Journal Of The International AIDS Society[JOURNAL]
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200 papers
Introducing differentiated service delivery models for tuberculosis treatment: a pilot project to inform national policy in Uganda.
Ferroussier-Davis O, Lukoye D, Alwedo S … +22 more , Mudiope MN, Nalunjogi J, Kirenga JB, Kabanda JN, Kalamya JN, Nasasira B, Birabwa E, Dejene S, Murungi M, Ddumba I, Moore B, Burua A, Luzze H, Quinto E, Sekadde M, Byaruhanga R, Ajuna P, Arinaitwe I, Katureebe C, Namuwenge P, Adler MR, Turyahabwe S
J Int AIDS Soc · 2025 Jul · PMID 40622376 · Full text
INTRODUCTION: Differentiated service delivery (DSD) models aim to tailor health services delivery to clients' preferences and clinical characteristics while reducing the burden on health systems. In Uganda, DSD models de...
INTRODUCTION: Differentiated service delivery (DSD) models aim to tailor health services delivery to clients' preferences and clinical characteristics while reducing the burden on health systems. In Uganda, DSD models developed for HIV care were adapted to the tuberculosis (TB) services context to mitigate disruptions from the COVID-19 pandemic and inform national efforts to improve TB care. METHODS: Beginning in April 2021, four facility-based and five community-based DSD models were implemented in 28 TB clinics in Kampala and Soroti Regions. All clients in the intensive (months 1-2) and continuation (months 3-6) phases of treatment were eligible. Client preference and clinician concurrence determined model choice. All models allowed TB medication dispensing intervals ranging from biweekly to multi-month dispensing (MMD; ≥ 2 months). Data abstracted in December 2022 from TB registers and DSD enrolment tracking tools at 21 of 28 implementing facilities were used to evaluate the intervention. The TB treatment success rate (i.e. proportion cured or who completed treatment, vs. those who died, failed, were lost-to-follow-up or had no recorded outcome) in the DSD cohort was compared to facilities' 2018-2019 results using Fischer's exact test. RESULTS: Most facilities offered one (Kampala) or two (Soroti) facility-based models and one community-based model. Among 1864 TB clients enrolled between April 2021 and March 2022, 1822 (97.7%) used ≥ 1 DSD models; 210/1822 (11.5%) ever switched models. Overall, 70.5% (1284/1822) of clients enrolled in ≥ 1 facility-based model and 40.5% (737/1822) in ≥ 1 community-based model. The use of community-based models increased during the continuation phase. Facility-Based Individual Management and Home Delivery were the most-used models. In the intensive phase, the longest medication dispensation interval was biweekly for 50.0% of patients, monthly for 41.3% and MMD for 8.8%. During the continuation phase, the longest interval was biweekly for 0.6%, monthly for 71.7% and MMD for 27.6%. Overall, 1582/1864 (84.9%) clients were successfully treated, compared to 858/1177 (72.9%) in 2018-2019 (p < 0.001). Seven (0.4%) patients failed treatment, 32 (1.7%) were lost to follow-up, 101 (5.4%) died and 142 (7.6%) were not evaluated. CONCLUSIONS: TB DSD models were successfully implemented. TB treatment outcomes under DSD compared favourably to historical outcomes. Investigating factors affecting MMD use and model choice could further inform programme design.
Exploring healthcare experiences of transgender people in the Jabula Uzibone study, South Africa: a longitudinal implementation science study.
Bothma R, Pettifor A, Maphosa I … +3 more , Ndlovu P, Imrie J, Poteat T
J Int AIDS Soc · 2025 Jul · PMID 40622372 · Full text
INTRODUCTION: The World Health Organization promotes a transgender-differentiated service delivery (TG-DSD) model to overcome barriers to HIV service engagement among transgender people (TGP). For TGP, an essential eleme...
INTRODUCTION: The World Health Organization promotes a transgender-differentiated service delivery (TG-DSD) model to overcome barriers to HIV service engagement among transgender people (TGP). For TGP, an essential element of DSD includes gender-affirming care which is non-stigmatising, free from discrimination and celebrates their gender identity. The Jabula Uzibone Study, launched in November 2023, assesses the cost and effectiveness of TG-DSD on HIV outcomes. In this paper, we describe the baseline characteristics of TGP in our study and explore whether there are differences in healthcare experiences among those seeking care at TG-DSD clinics versus standard service delivery (SSD) clinics at baseline. METHODS: This observational, mixed-method, prospective implementation study compares models of care at four TG-DSD and four SSD facilities using standardised observation checklists, in-depth and key informant interviews. For this paper, we asked participants about healthcare experiences and experiences of stigma through a structured, interviewer-administered quantitative survey. We assessed the sections of the quantitative survey which ask about self-reported experiences of stigma. RESULTS: The study enrolled 422 TGP with HIV (217 TG-DSD and 205 SSD) and 248 TGP without HIV (128 TG-DSD and 120 SSD); 15% (102/670) gender non-conforming, 15% (91/670) TG men and 70% (477/670) TG women. Participants' median age was 29 years, interquartile range: 24-35 years. SSD participants at baseline were 46% more likely to experience stigma compared to their TG-DSD counterparts (aOR = 1.46, 95% CI: 1.06, 2.01). SSD participants were more likely to encounter a healthcare provider who is unwilling to provide care for them (aOR = 1.55, 95% CI: 1.09, 2.21) and to report that healthcare workers are unable to provide the same quality care to TGP as they do other people (aOR = 1.46, 95% CI: 1.00, 1.91) compared to their TG-DSD counterparts. CONCLUSIONS: TGP from TG-DSD facilities were less likely to report experiences of facility-based enacted stigma at baseline, compared to the TGP from SSD facilities. Our study highlights the importance of provider training in tailored transgender healthcare to provide gender-affirming healthcare services. Results from the Jabula Uzibone study will provide further evidence of the effectiveness of TG-DSD models in sub-Saharan Africa, and the role of stigma and discrimination in HIV outcomes among TGP.
A prospective cohort study of the SEARCH integrated HIV/hypertension community health worker-led intervention in rural Kenya and Uganda.
Hickey MD, Owaraganise A, Ogachi S … +18 more , Sunday H, Aoko C, Sang N, Agengo G, Kabami J, Kakande E, Mugoma EW, Schwab J, Sutter N, Black D, Muiru A, Chamie G, Petersen ML, Balzer LB, Bukusi EA, Havlir DV, Kamya MR, Ayieko J
J Int AIDS Soc · 2025 Jul · PMID 40622370 · Full text
INTRODUCTION: Clinic-based hypertension screening and treatment for people with and without HIV depends on consistent clinic engagement. Retention is challenging in rural areas, especially for people with severe hyperten...
INTRODUCTION: Clinic-based hypertension screening and treatment for people with and without HIV depends on consistent clinic engagement. Retention is challenging in rural areas, especially for people with severe hypertension, which typically requires more frequent visits than clinically stable HIV. We hypothesised that Ministry of Health (MoH) community health workers (CHWs) could improve severe hypertension detection and treatment through an integrated hypertension/HIV intervention. METHODS: In rural Uganda and Kenya, we added HIV testing and a status-neutral hypertension intervention to CHW workflow in an ongoing cluster-randomised population-level study (SEARCH:NCT05768763). Data spans March 2023-August 2024. Trained CHWs screened all adults aged ≥ 40 years in intervention communities for hypertension, referring those with blood pressure (BP) ≥ 140/90 mmHg to MoH HIV/primary care clinics. After initial in-clinic evaluation, adults with BP ≥ 160/100 mmHg were offered choice of clinic-based or telehealth (CHW home visit, clinician telehealth evaluation, medication delivery) follow-up care. Telehealth used a MoH-compatible CHW smartphone app that syncs with electronic clinic records, prompts CHW follow-up visits and facilitates clinician telehealth assessment/medication prescribing. We report hypertension control achieved through the implementation of CHW-supported screening and telehealth and used targeted minimum loss-based estimation to estimate the change in population prevalence of uncontrolled hypertension from baseline to 1 year. RESULTS: Across eight communities, 198 CHWs measured BP in 14,378/15,879 adults aged ≥ 40 years at baseline (91%) and 13,334/15,879 after 1 year (84%); 55% were female and 19% living with HIV. Estimated population prevalence of BP ≥ 140/90 mmHg decreased from 16.0% at baseline to 6.4% at year 1 (9.6% absolute decrease, 95% CI 8.6%, 10.6%). Among people with HIV aged ≥ 40 years (n = 3036), the prevalence of BP ≥ 140/90 mmHg decreased from 10.5% to 4.7% (5.9% absolute decrease, 95% CI 3.0%, 8.8%). In the subset with BP ≥ 160/100 who enrolled in the intervention (n = 919), 96% received antihypertensive medication, 81% were retained in care at 1 year and 79% achieved BP control; people with HIV (n = 120) had similar retention (80%) and BP control (80%). CONCLUSIONS: Within the context of a pragmatic trial, leveraging existing CHWs in an integrated HIV/hypertension model reduced the population-level prevalence of uncontrolled hypertension by 60% among people with and without HIV, extending health services into the community at scale.
Preferences for models of sexual health service delivery among gay, bisexual and other men who have sex with men in Australia: a discrete choice experiment.
Ong JJ, Fraser D, Bourne C … +2 more , Grulich A, Bavinton BR
J Int AIDS Soc · 2025 Jul · PMID 40622365 · Full text
INTRODUCTION: Gay, bisexual and other men who have sex with men are disproportionately affected by HIV and other sexually transmitted infections (STIs). This study explores preferences for different models of sexual heal...
INTRODUCTION: Gay, bisexual and other men who have sex with men are disproportionately affected by HIV and other sexually transmitted infections (STIs). This study explores preferences for different models of sexual health services among gay, bisexual and other men who have sex with men in Australia, using discrete choice experiments (DCEs). METHODS: A cross-sectional online survey was conducted from November 2022 to February 2023, targeting three groups: (1) gay, bisexual and other men who have sex with men living with HIV; (2) pre-exposure prophylaxis (PrEP) users; and (3) non-PrEP users. Participants were recruited through paid advertisements, sexual health clinics and community networks. The survey included demographic questions, sexual behaviour inquiries and three tailored DCEs to quantify preferences for service delivery attributes such as cost, type of clinic, appointment type, appointment frequency, extra services and where samples are taken for HIV/STI testing. We used latent class analyses to identify subgroups of people with similar preferences. RESULTS: We recruited 1422 participants. The median age was 41 (interquartile range [IQR]: 32-54) for gay, bisexual and other men who have sex with men living with HIV (N = 396), 35 (IQR: 29-45) for PrEP users (N = 436) and 33 (IQR: 26-44) for non-PrEP users (N = 590). In our latent class analyses, gay, bisexual and other men who have sex with men living with HIV preferred sexual health services to be delivered via sexual health clinics (46.2%), general practitioners (GP) with expertise in lesbian, gay, bisexual, trans, queer and others (LGBTQ+) health (33.0%) or were happy to go anywhere and to pay (20.7%). PrEP users preferred either PrEP-only clinics or GP with expertise in LGBTQ+ health (75.2%) and GP with expertise in LGBTQ+ health only (24.8%). Non-PrEP users preferred GP with expertise in LGBTQ+ health (44.7%) or any free service (22.8%); some did not want to test (22.2%) or were unsure of their preferences (10.2%). CONCLUSIONS: To align service models with client needs, investment in specialist sexual health clinics and LGBTQ+ competent GPs is important, though this may depend on local resources and infrastructure. Future research should focus on addressing financial barriers, evaluating telehealth and digital health interventions, and understanding testing reluctance among non-PrEP users.
Preferences for TB treatment and support delivery models among people living with TB in Eastern Cape, South Africa: a discrete choice experiment.
Strauss M, George G, Lansdell E … +3 more , Fiphaza K, Medina-Marino A, Daniels J
J Int AIDS Soc · 2025 Jul · PMID 40622363 · Full text
INTRODUCTION: South Africa has one of the highest incidence rates of notified tuberculosis (TB) in the world. Achieving TB control requires strengthening treatment and support services. The implementation of differentiat...
INTRODUCTION: South Africa has one of the highest incidence rates of notified tuberculosis (TB) in the world. Achieving TB control requires strengthening treatment and support services. The implementation of differentiated delivery models can be used to improve service quality and enhance retention in care. This study aimed to identify treatment and support delivery preferences among people on TB treatment, specifically examining gender differences, to inform the development of differentiated care models for improving engagement and retention in TB treatment services. METHODS: A binary, unlabelled, fractional factorial design discrete choice experiment (DCE) was used to investigate preferences for TB treatment adherence support and service delivery. Attributes included who provides the support, how and where support is delivered, medication collection location and frequency of clinic visits. The DCE was administered to individuals who were currently on or recently completed TB treatment, and to those at-risk for being lost-to-care. Data from 284 individuals for the DCE were collected from March to August 2022. Mixed effects logistic regression models were used as primary analysis tools. Latent class analysis (LCA) was used to explore heterogeneity in preference structures. RESULTS: Compared to standard clinic-based treatment collection, participants preferred collecting their treatment from a mobile community-based location (ß = 0.231; 95% CI: 0.08-0.39), clinic-based fast-tracked pick-ups (ß = 0.539; 95% CI: 0.38-0.70) or home delivery (ß = 0.563; 95% CI: 0.37-0.75). Participants also significantly preferred support offered monthly compared to once-off (ß = 0.167; 95% CI: 0.01-0.32). Furthermore, participants preferred face-to-face support over group (ß = -0.142; 95% CI: -0.27 to -0.02) or phone-based (ß = -0.222; 95% CI: -0.36 to -0.09) support models. LCA revealed three classes with statistically similar preference structures; Class 1 (62%) preferred community-based treatment delivery and support services; Class 2 (28%) preferred clinic-based support and treatment delivery services; and Class 3 (10%), preferred self-selected peer navigator or nurse delivered, and group models of support and prioritised the location of medication pickups, with a preference for any model other than standard clinic collection. CONCLUSIONS: Though preference structures did not differ by gender, respondents revealed strong preferences for differentiated service delivery models. Future TB treatment and support interventions must include both clinic- and community-based models of care and support to ensure that those living with TB are provided the greatest access to TB treatment and support services.
Improving PrEP access for adolescent girls and young women: a descriptive analysis of community-based PrEP delivery in the DREAMS programme in Zambia.
Musheke M, Pry JM, Sikazwe I … +14 more , Muyunda WJ, Chiyenu K, Siame CM, Khondowe WK, Mushiki B, Mwaba MM, Zulu P, Mwape F, Siamasuku B, Shula D, Mweemba MB, Kanene C, Phiri A, Herce ME
J Int AIDS Soc · 2025 Jul · PMID 40622362 · Full text
INTRODUCTION: Despite being at high risk of HIV acquisition, access to pre-exposure prophylaxis (PrEP) among adolescent girls and young women (AGYW) is low in Zambia because PrEP is traditionally delivered in clinical se...
INTRODUCTION: Despite being at high risk of HIV acquisition, access to pre-exposure prophylaxis (PrEP) among adolescent girls and young women (AGYW) is low in Zambia because PrEP is traditionally delivered in clinical settings. We describe the effects of community centres supported by the Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) initiative on PrEP outcomes in Zambia and examine factors associated with PrEP continuation. METHODS: We collected individual-level PrEP data for AGYW aged 15-24 years at risk of HIV acquisition and enrolled in DREAMS in seven districts of Zambia between August 2022 and August 2024. We used Pearson's Chi-squared test to examine differences in beneficiary characteristics between clients with a PrEP initiation visit and ≥ 2 PrEP visits (i.e. an initiation plus ≥ 1 return visit), and mixed effects Poisson regression modelling to estimate the association between DREAMS enrolment criteria and PrEP continuation (defined as ≥ 1 PrEP visit within 180 days of initiation). We also estimated the marginal probability of PrEP continuation by number of DREAMS enrolment criteria and used Kaplan-Meier methods to estimate the time to the first PrEP return visit by client age band. RESULTS: Between 11 August 2022 and 23 August 2024, 15,502 AGYW aged 15-24 years were screened for PrEP eligibility, of whom 15,072 (97.2%) initiated PrEP per national guidelines. Of those initiating PrEP, 9807 (65.1%) had sufficient follow-up time to allow for observation of a PrEP return visit. The proportion of AGYW who had ≥ 1 PrEP return visit within 180 days of initiation was 59.0% (n/N = 5706/9675). Across age bands, the percent probability of having a PrEP return visit within 180 days of initiation was highest among clients who reported ≥ 4 DREAMS enrolment criteria at 91.7% (95% CI: 70.7, 112.7%) for clients aged 15-19 years and 83.6% (95% CI: 61.1, 106.2%) for clients aged 20-24 years. Overall, 41.5% of clients had a first PrEP return visit between 21 and 42 days of PrEP initiation. CONCLUSIONS: The high number and proportion of AGYW initiated on PrEP suggests that decentralising PrEP services to DREAMS community centres has the potential to improve PrEP access among AGYW. Increasing HIV risk perception among AGYW may improve PrEP continuation.
High acceptability, feasibility and sustainability of a direct-to-pharmacy differentiated PrEP delivery model in public health HIV clinics in Kenya: perspectives of PrEP clients and healthcare providers.
Owidi E, Ngure K, Ogello V … +11 more , Wairimu N, Etyang' L, Waituika W, Mwangi M, Mwangi D, Maina S, Irungu E, Kiptinness C, Mugo N, Mugwanya K, Efficiency Study Team
J Int AIDS Soc · 2025 Jul · PMID 40622359 · Full text
INTRODUCTION: High client opportunity costs and a burdened healthcare system limit oral pre-exposure prophylaxis (PrEP) delivery in Kenyan public HIV clinics. We conducted a qualitative study among PrEP clients and provi...
INTRODUCTION: High client opportunity costs and a burdened healthcare system limit oral pre-exposure prophylaxis (PrEP) delivery in Kenyan public HIV clinics. We conducted a qualitative study among PrEP clients and providers to understand the acceptability, feasibility and willingness to implement a client-centred, differentiated direct-to-pharmacy (DTP) PrEP refill visits intervention aimed at improving the efficiency of PrEP implementation in real-world clinics. METHODS: From March 2021 to March 2022, we conducted in-depth interviews with clients and healthcare providers participating in an individual facility pharmacy-based PrEP delivery model for PrEP refills among clients in the continuation phase at two public HIV clinics in central Kenya. The core components of the DTP model included directed-to-PrEP pharmacy refill visits conducted by facility pharmacy staff and client HIV self-testing (HIVST) while waiting for services at the pharmacy. We used semi-structured interview guides informed by the Consolidated Framework for Implementation Research (CFIR). We analysed data using thematic content analysis and organised findings by CFIR constructs. RESULTS: We interviewed 20 PrEP clients and 20 healthcare providers. PrEP clients included 15 females and had a median age of 39 years (interquartile range [IQR]: 33-48). Providers included 13 females, had a median age of 32 years (IQR: 30-41), and included 10 HIV counsellors, 5 pharmacy and 3 clinical providers. Both providers and clients reported high satisfaction with DTP PrEP refill visits derived from improved clinic flow and quality of service. Among clients, shorter waiting times and less movement between multiple clinic rooms reduced delays, improved privacy and reduced stigma associated with visiting HIV clinics. Furthermore, shorter waiting times and infrequent clinic visits reduced loss of working hours and income among clients, motivating PrEP continuation. Providers reported improved clinic flow, reduced work burden among non-pharmacy providers, improved knowledge and ease of implementing DTP refill visits. However, providers expressed concerns about the potential loss of roles among HIV counsellors and the shifting of workload burden to pharmacy providers. CONCLUSIONS: Differentiated DTP refill visits with HIVST were highly acceptable and feasible among PrEP clients and providers. Context-specific modifications and scale-up of the intervention could improve the efficiency of PrEP delivery within public HIV clinics in Kenya and similar settings.
Data-informed Stepped Care (DiSC) to improve adolescent and young adult HIV care outcomes in Kenya: a cluster randomized trial.
Kohler P, Jiang W, Badia J … +11 more , Kibugi J, Dyer J, Kadima J, Oketch D, Beima-Sofie K, Hicks S, Richardson BA, Inwani I, Shah SK, Agot K, John-Stewart G
J Int AIDS Soc · 2025 Jul · PMID 40622356 · Full text
INTRODUCTION: Systematic use of data-driven tools to allocate care services based on needs, including differentiated care for stable individuals and intensive care for those with higher risk, may improve retention and vi...
INTRODUCTION: Systematic use of data-driven tools to allocate care services based on needs, including differentiated care for stable individuals and intensive care for those with higher risk, may improve retention and viral suppression in adolescents and young adults living with HIV (AYLHIV). METHODS: This cluster randomised trial in western Kenya tested a data-informed stepped care intervention that assigned AYLHIV to four intensities of care according to need. AYLHIV at 12 intervention facilities underwent step assignment at each visit; those at lowest risk were offered differentiated models of service delivery (DSD), and those with risk factors more intensive services. AYLHIV at control sites received standard care. AYLHIV were followed for 12 months. Clinical and viral load data were abstracted from medical records. The primary outcome was the proportion of missed visits (defined as > 30 days late for scheduled visit). Secondary outcomes included loss to follow-up, viral non-suppression and assignment to DSD (multi-month refills or pharmacy fast-track visits). Mixed effects regression was clustered by individual and facility and adjusted for outcomes during the pre-enrolment period and baseline variables that differed by arm. RESULTS: Between April and July 2022, 1911 AYLHIV ages 10-24 were enrolled (control: 1016, intervention: 895, 1708.8 person-years). Median age was 17, and 1512 (79.5%) were in school. Characteristics were balanced by arm, except for a higher proportion coming to the clinic alone in control arm (68.5% vs. 61.1%, p = 0.04). At intervention facilities, using the DiSC tool, 574 (64.6%) AYLHIV were assigned to DSD, 122 (13.7%) to standard care, 100 (11.3%) to mental health and retention counselling, and 92 (10.4%) to intensive case management. Missed visits were 8.5% in intervention versus 8.3% in control (adjusted risk ratio [aRR]: 1.04, 95% CI: 0.89-1.20); viral non-suppression (7.7% vs. 9.7%, aRR 0.79 95% CI: 0.54-1.16) and antiretroviral therapy adherence (92.8% vs. 94.6%, aRR 0.98 95% CI: 0.94-1.02) were similar between arms. AYLHIV in the intervention arm received more fast-track visits (aRR 1.21, 95% CI: 1.01-1.46). Intervention facilities experienced fewer scheduled appointments compared to control (aRR: 0.95, 95% CI: 0.91-0.98, p = 0.004). CONCLUSIONS: Overall, missed visits and non-suppression were infrequent (< 10%) and did not decrease with the DiSC intervention. The DiSC intervention resulted in increased assignment to differentiated services without increasing missed visits or viral non-suppression.
The need to differentiate at re-engagement: lessons from South Africa and Zimbabwe's re-engagement algorithms.
Wilkinson LS, Bygrave H, Manganye M … +2 more , Mupanguri C, Grimsrud A
J Int AIDS Soc · 2025 Jul · PMID 40622355 · Full text
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"A cure might help, but it won't erase it all": a qualitative study of policy challenges and priorities for long-term survivors of HIV in the United States.
Ahmed A, Taylor J, Lau R … +10 more , Lai JC, Deshan Diunugala S, Louella M, Villa TJ, Freshwater W, Averitt D, Karris M, Berry J, Dee L, Dubé K
J Int AIDS Soc · 2025 Jul · PMID 40611541 · Full text
INTRODUCTION: Long-term survivors (LTS) of HIV, including individuals diagnosed before the availability of effective antiretroviral therapy (ART), have played a pivotal role in shaping the HIV response. Despite an increa...
INTRODUCTION: Long-term survivors (LTS) of HIV, including individuals diagnosed before the availability of effective antiretroviral therapy (ART), have played a pivotal role in shaping the HIV response. Despite an increase in their number in the United States, their unique medical, social and economic challenges remain underrepresented in HIV policy and research, particularly in the context of HIV cure advancements. While an HIV cure may alleviate ART-related burdens, LTS fear unintended consequences, including the potential loss of critical social benefits, economic support and healthcare access. This study explores the policy priorities of LTS, addressing their current unmet needs and the broader implications of an HIV cure. METHODS: We conducted qualitative interviews with 32 LTS across diverse racial, gender and geographic backgrounds, recruited through community-based organizations and research networks from 2023 to 2024. Using inductive thematic analysis, we identified key policy concerns and recommendations based on participants' lived experiences. Data collection continued until thematic saturation was reached. RESULTS: LTS emphasized four pressing policy domains: (1) Persistent Healthcare Disparities: Participants reported fragmented Medicare and Medicaid coverage, limited access to essential services (e.g. dental, vision and mental healthcare), and ongoing stigma and discrimination in healthcare settings. (2) Social and Economic Precarity: Housing instability, financial insecurity and employment barriers disproportionately affect LTS, many of whom face systemic barriers to re-entering the workforce. (3) Policy Implications of an HIV Cure: Participants voiced concerns that an HIV cure, while promising, could result in disqualification from disability and social assistance programmes, exacerbating socio-economic vulnerabilities. (4) Structural Reforms for LTS Inclusion: LTS underscored the urgent need for their direct involvement in HIV research, policy development and decision-making to ensure equitable, community-driven solutions. CONCLUSIONS: Policymakers must address comprehensive healthcare access, economic stability and social protections for LTS of HIV. HIV cure research must not undermine existing benefits or widen disparities. Ensuring LTS representation in decision-making is critical to developing equitable policies that safeguard their wellbeing before and after a cure.
Estimated impact of long-acting injectable PrEP in South Africa: a model comparison analysis.
Stansfield SE, Moore M, Jamieson L … +14 more , Meyer-Rath G, Johnson LF, Kaftan D, Bershteyn A, Smith J, Cambiano V, Bansi-Matharu L, Phillips A, Heitner J, Barnabas RV, Hanscom B, Donnell DJ, Boily MC, Dimitrov D
J Int AIDS Soc · 2025 Jul · PMID 40600502 · Full text
INTRODUCTION: Long-acting injectable cabotegravir (CAB-LA) demonstrated superiority to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) in...
INTRODUCTION: Long-acting injectable cabotegravir (CAB-LA) demonstrated superiority to daily tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) in two clinical trials. This analysis projects the impact of expanding PrEP coverage with CAB-LA in South Africa between 2022 and 2042. METHODS: Three independently calibrated models of HIV transmission in South Africa (Synthesis, EMOD-HIV, Thembisa) projected HIV acquisitions and effective coverage (average PrEP coverage across exposure groups, weighted by HIV incidence in the absence of PrEP in each group) over 20 years under multiple scenarios of PrEP expansion compared to no PrEP expansion. PrEP expansion scenarios differed in targeted overall coverage, speed of expansion, coverage of high-exposure groups, and relative coverage of women and men. RESULTS: Achieving 5% PrEP coverage with CAB-LA by 2032 prioritizing high-exposure groups resulted in 49% (Synthesis), 18% (EMOD-HIV), and 8% (Thembisa) effective coverage and averted a median of 43%, 29% and 10% of new HIV acquisitions, respectively. Similar expansion with TDF/FTC resulted in lower impact by 19 percentage points (pp), 18pp and 3pp, respectively. Increasing CAB-LA coverage to 15% led to an additional 7pp, 12pp and 16pp, respectively, of HIV acquisitions averted. Achieving 5% CAB-LA coverage expanding to women only resulted in a lower impact by 16pp (Synthesis) and 13pp (EMOD-HIV), and a higher impact by 2pp (Thembisa). Scenarios with similar effective coverage resulted in comparable impact estimates across models. CONCLUSIONS: Offering CAB-LA in South Africa may substantially impact the HIV epidemic based on these projections. Effective coverage proved to be a good predictor of intervention effectiveness.
Seizing the moment: the potential of PrEP choice and innovation to transform HIV prevention.
Schmidt HA, Prochazka M, Ingold H … +4 more , Reza-Paul S, Chidarikire T, Romyco I, Rodolph M
J Int AIDS Soc · 2025 Jul · PMID 40600501 · Full text
INTRODUCTION: The potential of pre-exposure prophylaxis (PrEP), as a highly effective and empowering HIV prevention intervention, has not yet been realized. Despite the recent acceleration in the scale-up of oral PrEP, t...
INTRODUCTION: The potential of pre-exposure prophylaxis (PrEP), as a highly effective and empowering HIV prevention intervention, has not yet been realized. Despite the recent acceleration in the scale-up of oral PrEP, there is a substantial unmet PrEP need, and the world is not on track to meet the 2025 prevention targets. New PrEP products, and service delivery approaches, could support greater access, uptake, persistence and effective use. This commentary discusses how offering choice in PrEP products and service delivery innovations could transform global HIV prevention efforts. DISCUSSION: Although oral PrEP accounts for almost all PrEP use to date, slow rollout and challenges in effective use and persistence have limited the global impact. Innovative products like long-acting injectable cabotegravir and injectable lenacapavir can overcome some of the challenges associated with oral PrEP. Expanding PrEP choices is also essential for addressing diverse individual preferences and maximizing prevention outcomes. Real-world evidence suggests that offering increased options can drive demand and increase coverage of prevention. Equally critical is tailoring service delivery through differentiated service delivery (DSD) models that prioritize accessibility and user needs and preferences, including integration of PrEP within other valued services. DSD models, including peer-led, pharmacy-based and telehealth approaches, have demonstrated success and acceptability for oral PrEP, but innovation is needed to adapt to long-acting injectable options. For example, regulatory and policy support are essential to support task-sharing with community health worker involvement may enable broader reach. Programmatic challenges, including PrEP product and service delivery costs, updating monitoring and evaluation and ensuring stakeholder support, must also be addressed. Scaling up new PrEP products using a precision prevention lens could help to optimize approaches for achieving impact. CONCLUSIONS: The new era of PrEP choice, with new long-acting PrEP products and DSD options, presents countries with an extraordinary opportunity to amplify prevention access, achieve higher prevention coverage and drive the meaningful reductions in new HIV acquisitions needed to end the HIV epidemic. Without coordinated and concerted efforts within countries and supported at the global level to leverage choice and embed it within the HIV prevention response, we risk prolonging the HIV epidemic.
User and healthcare provider early experiences with the PrEP ring: a quantitative study on the introduction of a new PrEP method in Eswatini.
Hettema A, Shongwe S, Sisel H … +6 more , Khumalo M, Gama N, Khanyile N, Mahlalela B, Matse SN, Peterson JM
J Int AIDS Soc · 2025 Jul · PMID 40600499 · Full text
INTRODUCTION: Eswatini prepared for the national rollout of HIV pre-exposure prophylaxis (PrEP) choice through a mixed-method demonstration study introducing the PrEP dapivirine vaginal ring in 12 Ministry of Health-supp...
INTRODUCTION: Eswatini prepared for the national rollout of HIV pre-exposure prophylaxis (PrEP) choice through a mixed-method demonstration study introducing the PrEP dapivirine vaginal ring in 12 Ministry of Health-supported sites. The Eswatini PrEP Ring Study aimed to describe user preferences for, and experiences with, the PrEP ring, and provider impressions. The objective was to provide real-world data on client preferences and experiences related to PrEP choice, and healthcare provider perspectives on the feasibility and acceptability of offering PrEP choice. A subset of quantitative findings is presented here. METHODS: During May 2023-August 2024, 12 study sites in Eswatini began offering a choice between the PrEP ring and oral PrEP to women 18 years and older who were HIV negative, not pregnant or breastfeeding, and interested in PrEP. Current oral PrEP users who were satisfied with the method were not recruited. Users' early experiences with the PrEP ring were assessed through structured enrolment and follow-up questionnaires. Factors associated with choosing the PrEP ring at enrolment were assessed using logistic regression. During the first 2 months of offering PrEP choice, providers (n = 16) completed a structured questionnaire on the feasibility and acceptability of PrEP choice service delivery. CLINICAL TRIAL NUMBER: NCT05889533 RESULTS: At enrolment, 69% (n = 625/904) chose the PrEP ring. Predictors for choosing the ring included ages 25+ (25-34 years AOR = 1.44, 95% CI [1.03, 2.02]; ages 35+ years AOR = 1.69, 95% CI [1.07, 2.68]), higher education (AOR = 1.71 for some/completed high school, 95% CI [1.20, 2.43]; AOR = 1.87 for vocational/tertiary education, 95% CI [1.21, 2.90]) and using either longer-acting (AOR = 2.23, 95% CI [1.28, 3.89]) or shorter-acting contraceptives (AOR = 1.63, 95% CI [1.14, 2.32]) versus no modern family planning method. Participants reported high levels of ease and confidence (98%) in using the ring. Ninety-four percent of PrEP counsellors (n = 8) and nurses (n = 8) felt prepared to offer PrEP choice and liked choice counselling but had concerns about clients' ability to return on time for refills of either method. CONCLUSIONS: Many women in Eswatini were willing to try the PrEP ring. Providers were enthusiastic about counselling on PrEP choice and introducing women to the ring.
Impact of changing pre-exposure prophylaxis regimens on retention among men who have sex with men in Hanoi, Vietnam (2020-2023): a cohort study.
Setrakian N, Bui HTM, Adamson PC … +3 more , Hoang TN, Gorbach PM, Giang LM
J Int AIDS Soc · 2025 Jul · PMID 40600497 · Full text
INTRODUCTION: We examined the association of pre-exposure prophylaxis (PrEP) programme retention with the use of daily, event-driven (ED) or regimen switching reported during follow-up at any point prior to discontinuati...
INTRODUCTION: We examined the association of pre-exposure prophylaxis (PrEP) programme retention with the use of daily, event-driven (ED) or regimen switching reported during follow-up at any point prior to discontinuation among men who have sex with men (MSM) in Hanoi, Vietnam. METHODS: Between April 2020 and February 2023, we collected data from PrEP clients at Hanoi Medical University Sexual Health Promotion clinic who were prescribed either ED or daily PrEP at the initial visit; at subsequent visits, clients reported the regimen used since the prior visit. We defined three categories of PrEP use: ED-PrEP exclusively, daily PrEP exclusively and switching regimens. The primary outcome was time to discontinuation in the PrEP programme during the study period, defined as missing a scheduled visit by > 30 days. We performed survival analysis using Kaplan-Meier curves. RESULTS: In total, 2107 people were included: 61.1% (n = 1288) reported exclusive use of daily PrEP, 10.4% (n = 220) reported exclusive use of ED-PrEP and 28.4% (n = 599) reported switching PrEP regimens. Among switchers, 29.40% (n = 176) switched more than once. Furthermore, 82.5% switched from daily to ED-PrEP and 17.5% switched from ED to daily PrEP. The median time to discontinuation in the PrEP programme was 105 days (IQR: 52-182) among those reporting exclusive use of ED-PrEP, 104 days (IQR: 56-274) among those reporting exclusive use of daily PrEP and 163 days (IQR: 101-308) among those who switched. Among switchers, those who switched more than once had a median time to discontinuation in the PrEP programme of 231 days (IQR: 137-380) in comparison to 133 days (IQR: 90-274) for those who switched once. CONCLUSIONS: We provide real-world data from MSM in an HIV PrEP programme in Vietnam that those who switched had longer periods of retention during the study period. Our findings suggest that offering flexible PrEP regimen options may improve engagement and long-term adherence among this population.
Transforming PrEP marketing: understanding the place of PrEP in the hearts and minds of adolescent girls and young women in sub-Saharan Africa.
Donaldson EL, Briedenhann E, Jeckonia P … +3 more , Bishopp C, Greeff A, Nhamo D
J Int AIDS Soc · 2025 Jul · PMID 40600496 · Full text
INTRODUCTION: Adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) remain one of the populations most affected by HIV. As HIV prevention options expand-such as the introduction of the dapivirine ring, long...
INTRODUCTION: Adolescent girls and young women (AGYW) in sub-Saharan Africa (SSA) remain one of the populations most affected by HIV. As HIV prevention options expand-such as the introduction of the dapivirine ring, long-acting injectable cabotegravir and other potential long-acting methods-alongside oral pre-exposure prophylaxis (PrEP), AGYW will have a choice of PrEP methods for HIV prevention, referred to as the PrEP category. Marketing and demand generation must evolve to communicate this choice to AGYW in real-world settings across SSA. METHODS: Using a phased approach to learn, build, iterate and validate, we developed a brand positioning strategy for the PrEP category for AGYW. In 2022, a review of existing and historic oral PrEP campaigns informed initial insights (learn). In 2023, these were further explored and developed with eight young women representatives under the age of 30 (build), then refined with PrEP implementers and Ministry of Health representatives from eight SSA countries (iterate), through five consultative virtual workshops of up to 25 participants each. Insights were funnelled through a private sector marketing framework-the 4C's-to develop a single key brand benefit (KBB), ensuring it was culturally relevant, category-specific, consumer-driven and product (company)-true. The KBB was then creatively applied to posters, narratives and key messages for validation with AGYW (validate). From July to August 2023, 121 AGYW aged 18-24 participated in 16 group discussions to validate the brand positioning strategy; 44 in South Africa (6 groups), 32 in Zimbabwe (4 groups) and 45 in Kenya (6 groups). RESULTS: Post-validation, an optimized KBB emerged: PrEP affirms that self-love is strength-positioning PrEP as a way for AGYW to prioritize their physical health and mental wellbeing, and live a life uninterrupted by HIV. We developed a deeper understanding of the influences shaping AGYW's relationship with the PrEP category, answering: What do AGYW feel in their hearts and think in their minds about PrEP? CONCLUSIONS: This strategic, evidence-informed brand positioning-developed with AGYW, confirms that communication to promote PrEP uptake and continued use must resonate with AGYW's inner strength and frame PrEP use as an act of self-love. It offers a powerful foundation for clear, consistent and inspiring communication that engage and retain AGYW's attention.
Expanding access to a choice-based multi-method PrEP market for HIV prevention.
Naidoo NP, Ayieko J, Fonner VA
J Int AIDS Soc · 2025 Jul · PMID 40600489 · Full text
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Leveraging existing market incentives to increase HIV pre-exposure prophylaxis access in the United States.
Ratevosian J, Piselli C, Sullivan P … +1 more , Nelson LE
J Int AIDS Soc · 2025 Jul · PMID 40600487 · Full text
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PrEP choice in the real world: Results of a prospective cohort study describing uptake and use patterns of oral PrEP and the dapivirine vaginal ring among women in sub-Saharan Africa.
Fonner VA, Irungu E, Conlon M … +32 more , Akello CA, Gwavava E, K'Orimba K, Naidoo NP, Jeckonia P, Mahaka I, Mullick S, Chabela M, Drysdale R, Kabongo J, Kiruki M, Segawa I, Dobbie M, Marake N, Mudiope P, Subedar H, Wafula R, Kazibwe A, Reed J, Kripke K, Taylor D, Lee MT, Chidumwa G, Chivafa A, Soothoane R, Eichleay M, Mayo A, McGuire C, McClure T, Yemeke T, Torjesen K, CATALYST study team
J Int AIDS Soc · 2025 Jul · PMID 40600484 · Full text
INTRODUCTION: HIV incidence remains high among women in Africa, especially adolescent girls and young women (AGYW), despite existing oral pre-exposure prophylaxis (PrEP) programmes. With expanding biomedical prevention o...
INTRODUCTION: HIV incidence remains high among women in Africa, especially adolescent girls and young women (AGYW), despite existing oral pre-exposure prophylaxis (PrEP) programmes. With expanding biomedical prevention options, understanding PrEP use patterns when women are offered choice can inform HIV prevention programming in Africa. METHODS: The CATALYST study offers informed PrEP choice through an enhanced service delivery package for women in 27 public health sites across Kenya, Lesotho, South Africa, Uganda, and Zimbabwe. Women attending sites who were HIV negative and interested in learning about HIV prevention were eligible. We describe uptake and use among those offered choice between oral PrEP and the monthly dapivirine ring from May 2023 through July 2024, explore factors associated with method choice using logistic regression, describe reasons for choice and assess time until PrEP discontinuation using survival analysis. RESULTS: Of 3967 participants, 44.9% were AGYW (15-24 years), 25.5% were sex workers, and 12.2% and 8.7% were breastfeeding and/or pregnant, respectively. At enrolment, 66.2% chose oral PrEP, 29.9% chose the dapivirine ring and 3.5% chose no method. Common reasons for choosing oral PrEP were ease of use (58.6%) and efficacy (31.7%); the ring was chosen due to ease of use (56.9%) and not needing to swallow pills (53.0%). In multivariable analysis, participants ≤ 24 years (p = 0.007) and participants who were pregnant (p = 0.002) or breastfeeding (p < 0.001) had lower odds of choosing the ring. Month 1 return was 32.7% for oral PrEP and 55.2% for the ring. Ring users reported higher adherence as compared to oral PrEP users (p < 0.001). Of participants returning for ≥ 1 PrEP refills, 12.1% switched methods at least once. Median time until PrEP discontinuation was 95 days (95% CI: 91, 110) for those choosing oral PrEP at enrolment and 169 days (95% CI: 139, 190) for those choosing the ring. Risk of discontinuation was greater for participants choosing oral PrEP at enrolment (p < 0.001) and those ≤ 24 years (p < 0.001), PrEP naïve at enrolment (p < 0.001) or not currently using contraception (p = 0.03). CONCLUSIONS: We demonstrated that women took advantage of PrEP choice. PrEP use varied by product, with 1 month return and method continuation higher for the ring. AGYW had a greater risk of discontinuing either method, suggesting more support is needed.
Strategies for implementing long-acting cabotegravir for PrEP in US clinics serving Black women: interim healthcare provider findings from the EBONI study.
Nelson KL, Evans Cooper T, Lawson Y … +18 more , Baker D, Mocherla S, Dieterich M, Hodge T, Dyson A, Sutherland-Philips D, Swygard H, Petty L, Jeffery P, Sutton K, Bonner CP, Andrews SM, Chang S, Budnik P, Smith K, de Ruiter A, Czarnogorski M, Pilgrim N
J Int AIDS Soc · 2025 Jul · PMID 40600480 · Full text
INTRODUCTION: Long-acting cabotegravir (CAB LA) is the first LA agent approved for HIV pre-exposure prophylaxis. EBONI (NCT05514509) is a Phase 4 implementation study evaluating the implementation of CAB LA delivery to B...
INTRODUCTION: Long-acting cabotegravir (CAB LA) is the first LA agent approved for HIV pre-exposure prophylaxis. EBONI (NCT05514509) is a Phase 4 implementation study evaluating the implementation of CAB LA delivery to Black cis- and transgender (cis-and-trans) women in clinics located in the United States, including infectious disease (ID), primary care (PC) and women's health (WH) clinics. We present interim perspectives, considerations and strategies from healthcare professionals' (HCPs') experiences during the initial implementation stages of administering CAB LA. METHODS: From August 2022 to June 2024, through quantitative surveys (prior to implementation [baseline] and Month 4 [M4]) and/or structured qualitative interviews (M4), HCPs provided their perceptions and experiences of integrating CAB LA in their clinical settings that served Black cis-and-trans women. Monthly implementation monitoring (IM) calls were also conducted. Survey data were analysed using descriptive statistics. Qualitative and IM data were coded and analysed using a Framework Analysis approach grounded in the Consolidated Framework for Implementation Research. RESULTS: Ninety-two HCPs across 20 sites completed baseline and M4 surveys; 57% were cisgender female and 43% were Black. HCPs across clinic types developed innovative approaches to support CAB LA implementation, with few HCPs (< 10%) reporting concerns about practice preparation. Initial HCP considerations related to patient adherence, insurance verification and patient identification reduced by M4 (absolute % reduction: 5-14%; 5-9%; and 4-12%, respectively). HCPs across clinic types serving Black women reported successful implementation strategies, including addressing medical mistrust and patient miseducation, staff training and reminder or tracking systems. Useful implementation strategies unique to clinic types included using electronic medical records to document whether patients were offered CAB LA (PC), designating specific days for administering injections (WH) and creating time for discussion with patients (ID). CONCLUSIONS: A range of strategies across clinics that routinely serve Black cis-and-trans women were used to support CAB LA implementation. Implementing CAB LA in clinical settings can be bolstered by addressing population-specific concerns, increasing staff/patient education about CAB LA and modifying clinical flows. Lessons learned in EBONI can help support future integration for Black cis- and transgender women and provide valuable insights for various clinical environments. GOV NUMBER: NCT05514509.
PrEP preferences and early acceptability of injectable cabotegravir among pregnant and lactating people in Cape Town, South Africa: findings from the PrEPared to Choose study.
Wara N, Pike C, Rousseau E … +8 more , Macdonald P, Mapukata P, Leonard B, Lebelo K, Hoffman R, Orrell C, Bekker LG, Davey DJ
J Int AIDS Soc · 2025 Jul · PMID 40600478 · Full text
INTRODUCTION: Providing pregnant and lactating people (PLP) with choice in HIV pre-exposure prophylaxis (PrEP) methods, including long-acting injectable cabotegravir (CAB-LA), may mitigate barriers to effective PrEP use....
INTRODUCTION: Providing pregnant and lactating people (PLP) with choice in HIV pre-exposure prophylaxis (PrEP) methods, including long-acting injectable cabotegravir (CAB-LA), may mitigate barriers to effective PrEP use. We evaluated PrEP preferences and acceptability among PLP offered CAB-LA versus oral PrEP in South Africa. METHODS: The PrEPared to Choose study in Cape Town, South Africa, enrolled young people ages 15-29 at one public clinic and one community-based mobile clinic. Using informed choice counselling, participants were offered oral PrEP or CAB-LA, with the option to switch methods at follow-up visits over 18 months. We report baseline CAB-LA and oral PrEP initiations among PLP in the study, acceptability of their initial choice within 3 months of enrolment and theoretical preferences regarding PrEP methods that may become available to PLP. We report descriptive statistics and use Chi-square and Fisher's exact to compare responses by initiated PrEP method and pregnancy status. RESULTS: From February to August 2024, we enrolled 58 PLP (n = 30 pregnant, n = 28 breastfeeding). Median age 23 years (IQR 19.5-26). Of 30 pregnant participants, 23 (77%) initiated CAB-LA and seven (23%) oral PrEP; among 28 breastfeeding participants, 25 (89%) initiated CAB-LA and three (11%) oral PrEP. Of enrolled PLP, 36 (62%, n = 13 pregnant, n = 23 breastfeeding) completed the acceptability survey. Of these, 83% (n = 12/13 pregnant, n = 20/23 breastfeeding) chose and received CAB-LA, and the remaining (n = 4) chose and received oral PrEP. PLP who received CAB-LA reported liking its ease of use (69%; n = 22/32) and long-acting protection (44%; n = 14/32). Half of CAB-LA users disliked side effects (e.g. injection site pain), although 41% of PLP (n = 13/32) described no CAB-LA dislikes. Almost all (97%; n = 31/32) PLP currently using CAB-LA were interested in continuing CAB-LA, and all PLP using oral PrEP reported interest in trying CAB-LA in the future. Eighty-six percent of surveyed PLP (n = 31/36) did not want to try the dapivirine vaginal ring. CONCLUSIONS: PLP in South Africa had a strong preference for CAB-LA over oral PrEP, and CAB-LA was found to be highly acceptable. Further research is needed to evaluate the effect of offering choice of PrEP methods, including CAB-LA, on PrEP continuation among PLP.
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