Journal Of The International AIDS Society[JOURNAL]
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200 papers
Epidemiological impact and cost-effectiveness analysis of PrEP provision expansion among MSM in the Netherlands.
Wang H, Popping S, van de Vijver D … +1 more , Jonas KJ
J Int AIDS Soc · 2025 Jun · PMID 40462500 · Full text
INTRODUCTION: Several European countries show potential for pre-exposure prophylaxis (PrEP) provision expansion, with many men who have sex with men (MSM) on waiting lists. In the Netherlands, approximately 15,000 PrEP-e...
INTRODUCTION: Several European countries show potential for pre-exposure prophylaxis (PrEP) provision expansion, with many men who have sex with men (MSM) on waiting lists. In the Netherlands, approximately 15,000 PrEP-eligible/intending MSM are awaiting PrEP access. We modelled the epidemiological and economic impact of extending PrEP provision considering several PrEP provision routes (National PrEP Programme and alternative PrEP providers). METHODS: We calibrated our HIV transmission model among the Dutch MSM epidemic. PrEP was expanded from 2022 onwards, covering an additional 3000 MSM on the waiting list and in addition one-third (5000), two-thirds (10,000), and all (15,000) PrEP-eligible/intending MSM by 2024, compared to a non-expansion scenario. The epidemiological impact was projected by 2030. Costs were calculated from a third-party payer's perspective over 40 years with Dutch-specific quality-adjusted life years (QALY). Additionally, a budget impact analysis was performed over 5 years. RESULTS: Covering the 3000 waiting-list MSM, one-third, two-thirds and all PrEP eligible/intending MSM by 2024 will avert 17 (5.7%), 46 (15.2%), 88 (29.1%) and 115 (37.9%) cumulative new HIV acquisitions compared to the base-case scenario. Consequently, 4, 2, 0 and 0 new HIV acquisitions will result by 2030, respectively. The epidemiological impact of PrEP expansion is sensitive to the users' PrEP adherence, but overall minimal by PrEP targeting strategies, given the strongly declining epidemic. Increasing the National PrEP Programme's capacity incurred more costs to the payer (short-term budget impact ranging from €2.25 to €45.29 million). PrEP expansion can be cost-saving when all PrEP-eligible/intending MSM are covered and fully provided by alternative PrEP providers, with an incremental cost-effectiveness ratio of -€2160/QALY over 40 years. This scenario dominated over all other scenarios. Our cost-effectiveness analysis is most sensitive to the individual co-payment for PrEP-related testing when accessing PrEP via alternative PrEP providers and on-demand PrEP use. CONCLUSIONS: Expanding PrEP coverage is crucial to reduce HIV acquisitions further and reach zero new acquisitions by 2030. As the Dutch National PrEP Programme reached capacity limits, PrEP expansion through alternative routes should be encouraged. Nevertheless, balancing out-of-pocket expenses and reimbursed care is key for healthcare equity.
Analytical treatment interruption among women with HIV in southern Africa who received VRC01 or placebo in the Antibody Mediated Prevention Study: ATI stakeholder engagement, implementation and early clinical data.
Karuna S, Laher F, Dadabhai S … +28 more , Yu PC, Grove D, Orrell C, Makhema J, Hosseinipour MC, Mathew CA, Brumskine W, Mgodi N, Andrew P, Gama L, Karg C, Broder G, Baepanye K, Lucas J, Andrasik M, Takuva S, Villaran M, Takalani A, Tressler R, Soto-Torres L, Woodward Davis AS, Dhai A, Sanne IM, Cohen MS, Corey L, Gray G, deCamp AC, Bar KJ
J Int AIDS Soc · 2025 Jun · PMID 40462491 · Full text
INTRODUCTION: Antiretroviral therapy (ART) prevents and treats, but does not eradicate, HIV. Early ART initiation is associated with post-ART virologic control, particularly among African women, and anti-HIV-1 broadly ne...
INTRODUCTION: Antiretroviral therapy (ART) prevents and treats, but does not eradicate, HIV. Early ART initiation is associated with post-ART virologic control, particularly among African women, and anti-HIV-1 broadly neutralizing antibodies (bnAbs) may modulate immune responses to HIV. We evaluate whether early ART with or without anti-HIV-1 bnAb VRC01, present at HIV acquisition, is associated with later ART-free control in African women and we assess potential associations with observed control. METHODS: Stakeholder engagement informed analytical treatment interruption (ATI) study design and implementation. Participants who received placebo or VRC01 and acquired HIV in the Antibody Mediated Prevention efficacy trial were assessed for ATI eligibility, including HIV acquisition within 8 weeks of receiving VRC01 or placebo, followed by early ART initiation and ≥1 year of viral suppression. Participation facilitators and barriers were assessed. From May 2021 to February 2024, participants enrolled, stopped ART and received frequent viral load and CD4+ T-cell count monitoring for safety and assessment of meeting ART reinitiation criteria. RESULTS: Thirteen women enrolled from southern Africa. No ATI-related serious adverse events (AEs), HIV transmissions, pregnancies or ≥Grade 2 AEs were observed. Eight sexually transmitted infections were diagnosed in seven women during ATI. Two participants had tenofovir levels consistent with use during ATI; 2/11 (18%) who completed ATI without antiretroviral use exhibited ART-free control for ≥32 weeks. The median time to confirmed VL≥200 was 5.4 weeks (range 2.7-112). The most common ART reinitiation criterion met was virologic (n = 7). VRC01 receipt proximate to HIV acquisition was not associated with control. Controllers versus non-controllers did not differ by early post-acquisition viral load kinetics, acquired virus characteristics, or time from estimated acquisition to closest infusion or to ART initiation. CONCLUSIONS: In a safe, well-tolerated ATI, 18% of 11 African women exhibited post-intervention control. Design and implementation lessons inform future ATIs in Africa. Analyses of peri-acquisition and post-ATI host and viral characteristics can inform the development of interventions for HIV cure, prevention and treatment. CLINICAL TRIAL REGISTRATION: NCT04860323.
HIV post-exposure prophylaxis in community settings and by lay health workers or through task sharing: a systematic review of effectiveness, case studies, values and preferences, and costs.
Kennedy CE, Dawit R, Yeh PT … +6 more , Rodolph M, Ford N, Schmidt HA, Schaefer R, Baggaley R, Macdonald V
J Int AIDS Soc · 2025 May · PMID 40426304 · Full text
INTRODUCTION: Post-exposure prophylaxis (PEP) for HIV prevention has been inadequately promoted, provided and used. Expanded access and task sharing could increase the HIV prevention impact of PEP, but scientific evidenc...
INTRODUCTION: Post-exposure prophylaxis (PEP) for HIV prevention has been inadequately promoted, provided and used. Expanded access and task sharing could increase the HIV prevention impact of PEP, but scientific evidence to inform programmatic and policy decisions has not been synthesized. METHODS: To inform World Health Organization guidelines, we conducted a systematic review of studies examining the provision of PEP in community settings, and by trained lay health workers or through task sharing. We searched CINAHL, PsycINFO, PubMed, EMBASE and scientific conferences for studies published between January 2012 and October 2023. We screened abstracts and extracted data in duplicate. The effectiveness review included randomized controlled trials and comparative observational studies; risk of bias was assessed using Cochrane Collaboration and Evidence Project tools, and the certainty of the evidence was assessed using GRADE. We also summarized implementation case studies, values and preferences studies, and cost and cost-effectiveness studies. RESULTS: For provision of PEP in community settings, we identified one effectiveness study, three case studies, one values and preferences study, and one cost study. Very low certainty evidence from one study in Kenya and Uganda suggested that PEP uptake, when offered as part of a dynamic prevention package, was highest in the community setting (vs. outpatient or antenatal care settings). For provision of PEP by trained lay health workers or task sharing, we identified three effectiveness studies, two case studies, four values and preferences studies, and one cost study. Very low certainty evidence from Kenya, Uganda and the United States suggested that engagement of lay providers or pharmacists increased PEP uptake and completion and decreased HIV acquisition. Studies from six countries found most health workers supported PEP provision by non-specialist providers. One modelling study suggested community-based provision may be cost-effective or cost-saving in Africa. DISCUSSION: Evidence on expanding PEP access through community delivery or task sharing is limited but generally suggests positive outcomes, feasibility, acceptability and cost-effectiveness of these approaches. Indirect evidence from HIV treatment and pre-exposure prophylaxis further supports these approaches. CONCLUSIONS: Programmes should be expanded to include community delivery and task sharing to dispense, distribute, provide and monitor PEP.
The lavender purge.
Mayer KH
J Int AIDS Soc · 2025 May · PMID 40413612 · Full text
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Feasibility and acceptability of peer-delivered HIV and syphilis self-test kits and assisted partner notification services for gay, bisexual and other men who have sex with men: a qualitative study in Uganda.
Okoboi S, Mujugira A, Ekusai-Sebatta D … +5 more , Twimukye A, Tumuhimbise P, Aliganyira B, Castelnuovo B, King R
J Int AIDS Soc · 2025 May · PMID 40390332 · Full text
INTRODUCTION: There is a need to combine different approaches to tackle the HIV epidemic, particularly in high-incidence populations. We explored the feasibility and acceptability of using peer-delivered HIV self-testing...
INTRODUCTION: There is a need to combine different approaches to tackle the HIV epidemic, particularly in high-incidence populations. We explored the feasibility and acceptability of using peer-delivered HIV self-testing (HIVST), syphilis self-testing (SST) and assisted partner notification (APN) services among gay, bisexual and other men who have sex with men (GBMSM) in Uganda. METHODS: From November 2023 to March 2024, we conducted in-depth interviews with 20 purposively selected GBMSM peers and 10 healthcare workers (HCWs). The GBMSM and HCWs interviews explored their perspectives on (1) the feasibility, acceptability and preferences for peer-delivered interventions (HIVST, SST and APN) and (2) strategies and methods of reaching individuals who had not been tested or tested more than 6 months before the interview. We used a content analysis approach to define and organize codes deductively and inductively to identify themes. RESULTS: The median age of the 20 GBMSM peers was 27 years (interquartile range [IQR], 22-35 years), and 37 years (IQR, 25-52) for the 10 HCWs, of whom seven were female. We identified four emerging categories: (1) Trust: GBMSM peers and HCWs expressed trust in the peer delivery of self-test kits (HIVST and SST) to obtain same-day results effectively. HCWs were preferred over peers for APN services in reaching sexual contacts of index clients for testing; (2) Intimate partner violence (IPV): Although initial concerns about IPV were raised concerning both HIVST programmes and peer APN strategies, such incidents were rarely reported in practice; (3) Entry point: Similar to HIVST, SST was a self-administered activity that served as an entry point for HIV testing discussions among GBMSM who had either never undergone or had postponed testing. Self-test kits could also facilitate pre-sexual testing among GBMSM; (4) Social media: Campaigns on social media dedicated to promoting self-testing could expand testing coverage services to GBMSM vulnerable to HIV and syphilis acquisition. CONCLUSIONS: HCWs and GBMSM peers preferred delivery of self-test kits through peers over facility-based approaches; however, they favoured HCWs for providing APN services. Integrating peer-delivered self-testing programmes into differentiated testing models and leveraging social media influencers could expand testing coverage among GBMSM.
HIV pre-exposure prophylaxis initiation in community safe spaces increases PrEP access among key populations in Zambia.
Mwango LK, Baumhart C, Lindsay B … +5 more , Olowski P, Sakala H, Phiri C, Claassen CW, Lavoie MC
J Int AIDS Soc · 2025 May · PMID 40390324 · Full text
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No significant drug-drug interaction between oral TAF-based PrEP and feminizing hormone therapy among transgender women in Thailand: the iFACT-3 study.
Hiransuthikul A, Thammajaruk N, Kerr S … +11 more , Janamnuaysook R, Nonenoy S, Hongchookiat P, Trichavaroj R, Tawon Y, Boonruang J, Teeratakulpisarn N, Cressey TR, Anderson PL, Phanuphak N, iFACT3 study team
J Int AIDS Soc · 2025 May · PMID 40390323 · Full text
INTRODUCTION: Concerns regarding potential drug-drug interaction (DDI) between feminizing hormone therapy (FHT) and HIV pre-exposure prophylaxis (PrEP) may hinder PrEP use among transgender women. We assessed the potenti...
INTRODUCTION: Concerns regarding potential drug-drug interaction (DDI) between feminizing hormone therapy (FHT) and HIV pre-exposure prophylaxis (PrEP) may hinder PrEP use among transgender women. We assessed the potential DDI between FHT and emtricitabine-tenofovir alafenamide (F/TAF)-based PrEP among transgender women. METHODS: Transgender women without HIV who never underwent orchiectomy were enrolled between January and February 2022. Oral FHT (oestradiol valerate 2 mg and cyproterone acetate 25 mg) was initiated at baseline and continued until week 9, while oral PrEP (F/TAF 200/25 mg) was initiated at week 3 and continued until week 12. Intensive blood sampling was performed at weeks 3 and 9 to assess the impact of PrEP on FHT; and weeks 9 and 12 to assess the impact of FHT on PrEP. Pharmacokinetics (PKs) of plasma oestradiol (E2), TAF, tenofovir (TFV) and emtricitabine (FTC); urine TFV and FTC; and tenofovir-diphosphate (TFV-DP) and emtricitabine-triphosphate (FTC-TP) in peripheral blood mononuclear cells (PBMCs) and rectal tissues were assessed. RESULTS: Eighteen participants completed all PK visits. No significant differences in PK parameters for plasma E2, TAF and TFV were observed with FHT and F/TAF administration. The geometric mean of FTC AUC at week 9 was 9% lower than at week 12, but the 90% CI (0.88-0.95) remained within the 80-125% range. There were no significant differences in PBMCs and rectal tissues TFV-DP and FTC-TP concentrations when F/TAF was administered with FHT. CONCLUSIONS: No bidirectional clinically significant DDI between FHT and F/TAF-based PrEP was observed across systemic and local tissue anatomical compartments, supporting the use of oral F/TAF-based PrEP among transgender women. CLINICAL TRIAL NUMBER: NCT04590417.
Dosing forgiveness of oral PrEP for cisgender women remains uncertain.
Moore M, Glidden D, Anderson P … +2 more , Hendrix C, Dimitrov D
J Int AIDS Soc · 2025 May · PMID 40384398 · Full text
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The changing cost-effectiveness of primary HIV prevention: simple calculations of direct effects.
Garnett GP, Herbeck JT, Akullian A
J Int AIDS Soc · 2025 May · PMID 40375630 · Full text
INTRODUCTION: Over the course of the HIV pandemic, prevention and treatment interventions have reduced HIV incidence, but there is still scope for new prevention tools to further control HIV. Studies of the cost-effectiv...
INTRODUCTION: Over the course of the HIV pandemic, prevention and treatment interventions have reduced HIV incidence, but there is still scope for new prevention tools to further control HIV. Studies of the cost-effectiveness of HIV prevention tools are often done using detailed, "transmission-aware" models, but there is a role for simpler analyses. DISCUSSION: We present equations to calculate the cost-effectiveness, budget impact and epidemiological impact of HIV prevention interventions including equations allowing for multiple interventions and heterogeneity in risk across populations. As HIV incidence declines, the number needed to cover to prevent one HIV acquisition increases. Along with the benefits of averting HIV acquisitions, the cost-effectiveness of HIV prevention interventions is driven by incidence, along with efficacy, duration and costs of the intervention. The budget impact is driven by cost, size of the population and coverage achieved, and impact is determined by the effective coverage of interventions. HIV incidence has declined in sub-Saharan Africa, making primary HIV prevention less cost-effective and decreasing the price at which new prevention products provide value. Heterogeneity in risk could in theory allow for focusing HIV prevention, but current screening tools do not appear to sufficiently differentiate risk in populations where they have been applied. The simple calculations shown here provide rough initial estimates that can be compared with more sophisticated transmission dynamic and health economic models. CONCLUSIONS: Simple equations show how the observed declines in HIV incidence in sub-Saharan Africa make primary prevention tools less cost-effective. If we require prevention to be more cost-effective, either we need primary prevention tools to be used disproportionately by those most at risk of acquiring HIV, or they need to be less expensive.
Status of HIV vaccine development: progress and promise.
Haynes BF, Saunders KO, Hahn BH … +3 more , Wiehe K, Baden LR, Shaw GM
J Int AIDS Soc · 2025 May · PMID 40375607 · Full text
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A severe dismantling of LGBTQI+ health equity and equality: impact of new U.S. policies on the global response to HIV.
Cahill SR
J Int AIDS Soc · 2025 May · PMID 40375596 · Full text
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Inequities in PrEP annualized pill-day coverage, United States, 2018-2022: a cross-sectional pharmacoequity analysis.
Sullivan PS, Hall E, Bradley H … +2 more , Russell ES, Woodyatt CR
J Int AIDS Soc · 2025 May · PMID 40364537 · Full text
INTRODUCTION: Pre-exposure prophylaxis (PrEP) is highly effective in reducing the risk of HIV acquisition, but the population-level impact of PrEP depends on the proportion of people with PrEP indications who use it (cov...
INTRODUCTION: Pre-exposure prophylaxis (PrEP) is highly effective in reducing the risk of HIV acquisition, but the population-level impact of PrEP depends on the proportion of people with PrEP indications who use it (coverage) and how long they stay on it while at risk (persistence). We aimed to assess the extent to which PrEP persistence varied by race/ethnicity, sex and age. METHODS: Previously reported methods and US commercial pharmacy data identified PrEP users and days covered. We calculated PrEP Days Covered (PDC) as the annual number of pills dispensed (i.e., pill-days) overall and by sex, race/ethnicity and age group. Statistical differences by demographic characteristics were calculated. To assess the potential impact of 2-1-1 PrEP dosing on median days of PrEP use, we compared 2018 and 2022 (pre- and post-US Public Health Service guideline for 2-1-1 dosing). RESULTS: There were 225,180 PrEP users in 2018, and 459,984 in 2022. In 2022, the median PDC was 167 (IQR: 67, 308). There were 90 versus 180 median PDC for female and male users, respectively (difference of 90 PDC, 95% CI, 89.6-90.4). Among PrEP users with race/ethnicity data, the median PDC was higher for White non-Hispanic (NH) (290 days) than Hispanic (268 days) or Black NH (251 days) users. Older users had significantly more PDC than younger users (<16 years: 60 days; 16-29 years: 120 days; 30-64 years: 191 days). Residents of states with PrEP-Drug Assistance Programs (PrEP-DAP) or Medicaid expansion had higher median PrEP duration than states without programmes. Median days covered for 2018 (154 days) and 2022 (167 days) did not suggest that the addition of the 2-1-1 PrEP guideline was associated with fewer covered days. CONCLUSIONS: PrEP programmes are often evaluated by enumerating people who used PrEP at any time during a year; our data indicate that significant differences in days of PrEP covered among users might mask further inequities in PrEP protection among women, and Black, Hispanic and younger people. Evaluations of PrEP equity should include a pharmacoequity component by assessing days covered as an additional indicator of PrEP equity.
Evaluation of point-of-care diagnostics for sexually transmitted infection on oral PrEP initiation and persistence among young people in South Africa: a randomized controlled study.
Joseph Davey D, Fynn L, Rousseau E … +6 more , Macdonald P, Leonard B, Lebelo K, Kolisa A, Little F, Bekker LG
J Int AIDS Soc · 2025 May · PMID 40356266 · Full text
INTRODUCTION: Pre-exposure prophylaxis (PrEP) services are linked to increased sexually transmitted infection (STI) diagnoses, which may facilitate PrEP uptake. We hypothesized that point-of-care (POC) STI testing and tr...
INTRODUCTION: Pre-exposure prophylaxis (PrEP) services are linked to increased sexually transmitted infection (STI) diagnoses, which may facilitate PrEP uptake. We hypothesized that point-of-care (POC) STI testing and treatment would improve PrEP initiation and persistence. METHODS: Between September 2023 and November 2024, we conducted a single-centre, open-label, unblinded, randomized controlled trial among adolescent girls and young women (15-29 years old) or male partners (any age). Participants were randomized 1:1 to standard syndromic STI management (SOC) or POC testing for C. trachomatis, N. gonorrhoeae, syphilis and T. vaginalis (women only). All participants received standard HIV prevention counselling, including the offer of oral PrEP. The primary outcome was effect of POC STI testing versus syndromic management on PrEP initiation; secondary outcomes included persistence at 1 and 4 months (PrEP prescription), verified in the secondary analysis of tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) in a random subset. TFV-DP in DBS was analysed in a subset. Analysis was intention-to-treat, adjusted for age and sex. RESULTS: We enrolled and randomized 900 participants (452 in intervention; 448 in SOC). The mean age was 20.4 years (SD = 4.2); 48% were female. In the intervention arm, 435 received POC STI testing (96%); 25% (110 of 435 tested) were diagnosed with =>1 STIs; 84% were treated. In SOC, 7% of participants reported symptoms of STIs (31); 88% were treated (27). Overall, 64% of participants in SOC versus 62% in intervention-initiated PrEP (RR = 0.98, 95% CI = 0.88ng women and partners1.08). In the intervention, 41% persisted on PrEP at 1 month and 25% through 4 months, compared to 46% and 19%, respectively, in SOC (aRR intervention = 1.39; 95% CI = 0.93-2.09; p = 0.08). In participants treated for STIs or syndromically, 77% initiated PrEP versus 60% untreated/diagnosed (aRR = 1.14; 95% CI = 1.02-1.27); 19% versus 14% persisted on PrEP at 4 months (aRR STI/syndrome treated = 1.41; 95% CI = 0.79-2.51). Overall, 30% of 64 DBS had any TFV-DP levels present with no difference by study arm (RR = 0.74; 95% CI: 0.38-1.41). CONCLUSIONS: POC STI testing did not increase PrEP initiation or 1-month persistence but showed a moderate association with 4-month persistence. STI treatment (syndromic or confirmed) was linked to higher PrEP uptake and persistence. Integrating STI management may improve PrEP persistence among youth.
Low-level viraemia as a risk factor for virologic failure in children and adolescents living with HIV on antiretroviral therapy in Tanzania: a multicentre, retrospective cohort study.
McKenzie KP, Nguyen DT, Komba LB … +4 more , Ketang'enyi EW, Kipiki NE, Mgeyi EN, Mwita LF
J Int AIDS Soc · 2025 May · PMID 40356263 · Full text
INTRODUCTION: Viral load (VL) of 1000 copies/ml or greater is commonly used to define virologic failure (VF) in children and adolescents living with HIV (CALHIV) in low- and middle-income countries (LMICs). However, evid...
INTRODUCTION: Viral load (VL) of 1000 copies/ml or greater is commonly used to define virologic failure (VF) in children and adolescents living with HIV (CALHIV) in low- and middle-income countries (LMICs). However, evidence in adults suggests that low-level viraemia (LLV) (VL 50-999 copies/ml) increases the risk of subsequent VF. There is limited research on LLV in CALHIV. METHODS: This study retrospectively reviewed VL data from Baylor College of Medicine Children's Foundation-Tanzania (sites in Mbeya and Mwanza) collected between January 2015 and December 2022. CALHIV (0-19 years) on antiretroviral therapy for ≥6 months with at least one VL <50 copies/ml plus ≥2 subsequent VLs were included. VF was defined as both VL ≥1000 and ≥200 copies/ml. Multivariable Cox regression models were used to assess the association between LLV and VF, reporting adjusted hazard ratios (aHR) with 95% confidence intervals (CI). RESULTS: Among 2618 CALHIV included in the outcome analysis (median age 13.2 years, 52.5% female), 81.9% were on first-line dolutegravir-based regimens and LLV was found in 40.5%. CALHIV with LLV had an increased risk of VF with aHRs of 1.63 (CI 1.38-1.91) (VL ≥1000 copies/ml) and 3.85 (3.33, 4.46) (VL ≥200 copies/ml). When stratifying by LLV (50-199, 200-399 and 400-999 copies/ml), all levels were associated with increased risk for VF (VL ≥1000 copies/ml) with aHRs of 1.39 (1.13, 1.69), 1.69 (1.33, 2.16) and 2.03 (1.63, 2.53). When VF was defined as VL ≥200 copies/ml, the corresponding aHRs were 1.41 (1.15, 1.72), 7.99 (6.68, 9.57) and 9.37 (7.85, 11.18). CONCLUSIONS: LLV is associated with a greater risk of VF in CALHIV. The risk of VF increases with higher levels of LLV. This study provides further evidence for revising guidelines in LMICs that define VF as VL ≥1000 copies/ml.
ART to prevent vertical transmission in Latin America: where are we in the "Treat-All" era?
Castillo-Rozas G, Fonseca FF, Castilho J … +8 more , Rebeiro PF, Machado DM, Luque MT, Jalil EM, Mejia F, Kim A, Shepherd BE, Cortes CP
J Int AIDS Soc · 2025 May · PMID 40292653 · Full text
INTRODUCTION: Antiretroviral therapy (ART) during pregnancy and at delivery has nearly eliminated vertical transmission (VT) in some settings but previously reported VT prevalence has been as high as 15% in Latin America...
INTRODUCTION: Antiretroviral therapy (ART) during pregnancy and at delivery has nearly eliminated vertical transmission (VT) in some settings but previously reported VT prevalence has been as high as 15% in Latin America and the Caribbean (LAC). We evaluated VT in the Caribbean, Central and South America network for HIV epidemiology to further study the benefit of ART on VT in our region. METHODS: We retrospectively collected data on cis-gender women ≥15 years of age enrolled in HIV clinics in Brazil, Chile, Honduras and Peru from 2003 to 2018 with ≥1 pregnancy resulting in a live birth after clinic entry to examine the association of ART use at the time of delivery and VT. We used propensity-score-matched logistic regression to examine the odds of VT by ART use. Matching weights incorporated site, HIV RNA, CD4 cell count, maternal age, year and HIV diagnosis before or during pregnancy. We also examined the proportion of women who received ART during pregnancy before and after the treat-all era, as defined within each country. RESULTS: A total of 623 pregnant women with HIV contributed 727 live births. Of all births, 613 (84.3%) infants had known HIV status and there were 22 (3.6%) VT events. Four of the 22 (18%) were born to women on ART at delivery, compared to 403 of 591 (68%) infants negative for HIV. In the propensity-score-matched model, ART use at delivery was associated with 85% decreased odds of VT (odds ratio = 0.15, 95% confidence interval 0.04-0.58). In the pre-treat-all era, 37% (181/485) of women received ART within 30 days of pregnancy diagnosis, compared to 59% (75/128) during the treat-all era (p<0.001). In the pre-treat-all era, 4.3% (21/485) of infants were born HIV positive, compared to 0.8% (1/128) in the treat-all era (p = 0.055). CONCLUSIONS: We found a low prevalence of VT in our cohort, especially in the treat-all era. ART use at delivery was strongly associated with a lower odd of VT. Despite improvements, access to ART during pregnancy remained far from universal. Therefore, new strategies to ensure its effective implementation in LAC are still warranted.
Current drug use patterns and HIV and HCV prevalence among people who inject drugs in suburban areas of Malaysia.
Pang J, Danaee M, Balasingam Kasinather V … +3 more , Des Jarlais D, Kamarulzaman A, Mohd Salleh NA
J Int AIDS Soc · 2025 May · PMID 40285368 · Full text
INTRODUCTION: National surveillance data in Malaysia has observed a marked reduction in the number of new HIV cases among people who inject drugs (PWID) in the past decade. This study sought to estimate the current preva...
INTRODUCTION: National surveillance data in Malaysia has observed a marked reduction in the number of new HIV cases among people who inject drugs (PWID) in the past decade. This study sought to estimate the current prevalence and associated risk factors of HIV and hepatitis C virus (HCV) among PWID in suburban areas of Klang Valley, Malaysia. METHODS: Between September 2021 and March 2022, a cross-sectional, respondent-driven sampling survey was conducted. Participants completed rapid HIV and HCV testing as well as social and behavioural assessments. Factors associated with HIV- and HCV-positive results were estimated using logistic regression. RESULTS: Four-hundred individuals were recruited in the study, of whom 382 (94%) were men. The prevalence of HIV and HCV was 5.5% (95% confidence interval [95% CI]: 3.6-8.3) and 40.5% (95% CI: 35.7-45.5), respectively. Current heroin and amphetamine-type stimulant (ATS) use, regardless of injection or non-injection use, were reported by 340 (85.0%) and 328 (82.0%) individuals, respectively. Past exposure to the criminal justice system (lock-ups, prison and compulsory drug detention centres) was associated with both HIV (Adjusted odds ratio [aOR] = 3.47, 95% CI: 1.33-10.2) and HCV (aOR = 3.32, 95% CI: 2.06-5.39)-positive results. Additionally, HIV-positive results were associated with current ATS use (aOR = 0.31, 95% CI: 0.12-0.86). Meanwhile, HCV-positive results were associated with current heroin use (aOR = 2.44, 95% CI: 1.16-5.48), lifetime enrolment in methadone treatment (aOR = 2.30, 95% CI: 1.23-4.27), current methadone treatment (aOR = 0.46, 95% CI: 0.23-0.92) and current mixing of drugs through injection use (aOR = 1.80, 95% CI: 1.08-3.03). CONCLUSIONS: This study observed low HIV prevalence among PWID, primarily associated with ATS use, while HCV prevalence, linked to heroin use, remained high. Higher odds of being HCV positive among PWID who reported to have ever but not currently enrolled in methadone programmes indicate that treatment may not be continuous once initiated, potentially due to exposure to the criminal justice system. These findings underscore the need for a dual approach: enhanced harm reduction programmes for PWID and a legal reform to address potential barriers posed by criminalization.
The key design features and effectiveness of social network interventions for HIV testing and linkage services in low- and middle-income countries: a systematic review and meta-analysis.
Mukoka M, Msosa TC, Twabi HH … +6 more , Semphere R, Nliwasa M, Harling G, Price A, Fielding K, Choko AT
J Int AIDS Soc · 2025 May · PMID 40285362 · Full text
INTRODUCTION: HIV remains a global health challenge with a reported 39 million people living with HIV (PLHIV) in 2022. Sub-Saharan Africa, Asia and the Pacific are home to 82% of PLHIV, where limited access to healthcare...
INTRODUCTION: HIV remains a global health challenge with a reported 39 million people living with HIV (PLHIV) in 2022. Sub-Saharan Africa, Asia and the Pacific are home to 82% of PLHIV, where limited access to healthcare resources underscores the urgency of innovative strategies to combat the epidemic effectively. Social network interventions (SNIs) hold promise for improving HIV testing and linkage services by engaging populations at greatest risk. This review evaluates the key design features and effectiveness of SNIs for HIV testing and linkage in low- and middle-income countries (LMICs). METHODS: We searched four databases (Medline, Embase, Global Health, Web of Science) for the period from 1st January 2003 until 16th June 2023. A combination of the terms "Social Network," "HIV," "testing" and "linkage" with an LMIC filter was used. We included interventional study designs that compared an SNI for HIV testing and/or linkage to care against non-network comparator approaches. Narrative synthesis and random effects meta-analyses were conducted to synthesize the results. RESULTS: Of the 6763 records, 13 studies met the inclusion criteria; eight were randomized controlled trials, and five were non-randomized designs. Nine studies engaged key populations. The most common strategy involved recruiting and training seeds, who then delivered HIV services to network members. The use of networks varied significantly across the papers. The network approaches used were induction (n = 11), alteration (n = 1) and a combination of individual and segmentation approaches (n = 1). The pooled estimates showed that SNIs had a modest effect on the uptake of HIV testing RR 1.12 [95% CI 1.08-1.17) but the directionality of effect for the proportion newly diagnosed positive (RR 0.88 [95% CI 0.74-1.04]) and linkage to care (RR 0.98 [95% CI 0.86-1.08]) was towards the null. DISCUSSION: SNIs improved the uptake of HIV testing and exhibit important variability in their design. CONCLUSIONS: There is a need for more studies designed to capture the complex relational dynamics of network interventions and to provide strong evidence on their isolated effects. Additionally, it is necessary to expand the use of network approaches to other priority populations. PROSPERO NUMBER: CRD42023434770.
"It gives me the strength and courage to take care of myself": a qualitative exploration of experiences with STI testing among women who initiated PrEP during pregnancy in Western Kenya.
Mogaka JN, Concepcion T, Abuna F … +12 more , Akim E, Morroni C, Mussa A, Mugambi M, Aketch H, Obatsa S, Webel AR, Kinuthia J, Ngure K, Beima-Sofie KM, John-Stewart G, Pintye J
J Int AIDS Soc · 2025 Apr · PMID 40268677 · Full text
INTRODUCTION: Sexually transmitted infections (STIs) in pregnancy contribute to poor perinatal outcomes and increased HIV acquisition risk, underscoring the importance of delivering STI/HIV services within antenatal care...
INTRODUCTION: Sexually transmitted infections (STIs) in pregnancy contribute to poor perinatal outcomes and increased HIV acquisition risk, underscoring the importance of delivering STI/HIV services within antenatal care. Few studies evaluate women's perspectives on the co-delivery of antenatal STI testing and HIV pre-exposure prophylaxis (PrEP). We sought to understand motivations for and experiences with STI testing among pregnant women who initiated HIV PrEP. METHODS: We conducted semi-structured in-depth interviews (IDIs) among a subset of women enrolled in a randomized trial in Western Kenya (NCT04472884) who initiated PrEP within antenatal clinics and tested for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in pregnancy and/or postpartum. As part of parent study procedures, IDIs were conducted between September 2023 and April 2024. Interviews were recorded, transcribed and thematically analysed using deductive and inductive methods. The Health Belief Model guided exploration of STI testing experiences, motivations for testing and the impact of testing on PrEP use. RESULTS: Overall, 39 women who initiated PrEP during pregnancy and tested for CT/NG participated in IDIs; six tested positive for CT and/or NG. Median age was 26 years (IQR 21-29), 77% of participants had >8 years of education, 15% were employed and 72% were married. Most (86%) did not know their partner's HIV status, and 82% persisted with PrEP use at 9 months postpartum. Perceived vulnerability to STI/HIV acquisition, fear of adverse outcomes from untreated infections (e.g. pregnancy loss or harm to baby) and desire to alleviate symptoms (e.g. abnormal discharge) motivated STI testing uptake when offered during antenatal visits. Provision of STI-related education, availability of STI services (i.e. immediate treatment, expedited partner therapy) and supportive interactions with providers promoted positive experiences with STI testing. STI testing encouraged health-promoting behaviours, including sustained PrEP use, even when STI results were negative, as testing made women feel proactively involved in preventing HIV/STI complications for themselves and their infants. CONCLUSIONS: In this qualitative evaluation among women who initiated PrEP in pregnancy, STI testing encouraged PrEP use, even when results were negative. Incorporating STI testing within PrEP delivery in antenatal care represents an opportunity for addressing HIV/STI in this priority population.
Machine learning to improve HIV screening using routine data in Kenya.
Friedman JD, Mwangi JM, Muthoka KJ … +9 more , Otieno BA, Odhiambo JO, Miruka FO, Nyagah LM, Mwele PM, Obat EO, Omoro GO, Ndisha MM, Kimanga DO
J Int AIDS Soc · 2025 Apr · PMID 40254897 · Full text
INTRODUCTION: Optimal use of HIV testing resources accelerates progress towards ending HIV as a global threat. In Kenya, current testing practices yield a 2.8% positivity rate for new diagnoses reported through the natio...
INTRODUCTION: Optimal use of HIV testing resources accelerates progress towards ending HIV as a global threat. In Kenya, current testing practices yield a 2.8% positivity rate for new diagnoses reported through the national HIV electronic medical record (EMR) system. Increasingly, researchers have explored the potential for machine learning to improve the identification of people with undiagnosed HIV for referral for HIV testing. However, few studies have used routinely collected programme data as the basis for implementing a real-time clinical decision support system to improve HIV screening. In this study, we applied machine learning to routine programme data from Kenya's EMR to predict the probability that an individual seeking care is undiagnosed HIV positive and should be prioritized for testing. METHODS: We combined de-identified individual-level EMR data from 167,509 individuals without a previous HIV diagnosis who were tested between June and November 2022. We included demographics, clinical histories and HIV-relevant behavioural practices with open-source data that describes population-level behavioural practices as other variables in the model. We used multiple imputations to address high rates of missing data, selecting the optimal technique based on out-of-sample error. We generated a stratified 60-20-20 train-validate-test split to assess model generalizability. We trained four machine learning algorithms including logistic regression, Random Forest, AdaBoost and XGBoost. Models were evaluated using Area Under the Precision-Recall Curve (AUCPR), a metric that is well-suited to cases of class imbalance such as this, in which there are far more negative test results than positive. RESULTS: All model types demonstrated predictive performance on the test set with AUCPR that exceeded the current positivity rate. XGBoost generated the greatest AUCPR, 10.5 times greater than the rate of positive test results. CONCLUSIONS: Our study demonstrated that machine learning applied to routine HIV testing data may be used as a clinical decision support tool to refer persons for HIV testing. The resulting model could be integrated in the screening form of an EMR and used as a real-time decision support tool to inform testing decisions. Although issues of data quality and missing data remained, these challenges could be addressed using sound data preparation techniques.
Prevalence, correlates and solutions to people with HIV in China being refused treatment for diseases not related to HIV: a mixed-methods study.
Hu Y, Zhou X, Fan X … +9 more , Bi R, Deng Y, Li H, Peng X, Luo D, Zhao H, Guo Z, He L, Zou H
J Int AIDS Soc · 2025 Apr · PMID 40211825 · Full text
INTRODUCTION: Existing studies on treatment refusal towards people with HIV (PWH) lack focus on the Chinese context and key factors. We aimed to elucidate the prevalence, correlates and solutions to PWH being refused tre...
INTRODUCTION: Existing studies on treatment refusal towards people with HIV (PWH) lack focus on the Chinese context and key factors. We aimed to elucidate the prevalence, correlates and solutions to PWH being refused treatment for diseases not related to HIV (DNRH) in China. METHODS: We conducted a mixed-methods study of PWH and healthcare providers (HCPs) between April 2021 and June 2022. An online survey of PWH assessed the prevalence and correlates of treatment refusal for DNRH during their most recent outpatient or inpatient visit. Semi-structured telephone interviews were conducted with PWH and HCPs to understand their experiences of treatment refusal and to generate potential solutions. RESULTS: We included 35 PWH and 30 HCPs in the interviews, and 902 PWH in the survey. In the survey, 42.2% and 63.0% of PWH reported treatment refusal for DNHR during their most recent outpatient and inpatient visit, respectively. Among outpatients, PWH who were <30 years old (AOR: 0.43, 95% CI: 0.25-0.73), acquired HIV through male-male sex (0.56, 0.35-0.90) and did not disclose their HIV status to HCPs (0.64, 0.42-0.96) were less likely to report treatment refusal. PWH who were not adherent to antiretroviral therapy (10.66, 1.16-98.20), had their outpatient visit before the COVID-19 pandemic (1.74, 1.00-3.00) and received care at a surgical department (2.10, 1.23-3.60) were more likely to report treatment refusal. Among inpatients, PWH who received care from a male HCP (2.31, 1.27-4.22) and were hospitalized in central provinces of China (2.60, 1.07-6.31) had higher odds of treatment refusal. In semi-structured interviews, we found HCP refusal to treat PWH for DNRH could be influenced by stigma against HIV, concerns about HIV acquisition, limited knowledge of HIV post-exposure prophylaxis and insufficient protection from health authorities against discrimination by HIV status. Participants identified several solutions that may help mitigate treatment refusal, including supporting PWH to achieve virologic suppression, HIV education for HCPs, employment protections and compensation for HCPs who acquire HIV in the workplace, and the establishment of dedicated government offices and laws to address treatment refusal. CONCLUSIONS: Treatment refusal for DNRH was common among PWH in China. Factors contributing to treatment refusal involve PWH, HCPs and health authorities. Systematic interventions involving all stakeholders, particularly legal protections against discrimination by HIV status, should be implemented to reduce treatment refusal.
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