Journal of the International Association of Providers of AIDS Care最新文献

BackgroundDespite global declines in HIV incidence, new infections continue to rise in Latin America. Oral tenofovir-based HIV pre-exposure prophylaxis (PrEP) is effective and can reduce incidence where implemented. PrEP PERU is a prospective cohort study evaluating daily oral PrEP delivery at HIV/AIDS service organizations (ASOs) in Peru.MethodsWe assessed 12-month PrEP retention and adherence among men who have sex with men (MSM) enrolled at 4 ASOs in Lima before the COVID-19 pandemic. The analysis included participants with ≥12 months of follow-up before the March 2020 lockdown. Follow-up visits occurred at weeks 4, 12, and quarterly thereafter. We used robust Poisson regression to evaluate associations between baseline characteristics and 2 outcomes: retention (attending ≥3 follow-up visits within 12 months) and optimal adherence (proportion of days covered ≥80%).ResultsAmong 264 MSM who initiated PrEP, median age was 31 years (IQR: 27-37). Retention at 12 months was 71%, and 55% achieved optimal adherence. Retention was associated with age ≥30 and bisexual identity in adjusted models. Optimal adherence was associated with being employed at baseline.ConclusionsPrEP delivery through ASOs in Lima is feasible and supports sustained engagement among MSM. Targeted strategies are needed to improve outcomes among younger individuals.

BackgroundChildren with perinatal HIV exposure are at increased risk for neurodevelopmental (ND) delays, yet little is known about ND screening implementation for this population.MethodsThis longitudinal study evaluated ND screening implementation at a health clinic in Kenya, from 9/2021 to 8/2023. Children aged 18-36 months with perinatal HIV exposure were screened using a 12-item general ND tool. Implementation outcomes-acceptability, feasibility, fidelity, and sustainability-were assessed through time-motion observations, clinic records, and semi-structured interviews with caregivers and staff.ResultsOf 507 eligible children, 405 (80%) were screened. Screening rates were consistent over 24 months, with average time reduced to under 5 min. Facilitators included staff collaboration and caregiver support; barriers included time constraints and child temperament.ConclusionsND screening was acceptable, feasible, and sustainable. Policymakers should embed ND screening within national child health programs, invest in workforce training and task-sharing models, strengthen referral and follow-up systems, and ensure affordable access to services.

IntroductionCrowdsourcing engages the community to create and share solutions; this participatory method could be used to create effective pre-exposure prophylaxis (PrEP) promotions. We explored acceptability of using crowdsourcing to develop PrEP promotions among sexual minority men (SMM) and sexual health providers in Alabama.MethodsWe conducted focus group discussions (FGDs) with SMM and interviews with sexual health providers with guides grounded in the Theoretical Framework of Acceptability. We employed thematic analysis through deductive and inductive coding.ResultsTen SMM (60% Black, 50% younger than 30 years) participated in FGDs, and six providers completed interviews. We found four themes: 1) Personal identity and background inform the participation and products of crowdsourcing, 2) SMM and providers are motivated to participate in crowdsourcing, 3) Crowdsourcing participants require resources to effectively engage, and 4) Logistic and social factors are barriers to crowdsourcing participation.DiscussionCrowdsourcing as a strategy to create PrEP promotions in the Southern United states would be acceptable and feasible in the correct context. These formative, yet novel, findings demonstrate that SMM and sexual health providers would be willing to participate in crowdsourcing events and also provide key insight to design crowdsourcing events.

BackgroundIn Cameroon, Prevention of Mother-to-Child Transmission (PMTCT) program has been implemented for over two decades, yet persistent challenges hinder their effectiveness. This study evaluates the effectiveness of PMTCT program between 2021 and 2023 throughout the national territory.MethodsThis was a retrospective analysis of data from Cameroon's PMTCT program with data sourced from the national health records and analyzed using advance statistic technics.ResultsThe findings indicate a slight upward trend in transmission prevalence from 0.98% in 2021 to 1.06% in 2023. Maternal human immunodeficiency virus (HIV) status during pregnancy emerged as a major driver of transmission, highlighting gaps in repeated HIV testing. We note a national wide decline of first antenatal attendances and HIV testing coverage. Male partner involvement remained low and retention in care varied overtime inline to specific indicators.ConclusionWhile Cameroon's PMTCT program has made progress, challenges persist with mother-to-child transmission-related program indicators.

BackgroundThe co-infection of human immunodeficiency virus (HIV) and neurosyphilis presents a significant clinical challenge due to the increased risk of opportunistic infections, including progressive multifocal leukoencephalopathy (PML).Case PresentationA 23-year-old unmarried male with an unprotected sexual history presented with progressive right upper limb weakness and slurred speech for 10 days. He was diagnosed with HIV and neurosyphilis co-infection, and neuroimaging/cerebrospinal fluid studies confirmed PML.ConclusionsThis case highlights the importance of screening for HIV and neurosyphilis in young patients with neurological symptoms and the need for awareness of opportunistic infections such as PML in immunocompromised individuals.

BackgroundHIV self-tests (HIVSTs) have been promoted as one way to increase testing.MethodsWe extracted data from the GetaKit study for October 11, 2023 to June 30, 2025, focusing on participants to whom we co-offered an HIVST and serology.ResultsWe co-offered HIVST and serology to 3611 persons; 71.9% agreed to go to a lab and 19.4% opted for only the HIVST. Participants who were Black, Indigenous, or Persons of Color were less willing to attend a lab; participants who were men who have sex with men or reported injection drug use or sex work were more willing to attend a lab. First-time testers opted for the HIVST at a higher rate. HIVST did not yield new diagnoses.ConclusionsHIVSTs were an entry point to testing for some but were not the preferred modality for most. Promoting HIVSTs too broadly would not align with patient preference.

Despite progress in human immunodeficiency virus (HIV) prevention, global targets remain unmet, with over 1.3 million new infections annually-driven by adherence challenges, stigma, and daily pill fatigue linked to oral pre-exposure prophylaxis (PrEP). Lenacapavir, a long-acting injectable capsid inhibitor approved by the FDA in June 2025, offers transformative twice-yearly subcutaneous dosing with sustained efficacy and minimal drug interactions. PURPOSE 1 and 2 trials demonstrated near-complete protection across cisgender women, men who have sex with men, transgender individuals, and adolescents, highlighting its potential to overcome barriers to PrEP uptake. Its high acceptability, infrequent dosing, and pharmacologic durability make it ideal for individuals facing stigma, mobility constraints, or limited healthcare access. WHO's endorsement marks a pivotal milestone, but real-world implementation must address cold-chain logistics, cost, provider training, and systemic inequities. Integrating lenacapavir through decentralized delivery models, differentiated care, and inclusive national guidelines will be key to equitable access, decreasing gaps and advancing epidemic control.

BackgroundDue to high-risk sexual networks along their transit routes, Long-distance truckers' (LDTs) risk of HIV is known to be high, as evidenced by prevalence rates of 14.34% in the region. Besides, the spaces in which LDTs operate are often marred with a multitude of barriers to HIV/AIDS risk reduction. However, there is limited evidence on the barriers encountered by LDTs in Kenya, hence the need for the current study.Methods and MethodologyWe used nine key informants and 18 in-depth interviews from purposively sampled participants, such as nurses and LDT peer educators at Kenya's Busia and Namanga international border points. We used semi-structured interview guides to collect data through audio records. Interviews were transcribed, coded, and thematically analysed using the QDA-Miner software to generate themes and sub-themes around barriers to HIV/AIDS risk reduction among LDTs.FindingsOverall, three themes, namely, health system, individual-level, and trucking career-related barriers emerged. The sub-themes under health system barriers included the location of healthcare facilities far from transit routes, long durations of hospital waiting time, and lack of targeted health facilities for LDTs, among several others. Under trucking career-related barriers, the sub-themes comprised tight work schedules, unfavourable trucking career policies, and insecurity along transit routes. For individual barriers, some of the sub-themes were language barriers and lack of awareness of current HIV/AIDS risk reduction services.ConclusionAlongside health system factors, individual level and trucking career-related factors were highlighted as the barriers to HIV/AIDS risk reduction among LDTs in Kenya. The existence of these barriers may complicate the fight against the pandemic in this hard-to-reach population, given their already known vulnerability to HIV infections.