% in 2015 to 1.78% in 2023, remaining below the elimination threshold. The annual rate of new paediatric HIV acquisitions also declined to low levels, being 5.99 per 100,000 live births in 2023, far below the PAHO/WHO targets. A certification for states and municipalities strategy further accelerated progress toward the elimination by strengthening accountability, improving data quality and engaging local health systems. CONCLUSIONS: Brazil's experience demonstrates that HIV vertical transmission elimination is feasible in large and unequal settings when supported by strong governance, integrated health systems and sustained political commitment. The certification of vertical transmission elimination of HIV by PAHO/WHO in 2025 represents a major milestone and offers valuable lessons for global health. Brazil remains committed to sustaining stainability of this certification and to advancing efforts for the elimination of other vertically transmitted infections, including syphilis, hepatitis B, Human T-cell lymphotropic virus (HTLV) and Chagas disease.
Getting Back on the Path to Eliminating HIV in Children.
Siberry GK
J Int AIDS Soc · 2026 Jun · PMID 42319245 · Full text
INTRODUCTION: The global community proved remarkably resilient in protecting the progress in and commitment to eliminating HIV in children in the face of the COVID-19 pandemic. However, sudden disruptions in 2025 in dono...
INTRODUCTION: The global community proved remarkably resilient in protecting the progress in and commitment to eliminating HIV in children in the face of the COVID-19 pandemic. However, sudden disruptions in 2025 in donor support for HIV assistance have posed new and existential threats to the hard-fought gains in global paediatric HIV control. DISCUSSION: Since the early 2000s, the reductions in paediatric HIV acquisitions, in deaths in children with HIV and in the number of children orphaned by HIV/AIDS have been breathtaking, but in recent years, progress has stalled, and gaps remain. The disruptions in political and financial support from the U.S. government obligate us to reframe our plans for ending HIV as a threat to children and also enable us to implement overdue changes in strategy to overcome barriers to success. Pillars for success include: robust integration of HIV into strengthened general healthcare systems; reassertion of national government leadership; prioritizing reduced donor funding for research and innovation; stronger partnership between private sectors and public health programmes; amplified community voices; and bold determination and creative solutions from global paediatric HIV stakeholders. CONCLUSIONS: The time is right for the global paediatric HIV community to consider the key factors that have enabled the tremendous progress towards ending the threat of HIV in children, the critical barriers to overcoming remaining gaps and a framework no longer so dependent on donor support for getting back on the path to eliminating HIV in children. The diverse and talented global HIV stakeholder coalition will find the opportunities for transformation and innovation in paediatric HIV care and boldly chart a lasting, evidence-based, person-centred, community-informed, national health system-aligned path to ending HIV as a threat to children.
Progress and Challenges in Elimination of Vertical HIV Transmission.
Mofenson LM, Pinto J, Mushavi A
J Int AIDS Soc · 2026 Jun · PMID 42319243 · Full text
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Optimizing Identification and Care of Pregnant/Breastfeeding Women Living With HIV in Resource-Limited Settings.
Fowler MG, Chou VB, Musoke P
J Int AIDS Soc · 2026 Jun · PMID 42319240 · Full text
INTRODUCTION: Since the mid-1990s, there have been major advances in diagnosing and providing antiretroviral therapy (ART) for pregnant women living with HIV (WLWH) in both resource-rich and resource-limited settings. In...
INTRODUCTION: Since the mid-1990s, there have been major advances in diagnosing and providing antiretroviral therapy (ART) for pregnant women living with HIV (WLWH) in both resource-rich and resource-limited settings. Initial progress was based on the 1994 landmark perinatal trial, which showed 67% reduction in vertical transmission among infants born to non-breastfeeding mothers in the United States when zidovudine was given during pregnancy, at labour/delivery and for 6 weeks after birth. International perinatal trials began testing "short-course" zidovudine regimens during late pregnancy and at labour/delivery to develop cost-effective, feasible and deliverable interventions for low-resource environments. More recent research has focused on the delivery of cost-effective combination triple ART during pregnancy and breastfeeding for WLWH. The latest trial results indicate that providing lifetime maternal ART at the time of antenatal diagnosis improves overall survival and decreases morbidity, while reducing vertical transmission to <1%. DISCUSSION: Translation of clinical trial results into successful widescale programme implementation remains a major challenge, particularly in low- and middle-income countries with high HIV seroprevalence and weak maternal and child health infrastructure. Interventions recommended earlier in the global epidemic are no longer adequate, but key points of the perinatal cascade of services remain crucial to both ensure successful HIV care for WLWH and maximize reductions in vertical transmission. Notable progress made in Botswana and Uganda is valuable to highlight country-led successes. Rapid HIV testing for pregnant women whose status is unknown, followed by immediate implementation of lifetime maternal ART, and linkage to long-term HIV care/treatment are essential. Counselling on adherence, as well as the use of long-acting ART regimens and holistic support for women's care, including psychosocial support, are also needed. A current major challenge has been the sudden reduction in international donor funding, which has had a significant negative impact on continuity and effective delivery of HIV care/treatment services. CONCLUSIONS: Much progress has been made in advancing HIV interventions and programmes for WLWH and pregnant and breastfeeding mothers. However, several challenges persist, which compromise delivery of effective interventions on the path to eliminate perinatal HIV transmission, and care/treatment remains suboptimal for WLWH, especially in resource-limited settings.
From the "Dark Days" to Golden Days: Lessons From the Botswana National Validation Committee's Journey on the Path to Elimination of Vertical Transmission of HIV.
Matshaba M, Nthusang Q, Setswalo J … +3 more , Madidimalo T, Nkomo B, Molefi M
J Int AIDS Soc · 2026 Jun · PMID 42319238 · Full text
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Baseline Data on Viral Suppression, Treatment Adherence and Mental Health in Peripartum Girls and Young Women With HIV in Zimbabwe.
Chawana-Mutingwende TD, Ngara B, Mudadi LS … +23 more , Tauya TT, Sibanda M, Mutambanengwe-Jacob M, Andifasi P, Malunda B, Chidemo T, Mapfunde A, Nyakudya S, Mufumisi AZ, Chirenda TH, Chitambo T, Nderecha WTS, Murandu C, Gwande M, Muringayi K, Micah Bongo R, Okochi H, Kuncze K, Mushavi A, Willis N, Webb K, Gandhi M, Stranix-Chibanda L
J Int AIDS Soc · 2026 Jun · PMID 42319224 · Full text
INTRODUCTION: Peripartum adolescent girls and young women (AGYW) with HIV have lower viral suppression compared to older women. But the recently introduced dolutegravir-based regimens and psychosocial peer motivation may...
INTRODUCTION: Peripartum adolescent girls and young women (AGYW) with HIV have lower viral suppression compared to older women. But the recently introduced dolutegravir-based regimens and psychosocial peer motivation may improve viral control. We assessed viral suppression, adherence, drug exposure and mental health in a cohort of peripartum AGYW with HIV. METHODS: We present baseline data from an ongoing randomized controlled and observational cohort study. Peripartum (conception to 24 months postpartum) AGYW 15- to 24-year-old with HIV and >3 months on tenofovir-based antiretroviral therapy were enrolled between September 2024 and July 2025. Point-of-care viral load and urine tenofovir assays were performed at entry, as well as data on sociodemographic, HIV, treatment and mental health characteristics. Anxiety was assessed using the Generalized Anxiety Disorder-7, depression using the Patient Health Questionnaire-9, stigma using the Modified HIV Stigma Scale and post-traumatic stress disorder using the Primary Care Post Traumatic Stress Disorder 5 tools. RESULTS: We enrolled 151 participants. Mean age was 21.1 years. All participants were receiving tenofovir, lamivudine and dolutegravir. Baseline mean viral load was 1133 copies/mL (cpm); 135 (89.4%) were virally suppressed (viral load <40 cpm). Mean self-reported adherence over the past 1 month was 97.5%. Tenofovir was detected in 141 (93.4%) participants at baseline. The following were significantly associated baseline with viral suppression (mean [SD]; 95% CI) or (n [%]): higher self-reported adherence (99.5 [1.7]; 99.2-99.8, p<0.001), detectable urine tenofovir (133 [94.3]; p<0.001), being married (79 [92.9]; p = 0.03), having food security (86 [95.6]; p = 0.004) and being financially secure (74 [96.1]; p = 0.02). Seven (4.6%) experienced post-traumatic stress disorder, 132 (88.0%) had minimal or no depression; 137 (92.0%) had minimal anxiety and 81 (53.6%) experienced moderate stigma. Participants without detectable tenofovir in urine were 0.05 times less likely to have baseline viral suppression, adjusted odds ratio (95% CI) (0.05 [0.006-0.4]; p = 0.004). Participants with higher self-reported adherence were 1.3 times more likely to have viral suppression (1.3 [1.1-1.6]; p = 0.008). CONCLUSIONS: We found high viral suppression at enrolment into a cohort study in peripartum AGYW with HIV. Viral suppression was strongly associated with positive urine tenofovir assays and higher self-reported adherence. High mental wellness was demonstrated.
Acceptability of a Dolutegravir Oral Dispersible Film in Term Neonates Born to Mothers Living With HIV.
Viljoen L, Purdy C, Luke V … +7 more , Toit SD, Groenewald M, Ganger L, Hesseling AC, Garcia-Prats AJ, Cressey TR, Bekker A
J Int AIDS Soc · 2026 Jun · PMID 42319215 · Full text
INTRODUCTION: Dolutegravir (DTG) is a key antiretroviral (ARV) drug for children living with HIV, but no specific formulation is available for neonates (<28 days old). One of the DTG formulations evaluated in the PETITE-...
INTRODUCTION: Dolutegravir (DTG) is a key antiretroviral (ARV) drug for children living with HIV, but no specific formulation is available for neonates (<28 days old). One of the DTG formulations evaluated in the PETITE-DTG trial was a novel 5 mg oral DTG dispersible film (DTG-Film). Acceptability to end-users is essential when introducing new ARV drugs. We report on the experiences of mothers and health workers related to the DTG-Film. METHODS: PETITE-DTG was a phase I/II, open-label two-stage study evaluating the pharmacokinetics, safety and acceptability of two paediatric DTG formulations in term neonates in South Africa. In the multi-dose stage, 43 term neonates born to women with HIV were randomized to receive either the 5 mg DTG-Film or half of a 10 mg DTG dispersible tablet, in addition to zidovudine syrup prophylaxis, for 28 days. In-depth interviews were conducted in a sub-set of mothers whose neonates received DTG-Film (at three time points) and with health workers (at two time points). Thematic analysis was employed. RESULTS: Data were collected (September 2023-October 2024) from 16 virologically suppressed mothers (median age: 38 years) whose neonates received DTG-Film and six female health workers (median age: 47 years) involved in the study. Usability was described positively-with participants highlighting ease of administration, quick dissolution, accurate dosing with no spillage and convenient packaging. Some mothers were initially hesitant due to unfamiliarity with the film, but after 1-2 doses, most reported liking or preferring the DTG-Film above other known ARV formulations. The film integrated well into households, was supported by family members and was considered discreet, helping to avoid unintentional HIV-status disclosure. Previous experience with neonatal ARV drugs and trust in health workers supported acceptability. Health workers noted DTG-Film was potentially fit for use in public health settings, where other formulations require manipulation prior to administration. Health workers played a key role in reassuring mothers that the "paper" was indeed medicine. CONCLUSIONS: Mothers and health workers found the new DTG-Film acceptable for neonatal use. While initial hesitancy was noted, acceptability increased with use. Targeted peer support and engagement with mothers and health workers will be essential to familiarize end-users with the novel DTG-Film.
Reimagining Paediatric HIV Care: Centering Infants and Young Children in Optimized, Integrated Models of Care.
Tsiouris F, Alons C, Maurice M … +5 more , Bhatt N, Rakhmanina N, Gill MM, Giphart A, Tiam A
J Int AIDS Soc · 2026 Jun · PMID 42319210 · Full text
INTRODUCTION: Despite substantial gains in the global HIV response, infants and young children continue to experience poorer outcomes across the HIV testing and care cascade. Rates of early infant diagnosis, timely antir...
INTRODUCTION: Despite substantial gains in the global HIV response, infants and young children continue to experience poorer outcomes across the HIV testing and care cascade. Rates of early infant diagnosis, timely antiretroviral therapy (ART) initiation, retention in care and viral suppression remain unacceptably low in paediatric populations. These disparities are compounded by systemic challenges, including fragmented service delivery, limited availability of child-friendly ART and other drug formulations, and health systems that fail to integrate HIV services within broader maternal and child health platforms. As a result, many children living with HIV are diagnosed and start treatment late and face high risks of mortality and morbidity, particularly in the first 2 years of life. DISCUSSION: In this commentary, we advocate for the urgent reimagining of paediatric HIV service delivery, emphasizing the need to centre infants and young children within models of care. We highlight four promising approaches: (1) Integrated mother-infant follow-up models that ensure continuity of care from pregnancy through the postpartum period and infancy until the infant's final HIV status is determined; (2) Family-centred models that treat the household as the unit of care; (3) Advanced HIV care strategies tailored to the needs of children with late presentation or treatment failure, including paediatric tailored ART regimens and diagnostics; and (4) Community-based interventions that leverage peer support, lay health workers, and provide stigma-free entry points to expand access and retention to care and treatment. These approaches have demonstrated that when services are designed to reflect the developmental, clinical and social needs of children and their caregivers, outcomes significantly improve. However, many of these models remain underutilized, fragmented or inadequately resourced. CONCLUSIONS: To close the paediatric HIV treatment gap, we must move beyond pilot projects towards national, integrated and adequately funded child-centred systems. This requires political will, strategic investment and prioritization of children in HIV policy, innovation and implementation research. A sustained and equitable HIV response must include infants and young children not as an afterthought, but as a core priority. Epidemic control cannot be achieved if the youngest children are left behind.
The Delivery Disconnect: Why We Could Not Model the Impact of Foreign Aid Reductions on Vertical HIV Transmission and What Remains Evident About Strategic Priorities.
Bilinski A, Ciaranello A, Ramaswamy A … +3 more , Walters M, Webb K, Imai-Eaton JW
J Int AIDS Soc · 2026 Jun · PMID 42319201 · Full text
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Timely and Efficient Infant Diagnosis Is Required to End AIDS in Children.
Vojnov L, Jani IV
J Int AIDS Soc · 2026 Jun · PMID 42319178 · Full text
INTRODUCTION: Though considerable effort and investment has significantly increased the proportion of pregnant women living with HIV accessing lifesaving antiretroviral therapy and lowered the prevalence of vertical HIV...
INTRODUCTION: Though considerable effort and investment has significantly increased the proportion of pregnant women living with HIV accessing lifesaving antiretroviral therapy and lowered the prevalence of vertical HIV transmission, more than 70,000 children die each year due to AIDS-related deaths, and nearly half of the 1.4 million children living with HIV are not receiving antiretroviral treatment (ART). Improving case-finding and identification of children acquiring HIV and accelerating linkage to ART will be fundamental to end AIDS in children. DISCUSSION: A variety of existing infant and child case-finding strategies could be tailored by countries to complement testing within vertical HIV transmission programmes, including establishing the HIV exposure status of sick infants and children attending malnutrition and inpatient wards and children accessing vaccines, as well as out-of-facility strategies such as community and family-based testing. Because the risk of HIV acquisition is persistent throughout pregnancy, delivery and breastfeeding, repeated testing throughout the exposure period and especially after cessation of breastfeeding will be critical in capturing HIV acquisitions as early as possible. Immediate or rapid linkage to ART is now possible through using same-day point-of-care testing technologies. CONCLUSIONS: As countries aim to end AIDS in children, adapted and nuanced strategies for case-finding, test timing and the technologies used should be leveraged to meet the needs of each setting and country. Several countries have shown us that it is possible to end AIDS; however, it requires political will, strategic thinking, funding, prioritization and creative innovations.
A Urine Tenofovir Point-of-Care Assay Facilitates Positive Antiretroviral Therapy Adherence Discussions Among People Living With HIV and Healthcare Providers-A Mixed-Methods Evaluation in Cape Town, South Africa.
Mcinziba A, Wademan DT, Viljoen L … +9 more , Myburgh H, Jennings L, Nkantsu Z, van Schalkwyk M, Decloedt E, Gandhi M, Orrell C, van Zyl G, Hoddinott G
J Int AIDS Soc · 2026 Jun · PMID 42316909 · Full text
INTRODUCTION: In South Africa, antiretroviral therapy adherence monitoring relies on self-reported adherence, which is prone to recall error, and only verified annually during blood viral load measurement. A novel urine...
INTRODUCTION: In South Africa, antiretroviral therapy adherence monitoring relies on self-reported adherence, which is prone to recall error, and only verified annually during blood viral load measurement. A novel urine tenofovir rapid assay (UTRA) is a low-cost point-of-care adherence support tool for people living with HIV (PLHIV). Nested in an effectiveness randomized trial, we aimed to understand the relative acceptability of adherence support experiences among PLHIV receiving the UTRA point-of-care adherence intervention versus standard of care. METHODS: All trial participants (n = 199) completed a brief, repeat-measures, quantitative acceptability questionnaire at months 3, 6 and 12. We also conducted longitudinal in-depth interviews with 25 PLHIV with three interactions per participant over 52 weeks-a total of 75 interviews. Interviewed PLHIV were purposively sampled for balance by arm, diversity in age and gender, rich-case sampling, and saturation. We also conducted once-off in-depth interviews with five healthcare providers administering the UTRA intervention. Data were collected between May 2022 and June 2024. Qualitative data analysis involved descriptive summaries of key emergent themes with illustrative case examples augmented by descriptive statistics from the questionnaires. RESULTS: Participants in the intervention arm reported that being tested and informed about their adherence levels in real-time served as a reminder to take treatment consistently. The UTRA facilitated conversations between PLHIV and healthcare providers on how to overcome barriers to adherence. Participants in the control arm reported that they relied on relatives for adherence support and accountability because there is limited time for adherence discussions with healthcare providers. Healthcare providers reported that providing adherence counselling to PLHIV receiving standard of care was challenging because they relied on voluntary disclosure of adherence interruptions. PLHIV in the intervention arm reported more positive experiences of adherence support compared to those in the control arm, regardless of their adherence practices. CONCLUSIONS: A point-of-care adherence tool like the UTRA provides a much-needed platform for PLHIV and healthcare providers to discuss adherence practices and challenges. PLHIV preferred this style of adherence support compared to the standard of care.
Facilitators and Barriers to Implementing Peer-Led Neurocognitive Screening for Older Adults Living With HIV at a Community Hospital in Thailand: A Multiple-Methods Study.
Aurpibul L, Thammalangka R, Threeyakul P … +4 more , Tangmunkongvorakul A, Phanuphak N, Philbin MM, Mellins CA
J Int AIDS Soc · 2026 Jun · PMID 42281172 · Full text
INTRODUCTION: Neurocognitive impairment (NCI) is increasingly prevalent among older adults living with HIV (OALHIV). HIV clinics in low- and middle-income countries often do not routinely screen for NCI. Task-shifting sc...
INTRODUCTION: Neurocognitive impairment (NCI) is increasingly prevalent among older adults living with HIV (OALHIV). HIV clinics in low- and middle-income countries often do not routinely screen for NCI. Task-shifting screening to peer educators might be an alternative approach. We explored facilitators and barriers to implementing a peer-led NCI screening tool in an HIV clinic in Thailand. METHODS: The study took place at a community hospital HIV clinic in suburban Chiang Mai. Peer educators were trained to screen OALHIV ≥50 years for NCI using the International HIV-Dementia Scale for global cognition, the Trail-Making Test for psychomotor speed and the General Practitioner Assessment of Cognition. We interviewed OALHIV who participated in the peer-led NCI screening during and after a 12-week implementation phase, peer educators and healthcare professionals to identify individual and intervention characteristics categorized according to the Consolidated Framework for Implementation Research. Transcribed and imported digital materials were used for thematic analysis in Dedoose (version 9.2.12). RESULTS: From March to June 2023, 162 eligible OALHIV were recruited. Among the 144 (89%) screened, the median age was 58 (IQR 54-62) years, and 93 (65%) were female. On at least one measure, 40 (28%) matched the study-defined referral criteria for NCI, of whom 20 (50%) were diagnosed with mild NCI, representing 14% of all those screened. We conducted 39 interviews with OALHIV (n = 26) and clinic-based staff (n = 12; five peer educators, eight healthcare professionals). The perceived benefits of neurocognitive screening, the empowerment of peer educators, the reliance on established links between peers and clinic clients, and OALHIV acceptance of screening were facilitators of the intervention. The main reported barriers were a lack of perceived necessity among OALHIV, clinic staff concerns about screening quality and comprehensiveness, and a lack of supportive national policies to integrate screening into routine HIV care for OALHIV. CONCLUSIONS: We demonstrated that a peer-led NCI screening intervention was feasible and acceptable in our setting. Raising awareness of the benefits of NCI screening among OALHIV and improved training and coordination in the healthcare setting would facilitate more effective implementation.
Cause of Death and Risk of Death for People Living With HIV Admitted to Hospital: A Systematic Review and Meta-Analysis.
Burke RM, Sabet N, Ellis J … +9 more , Rickman HM, Rangaraj A, Lawrence DS, Jarvis JN, Falconer J, Tugume L, Berhanu RH, Ford N, MacPherson P
J Int AIDS Soc · 2026 Jun · PMID 42261234 · Full text
INTRODUCTION: Despite increasing access to HIV treatment and care, HIV-associated deaths remain high. We aimed to summarize global and regional trends in risk and causes of death among people living with HIV (PLHIV) admi...
INTRODUCTION: Despite increasing access to HIV treatment and care, HIV-associated deaths remain high. We aimed to summarize global and regional trends in risk and causes of death among people living with HIV (PLHIV) admitted to hospital. METHODS: We conducted a systematic search across eight databases on 23 April 2023, identifying studies that reported cause of hospital admission or death among hospitalized PLHIV from first January 2014 onwards. We extracted data on age, geographical region, type of ward, antiretroviral treatment use, CD4 cell count, risk of death, cause of death and method of ascertainment of cause of death. We grouped studies into mutually exclusive groups: adults in medical wards by world region; adults in intensive care; and children. We used a Bayesian multilevel meta-regression model to pool data on causes of death. We additionally estimated temporal trends in risk of death among hospitalized PLHIV between 2000 and 2023. RESULTS: We identified 67 studies (59,013 participants) reporting risk of death among hospitalized PLHIV between 2014 and 2023. The overall risk of in-hospital death was 16% (95% credible interval [CrI]: 8%-27%). Mortality risk was highest among adults in Africa (19%, 95% CI: 15%-24%) and adults in intensive care units (44%, 95% CI: 34%-55%). Among 40 studies reporting cause of death in 6,838 participants, AIDS-related conditions predominated (72% of deaths, 95% CrI: 57%-85%), including tuberculosis deaths (27% of deaths, 95% CrI: 15%-40%). Bacterial infections were the second leading cause of death (25% of deaths, 95% CrI: 9%-47%). There was no strong evidence of risk of death changing between 2000 and 2023 (-2.2 percentage point decrease, 95% CrI -16.1 to +17.0 percentage points). CONCLUSIONS: Despite advances in HIV treatment, AIDS-related illnesses and bacterial infections remain the leading causes of in-hospital death among PLHIV. Our analysis reveals that in most regions, the risk of death for hospitalized PLHIV has remained largely unchanged in the past 23 years. These findings underscore the critical need to prioritize high-quality hospital care for opportunistic infections to reduce AIDS-related deaths.
Qualitative Insights on Client and Provider Barriers and Facilitators to Using a Novel Online HIV Pre- and Post-Exposure Delivery Model in Kenya.
Okello P, Thuo N, Roche SD … +9 more , Saravis AL, Mwai D, Naik P, Kiptinness C, Kareithi T, Mugambi ML, Sharma M, Ngure K, Ortbald KF
J Int AIDS Soc · 2026 Jun · PMID 42244233 · Full text
INTRODUCTION: Online delivery of HIV pre- and post-exposure prophylaxis (PrEP and PEP) could address persistent access barriers, yet implementation across Africa remains limited. The ePrEP Kenya Pilot (NCT05377138) integ...
INTRODUCTION: Online delivery of HIV pre- and post-exposure prophylaxis (PrEP and PEP) could address persistent access barriers, yet implementation across Africa remains limited. The ePrEP Kenya Pilot (NCT05377138) integrated PrEP and PEP services into an existing e-pharmacy platform and identified client- and provider-level barriers and facilitators to use. METHODS: In the pilot, clinicians screened adults (age 18+) in Nairobi and Mombasa Counties for PrEP and PEP eligibility via telehealth; pharmaceutical technologists courier-delivered HIV testing services (including self-testing) and dispensed PrEP or PEP to eligible clients who paid 150-250 KES (∼$1-2 USD) for HIV testing, ≤149 KES (∼$1 USD) for courier delivery and nothing for telehealth consultation or PrEP/PEP drugs. We conducted monthly check-in calls with providers and, near study endline, in-depth interviews (IDIs) with purposively sampled clients and all providers. We analysed verbatim call transcripts and IDIs inductively, then mapped identified barriers and facilitators to the Consolidated Framework for Implementation Research (CFIR). RESULTS: From February to November 2023, we conducted 10 check-in calls and interviewed 30 clients (10 PEP, 10 PrEP with 1+ refill, 10 PrEP with no refills) and 10 providers (4 clinicians, 6 pharm techs). Clients had a median age of 27 years (IQR 25-30) and providers 28 years (IQR 27-31); 53% (16/30) of clients and 30% (3/10) of providers were female. In the Outer Setting CFIR domain, providers identified motorcycle manoeuvrability as a delivery facilitator but noted that traffic, poor road infrastructure, bad weather and personal safety concerns posed challenges. In the Inner Setting domain, providers identified information-sharing practices and collegiality as facilitators. In the Individuals domain, clients' capability, opportunity and motivation to use online PrEP/PEP services was reportedly facilitated by app-guided HIV self-testing, broad delivery zones and enhanced privacy, but hindered by low awareness of these services, limited access to internet-enabled devices, data security concerns and uncertainties around couriers' pharmacy credentials. Recommendations included reducing client costs, expanding delivery coverage and hours, and offering alternative delivery options (e.g. medication pick-up lockers). CONCLUSIONS: Online PrEP and PEP delivery is a promising differentiated service model, especially if partially subsidized by third-party payers. Implementation success will require model adaptations that address logistical, infrastructural and awareness barriers.
Disparities in Awareness, Willingness and Uptake of Biomedical HIV Prevention Among Bisexual and Gay Men: A Systematic Review and Meta-Analysis.
Zhou Q, Sun X, Chaires S … +3 more , Klein V, Ingham R, Armstrong HL
J Int AIDS Soc · 2026 Jun · PMID 42231594 · Full text
INTRODUCTION: The field of HIV/STI prevention research has primarily focused on gay men, leaving bisexual men overshadowed in broader discussions on sexual minority men's health. Although also at increased risk of HIV ac...
INTRODUCTION: The field of HIV/STI prevention research has primarily focused on gay men, leaving bisexual men overshadowed in broader discussions on sexual minority men's health. Although also at increased risk of HIV acquisition, bisexual men are less likely to access biomedical HIV prevention. This systematic review and meta-analysis summarizes the prevalence of implementation of biomedical HIV prevention strategies among bisexual men as compared with gay men. METHODS: We searched PsycINFO, CINAHL, Scopus, PubMed and Web of Science for studies published between 1 January 2012 and 1 February 2024, with prevalence data of specified HIV biomedical prevention strategies (awareness, intention, adherence and use of pre-exposure prophylaxis [PrEP], post-exposure prophylaxis [PEP] and U = U). Studies that did not provide bisexual-specific data were excluded. We conducted six random-effect meta-analysis models to analyse PrEP awareness, PrEP intention, PrEP use and U = U use among bisexual men and gay men. We conducted trend analyses to determine variations in the prevalence of PrEP awareness, intention and use, fitted by locally estimated scatterplot smoothing regression and linear regression. This study was registered with PROSPERO (CRD42024519650). RESULTS: Data were extracted from 114 articles, encompassing 514,543 participants, including 94,004 bisexual men (18.3%) and 420,539 gay men (81.7%). The overall pooled prevalence of PrEP awareness (g: 61.4% vs. b: 42.9%), any PrEP use (g: 22.5% vs. b: 15.2%), lifetime PrEP use (g: 21.5% vs. b: 11.9%), current PrEP use (g: 20.9% vs. b: 16.0%) and U = U use (g: 76.3% vs. b: 69.3%) among gay men was significantly higher than among bisexual men, with odds ratios ranging from 1.52 to 2.77. There was no difference for PrEP intention (g: 55.6% vs. b: 56.7%). For both gay and bisexual men, the trends for PrEP awareness and use generally increased, while the trend for PrEP intention decreased over time. CONCLUSIONS: Results demonstrate that bisexual men are engaging less than gay men with biomedical HIV prevention strategies, indicating the need for increased dissemination, awareness, and tailored policies and strategies for bisexual men.
HIV in Gaza: From Chronic Under-Detection to Acute Collapse.
Majka R, Abuzerr S
J Int AIDS Soc · 2026 Jun · PMID 42204844 · Full text
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