Journal Of The International AIDS Society[JOURNAL]
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200 papers
Incidence and outcomes of anal and cervical cancer among adults with HIV in Latin America: a retrospective cohort study.
Pellegrino RA, Tu S, Ville-Benavides R … +12 more , Jalil EM, Sudenga SL, Crabtree-Ramírez B, Cortes CP, Varela D, Hilaire G, Riviere C, Gotuzzo E, Shepherd BE, Fink V, Castilho JL, Caribbean, Central and South America network for HIV Epidemiology
J Int AIDS Soc · 2025 Oct · PMID 41074705 · Full text
INTRODUCTION: Human papillomavirus (HPV)-associated cervical and anal cancers disproportionately affect people with HIV (PWH). This study aimed to determine the incidence trends of and risk factors for these malignancies...
INTRODUCTION: Human papillomavirus (HPV)-associated cervical and anal cancers disproportionately affect people with HIV (PWH). This study aimed to determine the incidence trends of and risk factors for these malignancies in PWH in Latin America. METHODS: We included PWH from the Caribbean, Central and South America network for HIV epidemiology (CCASAnet) who contributed person-time between 2000 and 2019. We calculated crude and age-standardized incidence rates, examining trends over time with Poisson regression. Adjusted hazard ratios were calculated using Cox proportional hazard models with propensity score adjustment. We calculated the probability of survival after cancer diagnosis using Kaplan-Meier curves. To understand factors that influence our results, we surveyed all adult CCASAnet sites on current practices of cervical and anal cancer screening. RESULTS: Overall, 5739 females with HIV (43,417 person-years) were included in cervical cancer analyses. There were 27 incident cervical cancers: crude incidence rate of 62.2 (95% confidence interval [CI]: 34.9-89.4) per 100,000 person years. In the anal cancer analysis, 12,489 males who have sex with men (MSM), 7324 males other than MSM and 5739 females were included for a total of 25,552 PWH, contributing 157,166 person-years. Anal cancer was diagnosed in 56 individuals: crude incidence rates of 59.1 [95% CI: 33.2-85.0], 20.7 [95% CI: 11.6-29.7] and 15.2 [95% CI: 8.6-21.9] per 100,000 person-years in MSM, females and males other than MSM, respectively. Age-standardized incidence rates did not significantly change over time. Anal cancer risk decreased significantly with higher time-updated CD4 cell count. The predicted probability of 5-year survival after cancer diagnosis was 72.6% (95% CI: 48.4-86.8) for cervical cancer and 58.5% (95% CI: 44.0-70.5) for anal cancer. CONCLUSIONS: In one of the few reports outside the United States or Europe, we did not observe a decrease in age-standardized incidence rates for anal and cervical cancer between 2000 and 2019. These data support continued efforts for cancer prevention through access to gender-neutral HPV vaccination and cancer screening.
The efficacy of community-led monitoring: successes, lessons learnt and opportunities for improvement from the Zimbabwean context.
Chinoona M, Matunhu J, Tobaiwa DD … +4 more , Mutungamiri K, Musendo M, Marange T, Chidede T
J Int AIDS Soc · 2025 Oct · PMID 41074704 · Full text
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Harnessing digital health data for person-centred HIV prevention monitoring: a survey of national health information systems.
Dalal S, Mathers B, Stelzle D … +24 more , Nyagah LM, Agbo F, Annang D, Bhavsar SP, Mbiriyawanda S, Mhlanga B, Molapo T, Moro L, Mudiope P, Ngwali L, Nyirenda MS, Sathane I, Adhikary R, Alonso Gonzalez M, Chan P, Gerritsen A, Izumi K, Kuchukhidze G, Mozalevskis A, Perrin G, Alaama AS, Tebogo M, Verster A, Low-Beer D
J Int AIDS Soc · 2025 Sep · PMID 41059651 · Full text
INTRODUCTION: Measuring HIV prevention impact is challenging because prevention is started and stopped as needed, and individual-level data availability has been suboptimal or not collected. WHO's 2022 Consolidated guide...
INTRODUCTION: Measuring HIV prevention impact is challenging because prevention is started and stopped as needed, and individual-level data availability has been suboptimal or not collected. WHO's 2022 Consolidated guidelines on person-centred HIV strategic information aim to bridge this gap by recommending a minimum dataset for HIV prevention monitoring. METHODS: We surveyed the availability of 42 HIV prevention data elements collected on an individual from WHO's recommended minimum dataset in 21 countries' national health information systems during a Prevention Outcome Monitoring Workshop held in September 2024 in Gaborone, Botswana. Over 150 participants representing ministries of health and programme implementers from 21 countries in Africa and Asia, as well as representatives from global organizations, attended. National HIV prevention managers completed the survey covering: registration (client demographics, use of unique identification, key population status), HIV testing, HIV prevention and vertical transmission. Data element availability determined which prevention indicators each country could calculate. Additionally, we describe global data on the use of unique identification for key populations. RESULTS: Of the 21 attending countries, 18 completed the survey. Fifteen countries (83%) used unique identification in their national health information systems. All 18 countries collected HIV testing data elements, while 14-18 countries (78-100%) collected those for vertical transmission. However, prevention data availability varied widely. Different data elements on pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) were collected by 13-17 (72-94%) countries, condoms by 15 (83%) and voluntary medical male circumcision by 11 (61%) countries. Data elements on harm reduction were available in 4-6 countries among 8-10 countries providing services. While all countries could calculate HIV testing indicators, around 90% could for vertical transmission, 50-94% for PrEP/PEP and 40-75% for harm reduction. Only two countries could calculate linkage to prevention, which incorporates all prevention interventions. Kenya was the only country that collected all recommended person-centred data elements. Overall, up to 37 of 105 reporting countries had a nationally harmonized personal unique identification method for key populations. CONCLUSIONS: Data building blocks for HIV prevention exist in most national health information systems. Aligning these systems with global standards offers potential to further strengthen person-centred HIV prevention monitoring.
Sustaining HIV prevention success in Australia through person-centred approaches.
Bavinton BR, Gray J, Grulich AE
J Int AIDS Soc · 2025 Sep · PMID 41059645 · Full text
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Person-centred HIV care and prevention for youth in rural South Africa: preliminary implementation findings from Thetha Nami ngithethe nawe stepped-wedge trial of peer-navigator mobilization into mobile sexual health services.
Busang J, Ngoma N, Zuma T … +15 more , Herbst C, Okesola N, Chimbindi N, Dreyer J, Smit T, Bird K, Mtolo L, Behuhuma O, Hanekom W, Herbst K, Lebina L, Seeley J, Copas A, Baisley K, Shahmanesh M
J Int AIDS Soc · 2025 Sep · PMID 41059644 · Full text
INTRODUCTION: Despite the efficacy of antiretroviral therapy (ART)-based prevention, population-level impact remains limited because those at high risk of HIV acquisition are not reached by conventional services. We inve...
INTRODUCTION: Despite the efficacy of antiretroviral therapy (ART)-based prevention, population-level impact remains limited because those at high risk of HIV acquisition are not reached by conventional services. We investigated whether youth-centred and tailored HIV prevention, delivered by community-based peer navigators alongside sexual and reproductive health (SRH) services, can mobilize demand for HIV pre-exposure prophylaxis (PrEP) and ART among adolescents and young adults (AYA) in KwaZulu-Natal, South Africa. METHODS: Thetha Nami ngithethe nawe is a cluster-randomized stepped-wedge trial (SWT) in 40 clusters within a rural health and demographic surveillance site. Clusters were randomized to receive the intervention in period 1 (early) or period 2 (delayed). Trained area-based peer navigators conducted needs assessments with youth aged 15-30 years to tailor health promotion, psychosocial support and referrals into nurse-led mobile SRH clinics that also provided HIV testing, and status-neutral ART and oral PrEP. Standard of care was PrEP delivered through primary health clinics. We report SRH service uptake from the 20 intervention clusters during the first period of the SWT (NCT05405582). RESULTS: Between June 2022 and September 2023, peer-navigators reached 9742 (74.9%) of the 13,000 youth in the target population, 46.8% males. Among 9576 individuals with needs assessment, peer-navigators identified 141 (1.5%) with social needs, and 4138 (43.5%) had medium to high health needs. These individuals were referred to mobile clinics, with 2269 (54.8%) attending, including 959 (42.3%) males. HIV testing uptake was high (92.7%; 2103/2269), with 10.1% (212/2103) testing positive for HIV, 62 (29.2%) of whom started ART for the first time. The prevalence of HIV was higher among females compared to males (15.1% vs. 3.3%; p < 0.001). Among clinic attendees, 96.8% were screened for PrEP eligibility, with 38.5% deemed eligible and offered PrEP. Of the 1433 (63.2%) individuals tested for sexually transmitted infections (STIs), 418 (29.2%) tested positive, with females having higher STI prevalence (37.2% vs. 17.9%; p < 0.001). Of these, 385 (92.1%) received STI treatment. Among 1310 females, 769 (58.7%) reported not using any contraception at their initial visit, and 275/769 (35.8%) started contraception during the trial. CONCLUSIONS: Community-based and person-centred approaches delivered through trained peer-navigators can link AYA with SRH and HIV prevention/care needs with mobile SRH services.
Laser hair removal to antiretrovirals: findings from a person-centred care model for transgender people in India.
Shaikh S, Mugundu Ramien P, Bell J … +16 more , Pawar K, McFall AM, Okram S, Enugu A, Ganapathi L, Ballester MS, Arumugam V, Kaptchuk RP, Singh A, Purohit SK, Keuroghlian A, Ard K, Mehta SH, Kaur S, Mayer KH, Solomon SS
J Int AIDS Soc · 2025 Sep · PMID 41059629 · Full text
INTRODUCTION: Transgender women (TGW) in India continue to bear disproportionate HIV burden and face persistent social, legal and structural barriers to receive gender-affirming care. METHODS: Since 2021, we established...
INTRODUCTION: Transgender women (TGW) in India continue to bear disproportionate HIV burden and face persistent social, legal and structural barriers to receive gender-affirming care. METHODS: Since 2021, we established three "Mitr" (meaning: friend) clinics in Hyderabad, Pune and Thane, India, for transgender people with staffing primarily from the community. Mitr clinics provide free HIV testing and pre-exposure prophylaxis (PrEP) on site with linkage to government antiretroviral therapy (ART) centres. They also provide free consultation for gender-affirming hormone therapy (GAHT), subsidized laser hair removal and legal assistance. Client service utilization data were analysed using summary statistics to evaluate uptake of HIV and gender-affirming services; correlates of HIV testing were examined using logistic regression. Semi-structured interviews conducted at one site were used to understand barriers/facilitators of HIV testing. RESULTS: A total of 5223 unique clients registered between March 2021 and September 2024; median age was 26 years. Most (86%) self-identified as TGW, and 35% reported transactional sex. Most clients (70%) had not previously accessed public sector HIV services. The majority (75%) accessed Mitr clinics for gender-affirming care, including laser hair removal (53%), GAHT consultations (34%) and surgical referral (26%). Over half (62%) of clients eligible for HIV testing underwent screening, of whom 6% were newly diagnosed. Accessing Mitr clinics for gender-affirming surgical services was significantly associated with HIV testing receipt (aOR: 1.51; 95% CI: 1.02, 2.25). Services provided by staff from the community were a prominent facilitator for HIV testing, while stigma and disclosure concerns were notable barriers. Among 585 clients interested in and eligible for PrEP, 576 (98%) initiated PrEP, and 378 (66%) were PrEP persistent at 3 months. Of 454 clients with HIV (newly diagnosed or previously known), 392 (86%) initiated ART. As of 30 September 2024, 233 (59%) were still receiving Mitr clinic services and retained in HIV care; viral suppression was 98% among the 156 clients with data. CONCLUSIONS: The Mitr model highlights the importance of aligning programme and community priorities. The provision of gender-affirming care attracted many clients who might not otherwise have accessed HIV services; indeed, laser hair removal served as the key entry point to HIV testing, PrEP and ART.
Empowering at-risk Thai adolescents and young adults: an observational study of "Stand By You" - a person-centred online service model for HIV self-screening, text-based counselling and linkage to care.
Sripanidkulchai K, Rungmaitree S, Durier Y … +9 more , Thiamprasert T, Boon-Yasidhi V, Werarak P, Somphoh Y, Urujchutchairut P, Pongsakul P, Khumcha B, Maleesatharn A, Chokephaibulkit K
J Int AIDS Soc · 2025 Sep · PMID 41059621 · Full text
INTRODUCTION: Adolescents and young adults (AYA) are disproportionately at risk of HIV acquisition. Person-centred online platforms could effectively reach AYA with HIV testing services. We assessed the effectiveness of...
INTRODUCTION: Adolescents and young adults (AYA) are disproportionately at risk of HIV acquisition. Person-centred online platforms could effectively reach AYA with HIV testing services. We assessed the effectiveness of Stand By You, a mobile application, in delivering HIV-related services to at-risk Thai AYAs. METHODS: Deidentified data from clients who accessed Stand By You services between August 2022 and February 2024 were analysed. HIV self-testing (HIVST) services were promoted through TikTok influencers to target AYAs vulnerable to HIV. An automated chatbot provided real-time responses to client inquiries, and trained counsellors provided confidential, text-based counselling daily. Clients who completed risk assessments received personalized recommendations for HIVST based on their risk profile. Clients who submitted their HIVST results received post-test counselling and linkage to care and prophylactic treatment. Multivariable logistic regression was used to assess risk factors for reactive HIVST kit results. The per unit direct cost of the programme's performance metrics were assessed. RESULTS: A total of 8863 clients provided 11,536 risk assessments. The majority were male (76.3%), under the age of 30 (76.0%), identified as members of key populations (60.4%) and first-time testers (56.1%). Additionally, 27.8% had a history of sexually transmitted infections (3,202/11,536), 16.5% reported receiving money or incentives for sex (1908/11,536) and clients indicated an average of 2.6 sexual partners in the past month (SD 3.4). Out of 7585 submitted HIVST results, 3.6% were reactive (n = 274); 60.2% were linked to care (n = 165/274) and 10.4% are in the process of linkage (n = 23/274). Of the 5.3% invalid results reported (n = 401/7585), nearly all were non-reactive by the second HIVST (117/187). A history of testing HIV negative (adjusted odds ratio [aOR] 0.54 [95% CI 0.40-0.72], p < 0.001) and receiving pre-exposure prophylaxis (aOR 0.20 [95% CI 0.06-0.64], p = 0.007) were independently associated with reduced odds of a reactive result. Average direct cost was $18.7, $40.3 and $1100 USD per distributed HIVST kit, first-time tester and new client linked to care, respectively. CONCLUSIONS: AYA populations at risk for HIV can be effectively reached through mobile phone applications that provide services anonymously. Online strategies for HIVST delivery and supportive text-based counselling can generate high demand, engagement and successful linkage to care.
Enhancing PrEP adherence through person-centred mobile app interventions: a real-world data and machine learning approach using UPrEPU among gay, bisexual and other men who have sex with men in Taiwan.
Liao JC, Wu HJ, Chuang TT … +2 more , Chen TW, Strong C
J Int AIDS Soc · 2025 Sep · PMID 41059606 · Full text
INTRODUCTION: Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool that relies on good adherence in high-risk scenarios. To understand the factors that predict adherence, technology such as mobile applicat...
INTRODUCTION: Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool that relies on good adherence in high-risk scenarios. To understand the factors that predict adherence, technology such as mobile applications like UPrEPU-allowing for logging users' daily behaviours at close to the time they have sex or PrEP intake-can be used as a person-centred, self-care intervention. This study aims to develop a machine learning model using logs of sexual activities and user attributes recorded in the UPrEPU mobile application in Taiwan to predict whether a sexual event was protected by oral PrEP among gay, bisexual and other men who have sex with men (GBMSM). METHODS: We used data from the UPrEPU app collected between January 2022 and May 2023 in Taiwan. The dataset included information on users' sex events, such as the timing and users' sex roles (e.g. versatile, receptive or insertive partner), and the dynamic user-based attributes related to sexual behaviours and PrEP use. Various subsets of these features were employed in CatBoost models to predict whether the sex events were associated with correct PrEP use. We evaluated the models' performance using five-fold cross-validation. The influential features were identified through feature importance analysis and Shapley Additive Explanations (SHAP) values to explain the models. RESULTS: A total of 198 users recorded 2356 anal sex events on UPrEPU. The model with dynamic user-based attributes outperformed those without them. The most parsimonious model had a good prediction performance (accuracy = 75%, precision = 78%, recall = 90%, F1-score = 83%) and identified the key features of PrEP protection. The model with five dynamic user-based attributes-age, cumulative PrEP use, condom use and the proportion of anal sex events with HIV-negative partners not on PrEP-significantly outperformed the model based on event-level attributes alone. CONCLUSIONS: Behavioural patterns significantly influence PrEP adherence among GBMSM. Person-centred mobile applications such as UPrEPU provide valuable data for tailored, just-in-time interventions, enhancing adherence. Recognizing these patterns can guide person-centred interventions. Incorporating these insights into clinical care or digital tools may improve consultations and support timely, informed HIV prevention decisions.
"From an HCV and HIV point of view, it's been remarkable": A qualitative study about using prescribed safer supply to support people who use drugs along the HIV and HCV prevention and treatment cascades in Ontario, Canada.
Guta A, Rudzinski K, Gagnon M … +8 more , Schmidt RA, Kolla G, German D, Kryszajtys D, Perri M, Sereda A, Sterling-Murphy C, Strike C
J Int AIDS Soc · 2025 Sep · PMID 41059585 · Full text
INTRODUCTION: Despite advances in HIV and hepatitis C virus (HCV) treatment, people who use drugs (PWUD) face significant barriers along prevention and treatment cascades. Safer supply programmes (SSPs) providing prescri...
INTRODUCTION: Despite advances in HIV and hepatitis C virus (HCV) treatment, people who use drugs (PWUD) face significant barriers along prevention and treatment cascades. Safer supply programmes (SSPs) providing prescribed pharmaceutical alternatives to the unregulated drug supply may create opportunities for enhanced healthcare engagement and person-centred care. METHODS: We conducted a qualitative study examining four SSPs in Ontario, Canada between February and October 2021. Semi-structured interviews were conducted with 52 patients and 21 providers (including physicians, registered nurse practitioners, nurses and allied health professionals). Interviews explored experiences with safer supply and HIV/HCV care. Analysis used thematic techniques guided by the Consolidated Framework for Implementation Research. RESULTS: SSPs supported HIV/HCV care by first addressing patients' substance use needs, which created subsequent opportunities for building trust for broader health engagement. Providers identified the safer supply model as giving PWUD something they wanted, which then opened opportunities to discuss HIV, HCV, and other sexually transmitted and blood-borne infections. SSPs provided opportunities to support patients with HIV and HCV testing and treatment initiation, and safer supply medications were bundled with HIV and HCV medications to support adherence. Non-punitive approaches helped overcome previous negative healthcare experiences by prioritizing patient autonomy. Implementation challenges included balancing flexible, patient-directed care with programme requirements and coordinating comprehensive services around individual needs. CONCLUSIONS: SSPs may improve HIV/HCV care delivery for PWUD by building services around their priorities and lived realities. The integration of safer supply with HIV/HCV care through daily dispensing and wraparound services showed promise for engaging people previously disconnected from care. While findings suggested improved treatment outcomes, limitations included data collection during COVID-19, limited representation of some populations and a focus on opioid-only programmes. Research examining long-term outcomes and programme sustainability is needed as SSPs face growing scrutiny and closure in Canada.
Put rights at the centre of person- and people-centred HIV prevention.
McLemore M, Amon JJ
J Int AIDS Soc · 2025 Sep · PMID 41059582 · Full text
INTRODUCTION: "Person-centred" and "people-centred" HIV prevention programmes both seek to scale up access to HIV prevention services. A "person-centred" approach presents a vision of a client with agency in decision-mak...
INTRODUCTION: "Person-centred" and "people-centred" HIV prevention programmes both seek to scale up access to HIV prevention services. A "person-centred" approach presents a vision of a client with agency in decision-making, engaged and empowered, working with providers in a process that is not disease-centric but focused on addressing, holistically, a client's needs. A "people-centred" approach recognizes the broader role of family and community, as well as the influence of the political and legal environment as barriers or facilitators to HIV services. In both cases, human rights are a critical determinant of positive or negative outcomes. DISCUSSION: In 2017, the Global Fund's Breaking Down Barriers initiative funded baseline assessments in 20 countries examining key human rights barriers to HIV services. Subsequent evaluations in 2019-2021 and 2022-2024 focused on the scale-up of community-led human rights interventions and the impact of these programmes on access to HIV prevention and care. Results from the latest assessment describe a range of strategies and impact across diverse countries, settings and populations. For example, in Indonesia, transgender-led organizations catalysed a national drive to allow transgender persons to receive gender-matched identity cards, allowing thousands of individuals to access HIV prevention and treatment and broader social benefits. In Mozambique, peer-led paralegals and community advocates promoted legal literacy and assisted clients with claims of human rights violations, preventing access to HIV services. In Jamaica, lesbian, gay, bisexual and transgender led organizations sponsored trainings that advanced community activism for HIV prevention, education and advocacy. Despite facing stigma and challenging legal environments, in each case, human rights-based programmes removed structural and legal barriers to HIV prevention services, strengthening accountability and increasing uptake and retention in HIV services, especially among marginalized and criminalized populations. CONCLUSIONS: Community mobilization led by key populations is a long-term undertaking that requires partnership and support from a wide range of stakeholders to ensure sustainability. A growing body of evidence across a range of diverse countries and settings demonstrates the impact of rights-based and people-centred programmes on access to, and retention in, HIV prevention and treatment.
Oral pre-exposure prophylaxis initiation, continuation and adherence among pregnant and postpartum women receiving antenatal and postnatal care: a systematic review.
Rotsaert A, Essack Z, Bosman S … +2 more , Davey DJ, Hensen B
J Int AIDS Soc · 2025 Sep · PMID 41059581 · Full text
INTRODUCTION: In 2023, one-fourth of new HIV acquisitions in children globally resulted from vertical transmission following incident HIV during pregnancy or breastfeeding. Oral pre-exposure prophylaxis (PrEP) with tenof...
INTRODUCTION: In 2023, one-fourth of new HIV acquisitions in children globally resulted from vertical transmission following incident HIV during pregnancy or breastfeeding. Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil and emtricitabine is safe and effective in pregnancy and postpartum, with long-acting options emerging. Integrating PrEP into antenatal and postnatal care (ANC/PNC) is a crucial person-centred approach to prevent maternal HIV acquisition and vertical transmission. This review summarizes oral PrEP initiation, continuation and adherence among pregnant and postpartum women receiving ANC/PNC. METHODS: We systematically searched three databases for English-language quantitative studies published between 1 January 2015 and 28 March 2024. Eligible studies focused on pregnant and/or postpartum women accessing PrEP through ANC/PNC, and reported on initiation (receipt of prescription or self-reported use), continuation (persistent use over time) and/or adherence (self-reported and/or objective). RESULTS: We identified 481 articles; 12 studies from Kenya, Lesotho, Malawi and South Africa met our inclusion criteria. Study heterogeneity (e.g. definitions used, population included, follow-up time) precluded meta-analysis. All studies enrolled pregnant women; three also enrolled postpartum women. Median gestational age at enrolment ranged from 20 to 26 weeks, and follow-up periods from 1 month post-enrolment to 12 months postpartum. Oral PrEP initiation ranged from 14% to 84%. Continuation at 3 months ranged from 22% to 90% and declined postpartum in all studies. Self-reported adherence (daily use) ranged from 11% to 81% in the past 7 or 30 days at 1 month (four studies) and from 54% to 81% at 3 months (two studies). Objectively measured adherence ranged from 34% to 62% for detectable tenofovir or tenofovir diphosphate levels at 1 month (three studies). One Kenyan trial demonstrated that universal versus risk-based offers of oral PrEP resulted in similar PrEP use and HIV incidence. Two-way SMS communication (Kenya) and real-time adherence biofeedback counselling using urine tenofovir testing (South Africa) enhanced PrEP continuation/adherence compared to standard-of-care. DISCUSSION: Integrating oral PrEP into ANC/PNC showed high initiation among pregnant/postpartum women; however, continuation and adherence were suboptimal. CONCLUSIONS: Oral PrEP integration into ANC/PNC can reach pregnant/postpartum women. Maximizing its impact will require offering long-acting PrEP, person-centred interventions to support adherence/continued use and differentiated delivery responsive to women's needs. PROSPERO NUMBER: CRD42024513442.
Person-centred HIV prevention in an era of innovation and uncertainties.
Mujugira A, Azwa I, Lavoie MC
J Int AIDS Soc · 2025 Sep · PMID 41059554 · Full text
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Prevalence and risk factors of hypertension and diabetes among persons living with HIV in Zambia: results of a national facility-based cross-sectional survey.
Mandyata C, Suilanji S, Bosomprah S … +13 more , Somwe P, Zyambo C, Musukuma M, Mweemba A, Chavula MP, Sichilima C, Bwembya P, Siwingwa M, Chibale R, Phiri H, Zulu J, Hikabasa H, Mutale W
J Int AIDS Soc · 2025 Oct · PMID 41055075 · Full text
INTRODUCTION: Despite growing evidence on the rising burden of non-communicable diseases (NCDs) in sub-Saharan Africa, the national prevalence of hypertension, prediabetes and diabetes among persons living with HIV (PLHI...
INTRODUCTION: Despite growing evidence on the rising burden of non-communicable diseases (NCDs) in sub-Saharan Africa, the national prevalence of hypertension, prediabetes and diabetes among persons living with HIV (PLHIV) in Zambia is largely unknown. This study aimed to determine the national prevalence of hypertension and diabetes mellitus and their associated risk factors among adult PLHIV in Zambia. METHODS: We conducted a cross-sectional study in 149 antiretroviral therapy (ART) clinics located in 52 rural and urban districts in Zambia based on the adapted World Health Organization (WHO) STEPwise approach to NCD risk factor Surveillance (STEPS) and the Zambia Population-Based HIV Impact Assessment (ZAMPHIA) questionnaire. We used proportional to size sampling to select districts and clinics, targeting 5775 PLHIV. Data was collected from 1 October 2023 to 30 November 2023. We estimated the prevalence of hypertension and diabetes mellitus and used robust Poisson regression to analyse associations with socio-demographic, behavioural and HIV-related risk factors, and reported prevalence ratios (PR). RESULTS: In the final analysis, we included a total of 5204 participants from 52 districts and 149 ART clinics countrywide: 67.2% were female, and 71.3% were from urban areas. The prevalence of hypertension, prediabetes and diabetes was 22.5% (95% confidence interval [CI]: 21.3-23.6), 26.7% (CI: 25.5-27.9) and 12.5% (CI: 11.6-13.4), respectively. In the multivariable model, being 30-44 (PR = 2.1; CI: 1.5-2.9), 45-49 (PR = 3.3; CI: 2.4-4.7) and 60 years or older (PR = 4.7; CI: 3.3-6.8) compared to those aged 18-29; widowed, divorced or separated individuals compared to those never married; being overweight (PR = 1.4; CI: 1.2-1.5) and obese (PR = 1.9; CI: 1.6-2.1) compared to normal weight PLHIV was associated with hypertension. College or university-educated PLHIV (PR = 2.1; CI: 1.3-3.4), compared to those with no formal education; and those with high total cholesterol ≥6.2 mmol/l (PR = 2.2; CI: 1.4-3.6), versus desirable total cholesterol (<5.2 mmol/l); being overweight (PR = 1.4; CI: 1.1-1.6) and obese (PR = 1.6; CI: 1.3-2.0), compared to those with normal weight, showed a significant association with diabetes mellitus. CONCLUSIONS: The prevalence of hypertension and diabetes mellitus among PLHIV in Zambia was notably high. This underscores the need for immediate and robust intervention strategies to mitigate the high prevalence of hypertension and diabetes mellitus, along with their associated risk factors, particularly within this vulnerable demographic.
Traditional healers can help facilitate HIV serostatus disclosure: results from a qualitative study in rural Uganda.
Gogineni S, Nuwagaba G, Hooda M … +9 more , Natukunda S, Birungi C, Bugeza W, Tushabe M, Nansera D, Muyindike W, Audet CM, Mwanga-Amumpaire J, Sundararajan R
J Int AIDS Soc · 2025 Oct · PMID 40999574 · Full text
INTRODUCTION: In Uganda, HIV-related stigma and discrimination remain major barriers to HIV care engagement and serostatus disclosure. While serostatus disclosure can improve access to, engagement with and retention in H...
INTRODUCTION: In Uganda, HIV-related stigma and discrimination remain major barriers to HIV care engagement and serostatus disclosure. While serostatus disclosure can improve access to, engagement with and retention in HIV care, many people living with HIV (PLWH) hesitate to disclose due to fear of negative consequences. Traditional healers (THs) are trusted community members offering accessible and confidential psychosocial support. This study explores the role of THs in facilitating HIV status disclosure among PLWH disengaged from clinical care in southwestern Uganda. METHODS: This qualitative sub-study was nested within a cluster-randomized trial evaluating the effectiveness of THs supporting PLWH to engage with HIV care in southwestern Uganda. In-depth semi-structured individual interviews were conducted with 22 healers (14 female) and 16 PLWH (10 female) from August 2023 to June 2024. Interviews explored experiences with HIV care and healer-facilitated support to engage with and remain in HIV care. Data was analysed thematically, with particular attention to serostatus disclosure practices. RESULTS: Four key themes emerged: (1) PLWH, who receive care from TH practices, preferred THs over healthcare workers to disclose their HIV serostatus due to perceived trust, confidentiality and personalized care; (2) HIV-related stigma and fear of domestic violence hindered disclosure within families, but disclosure to healers offered a safer alternative; (3) in some cases, THs were the first individuals to whom PLWH disclosed their status; and (4) THs actively encouraged and facilitated serostatus disclosure by PLWH to family members, offering guidance and mediating difficult conversations. These findings highlight the critical role of THs in reducing barriers to disclosure and fostering supportive networks to improve the quality of life for PLWH. CONCLUSIONS: THs provide a culturally sensitive and trusted avenue for HIV status disclosure in rural Uganda. Their unique position within the community allows them to address stigma, build trust and facilitate safe disclosure practices. Integrating healers into HIV care through training and collaboration with formal healthcare systems could enhance linkage, adherence, retention and overall care outcomes for PLWH. Future research should explore scalable models to leverage the positive influence and potential of THs to improve HIV care delivery.
Artificial intelligence for HIV care: a global systematic review of current studies and emerging trends.
Ngcobo S, Mntla EM, Shock J … +4 more , Louw M, Mbonambi L, Serite T, Rossouw T
J Int AIDS Soc · 2025 Oct · PMID 40990267 · Full text
INTRODUCTION: Artificial intelligence (AI) and, in particular, machine learning (ML) have emerged as transformative tools in HIV care, driving advancements in diagnostics, treatment monitoring and patient management. The...
INTRODUCTION: Artificial intelligence (AI) and, in particular, machine learning (ML) have emerged as transformative tools in HIV care, driving advancements in diagnostics, treatment monitoring and patient management. The present review aimed to systematically identify, map and synthesize studies on the use of AI methods across the HIV care continuum, including applications in HIV testing and linkage to care, treatment monitoring, retention in care, and management of clinical and immunological outcomes. METHODS: A comprehensive literature search was conducted across databases, including PubMed and ProQuest Central, Scopus and Web of Science, covering studies published between 2014 and 2024. The review followed PRISMA guidelines, screening 3185 records, of which 47 studies were included in the final analysis. RESULTS: Forty-seven studies were grouped into four thematic areas: (1) HIV testing, AI models improved diagnostic accuracy, with ML achieving up to 100% sensitivity and 98.8% specificity in self-testing and outperforming human interpretation of rapid tests; (2) Retention in care and virological response, ML predicted clinic attendance, viral suppression and virological failure (72-97% accuracy; area under the curve up to 0.76), enabling early identification of high-risk patients; (3) Clinical and immunological outcomes, AI predicted disease progression, immune recovery, comorbidities and HIV complications, achieving up to 97% CD4 status accuracy and outperforming clinicians in tuberculosis diagnosis; (4) Testing and treatment support, AI chatbots improved self-testing uptake, linkage to care and adherence support. Methods included random forests, neural networks, support vector machines, deep learning and many others. DISCUSSION: AI has the potential to transform HIV care by improving early diagnosis, treatment adherence and retention in care. However, challenges such as data quality, infrastructure limitations and ethical considerations must be addressed to ensure successful implementation. CONCLUSIONS: AI has demonstrated immense potential to address gaps in HIV care, improving diagnostic accuracy, enhancing retention strategies and supporting effective treatment monitoring. These advancements contribute towards achieving the UNAIDS 95-95-95 targets. However, challenges such as data quality and integration into healthcare systems remain. Future research should prioritize scalable AI solutions tailored to high-burden, resource-limited settings to maximize their impact on global HIV care. PROSPERO NUMBER: PROSPERO 2024 CRD42024517798 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024517798.
Impact of the Anti-Homosexuality Act on HIV service delivery in Uganda: Evidence from community-led monitoring.
Nsubuga A, Mugisha F, Ajonye B … +6 more , Mwehonge K, Lankiewicz E, Drake P, Kilande EJ, Kayongo A, Sharp AR
J Int AIDS Soc · 2025 Sep · PMID 40944333 · Full text
INTRODUCTION: In 2023, the Ugandan government enacted the Anti-Homosexuality Act (AHA), which included expanded and intensified criminal penalties for consensual same-sex relations. While arrests, harassment and violence...
INTRODUCTION: In 2023, the Ugandan government enacted the Anti-Homosexuality Act (AHA), which included expanded and intensified criminal penalties for consensual same-sex relations. While arrests, harassment and violence have been reported, evidence of the AHA's impact on HIV healthcare delivery is limited. Community-led monitoring (CLM) is an accountability mechanism that uses community-gathered evidence to advocate for improved healthcare quality and is well-positioned to describe changes in access and quality of care. METHODS: Data from the CLM programme in Uganda were used to identify changes in healthcare delivery and use related to the AHA. As part of the CLM programme, routine survey data were collected from clients and managers in 320 public health facilities and 50 drop-in centres (DICs) from 2022 to 2024. Survey data were analysed using a difference-in-differences logistic model to measure changes in indicator measures before and after the AHA was signed into law. Seven semi-structured individual interviews were conducted with DIC facility managers, deductively coded and thematically analysed. RESULTS: In public health facilities and DICs, the proportion of respondents identified as men who have sex with men (MSM) declined significantly after AHA. In facilities, all categories of key populations (KPs) reported high levels of discrimination. After the AHA, MSM reported significant reductions in key HIV-related services compared to other populations, including lower rates of pre-exposure prophylaxis (PrEP) counselling, lower participation in support groups and having fewer friendly staff interactions. In DICs, all types of clients were less likely to be referred to health facilities, receive PrEP and find the DIC easy to access after the AHA was signed. DIC managers described experiencing harassment, violence and staffing challenges due to AHA, which they responded to by leveraging partnerships with local and global allies, providing virtual services, and seeking registration as full-service clinics. CONCLUSIONS: Data from the Uganda CLM programme provide an early view of the impact of the AHA on service delivery in public health facilities and DICs. While DICs and health facilities developed strategies to build resiliency and adapt, the AHA created significant barriers to care. These findings provide empirical warnings of the barriers experienced by KPs when accessing healthcare services in a criminalized context.
Systematic review and meta-analysis of retention and disengagement after initiation on antiretroviral therapy in low- and middle-income countries after the introduction of Universal Test and Treat policies.
Zheng A, Kileel EM, Brennan AT … +3 more , Flynn DB, Rosen S, Fox MP
J Int AIDS Soc · 2025 Sep · PMID 40908808 · Full text
INTRODUCTION: We previously published a systematic review evaluating retention in care after antiretroviral therapy initiation among adults in low- and middle-income countries from 2008 to 2013. This review evaluates ret...
INTRODUCTION: We previously published a systematic review evaluating retention in care after antiretroviral therapy initiation among adults in low- and middle-income countries from 2008 to 2013. This review evaluates retention after the implementation of Universal Test and Treat (UTT) in 2015. METHODS: We searched PubMed, ISI Web of Science, Cochrane Database of Systematic Reviews and EMBASE for studies published 1 January 2017, through 31 December 2024 and searched conference abstract repositories from AIDS, IAS and CROI from 2015 to 2024. Retention for each study was estimated using (1) simple averages and (2) interpolated for missing time points through the last reported time point. Our outcomes were all-cause attrition and retention. We estimated retention rates using a generalized linear mixed model (GLMM) with a logit distribution using interpolated data. RESULTS: Seventy studies met our inclusion criteria. Most studies came from Africa, with very few from Europe and Asia. Few studies reported retention past the first 12 months following treatment initiation. Across all studies, we estimated simple average retention without interpolation of missing time points to be 72.6% at 12 months, 75.2% at 24 months, 67.7% at 36 months and 64.8% at 48 months. Utilizing a GLMM model, we estimated retention to be 79.6% at 12 months, 81.2% at 24 months, 75.6% at 36 months and 72.8% at 48 months. Whereas in our prior 2015 review, we estimated retention rates to be 86.0% at 12 months, 79.0% at 24 months, 75.0% at 36 months, and 69.0% at 48 months. These results generally reflect retention at the initiating facility and omit the effect of unreported transfers. DISCUSSION: Retention in care at 36 months was estimated to be between 67% and 75%. Compared to results from our prior review, retention is largely similar in the post-UTT era. Further research evaluating retention in other geographic areas (i.e. Latin America and the Caribbean, Europe, and Asia) is needed. CONCLUSIONS: Attrition after the first 2 years in treatment remains a concern, and concerted efforts should be made to ensure patients remain engaged in care over their lifetime. The impact of PEPFAR's recent cuts needs to be evaluated further to understand the effect it may have on long-term retention.
Bone health in a U.K. cohort of youth living with perinatally acquired HIV-1: a longitudinal study.
Henderson M, Blenkinsop A, Ratmann O … +5 more , Cheung M, Lyall H, Fidler S, Foster C, BONDY study group
J Int AIDS Soc · 2025 Sep · PMID 40904314 · Full text
INTRODUCTION: Low bone mineral density (BMD) has been described in children and young people with perinatally acquired HIV (PHIV), which may be related to both traditional (e.g. low body mass index and malnutrition) and...
INTRODUCTION: Low bone mineral density (BMD) has been described in children and young people with perinatally acquired HIV (PHIV), which may be related to both traditional (e.g. low body mass index and malnutrition) and HIV-related risk factors (e.g. longstanding exposure to HIV and antiretroviral therapy [ART], with immune suppression, chronic immune activation and inflammation). Here, we evaluate BMD in a U.K. cohort of young people with PHIV by age and ART. METHODS: This longitudinal, observational study was conducted at a U.K. tertiary PHIV service between November 2018 and March 2022. Bone health was assessed in 130 individuals aged 15-19 (n = 50), 20-24 (n = 50) and 25 years and older (n = 30) by dual-energy X-ray absorptiometry, bone mineralization and turnover markers. Low BMD was defined as lumbar spine (LS) and/or femur-BMD z-score below -2, relative to age, sex and ethnicity-matched U.K. population-based normative controls. Two-year follow-up evaluation was performed in those aged 15-19 (n = 42) and 20-24 years (n = 43) at enrolment, which included a group who switched from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF) ART at baseline. Bayesian logistic regression models examined predictors of low BMD and the effect of ART-backbone on BMD accrual. RESULTS: At baseline, 57% were female and 82% of black ethnicity, with 31 (24%) on TDF-ART. Sixteen (12%) had low baseline BMD. Over a median follow-up duration of 26 (interquartile range [IQR] 25-29) months, BMD accrual was lower-than-expected in those aged 15-19 years (mean change LS-BMD z-score -0.15 (standard deviation [SD] 0.44)), when compared to normative controls. No associations were seen with HIV parameters or the ART regimen. Participants who switched to TAF-ART had similar BMD accrual 26 (IQR 24-32) months post switch, when compared to those on non-TAF/TDF-ART (mean change LS-BMD z-score TAF -0.01 [SD 0.41] vs. non-TAF/TDF -0.03 [SD 0.54]). CONCLUSIONS: While rates of low BMD were reassuringly low in this cohort, lower-than-expected BMD accrual was observed in younger individuals, relative to normative controls. Overall, BMD accrual on TAF-ART was non-inferior to non-TAF/TDF-ART.
Effects of Stop-Work orders on HIV testing, treatment and programmes for prevention of vertical transmission in four sub-Saharan African countries.
Saito S, Farahani M, Kunda S … +9 more , Maluantesa L, Guambe A, Worku HA, Poirot E, Mahachi N, Bonaventure L, Koblavi S, Dzinamarira T, El-Sadr WM
J Int AIDS Soc · 2025 Sep · PMID 40904280 · Full text
INTRODUCTION: Beginning in late January 2025, Stop-Work orders and contract cancellations have disrupted HIV programmes supported by the President's Emergency Plan for AIDS Relief (PEPFAR). We assessed the effects on HIV...
INTRODUCTION: Beginning in late January 2025, Stop-Work orders and contract cancellations have disrupted HIV programmes supported by the President's Emergency Plan for AIDS Relief (PEPFAR). We assessed the effects on HIV service delivery in four African countries. METHODS: Weekly aggregate HIV services data from a convenience sample of 165 Center for Disease Control and Prevention (CDC)-funded, ICAP-supported facilities-22 in Angola, 75 in the Democratic Republic of the Congo (DRC), 20 in South Sudan and 48 in Zambia-were analysed. We compared data from pre-Stop-Work (7 October 2024-23 January 2025), Stop-Work (24 January 2025-11 February 2025) and post-resumption (12 February 2025-31 March 2025) phases. We examined the number of individuals: (1) who tested for HIV; (2) receiving index testing; (3) had HIV-positive results/yield; (4) initiated antiretroviral therapy (ART); as well as (5) number of pregnant women with known HIV status; and (6) number of HIV-exposed infants who received early infant diagnosis (EID) testing. We used phase-specific weekly averages, relative percentage changes across phases and linear trend tests to measure the magnitude of disruptions and recovery. RESULTS: In Angola, DRC and Zambia, significant declines in number of HIV-positive tests (-58%, -34%, -17%) and ART initiations (-16%, -32%, -17%) were observed across the three phases with limited recovery in number of positive tests in Zambia and ART initiations in Angola. In DRC and Zambia, HIV testing (-33%, -35%), including index testing (-37%, -72%), significantly declined; additionally, HIV testing of pregnant women significantly declined (-28%) in DRC. In Angola and Zambia, EID testing declined (-12%, -18%) with limited recovery. In Angola, HIV testing (2476→2205→2519), including testing for pregnant women (280→ 233→ 287), rebounded in the post-resumption phase; in DRC, EID (6.5→6.3→7.9) rebounded. There were increases in HIV testing yield in Zambia (2.8%→3.1%→4.0%) and index testing (20→24→36) in Angola. No reductions were observed in South Sudan. CONCLUSIONS: Stop-Work orders and award terminations have resulted in substantial short-term reductions in the delivery of HIV testing and treatment services. Long-term funding disruptions necessitate careful planning, realistic timelines and investment in cost-effective service models to sustain the gains and maintain the momentum in the global HIV response.
Integrating HIV and primary healthcare for key populations: community-led models from Vietnam, Nigeria and Eswatini.
Coleman M, Akolo C, Mbanusi A … +4 more , Sithole B, Siberry GK, Schowen R, Goldstein D
J Int AIDS Soc · 2025 Sep · PMID 40903995 · Full text
INTRODUCTION: Key populations (KP), including men who have sex with men, people who inject drugs, sex workers, transgender people and people in closed settings, are disproportionately affected by HIV and face structural...
INTRODUCTION: Key populations (KP), including men who have sex with men, people who inject drugs, sex workers, transgender people and people in closed settings, are disproportionately affected by HIV and face structural and legal barriers to care. While community-led responses are central to reaching KP, services are often disease-specific and disconnected from national primary healthcare (PHC) systems. PHC, defined by WHO as a whole-of-society approach to delivering integrated and person-centred services, is rarely designed to meet the broader health needs of KP, who also experience high burdens of non-communicable diseases, mental health conditions and violence. This paper describes three service delivery models, supported by PEPFAR, that integrate HIV and PHC services for KP in Vietnam, Nigeria and Eswatini. DISCUSSION: The three models are community-led, client-centred, and tailored to KP health and social needs. Each integrates HIV services-including testing, antiretroviral therapy, viral load monitoring, pre-exposure prophylaxis (PrEP) and advanced HIV disease management-alongside broader PHC services such as mental healthcare, sexual and reproductive health, non-communicable disease screening and tuberculosis services. All models include structural and community-based interventions such as gender-based violence support, stigma reduction, peer navigation and economic empowerment. These services are delivered in safe, trusted spaces by multidisciplinary teams including peer and clinical providers. While the models demonstrate alignment with PHC principles (accessibility, cultural competence, continuity and community empowerment), challenges remain related to integration within national health systems, financing and provider training. Recent U.S. global health policy shifts, including reductions in funding for KP-specific programming and limited PrEP access, pose additional threats to programme sustainability and client trust. CONCLUSIONS: Integrated models of HIV and PHC for KP can improve access, engagement and health outcomes across a range of services. They represent promising approaches for addressing intersecting health and structural needs, particularly in settings where stigma and criminalization persist. Sustained progress will require inclusion of KP in PHC policies and planning, protection of community-led services and domestic financing strategies that ensure continuity in the face of shifting donor priorities.
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