Megan Coleman, Christopher Akolo, Acapel Mbanusi, Bhekizitha Sithole, George K. Siberry, Ryan Schowen, Deborah Goldstein
Introduction
Key populations (KP), including men who have sex with men, people who inject drugs, sex workers, transgender people and people in closed settings, are disproportionately affected by HIV and face structural and legal barriers to care. While community-led responses are central to reaching KP, services are often disease-specific and disconnected from national primary healthcare (PHC) systems. PHC, defined by WHO as a whole-of-society approach to delivering integrated and person-centred services, is rarely designed to meet the broader health needs of KP, who also experience high burdens of non-communicable diseases, mental health conditions and violence. This paper describes three service delivery models, supported by PEPFAR, that integrate HIV and PHC services for KP in Vietnam, Nigeria and Eswatini.
Discussion
The three models are community-led, client-centred, and tailored to KP health and social needs. Each integrates HIV services—including testing, antiretroviral therapy, viral load monitoring, pre-exposure prophylaxis (PrEP) and advanced HIV disease management—alongside broader PHC services such as mental healthcare, sexual and reproductive health, non-communicable disease screening and tuberculosis services. All models include structural and community-based interventions such as gender-based violence support, stigma reduction, peer navigation and economic empowerment. These services are delivered in safe, trusted spaces by multidisciplinary teams including peer and clinical providers. While the models demonstrate alignment with PHC principles (accessibility, cultural competence, continuity and community empowerment), challenges remain related to integration within national health systems, financing and provider training. Recent U.S. global health policy shifts, including reductions in funding for KP-specific programming and limited PrEP access, pose additional threats to programme sustainability and client trust.
Conclusions
Integrated models of HIV and PHC for KP can improve access, engagement and health outcomes across a range of services. They represent promising approaches for addressing intersecting health and structural needs, particularly in settings where stigma and criminalization persist. Sustained progress will require inclusion of KP in PHC policies and planning, protection of community-led services and domestic financing strategies that ensure continuity in the face of shifting donor priorities.
{"title":"Integrating HIV and primary healthcare for key populations: community-led models from Vietnam, Nigeria and Eswatini","authors":"Megan Coleman, Christopher Akolo, Acapel Mbanusi, Bhekizitha Sithole, George K. Siberry, Ryan Schowen, Deborah Goldstein","doi":"10.1002/jia2.70027","DOIUrl":"https://doi.org/10.1002/jia2.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Key populations (KP), including men who have sex with men, people who inject drugs, sex workers, transgender people and people in closed settings, are disproportionately affected by HIV and face structural and legal barriers to care. While community-led responses are central to reaching KP, services are often disease-specific and disconnected from national primary healthcare (PHC) systems. PHC, defined by WHO as a whole-of-society approach to delivering integrated and person-centred services, is rarely designed to meet the broader health needs of KP, who also experience high burdens of non-communicable diseases, mental health conditions and violence. This paper describes three service delivery models, supported by PEPFAR, that integrate HIV and PHC services for KP in Vietnam, Nigeria and Eswatini.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>The three models are community-led, client-centred, and tailored to KP health and social needs. Each integrates HIV services—including testing, antiretroviral therapy, viral load monitoring, pre-exposure prophylaxis (PrEP) and advanced HIV disease management—alongside broader PHC services such as mental healthcare, sexual and reproductive health, non-communicable disease screening and tuberculosis services. All models include structural and community-based interventions such as gender-based violence support, stigma reduction, peer navigation and economic empowerment. These services are delivered in safe, trusted spaces by multidisciplinary teams including peer and clinical providers. While the models demonstrate alignment with PHC principles (accessibility, cultural competence, continuity and community empowerment), challenges remain related to integration within national health systems, financing and provider training. Recent U.S. global health policy shifts, including reductions in funding for KP-specific programming and limited PrEP access, pose additional threats to programme sustainability and client trust.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Integrated models of HIV and PHC for KP can improve access, engagement and health outcomes across a range of services. They represent promising approaches for addressing intersecting health and structural needs, particularly in settings where stigma and criminalization persist. Sustained progress will require inclusion of KP in PHC policies and planning, protection of community-led services and domestic financing strategies that ensure continuity in the face of shifting donor priorities.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935052","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}
Jennifer Velloza, Nomhle Ndimande-Khoza, Lisa Mills, Nicole Poovan, Aliza Adler, Elizabeth B. Sherwin, Carrie Mathew, Zinhle Sokhela, Ruth Verhey, Dixon Chibanda, Monica Gandhi, Connie Celum, Sinead Delany-Moretlwe
<div> <section> <h3> Introduction</h3> <p>Adolescent girls and young women (AGYW) at risk of HIV frequently have symptoms of common mental disorders (CMDs), which are associated with lower pre-exposure prophylaxis (PrEP) adherence. We conducted a pilot hybrid effectiveness-implementation trial (CHOMA) to evaluate whether an evidence-based mental health intervention adapted for PrEP delivery (“Youth Friendship Bench SA”) could address CMD and PrEP adherence among South African AGYW.</p> </section> <section> <h3> Methods</h3> <p>CHOMA was conducted in Johannesburg from April 2023 to February 2024. We enrolled AGYW (18−25 years) who were already on or willing to initiate PrEP and had CMD symptoms (Self-Reporting Questionnaire 20-item [SRQ-20]≥7). Participants were randomized to our Youth Friendship Bench SA intervention (five problem-solving sessions with a lay counsellor, one group session) or standard-of-care CMD services (brief CMD assessment, referral). Counselling sessions occurred at enrolment and Weeks 2, 4, 8 and 12. Co-primary outcomes were PrEP adherence (positive result on a urine tenofovir assay) and reduced CMD symptoms (SRQ-20<7) at Week 12 and, secondarily, Week 4. We used Poisson regression to assess intervention effects and summarized responses to three validated scales assessing intervention acceptability, appropriateness and feasibility (ranges: 1–4).</p> </section> <section> <h3> Results</h3> <p>Of 116 AGYW enrolled, the median SRQ-20 score was 9. We retained 69% through Week 12. Of 57 intervention participants, 64.9% (<i>N</i> = 37) received four or more sessions. At Week 4, 29/36 (80.6%) participants in the intervention and 25/41 (61.0%) in the standard-of-care had recent PrEP use (RR = 1.40; 95% CI = 1.03−1.89; <i>p</i> = 0.03), but this was not sustained through Week 12 (RR = 0.88; 95% CI = 0.64−1.22; <i>p</i> = 0.44). Enrolment SRQ-20 score was not associated with Week 12 PrEP adherence or retention. CMD symptoms did not differ by arm at Week 4 or 12, although the proportion with SRQ-20 scores >7 decreased overall between Weeks 4 (54.5%, 42/77) and 12 (35.0%, 28/80; <i>p</i> = 0.02). Median acceptability, appropriateness and feasibility scores were 3.50, 3.75 and 3.25, respectively.</p> </section> <section> <h3> Conclusions</h3> <p>The intervention improved PrEP adherence at Week 4, although the effect was not durable to Week 12, possibly due to retention challenges. Reductions in CMD symptoms were seen in both arms. Findings suggest different mental health and PrEP support interventions may be needed to improve integrat
面临艾滋病毒感染风险的少女和年轻妇女（AGYW）经常出现常见精神障碍（cmd）症状，这与暴露前预防（PrEP）依从性较低有关。我们进行了一项混合有效性实施试验（CHOMA），以评估一种基于证据的心理健康干预措施（“青年友谊长凳SA”）是否适用于PrEP的实施，可以解决南非AGYW的CMD和PrEP依从性问题。方法于2023年4月至2024年2月在约翰内斯堡进行CHOMA检查。我们招募了已经开始或愿意开始PrEP并有CMD症状的AGYW（18 - 25岁）（自我报告问卷20项[SRQ-20]≥7）。参与者被随机分配到我们的青年友谊长凳SA干预（五次与外行咨询师一起解决问题的会议，一次小组会议）或标准护理CMD服务（简短的CMD评估，转诊）。咨询课程在入学和第2、4、8和12周进行。共同的主要结果是PrEP依从性（尿替诺福韦检测阳性）和在第12周和第4周减少CMD症状（SRQ-20<7）。我们使用泊松回归来评估干预效果，并总结了对评估干预可接受性、适当性和可行性的三个有效量表的反应（范围：1-4）。结果116例AGYW入组，SRQ-20中位数为9分。第12周我们的留存率为69%。在57名干预参与者中，64.9% （N = 37）接受了4次或更多的治疗。在第4周，29/36（80.6%）的干预参与者和25/41（61.0%）的标准护理参与者最近使用过PrEP (RR = 1.40; 95% CI = 1.03 - 1.89; p = 0.03)，但这种情况没有持续到第12周（RR = 0.88; 95% CI = 0.64 - 1.22; p = 0.44）。入组SRQ-20评分与第12周PrEP依从性或保留无关。在第4周和第12周，不同组的CMD症状没有差异，尽管SRQ-20评分为>；7的比例在第4周（54.5%,42/77）和第12周（35.0%,28/80,p = 0.02）之间总体下降。可接受性、适宜性和可行性得分中位数分别为3.50、3.75和3.25。结论干预提高了第4周的PrEP依从性，尽管效果不能持续到第12周，可能是由于保留挑战。两组CMD症状均有所减轻。研究结果表明，可能需要不同的心理健康和PrEP支持干预措施来改善老年妇女之间的综合服务提供。
{"title":"Combining HIV prevention Options with Mental health service delivery for Adolescent girls and young women (CHOMA): results of a pilot hybrid effectiveness-implementation randomized trial in South Africa","authors":"Jennifer Velloza, Nomhle Ndimande-Khoza, Lisa Mills, Nicole Poovan, Aliza Adler, Elizabeth B. Sherwin, Carrie Mathew, Zinhle Sokhela, Ruth Verhey, Dixon Chibanda, Monica Gandhi, Connie Celum, Sinead Delany-Moretlwe","doi":"10.1002/jia2.70037","DOIUrl":"https://doi.org/10.1002/jia2.70037","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Adolescent girls and young women (AGYW) at risk of HIV frequently have symptoms of common mental disorders (CMDs), which are associated with lower pre-exposure prophylaxis (PrEP) adherence. We conducted a pilot hybrid effectiveness-implementation trial (CHOMA) to evaluate whether an evidence-based mental health intervention adapted for PrEP delivery (“Youth Friendship Bench SA”) could address CMD and PrEP adherence among South African AGYW.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>CHOMA was conducted in Johannesburg from April 2023 to February 2024. We enrolled AGYW (18−25 years) who were already on or willing to initiate PrEP and had CMD symptoms (Self-Reporting Questionnaire 20-item [SRQ-20]≥7). Participants were randomized to our Youth Friendship Bench SA intervention (five problem-solving sessions with a lay counsellor, one group session) or standard-of-care CMD services (brief CMD assessment, referral). Counselling sessions occurred at enrolment and Weeks 2, 4, 8 and 12. Co-primary outcomes were PrEP adherence (positive result on a urine tenofovir assay) and reduced CMD symptoms (SRQ-20<7) at Week 12 and, secondarily, Week 4. We used Poisson regression to assess intervention effects and summarized responses to three validated scales assessing intervention acceptability, appropriateness and feasibility (ranges: 1–4).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 116 AGYW enrolled, the median SRQ-20 score was 9. We retained 69% through Week 12. Of 57 intervention participants, 64.9% (<i>N</i> = 37) received four or more sessions. At Week 4, 29/36 (80.6%) participants in the intervention and 25/41 (61.0%) in the standard-of-care had recent PrEP use (RR = 1.40; 95% CI = 1.03−1.89; <i>p</i> = 0.03), but this was not sustained through Week 12 (RR = 0.88; 95% CI = 0.64−1.22; <i>p</i> = 0.44). Enrolment SRQ-20 score was not associated with Week 12 PrEP adherence or retention. CMD symptoms did not differ by arm at Week 4 or 12, although the proportion with SRQ-20 scores >7 decreased overall between Weeks 4 (54.5%, 42/77) and 12 (35.0%, 28/80; <i>p</i> = 0.02). Median acceptability, appropriateness and feasibility scores were 3.50, 3.75 and 3.25, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The intervention improved PrEP adherence at Week 4, although the effect was not durable to Week 12, possibly due to retention challenges. Reductions in CMD symptoms were seen in both arms. Findings suggest different mental health and PrEP support interventions may be needed to improve integrat","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70037","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144935053","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}
Silver K. Vargas, Kelika A. Konda, Ronaldo I. Moreira, Iuri C. Leite, Marcelo Cunha, Brenda Hoagland, Juan V. Guanira, Marcos Benedetti, Cristina Pimenta, Beatriz Grinztejn, Valdiléa G. Veloso, Carlos F. Caceres
<div> <section> <h3> Introduction</h3> <p>Syphilis remains a public health concern in Peru. Pre-exposure prophylaxis (PrEP) implementation programmes in Latin America need to assess their impact on sexually transmitted infections (STIs), along with their feasibility. We assessed the relationship between PrEP adherence and syphilis incidence among men who have sex with men (MSM) and transgender women (TW) enrolled in ImPrEP, a multi-country PrEP demonstration project; however, this analysis focuses on Peru.</p> </section> <section> <h3> Methods</h3> <p>Between April 2018 and June 2021, 2292 HIV-negative MSM/TW attending Peruvian STI clinics were enrolled and followed in ImPrEP. Participants had to be aged ≥18 years and report recent condomless anal sex (CAS), sex with a partner living with HIV, STI history (diagnosis/symptoms) and/or transactional sex. Quarterly follow-up visits included PrEP dispensing, behavioural assessment, HIV and syphilis screening (treponemal test and Rapid Plasma Reagin [RPR] if syphilis negative at enrolment; RPR only if reactive-treponemal test at baseline). PrEP adherence was assessed using the medication possession ratio (MPR: #pills prescribed / #days between visits). Generalized estimating equation (GEE) Poisson regression models were used to evaluate factors related to syphilis incidence and also assessed syphilis incidence during two periods: pre-COVID-19 lockdown (up to 16 March 2020) and during COVID-19-lockdown (17 March 2020−June 2021).</p> </section> <section> <h3> Results</h3> <p>We enrolled 2039 cisgender-MSM and 253 TW, with a median follow-up time of 514 days; 205 incident syphilis cases were identified among 185 individuals. Overall syphilis incidence was 9.1 cases/100 person-years (p.y.) (95% CI: 7.9−10.4), 14.7/100 p.y. (95% CI: 10.5−20.1) among TW and 8.3/100 p.y (95% CI: 7.1−10.0) among cisgender-MSM. During the COVID-19 pre-lockdown period, syphilis incidence was 10.0/100 p.y. (95% CI: 8.3−12.1) and 8.1/100 p.y. (95% CI: 6.6−10.0) during-lockdown. Multivariate GEE analysis showed higher syphilis incidence among PrEP-adherent participants (MPR≥0.6) (adjusted incidence rate ratio [aIRR]: 1.46 [95% CI: 1.08−1.99]), those reporting receptive CAS (aIRR: 1.53 [95% CI: 1.11−2.11]) and TW (aIRR: 1.64 [95% CI: 1.08−2.51]). Syphilis incidence pre-lockdown was higher for participants reporting receptive CAS (aIRR: 2.35 [95% CI: 1.43−3.86]); during-lockdown, syphilis incidence was higher among those diagnosed with syphilis at enrolment (aIRR: 2.70 [95% CI: 1.67−4.36]).</p> </section> <section> <h3> Conclusions</h3>
{"title":"High syphilis incidence among PrEP-adherent men who have sex with men and transgender women in Peru","authors":"Silver K. Vargas, Kelika A. Konda, Ronaldo I. Moreira, Iuri C. Leite, Marcelo Cunha, Brenda Hoagland, Juan V. Guanira, Marcos Benedetti, Cristina Pimenta, Beatriz Grinztejn, Valdiléa G. Veloso, Carlos F. Caceres","doi":"10.1002/jia2.70002","DOIUrl":"https://doi.org/10.1002/jia2.70002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Syphilis remains a public health concern in Peru. Pre-exposure prophylaxis (PrEP) implementation programmes in Latin America need to assess their impact on sexually transmitted infections (STIs), along with their feasibility. We assessed the relationship between PrEP adherence and syphilis incidence among men who have sex with men (MSM) and transgender women (TW) enrolled in ImPrEP, a multi-country PrEP demonstration project; however, this analysis focuses on Peru.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Between April 2018 and June 2021, 2292 HIV-negative MSM/TW attending Peruvian STI clinics were enrolled and followed in ImPrEP. Participants had to be aged ≥18 years and report recent condomless anal sex (CAS), sex with a partner living with HIV, STI history (diagnosis/symptoms) and/or transactional sex. Quarterly follow-up visits included PrEP dispensing, behavioural assessment, HIV and syphilis screening (treponemal test and Rapid Plasma Reagin [RPR] if syphilis negative at enrolment; RPR only if reactive-treponemal test at baseline). PrEP adherence was assessed using the medication possession ratio (MPR: #pills prescribed / #days between visits). Generalized estimating equation (GEE) Poisson regression models were used to evaluate factors related to syphilis incidence and also assessed syphilis incidence during two periods: pre-COVID-19 lockdown (up to 16 March 2020) and during COVID-19-lockdown (17 March 2020−June 2021).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We enrolled 2039 cisgender-MSM and 253 TW, with a median follow-up time of 514 days; 205 incident syphilis cases were identified among 185 individuals. Overall syphilis incidence was 9.1 cases/100 person-years (p.y.) (95% CI: 7.9−10.4), 14.7/100 p.y. (95% CI: 10.5−20.1) among TW and 8.3/100 p.y (95% CI: 7.1−10.0) among cisgender-MSM. During the COVID-19 pre-lockdown period, syphilis incidence was 10.0/100 p.y. (95% CI: 8.3−12.1) and 8.1/100 p.y. (95% CI: 6.6−10.0) during-lockdown. Multivariate GEE analysis showed higher syphilis incidence among PrEP-adherent participants (MPR≥0.6) (adjusted incidence rate ratio [aIRR]: 1.46 [95% CI: 1.08−1.99]), those reporting receptive CAS (aIRR: 1.53 [95% CI: 1.11−2.11]) and TW (aIRR: 1.64 [95% CI: 1.08−2.51]). Syphilis incidence pre-lockdown was higher for participants reporting receptive CAS (aIRR: 2.35 [95% CI: 1.43−3.86]); during-lockdown, syphilis incidence was higher among those diagnosed with syphilis at enrolment (aIRR: 2.70 [95% CI: 1.67−4.36]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 9","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144910036","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}
Urvi M. Parikh, Lauren D. Kudrick, Lisa Levy, Everline Bosek, Bhavna H. Chohan, Irene Mukui, Sarah Masyuko, Nonhlanhla Ndlovu, Imelda Mahaka, Owen Mugurungi, Gertrude Ncube, Anita Hettema, Sindy N. Matse, Saiqa Mullick, Carole L. Wallis, Amy L. Heaps, Kerri J. Penrose, Kevin D. McCormick, Lubbe Wiesner, Peter L. Anderson, Jill M. Peterson, Connie Celum, Barbra A. Richardson, Delivette Castor, Shannon Allen, Kristine Torjesen, John W. Mellors, Global Evaluation of Microbicide Sensitivity (GEMS) Project
<div> <section> <h3> Introduction</h3> <p>The ongoing rollout of oral tenofovir-based pre-exposure prophylaxis (PrEP) has the potential to reduce HIV-1 incidence, but HIV drug resistance (HIVDR) in individuals who acquire HIV-1 on PrEP could threaten the treatment effectiveness of overlapping antiretrovirals (tenofovir/emtricitabine), contribute to development of resistance, and undermine HIV control efforts. Accordingly, the Global Evaluation of Microbicide Sensitivity (GEMS) project was established to monitor HIVDR in PrEP rollout programmes in Southern and Eastern Africa.</p> </section> <section> <h3> Methods</h3> <p>GEMS monitored resistance in >100,000 estimated persons who accessed PrEP through national programmes or implementation projects in Southern/Eastern Africa. Participants self-reported demographics and PrEP adherence. HIV-1 RNA and tenofovir-diphosphate levels were measured in blood samples collected at the time of study enrolment from consenting participants diagnosed with HIV who had received PrEP. HIVDR mutations were detected by population genotyping.</p> </section> <section> <h3> Results</h3> <p>Of 283 reported seroconversions on PrEP from December 2017 through September 2023, 255 (90%) individuals enrolled in GEMS, of which 81 (32%) were from Kenya, 77 (30%) from South Africa, 69 (27%) from Zimbabwe and 28 (11%) from Eswatini. Half (130; 51%) were 15–24 years of age at seroconversion, and three-quarters (193; 76%) were female. Thirty-four seroconversions occurred within 30 days of PrEP initiation. Tenofovir-diphosphate levels were consistent with moderate to high levels (≥350 femtomoles per punch) in 53% (120 of 226) individuals with drug-level data. Of 154 samples successfully genotyped, 34 (22%; 95% CI [16%, 30%]) had PrEP-associated mutations; these included 27 samples with M184I/V, one sample with K65KR, and six samples with both K65R and M184I/V.</p> </section> <section> <h3> Conclusions</h3> <p>The frequency of HIVDR mutations associated with tenofovir or emtricitabine among individuals diagnosed with HIV who had received PrEP (22%) exceeded background levels of transmitted nucleoside <i>reverse transcriptase</i> inhibitor resistance in Southern and Eastern Africa (≤5%) but people with PrEP-associated mutations are likely to achieve virologic suppression with current first-line antiretroviral therapy (ART). Improved screening for acute infection before initiating PrEP, surveillance of HIVDR with the introduction of new PrEP programmes and the monitoring of longer-term ART outcomes in individuals who acquire HIV-1 on Pr
{"title":"A cross-sectional study evaluating the frequency of HIV drug resistance mutations among individuals diagnosed with HIV-1 in tenofovir disoproxil fumarate-based pre-exposure prophylaxis rollout programmes in Kenya, Zimbabwe, Eswatini and South Africa","authors":"Urvi M. Parikh, Lauren D. Kudrick, Lisa Levy, Everline Bosek, Bhavna H. Chohan, Irene Mukui, Sarah Masyuko, Nonhlanhla Ndlovu, Imelda Mahaka, Owen Mugurungi, Gertrude Ncube, Anita Hettema, Sindy N. Matse, Saiqa Mullick, Carole L. Wallis, Amy L. Heaps, Kerri J. Penrose, Kevin D. McCormick, Lubbe Wiesner, Peter L. Anderson, Jill M. Peterson, Connie Celum, Barbra A. Richardson, Delivette Castor, Shannon Allen, Kristine Torjesen, John W. Mellors, Global Evaluation of Microbicide Sensitivity (GEMS) Project","doi":"10.1002/jia2.70011","DOIUrl":"https://doi.org/10.1002/jia2.70011","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The ongoing rollout of oral tenofovir-based pre-exposure prophylaxis (PrEP) has the potential to reduce HIV-1 incidence, but HIV drug resistance (HIVDR) in individuals who acquire HIV-1 on PrEP could threaten the treatment effectiveness of overlapping antiretrovirals (tenofovir/emtricitabine), contribute to development of resistance, and undermine HIV control efforts. Accordingly, the Global Evaluation of Microbicide Sensitivity (GEMS) project was established to monitor HIVDR in PrEP rollout programmes in Southern and Eastern Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>GEMS monitored resistance in >100,000 estimated persons who accessed PrEP through national programmes or implementation projects in Southern/Eastern Africa. Participants self-reported demographics and PrEP adherence. HIV-1 RNA and tenofovir-diphosphate levels were measured in blood samples collected at the time of study enrolment from consenting participants diagnosed with HIV who had received PrEP. HIVDR mutations were detected by population genotyping.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 283 reported seroconversions on PrEP from December 2017 through September 2023, 255 (90%) individuals enrolled in GEMS, of which 81 (32%) were from Kenya, 77 (30%) from South Africa, 69 (27%) from Zimbabwe and 28 (11%) from Eswatini. Half (130; 51%) were 15–24 years of age at seroconversion, and three-quarters (193; 76%) were female. Thirty-four seroconversions occurred within 30 days of PrEP initiation. Tenofovir-diphosphate levels were consistent with moderate to high levels (≥350 femtomoles per punch) in 53% (120 of 226) individuals with drug-level data. Of 154 samples successfully genotyped, 34 (22%; 95% CI [16%, 30%]) had PrEP-associated mutations; these included 27 samples with M184I/V, one sample with K65KR, and six samples with both K65R and M184I/V.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The frequency of HIVDR mutations associated with tenofovir or emtricitabine among individuals diagnosed with HIV who had received PrEP (22%) exceeded background levels of transmitted nucleoside <i>reverse transcriptase</i> inhibitor resistance in Southern and Eastern Africa (≤5%) but people with PrEP-associated mutations are likely to achieve virologic suppression with current first-line antiretroviral therapy (ART). Improved screening for acute infection before initiating PrEP, surveillance of HIVDR with the introduction of new PrEP programmes and the monitoring of longer-term ART outcomes in individuals who acquire HIV-1 on Pr","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881368","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}
Warittha Tieosapjaroen, Benjamin R. Bavinton, Heather-Marie A. Schmidt, Curtis Chan, Kim E. Green, Nittaya Phanuphak, Midnight Poonkasetwattana, Nicky S. Suwandi, Doug Fraser, Hua Boonyapisomparn, Michael Cassell, Lei Zhang, Weiming Tang, Jason J. Ong
Introduction
Scaling up pre-exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM) and transgender women (TGW) in the Asia-Pacific region has been slow. We identified the drivers of PrEP use and forecasted PrEP uptake given different PrEP programmes for MSM and TGW living in 15 countries and territories in Asia and Australia.
Methods
Separate online discrete choice experiment surveys for MSM and TGW were distributed in 15 Asian countries and territories and Australia between May and November 2022. We used random parameters logit models to estimate the relative importance of service attributes and predicted PrEP uptake for different programme configurations.
Results
Among 21,943 participants included in the MSM survey and 1522 in the TGW survey, the mean age was 31.7 (±9.5) years and 28.1 (±7.0) years, respectively. Cost emerged as the primary driver of PrEP use for MSM and TGW across countries, followed by the type of PrEP. When switching from the least preferred PrEP programme (i.e. very high service fee, PrEP implant, rare kidney problems as side effects of PrEP and a 2-monthly clinic visit) to an optimal programme (i.e. free access to PrEP via peer-led community clinics which offered sexually transmitted infection [STI] testing, and a 6–12 monthly visit), the predicted PrEP uptake could improve by over 50% for MSM in Australia, China, Hong Kong SAR China, Japan, the Philippines, Taiwan (China) and Thailand, and 37% for TGW. Compared to those at lower risk of HIV, free access was more preferred by MSM at a higher risk of HIV, while telehealth was more preferred by TGW at a substantial risk of HIV.
Conclusions
Tailoring services to local contexts, including ensuring affordability, preferred type of PrEP and providing differentiated services, could accelerate the uptake of PrEP among MSM and TGW in Asia and Australia. Novel innovations, such as STI and HIV self-testing, should be explored as alternatives to conventional testing, given that most MSM and TGW prefer less frequent clinic visits and long-acting PrEP options.
{"title":"Preferences for HIV pre-exposure prophylaxis among men who have sex with men and trans women in 15 countries and territories in Asia and Australia: a discrete choice experiment","authors":"Warittha Tieosapjaroen, Benjamin R. Bavinton, Heather-Marie A. Schmidt, Curtis Chan, Kim E. Green, Nittaya Phanuphak, Midnight Poonkasetwattana, Nicky S. Suwandi, Doug Fraser, Hua Boonyapisomparn, Michael Cassell, Lei Zhang, Weiming Tang, Jason J. Ong","doi":"10.1002/jia2.70025","DOIUrl":"https://doi.org/10.1002/jia2.70025","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Scaling up pre-exposure prophylaxis (PrEP) for HIV among men who have sex with men (MSM) and transgender women (TGW) in the Asia-Pacific region has been slow. We identified the drivers of PrEP use and forecasted PrEP uptake given different PrEP programmes for MSM and TGW living in 15 countries and territories in Asia and Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Separate online discrete choice experiment surveys for MSM and TGW were distributed in 15 Asian countries and territories and Australia between May and November 2022. We used random parameters logit models to estimate the relative importance of service attributes and predicted PrEP uptake for different programme configurations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 21,943 participants included in the MSM survey and 1522 in the TGW survey, the mean age was 31.7 (±9.5) years and 28.1 (±7.0) years, respectively. Cost emerged as the primary driver of PrEP use for MSM and TGW across countries, followed by the type of PrEP. When switching from the least preferred PrEP programme (i.e. very high service fee, PrEP implant, rare kidney problems as side effects of PrEP and a 2-monthly clinic visit) to an optimal programme (i.e. free access to PrEP via peer-led community clinics which offered sexually transmitted infection [STI] testing, and a 6–12 monthly visit), the predicted PrEP uptake could improve by over 50% for MSM in Australia, China, Hong Kong SAR China, Japan, the Philippines, Taiwan (China) and Thailand, and 37% for TGW. Compared to those at lower risk of HIV, free access was more preferred by MSM at a higher risk of HIV, while telehealth was more preferred by TGW at a substantial risk of HIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Tailoring services to local contexts, including ensuring affordability, preferred type of PrEP and providing differentiated services, could accelerate the uptake of PrEP among MSM and TGW in Asia and Australia. Novel innovations, such as STI and HIV self-testing, should be explored as alternatives to conventional testing, given that most MSM and TGW prefer less frequent clinic visits and long-acting PrEP options.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70025","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144881370","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}
Yann Ruffieux, John A. Joska, Raynell Lang, Chunyan Zheng, Naomi Folb, Gregory D. Kirk, Angela M. Parcesepe, Michael J. Silverberg, Sonia Napravnik, Kelly Gebo, Joseph J. Eron Jr, Brenna C. Hogan, Keri N. Althoff, Mpho Tlali, David J. Grelotti, Mona Loutfy, Peter F. Rebeiro, Mary-Ann Davies, Matthias Egger, Gary Maartens, Andreas D. Haas
Introduction
People with HIV (PWH) have a high burden of mental health disorders, which contribute to increased mortality due to elevated rates of physical illness, suicide or fatal accidents. Additionally, mental health disorders can adversely affect antiretroviral therapy (ART) adherence, leading to increased HIV-related mortality. This study aims to quantify the difference in mortality between PWH who have a mental health disorder and PWH without mental health disorders in South Africa (SA) and North America (NA).
Methods
This cohort study includes PWH aged 18 years or older who initiated ART between 2000 and 2021 at a national private-sector HIV programme in SA and 13 programmes in the United States and Canada. Mental health disorders were diagnosed according to ICD-10 codes F10-F99, which include psychotic disorders, bipolar disorders, depression, anxiety and substance use disorders. We estimated life-years lost (LYL) associated with mental health disorders, quantifying the average difference in remaining life expectancy between individuals diagnosed with a mental health disorder and those without such diagnoses.
Results
The study included 119,785 participants from SA (57.4% female, median age 39 years) and 142,044 from NA (85.0% male, median age 43 years). In SA, 57,999 (48.4%) were diagnosed with a mental health disorder, compared with 93,518 (65.8%) in NA. In SA, the LYL associated with any mental health disorder were 3.42 years (95% CI 2.42−4.28) in males and 2.95 years (0.67−5.95) in females. Corresponding figures for NA were 4.16 years (3.71−4.59) in males and 4.64 years (2.93−6.05) in females. In both regions, LYL were higher for psychotic and substance use disorders than for depression and anxiety. Losses were primarily due to natural deaths at CD4 counts ≥200 cells/µl, with considerable contributions at CD4 counts <200 cells/µl. Unnatural causes also contributed to the loss of life-years in males from SA and males and females from NA.
Conclusions
PWH affected by mental health disorders experience higher mortality, primarily from natural causes. LYL were associated with both immunosuppression and higher CD4 levels. Improved management of HIV and physical comorbidities among PWH affected by mental health disorders may enhance their prognosis.
{"title":"Life-years lost associated with mental disorders in people with HIV: a cohort study in South Africa, Canada and the United States","authors":"Yann Ruffieux, John A. Joska, Raynell Lang, Chunyan Zheng, Naomi Folb, Gregory D. Kirk, Angela M. Parcesepe, Michael J. Silverberg, Sonia Napravnik, Kelly Gebo, Joseph J. Eron Jr, Brenna C. Hogan, Keri N. Althoff, Mpho Tlali, David J. Grelotti, Mona Loutfy, Peter F. Rebeiro, Mary-Ann Davies, Matthias Egger, Gary Maartens, Andreas D. Haas","doi":"10.1002/jia2.70023","DOIUrl":"https://doi.org/10.1002/jia2.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>People with HIV (PWH) have a high burden of mental health disorders, which contribute to increased mortality due to elevated rates of physical illness, suicide or fatal accidents. Additionally, mental health disorders can adversely affect antiretroviral therapy (ART) adherence, leading to increased HIV-related mortality. This study aims to quantify the difference in mortality between PWH who have a mental health disorder and PWH without mental health disorders in South Africa (SA) and North America (NA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cohort study includes PWH aged 18 years or older who initiated ART between 2000 and 2021 at a national private-sector HIV programme in SA and 13 programmes in the United States and Canada. Mental health disorders were diagnosed according to ICD-10 codes F10-F99, which include psychotic disorders, bipolar disorders, depression, anxiety and substance use disorders. We estimated life-years lost (LYL) associated with mental health disorders, quantifying the average difference in remaining life expectancy between individuals diagnosed with a mental health disorder and those without such diagnoses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 119,785 participants from SA (57.4% female, median age 39 years) and 142,044 from NA (85.0% male, median age 43 years). In SA, 57,999 (48.4%) were diagnosed with a mental health disorder, compared with 93,518 (65.8%) in NA. In SA, the LYL associated with any mental health disorder were 3.42 years (95% CI 2.42−4.28) in males and 2.95 years (0.67−5.95) in females. Corresponding figures for NA were 4.16 years (3.71−4.59) in males and 4.64 years (2.93−6.05) in females. In both regions, LYL were higher for psychotic and substance use disorders than for depression and anxiety. Losses were primarily due to natural deaths at CD4 counts ≥200 cells/µl, with considerable contributions at CD4 counts <200 cells/µl. Unnatural causes also contributed to the loss of life-years in males from SA and males and females from NA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PWH affected by mental health disorders experience higher mortality, primarily from natural causes. LYL were associated with both immunosuppression and higher CD4 levels. Improved management of HIV and physical comorbidities among PWH affected by mental health disorders may enhance their prognosis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70023","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144869376","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}
Adrien Allorant, Salome Kuchukhidze, James Stannah, Yiqing Xia, Sanele S. Masuku, Gatien K. Ekanmian, Jeffrey W. Imai-Eaton, Mathieu Maheu-Giroux
Introduction
Socio-demographic and geographic disparities in HIV prevalence, uptake of HIV testing and access to antiretroviral therapy (ART) persist in high HIV burden countries. Understanding demographic, spatial and temporal factors can guide interventions.
Methods
We analysed 108 geo-referenced population-based surveys conducted over 2000–2023 across 33 African countries, involving 2.3 million respondents. Multilevel Bayesian logistic regression models assessed associations between HIV outcomes (HIV prevalence, recent HIV testing and ART coverage) and socio-demographic characteristics (age, education, place of residence, relative wealth), geographic location (country, district) and time trends. Separate models were estimated for men and women in central, eastern, southern and western Africa.
Results
Inequalities in HIV risk and access to testing and treatment services were driven by differences in educational attainment and within-country variations. In southern Africa, women with tertiary education had a 12%-point lower HIV prevalence (95% Credible Interval [CrI]: −27% to −2%) than those with less than primary education. In eastern Africa, they had a 13%-points (95% CrI: 2−22%) higher probability of recent HIV testing. Associations with relative wealth were weaker and more heterogeneous: in southern Africa, HIV prevalence shifted over time from higher to lower wealth quintiles, and adolescent girls and young women became the most frequently tested age group. In central Africa, wealthier men maintained higher recent testing and ART coverage levels. District-level variations accounted for disparities in HIV outcomes. In western Africa, the expected difference in ART coverage between individuals with similar socio-demographic characteristics living in different districts was 14%-points (95% CrI: 3−32%) for men and 10%-points (95% CrI: 3−27%) for women.
Conclusions
Disparities in HIV outcomes are strongly associated with differences in education, and across districts of the same country. Higher education levels are associated with lower HIV prevalence, greater testing and higher ART coverage, while districts with limited services sustain higher population viraemia. Despite the scale-up of HIV prevention and treatment programmes, important disparities remain, and renewed education-centred and geographically targeted efforts are needed to close gaps.
{"title":"Socio-demographic and geographic disparities in HIV prevalence, HIV testing and treatment coverage: An analysis of 108 national household surveys in 33 African countries","authors":"Adrien Allorant, Salome Kuchukhidze, James Stannah, Yiqing Xia, Sanele S. Masuku, Gatien K. Ekanmian, Jeffrey W. Imai-Eaton, Mathieu Maheu-Giroux","doi":"10.1002/jia2.70024","DOIUrl":"https://doi.org/10.1002/jia2.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Socio-demographic and geographic disparities in HIV prevalence, uptake of HIV testing and access to antiretroviral therapy (ART) persist in high HIV burden countries. Understanding demographic, spatial and temporal factors can guide interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed 108 geo-referenced population-based surveys conducted over 2000–2023 across 33 African countries, involving 2.3 million respondents. Multilevel Bayesian logistic regression models assessed associations between HIV outcomes (HIV prevalence, recent HIV testing and ART coverage) and socio-demographic characteristics (age, education, place of residence, relative wealth), geographic location (country, district) and time trends. Separate models were estimated for men and women in central, eastern, southern and western Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Inequalities in HIV risk and access to testing and treatment services were driven by differences in educational attainment and within-country variations. In southern Africa, women with tertiary education had a 12%-point lower HIV prevalence (95% Credible Interval [CrI]: −27% to −2%) than those with less than primary education. In eastern Africa, they had a 13%-points (95% CrI: 2−22%) higher probability of recent HIV testing. Associations with relative wealth were weaker and more heterogeneous: in southern Africa, HIV prevalence shifted over time from higher to lower wealth quintiles, and adolescent girls and young women became the most frequently tested age group. In central Africa, wealthier men maintained higher recent testing and ART coverage levels. District-level variations accounted for disparities in HIV outcomes. In western Africa, the expected difference in ART coverage between individuals with similar socio-demographic characteristics living in different districts was 14%-points (95% CrI: 3−32%) for men and 10%-points (95% CrI: 3−27%) for women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Disparities in HIV outcomes are strongly associated with differences in education, and across districts of the same country. Higher education levels are associated with lower HIV prevalence, greater testing and higher ART coverage, while districts with limited services sustain higher population viraemia. Despite the scale-up of HIV prevention and treatment programmes, important disparities remain, and renewed education-centred and geographically targeted efforts are needed to close gaps.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.9,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144833152","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}
Yifan Li, Bethany L Dearlove, Eric Lewitus, Hongjun Bai, Shida Shangguan, Phuc Pham, Meera Bose, Eric Sanders-Buell, Shana Howell Miller, Yvonne Rosario, Philip K Ehrenberg, Sodsai Tovanabutra, Rasmi Thomas, Julie A Ake, Sandhya Vasan, Leigh Anne Eller, Sorachai Nitayaphan, Lucas Maganga, Hannah Kibuuka, Fredrick K Sawe, Merlin L Robb, Morgane Rolland
Introduction: Cases of spontaneous control of HIV-1 can help define strategies to induce remission. Since the identification of viral control in the absence of treatment typically occurs after a prolonged period post-HIV-1 diagnosis, our knowledge of the early events after HIV-1 acquisition that led to viral control is limited.
Methods: The RV217 prospective cohort enrolled 2276 participants in East Africa (Kenya, Uganda, Tanzania) and Thailand between 2009 and 2015. We analysed HIV-1 sequences and clinical data from 102 individuals who were diagnosed with acute HIV-1 infection and had a negative HIV-1 RNA test in the week before. We focused on 69 participants with longitudinal follow-up and identified viraemic controllers who maintained viral loads <2000 copies/ml for over a year without treatment. We evaluated viral genetic and clinical features that are associated with viral control.
Results: Eleven women from East Africa showed control of viral replication for an average duration of 891 (range: 405-1425) days within an average of 130 days from diagnosis. The majority were living with subtype A1 (n = 6), or A1 recombinant strains (n = 4), with one living with subtype D; 10 were from Kenya, one from Uganda. Controllers had significantly slower CD4+ T cell decline (p = 0.028) and higher Natural Killer (NK) cell counts (p = 0.047) than non-controllers, but none carried human leukocyte antigen (HLA) alleles previously reported to be associated with viral control. Peak viraemia was recorded at an average of 541 million copies/ml with no difference between controllers and non-controllers (p = 0.97). Viral loads became lower in controllers (3459 copies/ml) than in non-controllers (23,157 copies/ml) as early as nadir viraemia (p = 0.009), with a more significant difference observed at set point (1069 vs. 24,084 copies/ml, respectively; p<0.0001).
Conclusions: Our findings confirm the role of HIV-1 subtype A1 in mediating viral control. The fact that controllers showed high viral loads in acute infection indicates that these viruses were not intrinsically impaired for replication, underlining the intersection between host immunity and favourable genotypes in the subsequent control of HIV-1. These data suggest that conducting HIV-1 remission studies in East Africa could provide favourable conditions to achieve durable post-treatment control of viraemia.
{"title":"High peak viraemia followed by spontaneous HIV-1 control in women living with HIV-1 subtype A1 in East Africa.","authors":"Yifan Li, Bethany L Dearlove, Eric Lewitus, Hongjun Bai, Shida Shangguan, Phuc Pham, Meera Bose, Eric Sanders-Buell, Shana Howell Miller, Yvonne Rosario, Philip K Ehrenberg, Sodsai Tovanabutra, Rasmi Thomas, Julie A Ake, Sandhya Vasan, Leigh Anne Eller, Sorachai Nitayaphan, Lucas Maganga, Hannah Kibuuka, Fredrick K Sawe, Merlin L Robb, Morgane Rolland","doi":"10.1002/jia2.70016","DOIUrl":"https://doi.org/10.1002/jia2.70016","url":null,"abstract":"<p><strong>Introduction: </strong>Cases of spontaneous control of HIV-1 can help define strategies to induce remission. Since the identification of viral control in the absence of treatment typically occurs after a prolonged period post-HIV-1 diagnosis, our knowledge of the early events after HIV-1 acquisition that led to viral control is limited.</p><p><strong>Methods: </strong>The RV217 prospective cohort enrolled 2276 participants in East Africa (Kenya, Uganda, Tanzania) and Thailand between 2009 and 2015. We analysed HIV-1 sequences and clinical data from 102 individuals who were diagnosed with acute HIV-1 infection and had a negative HIV-1 RNA test in the week before. We focused on 69 participants with longitudinal follow-up and identified viraemic controllers who maintained viral loads <2000 copies/ml for over a year without treatment. We evaluated viral genetic and clinical features that are associated with viral control.</p><p><strong>Results: </strong>Eleven women from East Africa showed control of viral replication for an average duration of 891 (range: 405-1425) days within an average of 130 days from diagnosis. The majority were living with subtype A1 (n = 6), or A1 recombinant strains (n = 4), with one living with subtype D; 10 were from Kenya, one from Uganda. Controllers had significantly slower CD4+ T cell decline (p = 0.028) and higher Natural Killer (NK) cell counts (p = 0.047) than non-controllers, but none carried human leukocyte antigen (HLA) alleles previously reported to be associated with viral control. Peak viraemia was recorded at an average of 541 million copies/ml with no difference between controllers and non-controllers (p = 0.97). Viral loads became lower in controllers (3459 copies/ml) than in non-controllers (23,157 copies/ml) as early as nadir viraemia (p = 0.009), with a more significant difference observed at set point (1069 vs. 24,084 copies/ml, respectively; p<0.0001).</p><p><strong>Conclusions: </strong>Our findings confirm the role of HIV-1 subtype A1 in mediating viral control. The fact that controllers showed high viral loads in acute infection indicates that these viruses were not intrinsically impaired for replication, underlining the intersection between host immunity and favourable genotypes in the subsequent control of HIV-1. These data suggest that conducting HIV-1 remission studies in East Africa could provide favourable conditions to achieve durable post-treatment control of viraemia.</p>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":"e70016"},"PeriodicalIF":4.9,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12335669/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144937357","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}
Anange Fred Lwilla, Kira Elsbernd, Siriel Boniface, Raphael Edom, Arlete Mahumane, Bindiya Meggi, W. Chris Buck, Joaquim Lequechane, Kassia Pereira, Nhamo Chiwerengo, Falume Chale, Chishamiso Mudenyanga, Dadirayi Mutsaka, Marianna Mueller, Nyanda E. Ntinginya, Nuno Taveira, Michael Hoelscher, Ilesh Jani, Arne Kroidl, Issa Sabi, and the LIFE Study Consortium
Introduction
Despite global reductions in vertical HIV transmission (VHT), 120,000 children newly acquired HIV in 2023. High maternal viral load (VL) is a major risk factor for VHT. We estimated the impact of point-of-care (PoC) maternal VL testing at delivery in profiling the risk of VHT and its impact on appropriate postnatal prophylaxis for infants born to women living with HIV (WLWH).
Methods
The cluster-randomized LIFE (Long term Impact on inFant hEalth) study was conducted at 28 health facilities in Tanzania and Mozambique from 2019 to 2021. At delivery, the intervention arm applied PoC maternal VL plus clinical criteria for VHT risk assessment, while the control arm used clinical criteria only. In Tanzania, both arms provided ePNP based on maternal risk factors, while Mozambique provided ePNP universally. We used mixed effects logistic regression to estimate the intervention effect on the proportion of infants at high risk (Tanzania and Mozambique) and infants at high risk receiving ePNP (Tanzania only).
Results
A total of 6467 WLWH were enrolled: 66.3% were diagnosed before the third trimester, 99% were on antiretroviral therapy and 78% were virally suppressed at delivery. Of 6564 newborns of WLWH included, 774 (11.7%) were identified to be at a high risk: 629 (19.3%) versus 145 (4.4%) in intervention and control arms, respectively; p<0.0001. In the intervention arm, 520 (82.7%) infants at high risk were classified only based on maternal PoC VL at delivery. In the control arm, 720 (21.8%) additional infants at high risk would have been identified if their mothers had received PoC VL assessment. In Tanzania, infants at high risk in the intervention arm were significantly more likely to receive ePNP: 59.5% versus 31.4% (OR 4.42, 95% CI: 1.09, 17.89). However, 40.5% from intervention arm and 68.6% from control arm did not receive ePNP despite high-risk classification at delivery.
Conclusions
PoC maternal VL testing at delivery significantly increased the proportion of infants identified to be at high risk. Infants at high risk whose mothers received PoC VL at delivery were more often initiated on ePNP. However, the linkage of infants at high risk to appropriate prophylaxis remains suboptimal, warranting consideration of universal ePNP.
{"title":"Impact of point-of-care maternal viral load testing at delivery on vertical HIV transmission risk assessment and neonatal prophylaxis: a cluster randomized trial","authors":"Anange Fred Lwilla, Kira Elsbernd, Siriel Boniface, Raphael Edom, Arlete Mahumane, Bindiya Meggi, W. Chris Buck, Joaquim Lequechane, Kassia Pereira, Nhamo Chiwerengo, Falume Chale, Chishamiso Mudenyanga, Dadirayi Mutsaka, Marianna Mueller, Nyanda E. Ntinginya, Nuno Taveira, Michael Hoelscher, Ilesh Jani, Arne Kroidl, Issa Sabi, and the LIFE Study Consortium","doi":"10.1002/jia2.70021","DOIUrl":"https://doi.org/10.1002/jia2.70021","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite global reductions in vertical HIV transmission (VHT), 120,000 children newly acquired HIV in 2023. High maternal viral load (VL) is a major risk factor for VHT. We estimated the impact of point-of-care (PoC) maternal VL testing at delivery in profiling the risk of VHT and its impact on appropriate postnatal prophylaxis for infants born to women living with HIV (WLWH).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The cluster-randomized LIFE (Long term Impact on inFant hEalth) study was conducted at 28 health facilities in Tanzania and Mozambique from 2019 to 2021. At delivery, the intervention arm applied PoC maternal VL plus clinical criteria for VHT risk assessment, while the control arm used clinical criteria only. In Tanzania, both arms provided ePNP based on maternal risk factors, while Mozambique provided ePNP universally. We used mixed effects logistic regression to estimate the intervention effect on the proportion of infants at high risk (Tanzania and Mozambique) and infants at high risk receiving ePNP (Tanzania only).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 6467 WLWH were enrolled: 66.3% were diagnosed before the third trimester, 99% were on antiretroviral therapy and 78% were virally suppressed at delivery. Of 6564 newborns of WLWH included, 774 (11.7%) were identified to be at a high risk: 629 (19.3%) versus 145 (4.4%) in intervention and control arms, respectively; <i>p</i><0.0001. In the intervention arm, 520 (82.7%) infants at high risk were classified only based on maternal PoC VL at delivery. In the control arm, 720 (21.8%) additional infants at high risk would have been identified if their mothers had received PoC VL assessment. In Tanzania, infants at high risk in the intervention arm were significantly more likely to receive ePNP: 59.5% versus 31.4% (OR 4.42, 95% CI: 1.09, 17.89). However, 40.5% from intervention arm and 68.6% from control arm did not receive ePNP despite high-risk classification at delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>PoC maternal VL testing at delivery significantly increased the proportion of infants identified to be at high risk. Infants at high risk whose mothers received PoC VL at delivery were more often initiated on ePNP. However, the linkage of infants at high risk to appropriate prophylaxis remains suboptimal, warranting consideration of universal ePNP.</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144714925","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>Community-led monitoring (CLM) for HIV is a technique implemented by local community-led organizations and groups that systematically gather data about HIV services to advocate for improvement. This review was conducted to explore fields other than HIV where CLM or similar approaches have been used, and to identify methods and tools used to monitor the effectiveness of such approaches.</p> </section> <section> <h3> Methods</h3> <p>Using a systematic search in PubMed®, Embase® and Web of Science™, we identified publications describing community involvement in the monitoring of public services. We searched for English-language, peer-reviewed articles and abstracts published from inception until 7 March 2024 with search terms covering two broad areas: “community-led monitoring” and “impact/effectiveness.” We double-screened titles and abstracts and single-extracted data on publication type, region and geographic location, field, programme goals, the methods used to monitor the programme, indicators used for monitoring and the frequency with which the programme was monitored. In addition, a web search was conducted to identify relevant grey literature.</p> </section> <section> <h3> Results</h3> <p>We identified 282 records, of which 28 publications were included. Additionally, 24 documents were included through a search of grey literature. Seven peer-reviewed publications related to HIV CLM, 10 were from other health services and 11 were from monitoring of natural resources. No peer-reviewed publications documented results from routine evaluations of CLM programmes or described a monitoring framework for CLM.</p> <p>Common themes identified across different fields were the role of multi-stakeholder collaboration as an enabling factor for community monitoring, challenges in sustainability due to fragmented funding and the inability of existing evaluation approaches to capture the longer-term impact of community monitoring.</p> </section> <section> <h3> Discussion</h3> <p>Having a robust monitoring and evaluation system is essential for improving CLM programme operations and demonstrating impact. However, demonstrating the impact of community-led advocacy efforts is complex and more research is needed to assess longer-term impacts. Monitoring of locally led adaptation programmes for climate resilience offers useful examples of impact assessments.</p> </section> <section> <h3> Conclusions</h3>
社区主导的艾滋病毒监测（CLM）是一种由当地社区主导的组织和团体实施的技术，它们系统地收集有关艾滋病毒服务的数据，以倡导改进。本综述的目的是探索除HIV以外使用CLM或类似方法的领域，并确定用于监测此类方法有效性的方法和工具。方法通过在PubMed®、Embase®和Web of Science™中进行系统搜索，我们确定了描述社区参与公共服务监测的出版物。我们搜索了从成立到2024年3月7日发表的英文、同行评审的文章和摘要，搜索词涵盖了两个广泛的领域：“社区主导的监测”和“影响/有效性”。我们对标题和摘要进行了双重筛选，对出版物类型、区域和地理位置、领域、方案目标、用于监测方案的方法、用于监测的指标和监测方案的频率进行了单一筛选。此外，通过网络搜索来识别相关的灰色文献。结果共纳入282篇文献，其中纳入28篇文献。此外，通过灰色文献检索纳入了24份文献。7份同行评议的出版物与艾滋病毒CLM有关，10份来自其他卫生服务机构，11份来自自然资源监测。没有同行评议的出版物记录了CLM项目的常规评估结果或描述了CLM的监测框架。在不同领域确定的共同主题是，多方利益攸关方合作作为社区监测的有利因素的作用、资金分散造成的可持续性挑战以及现有评价方法无法捕捉社区监测的长期影响。拥有一个强有力的监测和评价系统对于改进CLM方案运作和展示影响至关重要。然而，证明社区主导的宣传工作的影响是复杂的，需要更多的研究来评估长期影响。监测地方主导的气候适应方案为影响评估提供了有用的例子。本次范围审查的综合发现和经验教训，以及与CLM实施者的磋商，已被用于制定一份指南，以监测艾滋病毒CLM规划的结果和影响。
{"title":"Approaches used to monitor the effectiveness of community-led monitoring programmes: a scoping review to inform HIV programmes","authors":"Farihah Malik, Nonna Turusbekova, Susan Perez","doi":"10.1002/jia2.70020","DOIUrl":"https://doi.org/10.1002/jia2.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Community-led monitoring (CLM) for HIV is a technique implemented by local community-led organizations and groups that systematically gather data about HIV services to advocate for improvement. This review was conducted to explore fields other than HIV where CLM or similar approaches have been used, and to identify methods and tools used to monitor the effectiveness of such approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a systematic search in PubMed®, Embase® and Web of Science™, we identified publications describing community involvement in the monitoring of public services. We searched for English-language, peer-reviewed articles and abstracts published from inception until 7 March 2024 with search terms covering two broad areas: “community-led monitoring” and “impact/effectiveness.” We double-screened titles and abstracts and single-extracted data on publication type, region and geographic location, field, programme goals, the methods used to monitor the programme, indicators used for monitoring and the frequency with which the programme was monitored. In addition, a web search was conducted to identify relevant grey literature.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified 282 records, of which 28 publications were included. Additionally, 24 documents were included through a search of grey literature. Seven peer-reviewed publications related to HIV CLM, 10 were from other health services and 11 were from monitoring of natural resources. No peer-reviewed publications documented results from routine evaluations of CLM programmes or described a monitoring framework for CLM.</p>\u0000 \u0000 <p>Common themes identified across different fields were the role of multi-stakeholder collaboration as an enabling factor for community monitoring, challenges in sustainability due to fragmented funding and the inability of existing evaluation approaches to capture the longer-term impact of community monitoring.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Having a robust monitoring and evaluation system is essential for improving CLM programme operations and demonstrating impact. However, demonstrating the impact of community-led advocacy efforts is complex and more research is needed to assess longer-term impacts. Monitoring of locally led adaptation programmes for climate resilience offers useful examples of impact assessments.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 8","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70020","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705551","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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