Journal Of The International AIDS Society[JOURNAL]
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200 papers
Characterizing tuberculosis diagnosis and the associations with economic instability and employment discrimination among women living with HIV across 11 countries in sub-Saharan Africa: a cross-sectional study.
Lyons C, Syarif O, Looze P … +16 more , Turpin G, Anoubissi JD, Brion S, Dunaway K, Chiu YC, Ocheret D, Sprague L, Moreno CGL, Sati H, Rao A, Rucinski K, Baral S, Chaisson R, Dowdy D, Beyrer C, Genberg B
J Int AIDS Soc · 2025 Dec · PMID 41495603 · Full text
INTRODUCTION: Tuberculosis (TB) is the leading cause of death among people living with HIV. Global estimates among people living with HIV demonstrate that more incident cases and more deaths due to TB occur among women t...
INTRODUCTION: Tuberculosis (TB) is the leading cause of death among people living with HIV. Global estimates among people living with HIV demonstrate that more incident cases and more deaths due to TB occur among women than men. Simultaneously, women experience higher levels of under and unpaid work compared to men. Given that poverty is an established determinant for TB, the aim of this study is to characterize the role of HIV-related employment discrimination and legal protections on TB outcomes for women living with HIV. METHODS: The People Living with HIV Stigma Index 2.0 study was implemented in 11 countries across sub-Saharan Africa, including Angola, Benin, Burkina Faso, Cote D'Ivoire, Ghana, Kenya, Mauritania, Nigeria, Lesotho, Togo and Zimbabwe. Study design and implementation were led by networks of people living with HIV in each country between 2020 and 2022. Interviewer-administered questionnaires were used to collect self-reported socio-behavioural measures among cisgender adult women living with HIV. Multilevel logistic regression models were used to estimate associations between economic instability and employment discrimination exposures and recent TB diagnoses in the context of varying discrimination protections for women living with HIV. RESULTS: Among 10,718 participants, 7.5% (n = 807) reported a recent TB diagnosis. Among women in countries without non-discrimination protections, recent TB diagnosis was negatively associated with current employment (aOR: 0.72; 95% CI: 0.62, 0.85) compared to no employment; and positively associated with being refused employment or income due to HIV status (aOR: 1.80; 95% CI: 1.36, 2.39) and ever being refused promotion (aOR: 2.00; 95% CI: 1.37, 2.91) compared to those who have not reported these experiences. Among women in countries with non-discrimination protections, recent TB diagnosis was associated with lower current employment (aOR: 0.72; 95% CI: 0.56, 0.92) but not associated with employment discrimination. CONCLUSIONS: The presence of social protections may modify the associations between employment discrimination and TB diagnosis. Employment discrimination was associated with TB diagnosis in settings without social protections but not in settings with those protections in place-highlighting a potential vulnerability among people living with HIV in settings without non-discrimination protections. Given the role of poverty in driving TB epidemics, social protections focused on employment, economic instability and opportunity may support TB prevention and control.
A roadmap to scale up person-centred care in the HIV response: recommendations from a global consensus-building process.
Golob L, Williams EL, Bras M … +13 more , Clifton B, Ford N, Geng EH, Green KE, Janamnuaysook R, Katz IT, Mworeko L, Olete RA, Pinto C, Rajasuriar R, Sikombe K, Tan DHS, Grinsztejn B
J Int AIDS Soc · 2025 Dec · PMID 41457454 · Full text
INTRODUCTION: World Health Organization global normative guidance recommends person-centred care (PCC) approaches to reduce HIV-related mortality and morbidity and to improve health-related quality of life (HrQoL). Howev...
INTRODUCTION: World Health Organization global normative guidance recommends person-centred care (PCC) approaches to reduce HIV-related mortality and morbidity and to improve health-related quality of life (HrQoL). However, consensus on the priority PCC elements and guidance on how different stakeholders can realize PCC principles at the health systems, service delivery and individual client-healthcare worker (HCW) levels are lacking. We conducted a global consensus-building process to define core PCC elements and develop recommendations for implementation at scale. METHODS: We used a multi-phase process to build consensus and prioritize recommendations, consisting of a literature review, five stakeholder consultations (34-43 participants each) between July 2022 and July 2023 and a three-round Delphi survey from March to July 2024 (49 participants). We sought diverse actors (including clients, HCWs, policymakers and researchers) from all world regions. Initial statements were drafted during the final consultation meeting, and adjustments to statements and recommendations were made during the Delphi survey. RESULTS: All statements achieved over 90% agreement, and recommendations reached at least 95% agreement. At the core of PCC is an effective primary healthcare (PHC) system, which prioritizes individual health, HrQoL and wellbeing and which adapts to evolving needs. Other core elements include: HCW responsibility to create safe, inclusive and stigma-free spaces; prioritizing community leadership, including in care provision by trained and compensated peers and community HCWs; power sharing within client-HCW relationships, reinforced by HCW training and client literacy; use of appropriate digital technology to increase engagement; and cross-disciplinary collaboration to address different health issues in an integrated manner. Recommendations include: policymakers setting national targets for self-reported HrQoL; strengthening integrated PHC; researchers prioritizing community-academic partnerships; and HCWs routinely assessing client-reported outcomes. CONCLUSIONS: Our findings outline a roadmap with roles and actions for different stakeholders to realize the full potential of PCC. Jointly, there is a need to foster a culture that hears all voices in the care team, including clients and their caregivers, the community and all HCW cadres. At a systems level, it will be crucial to strengthen HIV/PHC integration and align with the universal health coverage agenda for increased investment in inclusive, responsive and sustainable healthcare for all.
Wealth, income and HIV in sub-Saharan Africa: a systematic review.
Atkins K, Sievwright KM, Nishimura H … +1 more , Kennedy CE
J Int AIDS Soc · 2025 Dec · PMID 41431952 · Full text
INTRODUCTION: While economic vulnerability is an established driver of health disparities, the relationships between HIV and wealth, income, and economic inequality have been less consistently established. We conducted a...
INTRODUCTION: While economic vulnerability is an established driver of health disparities, the relationships between HIV and wealth, income, and economic inequality have been less consistently established. We conducted a systematic review of studies examining associations between wealth, income, and economic inequality and HIV incidence and prevalence in sub-Saharan Africa (SSA). METHODS: Following PRISMA guidelines, we searched PubMed, SCOPUS, Embase, EconLit and PsycINFO for quantitative publications through June 2024 examining the relationship between wealth, income or inequality and HIV status, acquisition, prevalence or incidence in SSA. From September 2022 to October 2024, we extracted data using standardized forms, assessed risk of bias and qualitatively summarized results. RESULTS: Overall, 47 studies covering 48 countries met the inclusion criteria. Studies had generally low risk of bias, and most focused on a single country (n = 38), assessed household wealth as the exposure (n = 36) and employed cross-sectional designs (n = 33). Studies assessing wealth and HIV incidence consistently identified a protective effect, while findings around HIV incidence and income were mixed. In studies assessing HIV prevalence, findings on HIV and individual and household income or wealth were mixed. Economic inequality was consistently associated with increased HIV prevalence at community, sub-national and national levels. DISCUSSION: Most included studies were cross-sectional, among the general population, and secondary analyses of existing data. These can generate new insights about potential economic predictors of HIV, but longitudinal research is needed to understand economic impacts on HIV in evolving programme and policy contexts. Limited studies outside the general population highlighted opportunities for future research exploring economic drivers of HIV among the key population and potential differences in the HIV-wealth relationship by gender and urbanicity. CONCLUSIONS: The evidence on HIV and wealth or income is mixed and varies by setting and population, while a limited literature suggests that economic inequality is more consistently associated with HIV risk. Longitudinal research is needed to assess causal relationships between economic factors and HIV, and to identify potential mediators of this relationship.
Setting up for success: the effectiveness of telling children about their HIV status.
Bernays S, Sellberg A, Lariat J … +1 more , Willis N
J Int AIDS Soc · 2025 Dec · PMID 41431921 · Full text
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A call to action to advance global research priorities related to Undetectable = Untransmittable.
Calabrese SK, Bor J, Dukashe M … +5 more , Kalwicz DA, Mupeli K, Onoya D, Stackpool-Moore L, Richman B
J Int AIDS Soc · 2025 Dec · PMID 41414745 · Full text
INTRODUCTION: The Undetectable = Untransmittable (U = U) message has failed to reach many people living with HIV (PLHIV) and their communities despite evidence of its favourable impacts. DISCUSSION: We describe and conte...
INTRODUCTION: The Undetectable = Untransmittable (U = U) message has failed to reach many people living with HIV (PLHIV) and their communities despite evidence of its favourable impacts. DISCUSSION: We describe and contextualize six global research priorities related to U = U, which focus on: (1) examining the effects of U = U messaging on health and economic outcomes; (2) illuminating and addressing barriers to U = U communication among healthcare providers, policymakers and other stakeholders; (3) expanding U = U research to include all key populations disproportionately affected by HIV; (4) addressing limited and inequitable access to information and resources; (5) determining how to optimally communicate about U = U in the context of evolving scientific knowledge and guidelines; and (6) collaborating on parallel studies across countries to improve comparability of study findings and identify cross-cultural differences. CONCLUSIONS: Future research targeting these six priorities is needed to guide effective messaging about U = U in healthcare settings and public health programmes throughout the world. Ultimately, bridging existing gaps in U = U awareness, understanding and acceptance can enable PLHIV and others to reap the benefits associated with this valuable message.
The persistent chasm between PrEP awareness and uptake: characterizing the biomedical HIV prevention continuum in a nationwide cohort of transgender women in the United States and Puerto Rico.
Cooney EE, Poteat TC, Stevenson M … +17 more , Radix AE, Borquez A, Althoff KN, Linton S, Pontes C, Beyrer C, Lint A, Miller M, Brown C, Wawrzyniak AJ, Brown CA, Ragone L, Vannappagari V, Guignard A, Reisner SL, Wirtz AL, ENCORE Study Group
J Int AIDS Soc · 2025 Dec · PMID 41414743 · Full text
INTRODUCTION: Transgender (trans) women are disproportionately impacted by HIV, yet data on the biomedical HIV PrEP continuum (HIVPC) among trans women are limited. We characterized the HIVPC among a large, nationwide co...
INTRODUCTION: Transgender (trans) women are disproportionately impacted by HIV, yet data on the biomedical HIV PrEP continuum (HIVPC) among trans women are limited. We characterized the HIVPC among a large, nationwide cohort of trans women in the United States and Puerto Rico by pre-exposure prophylaxis (PrEP) modality (daily oral and long-acting injectable, LAI) and identified correlates of uptake and non-adherence. METHODS: From April 2023 to December 2024, we enrolled English and Spanish-speaking adult trans women (age 18 years or older) not living with HIV (laboratory-confirmed via fourth-generation HIV-1/2 antigen/antibody testing) and residing in the United States and Puerto Rico into the cohort. PrEP data were collected via self-administered surveys. We characterized the HIVPC using descriptive statistics and assessed for differences in proportions for each step of the HIVPC by modality. Modified Poisson regression models estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) for correlates of HIVPC step (e.g. awareness to uptake). RESULTS: We enrolled 2504 participants, 1636 (65%) of whom may have benefitted from PrEP based on self-reported sexual history and/or needle sharing in the prior 6 months at baseline. Forty-two percent were 18-29 years old, 18% identified as Hispanic and/or Latina/x/e and 13% identified as Black (inclusive of multiracial participants). Among participants who may have benefitted from PrEP, 92% (n = 1495) had ever heard of PrEP, 36% (n = 591) had ever used PrEP, 27% (n = 441) had recently used PrEP (past 6 months) and 20% (n = 330) were adherent. The largest proportional difference in HIVPC step was from awareness to uptake (60% of PrEP-aware participants had never used PrEP). This difference was significantly greater for LAI PrEP (96% of LAI PrEP-aware participants had never used LAI). Correlates of PrEP uptake included high perceived HIV acquisition risk (aPR = 2.08, 95% CI = 1.59-2.72; ref = no perceived risk), current use of exogenous oestrogen and/or anti-androgens (aPR = 1.47 95% CI = 1.21-1.79), and receipt of health services at an LGBTQ+ clinic (aPR = 1.34, 95% CI = 1.16-1.55). Correlates of non-adherence among PrEP users included being a non-U.S. citizen (aPR: 2.41, 95% CI = 1.44-4.05) and recent food insecurity (aPR: 1.47, 95% CI = 1.04-2.06). CONCLUSIONS: Interventions to improve HIVPC outcomes-especially PrEP uptake-are needed to optimize HIV PrEP among trans women. PrEP interventions may need to include individually tailored, integrated programming to address risk perception, nutrition, gender-affirming care and comprehensive health, social, and legal needs.
Comparable real-world effectiveness between switches to cabotegravir + rilpivirine long-acting or modern daily oral regimens in the United States: an OPERA cohort study.
Hsu RK, Sension MG, Fusco JS … +8 more , Brunet L, Cochran Q, Levis B, Sridhar G, Vannappagari V, Wyk JV, Wohlfeiler MB, Fusco GP
J Int AIDS Soc · 2025 Dec · PMID 41405193 · Full text
INTRODUCTION: Cabotegravir + rilpivirine long-acting (CAB+RPV LA) injectable was approved in the United States in 2021 for HIV-1 treatment in virologically suppressed (viral load [VL] <50 copies/mI individuals. In clinic...
INTRODUCTION: Cabotegravir + rilpivirine long-acting (CAB+RPV LA) injectable was approved in the United States in 2021 for HIV-1 treatment in virologically suppressed (viral load [VL] <50 copies/mI individuals. In clinical trials, CAB+RPV LA was non-inferior to oral antiretroviral therapy (ART) regimens in virologically suppressed individuals. We compared real-world effectiveness between CAB+RPV LA and oral ART regimens and assessed predictors of confirmed virologic failure (CVF) on CAB+RPV LA. METHODS: From the OPERA cohort, ART-experienced, virologically suppressed adults with HIV switching to CAB+RPV LA or a new oral ART regimen between 21 January 2021 and 31 December 2022 were followed through 30 June 2023. CVF was defined as 2 VL ≥200 copies/ml or 1 VL ≥200 copies/ml + discontinuation. Logistic regression was used to assess CVF risk by regimen and CVF predictors among CAB+RPV LA users. RESULTS: During the study period, 1362 virologically suppressed adults switched to CAB+RPV LA, and 2783 switched to a new oral ART regimen (92% second-generation integrase inhibitor [INSTI]-based). Compared to oral ART users, CAB+RPV LA users were younger, on their prior regimen less time and more likely to switch from an INSTI; median CD4 counts at initiation were similar. At study end, 81% of CAB+RPV LA users and 80% of oral ART users were on their respective regimens. CVF risk with CAB+RPV LA did not statistically differ compared to oral ART (adjusted odds ratio: 0.64; 95% confidence interval [CI]: 0.34, 1.14). Among CAB+RPV LA users, only baseline CD4 predicted CVF; every 100 CD4 cells/µl increase was associated with 20% lower CVF risk (OR [95% CI]: 0.80 [0.64, 0.97]). CONCLUSIONS: In the United States, routine clinical care, CVF risk did not differ between a switch to CAB+RPV LA or new oral ART, with most individuals remaining on their regimens at study end. Lower CD4 count at initiation was the only predictor of CVF on CAB+RPV LA.
This is not normal: a call for HIV activism.
Daskalakis DC
J Int AIDS Soc · 2025 Dec · PMID 41311151 · Full text
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From Kigali to Rio: advancing an evidence-based and equitable HIV response.
Grinsztejn B, Ochanda RM, Allinder SM … +4 more , Janamnuaysook R, Grulich A, Ngure K, Road to Rio Advisory Group
J Int AIDS Soc · 2025 Dec · PMID 41311142 · Full text
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What is not measured cannot be improved: the urgency to understand causes of HIV-related deaths in Latin America.
Lopez-Villalba B, Alonso-Gonzalez M, Nuche-Berenguer B … +2 more , Castrodeza-Sanz JJ, Sued O
J Int AIDS Soc · 2025 Dec · PMID 41310940 · Full text
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Examining the effect of universal testing and treatment strategies for HIV prevention in Zambia and South Africa: generalizing the results of the HPTN 071 (PopART) trial.
Shook-Sa BE, Zivich PN, Cole SR … +10 more , Rosenberg NE, Hudgens MG, Donnell DJ, Moyo S, Zuma K, Ayles H, Bock P, Eron JJ, Hayes RJ, Edwards JK
J Int AIDS Soc · 2025 Dec · PMID 41298252 · Full text
INTRODUCTION: HIV Prevention Trials Network (HPTN) 071 (PopART) was a cluster-randomized trial to evaluate universal testing and treatment (UTT) strategies for HIV prevention. HPTN071 compared three arms: (A) combination...
INTRODUCTION: HIV Prevention Trials Network (HPTN) 071 (PopART) was a cluster-randomized trial to evaluate universal testing and treatment (UTT) strategies for HIV prevention. HPTN071 compared three arms: (A) combination prevention with UTT; (B) combination prevention with universal testing and antiretroviral therapy initiation according to local guidelines; and (C) standard of care (SOC). Interventions were implemented in entire randomized communities, with impacts on HIV incidence measured in "population cohorts," that is the HPTN071 sample. Unexpectedly, a significantly lower incidence was not observed in arm A relative to SOC. Importantly, rates of participation in the HPTN071 sample differed among population subgroups, for example men were underrepresented. METHODS: To correct for underrepresented subgroups, PopART intervention effects are estimated in a population of interest, adults aged 18-44 in trial provinces, characterized with two nationally representative HIV-focused surveys. The HPTN071 sample is weighted to match the population of interest by demographics and HIV risk factors. Risk of HIV acquisition is compared across arms, both in the trial population (unweighted) and the population of interest (weighted). Both (1) the risk of HIV acquisition between 1 and 3 years and (2) the risk of HIV acquisition by 3 years are compared. RESULTS: In the trial population, estimated risk in arm A is, counterintuitively, slightly higher than SOC (Year 1-3 Risk Difference [RD]: 0.10%; 95% CI: -1.15%, 1.25%). After weighting, risk in arm A is lower than SOC in the population of interest (RD: -0.34%; 95% CI: -2.04%, 0.96%). Weighting also strengthened the estimated effect in arm B relative to SOC (unweighted RD: -0.66%, 95% CI: -1.88%, 0.46%; weighted RD: -1.18%, 95% CI: -2.85%, 0.15%). Weighted year 3 risk difference estimates indicated even stronger possible intervention effects: A versus SOC -0.83% (95% CI: -2.94%, 0.99%), B versus SOC -1.86% (95% CI: -3.80%, -0.09%). CONCLUSIONS: PopART interventions are estimated to be more protective in the population of interest than observed in the HPTN071 sample. These results partially explain the unexpected finding in arm A, providing further support for UTT strategies for HIV prevention. This analysis also highlights the importance of considering heterogeneous treatment effects among population subgroups when measuring the overall efficacy of HIV interventions.
Early experiences with usage of long-acting injectable cabotegravir among adults in rural Ugandan and Kenyan communities: qualitative research from the SEARCH "Dynamic Choice HIV Prevention" intervention trials.
Camlin CS, Onyango A, Johnson-Peretz J … +17 more , Akatukwasa C, Arunga TO, Owino L, Atwine F, Byamukama A, Mutabazi A, Balzer LB, Czarnogorski M, Kakande E, Sunday H, Chamie G, Ayieko J, Petersen M, Sutter N, Kamya MR, Havlir DV, Kabami J
J Int AIDS Soc · 2025 Nov · PMID 41287362 · Full text
INTRODUCTION: Despite oral HIV pre-exposure prophylaxis (PrEP) effectiveness, uptake and adherence remains a challenge. Newer HIV prevention technologies, including long-acting injectable cabotegravir (CAB-LA), are promi...
INTRODUCTION: Despite oral HIV pre-exposure prophylaxis (PrEP) effectiveness, uptake and adherence remains a challenge. Newer HIV prevention technologies, including long-acting injectable cabotegravir (CAB-LA), are promising for addressing known barriers to oral PrEP uptake and adherence, yet research remains limited on experiences with CAB-LA among at-risk adults in community settings. This descriptive qualitative study explored experiences with CAB-LA among adults participating in the SEARCH Dynamic Choice HIV Prevention (DCP) trial in rural Kenya and Uganda, which evaluated HIV prevention uptake through a structured, person-centred DCP model. METHODS: We conducted in-depth semi-structured interviews in July-October 2023 with a purposively selected sample of 47 DCP trial participants who initiated CAB-LA and had at least two injections. Interviews explored participants' reasons for choosing CAB-LA and their experiences with the method. We also included 10 participants who subsequently discontinued CAB-LA or switched to another method. Data were analysed using inductive coding, memoing and framework analysis. RESULTS: The 47 participants ranged from 20 to 59 years of age; 13 were men and 34 were women. Participants were enthusiastic about CAB-LA. They perceived it as novel, efficacious and advantageous relative to oral daily PrEP, which had been hindered by stigma, interruptions due to work, family visits and travel, side effects, and pill attributes (size and smell). Two major advantages of CAB-LA over PrEP were improved protection from HIV stigma and from HIV acquisition due to easier adherence. Participants felt CAB-LA was clearly distinguishable from antiretroviral therapy and would not mark them (mistakenly) as living with HIV; among women, clandestine use to guard against stigma from family members was more achievable compared to oral PrEP. Appointments for injections were rare enough (monthly, then bimonthly) that they could be kept, especially with reminders from providers, although for some, unpredictable work and travel schedules hindered their uptake of CAB-LA. Participants cited injection-site pain as the main drawback. CONCLUSIONS: CAB-LA overcame several known barriers to HIV prevention uptake and adherence for women and men. In contexts of continued HIV-related stigma, CAB-LA met some participants' preferences for a product that permitted prevention to be visibly distinguishable from treatment, enabling HIV prevention uptake to feel safer. Moreover, adherence was more easily achieved with CAB-LA compared to PrEP, boosting confidence in prevention efficacy.
Evolving landscape of economic evaluations of HIV pre-exposure prophylaxis and pre-exposure prophylaxis implementation strategies: a systematic review.
Xi M, Tan DHS, Baral SD … +6 more , Kugathasan H, Masucci L, Skidmore B, MacFadden DR, Thavorn K, Mishra S
J Int AIDS Soc · 2025 Nov · PMID 41275419 · Full text
INTRODUCTION: Economic evaluations of HIV pre-exposure prophylaxis (PrEP) and associated implementation strategies guide evidence-based policies, programmes and resource allocation. Since 2015, there has been an evolutio...
INTRODUCTION: Economic evaluations of HIV pre-exposure prophylaxis (PrEP) and associated implementation strategies guide evidence-based policies, programmes and resource allocation. Since 2015, there has been an evolution in PrEP modalities, implementation strategies and prioritization of key populations with unmet HIV prevention needs, alongside the scale-up of other HIV prevention interventions. Our systematic review describes the evolving landscape of economic evaluations of PrEP to help identify evidence gaps relevant to the current HIV epidemic and response (PROSPERO: CRD42016038440). METHODS: We searched five databases, without language restrictions, for peer-reviewed economic evaluations from inception to 21 August 2025. We describe the evolution of study characteristics over time, including the perspective of analysis, region, population, PrEP modality/implementation strategy and comparators. RESULTS: Of 5400 studies identified, 128 met inclusion criteria, of which 94 examined HIV epidemics in 2015 or later and 17 adopted a societal perspective. HIV epidemics studied primarily spanned countries in sub-Saharan Africa (N = 51) and in North America (N = 34). Modelled populations for receipt of PrEP primarily comprised: gay, bisexual and other men who have sex with men (N = 73), female sex workers (N = 26), serodifferent partnerships (N = 17) and persons who inject drugs (N = 12). Most evaluated oral, daily PrEP (N = 76), followed by long-acting injectable PrEP (N = 17), on-demand PrEP (N = 16) and others (e.g. vaginal ring, topical gel; N = 7). Twelve studies compared different PrEP modalities with each other. Five studies evaluated different implementation strategies to increase PrEP uptake, adherence and persistence. Of the 123 studies that compared PrEP to a combination of other HIV prevention interventions, only 31 scaled up at least part of the comparator over time. DISCUSSION: To support decision-making, future economic evaluations should consider costs and benefits beyond the health system (society) and consider comparators that better reflect the current HIV response across regions and populations. The increasing availability of novel PrEP modalities allows future studies to evaluate a mix of PrEP modalities and person-centred implementation strategies. CONCLUSIONS: The growing number of PrEP economic evaluations have not kept pace with emerging PrEP modalities or the current HIV epidemic/response, resulting in challenges in making evidence-based policies, programmes and resource allocation.
The time is now to use the tools we have to end AIDS in children.
Vojnov L, Shapiro RL, Mulenga LB … +7 more , Kikitiinwa AR, Vrazo AC, Ekouévi PF, Dindi NP, Tiam A, Persaud D, Mofenson L
J Int AIDS Soc · 2025 Nov · PMID 41236077 · Full text
INTRODUCTION: Progress in reducing and eliminating vertical transmission of HIV in children has stagnated over recent years. Unfortunately, recent decisions in the global donor space are likely to lead to considerably lo...
INTRODUCTION: Progress in reducing and eliminating vertical transmission of HIV in children has stagnated over recent years. Unfortunately, recent decisions in the global donor space are likely to lead to considerably lower funding available for HIV and other disease programmes in high-burden low- and middle-income settings. Understanding and implementing the most effective strategies to prevent, diagnose, treat and monitor HIV acquisition in children are critical to maximize available resources and provide the best care for children. DISCUSSION: A set of tools to support the elimination of vertical transmission and end AIDS in children exists across the cascade of care for pregnant mothers and their children, including those for prevention, diagnosis, treatment, monitoring and service delivery. Each tool comes with its own challenges in implementation and scale-up; however, the effectiveness of many has been well-studied and documented. Ensuring all women living with HIV have consistent and secure access to optimized antiretroviral therapy will prevent the largest number of leaks in the cascade that can lead to vertical transmission events. Implementing effective infant diagnosis strategies, including same-day point-of-care testing and birth testing where feasible, will lead to earlier and faster identification of children living with HIV. Subsequently, rapid linkage to optimized treatment will save and improve the lives of children living with HIV. Finally, implementing accompanying monitoring modalities and country-specific service delivery approaches will improve implementation and the effectiveness of these tools as well as retention and commitment in care programmes by children as they become adolescents and adults. CONCLUSIONS: Ending AIDS in children is possible. We have the tools to do so. However, now is the time for national, regional and global stakeholders to come together to prioritize children and ensure appropriate funding, implementation and equitable access are in place. Testing infants quickly and accurately for HIV is the first step to ensuring their lifelong health and wellbeing. As national and global public health structures shift, programmes need to act quickly-gains in paediatric HIV cannot be lost but must be accelerated. Doing so will require political will, financing, infrastructure, community-led initiatives, and commitment by and access to all to achieve those goals.
A cluster-randomized controlled trial of a combination HIV risk reduction and economic empowerment intervention for women engaged in sex work in Uganda.
Witte SS, Ssewamala FM, Kiyingi J … +8 more , Bellamy SL, Yang LS, Nabunya P, Bahar OS, Mayo-Wilson LJ, Tozan Y, Mwebembezi A, Kagaayi J
J Int AIDS Soc · 2025 Nov · PMID 41211615 · Full text
INTRODUCTION: Women engaged in sex work (WESW) in Uganda face a high risk of HIV and other sexually transmitted infections (STIs), driven by the intersection of gender inequality, poverty and structural barriers. This pa...
INTRODUCTION: Women engaged in sex work (WESW) in Uganda face a high risk of HIV and other sexually transmitted infections (STIs), driven by the intersection of gender inequality, poverty and structural barriers. This paper reports on the Kyaterekera Project, a cluster-randomized controlled trial (c-RCT) testing the efficacy of a combined HIV risk reduction (HIVRR) and economic empowerment intervention to reduce biologically confirmed STIs and HIV risk behaviours. METHODS: The study recruited 542 WESW from 19 HIV hotspots across four districts in Uganda between June 2019 and March 2020. Participants were randomized into three groups: (1) HIVRR intervention alone; (2) HIVRR combined with financial literacy training and an unconditional matched savings account; or (3) HIVRR combined with financial literacy training and an unconditional matched savings account and vocational training. Although initially implemented as a three-arm c-RCT, the COVID-19 lockdown prevented the implementation of the vocational training component. Therefore, the two treatment groups were combined, and the trial was re-approved as a two-arm c-RCT. Biological assessments were conducted at baseline, 18 and 24 months. Behavioural assessments were conducted at baseline, 6, 12, 18 and 24 months from April 2019 to December 2023. Primary outcomes included incident HIV acquisitions (seroconversions among baseline HIV-negative participants), point prevalence of STIs at each visit, and the number/proportion of unprotected sexual acts with paying and regular partners. This study utilized community-based participatory research methods, engaging a community advisory board to ensure the study's alignment with local needs. RESULTS: Across follow-up, condomless sex with paying partners decreased and income shifted towards non-sex work in both arms; no between-group differences were detected. Eighteen incident HIV acquisitions occurred (14 by 18 months; 4 additional by 24 months) with no between-group differences. STI prevalence was lower at 18 months compared to baseline, but not sustained at 24 months. CONCLUSIONS: In an environment of high baseline HIV prevalence, substantial pre-exposure prophylaxis uptake and COVID-19 disruptions, the added financial literacy/savings components did not yield measurable incremental benefits over HIVRR alone. Integrating an unconditional matched-savings model within an HIVRR platform was feasible. CLINICAL TRIAL NUMBER: NCT03583541.
Evaluation of pharmacokinetic interactions between long-acting cabotegravir or emtricitabine/tenofovir disoproxil fumarate and hormonal contraceptive agents: a tertiary analysis of South African participants in HPTN 084.
Marzinke MA, Hanscom B, Haines D … +19 more , Scarsi KK, Agyei Y, Piwowar-Manning E, Hendrix CW, Gollings R, Rose S, Mathew C, Panchia R, Spooner E, Singh N, Bock P, Rinehart AR, Ford SL, Rooney JF, Soto-Torres L, Cohen MS, Hosseinipour MC, Delany-Moretlwe S, HPTN 084 Study Team
J Int AIDS Soc · 2025 Nov · PMID 41169120 · Full text
INTRODUCTION: HPTN 084 found that long-acting cabotegravir (CAB-LA) was well-tolerated and significantly reduced the risk of HIV acquisition in women compared to tenofovir disoproxil fumarate/emtricitabine (F/TDF). Durin...
INTRODUCTION: HPTN 084 found that long-acting cabotegravir (CAB-LA) was well-tolerated and significantly reduced the risk of HIV acquisition in women compared to tenofovir disoproxil fumarate/emtricitabine (F/TDF). During the blinded phase of the trial, participants were required to use an effective method of contraception, including an injectable or implantable hormonal contraceptive (HC) agent. A contraceptive sub-study assessed the pharmacokinetic interactions between pre-exposure prophylaxis agents (CAB-LA or F/TDF) and etonogestrel (ENG), medroxyprogesterone acetate (MPA) or norethindrone enanthate (NET-EN). METHODS: Participants were enrolled in a nested sub-study between 24 February 2020 and 26 October 2020. Via a convenience sampling strategy, plasma concentrations of ENG, MPA and NET-EN were evaluated at enrolment and weeks 25, 49 and 73; plasma tenofovir (TFV) and CAB concentrations were determined at contemporaneous visits. Participants were allowed to switch contraceptives, and HC assessments were adjusted accordingly. Geometric mean concentrations were calculated and compared using t-tests or Fisher's exact tests. RESULTS: One hundred and seventy participants were included in this analysis. Hormone concentrations at all study visits were comparable between the CAB-LA and F/TDF study arms. Among participants randomized to the CAB-LA arm, geometric mean concentrations declined from enrolment to the follow-up period for ENG (335 to 202 pg/ml), MPA (1520 to 1138 pg/ml) and NET-EN (3715 to 1888 pg/ml); similar findings were observed among participants randomized to the F/TDF arm. Observed HC declines are likely attributed to the timing of contraceptive administration relative to sampling; the percentage of participants with hormone concentrations above thresholds associated with ovulation suppression was high (73-100%) and did not differ between arms. CAB concentrations were comparable across contraceptive types, with 97.8-98.1% of participants yielding trough CAB concentrations above the protocol-specified target threshold. TFV concentrations were unquantifiable for most participants, irrespective of contraceptive agent, rendering comparisons largely uninformative. CONCLUSIONS: Given the comparable hormone concentrations between arms and the likely influence of the timing of sample collection on observed measurements, clinically significant interactions between CAB-LA and HC are not expected. Associations between F/TDF and hormone concentrations could not be effectively evaluated due to low adherence to F/TDF. CLINICAL TRIAL REGISTRATION: NCT0316456.
HIV incidence and prevalence among adults in Mozambique: estimates from the Population-based HIV Impact Assessment Survey (INSIDA 2021) and district-level modelling.
Gudo ES, McCabe KC, Fazito E … +8 more , Catano D, Tiberi O, Boothe M, McOwen J, Imai-Eaton JW, Stevens O, Manembe L, El-Sadr WM
J Int AIDS Soc · 2025 Nov · PMID 41152562 · Full text
INTRODUCTION: Accurate information is needed to prioritize programmes and resources that address gaps in the HIV response. We examined findings from the 2021 Mozambique Population-based HIV Impact Assessment (INSIDA) sur...
INTRODUCTION: Accurate information is needed to prioritize programmes and resources that address gaps in the HIV response. We examined findings from the 2021 Mozambique Population-based HIV Impact Assessment (INSIDA) survey, complemented with subnational model-based estimates of the number of new infections and district-level incidence to gauge progress in the HIV response and guide future priorities. METHODS: INSIDA 2021, a nationally representative cross-sectional household survey, measured national HIV incidence, national and provincial HIV prevalence, and factors associated with HIV. Consenting adults aged 15 years and older were interviewed and tested for HIV using the national diagnostic algorithm, followed by laboratory-based confirmation of HIV status. Testing for viral load, limiting antigen avidity and the presence of antiretrovirals were used to estimate HIV incidence. The Naomi model, a Bayesian small-area estimation model combining the INSIDA 2021 survey and routine HIV service delivery data, estimated provincial and district-level HIV incidence and district-level prevalence. Weighted HIV prevalence estimates, stratified by sex, are reported and factors associated with HIV infection modelled via multivariate logistic regression. RESULTS: National HIV prevalence was 12.5% (95% CI: 11.5-13.4) among adults 15 years and older, and national HIV incidence was 4.3 (95% CI: 2.3-6.3) per 1000 HIV-negative adults in 2021. Per model estimates, there were 84,000 (95% CI: 80,000-89,000) new infections per year, 55,000 among women (95% CI: 52,000-58,000) and 30,000 (95% CI: 28,000-31,000) among men. In 2023, an estimated 2.2 million (95% CI: 2,200,000-2,300,000) adults (15+ years) with HIV were living in Mozambique. District-level estimates highlighted areas of higher adult HIV prevalence and incidence in urban areas of key cities and ports, in the south, and along coastal districts in central Mozambique. Compared to men the same age, the distribution of HIV infections remains concentrated among women, particularly young women. CONCLUSIONS: Mozambique continues to face a high burden HIV epidemic, with high HIV incidence associated with spatial heterogeneity. Prevention of new infections through women and young women-centred prevention programmes, treatment for men, and focusing interventions in urban areas, port cities, and coastal areas in central and southern Mozambique could contribute to reducing the HIV burden in Mozambique.
Cognitive and mental health significantly contribute to disability in people ageing with HIV in Asia: an observational case-control study.
Lui G, Chen Y, Hung CC … +10 more , Wong PL, Wong CS, Leung J, Xu X, Cheung C, Li G, Wong V, Shan Lee S, Kwok T, Rajasuriar R
J Int AIDS Soc · 2025 Nov · PMID 41152202 · Full text
INTRODUCTION: Disability disproportionally impacts people living with HIV (PLWH). The burden and determinants of disability among PLWH in Asia have not been well studied. METHODS: We conducted a multi-country observation...
INTRODUCTION: Disability disproportionally impacts people living with HIV (PLWH). The burden and determinants of disability among PLWH in Asia have not been well studied. METHODS: We conducted a multi-country observational cross-sectional study in five cities in Asia involving PLWH and age- and sex-matched controls living without HIV from March 2020 to November 2023. We compared the prevalence of disability (measured by World Health Organization Disability Assessment Schedule 2.0, WHODAS 2.0) between PLWH and controls, and determined the association between living with HIV and disability using multivariable logistic regression and mediation analysis. RESULTS: A total of 1004 PLWH and 416 age- and sex-matched controls were enrolled. PLWH (mean age 53.6 ± 10.3 years, 84.4% male, 72.2% ≥1 comorbidities) had a higher Charlson Comorbidity Index, more depression, anxiety, stress, social isolation and loneliness, and poorer cognitive performance. The prevalence of disability was 50.9% among PLWH and 40.6% among controls (p<0.001). PLWH had significantly higher WHODAS 2.0 complex score, and significantly more PLWH had impairments in all of the six domains of disability. The presence of disability correlated with living with HIV after adjusting for demographic characteristics, physical health parameters and cognition, but not after adjusting for socio-behavioural variables and mental health parameters. Mediation analysis showed that living with HIV had a significant indirect effect on disability mediated by social isolation, mental health disorders and poor cognitive performance. CONCLUSIONS: PLWH in Asia had a higher burden of disability as compared with matched controls. The effect of living with HIV on disability was mediated by social isolation, mental health disorders and impaired cognition. Future work should be directed to developing interventions that mitigate these conditions with the goal of reducing disability among PLWH.
High rates of viral suppression in pregnancy drop postpartum in South African women on tenofovir-lamivudine-dolutegravir: a prospective cohort study.
Abrams EJ, Jao J, Mukonda E … +5 more , Madlala HP, Matyseni S, Zerbe A, Legbedze J, Myer L
J Int AIDS Soc · 2025 Oct · PMID 41131701 · Full text
INTRODUCTION: Achieving and maintaining viral suppression (VS) during pregnancy and breastfeeding is central to preventing vertical transmission and optimizing maternal health. High rates of VS have been demonstrated amo...
INTRODUCTION: Achieving and maintaining viral suppression (VS) during pregnancy and breastfeeding is central to preventing vertical transmission and optimizing maternal health. High rates of VS have been demonstrated among adult and paediatric populations receiving tenofovir-lamivudine-dolutegravir (TLD), but VS and viraemia among pregnant and postpartum women with HIV (WHIV) in high-burden settings have not been well-documented. METHODS: Between September 2021 and December 2023, pregnant WHIV, ≤18 weeks gestation, were enrolled in antenatal care (ANC) and followed postpartum in Cape Town, South Africa. WHIV received HIV care in routine health services and continued, switched to or initiated TLD at ANC entry. VS was defined as viral load (VL) <50 copies/ml; viraemic episodes (VEs) were categorized as major (>1000 copies/ml) or minor (50-1000 copies/ml). Mixed-effects Poisson regression models were fit to assess factors associated with major VE risk. RESULTS: Among 763 WHIV with ≥1 VL, median age was 30 years (interquartile range [IQR] 25-34) and median gestation was 14 weeks at enrolment (IQR 11-17); 89% were on antiretroviral therapy, including 74% on TLD. Overall 99% achieved ≥1 VL<50 copies/ml: 73% sustained VS through 48 weeks postpartum, with 16% having ≥1 minor VE and 15% ≥1 major VE. At enrolment, 77% of VL measures were <50 copies/ml, increasing to >90% during pregnancy through 12 weeks postpartum and declining to 81% by 24 weeks postpartum. In multivariable analysis, each additional year of age conferred a 6% (95% confidence interval [CI] 0.89, 0.98, p = 0.006) lower risk of subsequent major VE after achieving VS. WHIV with viraemia (50-1000 copies/ml) at enrolment were 3.6 (95% CI 1.94, 6.70, p<0.001) times more likely to have a subsequent major VE, whereas CD4+>500 cells/mm lowered major VE risk by 53% (95% CI 0.32, 0.89, p = 0.016). CONCLUSIONS: High rates of VS were maintained during pregnancy and early postpartum, but substantial viraemia emerged by 24 weeks postpartum, jeopardizing maternal and child health outcomes. These unique data provide further impetus to explore innovative approaches to supporting adherence among WHIV during the postpartum period.
Retention in a low-resource, high-burden South African cohort on antiretroviral therapy: Retrospective, longitudinal analysis comparing six measures of retention.
Keene CM, Euvrard J, Phillips TK … +3 more , English M, McKnight J, Orrell C
J Int AIDS Soc · 2025 Oct · PMID 41085485 · Full text
INTRODUCTION: Retention on antiretroviral therapy (ART) is a prerequisite for adherence and subsequent treatment success. Measuring retention is also easily implementable at facility and population levels, making it prag...
INTRODUCTION: Retention on antiretroviral therapy (ART) is a prerequisite for adherence and subsequent treatment success. Measuring retention is also easily implementable at facility and population levels, making it pragmatic to monitor ART programme success. However, despite its ubiquitous global use, there is little consistency in the measurement of retention. METHODS: This study retrospectively applied six measures of retention to one cohort of adults (initiating ART after 01-09-2016, with ≥1 year of observation time to database closure on 30-09-2022), in a low-resource, high HIV-burden setting in South Africa. Using routine healthcare data from the Western Cape's Provincial Health Data Centre, loss to follow-up (LTFU), fixed-point retention, visit constancy, visit gaps, treatment interruptions and medication possession ratio (MPR) were described over 5 years from initiation. Individuals were considered "continuously retained" if they did not experience attrition throughout their observed follow-up. Measures were compared using the proportion misassigned and Cohen's Kappa statistic. RESULTS: The median age of the cohort (n = 68,888) was 31 years (interquartile range [IQR] 26-38) at initiation, with 69% (47,631/68,888) female, and a median observed follow-up of 4 years (IQR 3-5). Across different measures, retention was low, and declined over time. There was variable overlap; the proportion continuously retained throughout their observed follow-up ranged from 60% (41,268/68,888 not LTFU) to 32% (22,381/68,888 MPR ≥80%). Retention by all measures was strongly associated with viral suppression. CONCLUSIONS: By all measures, large proportions of people in this setting were considered out of ART care during 5 years of observed follow-up time from initiation. This makes retention a critical target for intervention to improve population-level viral suppression and achieve epidemic control. Measuring longitudinal retention revealed that most people disengaged from ART care at some point after initiation. Certain measures of retention (e.g. treatment interruptions) identified people in and out of care with more granularity, whereas blunter measures (e.g. LTFU) misassigned individuals' retention status and missed patterns of retention over time as people cycled in and out of care between points of measurement. Ultimately, the choice of measure depends on the purpose of the evaluation and on the data available, but, where possible, more granular measures are recommended.
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