Journal of the International AIDS Society最新文献

{"title":"In-utero exposure to tenofovir-containing pre-exposure prophylaxis and bone mineral content in HIV-unexposed infants in South Africa","authors":"Kerusha Reddy,&nbsp;Kimesh L. Naidoo,&nbsp;Carl Lombard,&nbsp;Zukiswa Godlwana,&nbsp;Alicia C. Desmond,&nbsp;Richard Clark,&nbsp;James F. Rooney,&nbsp;Glenda Gray,&nbsp;Dhayendre Moodley","doi":"10.1002/jia2.26379","DOIUrl":"10.1002/jia2.26379","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Tenofovir disoproxil fumarate (TDF) is a common drug of choice for pre-exposure prophylaxis (PrEP) or as a combination HIV treatment for pregnant women. In-utero exposure to TDF was found to be associated with lower bone mineral content (BMC) in HIV-exposed uninfected neonates. Data for infants born to women taking TDF-PrEP are lacking. The CAP016 randomized control trial was conducted in South Africa between September 2017 and August 2021 and pregnant women either initiated TDF/FTC PrEP in pregnancy (Immediate PrEP arm-IP) or at cessation of breastfeeding (Deferred PrEP arm-DP). In a secondary data analysis, we evaluated BMC in HIV-unexposed infants in the CAP016 trial in the first 18 months of life in association with maternal TDF-PrEP use during pregnancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Infants born to women randomized to the IP arm or DP arm in the CAP016 clinical trial had BMC measurements of the whole body with head (WBH) and lumbar spine (LS) by dual energy X-ray absorptiometry (DXA) at 6, 26, 50 and 74 weeks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 481 infants born to women enrolled in the CAP016 clinical trial, 335 (69.6%) infants had a minimum of one DXA scan of the WBH and LS between 6 and 74 weeks of age (168 IP and 167 DP). Women in the IP arm received TDF-FTC PreP for a median of 19 weeks between initiation in pregnancy and delivery. Using a mixed linear regression model and adjusted for gestational age, sex and ever-breastfed, the mean difference (95% CI) for BMC of the WBH between IP and DP arms were −0.74 (−8.69 to 7.20), −1.26 (−10.75 to 8.23), −9.17 (−20.02 to 1.69) and 5.02 (−6.74 to 16.78) g at 6, 26, 50 and 74 weeks (<i>p</i> = 0.283). Mean differences in BMC of the LS were 0.07 (−0.10 to 0.23), 0.02 (−0.18 to 0.22), −0.14 (−0.36 to 0.09) and 0.14 (−0.11 to 0.38) g at 6, 26, 50 and 74 weeks, respectively (<i>p</i> = 0.329).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In a randomized controlled trial, there were no differences in BMC of the WBH and LS between infants exposed to in-utero TDF-FTC PrEP and unexposed infants in the first 18 months of life.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613147","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}

{"title":"Patient and public involvement in HIV research: a mapping review and development of an online evidence map","authors":"David Jackson-Perry,&nbsp;Ellen Cart-Richter,&nbsp;David Haerry,&nbsp;Lindrit Ahmeti,&nbsp;Annatina Bieri,&nbsp;Alexandra Calmy,&nbsp;Marie Ballif,&nbsp;Chloé Pasin,&nbsp;Julia Notter,&nbsp;Alain Amstutz,&nbsp;the Swiss HIV Cohort Study Young Researchers’ Group, and the Swiss HIV Cohort Study","doi":"10.1002/jia2.26385","DOIUrl":"10.1002/jia2.26385","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Increasing evidence indicates the benefits of patient and public involvement (PPI) in medical research, and PPI is increasingly expected by funders and publishers. We conducted a mapping review of studies reporting examples of PPI implementation in HIV research, and developed an online evidence map to guide HIV researchers.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We systematically searched Medline and Embase up until 18 August 2024, including search terms with variations for PPI and HIV. We extracted information from identified studies in duplicate and analysed the data descriptively and qualitatively to describe types of PPI models and reported benefits, challenges, and mitigation strategies. This study was co-initiated and co-led by people living with HIV.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We identified 17 studies reporting PPI in HIV research between 1992 and August 2024. Most PPI examples informed prospective clinical studies, but also qualitative research, questionnaire development, research priority setting and surveys. Ten studies described the number and characteristics of PPI members involved. We observed four PPI models, from a model that solely engaged PPI members for a specific task to a model whereby PPI representatives were integrated into the study team with decision-making authority. Benefits reported included wider dissemination of research results, better understanding of research material and results, and higher levels of trust and learning between researcher and communities. The most commonly reported challenges were the lack of specific resources for PPI, differing levels of knowledge and expertise, concern about HIV status disclosure, and lack of diversity of the PPI team. Uneven power dynamics, tensions, and differing expectations between stake-holder groups were also frequently noted.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This mapping review summarizes published examples of PPI in HIV research for various phases of research. There is a clear need to strengthen the reporting on PPI processes in HIV research, for example by following the Guidance for Reporting Involvement of Patients and the Public (GRIPP) 2 guidelines, and developing guidance on its hands-on implementation. We embedded PPI from study inception onwards, which potentially pre-empted some of the challenges reported in the reviewed examples. The resulting online evidence map is a starting point to guide researchers on integrating PPI into their own research.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11554430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613149","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}

{"title":"Abstract Supplement HIV Glasgow 10–13 November 2024, Glasgow, UK/Virtual","authors":"","doi":"10.1002/jia2.26370","DOIUrl":"10.1002/jia2.26370","url":null,"abstract":"<p>Commonly-used Abbreviations 1</p><p>Oral Presentations</p><p>Experience in the Implementation of Long-Acting Treatment 3</p><p>Antiretroviral Treatment Strategies 5</p><p>Infection Prevention 6</p><p>Integrase Strand Transfer Inhibitor (INSTI) Resistance 7</p><p>Co-morbidities and Co-infections 9</p><p>PrEP-ing for the Future 17</p><p>Poster Presentations</p><p>ARV-based prevention—Vertical transmission 20</p><p>ARV-based prevention—PEP 28</p><p>ARV-based prevention—PrEP 29</p><p>Treatment strategies—Novel therapeutic targets (phase I and II) 45</p><p>Treatment strategies—RCTs: Oral and injectable therapy in first line and suppressed switch populations 47</p><p>Treatment strategies—Real-world and implementation science studies oral and injectable therapy 66</p><p>Treatment strategies—Treatment experienced adults (second line and multi-drug resistance studies) 122</p><p>Treatment strategies—Models of care for ageing/frail populations including virological failure and switching 147</p><p>Treatment strategies—Rapid ART initiation 149</p><p>Treatment strategies—Adherence 158</p><p>Clinical management considerations—Women 164</p><p>Clinical management considerations—Late presenters 170</p><p>Clinical management considerations—People who inject drugs (PWID) 180</p><p>Clinical management considerations—Transgender people 181</p><p>Clinical management considerations—Adolescents 182</p><p>Clinical management considerations—Paediatrics 183</p><p>Clinical management considerations—Drug-drug interactions 187</p><p>Cure/post-treatment control 194</p><p>Opportunistic infections and AIDS-defining cancers 200</p><p>Clinical pharmacology 206</p><p>Community-based treatment and prevention initiatives, including primary care screening 209</p><p>Public health strategies including of policy options 219</p><p>Cost and cost-effectiveness 233</p><p>Models of care: evaluation of ARV delivery and coverage 237</p><p>Co-morbidities and complications of disease and/or treatment—Ageing and frailty 245</p><p>Co-morbidities and complications of disease and/or treatment—Cardiovascular/metabolic including weight gain 249</p><p>Co-morbidities and complications of disease and/or treatment—Malignancies: non-AIDS defining 273</p><p>Co-morbidities and complications of disease and/or treatment—Neurological 280</p><p>Co-morbidities and complications of disease and/or treatment—Renal 282</p><p>Co-morbidities and complications of disease and/or treatment—Mental health disorders 287</p><p>Co-morbidities and complications of disease and/or treatment—Other 291</p><p>People living with HIV and COVID-19: Outcomes 304</p><p>People living with HIV and mpox virus 307</p><p>People living with HIV and sexually transmitted diseases 311</p><p>People living with HIV and tuberculosis 320</p><p>People living with HIV and viral hepatitis 323</p><p>People living with HIV and other diseases 329</p><p>Author Index 335</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 S6","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26370","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602662","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}

{"title":"Excess mortality attributable to AIDS among people living with HIV in high-income countries: a systematic review and meta-analysis","authors":"Adam Trickey,&nbsp;Julie Ambia,&nbsp;Robert Glaubius,&nbsp;Cari van Schalkwyk,&nbsp;Jeffrey W. Imai-Eaton,&nbsp;Eline L. Korenromp,&nbsp;Leigh F. Johnson","doi":"10.1002/jia2.26384","DOIUrl":"10.1002/jia2.26384","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Identifying strategies to further reduce AIDS-related mortality requires accurate estimates of the extent to which mortality among people living with HIV (PLHIV) is due to AIDS-related or non-AIDS-related causes. Existing approaches to estimating AIDS-related mortality have quantified AIDS-related mortality as total mortality among PLHIV in excess of age- and sex-matched mortality in populations without HIV. However, recent evidence suggests that, with high antiretroviral therapy (ART) coverage, a growing proportion of excess mortality among PLHIV is non-AIDS-related.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We searched Embase on 22/09/2023 for English language studies that contained data on AIDS-related mortality rates among adult PLHIV and age-matched comparator all-cause mortality rates among people without HIV. We extracted data on the number and rates of all-cause and AIDS-related deaths, demographics, ART use and AIDS-related mortality definitions. We calculated the proportion of excess mortality among PLHIV that is AIDS-related. The proportion of excess mortality due to AIDS was pooled using random-effects meta-analysis.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of 4485 studies identified by the initial search, eight were eligible, all from high-income settings: five from Europe, one from Canada, one from Japan and one from South Korea. No studies reported on mortality among only untreated PLHIV. One study included only PLHIV on ART. In all studies, most PLHIV were on ART by the end of follow-up. Overall, 1,331,742 person-years and 17,471 deaths were included from PLHIV, a mortality rate of 13.1 per 1000 person-years. Of these deaths, 7721 (44%) were AIDS-related, an overall AIDS-related mortality rate of 5.8 per 1000 person-years. The mean overall mortality rate among the general population was 2.8 (95% CI: 1.8–4.0) per 1000 person-years. The meta-analysed percentage of excess mortality that was AIDS-related was 53% (95% CI: 45–61%); 52% (43–60%) in Western and Central Europe and North America, and 71% (69–74%) in the Asia-Pacific region.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Although we searched all regions, we only found eligible studies from high-income countries, mostly European, so, the generalizability of these results to other regions and epidemic settings is unknown.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Around half of the excess mortality among PLHIV in high-","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26384","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575175","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}

{"title":"Pre-exposure prophylaxis implementation gaps among people vulnerable to HIV acquisition: a cross-sectional analysis in two communities in western Kenya, 2021–2023","authors":"Matthew L. Romo,&nbsp;Glenna Schluck,&nbsp;Josphat Kosgei,&nbsp;Christine Akoth,&nbsp;Rael Bor,&nbsp;Deborah Langat,&nbsp;Curtisha Charles,&nbsp;Paul Adjei,&nbsp;Britt Gayle,&nbsp;Elyse LeeVan,&nbsp;David Chang,&nbsp;Adam Yates,&nbsp;Margaret Yacovone,&nbsp;Julie A. Ake,&nbsp;Fred Sawe,&nbsp;Trevor A. Crowell,&nbsp;for the Multinational Observational Cohort of HIV and other Infections (MOCHI) Study Group","doi":"10.1002/jia2.26372","DOIUrl":"10.1002/jia2.26372","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite the increasing availability of prevention tools like pre-exposure prophylaxis (PrEP), HIV incidence remains disproportionately high in sub-Saharan Africa. We examined PrEP awareness, uptake and persistence among participants enrolling into an HIV incidence cohort in Kenya.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used cross-sectional enrolment data from the Multinational Observational Cohort of HIV and other Infections (MOCHI) in Homa Bay and Kericho, Kenya. The cohort recruited individuals aged 14–55 years with a recent history of sexually transmitted infection, transactional sex, condomless sex and/or injection drug use. Participants completed questionnaires on PrEP, demographics and sexual behaviours. We used multivariable robust Poisson regression to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for associations with never hearing of PrEP, never taking PrEP and ever stopping PrEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 12/2021 and 5/2023, 399 participants attempted the PrEP questionnaire, of whom 316 (79.2%) were female and median age was 22 years (interquartile range 19–24); 316 of 390 participants (81.0%) engaged in sex work or transactional sex. Of 396 participants who responded to the question, 120 (30.3%) had never heard of PrEP. Of 275 participants who had heard of PrEP, 206 (74.9%) had never taken it. Of 69 participants who had ever taken PrEP, 50 (72.5%) stopped it at some time prior to enrolment. Participants aged 15–19 years more often reported never taking PrEP compared with those 25–36 years (aPR 1.31, 95% CI: 1.06–1.61). Participants who knew someone who took PrEP less often reported never hearing about PrEP (aPR 0.10, 95% CI: 0.04–0.23) and never taking PrEP (aPR: 0.69, 95% CI: 0.60–0.80). Stopping PrEP was more common among participants with a weekly household income ≤1000 versus &gt;1000 Kenyan shillings (aPR 1.40, 95% CI: 1.02–1.93) and those using alcohol/drugs before sex (aPR 1.53, 95% CI: 1.03–2.26). Stopping PrEP was less common among those engaging in sex work or transactional sex (aPR 0.6, 95% CI: 0.40–0.92).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We identified substantial gaps in PrEP awareness, uptake and persistence, which were associated with potential system- and individual-level risk factors. Our analyses also highlight the importance of increasing PrEP engagement among individuals who do not know others taking PrEP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26372","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142575179","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}

{"title":"Power, data and social accountability: defining a community-led monitoring model for strengthened health service delivery","authors":"Ndivhuwo Rambau,&nbsp;Soeurette Policar,&nbsp;Alana R. Sharp,&nbsp;Elise Lankiewicz,&nbsp;Allan Nsubuga,&nbsp;Luke Chimhanda,&nbsp;Anele Yawa,&nbsp;Kenneth Mwehonge,&nbsp;Donald Denis Tobaiwa,&nbsp;Gérald Marie Alfred,&nbsp;Matthew M. Kavanagh,&nbsp;Asia Russell,&nbsp;Solange Baptiste,&nbsp;Onesmus Mlewa Kalama,&nbsp;Rodelyn M. Marte,&nbsp;Naïké Ledan,&nbsp;Brian Honermann,&nbsp;Krista Lauer,&nbsp;Nadia Rafif,&nbsp;Susan Perez,&nbsp;Gang Sun,&nbsp;Anna Grimsrud,&nbsp;Laurel Sprague,&nbsp;Keith Mienies","doi":"10.1002/jia2.26374","DOIUrl":"10.1002/jia2.26374","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite international commitment to achieving the end of HIV as a public health threat, progress is off-track and existing gaps have been exacerbated by COVID-19's collision with existing pandemics. Born out of models of political accountability and historical healthcare advocacy led by people living with HIV, community-led monitoring (CLM) of health service delivery holds potential as a social accountability model to increase the accessibility and quality of health systems. However, the effectiveness of the CLM model in strengthening accountability and improving service delivery relies on its alignment with evidence-based principles for social accountability mechanisms. We propose a set of unifying principles for CLM to support the impact on the quality and availability of health services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Building on the social accountability literature, core CLM implementation principles are defined. CLM programmes include a community-led and independent data collection effort, in which the data tools and methodology are designed by service users and communities most vulnerable to, and most impacted by, service quality. Data are collected routinely, with an emphasis on prioritizing and protecting respondents, and are then be used to conduct routine and community-led advocacy, with the aim of increasing duty-bearer accountability to service users. CLM efforts should represent a broad and collective community response, led independently by impacted communities, incorporating both data collection and advocacy, and should be understood as a long-term approach to building meaningful engagement in systems-wide improvements rather than discrete interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The CLM model is an important social accountability mechanism for improving the responsiveness of critical health services and systems to communities. By establishing a collective understanding of CLM principles, this model paves the way for improved proliferation of CLM with fidelity of implementation approaches to core principles, rigorous examinations of CLM implementation approaches, impact assessments and evaluations of CLM's influence on service quality improvement.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142491713","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}

{"title":"Very high HIV prevalence and incidence among men who have sex with men and transgender women in Indonesia: a retrospective observational cohort study in Bali and Jakarta, 2017–2020","authors":"Brigitta Dhyah Kunthi Wardhani,&nbsp;Andrew E. Grulich,&nbsp;Nurhayati H. Kawi,&nbsp;Yogi Prasetia,&nbsp;Hendry Luis,&nbsp;Gede Benny S. Wirawan,&nbsp;Putu Erma Pradnyani,&nbsp;John Kaldor,&nbsp;Matthew Law,&nbsp;Sudarto Ronoatmodjo,&nbsp;Erik Parulian Sihotang,&nbsp;Pande Putu Januraga,&nbsp;Benjamin R. Bavinton","doi":"10.1002/jia2.26386","DOIUrl":"10.1002/jia2.26386","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;There are no longitudinal HIV incidence data among men who have sex with men (MSM) and transgender women (TGW) in Indonesia. We aimed to estimate HIV prevalence and incidence and identify associated factors among clinic attendees in Jakarta and Bali.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We conducted a retrospective cohort study using medical records from five clinics. We reviewed HIV tests among MSM/TGW aged ≥18 years who attended the clinics between 1 January 2018 to 31 December 2020 in Jakarta and 1 January 2017 to 31 December 2019 in Bali. HIV prevalence was measured at the first test. Those with an HIV-negative test and ≥1 follow-up test/s were included in the person-years (PY) at risk to determine HIV incidence. The PY at risk calculation started at the first negative test until the last recorded negative test or seroconversion. Multivariate Poisson regression was used to determine factors associated with HIV acquisition.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Among 5203 and 2815 individuals with an HIV test result in Jakarta and Bali, respectively, at the first HIV test, 1205 and 616 were HIV positive (HIV prevalence 23.2% and 21.9%). The longitudinal sample included 1418 and 873 individuals, respectively. The median number of tests among repeat testers was 3 in Jakarta (interquartile range [IQR] = 2–4) and 3 in Bali (IQR = 2–5). At baseline, about one-quarter were aged &lt;25 years, &gt;90% were MSM and &gt;35% had been tested for HIV previously. In Jakarta, there were 127 HIV seroconversions in 1353 PY (incidence 9.39/100 PY, 95% CI = 7.89–11.17), and in Bali, 71 seroconversions in 982 PY (incidence 7.24/100 PY, 95% CI = 5.73–9.13). Compared to those aged 18–24 years, the incidence rate was lower in older patients (Jakarta—30–39 years: aRR = 0.56, 95% CI = 0.34–0.92; 40+ years: aRR = 0.34, 95% CI = 0.14–0.81; Bali—25–29 years: aRR = 0.44, 95% CI = 0.25–0.79; 30–39 years: aRR = 0.33, 95% CI = 0.18–0.61; 40+ years: aRR = 0.06, 95% CI = 0.01–0.48). In Jakarta, incidence was lower in those with university education than in those without (aRR = 0.66, 95% CI = 0.45–0.96). In Bali, those who had been referred by outreach workers had a higher incidence than those who self-presented for testing (aRR = 1.85, 95% CI = 1.12–3.07).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We observed very high HIV prevalence and incidence rate estimates. Measures to encourage regular testing and effective use of HIV prevention, including pre-exposure prophylaxis scale-up and demand creation, are needed.&lt;","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 11","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11502302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142491714","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}

{"title":"Bridging the access gaps in HIV services for female sex workers who use drugs with person-centred DSD models in Nairobi, Kenya: lessons learnt","authors":"Peninah Mwangi,&nbsp;Josephine Achieng,&nbsp;Beryl Abade,&nbsp;Janeffer Gacheru,&nbsp;Maureen Wanjiku,&nbsp;Daisy Kwala","doi":"10.1002/jia2.26378","DOIUrl":"https://doi.org/10.1002/jia2.26378","url":null,"abstract":"&lt;p&gt;The Bar Hostess Empowerment &amp; Support Programme (BHESP) was established in 1998 in Nairobi, Kenya, to provide a voice for women vulnerable to sexual and gender-based violence to influence policy, reduce HIV acquisitions, support access to justice and reduce stigma and discrimination. BHESP operates for and by female sex workers (FSWs), women having sex with women and women using drugs and bar hostesses, many of whom live in informal settlements. BHESP engages their clients in HIV prevention, treatment and support services; gender and human rights awareness; legal services; advocacy and economic empowerment opportunities.&lt;/p&gt;&lt;p&gt;In 2020, BHESP observed that FSWs using drugs were alienated from accessing the current service delivery models due to community stigma, cultural and religious barriers. Consistent with BHESP's principles of community action, human rights and an evidence-based response that puts the client at the centre of service delivery, FSWs who use drugs, peer educators, outreach workers, support group coordinators and clinicians were convened to lead the development, implementation and evaluation of tailored interventions to improve access for FSWs who use drugs. This was carried out in three parts: a community needs assessment; participatory processes and stakeholder consultations; and continuous monitoring and evaluation.&lt;/p&gt;&lt;p&gt;BHESP initiated this process by conducting a comprehensive community needs assessment with FSWs who use drugs to understand their diverse needs and challenges at each point of service delivery, including experiences of stigma, violence or geographic isolation (hidden sex workers). This individualized approach ensured that differentiated service delivery (DSD) models were tailored to the specific needs and circumstances of the FSW community.&lt;/p&gt;&lt;p&gt;BHESP organized community forums, focus group discussions and stakeholder meetings where FSWs and other key stakeholders, including clinicians, could contribute their perspectives, share experiences and co-design solutions. By fostering collaboration and dialogue among diverse stakeholders, BHESP ensured that DSD models were informed by a holistic understanding of the social, cultural and structural factors influencing access to healthcare for FSWs who use drugs. The participants evaluated the unique individual needs of the clients and worked consultatively to come up with a mix of models that would best address those needs. This collaborative approach also enhanced the ownership and sustainability of DSD interventions within the community.&lt;/p&gt;&lt;p&gt;BHESP established robust monitoring and evaluation mechanisms to assess the effectiveness and impact of DSD models on the health outcomes and wellbeing of FSWs who use drugs. This involved tracking key indicators related to service utilization, health status and client satisfaction, as well as conducting regular assessments of programme implementation fidelity and quality. BHESP also solicited feedback from FSWs who u","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 10","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26378","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142451244","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}

{"title":"Letter to the Editor: “Cost-effectiveness and budget impact analysis of the implementation of differentiated service delivery models for HIV treatment in Mozambique: a modelling study”: Resource reductions are not equal to cost savings","authors":"Sydney Rosen,&nbsp;Nkgomeleng Lekodeba,&nbsp;Linda Sande,&nbsp;Brooke Nichols","doi":"10.1002/jia2.26367","DOIUrl":"https://doi.org/10.1002/jia2.26367","url":null,"abstract":"&lt;p&gt;For the past decade, differentiated service delivery has been a major focus of national HIV treatment programmes in sub-Saharan Africa [&lt;span&gt;1-3&lt;/span&gt;]. While its main objective has been to make antiretroviral therapy (ART) provision more client-centred, it has also been seen as a way to increase the efficiency of ART delivery, largely by lowering the “intensity” of care by allowing less frequent clinic visits, longer medication dispensing intervals, out-of-facility service locations, and, in some cases, task shifting to lower-paid or less skilled staff cadres [&lt;span&gt;4, 5&lt;/span&gt;]. The few published studies of the costs of differentiated service delivery (DSD) models have had conflicting results, with the simplest models of care, such as facility-based 6-month dispensing of medications, appearing to cost less than conventional care per client served and other models, such as adherence clubs, potentially costing more [&lt;span&gt;6, 7&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Given the variation in cost results to date, we read with interest the paper by Uetela et al. [&lt;span&gt;8&lt;/span&gt;] reporting their cost-effectiveness and budget impact analysis of DSD models for HIV treatment in Mozambique. Studies of this type turn out to be far more challenging to conduct than they first appear, because of the difficulty of defining a comparison population, obtaining complete individual-level data on resource utilization, observing actual resource utilization for health system interactions that often occur outside fixed healthcare facilities, accounting for participants who switch models during the study observation period, and incorporating individual facility idiosyncrasies in model implementation. We therefore congratulate the authors for their effort in pulling together all the disparate types of data needed to make these estimates.&lt;/p&gt;&lt;p&gt;We do, however, have one major concern about this paper's conclusions that we believe should be called to readers’ attention. The paper states that “the implementation of these models will result in savings of approximately US$14 million to the health system between 2022 and 2024.” It is critical to note that, as far as we can tell, none of these “savings” is in fact a cash or budgetary saving to the health system. The “savings” reported are generated primarily by a reduction in the use of healthcare provider time required by the DSD models. This is time that facility managers can reallocate to other purposes, and it may allow them to see more clients or provide higher-quality care to existing clients, but it does not represent money saved, unless absolute numbers of healthcare staff are reduced, for example by laying off nurses or pharmacy technicians. We have never encountered a healthcare system in this region that is either able or willing to reduce its total complement of healthcare workers in response to the advent of DSD models. No mechanism or pathway exists for DSD models to “save money.” They do, without doubt, save resources (e.g. staff tim","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 10","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26367","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142438958","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}

{"title":"Response: “Cost-effectiveness and budget impact analysis of the implementation of differentiated service delivery models for HIV treatment in Mozambique: a modelling study”: resource reductions are not equal to cost savings","authors":"Dorlim Moiana Uetela,&nbsp;Marita Zimmermann,&nbsp;Ruanne Barnabas,&nbsp;Kenneth Sherr","doi":"10.1002/jia2.26368","DOIUrl":"https://doi.org/10.1002/jia2.26368","url":null,"abstract":"<p>Dear Editor,</p><p>We appreciate the opportunity to respond to the comments made in the letter “Cost-Effectiveness and Budget Impact Analysis of the Implementation of Differentiated Service Delivery Models for HIV Treatment in Mozambique: a Modelling Study”: Resource reductions are not equal to cost savings [<span>1</span>].</p><p>First, we appreciate the authors’ recognition of the challenging work that we have done to generate evidence of the cost-effectiveness and budget impact of differentiated service delivery (DSD) models for HIV treatment in Mozambique.</p><p>Second, we agree with the authors that the savings mentioned in our work are not monetary, but opportunity costs, mainly due to the reduction in the use of healthcare provider time. This reduction could theoretically allow providers to see more clients and/or provide higher-quality care. The authors state that they have never encountered a healthcare system in sub-Saharan Africa that is either able or willing to reduce its total complement of healthcare workers in response to the advent of DSD models, and no mechanism or pathway exists for DSD models to “save money.” We agree that these responses are unlikely. Rather, the reduction of provider time represents time that could be used to increase care for other clients or health areas, improving the health of the population overall without increasing costs. Our study focused on describing the opportunity costs saved through DSD model implementation. While investigating specifically how those savings could be used to advance health was beyond the scope of our work, we appreciate the discussion of implications and application of our work.</p><p>The authors have no conflicts of interest to declare.</p><p>DMU drafted the response. MZ, RB and KS reviewed the draft. All authors from the original article approved the final letter.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"27 10","pages":""},"PeriodicalIF":4.6,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26368","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142438957","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}