Journal of the International AIDS Society最新文献

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Eliminating perinatal transmission of hepatitis B virus: it is time for action 消除围产期乙型肝炎病毒传播：是采取行动的时候了。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-07-25 DOI: 10.1002/jia2.26337

Rania A. Tohme, Su Wang, Benjamin Cowie, Sandra Dudareva, Carolyn Wester

Chronic hepatitis B virus (HBV) infection is a leading cause of liver cirrhosis and liver cancer causing 1.1 million deaths globally in 2022 [1]. In 2022, an estimated 254 million persons were living with chronic HBV infection. Globally, HBV is mainly acquired through mother-to-child transmission (MTCT) at birth (vertical or perinatal transmission), and during early childhood (horizontal transmission). Up to 90% of newborns who acquire HBV through MTCT will develop chronic hepatitis B compared to 30%–50% of children infected between the ages of 1–5 years, while <5% of those infected in adulthood develop chronic hepatitis B [2]. The hepatitis B vaccine is >90% effective at preventing infections and is given as a series starting with a dose of monovalent vaccine within 24 hours of birth (hepatitis B-birth dose [hepB-BD]) (70%–95% effective in preventing perinatal HBV infection), followed by two or three additional doses during infancy [2].

Elimination targets for MTCT of HBV include achieving ≤0.1% prevalence of hepatitis B surface antigen (HBsAg) in children ≤5 years of age, and ≥90% coverage with timely HepB-BD and three doses of hepatitis B vaccine (HepB3) [3]. In addition, countries that provide selective HepB-BD (e.g. only to infants with known exposure) need to screen ≥90% of pregnant women for hepatitis B and treat ≥90% of those eligible [3]. Prevention of HBV infection in infancy and childhood through vaccination and treatment of pregnant women would be the most impactful interventions to reduce the prevalence of chronic hepatitis B in the population.

An analysis of the impact of childhood vaccination in 98 low- and middle-income countries showed that hepatitis B vaccination will have prevented 38 million (range: 25–52 million) deaths over the lifetime of those born from 2000 to 2030, which was second only to measles vaccine [4]. Yet, despite the availability of safe and effective hepatitis B vaccines since 1982, coverage with timely hepB-BD has been suboptimal in most regions (Figure 1). By 2023, 140 of 195 (72%) countries have introduced either universal or selective HepB-BD, with 115 (59%) countries providing HepB-BD to all newborns [5]. In 2022, almost 5.6 million children aged ≤5 years were living with HBV infection [6]. In the World Health Organization (WHO) African region where the burden of HBV infection in children is the highest, only 16 of 47 (34%) countries have introduced HepB-BD mainly due to lack of financial support from Gavi, the Vaccine Alliance [7]. In 2020, Gavi approved funding for HepB-BD introduction; however, this was put on hold due to the COVID-19 pandemic. In June 2024, Gavi launched official funding support for eligible countries for HepB-BD introduction [8]. Countries must now take urgent action to introduce HepB-BD, including submitting applications for Gavi fund

慢性乙型肝炎病毒（HBV）感染是导致肝硬化和肝癌的主要原因，2022 年全球将有 110 万人因此死亡[1]。2022 年，估计有 2.54 亿人患有慢性乙型肝炎病毒感染。在全球范围内，HBV 主要通过出生时的母婴传播（MTCT）（垂直或围产期传播）和幼儿期的母婴传播（水平传播）获得。在通过母婴传播感染 HBV 的新生儿中，高达 90% 的人会发展为慢性乙型肝炎，而在 1-5 岁感染 HBV 的儿童中，这一比例为 30%-50%，而在成年期感染 HBV 的人中，有 5% 会发展为慢性乙型肝炎 [2]。乙型肝炎疫苗预防感染的有效率为 90%，疫苗接种为系列接种，首先在婴儿出生后 24 小时内接种一剂单价疫苗（乙型肝炎出生剂量 [hepB-BD]）（预防围产期 HBV 感染的有效率为 70%-95%），然后在婴儿期再接种两到三剂 [2]。消除 HBV MTCT 的目标包括：5 岁以下儿童乙肝表面抗原 (HBsAg) 感染率≤0.1%，及时接种乙肝疫苗和三剂乙肝疫苗 (HepB3) 的覆盖率≥90%[3]。此外，提供选择性 HepB-BD 的国家（例如，仅向已知暴露的婴儿提供 HepB-BD）需要筛查≥90% 的孕妇是否患有乙型肝炎，并治疗≥90% 符合条件的孕妇 [3]。对 98 个中低收入国家儿童疫苗接种的影响进行的分析表明，乙肝疫苗接种将在 2000 年至 2030 年出生的人的一生中预防 3 800 万例（范围：2 500 万至 5 200 万例）死亡，仅次于麻疹疫苗[4]。然而，尽管自 1982 年以来就有了安全有效的乙肝疫苗，但在大多数地区，及时接种乙肝疫苗的覆盖率并不理想（图 1）。到 2023 年，195 个国家中有 140 个国家（72%）已普及或选择性接种乙肝疫苗，其中 115 个国家（59%）为所有新生儿接种乙肝疫苗[5]。2022 年，近 560 万≤5 岁的儿童患有 HBV 感染[6]。在儿童 HBV 感染负担最重的世界卫生组织（WHO）非洲地区，47 个国家中只有 16 个国家（34%）引入了 HepB-BD，主要原因是缺乏疫苗联盟 Gavi 的财政支持[7]。2020 年，Gavi 批准为引进 HepB-BD 提供资金；但由于 COVID-19 的流行，这一计划被搁置。2024 年 6 月，Gavi 启动了对符合条件的国家引入乙肝疫苗的正式资助[8]。各国现在必须采取紧急行动，引进乙肝疫苗，包括提交 Gavi 资金申请。还需要实施各种战略，提高乙肝疫苗在医疗机构内和医疗机构外分娩的及时覆盖率[9]。对医护人员进行教育、鼓励妇女在医疗机构内分娩、通过产房而非免疫诊所的母婴健康计划提供疫苗以及确保产房的疫苗供应，这些措施已被证明可提高医疗机构内分娩的乙肝疫苗及时接种率[9]。为了覆盖家庭分娩，对孕妇和社区卫生工作者进行有关及时接种乙肝疫苗重要性的教育，利用社区卫生工作者识别所有孕妇并向医疗机构通报最近的分娩情况，在产后护理访视期间整合乙肝疫苗接种，以及使用小巧的预充式自动停药装置，减少接种培训，这些都已被证明可提高及时接种乙肝疫苗的覆盖率[9]。此外，疫苗制备和给药方面的创新，如乙肝疫苗微针贴片 (MNP)，已在动物实验中被证明能引起强有力的免疫反应 [10]。最近，在冈比亚儿童和成人中开展的麻疹和风疹疫苗（MRV）-MNP 的 1/2 期临床试验显示，该疫苗安全且具有免疫原性，支持加速开发 MRV-MNP[11]。对孕妇进行 HBV 感染筛查并为符合条件者提供免费抗病毒治疗是确保最大限度预防围产期感染和防止妇女肝病恶化的额外需要[12]。将消除 HBV 经母体传播（eMTCT）与经常实施的 HIV 和梅毒服务相结合，既符合成本效益，又切实可行，柬埔寨和越南的实践证明了这一点[13, 14]。

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引用次数: 0

Social network strategies to distribute HIV self-testing kits: a global systematic review and network meta-analysis 分发艾滋病毒自我检测包的社交网络策略：全球系统性回顾和网络荟萃分析。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-07-24 DOI: 10.1002/jia2.26342

Siyue Hu, Fengshi Jing, Chengxin Fan, Yifan Dai, Yewei Xie, Yi Zhou, Hang Lv, Xi He, Dan Wu, Joseph D. Tucker, Weiming Tang

Introduction

Social network strategies, in which social networks are utilized to influence individuals or communities, are increasingly being used to deliver human immunodeficiency virus (HIV) interventions to key populations. We summarized and critically assessed existing research on the effectiveness of social network strategies in promoting HIV self-testing (HIVST).

Methods

Using search terms related to social network interventions and HIVST, we searched five databases for trials published between 1st January 2010 and 30th June 2023. Outcomes included uptake of HIV testing, HIV prevalence and linkage to antiretroviral therapy (ART) or HIV care. We used network meta-analysis to assess the uptake of HIV testing through social network strategies compared with control methods. A pairwise meta-analysis of studies with a comparison arm that reported outcomes was performed to assess relative risks (RR) and their corresponding 95% confidence intervals (CI).

Results

Among the 4496 manuscripts identified, 39 studies fulfilled the inclusion criteria, including one quasi-experimental study, 22 randomized controlled trials and 16 observational studies. Networks HIVST testing was organized by peers (distributed to known peers, 15 studies), partners (distributed to their sexual partners, 16 studies) and peer educators (distributed to unknown peers, 8 studies). Among social networks, simulating the possibilities of ranking position, peer distribution had the highest uptake of HIV testing (84% probability), followed by partner distribution (80% probability) and peer educator distribution (74% probability). Pairwise meta-analysis showed that peer distribution (RR 2.29, 95% CI 1.54−3.39, 5 studies) and partner distribution (RR 1.76, 95% CI 1.50−2.07, 10 studies) also increased the probability of detecting HIV reactivity during testing within the key population when compared to the control.

Discussion

All of the three social network distribution strategies enhanced the uptake of HIV testing compared to standard facility-based testing. Linkage to ART or HIV care remained comparable to facility-based testing across the three HIVST distribution strategies.

Conclusions

Network-based HIVST distribution is considered effective in augmenting HIV testing rates and reaching marginalized populatio

导言：利用社会网络影响个人或社区的社会网络策略正越来越多地被用于向重点人群提供人类免疫缺陷病毒（HIV）干预措施。我们总结并严格评估了有关社交网络策略在促进 HIV 自我检测（HIVST）方面有效性的现有研究：我们使用与社交网络干预和 HIVST 相关的搜索关键词，在五个数据库中搜索了 2010 年 1 月 1 日至 2023 年 6 月 30 日期间发表的试验。结果包括接受 HIV 检测的人数、HIV 感染率以及与抗逆转录病毒疗法（ART）或 HIV 护理的联系。我们使用网络荟萃分析法来评估通过社交网络策略与对照方法进行 HIV 检测的吸收率。我们对报告结果的有对比臂的研究进行了配对荟萃分析，以评估相对风险（RR）及其相应的 95% 置信区间（CI）：在已确定的 4496 篇手稿中，有 39 项研究符合纳入标准，包括 1 项准实验研究、22 项随机对照试验和 16 项观察性研究。网络 HIVST 检测由同伴（分发给已知同伴，15 项研究）、伴侣（分发给性伴侣，16 项研究）和同伴教育者（分发给未知同伴，8 项研究）组织。在社会网络中，模拟排名位置的可能性，同伴分布的艾滋病毒检测接受率最高（概率为 84%），其次是性伴侣分布（概率为 80%）和同伴教育者分布（概率为 74%）。配对荟萃分析表明，与对照组相比，同伴分布（RR 2.29，95% CI 1.54-3.39，5 项研究）和伙伴分布（RR 1.76，95% CI 1.50-2.07，10 项研究）也提高了重点人群在检测过程中发现 HIV 反应的概率：讨论：与标准设施检测相比，三种社会网络传播策略都提高了艾滋病检测的接受率。在这三种 HIVST 传播策略中，抗逆转录病毒疗法或 HIV 护理的衔接仍与基于设施的检测相当：结论：与基于设施的检测相比，基于网络的 HIVST 传播被认为能有效提高 HIV 检测率并覆盖边缘化人群。这些策略可与现有的艾滋病护理服务相结合，以填补全球关键人群中的检测缺口：CRD42022361782。

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引用次数: 0

A thank you note to our peer reviewers (2023) 致同行评审员的感谢信（2023 年）。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-07-24 DOI: 10.1002/jia2.26335

Kenneth H. Mayer, Annette H. Sohn, Marlène Bras

The Journal of the International AIDS Society (JIAS) would like to express our gratitude to the peer reviewers who contributed to reviewing articles for the journal in 2023. Their time and expertise are crucial to upholding the quality of this publication, and we are thankful for their engagement.

We also wish to extend our appreciation to the JIAS Editorial Board members, Deputy Editors, statistical experts and Ethical Committee members for their valuable contributions in assessing and reviewing articles submitted to the journal.

Kenneth Mayer, co-Editors-in-Chief

Annette Sohn, co-Editors-in-Chief

Marlène Bras, Executive Editor

Aaloke Mody

Adam Trickey

Adekemi Sekoni

Aditi Ramakrishnan

Aditya Subhash Khanna

Alana T. Brennan

Albert Liu

Alex Dubov

Alex Keuroghlian

Alex Viguerie

Alexander Adia

Alexandra C. Vrazo

Allan Maleche

Allanise Cloete

Allison McFall

Amelia M. Stanton

Amy Zheng

Anatole Menon-Johansson

Andrea Jane Low

Andrew Hill

Andrew McAuley

Andrew Prendergast

Angela Bengtson

Aniruddha Hazra

Ann Gottert

Anna Bershteyn

Anna Grimsrud

Anthony Fojo

Antons Mozalevskis

Anupam Garrib

Aoife Doyle

April D. Kimmel

Ariane van der Straten

Ashley Lacombe-Duncan

Augustine Talumba Choko

Bankole Olatosi

Benjamin Brown

Benjamin H. Chi

Bernadette Kina Kombo

Bernard Surial

Bill G. Kapogiannis

Bindiya Meggi

Brandon Guthrie

Brenda Hoagland

Brennan Cebula

Brian Zanoni

Bronwyn Elizabeth Bosch

Brooke E. Nichols

Bruce Richman

Caitlin Dugdale

Camille Cioffi

Carla Pires

Carmen Logie

Carol S. Camlin

Carol Strong

Caroline De Schacht

Caroline Foster

Carolyn Bolton-Moore

Carolyn Lauckner

Catherine Godfrey

Catherine Lesko

Cheryl Case Johnson

Chris Collins

Christian Kraef

Christina Psaros

Chutima Suraratdecha

Claudia Estcourt

Clemens Benedikt

Collins Iwuji

Daisuke Mizushima

Daniel Fierer

Danielle Resar

Darrell Tan

David Allen Roberts

David B. Hanna

David Dunn

David Hoos

David V. Glidden

Dean Murphy

Deanna Kerrigan

Debrah Boeras

Denis Nash

Denise Jacobson

Didier Ekouevi

Dobromir Dimitrov

Donn Colby

Doris Chibo

Dorlim Antonio Moiana Uetela

Dvora Joseph Davey

Edinah Mudimu

Elaine J. Abrams

Elenore P. Bhatraju

Elijah Kakande

Elizabeth T. Knippler

Elliot Raizes

Elona Toska

Emily Chasco

Emily Hyle

Emma Kalk

Erica N. Browne

Erin Graves

Erin Wilson

Estevão P. Nunes

Esther C. Atukunda

Fiona Burns

Florence Anabwani

Fran

国际艾滋病学会学报》（JIAS）谨向为2023年学报审稿做出贡献的同行评审员表示感谢。我们还要向JIAS编委会成员、副主编、统计专家和伦理委员会成员表示感谢，感谢他们在评估和审阅投稿文章方面做出的宝贵贡献。Kenneth Mayer，联席主编Annette Sohn，联席主编Marlène Bras，执行主编Aaloke ModyAdam TrickeyAdekemi SekoniAditi RamakrishnanAditya Subhash KhannaAlana T. BrennanAlbert LiuAlex DubovAlex KeuroghlianAlex ViguerieAlexander AdiaAlexandra C. VrazoAllan Malechey，联席主编Alex DubovAlex KeuroghlianAlex ViguerieAlexander AdiaAlexandra C. VrazoVrazoAllan MalecheAllanise CloeteAllison McFallAmelia M. StantonAmy ZhengAnatole Menon-JohanssonAndrea Jane LowAndrew HillAndrew McAuleyAndrew PrendergastAngela BengtsonAniruddha HazraAnn GottertAnna BershteynAnna GrimsrudAnthony FojoAntons MozalevskisAnupam GarribAoife DoyleApril D. KimmelAriane van der StrangerKimmelAriane van der StratenAshley Lacombe-DuncanAugustine Talumba ChokoBankole OlatosiBenjamin BrownBenjamin H. ChiBernadette Kina KomboBernard SurialBill G. KapogiannisBindiya MeggiBrandon GuthrieBrenda HoaglandBrennan CebulaBrian ZanoniBronwyn Elizabeth BoschBrooke E. NicholsBruce RichmanCruk E. NicholsBronwyn Elizabeth BoschBronwyn Elizabeth BoschBronwyn Elizabeth BoschNicholsBruce RichmanCaitlin DugdaleCamille CioffiCarla PiresCarmen LogieCarol S．CamlinCarol StrongCaroline De SchachtCaroline FosterCarolyn Bolton-MooreCarolyn LaucknerCatherine GodfreyCatherine LeskoCheryl Case JohnsonChris CollinsChristian KraefChristina PsarosChutima SuraratdechaClaudia EstcourtClemens BenediktCollins IwujiDaisuke MizushimaDaniel FiererDanielle ResarDarrell TanDavid Allen RobertsDavid B．HannaDavid DunnDavid HoosDavid V. GliddenDean MurphyDeanna KerriganDebrah BoerasDenis NashDenise JacobsonDidier EkoueviDobromir DimitrovDonn ColbyDoris ChiboDorlim Antonio Moiana UetelaDvora Joseph DaveyEdinah MudimuElaine J.AbramsElenore P. BhatrajuElijah KakandeElizabeth T. KnipplerElliot RaizesElona ToskaEmily ChascoEmily HyleEmma KalkErica N. BrowneErin GravesErin WilsonEstevão P. NunesEsther C．AtukundaFiona BurnsFlorence AnabwaniFrancoise RenaudFumiyo NakagawaGabriel ChamieGbolahan AjibolaGene MorseGeorge AyalaGeorge SiberryGesine Meyer RathGiang Thi HoangGillian DoughertyGiuliana Jacqueline MoralesGuan-Jhou ChenHabib RamadhaniHalima DawoodHanne ZimmermannHeather BaileyHeather PinesHeather-Marie SchmidtHelena RabieHomaira HanifHong ChenIan HodgsonJ.Joseph LawrenceJack DeHovitzJack StoneJacklyn D. FoleyJames AyiekoJames CarlucciJane TomnayJason W. MitchellJasper S. LeeJavier Rodriguez-CentenoJean de Dieu TapsobaJean-Pierre RoutyJennifer CocohobaJennifer M. BelusJennifer SherwoodJeremy PennerJerome Timothy GaleaJessica E.HabererJessica J. JustmanJienchi DorwardJing ZhangJoel Msafiri FrancisJoep J. Van OosterhoutJohn ChiosiJohn M. HumphreyJohn StoverJonathan RossJose A. BauermeisterJoseph KagaayiJulia RaifmanJulia RohrJulie PulerwitzJunko TanumaK.Rivet Amico Kai J. JonasKaitlyn AtkinsKarin HatzoldKarl TechnauKarsten LunzeKassem BourgiKate WilsonKaterina ChristopoulosKatherine HortonKathleen MacQueenKathrine MeyersKatrina Frances OrtbladKawango AgotKelika K

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引用次数: 0

Abstract Supplement Abstracts from AIDS 2024, the 25th International AIDS Conference, 22 – 26 July, Munich, Germany & Virtual [第 25 届国际艾滋病大会 AIDS 2024（7 月 22-26 日，德国慕尼黑，虚拟）摘要补编]。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-07-23 DOI: 10.1002/jia2.26279

引用次数: 0

HIV vulnerabilities and psychosocial health among young transgender women in Lima, Peru: results from a bio-behavioural survey 秘鲁利马年轻变性妇女的艾滋病毒易感性和社会心理健康：生物行为调查的结果。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-07-23 DOI: 10.1002/jia2.26299

Alfonso Silva-Santisteban, Dorothy Apedaile, Amaya Perez-Brumer, Segundo R. Leon, Leyla Huerta, Francezka Leon, Rodrigo Aguayo-Romero, Sari L. Reisner

Introduction

Peruvian young transgender women (YTW) ages 16−24 years are a critical but understudied group for primary HIV prevention efforts, due to sharp increases in HIV prevalence among TW ages 25 years and older.

Methods

Between February and July 2022, a cross-sectional quantitative study with YTW ages 16−24 years in Peru (N = 211) was conducted consisting of a bio-behavioural survey accompanied by laboratory-based testing for HIV and sexually transmitted infections (STIs). Bivariate and multivariable Poisson regression models were used to estimate prevalence ratios between socio-demographic and behavioural characteristics and HIV status.

Results

HIV prevalence was 41.5% (95% CI: 33.9−49.4%), recent syphilis acquisition 19.4% (95% CI: 12.7−28.4), chlamydia 6.3% (95% CI: 3.1−11.1) and gonorrhoea 12.3% (95% CI: 7.9−18.7). Almost half (47.9%) reported condomless anal sex in the past 6 months, 50.7% reported sex work in the past 30 days and 13.7% reported accepting more money for condomless sex. There were no significant differences in reported sexual behaviours by HIV status. Only 60.8% of participants reported ever having been tested for HIV, and 25.6% reported a past 6-month STI test. More than two-thirds (67.8%) had not heard of antiretroviral pre-exposure prophylaxis (PrEP) and only 4.7% had taken PrEP in the past month. Current moderate-to-severe psychological distress was endorsed by 20.3%, 10.0% reported attempting suicide in the past 6 months and 85.4% reported alcohol misuse.

Conclusions

Findings show that the HIV epidemic for YTW in Lima, Peru is situated in the context of widespread social exclusion, including economic vulnerabilities, violence victimization and the mental health sequelae of transphobic stigma that starts early in life. Future research should aim to further understand the intersection of these vulnerabilities. Moreover, there is an urgent necessity to design and evaluate HIV prevention programmes that address the root systems driving HIV vulnerabilities in YTW and that focus on developmentally specific clusters of stigma-related conditions.

简介：秘鲁 16-24 岁的年轻变性女性（YTW）是艾滋病初级预防工作中的一个关键群体，但对其研究不足，原因是 25 岁及以上 TW 的艾滋病感染率急剧上升：2022 年 2 月至 7 月期间，对秘鲁 16-24 岁的变性人（N = 211）进行了一项横断面定量研究，包括一项生物行为调查，以及基于实验室的艾滋病毒和性传播感染（STI）检测。采用双变量和多变量泊松回归模型来估算社会人口学特征和行为特征与 HIV 感染状况之间的流行率：艾滋病毒感染率为 41.5%（95% CI：33.9-49.4%），近期感染梅毒的比例为 19.4%（95% CI：12.7-28.4），衣原体感染率为 6.3%（95% CI：3.1-11.1），淋病感染率为 12.3%（95% CI：7.9-18.7）。近一半（47.9%）的受访者表示在过去 6 个月中发生过无套肛交，50.7%的受访者表示在过去 30 天中从事过性工作，13.7%的受访者表示在无套性交中接受了更多的金钱。在报告的性行为中，艾滋病毒感染状况没有明显差异。只有 60.8% 的参与者报告曾经接受过 HIV 检测，25.6% 的参与者报告在过去 6 个月中接受过 STI 检测。超过三分之二（67.8%）的人没有听说过抗逆转录病毒暴露前预防疗法（PrEP），只有 4.7% 的人在过去一个月中服用过 PrEP。20.3%的人表示目前有中度至严重的心理困扰，10.0%的人表示在过去 6 个月中曾试图自杀，85.4%的人表示酗酒：研究结果表明，在秘鲁利马，YTW 感染艾滋病毒的背景是广泛的社会排斥，包括经济脆弱性、暴力伤害以及从生命早期就开始的对变性人的歧视所造成的心理健康后遗症。未来的研究应旨在进一步了解这些脆弱性的交叉点。此外，亟需设计和评估艾滋病毒预防方案，解决导致青年变性者易感染艾滋病毒的根本原因，并将重点放在与污名相关的特定发展群组上。

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引用次数: 0

The audacious goal to end AIDS by 2030: aspiration or reality? 到 2030 年消除艾滋病的大胆目标：愿望还是现实？

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-07-22 DOI: 10.1002/jia2.26339

Quarraisha Abdool Karim, Kenneth H. Mayer, Jivanka Mohan, Carlos del Rio

In 2015, world leaders pledged to end the AIDS epidemic as a public health threat by 2030 with the goals of zero new acquisitions, zero AIDS-related deaths, and zero stigma and discrimination. It is undeniable that great strides have been made in initiating those living with HIV on antiretroviral medication (7.7 million in 2010 to 29.8 million in 2022) resulting in an estimated 51% reduction in AIDS-related deaths (1.3 million in 2010 to 630,000 in 2022), a 58% decline in perinatal transmissions (310,000 in 2010 to 130,000 in 2022), and a 38% reduction in new acquisitions (2.1 million in 2010 to 1.3 million in 2022) [1]. However, the path ahead poses multiple challenges, particularly for ending new acquisitions and eliminating stigma and discrimination. The reality is that there is no room for complacency, as much remains to be done to get us to the UNAIDS 2030 goals. Furthermore, achieving these goals has become even more complicated because of disruptions in testing, treatment and support services caused by the COVID-19 pandemic [2].

The global response to HIV/AIDS has been the most extraordinary and unprecedented public health endeavour in history. From the epidemic's bleakest days in the 1980s and early 90s, through the advent of life-saving antiretroviral therapy in 1996, to global solidarity in the 2000s, we have seen the might of political will, science, activism and empathy [3].

Unfortunately, the phrase “ending the AIDS epidemic as a public health threat” has been heard by many—including political leaders, decision-makers and the public—as “we have ended the AIDS epidemic,” which has resulted in unintended negative consequences, including threats to end programmes such as the Global Fund to Fight AIDS, Tuberculosis, and Malaria [4] and the President's Emergency Plan for AIDS Relief (PEPFAR) [5]. Achieving the 2030 goals will require renewed political commitment, innovative approaches and collaboration across sectors and borders—an all-of-society approach. In the absence of a vaccine and a cure, funding will be necessary beyond 2030 to sustain the gains, maintain 30 million people on treatment, support medication adherence, strengthen primary prevention including pre-exposure prophylaxis (PrEP) and continue research to find effective vaccines and cures. Communicating this message to politicians, decision-makers, funders and the public is a priority imperative.

Significant governmental and foundation investments have been made in research to find a vaccine and a cure for HIV [6], but more work needs to be done. Additionally, the development of new antiretroviral drugs and long-acting formulations is necessary to improve adherence and clinical outcomes [7] as well as to increase uptake and persistent use among PrEP users. But the incentives for the industry to continue to innovate are predicated on the assumption that there will b

社区主导的倡议解决了当地的具体挑战，改善了艾滋病毒服务的覆盖面和影响，例如通过同伴坚持支持小组和社区收集点进行多月配药。努力减少污名化和歧视对于确保艾滋病毒感染者和高危人群能够获得所需的护理和支持至关重要，包括保护人权的计划[14]。一些国家改革了法律和政策，以保护艾滋病毒感染者、性工作者、吸毒者和 LGBTQ+ 人士的权利，鼓励他们寻求检测和治疗，而不必担心受到歧视，而另一些国家则推翻了进步的立法。自 2023 年以来，非洲各地针对 LGBTQ+ 的歧视性立法激增。如今，在 55 个非洲国家中的 33 个国家，同性恋是一种可判处监禁的罪行，在乌干达等一些国家，法律还规定了死刑[15]。性工作和吸毒也仍然是刑事犯罪活动。扭转倒退的立法和/或非刑罪化对于实现 2030 年目标至关重要。为了实现这些目标，我们应集中精力，加大力度，推广行之有效的干预措施，帮助风险最高的人群。国际捐助者和国内政府的持续承诺对于确保保持长期成果至关重要[16]。解决健康问题的社会决定因素，减少医疗服务获取方面的差距，将有助于减少不公平现象。加强政府、民间社会、私营部门和国际组织之间的合作对于加强伙伴关系至关重要[17]。毫无疑问，前方的道路依然崎岖，尤其是在终止新的获取以及消除对关键人群和弱势群体的羞辱和歧视方面。然而，我们希望通过坚定不移的努力、政治承诺和全球团结，在这十年内实现无新感染、无艾滋病相关死亡、无污名化和歧视的目标仍然是可以实现的。作者声明与本文的研究、作者身份和/或发表没有潜在利益冲突。披露：QAK、KM 和 CdR 是 PEPFAR 科学顾问委员会成员。QAK、KHM、JM 和 CdR 对本文的起草和定稿做出了同等贡献。

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引用次数: 0

Implementing a male-specific ART counselling curriculum: a quality assessment with healthcare workers in Malawi 实施男性专用抗逆转录病毒疗法咨询课程：马拉维医护人员质量评估。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-07-22 DOI: 10.1002/jia2.26270

Isabella Robson, Misheck Mphande, Jiyoung Lee, Julie Anne Hubbard, Joseph Daniels, Khumbo Phiri, Elijah Chikuse, Thomas J. Coates, Morna Cornell, Kathryn Dovel

Introduction

There is little HIV counselling that directly meets the needs of men in Eastern and Southern Africa, limiting men's knowledge about the benefits of HIV treatment and how to overcome barriers to engagement, contributing to poorer HIV-related outcomes than women. Male-specific approaches are needed to improve men's outcomes but may be difficult for healthcare workers (HCWs) to implement with fidelity and quality in low-resource settings. We developed a male-specific counselling curriculum which was implemented by male HCWs and then conducted a mixed-methods quality assessment.

Methods

We audio-recorded counselling sessions to assess the quality of implementation (n = 50) by male HCWs from two cadres (nurse, n = 10 and lay cadre, n = 10) and conducted focus group discussions (FGDs) with HCWs at 6 and 9 months after rollout to understand barriers and facilitators to implementation. Counselling sessions and FGDs were translated, transcribed and analysed using thematic analysis adapted from WHO Quality Counselling Guidelines. We assessed if sessions were respectful, informative, interactive, motivating and included tailored action plans for overcoming barriers to care. All data were collected September 2021−June 2022.

Results

All sessions used respectful, non-judgemental language. Sessions were highly interactive with most HCWs frequently asking open-ended questions (n = 46, 92%) and often incorporating motivational explanations of how antiretroviral therapy contributes to life goals (n = 42, 84%). Few sessions included individually tailored action plans for clients to overcome barriers to care (n = 9, 18%). New counselling themes were well covered; however, occasionally themes of self-compassion and safe sex were not covered during sessions (n = 16 and n = 11). HCWs believed that having male HCWs conduct counselling, ongoing professional development and keeping detailed counselling notes facilitated quality implementation. Perceived barriers included curriculum length and client hesitancy to participate in action plan development. Findings were similar across cadres.

Conclusions

Implementing high-quality male-specific counselling using male nurses and/or lay cadre is feasible. Efforts to utilize lay cadres should be prioritized, particularly in low-resource settings. Programmes should provide comprehensive job aids to support HCWs. Ongoing train

导言：在东部和南部非洲，几乎没有直接满足男性需求的艾滋病咨询，这限制了男性对艾滋病治疗益处以及如何克服参与障碍的了解，导致与艾滋病相关的结果比女性更差。我们需要针对男性的方法来改善男性的治疗效果，但在资源匮乏的环境中，医疗工作者（HCW）可能很难忠实、高质量地实施这些方法。我们开发了男性专用咨询课程，由男性医护人员实施，然后进行了混合方法质量评估：方法：我们对咨询课程进行了录音，以评估由两个级别（护士，n = 10；非专业人员，n = 10）的男性保健工作者实施的课程（n = 50）的质量，并在课程推出 6 个月和 9 个月后与保健工作者进行了焦点小组讨论（FGD），以了解实施过程中的障碍和促进因素。我们对咨询课程和 FGD 进行了翻译、誊写，并根据世界卫生组织《优质咨询指南》进行了专题分析。我们评估了辅导课是否尊重他人、内容丰富、互动性强、具有激励性，是否包含克服护理障碍的定制行动计划。所有数据的收集时间为 2021 年 9 月至 2022 年 6 月：结果：所有课程都使用了尊重和非评判性的语言。会议互动性很强，大多数医护人员经常提出开放式问题（n = 46，92%），并经常就抗逆转录病毒疗法如何有助于实现生活目标进行激励性解释（n = 42，84%）。只有极少数课程包括为客户量身定制的行动计划，以克服治疗障碍（9 人，占 18%）。新的咨询主题得到了很好的诠释；但是，偶尔也会有一些主题在咨询过程中没有涉及到，如自我同情和安全性行为（16 人和 11 人）。心理咨询师认为，由男性心理咨询师进行咨询、持续的专业发展和保留详细的咨询记录有助于提高实施质量。认为存在的障碍包括课程长度和客户对参与行动计划制定犹豫不决。不同干部的调查结果相似：结论：利用男护士和/或非专业骨干实施高质量的男性咨询是可行的。应优先考虑利用非专业骨干，尤其是在资源匮乏的环境中。计划应提供全面的工作辅助工具，为医护人员提供支持。需要进行持续的培训和专业发展，以便：（1）提高医护人员制定有针对性的行动计划的技能；（2）使医护人员认识到男性客户需要自我同情，以促进全面的性健康。

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引用次数: 0

Adults with perinatally acquired HIV in low- and middle-income settings: time for a generational shift in HIV care and global guidance 低收入和中等收入环境中的围产期感染艾滋病毒的成年人：是时候对艾滋病毒护理和全球指导进行世代交替了。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-07-22 DOI: 10.1002/jia2.26338

Annette H. Sohn, Mary-Ann Davies

Paediatricians caring for children living with HIV started sounding alarm bells about their poorer clinical outcomes from the very beginnings of the HIV epidemic. They were routinely diagnosed late and with advanced disease, lacked appropriate antiretroviral formulations for treatment and their viruses became resistant to these regimens more rapidly, and suffered higher mortality rates [1]. As those who survived became adolescents, they experienced long-term side effects of their treatment, increased risks for non-communicable diseases, and the social and mental health impacts of stigma, discrimination and orphanhood [2, 3]. Adults with perinatal HIV are now being managed with limited standards around optimal care delivery.

UNAIDS estimates that there were about 660,000 (560,000–760,000) adults 20–24 years of age living with perinatally acquired HIV in 2023, 88% of whom were in Africa (UNAIDS 2024 epidemiologic estimates). In Asia, Thailand was one of the earliest countries to begin a national HIV treatment programme for children in the mid-2000s, and now ∼1800 adults >18 years of age are estimated to be living with perinatal HIV—with the oldest in their third decade (Thai National AIDS Program, 2022 data). Although many national surveillance systems do not capture the mode of HIV acquisition, data on age at diagnosis are sufficient to identify those with early exposure to HIV and antiretroviral therapy and track them into adulthood. There is an urgent need for evidence-based guidelines for the treatment and care of adults with perinatal HIV that can be implemented in low- and middle-income country (LMIC) settings, as well as standardized provider training to effectively implement them.

In high-income contexts like the United States (US) and the United Kingdom (UK), most of those with perinatal HIV have already transitioned into adult life and HIV care, with some entering their fifth decade [4, 5]. Data on their outcomes are sobering. In the US, by age 30, the cumulative incidence of type-2 diabetes among those with perinatally acquired HIV was 19%, 22% for hypertension and 25% for chronic kidney disease [6]. A modelling study estimated that life expectancy in US male youth with perinatal HIV was 10.4 years lower and in female youth 11.8 years lower than their HIV-negative peers [7]. A UK study showed that a lower nadir CD4 count in early childhood had an ongoing negative impact on CD4 by age 20 [8].

Research from LMICs has reflected increased risks for adolescents with perinatal HIV that similarly bode poorly for their health outcomes as adults. Cohorts from South Africa and Thailand have reported bone, cardiac, neurocognitive or respiratory impairments [2, 9]. The lack of prior access to human papillomavirus vaccines has put the current generation of young adults at risk for anogenital cancers (e.g. cervical) [10]. Ear

目前还没有正式的程序来培训和支持艾滋病服务提供者，让他们负责照顾这些在童年和青少年时期感染了艾滋病毒的成年人。为了帮助服务提供者做好准备，需要制定可适用于低收入和中等收入国家的筛查和治疗干预管理指南。全球艾滋病治疗指南一直是艾滋病防治工作的重要组成部分。各国的计划对主要通过世界卫生组织制定的这一指南所采取的严格方法充满信心，并例行采用这些指南。随着每年有越来越多的青少年和年轻成人转到成人艾滋病毒提供者和护理诊所，全面的指南将有助于为围产期艾滋病毒成人感染者所接受的护理类型制定标准。虽然这通常是适当的，但我们需要结合以个人需求为中心的差异化服务。早年确诊、在关键发育阶段接触艾滋病毒时间较长的人，与晚年感染艾滋病毒的人相比，有不同的护理需求。与同龄人相比，他们可能需要更早地接受非传染性疾病的筛查和临床干预。从出生起就带着污名生活的影响也意味着医疗服务提供者不能只关注抗逆转录病毒疗法和实验室检测来满足他们的需求。AHS和M-AD接受ViiV Healthcare对其机构的资助。AHS起草了本观点，M-AD进行了严格审查，并批准了最终版本。

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引用次数: 0

Ending the HIV Epidemic in Metropolitan Atlanta: a mixed-methods study to support the local HIV/AIDS response 结束亚特兰大大都市的艾滋病毒流行：支持当地艾滋病毒/艾滋病应对措施的混合方法研究。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-07-22 DOI: 10.1002/jia2.26322

Micah Piske, Bohdan Nosyk, Justin C. Smith, Bianca Yeung, Benjamin Enns, Xiao Zang, Patrick S. Sullivan, Wendy S. Armstrong, Melanie A. Thompson, Gaea Daniel, Carlos del Rio

Introduction

Four counties within the Atlanta, Georgia 20-county eligible metropolitan area (EMA) are currently prioritized by the US “Ending the HIV Epidemic” (EHE) initiative which aims for a 90% reduction in HIV incidence by 2030. Disparities driving Atlanta's HIV epidemic warrant an examination of local service availability, unmet needs and organizational capacity to reach EHE targets. We conducted a mixed-methods evaluation of the Atlanta EMA to examine geographic HIV epidemiology and distribution of services, service needs and organization infrastructure for each pillar of the EHE initiative.

Methods

We collected 2021 county-level data (during June 2022), from multiple sources including: AIDSVu (HIV prevalence and new diagnoses), the Centers for Disease Control and Prevention web-based tools (HIV testing and pre-exposure prophylaxis [PrEP] locations) and the Georgia Department of Public Health (HIV testing, PrEP screenings, viral suppression and partner service interviews). We additionally distributed an online survey to key local stakeholders working at major HIV care agencies across the EMA to assess the availability of services, unmet needs and organization infrastructure (June−December 2022). The Organizational Readiness for Implementing Change questionnaire assessed the organization climate for services in need of scale-up or implementation.

Results

We found racial/ethnic and geographic disparities in HIV disease burden and service availability across the EMA—particularly for HIV testing and PrEP in the EMA's southern counties. Five counties not currently prioritized by EHE (Clayton, Douglas, Henry, Newton and Rockdale) accounted for 16% of the EMA's new diagnoses, but <9% of its 177 testing sites and <7% of its 130 PrEP sites. Survey respondents (N = 48; 42% health agency managers/directors) reported high unmet need for HIV self-testing kits, mobile clinic testing, HIV case management, peer outreach and navigation, integrated care, housing support and transportation services. Respondents highlighted insufficient existing staffing and infrastructure to facilitate the necessary expansion of services, and the need to reduce inequities and address intersectional stigma.

Conclusions

Service delivery across all EHE pillars must substantially expand to reach national goals and address HIV disparities in metro Atlanta. High-resolution geographic data on HIV epidemiology and service delivery

导言：美国 "结束艾滋病毒流行"（EHE）倡议的目标是到 2030 年将艾滋病毒发病率降低 90%，佐治亚州亚特兰大 20 个符合条件的大都市区（EMA）中有四个县目前被列为优先考虑的地区。由于亚特兰大艾滋病疫情存在差异，因此有必要对当地的服务可用性、未满足的需求以及组织能力进行检查，以实现 EHE 目标。我们对亚特兰大 EMA 进行了一次混合方法评估，以检查艾滋病毒流行病学和服务的地理分布、服务需求以及 EHE 计划每个支柱的组织基础设施：我们收集了 2021 年县级数据（2022 年 6 月期间），这些数据来自多个来源，包括AIDSVu（HIV 感染率和新诊断）、美国疾病控制和预防中心的网络工具（HIV 检测和暴露前预防[PrEP]地点）以及佐治亚州公共卫生部（HIV 检测、PrEP 筛查、病毒抑制和合作伙伴服务访谈）。此外，我们还向在整个 EMA 地区主要 HIV 护理机构工作的当地主要利益相关者分发了一份在线调查，以评估服务的可用性、未满足的需求和组织基础设施（2022 年 6 月至 12 月）。组织实施变革准备情况调查问卷评估了需要扩大或实施服务的组织氛围：结果：我们发现整个 EMA 在 HIV 疾病负担和服务可用性方面存在种族/民族和地域差异，尤其是在 EMA 南部各县的 HIV 检测和 PrEP 方面。目前未被 EHE 优先考虑的五个县（Clayton、Douglas、Henry、Newton 和 Rockdale）占 EMA 新诊断病例的 16%，但 Conclusions：要实现国家目标并解决亚特兰大大都会区的艾滋病差异问题，必须大幅扩大 EHE 所有支柱的服务范围。有关 HIV 流行病学和服务提供情况的高分辨率地理数据以及社区意见可为支持地方 EHE 工作提供有针对性的指导。

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引用次数: 0

Low HIV drug resistance prevalence among recently diagnosed HIV-positive men who have sex with men in a setting of high PrEP use 在大量使用 PrEP 的环境中，新近确诊的 HIV 阳性男男性行为者的 HIV 耐药性发生率较低。

IF 4.6 1区医学 Q2 IMMUNOLOGY

Journal of the International AIDS Society

Pub Date : 2024-07-21 DOI: 10.1002/jia2.26308

Jonathan M King, Francesca Di Giallonardo, Ansari Shaik, Skye McGregor, Julie Yuek Kee Yeung, Tharshini Sivaruban, Frederick J Lee, Philip Cunningham, Dominic E Dwyer, Steven J Nigro, Andrew E Grulich, Anthony D Kelleher

Introduction

New South Wales (NSW) has one of the world's highest uptake rates of HIV pre-exposure prophylaxis (PrEP). This uptake has been credited with sharp declines in HIV transmission, particularly among Australian-born gay and bisexual men. Concerns have been raised around the potential for the emergence of tenofovir (TFV) and XTC (lamivudine/emtricitabine) resistance in settings of high PrEP use. Such an emergence could also increase treatment failure and associated clinical outcomes among people living with HIV (PLHIV). Despite low levels of nucleoside reverse-transcriptase inhibitor (NRTI) resistance relating to PrEP use in clinical settings, there are few published studies describing the prevalence of NRTI resistance among people newly diagnosed with HIV in a setting of high PrEP use.

Methods

Using HIV antiretroviral drug resistance data linked to NSW HIV notifications records of people diagnosed from 1 January 2015 to 31 December 2021 and with HIV attributed to male-to-male sex, we described trends in TFV and XTC resistance. Resistance was identified using the Stanford HIV Drug Resistance genotypic resistance interpretation system. To focus on transmitted drug resistance, resistance prevalence estimates were generated using sequences taken less than 3 months post-HIV diagnosis. These estimates were stratified by timing of sequencing relative to the date of diagnosis, year of sequencing, birthplace, likely place of HIV acquisition, and stage of HIV at diagnosis.

Results

Among 1119 diagnoses linked to HIV genomes sequenced less than 3 months following diagnosis, overall XTC resistance prevalence was 1.3%. Between 2015 and 2021, XTC resistance fluctuated between 0.5% to 2.9% and was 1.0% in 2021. No TFV resistance was found over the study period in any of the sequences analysed. Higher XTC resistance prevalence was observed among people with newly acquired HIV (evidence of HIV acquisition in the 12 months prior to diagnosis; 2.9%, p = 0.008).

Conclusions

In this Australian setting, TFV and XTC resistance prevalence in new HIV diagnoses remained low. Our findings offer further evidence for the safe scale-up of PrEP in high-income settings, without jeopardizing the treatment of those living with HIV.

导言：新南威尔士州（NSW）是世界上艾滋病暴露前预防疗法（PrEP）使用率最高的地区之一。艾滋病毒传播率的大幅下降，尤其是在澳大利亚出生的男同性恋者和双性恋者中的传播率大幅下降，都归功于这种预防措施。有人担心，在大量使用 PrEP 的情况下，可能会出现替诺福韦（TFV）和 XTC（拉米夫定/恩曲他滨）的抗药性。这种耐药性的出现也会增加艾滋病病毒感染者（PLHIV）的治疗失败和相关临床结果。尽管在临床环境中与 PrEP 使用相关的核苷类逆转录酶抑制剂（NRTI）耐药性水平较低，但很少有公开发表的研究描述在大量使用 PrEP 的环境中新诊断出的 HIV 感染者中 NRTI 耐药性的流行情况：我们利用与新南威尔士州 2015 年 1 月 1 日至 2021 年 12 月 31 日期间确诊的艾滋病病毒感染者通知记录相关联的艾滋病抗逆转录病毒药物耐药性数据，描述了 TFV 和 XTC 耐药性的趋势。耐药性是通过斯坦福艾滋病耐药性基因型耐药性解释系统确定的。为了重点关注传播耐药性，我们使用艾滋病毒确诊后不到 3 个月的序列生成了耐药性流行率估计值。这些估计值按相对于诊断日期的测序时间、测序年份、出生地、可能感染 HIV 的地点以及诊断时 HIV 的阶段进行了分层：结果：在与诊断后不到 3 个月测序的 HIV 基因组相关的 1119 例诊断中，XTC 耐药率总体为 1.3%。2015 年至 2021 年期间，XTC 耐药率在 0.5% 至 2.9% 之间波动，2021 年为 1.0%。在研究期间，所分析的序列中均未发现 TFV 耐药性。在新感染艾滋病毒（确诊前 12 个月内有感染艾滋病毒的证据；2.9%，p = 0.008）的人群中，XTC 耐药率较高：在澳大利亚的这一环境中，新诊断出的艾滋病毒感染者中 TFV 和 XTC 耐药率仍然很低。我们的研究结果为在高收入地区安全推广 PrEP 提供了进一步的证据，同时不会影响对艾滋病感染者的治疗。

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