Journal Of The International AIDS Society[JOURNAL]
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200 papers
Uptake and patterns of PEP use within the context of a dynamic choice HIV prevention model in rural Uganda and Kenya: SEARCH Study.
Ayieko J, Balzer LB, Aoko C … +8 more , Sunday H, Kakande E, Kabami J, Koss C, Chamie G, Kamya MR, Petersen ML, Havlir DV
J Int AIDS Soc · 2025 Jun · PMID 40569865 · Full text
INTRODUCTION: Post-exposure prophylaxis (PEP) remains underutilized despite being the only prevention option currently available that covers risk after an exposure. We sought to evaluate uptake and patterns of use of PEP...
INTRODUCTION: Post-exposure prophylaxis (PEP) remains underutilized despite being the only prevention option currently available that covers risk after an exposure. We sought to evaluate uptake and patterns of use of PEP among men and women in rural Uganda and Kenya. METHODS: We analysed PEP uptake from three randomized trials enrolling persons aged ≥15 years with HIV risk from antenatal clinics, outpatient departments and community settings from April through August 2021 (NCT04810650). In each trial, participants were randomized to a person-centred, dynamic choice HIV prevention (DCP) model or standard-of-care (SoC) arm. DCP offered choice of biomedical product (oral pre-exposure prophylaxis [PrEP] or PEP) with an option to switch over time; service location (clinic vs. out-of-clinic); testing option (rapid blood-based test or oral HIV self-test). The SoC offered HIV prevention services as per in-country guidelines. In both arms, PEP comprised a 28-day oral Tenofovir/Lamivudine/Dolutegravir course with HIV testing at start and end of the 28-day period. We described patterns of and predictors of self-reported PEP use over the 12 months of follow-up. RESULTS: A total of 1232 participants were enrolled, balanced by arm and country. Of the 1147 (93%) who completed at least one survey on self-reported use of biomedical prevention, the median follow-up time was 12 months [IQR: 11, 12]. Overall, a total of 104 courses of PEP were dispensed to 59 participants. PEP use was significantly higher among persons enrolled in the DCP arm (relative risk [RR] = 3.30; 95% CI: 1.58-6.91), from Uganda (RR = 3.17; 95% CI: 1.53-6.59), reporting alcohol use (RR = 2.20; 95% CI: 1.30-3.72) and men (RR = 2.08; 95% CI: 1.11-3.91). Of the 59 PEP users, 14 (24%) transitioned to PrEP and 28(47%) used PEP on more than one occasion. Multiple uses of PEP were more common among persons from Uganda versus Kenya (RR = 4.43; 95% CI: 1.10-17.80) and persons enrolled from the community (RR = 4.45; 95% CI: 1.89-10.45) versus clinic. There were no seroconversions reported among PEP users. No serious adverse events were reported. CONCLUSIONS: PEP reaches groups such as men and those who use alcohol who are more likely to benefit from this short-term prevention modality than PrEP. There is a need to make PEP accessible within a context of person-centred delivery to optimize its benefits.
Online delivery of oral HIV pre- and post-exposure prophylaxis: findings from the ePrEP Kenya pilot.
Kiptinness C, Naik P, Kareithi T … +22 more , Thuo N, Okello P, Culquichicon C, Rafferty M, Abdulrashid S, Jomo E, Nyamasyo N, Wood T, Mendonca R, Malen RC, Dettinger JC, Pintye J, Mwangi J, Stergachis A, Onentia J, Curran K, Mugambi ML, Were D, Ngure K, Sharma M, Ortblad KF, ePrEP Kenya team
J Int AIDS Soc · 2025 Jun · PMID 40569864 · Full text
INTRODUCTION: The expansion of telecommunication networks and smartphones in many African countries could be leveraged to deliver HIV prevention products directly to consumers. In collaboration with a private e-commerce...
INTRODUCTION: The expansion of telecommunication networks and smartphones in many African countries could be leveraged to deliver HIV prevention products directly to consumers. In collaboration with a private e-commerce platform and online pharmacy in Kenya, MYDAWA, we piloted a new model of HIV pre- and post-exposure prophylaxis (PrEP/PEP) delivery. METHODS: In the ePrEP Kenya pilot (NCT05377138), individuals living in Nairobi and Mombasa Counties could complete a free telehealth visit with a remote clinician to assess eligibility for online PrEP/PEP (i.e. ≥18 years; no medical contraindications). Eligible individuals could order HIV testing services-courier delivered to clients' choice location-for a fee of 250 KES (∼$2 USD) for self-testing or 150 KES (∼$1 USD) for provider-administered rapid diagnostic testing. Following confirmation of clients' HIV-negative status (via an uploaded test result image), free PrEP/PEP drugs from government supply were courier delivered with or separately from HIV testing services. Clients paid a delivery fee ≤149 KES (∼$1 USD) per courier visit. RESULTS: From October 2022 to December 2023, we screened 2257 individuals and enrolled 1915. Most PrEP/PEP clients were men (63%, 1428/1915), ≥25 years (72%, 1631/1915) and never married (80%, 1796/1915); few had ever used PrEP (3%, 48/1915) or PEP (14%, 263/1915). At enrolment, 227 (12%) were preliminarily eligible for PrEP and 1688 (88%) for PEP. Among PrEP-eligible clients, 89% (203/227) completed HIV testing and 92% (208/227) received PrEP; among PEP-eligible clients, 92% (1551/1688) completed HIV testing and 92% (1549/1688) received PEP. Most PrEP/PEP clients completed HIV testing within 6 hours of their telehealth visit (53%, 927/1757) and had drugs delivered with testing services (88%, 1546/1757). Among PrEP clients eligible for follow-up, 47% (120/256) continued PrEP and 4% (10/256) initiated PEP following PrEP discontinuation. Among PEP clients eligible for follow-up, 7% (99/1428) repeated PEP use and 6% (83/1428) transitioned from PEP to PrEP.). CONCLUSIONS: Online PrEP/PEP delivery could expand access to prevention services by reaching individuals not engaged in existing delivery platforms. The uptake of online PEP was five times greater than PrEP, underscoring an unmet demand for PEP and highlighting the potential for online pharmacies to deliver time-sensitive PEP services.
HIV Post Exposure Prophylaxis: prospects, opportunities and challenges.
Fox J, Sibanda EL, Godfrey-Faussett P
J Int AIDS Soc · 2025 Jun · PMID 40569861 · Full text
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Strengthening post-exposure prophylaxis uptake among survivors of sexual violence through immediate access at police stations in Nigeria's Federal Capital Territory.
Adewumi B, Cain M, Kanagasabai U … +14 more , Dahal S, Collins-Kalu D, Ayuba AM, Adamu V, Efuntoye T, Ayeni C, Omuh H, Nwafor C, Ajuwon AR, Oluwaniyi O, Dakum P, Oki-Emesim R, Daggash F, Fagbamigbe O
J Int AIDS Soc · 2025 Jun · PMID 40569860 · Full text
INTRODUCTION: Data on sexual violence (SV) prevalence in Nigeria is limited; however, 2014 data indicate that 24.8% of females aged 18-24 years experienced SV in childhood and only 3.5% received any form of services. Ini...
INTRODUCTION: Data on sexual violence (SV) prevalence in Nigeria is limited; however, 2014 data indicate that 24.8% of females aged 18-24 years experienced SV in childhood and only 3.5% received any form of services. Initiation of post-exposure prophylaxis (PEP) to prevent HIV acquisition following SV is most effective when started immediately and is not recommended after 72 hours. Police stations are often entry points for survivors; however, lengthy processes may result in delays and missed PEP opportunities. Using an ongoing phased approach, we introduced PEP into selected police stations in Nigeria's Federal Capital Territory in order to explore expanding access to time-sensitive HIV prevention within non-health services. METHODS: Our intervention phase consisted of the provision of training of police officers and the provision of PEP starter packs coupled with linkage to referral facilities. During two time periods (pre-intervention: January-March 2023) and (during intervention: July-September 2023), we evaluated routinely reported programme data from 27 U.S. Centers for Disease Control and Prevention-supported health facilities for changes in the provision of SV services and PEP initiation. We used geospatial mapping to assess the proximity of participating health facilities to police stations and to see changes in both SV and PEP service provision. The statistical significance of the difference in PEP uptake proportion during the two periods was determined using the Wilcoxon signed rank test at a 0.05 level of significance. RESULTS: Of the total 27 health facilities, 24 were within a 5-km radius of a participating police station. Total SV service provision increased from 114 cases to 218 cases, representing a 91.2% increase and with most of this increase seen among females. PEP initiation increased by 289.3% at the two time points, with 56 initiations pre-intervention to 218 PEP initiations during the intervention. CONCLUSIONS: Our findings showed promise in increasing immediate access to PEP in non-health services and highlighted the feasibility of police stations and health facilities collaboration to address urgent health needs. There was an overall increase in PEP initiations by referral and non-referral facilities which could be the result of demand creation and increased access at police stations.
Factors associated with PEP awareness among adolescent girls and young women in Eswatini.
Laterra A, Miedema SS, Li M … +10 more , Mndzebele P, Nzuza-Motsa N, Charania SN, Ong K, Cain M, Kanagasabai U, Mkhonta T, Chiang L, Annor FB, Adler MR
J Int AIDS Soc · 2025 Jun · PMID 40569858 · Full text
INTRODUCTION: In Eswatini, HIV incidence among adolescent girls and young women (AGYW), aged 15-24 years, is 10 times that of their male peers. Despite the World Health Organization's 2014 recommendation for post-exposur...
INTRODUCTION: In Eswatini, HIV incidence among adolescent girls and young women (AGYW), aged 15-24 years, is 10 times that of their male peers. Despite the World Health Organization's 2014 recommendation for post-exposure prophylaxis (PEP) to be available for all HIV exposures, it has been underutilized among youth. PEP is an effective prevention method, and a better understanding of the characteristics, risk factors and behaviours that are associated with PEP awareness, as a precursor to effective use, is needed. METHODS: Using data from the 2022 Eswatini Violence Against Children and Youth Survey, we used logistic regression models to explore the relationships between PEP awareness and a set of hypothesized explanatory variables among AGYW aged 13-24 years who had ever had sex (N = 2648). Explanatory variables included socio-demographic characteristics, sexual risk factors and sexual health behaviours. RESULTS: A slight majority (57.3%) of AGYW who had ever had sex were aware of PEP as an HIV prevention method. PEP awareness increased with age (aOR 1.1, 95% CI 1.0, 1.1) and was higher among AGYW who had a sexual partner whose age was 5 or more years older in the past 12 months (aOR 1.4, 95% CI 1.1, 1.9), those who had ever taken part in an HIV prevention programme (aOR 1.6, 95% CI 1.2, 2.3) and those who had ever heard of pre-exposure prophylaxis (aOR 8.1, 95% CI 6.4, 10.2). Participants who were ever married or partnered (aOR 0.7, 95% CI 0.5, 1.0) and those who engaged in inconsistent condom use with non-spouse/main partner or multiple partners in the past 12 months (aOR 0.8, 95% CI 0.6, 1.00) had lower odds of knowing about PEP in the adjusted model. CONCLUSIONS: We identified sub-optimal PEP awareness among Swazi AGYW who had ever had sex. Our findings suggest that engagement in HIV prevention programmes increased PEP awareness and that knowing about pre-exposure prophylaxis (PrEP) was associated with PEP awareness. Future efforts could include tailored PEP awareness activities and campaigns to resonate with AGYW at elevated risk of HIV and integration of PEP education into routine sexual and reproductive service delivery and school-based HIV curriculum.
Do we need a regulatory path for HIV post-exposure prophylaxis?
Miller V, Schaefer R
J Int AIDS Soc · 2025 Jun · PMID 40569853 · Full text
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Implementing the new WHO guidelines on HIV post-exposure prophylaxis: perspectives from five African countries.
Magni S, Byamukama D, Haske MS … +3 more , Mukami J, Moyo I, Auerbach JD
J Int AIDS Soc · 2025 Jun · PMID 40569845 · Full text
INTRODUCTION: Post-exposure prophylaxis (PEP) is an important component of comprehensive HIV prevention, yet its uptake has been suboptimal globally. In July 2024, the World Health Organization (WHO) updated its global g...
INTRODUCTION: Post-exposure prophylaxis (PEP) is an important component of comprehensive HIV prevention, yet its uptake has been suboptimal globally. In July 2024, the World Health Organization (WHO) updated its global guidance on PEP to include two new recommendations intended to increase timely access to and delivery of PEP. These recommendations specifically aim to expand both where PEP can be delivered, to include community settings, and who can provide PEP, to include community health workers and task-sharing. The practical realities of adopting new public health guidelines to achieve the intended benefits in most contexts are complex. Articulating these realities is important for identifying what will be required to ensure the feasibility of expanded PEP access in community settings. DISCUSSION: We provide stakeholder perspectives from five African countries-Kenya, Nigeria, South Africa, Uganda and Zimbabwe-on both barriers to and strategies for implementing the new WHO PEP recommendations. These perspectives are informed by experiences in these countries that were shared at a recent workshop and highlight key themes related to PEP uptake and use: awareness and acceptability; administration and monitoring; policy alignment, including regulatory considerations; logistics; integration of services; stakeholder involvement and capacity building; and linking PEP and PrEP more directly. Running across these themes are the roles of socio-cultural norms and the need for increased resources to pay for implementing the recommendations, including capacity strengthening and monitoring in communities. CONCLUSIONS: While significant challenges exist to expanding PEP access in community settings and through task-sharing, there are examples from our countries of successful efforts to mitigate them by leveraging existing community resources and capacities in innovative ways. Additional efforts will require engagement across multiple stakeholders to address remaining awareness gaps, logistical and regulatory obstacles, and political will. As countries work to update their guidelines and align with the new WHO recommendations, continued collaboration and innovation within and across countries will be essential to realize the full potential of PEP in comprehensive HIV prevention efforts.
Age-specific all-cause mortality rates among adolescents and youth living with and without HIV: Evidence from a cohort study in South Africa.
Zhou S, Toska E, Gwampi B … +6 more , Johnson LF, Tolmay J, Saal W, Leon Z, Knight L, Cluver L
J Int AIDS Soc · 2025 Jun · PMID 40556491 · Full text
INTRODUCTION: Mortality among adolescents living with HIV (ALHIV) remains a global health problem. We lack granular (age- and sex-disaggregated) data on mortality among ALHIV, hence, this study aims to assess all-cause m...
INTRODUCTION: Mortality among adolescents living with HIV (ALHIV) remains a global health problem. We lack granular (age- and sex-disaggregated) data on mortality among ALHIV, hence, this study aims to assess all-cause mortality among ALHIV in a low-resource setting. METHODS: All adolescents ever initiated on antiretroviral treatment (ART, N = 1107) and their HIV-negative peers (N = 456) aged 10-19 years, recruited as part of the Mzantsi Wakho study cohort, were followed up between 2014 and 2022 (yielding 12,427.7 person-years of follow-up). First, we assessed the proportion of deaths and estimated crude mortality incidence rates per 100 person-years of follow-up and their 95% confidence intervals, stratified by HIV status, sex and mode of HIV acquisition (vertical vs. sexual). We then estimated adjusted incidence rate ratios (IRRs) using Poisson regression adjusted for time-varying age, sex and time on ART. Last, we used the Cox proportional hazards regression model to estimate the risk of death by ART adherence. RESULTS: A total of 1563 adolescents and young people were included in this analysis, 70.8% ALHIV and 57% female. More deaths occurred in ALHIV compared to their HIV-negative peers (8.3% vs. 0.4%, p<0.001). Among ALHIV, we observed a significantly higher proportion of deaths among males compared to females (10.7% vs. 7.1%, p = 0.036). Overall, mortality increased significantly with age, and males had a higher risk of mortality compared to females. Adolescents and youth living with vertically acquired HIV had a higher risk of mortality than those living with sexually acquired HIV. Comparing mortality rates by mode of HIV acquisition stratified by age and sex, mortality risk was higher among females aged 20+ years with vertically acquired HIV (IRR: 3.61, 95% CI 1.48-8.82) compared to females with sexually acquired HIV of the same age group. In a sub-sample analysis, sustained ART adherence was associated with a lower risk of death (aHR: 0.44, 95% CI 0.23-0.85). CONCLUSIONS: ALHIV experience higher all-cause mortality than their HIV-negative peers, despite having initiated ART. Among ALHIV, mortality risk was higher among males and adolescents who acquired HIV vertically. Strategies to improve survival among ALHIV, including adolescent-tailored care and support for adherence to ART, are urgently needed.
The unintended outcome: a retrospective cross-sectional study using a urine lateral flow assay to detect ART use reveals non-disclosure of taking ART in South Africa's public health system.
Sithole N, Govender I, Spinelli M … +14 more , Smit T, Cibane S, Zwane M, Phakathi N, Krows M, Nkosi B, Seeley J, Barnabas RV, Siedner MJ, Moshabela M, Celum C, Grant A, Gandhi M, Shapiro AE
J Int AIDS Soc · 2025 Jun · PMID 40551583 · Full text
INTRODUCTION: Differentiated service delivery (DSD) models for HIV and tuberculosis (TB) care prioritize efficient resource allocation and targeted interventions, and benefit from accurate assessment of patients' antiret...
INTRODUCTION: Differentiated service delivery (DSD) models for HIV and tuberculosis (TB) care prioritize efficient resource allocation and targeted interventions, and benefit from accurate assessment of patients' antiretroviral therapy (ART) pill-taking status. Accurate ART use identification is essential for ensuring proper care transition services rather than unnecessary initiation. A point-of-care urine tenofovir (TFV) assay may identify undisclosed ART use in settings with high rates of TB and HIV coinfection. METHODS: A cohort of people living with HIV (PWH) presenting for routine care, including newly diagnosed and those returning to care, and reporting no ART use within 90 days, was enrolled in a clinic-based cross-sectional study of TB prevalence which tested for TB using sputum and urine-based TB tests in two clinics in KwaZulu-Natal, South Africa. CD4 counts were determined at the time of ART initiation, per national guidelines. A novel urine-based lateral flow assay (LFA) which detects TFV ingested within the past 4-7 days was used to assess ART use from thawed urine samples, which were collected concurrently with the self-report assessment. Conditional logistic regression models assessed predictors of ART non-disclosure. RESULTS: Between 12/2021 and 5/2024, 404 PWH (40% male) reporting no recent ART use presented for ART initiation. TB testing identified 14 (3%) PWH with undiagnosed TB. Seventy-nine (20%) had detectable TFV in urine indicating undisclosed ART use, with a median CD4 count of 466 cells/mm (IQR 277-625) compared to 322 cells/mm (IQR 175-490, p = 0.001) in those without undisclosed ART use. In a multivariable model, undisclosed ART use was associated with older age, rural clinic site, higher CD4 count and having active TB, but not with gender, education or employment. CONCLUSIONS: Among people presenting for HIV treatment initiation, 20% had evidence of ART use within 4-7 days by TFV urine LFA testing. Integration of point-of-care urine TFV assays into DSD models of HIV care may support providers to engage PWH about treatment challenges, address potential barriers to disclosure and facilitate seamless transfers between clinics. If successful, this strategy may reduce duplicative care entries and promote more efficient use of resources.
Effectiveness of islatravir post-exposure prophylaxis after intravenous challenge with simian immunodeficiency virus in rhesus macaques.
Markowitz M, Gettie A, St Bernard L … +8 more , Grasperge B, Vargo R, Pham M, Fillgrove K, Dube N, Diamond TL, Hazuda DJ, Grobler JA
J Int AIDS Soc · 2025 Jun · PMID 40534150 · Full text
INTRODUCTION: Islatravir (ISL) is a nucleoside reverse transcriptase translocation inhibitor (NRTTI) with robust antiretroviral activity. The efficacy of ISL administered for post-exposure prophylaxis (PEP) was evaluated...
INTRODUCTION: Islatravir (ISL) is a nucleoside reverse transcriptase translocation inhibitor (NRTTI) with robust antiretroviral activity. The efficacy of ISL administered for post-exposure prophylaxis (PEP) was evaluated in a simian immunodeficiency virus (SIV) rhesus macaque intravenous (IV) challenge model. METHODS: Twelve rhesus macaques were challenged with SIVmac251 via IV administration. After 24 hours, six animals received ISL 3.9 mg/kg (the minimum effective dose that gives maximal protection) and six animals were untreated controls. In stage 1, treated animals received 4 weekly oral doses of ISL and were monitored for SIV infection for 7 weeks after the last dose. In stage 2, uninfected, treated animals from stage 1 were challenged similarly; 24 hours after challenge, 3 weekly oral doses of ISL 3.9 mg/kg were initiated. The treated animals were monitored for 7 weeks, as in stage 1. Uninfected, treated animals (from stage 2) entered stage 3. In stage 3, the animals were challenged as in stage 2; 24 hours after challenge, 2 weekly oral doses of ISL 3.9 mg/kg were initiated. The treated animals were monitored for 7 weeks, as before. Finally, in stage 4, uninfected, treated animals were challenged using IV administration and 24 hours later were treated with a single oral dose of ISL 3.9 mg/kg and monitored for 7 weeks. Infection was monitored through plasma viral RNA and proviral DNA amplification. Virus-specific antibody responses were measured using a commercial assay. ISL concentrations in plasma and ISL triphosphate (ISL-TP) levels in peripheral blood mononuclear cells were measured longitudinally. RESULTS: All untreated controls were viraemic 7 days after SIVmac251 IV challenge. All six ISL-treated animals were completely protected in stages 1-3 (Fisher exact test p = 0.0022). In stage 4, two of six ISL-treated animals became infected with wild-type SIVmac251: viraemia was observed at days 14 and 49 in the two animals (Fisher exact test p = 0.06). Both animals had unquantifiable ISL-TP on the day viraemia was observed. CONCLUSIONS: Two weekly oral doses of ISL 3.9 mg/kg, administered 24 hours post IV SIV exposure, prevents infection of rhesus macaques. These results support further investigation of a long-acting oral NRTTI for PEP.
Factors associated with awareness of and willingness to use PrEP among stable, heterosexual HIV-serodifferent couples in seven African countries, 2019-2022.
Sharpe JD, Laws RL, West CA … +20 more , Djomand G, Omolo J, Ramaabya D, Li M, Dlamini S, Motebang M, Marake N, Singano V, Ozituosauka W, McCabe C, Sathane I, Kancheya N, Chisenga T, Malaba R, Ncube G, Philip NM, Biraro S, Charurat ME, Rolle I, Voetsch AC
J Int AIDS Soc · 2025 Jun · PMID 40534141 · Full text
INTRODUCTION: HIV pre-exposure prophylaxis (PrEP) is an effective biomedical intervention for preventing HIV; however, PrEP adoption initially lagged across sub-Saharan Africa (SSA) and may have been affected by barriers...
INTRODUCTION: HIV pre-exposure prophylaxis (PrEP) is an effective biomedical intervention for preventing HIV; however, PrEP adoption initially lagged across sub-Saharan Africa (SSA) and may have been affected by barriers to engagement in PrEP care. Stable, heterosexual HIV-serodifferent couples are a priority population of PrEP expansion efforts. We assessed factors associated with PrEP awareness and willingness among HIV-serodifferent couples in SSA to guide PrEP interventions for this population. METHODS: We conducted a cross-sectional analysis using pooled data from nationally representative, two-stage cluster sampling, HIV-focused household surveys completed during 2019-2022 in seven African countries. We analysed data from 1738 persons without HIV aged ≥15 years in stable, heterosexual HIV-serodifferent couples and included clinical information from their partners with HIV. Higher HIV risk was defined by unawareness of a partner's HIV-positive status or having a partner with an unsuppressed viral load (≥200 copies/ml). Lower HIV risk was defined by awareness of a partner's HIV-positive status and having a partner with a suppressed viral load (<200 copies/ml). We conducted multivariable logistic regression using survey weights and jackknife variance estimation to assess factors associated with PrEP awareness and willingness. RESULTS: Overall, 18.1% were aware of PrEP, 69.1% were willing to use PrEP and 5.1% had ever used PrEP. Forty-four percent had higher HIV risk. Higher odds of PrEP awareness were associated with being female (adjusted odds ratio [aOR]: 1.73; 95% confidence interval [CI]: 1.15-2.59), secondary education or higher (aOR: 6.42; 95% CI: 2.97-13.91) and lower HIV risk (aOR: 1.58; 95% CI: 1.00-2.48). Higher odds of PrEP willingness were associated with employment in the past year (aOR: 1.55; 95% CI: 1.01-2.37), previous PrEP awareness (aOR: 2.44; 95% CI: 1.36-4.36) and lower HIV risk (aOR: 1.70; 95% CI: 1.07-2.70). CONCLUSIONS: Persons in stable, heterosexual HIV-serodifferent couples with lower HIV risk were more aware of and willing to use PrEP than those with higher risk. Our findings highlight the importance of encouraging HIV status disclosure, educating about HIV-serodifference and PrEP, and providing PrEP linkage during HIV testing and prevention counselling to increase PrEP awareness, willingness and use among HIV-serodifferent couples in SSA.
Characterizing the HIV care continuum among children and adolescents with HIV in eastern and southern Africa in the era of "Universal Test and Treat": A systematic review and meta-analysis.
Haw NJL, Banegas M, Lujintanon S … +5 more , Fairlie L, Bwakura-Dangarembizi M, Agwu A, Ng DK, Lesko CR
J Int AIDS Soc · 2025 Jun · PMID 40515449 · Full text
INTRODUCTION: The "Universal Test and Treat" (UTT) era for antiretroviral therapy (ART) increased HIV service delivery to children and adolescents aged 0-19 with HIV. The goal is to reach ≥95% of people with HIV diagnose...
INTRODUCTION: The "Universal Test and Treat" (UTT) era for antiretroviral therapy (ART) increased HIV service delivery to children and adolescents aged 0-19 with HIV. The goal is to reach ≥95% of people with HIV diagnosed, receiving ART and virally suppressed. We conducted a systematic review and meta-analysis to describe the care continuum among children and adolescents with HIV during the UTT era in the UNAIDS eastern and southern African region. METHODS: We searched PubMed, EMBASE and African Index Medicus databases for peer-reviewed articles published from 1 January 2010 to 1 June 2023. We included studies reporting ≥1 care continuum proportion in ≥1 country in the study region during the country's UTT implementation. We extracted summary proportions and pooled them using random-effects logistic regression. RESULTS: Of 10,281 studies screened, 190 met the inclusion criteria. Studies came from 16 countries; many from South Africa (n = 37) and Ethiopia (n = 32). The meta-analysis pooled proportions (95% confidence intervals) for children aged 0-14 were: 72% (60%, 81%) aware of HIV diagnosis; 95% (89%, 97%) on ART among diagnosed; 88% (76%, 95%) retained in HIV care after 12 months on ART; 77% (68%, 84%) self-/caregiver-reported ART adherence; 90% (79%, 95%) had a viral load test after ART initiation; and 76% (72%, 79%) viral suppression (<1000 copies/ml) while on ART with a viral load test. Similar proportions were estimated among adolescents aged 15-19: 73% (66%, 79%) diagnosed; 93% (92%, 94%) on ART; 80% (54%, 93%) retained; 74% (63%, 83%) adherent; 90% (79%, 95%) viral load test; and 78% (74%, 81%) viral suppression. DISCUSSION: Estimates from this study on diagnosis, ART initiation and viral suppression were consistent with UNAIDS official estimates. Estimates on retention, adherence and viral suppression were similar to previous meta-analyses conducted before UTT. CONCLUSIONS: Consistent with UTT expectations, most children and adolescents with HIV in eastern and southern Africa have initiated ART, but challenges remain on other care continuum indicators. Future planning for HIV programmes should consider locally informed, community-supported approaches to consistently support children and adolescents with HIV throughout the HIV care continuum.
REPRIEVE final results: What does it mean for guidelines in low- and middle-income countries?
Sokhela S, Manne-Goehler JM, Lalla-Edward S … +7 more , Siedner MJ, Ali MK, Hill A, Mody A, Pozniak A, Nel J, Venter WDF
J Int AIDS Soc · 2025 Jun · PMID 40495360 · Full text
INTRODUCTION: The REPRIEVE study demonstrated significant reductions in major adverse cardiovascular events (MACE) with pitavastatin among people living with HIV (PWH) with low to moderate cardiovascular risk. Most MACE...
INTRODUCTION: The REPRIEVE study demonstrated significant reductions in major adverse cardiovascular events (MACE) with pitavastatin among people living with HIV (PWH) with low to moderate cardiovascular risk. Most MACE events occurred in higher-income countries, raising important considerations for similar primary prevention interventions within HIV programmes in low- and middle-income countries (LMICs) as antiretrovirals become safer and as PWH age. DISCUSSION: Limited data from Africa and within REPRIEVE suggests that MACE may not be as prevalent among PWH as within other geographies. Consequently, there remain questions about the appropriateness of extrapolating REPRIEVE data to the region and whether it should motivate programmatic implementation on the continent. Moreover, glucose and lipid screening used in REPRIEVE raise concerns about additional resources for similar screening, where there is little existing infrastructure and subsequent treatment. Similarly, questions around funding priorities, and health worker resource allocation for MACE prevention, particularly in the context of competing health priorities and limited health financing, need to be addressed. Newer cardiovascular medications, with cardiac, renal, hepatic, diabetes and weight loss benefits, may have greater promise, although cost remains a major concern. Finally, successful implementation with statins or other proven interventions will be unlikely, unless systemic change within non-communicable disease health system delivery programmes occurs first. However, HIV programmes and public health systems more generally have shown themselves to be poor at screening and treating other cardiovascular risk factors, including aspects as simple as raised blood pressure, even in high-income countries, and statins remain grossly under-prescribed for primary and secondary prevention internationally. CONCLUSIONS: REPRIEVE turned a spotlight on how ill-prepared current HIV programmes are to implement the simplest and safest primary care prevention interventions for cardiometabolic disease within LMICs. As data for existing and new interventions become available, HIV delivery systems will need to raise their standard beyond simply prescribing antiretrovirals and taking viral loads.
Correction to PrEP use and willingness cascades among GBMSM in 15 Asian countries/territories: An analysis of the PrEP APPEAL survey.
J Int AIDS Soc · 2025 Jun · PMID 40495350 · Full text
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HIV drug resistance, early treatment outcomes and impact of guidelines compliance after protease inhibitor-based second-line failure in a dedicated resistance clinic in western Kenya: a retrospective cohort study.
Humphrey JM, Ali SM, DeLong A … +9 more , Novitsky V, Sang E, Jawed B, Kemboi E, Ngetich C, Goodrich S, Gardner A, Hogan JW, Kantor R
J Int AIDS Soc · 2025 Jun · PMID 40490983 · Full text
INTRODUCTION: Data on drug resistance, viral outcomes and guidelines compliance following protease inhibitor (PI)-based second-line failure in low- and middle-income countries are limited, particularly in the era of dolu...
INTRODUCTION: Data on drug resistance, viral outcomes and guidelines compliance following protease inhibitor (PI)-based second-line failure in low- and middle-income countries are limited, particularly in the era of dolutegravir-containing antiretroviral therapy (ART). METHODS: We conducted a retrospective cohort study of people living with HIV (PLWH) ≥3 years old with second-line viral failure (VF, ≥1000 copies/ml) at the Academic Model Providing Access to Healthcare from 2011 to 2021. We assessed resistance prevalence and patterns at second-line VF, stratified by PI (atazanavir/ritonavir or lopinavir/ritonavir), and examined correlations of resistance and treatment strategies with VF at 6-18 months post-genotype. Analyses employed inverse probability weighting, adjusting for calendar year, age, gender, ART duration, PI at genotyping and class-specific resistance, and considered guidelines-supported versus unsupported strategies. RESULTS: Of 187 participants (median age 41 years, 54% female, 41% on atazanavir/ritonavir, 59% on lopinavir/ritonavir-based ART), 91% had any resistance (NRTI 79%, NNRTI 80%, major PI 37%, dual-class 36%, triple-class 37%). Predicted resistance to third-line options was 67% for etravirine or rilpivirine and 10% for darunavir/ritonavir. Despite higher resistance detected on atazanavir/ritonavir versus lopinavir/ritonavir, predicted darunavir/ritonavir resistance was similar. At median 9 months post-genotype, 95% of 173 participants with available data were on a guidelines-supported regimen (55% second-line; 45% third-line, 86% dolutegravir-based), of whom 28% had post-genotype VF. Of the 5% not on guidelines-supported regimens, 71% had post-genotype VF. Adjusted odds of VF were higher for guidelines-unsupported versus supported regimens (OR = 4.52; 95% CI 1.02-26.24), and odds of VF were 97% lower for those on third-line versus second-line (OR = 0.07; 95% CI 0.02-0.20). CONCLUSIONS: We found high levels of drug resistance and early VF following PI-based second-line failure in Kenya. Treatment guidelines compliance and switches to third-line, even within guidelines recommendations, improved early viral outcomes. Findings highlight the vulnerability of PLWH with advanced ART experience and resistance profiles, and the importance of following guidelines and improving access to third-line and drug resistance testing, particularly in the new ART era.
Correction to Evaluation of point-of-care diagnostics for sexually transmitted infection on oral PrEP initiation and persistence among young people in South Africa: a randomized controlled study.
J Int AIDS Soc · 2025 Jun · PMID 40474537 · Full text
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Risk of suicide in people living with HIV: A nationwide, retrospective population-based cohort study in South Korea.
Oh TK, Song KH, Heo E … +2 more , Park HY, Song IA
J Int AIDS Soc · 2025 Jun · PMID 40474535 · Full text
INTRODUCTION: There is a paucity of studies that compare suicide- and non-suicide-related deaths, with strict adjustments for people living with human immunodeficiency virus (HIV; PLWH) and those without HIV. We, therefo...
INTRODUCTION: There is a paucity of studies that compare suicide- and non-suicide-related deaths, with strict adjustments for people living with human immunodeficiency virus (HIV; PLWH) and those without HIV. We, therefore, aimed to determine whether the risk of suicide differs between these groups. METHODS: This study included all PLWH diagnosed with HIV in South Korea between 1 January 2017 and 31 December 2017. Individuals who had never been diagnosed with HIV were selected as controls using 1:10 stratified random sampling, considering age and sex. The heterogeneity of covariates between PLWH and controls was decreased by 1:5 propensity score matching. The endpoint of the study was death by suicide, with follow-up from 1 January 2018 to 31 December 2022. Death that was not ruled as a suicide was categorized as being due to other causes. RESULTS: After propensity score matching, 22,415 PLWH (mean age 45.9 years; 91% male) and 96,790 controls (mean age 45.8 years; 90.5% male) were included in the final analysis. Within 5 years, 104 (0.5%) of PLWH and 246 (0.3%) of controls died by suicide. Cox regression analysis revealed a 1.84-fold higher risk of suicide among PLWH compared with controls (hazard ratio [HR], 1.84; 95% confidence interval [CI], 1.46-2.31; p < 0.001). Moreover, 836 (3.7%) of 22,415 PLWH and 2882 (3.0%) of 96,790 controls died of other causes within 5 years. Cox regression analysis also revealed a 1.26-fold increase in the risk of mortality due to other causes among PLWH (HR: 1.26; 95% CI, 1.17-1.36; p < 0.001). CONCLUSIONS: This analysis of a South Korean cohort found higher rates of death due to suicide and other causes among people living with and without HIV. The risk of death by suicide was higher than that of other causes among PLWH.
Household economic impact of HIV-associated cryptococcal meningitis in five countries in Southern and Eastern Africa.
Lawrence DS, Muthoga C, Adams J … +30 more , Ndweni AB, Boulware DR, Chawinga C, Comins K, Dziwani EN, Hlupeni A, Hosseinipour MC, Jjunju S, Kanyama C, Leeme TB, Meintjes G, Meya DB, Mosepele M, Moyo M, Mwandumba HC, Muzoora C, Ndhlovu CE, Nuwagira E, Schutz C, Tugume L, Williams D, Molloy SF, Boyer-Chammard T, Youssouf N, Jaffar S, Niessen LW, Harrison TS, Cunnama L, Jarvis JN, AMBITION Study Group
J Int AIDS Soc · 2025 Jun · PMID 40474529 · Full text
INTRODUCTION: HIV-associated cryptococcal meningitis is the second leading cause of AIDS-related mortality. Cryptococcal meningitis is a poverty-related disease and the majority of cases occur in settings where resources...
INTRODUCTION: HIV-associated cryptococcal meningitis is the second leading cause of AIDS-related mortality. Cryptococcal meningitis is a poverty-related disease and the majority of cases occur in settings where resources are limited and access to quality care is often linked to an individual's ability to pay for services. We have previously demonstrated the efficacy, safety and cost-effectiveness of a single, high-dose liposomal amphotericin-based treatment regimen within the AMBITION-cm trial. Here, we present a five-country, within-trial analysis exploring the household economic impact of cryptococcal meningitis. METHODS: Eight hundred and ten participants were recruited into this sub-study in Botswana, Malawi, South Africa, Uganda and Zimbabwe between January 2018 and February 2021. We collected data on annual household expenditure, direct costs and indirect costs incurred prior to enrolment and during the 10-week trial period. Costs were inflated and converted to 2022 USD. We calculated out-of-pocket expenditure, lost income and catastrophic healthcare expenditure, defined as costs exceeding 20% of annual household expenditure. RESULTS: The average total out-of-pocket expenditure plus lost income prior to enrolment was $132 and 17.9% (145/810, 95% CI 15.3-20.5) of participant households had already experienced catastrophic healthcare expenditure. Among the 592 surviving participants, when combining out-of-pocket expenditure and lost income, the average cost was $516 and 29.1% of annual household expenditure across all countries, ranging from $230 (7.6%) in South Africa to $592 (64.2%) in Zimbabwe. More than half (296/581, 51.0%, 95% CI 46.9-55.0) of households experienced catastrophic healthcare expenditure by the end of the trial, ranging from 16.0% (13/81, 95% CI 7.9-24.2) in South Africa to 68.1% (156/229, 95% CI 62.0-74.2) in Uganda. CONCLUSIONS: This is the first study exploring the household economic impact experienced by those diagnosed with cryptococcal meningitis. The household economic impact of cryptococcal meningitis is high and more than half of households of individuals who survive experience catastrophic healthcare expenditure. It is likely these figures are higher outside of the research setting. This highlights the profound financial impact of this devastating infection and provides a rationale to offer financial and social protection to those affected. TRIAL REGISTRATION NUMBER: ISRCTN72509687.
Measuring mobility in HIV research in sub-Saharan Africa: a scoping review.
Khalifa A, Wallach S, Grabowski MK … +4 more , Duncan DT, Nalugoda F, Abdool Karim Q, Mathema B
J Int AIDS Soc · 2025 Jun · PMID 40474522 · Full text
INTRODUCTION: Mobility-from overnight travel to permanent migration-can reduce service access and increase HIV risk, driving the epidemic in sub-Saharan Africa (SSA). This scoping review described mobility measures used...
INTRODUCTION: Mobility-from overnight travel to permanent migration-can reduce service access and increase HIV risk, driving the epidemic in sub-Saharan Africa (SSA). This scoping review described mobility measures used in HIV research to identify gaps and guide research on mobility to strengthen HIV responses in SSA. METHODS: Literature from three databases (PubMed, Embase, Web of Science) were systematically screened to identify research articles examining relationships between mobility and individual-level HIV-related outcomes in SSA from 2014 through 2023. Key terms for mobility included "mobility," "movement," "migration" and "travel." Measures were first extracted according to International Organization of Migration definitions of migration (a change in the place of usual residence) and travel (movement between geographies). Then, metrics used to categorize or quantify mobility were organized by the stage (origin, transit, destination, return) and dimension (spatial, temporal, socio-structural) of the movement captured. Measures were analysed within three research contexts: the HIV outcome(s) of interest, study population and local geographies. Outcomes included HIV acquisition, AIDS-related death, and indicators along the prevention, care and treatment cascade. RESULTS: We identified 69 studies after screening 5343 titles/abstracts and 200 full texts for eligibility. Studies included research from 16 countries, mostly representing general adult populations in eastern and southern Africa. Most studies measured migration (51) versus travel (21) and examined relationships with HIV prevalent infection (29) or care and treatment indicators (44) compared to other epidemiological and programmatic outcomes. Studies employed a range of metrics, mostly of the duration of stay at the destination (28), the number of mobility events (12) or the geographic boundaries across which individuals moved (14). Socio-structural dimensions like the motivation for movement were measured less often. Only 15 studies examined more than one dimension. DISCUSSION: Mobility measures varied widely and were inconsistently studied across research contexts. Future studies should fill evidence gaps, standardize reporting and develop multidimensional mobility measures tailored to local settings and HIV outcomes. CONCLUSIONS: People on the move are a vast and diverse group, yet they are often labelled as a monolith. Improved measures can disentangle how different forms of mobility relate to HIV, generating actionable evidence to enhance HIV programming for ending the epidemic.
Postnatal prophylaxis and the use of presumptive HIV therapy for the prevention of vertical transmission of HIV in Canada 1997-2020.
Brochon J, Lee T, Brophy J … +10 more , Singer J, Metras ME, Comeau J, Tse-Chang A, McConnell A, Money D, Boucoiran I, Sauve LJ, Bitnun A, Kakkar F
J Int AIDS Soc · 2025 Jun · PMID 40462501 · Full text
INTRODUCTION: Presumptive HIV therapy (PHT) is recommended for post-natal HIV prophylaxis (PNP) in situations at high risk of HIV vertical transmission (VT), for both prevention of transmission and as early treatment in...
INTRODUCTION: Presumptive HIV therapy (PHT) is recommended for post-natal HIV prophylaxis (PNP) in situations at high risk of HIV vertical transmission (VT), for both prevention of transmission and as early treatment in cases of in utero transmission. The objective of this study was to describe the risk of VT and use PHT among newborns in Canada, and specifically, factors associated with the use of PHT. METHODS: Data were analysed for all mother-infant pairs (MIPs) in the Canadian Perinatal HIV Surveillance Program (1997-2020), collected annually from 22 perinatal HIV centres in Canada. Infants were categorized as high risk (delivery viral load [dVL] ≥1000 copies/ml or maternal combined antiretroviral [cART] <4 weeks prior to delivery), moderate risk (dVL detectable and <1000 copies/ml, and maternal cART ≥4 weeks prior to delivery) and low risk (dVL undetectable and maternal cART ≥4 weeks prior to delivery). Neonatal prophylaxis and HIV transmission risk were compared between groups. RESULTS: A total of 4743 MIPs were included in the analysis. Overall, 13.3% of newborns received PHT; the most prescribed PHT regimens included combinations using zidovudine, lamivudine and nelfinavir (48.5%) or nevirapine (41.9%). While the most significant risk factor for transmission on univariate analysis was a detectable dVL ≥1000 copies/ml versus undetectable (odds ratio [OR] 27.91 [11.20-69.54]), the risk remained significantly increased at dVL between 400 and 999 copies/ml (OR 31.71 [8.31-120.98], but not at dVL between 50 and 399 copies/ml (OR 3.03 [0.72-12.81]). At dVL 50-399 copies/ml, 29.8% of infants received PHT, increasing to 46.7% at dVL 400-999 copies/ml, and 64.4% of infants at dVL≥1000 copies/ml. The overall risk of transmission was 6% in the high-risk group, 0.5% in the moderate-risk group and 0.2% in the low-risk group. CONCLUSIONS: PHT has been widely used in Canada in situations at high risk of VT, with 25% of newborns in this risk group receiving PHT as PNP. While PHT may reduce the risk of VT in high-risk situations and may be of benefit in cases of VT, these data also highlight ongoing gaps in perinatal HIV prevention in Canada.
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