Claire M. Keene, Jonathan Euvrard, Tamsin K. Phillips, Mike English, Jacob McKnight, Catherine Orrell
Introduction
Retention on antiretroviral therapy (ART) is a prerequisite for adherence and subsequent treatment success. Measuring retention is also easily implementable at facility and population levels, making it pragmatic to monitor ART programme success. However, despite its ubiquitous global use, there is little consistency in the measurement of retention.
Methods
This study retrospectively applied six measures of retention to one cohort of adults (initiating ART after 01-09-2016, with ≥1 year of observation time to database closure on 30-09-2022), in a low-resource, high HIV-burden setting in South Africa. Using routine healthcare data from the Western Cape's Provincial Health Data Centre, loss to follow-up (LTFU), fixed-point retention, visit constancy, visit gaps, treatment interruptions and medication possession ratio (MPR) were described over 5 years from initiation. Individuals were considered “continuously retained” if they did not experience attrition throughout their observed follow-up. Measures were compared using the proportion misassigned and Cohen's Kappa statistic.
Results
The median age of the cohort (n = 68,888) was 31 years (interquartile range [IQR] 26–38) at initiation, with 69% (47,631/68,888) female, and a median observed follow-up of 4 years (IQR 3–5). Across different measures, retention was low, and declined over time. There was variable overlap; the proportion continuously retained throughout their observed follow-up ranged from 60% (41,268/68,888 not LTFU) to 32% (22,381/68,888 MPR ≥80%). Retention by all measures was strongly associated with viral suppression.
Conclusions
By all measures, large proportions of people in this setting were considered out of ART care during 5 years of observed follow-up time from initiation. This makes retention a critical target for intervention to improve population-level viral suppression and achieve epidemic control. Measuring longitudinal retention revealed that most people disengaged from ART care at some point after initiation. Certain measures of retention (e.g. treatment interruptions) identified people in and out of care with more granularity, whereas blunter measures (e.g. LTFU) misassigned individuals’ retention status and missed patterns of retention over time as people cycled in and out of care between points of measurement. Ultimately, the choice of measure depends on the purpose of the evaluation and on the data available, b
{"title":"Retention in a low-resource, high-burden South African cohort on antiretroviral therapy: Retrospective, longitudinal analysis comparing six measures of retention","authors":"Claire M. Keene, Jonathan Euvrard, Tamsin K. Phillips, Mike English, Jacob McKnight, Catherine Orrell","doi":"10.1002/jia2.70046","DOIUrl":"10.1002/jia2.70046","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Retention on antiretroviral therapy (ART) is a prerequisite for adherence and subsequent treatment success. Measuring retention is also easily implementable at facility and population levels, making it pragmatic to monitor ART programme success. However, despite its ubiquitous global use, there is little consistency in the measurement of retention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study retrospectively applied six measures of retention to one cohort of adults (initiating ART after 01-09-2016, with ≥1 year of observation time to database closure on 30-09-2022), in a low-resource, high HIV-burden setting in South Africa. Using routine healthcare data from the Western Cape's Provincial Health Data Centre, loss to follow-up (LTFU), fixed-point retention, visit constancy, visit gaps, treatment interruptions and medication possession ratio (MPR) were described over 5 years from initiation. Individuals were considered “continuously retained” if they did not experience attrition throughout their observed follow-up. Measures were compared using the proportion misassigned and Cohen's Kappa statistic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The median age of the cohort (<i>n</i> = 68,888) was 31 years (interquartile range [IQR] 26–38) at initiation, with 69% (47,631/68,888) female, and a median observed follow-up of 4 years (IQR 3–5). Across different measures, retention was low, and declined over time. There was variable overlap; the proportion continuously retained throughout their observed follow-up ranged from 60% (41,268/68,888 not LTFU) to 32% (22,381/68,888 MPR ≥80%). Retention by all measures was strongly associated with viral suppression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>By all measures, large proportions of people in this setting were considered out of ART care during 5 years of observed follow-up time from initiation. This makes retention a critical target for intervention to improve population-level viral suppression and achieve epidemic control. Measuring longitudinal retention revealed that most people disengaged from ART care at some point after initiation. Certain measures of retention (e.g. treatment interruptions) identified people in and out of care with more granularity, whereas blunter measures (e.g. LTFU) misassigned individuals’ retention status and missed patterns of retention over time as people cycled in and out of care between points of measurement. Ultimately, the choice of measure depends on the purpose of the evaluation and on the data available, b","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12519882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145285187","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}
Rachael A. Pellegrino, Shengxin Tu, Rodrigo Ville-Benavides, Emilia M. Jalil, Staci L. Sudenga, Brenda Crabtree-Ramírez, Claudia P. Cortes, Diana Varela, Genevieve Hilaire, Cynthia Riviere, Eduardo Gotuzzo, Bryan E. Shepherd, Valeria Fink, Jessica L. Castilho, the Caribbean, Central and South America network for HIV Epidemiology
Introduction
Human papillomavirus (HPV)-associated cervical and anal cancers disproportionately affect people with HIV (PWH). This study aimed to determine the incidence trends of and risk factors for these malignancies in PWH in Latin America.
Methods
We included PWH from the Caribbean, Central and South America network for HIV epidemiology (CCASAnet) who contributed person-time between 2000 and 2019. We calculated crude and age-standardized incidence rates, examining trends over time with Poisson regression. Adjusted hazard ratios were calculated using Cox proportional hazard models with propensity score adjustment. We calculated the probability of survival after cancer diagnosis using Kaplan−Meier curves. To understand factors that influence our results, we surveyed all adult CCASAnet sites on current practices of cervical and anal cancer screening.
Results
Overall, 5739 females with HIV (43,417 person-years) were included in cervical cancer analyses. There were 27 incident cervical cancers: crude incidence rate of 62.2 (95% confidence interval [CI]: 34.9−89.4) per 100,000 person years. In the anal cancer analysis, 12,489 males who have sex with men (MSM), 7324 males other than MSM and 5739 females were included for a total of 25,552 PWH, contributing 157,166 person-years. Anal cancer was diagnosed in 56 individuals: crude incidence rates of 59.1 [95% CI: 33.2−85.0], 20.7 [95% CI: 11.6−29.7] and 15.2 [95% CI: 8.6−21.9] per 100,000 person-years in MSM, females and males other than MSM, respectively. Age-standardized incidence rates did not significantly change over time. Anal cancer risk decreased significantly with higher time-updated CD4 cell count. The predicted probability of 5-year survival after cancer diagnosis was 72.6% (95% CI: 48.4−86.8) for cervical cancer and 58.5% (95% CI: 44.0−70.5) for anal cancer.
Conclusions
In one of the few reports outside the United States or Europe, we did not observe a decrease in age-standardized incidence rates for anal and cervical cancer between 2000 and 2019. These data support continued efforts for cancer prevention through access to gender-neutral HPV vaccination and cancer screening.
{"title":"Incidence and outcomes of anal and cervical cancer among adults with HIV in Latin America: a retrospective cohort study","authors":"Rachael A. Pellegrino, Shengxin Tu, Rodrigo Ville-Benavides, Emilia M. Jalil, Staci L. Sudenga, Brenda Crabtree-Ramírez, Claudia P. Cortes, Diana Varela, Genevieve Hilaire, Cynthia Riviere, Eduardo Gotuzzo, Bryan E. Shepherd, Valeria Fink, Jessica L. Castilho, the Caribbean, Central and South America network for HIV Epidemiology","doi":"10.1002/jia2.70050","DOIUrl":"https://doi.org/10.1002/jia2.70050","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Human papillomavirus (HPV)-associated cervical and anal cancers disproportionately affect people with HIV (PWH). This study aimed to determine the incidence trends of and risk factors for these malignancies in PWH in Latin America.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We included PWH from the Caribbean, Central and South America network for HIV epidemiology (CCASAnet) who contributed person-time between 2000 and 2019. We calculated crude and age-standardized incidence rates, examining trends over time with Poisson regression. Adjusted hazard ratios were calculated using Cox proportional hazard models with propensity score adjustment. We calculated the probability of survival after cancer diagnosis using Kaplan−Meier curves. To understand factors that influence our results, we surveyed all adult CCASAnet sites on current practices of cervical and anal cancer screening.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 5739 females with HIV (43,417 person-years) were included in cervical cancer analyses. There were 27 incident cervical cancers: crude incidence rate of 62.2 (95% confidence interval [CI]: 34.9−89.4) per 100,000 person years. In the anal cancer analysis, 12,489 males who have sex with men (MSM), 7324 males other than MSM and 5739 females were included for a total of 25,552 PWH, contributing 157,166 person-years. Anal cancer was diagnosed in 56 individuals: crude incidence rates of 59.1 [95% CI: 33.2−85.0], 20.7 [95% CI: 11.6−29.7] and 15.2 [95% CI: 8.6−21.9] per 100,000 person-years in MSM, females and males other than MSM, respectively. Age-standardized incidence rates did not significantly change over time. Anal cancer risk decreased significantly with higher time-updated CD4 cell count. The predicted probability of 5-year survival after cancer diagnosis was 72.6% (95% CI: 48.4−86.8) for cervical cancer and 58.5% (95% CI: 44.0−70.5) for anal cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In one of the few reports outside the United States or Europe, we did not observe a decrease in age-standardized incidence rates for anal and cervical cancer between 2000 and 2019. These data support continued efforts for cancer prevention through access to gender-neutral HPV vaccination and cancer screening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70050","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272818","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}
<p>Community-led monitoring (CLM) is vital in the global HIV response as it enables community participation and evidence-based advocacy for improved health service delivery. CLM is “an accountability mechanism for HIV responses at different levels, led and implemented by community-led organizations of people living with HIV (PLHIV), networks of key populations (KP), other affected groups” [<span>1</span>]. It is a form of social accountability, where citizens hold duty bearers accountable for the services they provide. Evidence highlights its effectiveness in bridging gaps between healthcare providers and communities, addressing systemic inequities and strengthening accountability [<span>2</span>]. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) supported CLM coordinated by Family AIDS Caring Trust (FACT) commenced in 2021, driving community-led action to improve services at 246 health facilities in 21 districts of Zimbabwe. It was initiated by civil society organizations in collaboration with PLHIV and KP communities, who determined its scope and priorities. Districts were consultatively selected with consideration of epidemiological burden and CLM coverage. CLM targets PLHIV, adolescent girls and young women and KP, including sex workers, men who have sex with men and sexual minorities. It involves 718 community health monitors (CHMs) selected by communities based on representation and levels of their literacy and commitment. CHMs utilize Kobo Collect surveys and community score cards to monitor availability, accessibility, acceptability, appropriateness and quality of HIV-health services. Data are collected and synchronized from various tools, drawing insights that are disseminated and actioned on a quarterly basis at the facility and district levels.</p><p>CLM recognizes that, while HIV prevalence declined from 12.6% in 2019 to 10.5% in 2023 in Zimbabwe, some subpopulations remain behind [<span>3</span>]. Stigma and discrimination remain high, with the 2022 PLHIV Stigma Index noting 77.7% of sex workers reporting HIV status-related stigma and 17.9% PLHIV discontinuing Antiretroviral Therapy (ART) in the preceding year due to stigma [<span>4</span>]. Stigma and legal barriers disproportionately hinder KP's access to equitable HIV services owing to Zimbabwe's socio-cultural landscape dominated by Christian (85.3%) and traditional beliefs [<span>3</span>].</p><p>In this context, this article aims to (1) highlight CLM's achievements in improving access and uptake of HIV and sexual and reproductive health services, and (2) share experiences from CLM implementation in Zimbabwe, highlighting lessons and opportunities for improvement.</p><p>As highlighted in Table 1, between 2023 and 2025, CLM improved access to HIV/AIDS services, enhanced healthcare staff attitudes and strengthened linkages between healthcare facilities and communities. CLM has been instrumental in resolving stock-outs and promoting differentiated service delivery. Neve
{"title":"The efficacy of community-led monitoring: successes, lessons learnt and opportunities for improvement from the Zimbabwean context","authors":"Morgen Chinoona, Jephias Matunhu, Donald Denis Tobaiwa, Kudzaishe Mutungamiri, Melody Musendo, Tinashe Marange, Tinashe Chidede","doi":"10.1002/jia2.70053","DOIUrl":"https://doi.org/10.1002/jia2.70053","url":null,"abstract":"<p>Community-led monitoring (CLM) is vital in the global HIV response as it enables community participation and evidence-based advocacy for improved health service delivery. CLM is “an accountability mechanism for HIV responses at different levels, led and implemented by community-led organizations of people living with HIV (PLHIV), networks of key populations (KP), other affected groups” [<span>1</span>]. It is a form of social accountability, where citizens hold duty bearers accountable for the services they provide. Evidence highlights its effectiveness in bridging gaps between healthcare providers and communities, addressing systemic inequities and strengthening accountability [<span>2</span>]. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) supported CLM coordinated by Family AIDS Caring Trust (FACT) commenced in 2021, driving community-led action to improve services at 246 health facilities in 21 districts of Zimbabwe. It was initiated by civil society organizations in collaboration with PLHIV and KP communities, who determined its scope and priorities. Districts were consultatively selected with consideration of epidemiological burden and CLM coverage. CLM targets PLHIV, adolescent girls and young women and KP, including sex workers, men who have sex with men and sexual minorities. It involves 718 community health monitors (CHMs) selected by communities based on representation and levels of their literacy and commitment. CHMs utilize Kobo Collect surveys and community score cards to monitor availability, accessibility, acceptability, appropriateness and quality of HIV-health services. Data are collected and synchronized from various tools, drawing insights that are disseminated and actioned on a quarterly basis at the facility and district levels.</p><p>CLM recognizes that, while HIV prevalence declined from 12.6% in 2019 to 10.5% in 2023 in Zimbabwe, some subpopulations remain behind [<span>3</span>]. Stigma and discrimination remain high, with the 2022 PLHIV Stigma Index noting 77.7% of sex workers reporting HIV status-related stigma and 17.9% PLHIV discontinuing Antiretroviral Therapy (ART) in the preceding year due to stigma [<span>4</span>]. Stigma and legal barriers disproportionately hinder KP's access to equitable HIV services owing to Zimbabwe's socio-cultural landscape dominated by Christian (85.3%) and traditional beliefs [<span>3</span>].</p><p>In this context, this article aims to (1) highlight CLM's achievements in improving access and uptake of HIV and sexual and reproductive health services, and (2) share experiences from CLM implementation in Zimbabwe, highlighting lessons and opportunities for improvement.</p><p>As highlighted in Table 1, between 2023 and 2025, CLM improved access to HIV/AIDS services, enhanced healthcare staff attitudes and strengthened linkages between healthcare facilities and communities. CLM has been instrumental in resolving stock-outs and promoting differentiated service delivery. Neve","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 10","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70053","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145272817","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}
“Person-centred” and “people-centred” HIV prevention programmes both seek to scale up access to HIV prevention services. A “person-centred” approach presents a vision of a client with agency in decision-making, engaged and empowered, working with providers in a process that is not disease-centric but focused on addressing, holistically, a client's needs. A “people-centred” approach recognizes the broader role of family and community, as well as the influence of the political and legal environment as barriers or facilitators to HIV services. In both cases, human rights are a critical determinant of positive or negative outcomes.
Discussion
In 2017, the Global Fund's Breaking Down Barriers initiative funded baseline assessments in 20 countries examining key human rights barriers to HIV services. Subsequent evaluations in 2019–2021 and 2022–2024 focused on the scale-up of community-led human rights interventions and the impact of these programmes on access to HIV prevention and care. Results from the latest assessment describe a range of strategies and impact across diverse countries, settings and populations. For example, in Indonesia, transgender-led organizations catalysed a national drive to allow transgender persons to receive gender-matched identity cards, allowing thousands of individuals to access HIV prevention and treatment and broader social benefits. In Mozambique, peer-led paralegals and community advocates promoted legal literacy and assisted clients with claims of human rights violations, preventing access to HIV services. In Jamaica, lesbian, gay, bisexual and transgender led organizations sponsored trainings that advanced community activism for HIV prevention, education and advocacy. Despite facing stigma and challenging legal environments, in each case, human rights-based programmes removed structural and legal barriers to HIV prevention services, strengthening accountability and increasing uptake and retention in HIV services, especially among marginalized and criminalized populations.
Conclusions
Community mobilization led by key populations is a long-term undertaking that requires partnership and support from a wide range of stakeholders to ensure sustainability. A growing body of evidence across a range of diverse countries and settings demonstrates the impact of rights-based and people-centred programmes on access to, and retention in, HIV prevention and treatment.
{"title":"Put rights at the centre of person- and people-centred HIV prevention","authors":"Megan McLemore, Joseph J. Amon","doi":"10.1002/jia2.70028","DOIUrl":"https://doi.org/10.1002/jia2.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>“Person-centred” and “people-centred” HIV prevention programmes both seek to scale up access to HIV prevention services. A “person-centred” approach presents a vision of a client with agency in decision-making, engaged and empowered, working with providers in a process that is not disease-centric but focused on addressing, holistically, a client's needs. A “people-centred” approach recognizes the broader role of family and community, as well as the influence of the political and legal environment as barriers or facilitators to HIV services. In both cases, human rights are a critical determinant of positive or negative outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>In 2017, the Global Fund's <i>Breaking Down Barriers</i> initiative funded baseline assessments in 20 countries examining key human rights barriers to HIV services. Subsequent evaluations in 2019–2021 and 2022–2024 focused on the scale-up of community-led human rights interventions and the impact of these programmes on access to HIV prevention and care. Results from the latest assessment describe a range of strategies and impact across diverse countries, settings and populations. For example, in Indonesia, transgender-led organizations catalysed a national drive to allow transgender persons to receive gender-matched identity cards, allowing thousands of individuals to access HIV prevention and treatment and broader social benefits. In Mozambique, peer-led paralegals and community advocates promoted legal literacy and assisted clients with claims of human rights violations, preventing access to HIV services. In Jamaica, lesbian, gay, bisexual and transgender led organizations sponsored trainings that advanced community activism for HIV prevention, education and advocacy. Despite facing stigma and challenging legal environments, in each case, human rights-based programmes removed structural and legal barriers to HIV prevention services, strengthening accountability and increasing uptake and retention in HIV services, especially among marginalized and criminalized populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Community mobilization led by key populations is a long-term undertaking that requires partnership and support from a wide range of stakeholders to ensure sustainability. A growing body of evidence across a range of diverse countries and settings demonstrates the impact of rights-based and people-centred programmes on access to, and retention in, HIV prevention and treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237104","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}
Anke Rotsaert, Zaynab Essack, Shannon Bosman, Dvora Joseph Davey, Bernadette Hensen
<div> <section> <h3> Introduction</h3> <p>In 2023, one-fourth of new HIV acquisitions in children globally resulted from vertical transmission following incident HIV during pregnancy or breastfeeding. Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil and emtricitabine is safe and effective in pregnancy and postpartum, with long-acting options emerging. Integrating PrEP into antenatal and postnatal care (ANC/PNC) is a crucial person-centred approach to prevent maternal HIV acquisition and vertical transmission. This review summarizes oral PrEP initiation, continuation and adherence among pregnant and postpartum women receiving ANC/PNC.</p> </section> <section> <h3> Methods</h3> <p>We systematically searched three databases for English-language quantitative studies published between 1 January 2015 and 28 March 2024. Eligible studies focused on pregnant and/or postpartum women accessing PrEP through ANC/PNC, and reported on initiation (receipt of prescription or self-reported use), continuation (persistent use over time) and/or adherence (self-reported and/or objective).</p> </section> <section> <h3> Results</h3> <p>We identified 481 articles; 12 studies from Kenya, Lesotho, Malawi and South Africa met our inclusion criteria. Study heterogeneity (e.g. definitions used, population included, follow-up time) precluded meta-analysis. All studies enrolled pregnant women; three also enrolled postpartum women. Median gestational age at enrolment ranged from 20 to 26 weeks, and follow-up periods from 1 month post-enrolment to 12 months postpartum. Oral PrEP initiation ranged from 14% to 84%. Continuation at 3 months ranged from 22% to 90% and declined postpartum in all studies. Self-reported adherence (daily use) ranged from 11% to 81% in the past 7 or 30 days at 1 month (four studies) and from 54% to 81% at 3 months (two studies). Objectively measured adherence ranged from 34% to 62% for detectable tenofovir or tenofovir diphosphate levels at 1 month (three studies). One Kenyan trial demonstrated that universal versus risk-based offers of oral PrEP resulted in similar PrEP use and HIV incidence. Two-way SMS communication (Kenya) and real-time adherence biofeedback counselling using urine tenofovir testing (South Africa) enhanced PrEP continuation/adherence compared to standard-of-care.</p> </section> <section> <h3> Discussion</h3> <p>Integrating oral PrEP into ANC/PNC showed high initiation among pregnant/postpartum women; however, continuation and adherence were suboptimal.</p> </section> <section>
{"title":"Oral pre-exposure prophylaxis initiation, continuation and adherence among pregnant and postpartum women receiving antenatal and postnatal care: a systematic review","authors":"Anke Rotsaert, Zaynab Essack, Shannon Bosman, Dvora Joseph Davey, Bernadette Hensen","doi":"10.1002/jia2.70035","DOIUrl":"https://doi.org/10.1002/jia2.70035","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>In 2023, one-fourth of new HIV acquisitions in children globally resulted from vertical transmission following incident HIV during pregnancy or breastfeeding. Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil and emtricitabine is safe and effective in pregnancy and postpartum, with long-acting options emerging. Integrating PrEP into antenatal and postnatal care (ANC/PNC) is a crucial person-centred approach to prevent maternal HIV acquisition and vertical transmission. This review summarizes oral PrEP initiation, continuation and adherence among pregnant and postpartum women receiving ANC/PNC.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We systematically searched three databases for English-language quantitative studies published between 1 January 2015 and 28 March 2024. Eligible studies focused on pregnant and/or postpartum women accessing PrEP through ANC/PNC, and reported on initiation (receipt of prescription or self-reported use), continuation (persistent use over time) and/or adherence (self-reported and/or objective).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 481 articles; 12 studies from Kenya, Lesotho, Malawi and South Africa met our inclusion criteria. Study heterogeneity (e.g. definitions used, population included, follow-up time) precluded meta-analysis. All studies enrolled pregnant women; three also enrolled postpartum women. Median gestational age at enrolment ranged from 20 to 26 weeks, and follow-up periods from 1 month post-enrolment to 12 months postpartum. Oral PrEP initiation ranged from 14% to 84%. Continuation at 3 months ranged from 22% to 90% and declined postpartum in all studies. Self-reported adherence (daily use) ranged from 11% to 81% in the past 7 or 30 days at 1 month (four studies) and from 54% to 81% at 3 months (two studies). Objectively measured adherence ranged from 34% to 62% for detectable tenofovir or tenofovir diphosphate levels at 1 month (three studies). One Kenyan trial demonstrated that universal versus risk-based offers of oral PrEP resulted in similar PrEP use and HIV incidence. Two-way SMS communication (Kenya) and real-time adherence biofeedback counselling using urine tenofovir testing (South Africa) enhanced PrEP continuation/adherence compared to standard-of-care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Integrating oral PrEP into ANC/PNC showed high initiation among pregnant/postpartum women; however, continuation and adherence were suboptimal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237232","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}
Simran Shaikh, Parthasarathy Mugundu Ramien, Jade Bell, Kanchan Pawar, Allison M. McFall, Saya Okram, Ajay Enugu, Lakshmi Ganapathi, Maria Salvat Ballester, Viswanathan Arumugam, Rose Pollard Kaptchuk, Aditya Singh, Shantanu Kumar Purohit, Alex Keuroghlian, Kevin Ard, Shruti H. Mehta, Sukhvinder Kaur, Kenneth H. Mayer, Sunil Suhas Solomon
<div> <section> <h3> Introduction</h3> <p>Transgender women (TGW) in India continue to bear disproportionate HIV burden and face persistent social, legal and structural barriers to receive gender-affirming care.</p> </section> <section> <h3> Methods</h3> <p>Since 2021, we established three “<i>Mitr</i>” (meaning: friend) clinics in Hyderabad, Pune and Thane, India, for transgender people with staffing primarily from the community. <i>Mitr</i> clinics provide free HIV testing and pre-exposure prophylaxis (PrEP) on site with linkage to government antiretroviral therapy (ART) centres. They also provide free consultation for gender-affirming hormone therapy (GAHT), subsidized laser hair removal and legal assistance. Client service utilization data were analysed using summary statistics to evaluate uptake of HIV and gender-affirming services; correlates of HIV testing were examined using logistic regression. Semi-structured interviews conducted at one site were used to understand barriers/facilitators of HIV testing.</p> </section> <section> <h3> Results</h3> <p>A total of 5223 unique clients registered between March 2021 and September 2024; median age was 26 years. Most (86%) self-identified as TGW, and 35% reported transactional sex. Most clients (70%) had not previously accessed public sector HIV services. The majority (75%) accessed <i>Mitr</i> clinics for gender-affirming care, including laser hair removal (53%), GAHT consultations (34%) and surgical referral (26%). Over half (62%) of clients eligible for HIV testing underwent screening, of whom 6% were newly diagnosed. Accessing <i>Mitr</i> clinics for gender-affirming surgical services was significantly associated with HIV testing receipt (aOR: 1.51; 95% CI: 1.02, 2.25). Services provided by staff from the community were a prominent facilitator for HIV testing, while stigma and disclosure concerns were notable barriers. Among 585 clients interested in and eligible for PrEP, 576 (98%) initiated PrEP, and 378 (66%) were PrEP persistent at 3 months. Of 454 clients with HIV (newly diagnosed or previously known), 392 (86%) initiated ART. As of 30 September 2024, 233 (59%) were still receiving <i>Mitr</i> clinic services and retained in HIV care; viral suppression was 98% among the 156 clients with data.</p> </section> <section> <h3> Conclusions</h3> <p>The <i>Mitr</i> model highlights the importance of aligning programme and community priorities. The provision of gender-affirming care attracted many clients who might not otherwise have accessed HIV services; indeed, laser hair removal served as the ke
{"title":"Laser hair removal to antiretrovirals: findings from a person-centred care model for transgender people in India","authors":"Simran Shaikh, Parthasarathy Mugundu Ramien, Jade Bell, Kanchan Pawar, Allison M. McFall, Saya Okram, Ajay Enugu, Lakshmi Ganapathi, Maria Salvat Ballester, Viswanathan Arumugam, Rose Pollard Kaptchuk, Aditya Singh, Shantanu Kumar Purohit, Alex Keuroghlian, Kevin Ard, Shruti H. Mehta, Sukhvinder Kaur, Kenneth H. Mayer, Sunil Suhas Solomon","doi":"10.1002/jia2.70041","DOIUrl":"https://doi.org/10.1002/jia2.70041","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Transgender women (TGW) in India continue to bear disproportionate HIV burden and face persistent social, legal and structural barriers to receive gender-affirming care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Since 2021, we established three “<i>Mitr</i>” (meaning: friend) clinics in Hyderabad, Pune and Thane, India, for transgender people with staffing primarily from the community. <i>Mitr</i> clinics provide free HIV testing and pre-exposure prophylaxis (PrEP) on site with linkage to government antiretroviral therapy (ART) centres. They also provide free consultation for gender-affirming hormone therapy (GAHT), subsidized laser hair removal and legal assistance. Client service utilization data were analysed using summary statistics to evaluate uptake of HIV and gender-affirming services; correlates of HIV testing were examined using logistic regression. Semi-structured interviews conducted at one site were used to understand barriers/facilitators of HIV testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 5223 unique clients registered between March 2021 and September 2024; median age was 26 years. Most (86%) self-identified as TGW, and 35% reported transactional sex. Most clients (70%) had not previously accessed public sector HIV services. The majority (75%) accessed <i>Mitr</i> clinics for gender-affirming care, including laser hair removal (53%), GAHT consultations (34%) and surgical referral (26%). Over half (62%) of clients eligible for HIV testing underwent screening, of whom 6% were newly diagnosed. Accessing <i>Mitr</i> clinics for gender-affirming surgical services was significantly associated with HIV testing receipt (aOR: 1.51; 95% CI: 1.02, 2.25). Services provided by staff from the community were a prominent facilitator for HIV testing, while stigma and disclosure concerns were notable barriers. Among 585 clients interested in and eligible for PrEP, 576 (98%) initiated PrEP, and 378 (66%) were PrEP persistent at 3 months. Of 454 clients with HIV (newly diagnosed or previously known), 392 (86%) initiated ART. As of 30 September 2024, 233 (59%) were still receiving <i>Mitr</i> clinic services and retained in HIV care; viral suppression was 98% among the 156 clients with data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The <i>Mitr</i> model highlights the importance of aligning programme and community priorities. The provision of gender-affirming care attracted many clients who might not otherwise have accessed HIV services; indeed, laser hair removal served as the ke","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70041","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237233","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}
Benjamin R. Bavinton, James Gray, Andrew E. Grulich
<p>Person-centred care is a critical element of HIV care. Global and country-level consensus statements, including from Australia, have emphasized holistic, rights-based approaches centring the autonomy, dignity, experiences, diverse needs, preferences and wellbeing of people living with HIV (PLHIV) [<span>1</span>]. However, the focus has been on HIV care with less focus on person-centred prevention, despite its recent integration into the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal that 95% of individuals at risk of HIV will utilize “appropriate, person-centred, prioritised, and effective combination prevention options” by 2025 [<span>2</span>].</p><p>Drawing on the concept of person-centred care, person-centred HIV prevention [<span>3</span>] prioritizes individuals – their autonomy, dignity, rights, decisions and experiences – over interventions or risk categories. It recognizes that individuals are best placed to determine suitable prevention methods, respecting their personal choice and agency. This approach acknowledges the dynamic nature of needs and choices, shaped by personal, contextual and structural factors, such as stigma, discrimination, criminalization and socio-economic conditions. It requires services to be appropriate, responsive and accessible, particularly for marginalized communities facing barriers to care.</p><p>Australia has achieved considerable success in HIV prevention, and has an ambitious goal to virtually eliminate HIV transmission by 2030 [<span>4</span>]. In gay, bisexual and other men who have sex with men (GBMSM) in certain urban areas, reductions in HIV diagnoses are approaching the UNAIDS 2030 goal of a 90% reduction from a 2010 baseline [<span>5</span>]. Nonetheless, disparities are evident, particularly among overseas-born GBMSM and those residing outside inner-city suburbs. While nationwide HIV diagnoses decreased by 54% in Australian-born GBMSM between 2010 and 2023, there was a 55% increase in migrant GBMSM, and by 2023, 59% of all GBMSM diagnoses were in migrants [<span>6</span>]. Diagnoses among sex workers and people who use drugs are very low, and HIV rates are also very low among heterosexuals, though those born overseas are at higher risk [<span>6</span>].</p><p>Community and community-based organizations (CBOs) have long been integral to HIV prevention, and play an essential role in understanding, articulating and advocating for the needs and preferences of communities affected by HIV [<span>7</span>]. Referred to in Australia as the “partnership approach” [<span>8</span>], collaboration between community, government, policymakers, clinicians and researchers has ensured that communities affected by HIV are key players in decision-making. Despite occasional fluctuations, there has been sustained investment in Australia's HIV-focused CBOs, including support to diversify their remit to encompass broader elements of LGBTQ+ health, other blood-borne viruses and/or sexually transmitted infec
{"title":"Sustaining HIV prevention success in Australia through person-centred approaches","authors":"Benjamin R. Bavinton, James Gray, Andrew E. Grulich","doi":"10.1002/jia2.70007","DOIUrl":"https://doi.org/10.1002/jia2.70007","url":null,"abstract":"<p>Person-centred care is a critical element of HIV care. Global and country-level consensus statements, including from Australia, have emphasized holistic, rights-based approaches centring the autonomy, dignity, experiences, diverse needs, preferences and wellbeing of people living with HIV (PLHIV) [<span>1</span>]. However, the focus has been on HIV care with less focus on person-centred prevention, despite its recent integration into the Joint United Nations Programme on HIV/AIDS (UNAIDS) goal that 95% of individuals at risk of HIV will utilize “appropriate, person-centred, prioritised, and effective combination prevention options” by 2025 [<span>2</span>].</p><p>Drawing on the concept of person-centred care, person-centred HIV prevention [<span>3</span>] prioritizes individuals – their autonomy, dignity, rights, decisions and experiences – over interventions or risk categories. It recognizes that individuals are best placed to determine suitable prevention methods, respecting their personal choice and agency. This approach acknowledges the dynamic nature of needs and choices, shaped by personal, contextual and structural factors, such as stigma, discrimination, criminalization and socio-economic conditions. It requires services to be appropriate, responsive and accessible, particularly for marginalized communities facing barriers to care.</p><p>Australia has achieved considerable success in HIV prevention, and has an ambitious goal to virtually eliminate HIV transmission by 2030 [<span>4</span>]. In gay, bisexual and other men who have sex with men (GBMSM) in certain urban areas, reductions in HIV diagnoses are approaching the UNAIDS 2030 goal of a 90% reduction from a 2010 baseline [<span>5</span>]. Nonetheless, disparities are evident, particularly among overseas-born GBMSM and those residing outside inner-city suburbs. While nationwide HIV diagnoses decreased by 54% in Australian-born GBMSM between 2010 and 2023, there was a 55% increase in migrant GBMSM, and by 2023, 59% of all GBMSM diagnoses were in migrants [<span>6</span>]. Diagnoses among sex workers and people who use drugs are very low, and HIV rates are also very low among heterosexuals, though those born overseas are at higher risk [<span>6</span>].</p><p>Community and community-based organizations (CBOs) have long been integral to HIV prevention, and play an essential role in understanding, articulating and advocating for the needs and preferences of communities affected by HIV [<span>7</span>]. Referred to in Australia as the “partnership approach” [<span>8</span>], collaboration between community, government, policymakers, clinicians and researchers has ensured that communities affected by HIV are key players in decision-making. Despite occasional fluctuations, there has been sustained investment in Australia's HIV-focused CBOs, including support to diversify their remit to encompass broader elements of LGBTQ+ health, other blood-borne viruses and/or sexually transmitted infec","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237384","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}
Adrian Guta, Katherine Rudzinski, Marilou Gagnon, Rose A. Schmidt, Gillian Kolla, Danielle German, David Kryszajtys, Melissa Perri, Andrea Sereda, Christopher Sterling-Murphy, Carol Strike
Introduction
Despite advances in HIV and hepatitis C virus (HCV) treatment, people who use drugs (PWUD) face significant barriers along prevention and treatment cascades. Safer supply programmes (SSPs) providing prescribed pharmaceutical alternatives to the unregulated drug supply may create opportunities for enhanced healthcare engagement and person-centred care.
Methods
We conducted a qualitative study examining four SSPs in Ontario, Canada between February and October 2021. Semi-structured interviews were conducted with 52 patients and 21 providers (including physicians, registered nurse practitioners, nurses and allied health professionals). Interviews explored experiences with safer supply and HIV/HCV care. Analysis used thematic techniques guided by the Consolidated Framework for Implementation Research.
Results
SSPs supported HIV/HCV care by first addressing patients’ substance use needs, which created subsequent opportunities for building trust for broader health engagement. Providers identified the safer supply model as giving PWUD something they wanted, which then opened opportunities to discuss HIV, HCV, and other sexually transmitted and blood-borne infections. SSPs provided opportunities to support patients with HIV and HCV testing and treatment initiation, and safer supply medications were bundled with HIV and HCV medications to support adherence. Non-punitive approaches helped overcome previous negative healthcare experiences by prioritizing patient autonomy. Implementation challenges included balancing flexible, patient-directed care with programme requirements and coordinating comprehensive services around individual needs.
Conclusions
SSPs may improve HIV/HCV care delivery for PWUD by building services around their priorities and lived realities. The integration of safer supply with HIV/HCV care through daily dispensing and wraparound services showed promise for engaging people previously disconnected from care. While findings suggested improved treatment outcomes, limitations included data collection during COVID-19, limited representation of some populations and a focus on opioid-only programmes. Research examining long-term outcomes and programme sustainability is needed as SSPs face growing scrutiny and closure in Canada.
{"title":"“From an HCV and HIV point of view, it's been remarkable”: A qualitative study about using prescribed safer supply to support people who use drugs along the HIV and HCV prevention and treatment cascades in Ontario, Canada","authors":"Adrian Guta, Katherine Rudzinski, Marilou Gagnon, Rose A. Schmidt, Gillian Kolla, Danielle German, David Kryszajtys, Melissa Perri, Andrea Sereda, Christopher Sterling-Murphy, Carol Strike","doi":"10.1002/jia2.70038","DOIUrl":"https://doi.org/10.1002/jia2.70038","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite advances in HIV and hepatitis C virus (HCV) treatment, people who use drugs (PWUD) face significant barriers along prevention and treatment cascades. Safer supply programmes (SSPs) providing prescribed pharmaceutical alternatives to the unregulated drug supply may create opportunities for enhanced healthcare engagement and person-centred care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a qualitative study examining four SSPs in Ontario, Canada between February and October 2021. Semi-structured interviews were conducted with 52 patients and 21 providers (including physicians, registered nurse practitioners, nurses and allied health professionals). Interviews explored experiences with safer supply and HIV/HCV care. Analysis used thematic techniques guided by the Consolidated Framework for Implementation Research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>SSPs supported HIV/HCV care by first addressing patients’ substance use needs, which created subsequent opportunities for building trust for broader health engagement. Providers identified the safer supply model as giving PWUD something they wanted, which then opened opportunities to discuss HIV, HCV, and other sexually transmitted and blood-borne infections. SSPs provided opportunities to support patients with HIV and HCV testing and treatment initiation, and safer supply medications were bundled with HIV and HCV medications to support adherence. Non-punitive approaches helped overcome previous negative healthcare experiences by prioritizing patient autonomy. Implementation challenges included balancing flexible, patient-directed care with programme requirements and coordinating comprehensive services around individual needs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>SSPs may improve HIV/HCV care delivery for PWUD by building services around their priorities and lived realities. The integration of safer supply with HIV/HCV care through daily dispensing and wraparound services showed promise for engaging people previously disconnected from care. While findings suggested improved treatment outcomes, limitations included data collection during COVID-19, limited representation of some populations and a focus on opioid-only programmes. Research examining long-term outcomes and programme sustainability is needed as SSPs face growing scrutiny and closure in Canada.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237105","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}
Andrew Mujugira, Iskandar Azwa, Marie-Claude Lavoie
<p>Person-centred care (PCC) is a healthcare approach that focuses on understanding and respecting clients’ preferences, values and beliefs. It aims to empower clients by actively involving them in their own care and highlighting the importance of effective communication and relationships between providers and clients [<span>1-3</span>]. Person-centred health systems are widely endorsed in political and policy statements as essential for addressing health system challenges, promoting equity in access, delivering quality and effective care, and ensuring that no one is left behind [<span>4</span>]. Despite widespread recognition of these PCC principles, current healthcare delivery models often fall short of these ideals because they tend to be disease-focused, fragmented and siloed, emphasising specific programmatic outputs, putting pressure on health workers and jeopardising client-centred care delivery [<span>5</span>]. There is an urgent need to transition from disease-focused health systems to those centred on individuals because nearly half of the global population lacks equitable access to essential healthcare services.</p><p>This transformation requires innovative solutions that meet client needs while maintaining accessibility and continuity of care. Recent advances in HIV prevention, including long-acting injectables for pre-exposure prophylaxis (LAI-PrEP), create unprecedented opportunities for PCC. In 2024, the ground-breaking PURPOSE 1 trial reported 100% efficacy among young women receiving twice-yearly lenacapavir [<span>6</span>]. Similarly, the PURPOSE 2 trial demonstrated that HIV incidence was 96% lower with lenacapavir compared to the background incidence [<span>7</span>]. For the first time, individuals can choose from multiple PrEP options—pills, rings or injectables—that align with their sexual behaviours, needs, preferences and life circumstances. Health providers need to educate and counsel individuals about these options, providing evidence-based information about their effectiveness, side effects and requirements (such as adherence to daily dosing or injection schedule) to facilitate autonomous and informed decision-making.</p><p>HIV self-testing (HIVST) utilisation can be improved through PCC approaches and complement PrEP. A meta-analysis of 33 studies from around the globe found that HIVST kit distribution by sexual partners, peers or through online platforms achieved higher testing rates than facility-based testing [<span>8</span>]. Significantly, it expanded testing coverage in key populations without reducing test accuracy or safety. Recent evidence suggests that HIVST streamlines HIV screening for people on PrEP and promotes PrEP uptake by individuals not accessing care. It can be leveraged to support PrEP initiation, continuation and re-engagement in care [<span>9</span>]. Technological innovations, such as LAI-PrEP and HIVST, represent only one component of effective prevention. To maximise their effectiveness, i
{"title":"Person-centred HIV prevention in an era of innovation and uncertainties","authors":"Andrew Mujugira, Iskandar Azwa, Marie-Claude Lavoie","doi":"10.1002/jia2.70043","DOIUrl":"https://doi.org/10.1002/jia2.70043","url":null,"abstract":"<p>Person-centred care (PCC) is a healthcare approach that focuses on understanding and respecting clients’ preferences, values and beliefs. It aims to empower clients by actively involving them in their own care and highlighting the importance of effective communication and relationships between providers and clients [<span>1-3</span>]. Person-centred health systems are widely endorsed in political and policy statements as essential for addressing health system challenges, promoting equity in access, delivering quality and effective care, and ensuring that no one is left behind [<span>4</span>]. Despite widespread recognition of these PCC principles, current healthcare delivery models often fall short of these ideals because they tend to be disease-focused, fragmented and siloed, emphasising specific programmatic outputs, putting pressure on health workers and jeopardising client-centred care delivery [<span>5</span>]. There is an urgent need to transition from disease-focused health systems to those centred on individuals because nearly half of the global population lacks equitable access to essential healthcare services.</p><p>This transformation requires innovative solutions that meet client needs while maintaining accessibility and continuity of care. Recent advances in HIV prevention, including long-acting injectables for pre-exposure prophylaxis (LAI-PrEP), create unprecedented opportunities for PCC. In 2024, the ground-breaking PURPOSE 1 trial reported 100% efficacy among young women receiving twice-yearly lenacapavir [<span>6</span>]. Similarly, the PURPOSE 2 trial demonstrated that HIV incidence was 96% lower with lenacapavir compared to the background incidence [<span>7</span>]. For the first time, individuals can choose from multiple PrEP options—pills, rings or injectables—that align with their sexual behaviours, needs, preferences and life circumstances. Health providers need to educate and counsel individuals about these options, providing evidence-based information about their effectiveness, side effects and requirements (such as adherence to daily dosing or injection schedule) to facilitate autonomous and informed decision-making.</p><p>HIV self-testing (HIVST) utilisation can be improved through PCC approaches and complement PrEP. A meta-analysis of 33 studies from around the globe found that HIVST kit distribution by sexual partners, peers or through online platforms achieved higher testing rates than facility-based testing [<span>8</span>]. Significantly, it expanded testing coverage in key populations without reducing test accuracy or safety. Recent evidence suggests that HIVST streamlines HIV screening for people on PrEP and promotes PrEP uptake by individuals not accessing care. It can be leveraged to support PrEP initiation, continuation and re-engagement in care [<span>9</span>]. Technological innovations, such as LAI-PrEP and HIVST, represent only one component of effective prevention. To maximise their effectiveness, i","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70043","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237235","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}
<div> <section> <h3> Introduction</h3> <p>Despite the efficacy of antiretroviral therapy (ART)-based prevention, population-level impact remains limited because those at high risk of HIV acquisition are not reached by conventional services. We investigated whether youth-centred and tailored HIV prevention, delivered by community-based peer navigators alongside sexual and reproductive health (SRH) services, can mobilize demand for HIV pre-exposure prophylaxis (PrEP) and ART among adolescents and young adults (AYA) in KwaZulu-Natal, South Africa.</p> </section> <section> <h3> Methods</h3> <p><i>Thetha Nami ngithethe nawe</i> is a cluster-randomized stepped-wedge trial (SWT) in 40 clusters within a rural health and demographic surveillance site. Clusters were randomized to receive the intervention in period 1 (early) or period 2 (delayed). Trained area-based peer navigators conducted needs assessments with youth aged 15–30 years to tailor health promotion, psychosocial support and referrals into nurse-led mobile SRH clinics that also provided HIV testing, and status-neutral ART and oral PrEP. Standard of care was PrEP delivered through primary health clinics. We report SRH service uptake from the 20 intervention clusters during the first period of the SWT (NCT05405582).</p> </section> <section> <h3> Results</h3> <p>Between June 2022 and September 2023, peer-navigators reached 9742 (74.9%) of the 13,000 youth in the target population, 46.8% males. Among 9576 individuals with needs assessment, peer-navigators identified 141 (1.5%) with social needs, and 4138 (43.5%) had medium to high health needs. These individuals were referred to mobile clinics, with 2269 (54.8%) attending, including 959 (42.3%) males. HIV testing uptake was high (92.7%; 2103/2269), with 10.1% (212/2103) testing positive for HIV, 62 (29.2%) of whom started ART for the first time. The prevalence of HIV was higher among females compared to males (15.1% vs. 3.3%; <i>p</i> < 0.001). Among clinic attendees, 96.8% were screened for PrEP eligibility, with 38.5% deemed eligible and offered PrEP. Of the 1433 (63.2%) individuals tested for sexually transmitted infections (STIs), 418 (29.2%) tested positive, with females having higher STI prevalence (37.2% vs. 17.9%; <i>p</i> < 0.001). Of these, 385 (92.1%) received STI treatment. Among 1310 females, 769 (58.7%) reported not using any contraception at their initial visit, and 275/769 (35.8%) started contraception during the trial.</p> </section> <section> <h3> Conclusions</h3> <p>Community-based and person-centred approaches delivered thr
尽管以抗逆转录病毒疗法（ART）为基础的预防有效，但人口水平的影响仍然有限，因为传统服务无法覆盖艾滋病毒感染高风险人群。我们调查了在南非夸祖鲁-纳塔尔省，以社区为基础的同伴导航员与性健康和生殖健康（SRH）服务一起提供的以青年为中心和量身定制的艾滋病毒预防是否可以调动青少年和年轻人（AYA）对艾滋病毒暴露前预防（PrEP）和抗逆转录病毒治疗的需求。方法采用聚类随机楔形试验（SWT）对某农村卫生人口监测点的40个聚类进行研究。分组随机分为第一阶段（早期）或第二阶段（延迟）接受干预。经过培训的地区同伴导览员对15-30岁的青年进行了需求评估，以量身定制健康宣传、社会心理支持和转诊到护士领导的流动性健康和生殖健康诊所，这些诊所还提供艾滋病毒检测、身份中立的抗逆转录病毒治疗和口服PrEP。我们报告了在SWT （NCT05405582）的第一阶段，20个干预集群的性健康健康服务吸收情况。结果2022年6月至2023年9月，在目标人群13000名青少年中，同行导航员达到9742人（74.9%），其中男性46.8%。在9576名进行需求评估的个体中，同伴导航员确定141人（1.5%）有社会需求，4138人（43.5%）有中高健康需求。这些人被转介到流动诊所，就诊人数为2269人（54.8%），其中男性959人（42.3%）。艾滋病毒检测使用率高（92.7%;2103/2269），其中10.1%（212/2103）为艾滋病毒检测阳性，其中62人（29.2%）为首次开始抗逆转录病毒治疗。女性的HIV感染率高于男性（15.1% vs. 3.3%; p < 0.001）。在临床参与者中，96.8%的人接受了PrEP资格筛查，38.5%的人认为符合条件并提供了PrEP。在接受性传播感染（STI）检测的1433人中（63.2%），418人（29.2%）检测呈阳性，女性的STI患病率更高（37.2% vs. 17.9%; p < 0.001）。其中，385人（92.1%）接受了性传播感染治疗。在1310名女性中，769名（58.7%）报告首次就诊时未使用任何避孕措施，275/769名（35.8%）在试验期间开始避孕。结论：通过训练有素的同伴导航员提供的以社区为基础和以人为本的方法可以将AYA与性健康生殖健康和艾滋病毒预防/护理需求与流动性健康生殖健康服务联系起来。
{"title":"Person-centred HIV care and prevention for youth in rural South Africa: preliminary implementation findings from Thetha Nami ngithethe nawe stepped-wedge trial of peer-navigator mobilization into mobile sexual health services","authors":"Jacob Busang, Nqobile Ngoma, Thembelihle Zuma, Carina Herbst, Nonhlanhla Okesola, Natsayi Chimbindi, Jaco Dreyer, Theresa Smit, Kristien Bird, Lucky Mtolo, Osee Behuhuma, Willem Hanekom, Kobus Herbst, Limakatso Lebina, Janet Seeley, Andrew Copas, Kathy Baisley, Maryam Shahmanesh","doi":"10.1002/jia2.70032","DOIUrl":"https://doi.org/10.1002/jia2.70032","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite the efficacy of antiretroviral therapy (ART)-based prevention, population-level impact remains limited because those at high risk of HIV acquisition are not reached by conventional services. We investigated whether youth-centred and tailored HIV prevention, delivered by community-based peer navigators alongside sexual and reproductive health (SRH) services, can mobilize demand for HIV pre-exposure prophylaxis (PrEP) and ART among adolescents and young adults (AYA) in KwaZulu-Natal, South Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p><i>Thetha Nami ngithethe nawe</i> is a cluster-randomized stepped-wedge trial (SWT) in 40 clusters within a rural health and demographic surveillance site. Clusters were randomized to receive the intervention in period 1 (early) or period 2 (delayed). Trained area-based peer navigators conducted needs assessments with youth aged 15–30 years to tailor health promotion, psychosocial support and referrals into nurse-led mobile SRH clinics that also provided HIV testing, and status-neutral ART and oral PrEP. Standard of care was PrEP delivered through primary health clinics. We report SRH service uptake from the 20 intervention clusters during the first period of the SWT (NCT05405582).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between June 2022 and September 2023, peer-navigators reached 9742 (74.9%) of the 13,000 youth in the target population, 46.8% males. Among 9576 individuals with needs assessment, peer-navigators identified 141 (1.5%) with social needs, and 4138 (43.5%) had medium to high health needs. These individuals were referred to mobile clinics, with 2269 (54.8%) attending, including 959 (42.3%) males. HIV testing uptake was high (92.7%; 2103/2269), with 10.1% (212/2103) testing positive for HIV, 62 (29.2%) of whom started ART for the first time. The prevalence of HIV was higher among females compared to males (15.1% vs. 3.3%; <i>p</i> < 0.001). Among clinic attendees, 96.8% were screened for PrEP eligibility, with 38.5% deemed eligible and offered PrEP. Of the 1433 (63.2%) individuals tested for sexually transmitted infections (STIs), 418 (29.2%) tested positive, with females having higher STI prevalence (37.2% vs. 17.9%; <i>p</i> < 0.001). Of these, 385 (92.1%) received STI treatment. Among 1310 females, 769 (58.7%) reported not using any contraception at their initial visit, and 275/769 (35.8%) started contraception during the trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Community-based and person-centred approaches delivered thr","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S5","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145237385","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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