Elizabeth Nalintya, Elizabeth L. Schwartz, Patricia Nerima, Ann Fieberg, Sarah M. Najjuka, Ruth E. Ajilong, Tessa Adzemovic, Olive Namakula, Atukunda Mucunguzi, Kiiza Kandole Tadeo, Mark Oilor, Preethiya Sekar, Alice Lehman, Bruce Larson, Biyue Dai, David B. Meya, David R. Boulware, Radha Rajasingham, the ENCORE team
<div> <section> <h3> Introduction</h3> <p>Despite significant progress in HIV care globally, a persistent 30–40% of people present with advanced HIV disease with ≤200 CD4 cells/µl. The Visitect CD4 Advanced Disease platform is a point-of-care CD4 test being implemented in resource-limited settings. We sought to assess clinical outcomes of survival and retention-in-care among people with advanced HIV disease based on CD4 testing modality.</p> </section> <section> <h3> Methods</h3> <p>We performed a cluster randomized clinical trial to evaluate the Visitect CD4 compared with onsite standard laboratory-based CD4 testing. The trial was conducted at 16 outpatient HIV clinics in Uganda. Those identified with CD4≤200 cells/µl received a standardized package of care for advanced HIV disease. The primary outcome was 24-week survival with retention-in-care. A costing analysis was performed. Randomization by CD4 methodology was stopped on 18 June, 2024, as the Visitect CD4 Advanced Disease platform was being implemented widely in Uganda, and randomization to non-Visitect CD4 platforms was unethical if no alternative CD4 strategies were available in a timely manner. We conducted a micro-costing analysis to estimate the resources used for each trial participant over the 6-month study period.</p> </section> <section> <h3> Results</h3> <p>Between 5 May 2022 and 18 February 2025, 1724 participants were enrolled; 927 participants received Visitect CD4 testing (eight clusters), and 797 received standard CD4 testing (eight clusters). The composite endpoint of death or lost to follow-up occurred in 7.0% (63/901) who received Visitect CD4 testing and 7.2% (57/788) who received standard CD4 testing (hazard ratio, 0.98; 95% CI, 0.69, 1.40). The estimated risk difference between arms was 0.01% (95% CI, −2.5, 2.5). Median time to antiretroviral therapy initiation was 0 days with Visitect testing versus 7 days with standard CD4 testing (adjusted hazard ratio, 1.23; 95% CI, 1.05, 1.45). Mean cost of 6-month care was US$115 for Visitect CD4 testing versus US$131 for standard-of-care CD4 testing.</p> </section> <section> <h3> Conclusions</h3> <p>Implementation of Visitect CD4 testing demonstrated more rapid initiation of HIV therapy with equivalent 24-week survival and retention-in-care compared with other point-of-care CD4 strategies at equivalent cost. Despite its poor specificity, the Visitect CD4 platform remains a cost-neutral option compared to standard CD4 modalities.</p> </section> <section> <h3> Ar
{"title":"A cluster randomized trial of Visitect CD4 Advanced Disease platform among outpatients with advanced HIV disease in Uganda","authors":"Elizabeth Nalintya, Elizabeth L. Schwartz, Patricia Nerima, Ann Fieberg, Sarah M. Najjuka, Ruth E. Ajilong, Tessa Adzemovic, Olive Namakula, Atukunda Mucunguzi, Kiiza Kandole Tadeo, Mark Oilor, Preethiya Sekar, Alice Lehman, Bruce Larson, Biyue Dai, David B. Meya, David R. Boulware, Radha Rajasingham, the ENCORE team","doi":"10.1002/jia2.70075","DOIUrl":"10.1002/jia2.70075","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite significant progress in HIV care globally, a persistent 30–40% of people present with advanced HIV disease with ≤200 CD4 cells/µl. The Visitect CD4 Advanced Disease platform is a point-of-care CD4 test being implemented in resource-limited settings. We sought to assess clinical outcomes of survival and retention-in-care among people with advanced HIV disease based on CD4 testing modality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a cluster randomized clinical trial to evaluate the Visitect CD4 compared with onsite standard laboratory-based CD4 testing. The trial was conducted at 16 outpatient HIV clinics in Uganda. Those identified with CD4≤200 cells/µl received a standardized package of care for advanced HIV disease. The primary outcome was 24-week survival with retention-in-care. A costing analysis was performed. Randomization by CD4 methodology was stopped on 18 June, 2024, as the Visitect CD4 Advanced Disease platform was being implemented widely in Uganda, and randomization to non-Visitect CD4 platforms was unethical if no alternative CD4 strategies were available in a timely manner. We conducted a micro-costing analysis to estimate the resources used for each trial participant over the 6-month study period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 5 May 2022 and 18 February 2025, 1724 participants were enrolled; 927 participants received Visitect CD4 testing (eight clusters), and 797 received standard CD4 testing (eight clusters). The composite endpoint of death or lost to follow-up occurred in 7.0% (63/901) who received Visitect CD4 testing and 7.2% (57/788) who received standard CD4 testing (hazard ratio, 0.98; 95% CI, 0.69, 1.40). The estimated risk difference between arms was 0.01% (95% CI, −2.5, 2.5). Median time to antiretroviral therapy initiation was 0 days with Visitect testing versus 7 days with standard CD4 testing (adjusted hazard ratio, 1.23; 95% CI, 1.05, 1.45). Mean cost of 6-month care was US$115 for Visitect CD4 testing versus US$131 for standard-of-care CD4 testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Implementation of Visitect CD4 testing demonstrated more rapid initiation of HIV therapy with equivalent 24-week survival and retention-in-care compared with other point-of-care CD4 strategies at equivalent cost. Despite its poor specificity, the Visitect CD4 platform remains a cost-neutral option compared to standard CD4 modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Ar","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 1","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12824445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146016693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Haroon Moolla, Reshma Kassanjee, Jonathan Euvrard, Gary Maartens, Hans W. Prozesky, Matthew P. Fox, Catherine Orrell, Geoffrey Fatti, Frank Tanser, Gilles Wandeler, Mary-Ann Davies, Renee de Waal, Patience Nyakato, Leigh F. Johnson, the International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration
<div> <section> <h3> Introduction</h3> <p>Viral suppression estimates are essential for monitoring the performance of HIV programmes. South Africa introduced dolutegravir (DTG)-based antiretroviral therapy (ART) in 2019. We sought to generate updated estimates of viral suppression in South African adults on ART and investigate predictors of viral non-suppression.</p> </section> <section> <h3> Methods</h3> <p>This retrospective cohort study used data from seven South African cohorts participating in the International epidemiology Databases to Evaluate AIDS collaboration. Three main analyses were performed using a viral suppression threshold of 1000 HIV RNA copies/ml. In the first analysis, we fitted a logistic regression model using the full data from the study period (2005−2023). Then, in two causal analyses, we used logistic regression with inverse probability weighting to assess the effects of starting ART on DTG-based regimens (as opposed to starting on non-DTG-based ART) and switching to DTG while virally suppressed (compared to remaining on non-DTG-based ART). In sensitivity analyses, we reduced the suppression threshold to 400 copies/ml and excluded those with missing baseline CD4+ cell count measurements.</p> </section> <section> <h3> Results</h3> <p>There were 380,720 participants contributing 2,090,912 person-years of observation. Most participants were female (64.7%), and the median age at ART initiation was 35.0 years (interquartile range 28.9−42.3). Viral suppression increased over time, reaching 95.9% in 2023. Twenty-one percent of participants either started ART on DTG-based regimens (7.1%) or switched to DTG-based regimens from a virally suppressed state (14.0%). DTG-based ART was protective against viral non-suppression in both causal models, with adjusted odds ratios of 0.54 (95% confidence interval [CI] 0.48−0.61) and 0.36 (95% CI 0.32−0.39) for those initiating ART on DTG and those switching to DTG, respectively. A history of ART interruption was strongly associated with viral non-suppression, with adjusted odds ratios ranging from 2.49 to 4.55. The odds of non-suppression decreased with increasing age, increasing duration on ART and increasing baseline CD4+ cell count. Results were consistent across sensitivity analyses.</p> </section> <section> <h3> Conclusions</h3> <p>DTG-based regimens improve viral suppression among both ART-naïve individuals and those transitioning while suppressed. ART interruptions pose a risk to the sustained success of ART programmes and may further impede efforts to recover from the impacts of recent f
病毒抑制估计对于监测艾滋病毒规划的执行情况至关重要。南非于2019年推出了基于多替格拉韦（DTG）的抗逆转录病毒疗法（ART）。我们试图对南非接受抗逆转录病毒治疗的成年人中病毒抑制的最新估计，并研究病毒不抑制的预测因素。方法：这项回顾性队列研究使用了参与国际流行病学数据库评估艾滋病合作的7个南非队列的数据。使用1000 HIV RNA拷贝/ml的病毒抑制阈值进行了三个主要分析。在第一个分析中，我们使用研究期间（2005-2023）的全部数据拟合了一个逻辑回归模型。然后，在两个因果分析中，我们使用逆概率加权的逻辑回归来评估在基于DTG的方案中开始ART（相对于开始非DTG的ART）和在病毒抑制时切换到DTG（与继续使用非DTG的ART相比）的影响。在敏感性分析中，我们将抑制阈值降低到400拷贝/ml，并排除了那些缺少基线CD4+细胞计数测量的患者。结果：共有380,720名参与者，贡献了2,090,912人年的观察。大多数参与者为女性（64.7%），开始抗逆转录病毒治疗的中位年龄为35.0岁（四分位数范围28.9-42.3岁）。随着时间的推移，病毒抑制率上升，2023年达到95.9%。21%的参与者要么在基于dtg的方案中开始ART(7.1%)，要么从病毒抑制状态切换到基于dtg的方案（14.0%）。在两种因果模型中，以DTG为基础的抗逆转录病毒治疗对病毒无抑制具有保护作用，在DTG开始抗逆转录病毒治疗和转向DTG的患者中，调整后的优势比分别为0.54（95%置信区间[CI] 0.48-0.61）和0.36 （95% CI 0.32-0.39）。ART中断史与病毒不抑制密切相关，调整后的优势比为2.49 - 4.55。随着年龄的增加、抗逆转录病毒治疗时间的延长和基线CD4+细胞计数的增加，非抑制的几率降低。敏感性分析的结果是一致的。结论：dtg为基础的方案改善了ART-naïve个体和那些在抑制中过渡的人的病毒抑制。抗逆转录病毒治疗中断对抗逆转录病毒治疗规划的持续成功构成风险，并可能进一步阻碍从最近经费削减的影响中恢复过来的努力。
{"title":"Estimates and predictors of HIV viral non-suppression in South African adults on antiretroviral treatment","authors":"Haroon Moolla, Reshma Kassanjee, Jonathan Euvrard, Gary Maartens, Hans W. Prozesky, Matthew P. Fox, Catherine Orrell, Geoffrey Fatti, Frank Tanser, Gilles Wandeler, Mary-Ann Davies, Renee de Waal, Patience Nyakato, Leigh F. Johnson, the International epidemiology Databases to Evaluate AIDS Southern Africa (IeDEA-SA) Collaboration","doi":"10.1002/jia2.70076","DOIUrl":"10.1002/jia2.70076","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Viral suppression estimates are essential for monitoring the performance of HIV programmes. South Africa introduced dolutegravir (DTG)-based antiretroviral therapy (ART) in 2019. We sought to generate updated estimates of viral suppression in South African adults on ART and investigate predictors of viral non-suppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study used data from seven South African cohorts participating in the International epidemiology Databases to Evaluate AIDS collaboration. Three main analyses were performed using a viral suppression threshold of 1000 HIV RNA copies/ml. In the first analysis, we fitted a logistic regression model using the full data from the study period (2005−2023). Then, in two causal analyses, we used logistic regression with inverse probability weighting to assess the effects of starting ART on DTG-based regimens (as opposed to starting on non-DTG-based ART) and switching to DTG while virally suppressed (compared to remaining on non-DTG-based ART). In sensitivity analyses, we reduced the suppression threshold to 400 copies/ml and excluded those with missing baseline CD4+ cell count measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 380,720 participants contributing 2,090,912 person-years of observation. Most participants were female (64.7%), and the median age at ART initiation was 35.0 years (interquartile range 28.9−42.3). Viral suppression increased over time, reaching 95.9% in 2023. Twenty-one percent of participants either started ART on DTG-based regimens (7.1%) or switched to DTG-based regimens from a virally suppressed state (14.0%). DTG-based ART was protective against viral non-suppression in both causal models, with adjusted odds ratios of 0.54 (95% confidence interval [CI] 0.48−0.61) and 0.36 (95% CI 0.32−0.39) for those initiating ART on DTG and those switching to DTG, respectively. A history of ART interruption was strongly associated with viral non-suppression, with adjusted odds ratios ranging from 2.49 to 4.55. The odds of non-suppression decreased with increasing age, increasing duration on ART and increasing baseline CD4+ cell count. Results were consistent across sensitivity analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>DTG-based regimens improve viral suppression among both ART-naïve individuals and those transitioning while suppressed. ART interruptions pose a risk to the sustained success of ART programmes and may further impede efforts to recover from the impacts of recent f","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 1","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12816880/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146002783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jesse A. Heitner, Sarah E. Stansfield, Kate M. Mitchell, Carla M. Doyle, Rachael M. Milwid, Mia Moore, Deborah J. Donnell, Yiqing Xia, Mathieu Maheu-Giroux, Ruanne V. Barnabas, Marie-Claude Boily, Dobromir T. Dimitrov
<div> <section> <h3> Introduction</h3> <p>Long-acting injectable cabotegravir (CAB-LA) is superior to daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for HIV pre-exposure prophylaxis (PrEP) and could expand PrEP usage. Given price differentials between CAB-LA and TDF/FTC, evaluating the cost-effectiveness of potential PrEP coverage scenarios is warranted.</p> </section> <section> <h3> Methods</h3> <p>We simulated PrEP coverage expansion among men who have sex with men (MSM) via introducing CAB-LA using two age- and risk-stratified HIV transmission models separately calibrated to local data from a high-incidence (Atlanta, USA) and a low-incidence (Montréal, Canada) North American setting. PrEP coverage of HIV-negative MSM was simulated to increase from 6% to 15%, 30%, 40% or 50% (Montréal) or from 29% to 40% or 50% (Atlanta), within 5 or 10 years, with 0%, 15%, 30%, 50% or 100% of current TDF/FTC users switching to CAB-LA. Costing took a healthcare payer perspective and included PrEP pharmaceuticals, PrEP programmatic costs and HIV-related care. Atlanta scenarios considered oral PrEP acquired at average recent market prices (primary analysis), and both settings modelled universal acquisition at the lowest available generic price (LAGP). Simulations were compared to baseline projections without CAB-LA-based expansions over 20 years, with costs and disability-adjusted life years (DALYs) discounted 3% annually. Incremental cost-effectiveness ratios (ICERs) of expansions were assessed against a $100,000 per DALY averted threshold.</p> </section> <section> <h3> Results</h3> <p>In Atlanta, scenario median ICERs at recent prices ranged from $141,600 (90% CI $60,100−$256,000) to $203,800 ($99,300−$359,200) per DALY averted. All uncertainty intervals covered $100,000. Under universal LAGP TDF-FTC, median ICERs ranged from $255,800 ($112,900−$452,30) to $370,700 ($172,200−$669,100). The strongest expansion scenarios were expected to remain cost-effective until approximately $2800/dose, or approximately $1350 with universal LAGP TDF/FTC. In Montréal, scenarios had median ICERs from $920,000 to $2,540,000, excluding dominated runs.</p> </section> <section> <h3> Conclusions</h3> <p>In a high-incidence Atlanta MSM population, CAB-LA-based PrEP expansions are not projected to be cost-effective, though a minority of simulations achieved cost-effectiveness. However, lower prices could achieve cost-effectiveness. In a low-incidence Montréal MSM population, broad expansions are not expected to be cost-effective at modelled prices. Prioritizing CAB-LA
{"title":"Cost-effectiveness of leveraging long-acting injectable cabotegravir to expand PrEP coverage among MSM in two contrasting North American cities","authors":"Jesse A. Heitner, Sarah E. Stansfield, Kate M. Mitchell, Carla M. Doyle, Rachael M. Milwid, Mia Moore, Deborah J. Donnell, Yiqing Xia, Mathieu Maheu-Giroux, Ruanne V. Barnabas, Marie-Claude Boily, Dobromir T. Dimitrov","doi":"10.1002/jia2.70061","DOIUrl":"10.1002/jia2.70061","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Long-acting injectable cabotegravir (CAB-LA) is superior to daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for HIV pre-exposure prophylaxis (PrEP) and could expand PrEP usage. Given price differentials between CAB-LA and TDF/FTC, evaluating the cost-effectiveness of potential PrEP coverage scenarios is warranted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We simulated PrEP coverage expansion among men who have sex with men (MSM) via introducing CAB-LA using two age- and risk-stratified HIV transmission models separately calibrated to local data from a high-incidence (Atlanta, USA) and a low-incidence (Montréal, Canada) North American setting. PrEP coverage of HIV-negative MSM was simulated to increase from 6% to 15%, 30%, 40% or 50% (Montréal) or from 29% to 40% or 50% (Atlanta), within 5 or 10 years, with 0%, 15%, 30%, 50% or 100% of current TDF/FTC users switching to CAB-LA. Costing took a healthcare payer perspective and included PrEP pharmaceuticals, PrEP programmatic costs and HIV-related care. Atlanta scenarios considered oral PrEP acquired at average recent market prices (primary analysis), and both settings modelled universal acquisition at the lowest available generic price (LAGP). Simulations were compared to baseline projections without CAB-LA-based expansions over 20 years, with costs and disability-adjusted life years (DALYs) discounted 3% annually. Incremental cost-effectiveness ratios (ICERs) of expansions were assessed against a $100,000 per DALY averted threshold.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In Atlanta, scenario median ICERs at recent prices ranged from $141,600 (90% CI $60,100−$256,000) to $203,800 ($99,300−$359,200) per DALY averted. All uncertainty intervals covered $100,000. Under universal LAGP TDF-FTC, median ICERs ranged from $255,800 ($112,900−$452,30) to $370,700 ($172,200−$669,100). The strongest expansion scenarios were expected to remain cost-effective until approximately $2800/dose, or approximately $1350 with universal LAGP TDF/FTC. In Montréal, scenarios had median ICERs from $920,000 to $2,540,000, excluding dominated runs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a high-incidence Atlanta MSM population, CAB-LA-based PrEP expansions are not projected to be cost-effective, though a minority of simulations achieved cost-effectiveness. However, lower prices could achieve cost-effectiveness. In a low-incidence Montréal MSM population, broad expansions are not expected to be cost-effective at modelled prices. Prioritizing CAB-LA ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 1","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12813553/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145996738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evelina Chapman, Omar Sued, Jorge O. Maia Barreto, Claudia P. Cortes, Brenda Crabtree Ramírez, José E. Vidal, Antonio Camiro-Zúñiga, Freddy Perez
Introduction
Advanced HIV disease (AHD) remains a leading cause of mortality in Latin America and the Caribbean (LAC), driven by late diagnosis, treatment gaps and structural barriers, particularly among key populations and children. Persistent disparities in healthcare access, stigma, and limited health system capacity highlight the need for targeted research to improve AHD outcomes in the region.
Methods
The modified Delphi process to prioritize AHD research questions in LAC was conducted between August and November 2024. Systematic reviews, expert consultations and two Delphi rounds involving 74 and 69 participants from 17 LAC countries assessed questions based on public health relevance, feasibility and equity. A subsequent in-person workshop with 24 experts refined and validated the results, organizing the prioritized questions into short-, medium- and long-term priorities.
Results
Seventy-seven high-priority research questions were identified, 60 focused on adults and 17 on children. These questions centred on opportunistic infections (OIs), HIV-related cancers and health system interventions. Tuberculosis was the most frequently addressed OI (44% of OI-related questions), followed by cryptococcosis, histoplasmosis and HIV-related malignancies. Short-term priorities included interventions to reduce late diagnosis, improve retention in care and strengthen health systems, particularly for vulnerable populations such as children, pregnant women and incarcerated individuals.
Conclusions
This study presents a comprehensive research agenda for AHD in LAC, emphasizing interventions to address OIs, strengthen the health system and support at-risk populations. The prioritized questions provide a roadmap for researchers, policymakers and funders to allocate resources effectively, ultimately improving AHD outcomes and reducing HIV-related mortality. Strengthening regional collaboration and political commitment will be critical to translating research into actionable policies and interventions.
{"title":"Research priorities for advanced HIV disease in Latin America and the Caribbean region: a modified Delphi study","authors":"Evelina Chapman, Omar Sued, Jorge O. Maia Barreto, Claudia P. Cortes, Brenda Crabtree Ramírez, José E. Vidal, Antonio Camiro-Zúñiga, Freddy Perez","doi":"10.1002/jia2.70074","DOIUrl":"https://doi.org/10.1002/jia2.70074","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Advanced HIV disease (AHD) remains a leading cause of mortality in Latin America and the Caribbean (LAC), driven by late diagnosis, treatment gaps and structural barriers, particularly among key populations and children. Persistent disparities in healthcare access, stigma, and limited health system capacity highlight the need for targeted research to improve AHD outcomes in the region.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The modified Delphi process to prioritize AHD research questions in LAC was conducted between August and November 2024. Systematic reviews, expert consultations and two Delphi rounds involving 74 and 69 participants from 17 LAC countries assessed questions based on public health relevance, feasibility and equity. A subsequent in-person workshop with 24 experts refined and validated the results, organizing the prioritized questions into short-, medium- and long-term priorities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Seventy-seven high-priority research questions were identified, 60 focused on adults and 17 on children. These questions centred on opportunistic infections (OIs), HIV-related cancers and health system interventions. Tuberculosis was the most frequently addressed OI (44% of OI-related questions), followed by cryptococcosis, histoplasmosis and HIV-related malignancies. Short-term priorities included interventions to reduce late diagnosis, improve retention in care and strengthen health systems, particularly for vulnerable populations such as children, pregnant women and incarcerated individuals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study presents a comprehensive research agenda for AHD in LAC, emphasizing interventions to address OIs, strengthen the health system and support at-risk populations. The prioritized questions provide a roadmap for researchers, policymakers and funders to allocate resources effectively, ultimately improving AHD outcomes and reducing HIV-related mortality. Strengthening regional collaboration and political commitment will be critical to translating research into actionable policies and interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"29 1","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70074","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145987220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Carrie Lyons, Omar Syarif, Pim Looze, Gnilane Turpin, Jean de Dieu Anoubissi, Sophie Brion, Keren Dunaway, Yi-Chi Chiu, Daria Ocheret, Laurel Sprague, Carlos Garcia de Leon Moreno, Hatim Sati, Amrita Rao, Katherine Rucinski, Stefan Baral, Richard Chaisson, David Dowdy, Chris Beyrer, Becky Genberg
<div> <section> <h3> Introduction</h3> <p>Tuberculosis (TB) is the leading cause of death among people living with HIV. Global estimates among people living with HIV demonstrate that more incident cases and more deaths due to TB occur among women than men. Simultaneously, women experience higher levels of under and unpaid work compared to men. Given that poverty is an established determinant for TB, the aim of this study is to characterize the role of HIV-related employment discrimination and legal protections on TB outcomes for women living with HIV.</p> </section> <section> <h3> Methods</h3> <p>The People Living with HIV Stigma Index 2.0 study was implemented in 11 countries across sub-Saharan Africa, including Angola, Benin, Burkina Faso, Cote D'Ivoire, Ghana, Kenya, Mauritania, Nigeria, Lesotho, Togo and Zimbabwe. Study design and implementation were led by networks of people living with HIV in each country between 2020 and 2022. Interviewer-administered questionnaires were used to collect self-reported socio-behavioural measures among cisgender adult women living with HIV. Multilevel logistic regression models were used to estimate associations between economic instability and employment discrimination exposures and recent TB diagnoses in the context of varying discrimination protections for women living with HIV.</p> </section> <section> <h3> Results</h3> <p>Among 10,718 participants, 7.5% (<i>n</i> = 807) reported a recent TB diagnosis. Among women in countries without non-discrimination protections, recent TB diagnosis was negatively associated with current employment (aOR: 0.72; 95% CI: 0.62, 0.85) compared to no employment; and positively associated with being refused employment or income due to HIV status (aOR: 1.80; 95% CI: 1.36, 2.39) and ever being refused promotion (aOR: 2.00; 95% CI: 1.37, 2.91) compared to those who have not reported these experiences. Among women in countries with non-discrimination protections, recent TB diagnosis was associated with lower current employment (aOR: 0.72; 95% CI: 0.56, 0.92) but not associated with employment discrimination.</p> </section> <section> <h3> Conclusions</h3> <p>The presence of social protections may modify the associations between employment discrimination and TB diagnosis. Employment discrimination was associated with TB diagnosis in settings without social protections but not in settings with those protections in place—highlighting a potential vulnerability among people living with HIV in settings without non-discrimination protections. Given the role of poverty in driving TB epidemi
{"title":"Characterizing tuberculosis diagnosis and the associations with economic instability and employment discrimination among women living with HIV across 11 countries in sub-Saharan Africa: a cross-sectional study","authors":"Carrie Lyons, Omar Syarif, Pim Looze, Gnilane Turpin, Jean de Dieu Anoubissi, Sophie Brion, Keren Dunaway, Yi-Chi Chiu, Daria Ocheret, Laurel Sprague, Carlos Garcia de Leon Moreno, Hatim Sati, Amrita Rao, Katherine Rucinski, Stefan Baral, Richard Chaisson, David Dowdy, Chris Beyrer, Becky Genberg","doi":"10.1002/jia2.70022","DOIUrl":"10.1002/jia2.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Tuberculosis (TB) is the leading cause of death among people living with HIV. Global estimates among people living with HIV demonstrate that more incident cases and more deaths due to TB occur among women than men. Simultaneously, women experience higher levels of under and unpaid work compared to men. Given that poverty is an established determinant for TB, the aim of this study is to characterize the role of HIV-related employment discrimination and legal protections on TB outcomes for women living with HIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The People Living with HIV Stigma Index 2.0 study was implemented in 11 countries across sub-Saharan Africa, including Angola, Benin, Burkina Faso, Cote D'Ivoire, Ghana, Kenya, Mauritania, Nigeria, Lesotho, Togo and Zimbabwe. Study design and implementation were led by networks of people living with HIV in each country between 2020 and 2022. Interviewer-administered questionnaires were used to collect self-reported socio-behavioural measures among cisgender adult women living with HIV. Multilevel logistic regression models were used to estimate associations between economic instability and employment discrimination exposures and recent TB diagnoses in the context of varying discrimination protections for women living with HIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 10,718 participants, 7.5% (<i>n</i> = 807) reported a recent TB diagnosis. Among women in countries without non-discrimination protections, recent TB diagnosis was negatively associated with current employment (aOR: 0.72; 95% CI: 0.62, 0.85) compared to no employment; and positively associated with being refused employment or income due to HIV status (aOR: 1.80; 95% CI: 1.36, 2.39) and ever being refused promotion (aOR: 2.00; 95% CI: 1.37, 2.91) compared to those who have not reported these experiences. Among women in countries with non-discrimination protections, recent TB diagnosis was associated with lower current employment (aOR: 0.72; 95% CI: 0.56, 0.92) but not associated with employment discrimination.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The presence of social protections may modify the associations between employment discrimination and TB diagnosis. Employment discrimination was associated with TB diagnosis in settings without social protections but not in settings with those protections in place—highlighting a potential vulnerability among people living with HIV in settings without non-discrimination protections. Given the role of poverty in driving TB epidemi","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 12","pages":""},"PeriodicalIF":4.9,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12774796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145909592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lina Golob, Emma L. Williams, Marlène Bras, Brent Clifton, Nathan Ford, Elvin H. Geng, Kimberly E. Green, Rena Janamnuaysook, Ingrid T. Katz, Lillian Mworeko, Rodenie A. Olete, Clarice Pinto, Reena Rajasuriar, Kombatende Sikombe, Darrell H. S. Tan, Beatriz Grinsztejn
<div> <section> <h3> Introduction</h3> <p>World Health Organization global normative guidance recommends person-centred care (PCC) approaches to reduce HIV-related mortality and morbidity and to improve health-related quality of life (HrQoL). However, consensus on the priority PCC elements and guidance on how different stakeholders can realize PCC principles at the health systems, service delivery and individual client-healthcare worker (HCW) levels are lacking. We conducted a global consensus-building process to define core PCC elements and develop recommendations for implementation at scale.</p> </section> <section> <h3> Methods</h3> <p>We used a multi-phase process to build consensus and prioritize recommendations, consisting of a literature review, five stakeholder consultations (34−43 participants each) between July 2022 and July 2023 and a three-round Delphi survey from March to July 2024 (49 participants). We sought diverse actors (including clients, HCWs, policymakers and researchers) from all world regions. Initial statements were drafted during the final consultation meeting, and adjustments to statements and recommendations were made during the Delphi survey.</p> </section> <section> <h3> Results</h3> <p>All statements achieved over 90% agreement, and recommendations reached at least 95% agreement. At the core of PCC is an effective primary healthcare (PHC) system, which prioritizes individual health, HrQoL and wellbeing and which adapts to evolving needs. Other core elements include: HCW responsibility to create safe, inclusive and stigma-free spaces; prioritizing community leadership, including in care provision by trained and compensated peers and community HCWs; power sharing within client−HCW relationships, reinforced by HCW training and client literacy; use of appropriate digital technology to increase engagement; and cross-disciplinary collaboration to address different health issues in an integrated manner. Recommendations include: policymakers setting national targets for self-reported HrQoL; strengthening integrated PHC; researchers prioritizing community-academic partnerships; and HCWs routinely assessing client-reported outcomes.</p> </section> <section> <h3> Conclusions</h3> <p>Our findings outline a roadmap with roles and actions for different stakeholders to realize the full potential of PCC. Jointly, there is a need to foster a culture that hears all voices in the care team, including clients and their caregivers, the community and all HCW cadres. At a systems level, it will be crucial to strengthen HIV/PHC integration an
{"title":"A roadmap to scale up person-centred care in the HIV response: recommendations from a global consensus-building process","authors":"Lina Golob, Emma L. Williams, Marlène Bras, Brent Clifton, Nathan Ford, Elvin H. Geng, Kimberly E. Green, Rena Janamnuaysook, Ingrid T. Katz, Lillian Mworeko, Rodenie A. Olete, Clarice Pinto, Reena Rajasuriar, Kombatende Sikombe, Darrell H. S. Tan, Beatriz Grinsztejn","doi":"10.1002/jia2.70071","DOIUrl":"10.1002/jia2.70071","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>World Health Organization global normative guidance recommends person-centred care (PCC) approaches to reduce HIV-related mortality and morbidity and to improve health-related quality of life (HrQoL). However, consensus on the priority PCC elements and guidance on how different stakeholders can realize PCC principles at the health systems, service delivery and individual client-healthcare worker (HCW) levels are lacking. We conducted a global consensus-building process to define core PCC elements and develop recommendations for implementation at scale.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used a multi-phase process to build consensus and prioritize recommendations, consisting of a literature review, five stakeholder consultations (34−43 participants each) between July 2022 and July 2023 and a three-round Delphi survey from March to July 2024 (49 participants). We sought diverse actors (including clients, HCWs, policymakers and researchers) from all world regions. Initial statements were drafted during the final consultation meeting, and adjustments to statements and recommendations were made during the Delphi survey.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All statements achieved over 90% agreement, and recommendations reached at least 95% agreement. At the core of PCC is an effective primary healthcare (PHC) system, which prioritizes individual health, HrQoL and wellbeing and which adapts to evolving needs. Other core elements include: HCW responsibility to create safe, inclusive and stigma-free spaces; prioritizing community leadership, including in care provision by trained and compensated peers and community HCWs; power sharing within client−HCW relationships, reinforced by HCW training and client literacy; use of appropriate digital technology to increase engagement; and cross-disciplinary collaboration to address different health issues in an integrated manner. Recommendations include: policymakers setting national targets for self-reported HrQoL; strengthening integrated PHC; researchers prioritizing community-academic partnerships; and HCWs routinely assessing client-reported outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings outline a roadmap with roles and actions for different stakeholders to realize the full potential of PCC. Jointly, there is a need to foster a culture that hears all voices in the care team, including clients and their caregivers, the community and all HCW cadres. At a systems level, it will be crucial to strengthen HIV/PHC integration an","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 12","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-12-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12745492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145848500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kaitlyn Atkins, Kirsty M. Sievwright, Holly Nishimura, Caitlin E. Kennedy
<div> <section> <h3> Introduction</h3> <p>While economic vulnerability is an established driver of health disparities, the relationships between HIV and wealth, income, and economic inequality have been less consistently established. We conducted a systematic review of studies examining associations between wealth, income, and economic inequality and HIV incidence and prevalence in sub-Saharan Africa (SSA).</p> </section> <section> <h3> Methods</h3> <p>Following PRISMA guidelines, we searched PubMed, SCOPUS, Embase, EconLit and PsycINFO for quantitative publications through June 2024 examining the relationship between wealth, income or inequality and HIV status, acquisition, prevalence or incidence in SSA. From September 2022 to October 2024, we extracted data using standardized forms, assessed risk of bias and qualitatively summarized results.</p> </section> <section> <h3> Results</h3> <p>Overall, 47 studies covering 48 countries met the inclusion criteria. Studies had generally low risk of bias, and most focused on a single country (<i>n</i> = 38), assessed household wealth as the exposure (<i>n</i> = 36) and employed cross-sectional designs (<i>n</i> = 33). Studies assessing wealth and HIV incidence consistently identified a protective effect, while findings around HIV incidence and income were mixed. In studies assessing HIV prevalence, findings on HIV and individual and household income or wealth were mixed. Economic inequality was consistently associated with increased HIV prevalence at community, sub-national and national levels.</p> </section> <section> <h3> Discussion</h3> <p>Most included studies were cross-sectional, among the general population, and secondary analyses of existing data. These can generate new insights about potential economic predictors of HIV, but longitudinal research is needed to understand economic impacts on HIV in evolving programme and policy contexts. Limited studies outside the general population highlighted opportunities for future research exploring economic drivers of HIV among the key population and potential differences in the HIV-wealth relationship by gender and urbanicity.</p> </section> <section> <h3> Conclusions</h3> <p>The evidence on HIV and wealth or income is mixed and varies by setting and population, while a limited literature suggests that economic inequality is more consistently associated with HIV risk. Longitudinal research is needed to assess causal relationships between economic factors and
{"title":"Wealth, income and HIV in sub-Saharan Africa: a systematic review","authors":"Kaitlyn Atkins, Kirsty M. Sievwright, Holly Nishimura, Caitlin E. Kennedy","doi":"10.1002/jia2.70060","DOIUrl":"10.1002/jia2.70060","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>While economic vulnerability is an established driver of health disparities, the relationships between HIV and wealth, income, and economic inequality have been less consistently established. We conducted a systematic review of studies examining associations between wealth, income, and economic inequality and HIV incidence and prevalence in sub-Saharan Africa (SSA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following PRISMA guidelines, we searched PubMed, SCOPUS, Embase, EconLit and PsycINFO for quantitative publications through June 2024 examining the relationship between wealth, income or inequality and HIV status, acquisition, prevalence or incidence in SSA. From September 2022 to October 2024, we extracted data using standardized forms, assessed risk of bias and qualitatively summarized results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 47 studies covering 48 countries met the inclusion criteria. Studies had generally low risk of bias, and most focused on a single country (<i>n</i> = 38), assessed household wealth as the exposure (<i>n</i> = 36) and employed cross-sectional designs (<i>n</i> = 33). Studies assessing wealth and HIV incidence consistently identified a protective effect, while findings around HIV incidence and income were mixed. In studies assessing HIV prevalence, findings on HIV and individual and household income or wealth were mixed. Economic inequality was consistently associated with increased HIV prevalence at community, sub-national and national levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Most included studies were cross-sectional, among the general population, and secondary analyses of existing data. These can generate new insights about potential economic predictors of HIV, but longitudinal research is needed to understand economic impacts on HIV in evolving programme and policy contexts. Limited studies outside the general population highlighted opportunities for future research exploring economic drivers of HIV among the key population and potential differences in the HIV-wealth relationship by gender and urbanicity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The evidence on HIV and wealth or income is mixed and varies by setting and population, while a limited literature suggests that economic inequality is more consistently associated with HIV risk. Longitudinal research is needed to assess causal relationships between economic factors and","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 12","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah Bernays, Ann Sellberg, Joni Lariat, Nicola Willis
<p>Once children and adolescents living with HIV (CALHIV) are on HIV treatment, telling them about their HIV status (also known as disclosure) is a core proactive and protective act. Supporting their understanding of HIV helps them recognize that the condition is manageable and untransmittable with effective treatment, which equips them to feel safe and minimize its impact on their lives [<span>1, 2</span>]. Evidence indicates that this is catalytic in achieving sustained viral suppression [<span>3</span>] and buoyant mental health [<span>4</span>]. This underpins the global recommendation that CALHIV be informed of their HIV status, explicitly naming it as such, once they reach school age (6–12 years, depending on cognitive skills and social maturity) [<span>5</span>].</p><p>Despite this, estimates indicate that around 40% of adolescents living with HIV (ALHIV), 13 years and older, have not been told about their HIV status [<span>3</span>]. The absence of clinical documentation limits the clarity of our understanding but also signifies our persistent under-valuing of its impact on ALHIVs’ health outcomes. Ironically, if telling a child about their HIV status (disclosing) was classified as a clinical rather than a psychosocial intervention, we would more likely recognize it as a transformative intervention worthy of investment.</p><p>Conversations to tell CALHIV about their HIV status are hard. For caregivers, who are generally designated this responsibility, this often involves sharing information about the HIV status of biological parents. The anticipated emotional weight of these discussions means that they are commonly clouded in obfuscation and deferral. Meanwhile, CALHIV do not know the truth about the nature of their condition or why they are taking treatment. These delays have profound sequelae: deciphering their HIV status on their own, sometimes late into their adolescence, can provoke acute anxiety, distrust and moral injury, which can, in turn, reflect in poor mental health and suboptimal viral suppression rates [<span>6</span>].</p><p>Our stuttering implementation of telling children about their HIV status over the last few decades has not been because we do not know why or how to do it well. Best practices are well-elucidated [<span>7</span>]: disclosure is a process, not a single event [<span>8</span>], requiring ongoing, age-appropriate conversations that help CALHIV understand the implications and manageability of their HIV status safely and progressively. The recently published WHO guidance reinforces the need to act on proven approaches [<span>7</span>]. It identifies 25 interventions that effectively support HIV status disclosure among CALHIV, built around core elements such as respect for autonomy and dignity, tools that enhance engagement, and attention to health and environmental contexts. Collectively, these components improve confidence, acceptance, communication and knowledge, while providing essential support for disclo
{"title":"Setting up for success: the effectiveness of telling children about their HIV status","authors":"Sarah Bernays, Ann Sellberg, Joni Lariat, Nicola Willis","doi":"10.1002/jia2.70072","DOIUrl":"10.1002/jia2.70072","url":null,"abstract":"<p>Once children and adolescents living with HIV (CALHIV) are on HIV treatment, telling them about their HIV status (also known as disclosure) is a core proactive and protective act. Supporting their understanding of HIV helps them recognize that the condition is manageable and untransmittable with effective treatment, which equips them to feel safe and minimize its impact on their lives [<span>1, 2</span>]. Evidence indicates that this is catalytic in achieving sustained viral suppression [<span>3</span>] and buoyant mental health [<span>4</span>]. This underpins the global recommendation that CALHIV be informed of their HIV status, explicitly naming it as such, once they reach school age (6–12 years, depending on cognitive skills and social maturity) [<span>5</span>].</p><p>Despite this, estimates indicate that around 40% of adolescents living with HIV (ALHIV), 13 years and older, have not been told about their HIV status [<span>3</span>]. The absence of clinical documentation limits the clarity of our understanding but also signifies our persistent under-valuing of its impact on ALHIVs’ health outcomes. Ironically, if telling a child about their HIV status (disclosing) was classified as a clinical rather than a psychosocial intervention, we would more likely recognize it as a transformative intervention worthy of investment.</p><p>Conversations to tell CALHIV about their HIV status are hard. For caregivers, who are generally designated this responsibility, this often involves sharing information about the HIV status of biological parents. The anticipated emotional weight of these discussions means that they are commonly clouded in obfuscation and deferral. Meanwhile, CALHIV do not know the truth about the nature of their condition or why they are taking treatment. These delays have profound sequelae: deciphering their HIV status on their own, sometimes late into their adolescence, can provoke acute anxiety, distrust and moral injury, which can, in turn, reflect in poor mental health and suboptimal viral suppression rates [<span>6</span>].</p><p>Our stuttering implementation of telling children about their HIV status over the last few decades has not been because we do not know why or how to do it well. Best practices are well-elucidated [<span>7</span>]: disclosure is a process, not a single event [<span>8</span>], requiring ongoing, age-appropriate conversations that help CALHIV understand the implications and manageability of their HIV status safely and progressively. The recently published WHO guidance reinforces the need to act on proven approaches [<span>7</span>]. It identifies 25 interventions that effectively support HIV status disclosure among CALHIV, built around core elements such as respect for autonomy and dignity, tools that enhance engagement, and attention to health and environmental contexts. Collectively, these components improve confidence, acceptance, communication and knowledge, while providing essential support for disclo","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 12","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12723440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145809046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Erin E. Cooney, Tonia C. Poteat, Meg Stevenson, Asa E. Radix, Annick Borquez, Keri N. Althoff, Sabriya Linton, Ceza Pontes, Chris Beyrer, Arianna Lint, Marissa Miller, Carter Brown, Andrew J. Wawrzyniak, Carolyn A. Brown, Leigh Ragone, Vani Vannappagari, Adrienne Guignard, Sari L. Reisner, Andrea L. Wirtz, ENCORE Study Group
<div> <section> <h3> Introduction</h3> <p>Transgender (trans) women are disproportionately impacted by HIV, yet data on the biomedical HIV PrEP continuum (HIVPC) among trans women are limited. We characterized the HIVPC among a large, nationwide cohort of trans women in the United States and Puerto Rico by pre-exposure prophylaxis (PrEP) modality (daily oral and long-acting injectable, LAI) and identified correlates of uptake and non-adherence.</p> </section> <section> <h3> Methods</h3> <p>From April 2023 to December 2024, we enrolled English and Spanish-speaking adult trans women (age 18 years or older) not living with HIV (laboratory-confirmed via fourth-generation HIV-1/2 antigen/antibody testing) and residing in the United States and Puerto Rico into the cohort. PrEP data were collected via self-administered surveys. We characterized the HIVPC using descriptive statistics and assessed for differences in proportions for each step of the HIVPC by modality. Modified Poisson regression models estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) for correlates of HIVPC step (e.g. awareness to uptake).</p> </section> <section> <h3> Results</h3> <p>We enrolled 2504 participants, 1636 (65%) of whom may have benefitted from PrEP based on self-reported sexual history and/or needle sharing in the prior 6 months at baseline. Forty-two percent were 18–29 years old, 18% identified as Hispanic and/or Latina/x/e and 13% identified as Black (inclusive of multiracial participants). Among participants who may have benefitted from PrEP, 92% (<i>n</i> = 1495) had ever heard of PrEP, 36% (<i>n</i> = 591) had ever used PrEP, 27% (<i>n</i> = 441) had recently used PrEP (past 6 months) and 20% (<i>n</i> = 330) were adherent. The largest proportional difference in HIVPC step was from awareness to uptake (60% of PrEP-aware participants had never used PrEP). This difference was significantly greater for LAI PrEP (96% of LAI PrEP-aware participants had never used LAI). Correlates of PrEP uptake included high perceived HIV acquisition risk (aPR = 2.08, 95% CI = 1.59−2.72; ref = no perceived risk), current use of exogenous oestrogen and/or anti-androgens (aPR = 1.47 95% CI = 1.21−1.79), and receipt of health services at an LGBTQ+ clinic (aPR = 1.34, 95% CI = 1.16−1.55). Correlates of non-adherence among PrEP users included being a non-U.S. citizen (aPR: 2.41, 95% CI = 1.44−4.05) and recent food insecurity (aPR: 1.47, 95% CI = 1.04−2.06).</p> </section> <section> <h3> Conclusions</h3> <p>Interventions to improve HIVPC outcomes—especially PrEP uptak
简介：跨性别（trans）妇女受到艾滋病毒的影响不成比例，但关于跨性别妇女的生物医学艾滋病毒PrEP连续体（HIVPC）的数据有限。我们通过暴露前预防（PrEP）方式（每日口服和长效注射，LAI）在美国和波多黎各的一个大型全国性跨性别女性队列中对HIVPC进行了表征，并确定了摄取和不依从性的相关性。方法：从2023年4月到2024年12月，我们招募了居住在美国和波多黎各的无HIV感染（通过第四代HIV-1/2抗原/抗体检测实验室确诊）的英语和西班牙语成年变性女性（18岁或以上）进入队列。PrEP数据通过自我管理的调查收集。我们使用描述性统计来描述HIVPC的特征，并根据模式评估HIVPC每个步骤的比例差异。修正的泊松回归模型估计了HIVPC步骤（例如意识到摄取）相关因素的调整患病率比（aPR）和95%置信区间（95% CI）。结果：我们招募了2504名参与者，其中1636人（65%）根据自我报告的性史和/或在基线前6个月内共用针头，可能从PrEP中受益。42%为18-29岁，18%为西班牙裔和/或拉丁裔，13%为黑人（包括多种族参与者）。在可能受益于PrEP的参与者中，92% （n = 1495）曾经听说过PrEP， 36% （n = 591）曾经使用过PrEP， 27% （n = 441）最近使用过PrEP（过去6个月），20% （n = 330）坚持使用PrEP。HIVPC步骤中最大的比例差异是从意识到吸收（60%的PrEP意识参与者从未使用过PrEP）。这种差异在LAI PrEP中更为显著（96%知晓LAI PrEP的参与者从未使用过LAI）。PrEP使用的相关因素包括高感知HIV感染风险（aPR = 2.08, 95% CI = 1.59-2.72; ref =无感知风险），目前使用外源性雌激素和/或抗雄性激素（aPR = 1.47, 95% CI = 1.21-1.79），以及在LGBTQ+诊所接受卫生服务（aPR = 1.34, 95% CI = 1.16-1.55）。PrEP使用者不遵守规定的相关因素包括非美国人；公民（aPR: 2.41, 95% CI = 1.44-4.05）和最近的粮食不安全（aPR: 1.47, 95% CI = 1.04-2.06）。结论：需要干预措施来改善HIVPC的结果，特别是PrEP的接受，以优化跨性别女性的HIV PrEP。预防措施可能需要包括量身定制的综合规划，以解决风险认知、营养、性别肯定护理和全面的保健、社会和法律需求。
{"title":"The persistent chasm between PrEP awareness and uptake: characterizing the biomedical HIV prevention continuum in a nationwide cohort of transgender women in the United States and Puerto Rico","authors":"Erin E. Cooney, Tonia C. Poteat, Meg Stevenson, Asa E. Radix, Annick Borquez, Keri N. Althoff, Sabriya Linton, Ceza Pontes, Chris Beyrer, Arianna Lint, Marissa Miller, Carter Brown, Andrew J. Wawrzyniak, Carolyn A. Brown, Leigh Ragone, Vani Vannappagari, Adrienne Guignard, Sari L. Reisner, Andrea L. Wirtz, ENCORE Study Group","doi":"10.1002/jia2.70070","DOIUrl":"10.1002/jia2.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Transgender (trans) women are disproportionately impacted by HIV, yet data on the biomedical HIV PrEP continuum (HIVPC) among trans women are limited. We characterized the HIVPC among a large, nationwide cohort of trans women in the United States and Puerto Rico by pre-exposure prophylaxis (PrEP) modality (daily oral and long-acting injectable, LAI) and identified correlates of uptake and non-adherence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>From April 2023 to December 2024, we enrolled English and Spanish-speaking adult trans women (age 18 years or older) not living with HIV (laboratory-confirmed via fourth-generation HIV-1/2 antigen/antibody testing) and residing in the United States and Puerto Rico into the cohort. PrEP data were collected via self-administered surveys. We characterized the HIVPC using descriptive statistics and assessed for differences in proportions for each step of the HIVPC by modality. Modified Poisson regression models estimated adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) for correlates of HIVPC step (e.g. awareness to uptake).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 2504 participants, 1636 (65%) of whom may have benefitted from PrEP based on self-reported sexual history and/or needle sharing in the prior 6 months at baseline. Forty-two percent were 18–29 years old, 18% identified as Hispanic and/or Latina/x/e and 13% identified as Black (inclusive of multiracial participants). Among participants who may have benefitted from PrEP, 92% (<i>n</i> = 1495) had ever heard of PrEP, 36% (<i>n</i> = 591) had ever used PrEP, 27% (<i>n</i> = 441) had recently used PrEP (past 6 months) and 20% (<i>n</i> = 330) were adherent. The largest proportional difference in HIVPC step was from awareness to uptake (60% of PrEP-aware participants had never used PrEP). This difference was significantly greater for LAI PrEP (96% of LAI PrEP-aware participants had never used LAI). Correlates of PrEP uptake included high perceived HIV acquisition risk (aPR = 2.08, 95% CI = 1.59−2.72; ref = no perceived risk), current use of exogenous oestrogen and/or anti-androgens (aPR = 1.47 95% CI = 1.21−1.79), and receipt of health services at an LGBTQ+ clinic (aPR = 1.34, 95% CI = 1.16−1.55). Correlates of non-adherence among PrEP users included being a non-U.S. citizen (aPR: 2.41, 95% CI = 1.44−4.05) and recent food insecurity (aPR: 1.47, 95% CI = 1.04−2.06).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Interventions to improve HIVPC outcomes—especially PrEP uptak","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 12","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12715324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145779845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sarah K. Calabrese, Jacob Bor, Mandisa Dukashe, David A. Kalwicz, Kennedy Mupeli, Dorina Onoya, Lucy Stackpool-Moore, Bruce Richman
Introduction
The Undetectable = Untransmittable (U = U) message has failed to reach many people living with HIV (PLHIV) and their communities despite evidence of its favourable impacts.
Discussion
We describe and contextualize six global research priorities related to U = U, which focus on: (1) examining the effects of U = U messaging on health and economic outcomes; (2) illuminating and addressing barriers to U = U communication among healthcare providers, policymakers and other stakeholders; (3) expanding U = U research to include all key populations disproportionately affected by HIV; (4) addressing limited and inequitable access to information and resources; (5) determining how to optimally communicate about U = U in the context of evolving scientific knowledge and guidelines; and (6) collaborating on parallel studies across countries to improve comparability of study findings and identify cross-cultural differences.
Conclusions
Future research targeting these six priorities is needed to guide effective messaging about U = U in healthcare settings and public health programmes throughout the world. Ultimately, bridging existing gaps in U = U awareness, understanding and acceptance can enable PLHIV and others to reap the benefits associated with this valuable message.
{"title":"A call to action to advance global research priorities related to Undetectable = Untransmittable","authors":"Sarah K. Calabrese, Jacob Bor, Mandisa Dukashe, David A. Kalwicz, Kennedy Mupeli, Dorina Onoya, Lucy Stackpool-Moore, Bruce Richman","doi":"10.1002/jia2.70069","DOIUrl":"10.1002/jia2.70069","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The Undetectable = Untransmittable (U = U) message has failed to reach many people living with HIV (PLHIV) and their communities despite evidence of its favourable impacts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>We describe and contextualize six global research priorities related to U = U, which focus on: (1) examining the effects of U = U messaging on health and economic outcomes; (2) illuminating and addressing barriers to U = U communication among healthcare providers, policymakers and other stakeholders; (3) expanding U = U research to include all key populations disproportionately affected by HIV; (4) addressing limited and inequitable access to information and resources; (5) determining how to optimally communicate about U = U in the context of evolving scientific knowledge and guidelines; and (6) collaborating on parallel studies across countries to improve comparability of study findings and identify cross-cultural differences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Future research targeting these six priorities is needed to guide effective messaging about U = U in healthcare settings and public health programmes throughout the world. Ultimately, bridging existing gaps in U = U awareness, understanding and acceptance can enable PLHIV and others to reap the benefits associated with this valuable message.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 12","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12715337/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145779824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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