首页 > 最新文献

Journal of the International AIDS Society最新文献

英文 中文
High peak viraemia followed by spontaneous HIV-1 control in women living with HIV-1 subtype A1 in East Africa. 东非携带HIV-1 A1亚型的妇女出现病毒血症高峰，随后出现自发的HIV-1控制。
IF 4.9 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-08-01 DOI: 10.1002/jia2.70016
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.

介绍：自发控制HIV-1的病例可以帮助确定诱导缓解的策略。由于在没有治疗的情况下识别病毒控制通常发生在HIV-1诊断后很长一段时间之后，我们对HIV-1获得后导致病毒控制的早期事件的了解有限。方法：RV217前瞻性队列在2009年至2015年期间在东非（肯尼亚、乌干达、坦桑尼亚）和泰国招募了2276名参与者。我们分析了102名被诊断为急性HIV-1感染且在一周前HIV-1 RNA检测呈阴性的患者的HIV-1序列和临床数据。我们对69名参与者进行了纵向随访，并确定了保持病毒载量的病毒控制者。结果：来自东非的11名妇女在诊断后的平均130天内，病毒复制的平均持续时间为891（范围：405-1425）天。多数为A1亚型（n = 6）或A1重组菌株（n = 4）， 1例为D亚型；其中10人来自肯尼亚，1人来自乌干达。控制者的CD4+ T细胞下降明显慢于非控制者（p = 0.028），自然杀伤细胞（NK）计数明显高于非控制者（p = 0.047），但没有人携带先前报道的与病毒控制相关的人类白细胞抗原（HLA）等位基因。病毒血症峰值平均为5.41亿拷贝/ml，对照组和非对照组之间无差异（p = 0.97）。早在病毒血症最低点时，控制组的病毒载量（3459拷贝/ml）就低于非控制组（23157拷贝/ml） （p = 0.009），在设定点时观察到的差异更为显著（分别为1069拷贝/ml和24,084拷贝/ml）。控制者在急性感染中表现出高病毒载量的事实表明，这些病毒在复制方面并没有受到本质上的损害，这强调了宿主免疫与随后HIV-1控制中有利基因型之间的交叉。这些数据表明，在东非开展HIV-1缓解研究可以为实现持久的治疗后病毒血症控制提供有利条件。
{"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}
引用次数: 0
Impact of point-of-care maternal viral load testing at delivery on vertical HIV transmission risk assessment and neonatal prophylaxis: a cluster randomized trial 分娩时点产妇病毒载量检测对艾滋病毒垂直传播风险评估和新生儿预防的影响：一项聚类随机试验
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-28 DOI: 10.1002/jia2.70021
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.

尽管全球艾滋病毒垂直传播（VHT）有所减少，但2023年仍有12万名儿童新感染艾滋病毒。高母体病毒载量（VL）是VHT的主要危险因素。我们估计了分娩时的母婴VL检测在分析VHT风险方面的影响，以及它对感染艾滋病毒（WLWH）的妇女所生婴儿的适当产后预防的影响。方法2019年至2021年在坦桑尼亚和莫桑比克的28家卫生机构进行了聚类随机LIFE（对婴儿健康的长期影响）研究。分娩时，干预组采用PoC孕妇VL加临床标准进行VHT风险评估，而对照组仅采用临床标准。在坦桑尼亚，两个部门都根据产妇风险因素提供紧急方案，而莫桑比克则普遍提供紧急方案。我们使用混合效应逻辑回归来估计干预对高危婴儿（坦桑尼亚和莫桑比克）和高危婴儿接受ePNP（仅坦桑尼亚）比例的影响。结果共纳入6467例WLWH， 66.3%在妊娠晚期前确诊，99%接受抗逆转录病毒治疗，78%在分娩时病毒被抑制。在纳入的6564名WLWH新生儿中，774名（11.7%）被确定为高危人群：干预组和对照组分别为629名（19.3%）和145名（4.4%）；术;0.0001。在干预组中，520例（82.7%）高危婴儿仅根据分娩时母体PoC VL进行分类。在对照组中，如果他们的母亲接受了PoC VL评估，将会发现720名（21.8%）额外的高危婴儿。在坦桑尼亚，干预组的高危婴儿接受ePNP的可能性明显更高：59.5%比31.4% （OR 4.42, 95% CI: 1.09, 17.89）。然而，40.5%的干预组和68.6%的对照组没有接受ePNP治疗，尽管在分娩时进行了高风险分类。结论PoC产妇分娩时VL检测显著增加了高危婴儿的比例。母亲在分娩时接受PoC VL的高危婴儿更常开始使用ePNP。然而，高危婴儿与适当预防的联系仍然不够理想，需要考虑普遍的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,&nbsp;Kira Elsbernd,&nbsp;Siriel Boniface,&nbsp;Raphael Edom,&nbsp;Arlete Mahumane,&nbsp;Bindiya Meggi,&nbsp;W. Chris Buck,&nbsp;Joaquim Lequechane,&nbsp;Kassia Pereira,&nbsp;Nhamo Chiwerengo,&nbsp;Falume Chale,&nbsp;Chishamiso Mudenyanga,&nbsp;Dadirayi Mutsaka,&nbsp;Marianna Mueller,&nbsp;Nyanda E. Ntinginya,&nbsp;Nuno Taveira,&nbsp;Michael Hoelscher,&nbsp;Ilesh Jani,&nbsp;Arne Kroidl,&nbsp;Issa Sabi,&nbsp;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>&lt;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}
引用次数: 0
Approaches used to monitor the effectiveness of community-led monitoring programmes: a scoping review to inform HIV programmes 用于监测社区主导的监测规划有效性的方法：为艾滋病毒规划提供信息的范围审查
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-25 DOI: 10.1002/jia2.70020
Farihah Malik, Nonna Turusbekova, Susan Perez
<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,&nbsp;Nonna Turusbekova,&nbsp;Susan Perez","doi":"10.1002/jia2.70020","DOIUrl":"https://doi.org/10.1002/jia2.70020","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Introduction&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We identified 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.&lt;/p&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Discussion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;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.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\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}
引用次数: 0
Opportunities and challenges for hepatitis B cure in people living with HIV and hepatitis B virus 艾滋病毒和乙型肝炎病毒感染者乙型肝炎治疗的机遇和挑战
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-25 DOI: 10.1002/jia2.70015
Kasha P. Singh, Jennifer Audsley, Wei Zhao, Sharon R. Lewin
<p>Despite effective antiviral treatment, hepatitis B virus (HBV) is the leading cause of cirrhosis and liver cancer globally, with over 250 million people living with chronic hepatitis B. Antiviral treatment for people with chronic hepatitis B is usually with just a single tablet a day and, for most people, continues lifelong [<span>1</span>]. Therefore, similar to HIV, there is high interest in developing a cure for chronic hepatitis B [<span>2</span>]. Of the 37 million people living with HIV (PWH), 7% are also living with chronic hepatitis B [<span>3</span>]. People living with HIV and HBV co-infection present both challenges and opportunities to advance the field of HBV cure.</p><p>Chronic hepatitis B is defined as persistence of hepatitis B surface antigen (HBsAg) for at least 6 months. The natural history of chronic hepatitis B is characterized initially by high levels of HBV DNA in blood and a normal alanine aminotransferase (ALT), followed by intrahepatic inflammation with increased ALT, which can then progress to fibrosis, cirrhosis and hepatocellular carcinoma [<span>4</span>]. However, in contrast to HIV, a small percentage of people with chronic hepatitis B can lose HBsAg either spontaneously or following antiviral therapy [<span>4</span>]. The loss of HBsAg is associated with markedly reduced risk of liver disease and hepatocellular carcinoma [<span>5</span>], and is, therefore, considered a functional cure.</p><p>Multiple strategies are being developed to increase HBsAg loss. These include strategies to better block HBV replication, suppress production of HBsAg (which is immunosuppressive) or enhance HBV-specific immunity (reviewed in [<span>4, 6</span>]) (Table 1). Some strategies being developed for HBV cure are also being investigated for HIV cure [<span>10</span>]. Examples include immune modulation with agents such as anti-programmed death-1 and toll-like receptor agonists [<span>10</span>]. However, unfortunately, most people living with HIV and HBV co-infection are excluded from both HIV and HBV cure clinical trials.</p><p>Studies from the early 1990s showed very high liver-related mortality among people living with HIV and HBV co-infection compared to people with HBV mono-infection, especially among those with low CD4+ T-cell counts [<span>11</span>]. HBV-active antiretroviral therapy (ART) that contains tenofovir (or tenofovir alafenamide), lamivudine (or emtricitabine) or both, suppresses replication of both HIV and HBV and improves health and life expectancy for people living with co-infection. Interestingly, initiation of HBV-active ART results in high rates of HBsAg loss with a prevalence of up to 20% in the first 2 years of treatment [<span>12</span>]. This is in contrast to HBsAg loss of only 1% per year following initiation of nucleo(s/t)ide reverse transcriptase inhibitors in HBV mono-infection [<span>13</span>]. Therefore, understanding HBsAg loss in people living with HIV and HBV co-infection could provide import
尽管有有效的抗病毒治疗，但乙型肝炎病毒（HBV）是全球肝硬化和肝癌的主要原因，有超过2.5亿人患有慢性乙型肝炎。慢性乙型肝炎患者的抗病毒治疗通常仅为每天一片，对大多数人来说，终生服用。因此，与艾滋病毒类似，人们对开发一种治疗慢性乙型肝炎的方法非常感兴趣。在3700万艾滋病毒感染者（PWH）中，7%同时患有慢性乙型肝炎。艾滋病毒和乙型肝炎病毒合并感染者为推进乙型肝炎病毒治疗领域提供了挑战和机遇。慢性乙型肝炎定义为乙型肝炎表面抗原（HBsAg）持续至少6个月。慢性乙型肝炎的自然史最初的特征是血液中HBV DNA水平高，谷丙转氨酶（ALT）正常，随后肝内炎症伴ALT升高，随后可发展为纤维化、肝硬化和肝细胞癌[4]。然而，与艾滋病毒相反，一小部分慢性乙型肝炎患者可以自发地或在抗病毒治疗后失去HBsAg。HBsAg的减少与肝脏疾病和肝细胞癌的风险显著降低相关，因此被认为是一种功能性治愈。目前正在开发多种策略来增加HBsAg损失。这些策略包括更好地阻断HBV复制，抑制HBsAg的产生（具有免疫抑制作用）或增强HBV特异性免疫（参见[4,6]）（表1）。正在制定的一些治疗乙肝病毒的策略也正在研究治疗艾滋病毒的策略。例子包括使用抗程序性死亡-1和toll样受体激动剂[10]等药物进行免疫调节。然而，不幸的是，大多数艾滋病毒和乙型肝炎病毒合并感染的人被排除在艾滋病毒和乙型肝炎病毒治愈临床试验之外。20世纪90年代初的研究表明，与HBV单一感染者相比，HIV和HBV合并感染者的肝脏相关死亡率非常高，尤其是CD4+ t细胞计数低的人群。含有替诺福韦（或替诺福韦阿拉那胺）、拉米夫定（或恩曲他滨）或两者兼有的HBV活性抗逆转录病毒疗法（ART）可抑制HIV和HBV的复制，并改善合并感染者的健康和预期寿命。有趣的是，开始乙肝病毒活性抗逆转录病毒治疗导致HBsAg损失率高，在治疗的前2年患病率高达20%。与此形成鲜明对比的是，在单HBV感染患者开始使用核苷（s/t）逆转录酶抑制剂后，HBsAg每年仅损失1%。因此，了解HIV和HBV合并感染患者的HBsAg损失可以为实现HBV治愈的策略提供重要见解。合并感染人群中HBsAg丢失频率高的驱动因素目前尚不清楚。值得注意的是，在合并感染的人群中，无论HBV感染处于哪个阶段，每个人在HIV诊断时都接受了HBV治疗。这与HBV单一感染者形成对比，后者开始抗病毒治疗的标准是HBV感染的阶段，即存在肝损伤，可以通过ALT bb0升高来证明。在没有肝脏炎症的情况下，抗病毒治疗可能在某种程度上导致HBsAg损失的机会更大，尽管在最近的一项研究中，在没有肝脏炎症的HBV单感染bbb中，用替诺福韦开始治疗并没有发现类似的结果。合并感染患者HBsAg损失高的另一个可能解释是抗逆转录病毒治疗开始后的免疫失调。在合并感染和CD4计数低的人群中，开始抗逆转录病毒治疗后可发生hbv相关的免疫恢复疾病和肝脏耀斑。但即使在没有免疫恢复疾病的情况下，抗逆转录病毒治疗启动后特异性细胞因子或趋化因子的升高也可能有利于增强hbv特异性免疫。我们最近在一项泰国合并感染患者的大型前瞻性队列研究中发现，HBsAg损失与ALT升高、年龄较年轻、肝僵硬度较低、基线HBsAg较低和含替诺福韦·阿拉法胺方案[16]相关。与慢性乙型肝炎类似，人们对通过终身抗逆转录病毒治疗PWH的艾滋病毒非常感兴趣。然而，鉴于某些艾滋病毒治愈干预措施对乙型肝炎病毒的影响尚不清楚，以及在艾滋病毒治愈试验中越来越需要接受短期停止抗逆转录病毒治疗，艾滋病毒和乙型肝炎病毒合并感染者通常被排除在艾滋病毒治愈试验之外。此外，HBV对HIV库的影响在很大程度上还没有得到充分的研究。在泰国另一组接受抗逆转录病毒治疗的合并感染人群中，我们发现HIV DNA持续存在于肝脏中，但转录沉默。 进一步了解肝脏中HIV转录控制的工作可以为HIV潜伏期和宿主细胞对病毒转录的影响提供新的见解，例如在肝细胞或通过肝脏运输的HIV感染T细胞中。HIV和HBV合并感染人群免疫激活的增加可能改变HIV潜伏期的建立、维持和潜在的逆转。然而，迄今为止，很少有研究专门探讨PWH和长期抑制性抗逆转录病毒治疗合并感染的人群之间潜伏性HIV病毒库的大小和组成是否存在差异。尽管目前正在进行多种治疗慢性乙型肝炎或艾滋病毒的介入研究，但据我们所知，只有一项针对艾滋病毒和HBV合并感染患者的HBV治疗的介入研究。鉴于先前有关于selgantolmod治疗HBV单感染bb0的有希望的报道，本研究正在调查selgantolmod（一种TLR8激动剂）对合并感染患者HBsAg损失的作用。TLR8激动剂也可以逆转HIV潜伏期，正如体外研究所显示的那样，这项研究也为了解selgantolmod对HIV储存库的影响提供了一个令人兴奋的机会。HIV和HBV合并感染人群中较高的HBsAg损失率为了解HBsAg损失的机制提供了独特的机会。鉴于合并感染的人数众多，在这些人中研究新的HBV治愈疗法至关重要。我们建议同时携带艾滋病毒和乙型肝炎的人应作为此类研究的优先人群，而不是排除在外。艾滋病毒和乙型肝炎病毒合并感染者不应在治愈乙型肝炎病毒或艾滋病毒的过程中掉队。SRL得到澳大利亚国家卫生和医学研究委员会（NHMRC）、维多利亚州政府卫生部和国立卫生研究院的研究支持。她曾获得Abivax， Geovax, ViiV, Tetralogic， Vaxxinity和Esfam的咨询费；以及来自吉利德科学、艾伯维和默克的诺拉瑞亚。所有其他作者没有潜在的竞争利益需要申报。KPS， JA， WZ和SRL出主意，起草和审稿，最终通过文章。
{"title":"Opportunities and challenges for hepatitis B cure in people living with HIV and hepatitis B virus","authors":"Kasha P. Singh,&nbsp;Jennifer Audsley,&nbsp;Wei Zhao,&nbsp;Sharon R. Lewin","doi":"10.1002/jia2.70015","DOIUrl":"https://doi.org/10.1002/jia2.70015","url":null,"abstract":"&lt;p&gt;Despite effective antiviral treatment, hepatitis B virus (HBV) is the leading cause of cirrhosis and liver cancer globally, with over 250 million people living with chronic hepatitis B. Antiviral treatment for people with chronic hepatitis B is usually with just a single tablet a day and, for most people, continues lifelong [&lt;span&gt;1&lt;/span&gt;]. Therefore, similar to HIV, there is high interest in developing a cure for chronic hepatitis B [&lt;span&gt;2&lt;/span&gt;]. Of the 37 million people living with HIV (PWH), 7% are also living with chronic hepatitis B [&lt;span&gt;3&lt;/span&gt;]. People living with HIV and HBV co-infection present both challenges and opportunities to advance the field of HBV cure.&lt;/p&gt;&lt;p&gt;Chronic hepatitis B is defined as persistence of hepatitis B surface antigen (HBsAg) for at least 6 months. The natural history of chronic hepatitis B is characterized initially by high levels of HBV DNA in blood and a normal alanine aminotransferase (ALT), followed by intrahepatic inflammation with increased ALT, which can then progress to fibrosis, cirrhosis and hepatocellular carcinoma [&lt;span&gt;4&lt;/span&gt;]. However, in contrast to HIV, a small percentage of people with chronic hepatitis B can lose HBsAg either spontaneously or following antiviral therapy [&lt;span&gt;4&lt;/span&gt;]. The loss of HBsAg is associated with markedly reduced risk of liver disease and hepatocellular carcinoma [&lt;span&gt;5&lt;/span&gt;], and is, therefore, considered a functional cure.&lt;/p&gt;&lt;p&gt;Multiple strategies are being developed to increase HBsAg loss. These include strategies to better block HBV replication, suppress production of HBsAg (which is immunosuppressive) or enhance HBV-specific immunity (reviewed in [&lt;span&gt;4, 6&lt;/span&gt;]) (Table 1). Some strategies being developed for HBV cure are also being investigated for HIV cure [&lt;span&gt;10&lt;/span&gt;]. Examples include immune modulation with agents such as anti-programmed death-1 and toll-like receptor agonists [&lt;span&gt;10&lt;/span&gt;]. However, unfortunately, most people living with HIV and HBV co-infection are excluded from both HIV and HBV cure clinical trials.&lt;/p&gt;&lt;p&gt;Studies from the early 1990s showed very high liver-related mortality among people living with HIV and HBV co-infection compared to people with HBV mono-infection, especially among those with low CD4+ T-cell counts [&lt;span&gt;11&lt;/span&gt;]. HBV-active antiretroviral therapy (ART) that contains tenofovir (or tenofovir alafenamide), lamivudine (or emtricitabine) or both, suppresses replication of both HIV and HBV and improves health and life expectancy for people living with co-infection. Interestingly, initiation of HBV-active ART results in high rates of HBsAg loss with a prevalence of up to 20% in the first 2 years of treatment [&lt;span&gt;12&lt;/span&gt;]. This is in contrast to HBsAg loss of only 1% per year following initiation of nucleo(s/t)ide reverse transcriptase inhibitors in HBV mono-infection [&lt;span&gt;13&lt;/span&gt;]. Therefore, understanding HBsAg loss in people living with HIV and HBV co-infection could provide import","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144705547","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}
引用次数: 0
Rewriting the narrative: resilience of youth in the HIV response 改写叙事：青年应对艾滋病毒的韧性
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-18 DOI: 10.1002/jia2.70019
Fletcher Chiu, Kairon Liu, Ismail Senyonga
<p>The United Nations defines “youth” as individuals aged 15–24 years, although some countries extend this range up to 35 years. According to 2024 UNAIDS epidemiologic estimates, young people aged 15–24 years bear a disproportionate burden of new HIV acquisitions, accounting for approximately 28% of all new acquisitions despite representing only 8% of all people living with HIV [<span>1</span>]. As we commemorate International Youth Day 2025, the global HIV response stands at a critical juncture. Yet, amid adversity, youth-led organizations and young people persist in their fight—not only for survival, but also for dignity, health and a future free from stigma.</p><p>Recent policy shifts and funding cuts—especially to the U.S. PEPFAR programme—have severely disrupted youth-led organizations in low- and middle-income countries, jeopardizing critical HIV prevention, treatment, care and support services for young people. A survey conducted by Y+ Global and partners in early 2025 revealed that 60% of youth-led organizations had experienced interruptions in delivering core HIV services as a result of these cuts. Despite the setbacks, they have demonstrated remarkable resilience by uniting to urge stakeholders to take action to preserve youth-led HIV responses. They have also swiftly adapted by exploring alternative funding mechanisms, such as crowdfunding campaigns and partnerships with the private sector [<span>2</span>].</p><p>In addition to these challenges to healthcare access and advancing youth leadership, people living with HIV continue to face pervasive stigma, resulting in barriers in the workplace, intimate relationships, community settings and beyond. The 2023 People Living with HIV Stigma Index Global Report found that 85% of individuals living with HIV experience internalized stigma, underscoring the profound psychological impact of the epidemic. Notably, this rate is even higher among young people, with 88% reporting internalized stigma [<span>3</span>]. The growing backlash against Diversity, Equity and Inclusion principles and programmes further exacerbates the potential for stigma and discrimination against HIV and key populations.</p><p>In this context, the dual meaning of “ART” as standing for both antiretroviral therapy and artistic creation takes on powerful significance. While ART sustains biological life and can help prevent HIV transmission, art fosters hope and social connection—elements equally essential for thriving with HIV. The HIV Science as Art programme, launched in 2023, has highlighted how art enriches the value of medical approaches by deepening society's understanding of HIV and supporting people living with HIV to tell the stories of their communities [<span>4, 5</span>]. The initiative, across two editions of the programme, included a total of 24 artists from diverse age groups and regions around the world. Among them, two youth artists—Kairon Liu from the Asia-Pacific region and Ismail Senyonga from the African r
联合国将“青年”定义为年龄在15-24岁之间的人，尽管有些国家将这一范围扩大到35岁。根据联合国艾滋病规划署2024年的流行病学估计，15-24岁的年轻人承担着不成比例的艾滋病毒新感染负担，尽管仅占所有艾滋病毒感染者的8%，但约占所有新感染人数的28%。在我们纪念2025年国际青年日之际，全球艾滋病毒应对正处于关键时刻。然而，在逆境中，青年领导的组织和年轻人坚持斗争，不仅是为了生存，也是为了尊严、健康和没有耻辱的未来。最近的政策转变和资金削减——尤其是对美国总统防治艾滋病紧急救援计划的削减——严重扰乱了中低收入国家由青年领导的组织，危及对年轻人至关重要的艾滋病毒预防、治疗、护理和支持服务。Y+ Global及其合作伙伴在2025年初进行的一项调查显示，由于这些削减，60%的青年领导的组织在提供核心艾滋病毒服务方面出现中断。尽管遭遇挫折，但他们团结一致，敦促利益攸关方采取行动，维护青年主导的艾滋病毒应对行动，表现出了非凡的韧性。他们还通过探索其他筹资机制（如众筹活动和与私营部门合作）迅速适应环境。除了在获得医疗保健和提高青年领导力方面面临的这些挑战外，艾滋病毒感染者继续面临普遍的耻辱，导致在工作场所、亲密关系、社区环境等方面存在障碍。《2023年艾滋病毒感染者耻辱感指数全球报告》发现，85%的艾滋病毒感染者有内在化的耻辱感，凸显了这一流行病的深刻心理影响。值得注意的是，这一比例在年轻人中甚至更高，88%的人表示内心有耻辱感。对多样性、公平和包容原则和规划的强烈反对进一步加剧了对艾滋病毒和关键人群的污名化和歧视。在这种背景下，“ART”作为抗逆转录病毒治疗和艺术创作的双重含义就具有了强大的意义。虽然抗逆转录病毒疗法维持生物生命并有助于预防艾滋病毒传播，但艺术促进了希望和社会联系，这些因素对艾滋病毒携带者的繁荣同样至关重要。2023年启动的艾滋病毒科学艺术项目强调了艺术如何通过加深社会对艾滋病毒的理解和支持艾滋病毒感染者讲述他们社区的故事来丰富医疗方法的价值[4,5]。该计划分为两期，共有24位来自世界各地不同年龄段和地区的艺术家参加。其中，来自亚太地区的刘凯龙（kairon Liu）和来自非洲地区的伊斯梅尔·森永加（Ismail Senyonga）这两位青年艺术家不仅用他们的艺术来提高公众意识，还展示了艺术表达如何成为一种自我反思的形式。通过他们的工作，他们记录了艾滋病毒感染者的生活道路，并将这些经历转化为自我照顾和复原力的有力叙述。在2023年的“不可传播”展览中，凯龙对台湾HIV社区捐赠的过期抗逆转录病毒药物进行了再利用，揭示了生物医学材料中蕴含的复杂社会意义，同时传达了最新的HIV知识。这张照片在视觉上参考了医学的进步，这些进步使艾滋病毒在持续的抗逆转录病毒治疗下无法传播。然而，它也悄悄地表明了一个令人不安的事实：尽管有抗逆转录病毒药物，但经济和心理负担继续沉重地压在人们身上。由于个人和结构障碍，科学进步仍然无法实现，使许多人无法获得高质量的生活。即使是现在，这一点仍然是不可否认的，因为存在许多艾滋病毒治疗和预防选择，但仍然缺乏对有需要的人的公平获取。2024年展出的《孤独与恐惧》、《爱的圆圈》和《接受》是Ismail Senyonga的系列画作，强调了对更好的儿科药物的迫切需求，并强调了从童年到成年的复杂过渡。对于感染艾滋病毒的年轻人，特别是那些围产期感染艾滋病毒的年轻人来说，这一时期的特点往往是恐惧、焦虑、抑郁，甚至有自杀念头。这些画作中人物的沮丧和疲惫的肢体语言和表情有力地捕捉到了感染艾滋病毒的年轻人在应对个人挑战和克服在社会中成长的焦虑时所面临的坦率和情感现实。 这些深刻的情感片段并不是要把感染艾滋病毒的年轻人描绘成仅仅是脆弱的；相反，它们触及了一个更深层次问题的核心——我们社会中年轻人长期面临的不平等。无论是获得医疗资源的不平等，还是缺乏社会接受和包容性，这些作品都是对紧急社会变革的有力呼吁。这一变革呼吁背后的推动力不是别人，正是充满希望和勇气的一代年轻人自己。值此国际青年日之际，我们鼓励所有利益攸关方重新为以青年为中心的艾滋病毒应对工作投入资源。这包括有意义地让年轻人参与与公平分配医疗资源、加强卫生保健系统、增强经济权能、精神卫生支持和重点人群除罪化有关的决策空间。年轻人对有效的服务提供模式、社区参与战略和减少耻辱的方法有独特的见解。他们的观点必须与地方、国家和国际各级的方案设计、资源分配和政策制定结合起来。应继续优先考虑青年在IAS青年中心和全球基金青年理事会等主要国际组织中的代表，以加强他们积极参与和领导这些空间的能力。我们今天特别介绍了两位青年艺术家，以提醒我们年轻人容易感染艾滋病毒，以及抗逆转录病毒治疗的卓越能力，提醒我们我们共同的价值观。我们将继续激发讨论和新思维，激励我们周围的人了解艾滋病毒并改变叙述-从风险到亲密，从病理到人性。通过采纳这些全面的战略，防治艾滋病毒运动可以取得持久的进展，使我们不仅能够实现联合国艾滋病规划署2030年目标，而且能够保持对远远超过这些里程碑的未来的希望和信心。作者声明没有利益冲突。FC， KL和IS对文章的撰写和审查做出了贡献。文章中引用的艺术品可通过以下链接访问。Untransmittable: www.kaironliu.com/untransmittable。
{"title":"Rewriting the narrative: resilience of youth in the HIV response","authors":"Fletcher Chiu,&nbsp;Kairon Liu,&nbsp;Ismail Senyonga","doi":"10.1002/jia2.70019","DOIUrl":"https://doi.org/10.1002/jia2.70019","url":null,"abstract":"&lt;p&gt;The United Nations defines “youth” as individuals aged 15–24 years, although some countries extend this range up to 35 years. According to 2024 UNAIDS epidemiologic estimates, young people aged 15–24 years bear a disproportionate burden of new HIV acquisitions, accounting for approximately 28% of all new acquisitions despite representing only 8% of all people living with HIV [&lt;span&gt;1&lt;/span&gt;]. As we commemorate International Youth Day 2025, the global HIV response stands at a critical juncture. Yet, amid adversity, youth-led organizations and young people persist in their fight—not only for survival, but also for dignity, health and a future free from stigma.&lt;/p&gt;&lt;p&gt;Recent policy shifts and funding cuts—especially to the U.S. PEPFAR programme—have severely disrupted youth-led organizations in low- and middle-income countries, jeopardizing critical HIV prevention, treatment, care and support services for young people. A survey conducted by Y+ Global and partners in early 2025 revealed that 60% of youth-led organizations had experienced interruptions in delivering core HIV services as a result of these cuts. Despite the setbacks, they have demonstrated remarkable resilience by uniting to urge stakeholders to take action to preserve youth-led HIV responses. They have also swiftly adapted by exploring alternative funding mechanisms, such as crowdfunding campaigns and partnerships with the private sector [&lt;span&gt;2&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;In addition to these challenges to healthcare access and advancing youth leadership, people living with HIV continue to face pervasive stigma, resulting in barriers in the workplace, intimate relationships, community settings and beyond. The 2023 People Living with HIV Stigma Index Global Report found that 85% of individuals living with HIV experience internalized stigma, underscoring the profound psychological impact of the epidemic. Notably, this rate is even higher among young people, with 88% reporting internalized stigma [&lt;span&gt;3&lt;/span&gt;]. The growing backlash against Diversity, Equity and Inclusion principles and programmes further exacerbates the potential for stigma and discrimination against HIV and key populations.&lt;/p&gt;&lt;p&gt;In this context, the dual meaning of “ART” as standing for both antiretroviral therapy and artistic creation takes on powerful significance. While ART sustains biological life and can help prevent HIV transmission, art fosters hope and social connection—elements equally essential for thriving with HIV. The HIV Science as Art programme, launched in 2023, has highlighted how art enriches the value of medical approaches by deepening society's understanding of HIV and supporting people living with HIV to tell the stories of their communities [&lt;span&gt;4, 5&lt;/span&gt;]. The initiative, across two editions of the programme, included a total of 24 artists from diverse age groups and regions around the world. Among them, two youth artists—Kairon Liu from the Asia-Pacific region and Ismail Senyonga from the African r","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70019","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144657696","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}
引用次数: 0
A thank you note to our peer reviewers (2024) 致同行评审的感谢信（2024）
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-15 DOI: 10.1002/jia2.70017
Kenneth H. Mayer, Annette H. Sohn, Marlène Bras
<p>The <i>Journal of the International AIDS Society</i> (JIAS) would like to express our gratitude to the peer reviewers who contributed to reviewing articles for the journal in 2024, and to those senior scientists who have mentored early career researchers in reviewing.</p><p>Your time and expertise are crucial to upholding the quality of this publication, and we are thankful for your engagement.</p><p>We also wish to extend our appreciation to the JIAS Editorial Board members, Deputy Editors, Statistical Committee and Ethical Committee members for their valuable contributions in assessing and reviewing submitted articles.</p><p>Kenneth Mayer, co-Editor-in-Chief</p><p>Annette Sohn, co-Editor-in-Chief</p><p>Marlène Bras, Executive Editor</p><p>Aaloke Mody</p><p>Abhishek Reddy Mogili</p><p>Abiye Kalaiwo</p><p>Adiatma Yudistira</p><p>Aditya Singh</p><p>Akarin Hiransuthikul</p><p>Akshay Sharma</p><p>Alana Sharp</p><p>Alana T Brennan</p><p>Alex de voux</p><p>Alexandra Calmy</p><p>Alison Castle</p><p>Alison Kutywayo</p><p>Alison Roxby</p><p>Alissa Davis</p><p>Aliza Monroe-Wise</p><p>Allanise Cloete</p><p>Amit Achhra</p><p>Amy Medley</p><p>Amy Zheng</p><p>Andrew David Forsyth</p><p>Andrew Mujugira</p><p>Andrew Wiznia</p><p>Angela Bengtson</p><p>Angela Colbers</p><p>Angela Hutchinson</p><p>Ann Gottert</p><p>Anna Bershteyn</p><p>Anna Bowring</p><p>Anna Downie</p><p>Anna Klicpera</p><p>Anna Yeung</p><p>Annaliese M. Limb</p><p>Anne Neilan</p><p>Antons Mozalevskis</p><p>Apostolos Beloukas</p><p>Ariane van der Straten</p><p>Arman Oganisian</p><p>Arturo M. Ongkeko</p><p>Assel Terlikbayeva</p><p>Audrey Pettifor</p><p>Ava Avalos</p><p>Ayako Fujita</p><p>Barbara A. Friedland</p><p>Beatrice Wamuti</p><p>Benjamin Brown</p><p>Benjamin Ryan Phelps</p><p>Bindiya Meggi</p><p>Bluma Brenner</p><p>Brendan Harney</p><p>Brian Honermann</p><p>Brian T Foley</p><p>Bridget Haire</p><p>Bright Ofori</p><p>Brittany Moore</p><p>Brooke E Nichols</p><p>Bruno Spire</p><p>Caitlin E. Kennedy</p><p>Carlos Cáceres</p><p>Carlos E. Rodriguez-Diaz</p><p>Carol Strong</p><p>Caroline A. Bulstra</p><p>Caroline DeSchacht</p><p>Carolyn Chu</p><p>Caryl Feldacker</p><p>Catherine Godfrey</p><p>Catherine Koss</p><p>Catherine Orrell</p><p>Catherine Verde Hashim</p><p>Cedric Bien-Gund</p><p>Chanda Mwamba</p><p>Charles Ssonko</p><p>Chen Seong Wong</p><p>Chenai Mlandu</p><p>Chenglin Hong</p><p>Cheryl Case Johnson</p><p>Chloe A. Teasdale</p><p>Chris Collins</p><p>Christian Grov</p><p>Christian Stillson</p><p>Christiana Noestlinger</p><p>Christopher James Hoffmann</p><p>Connie Celum</p><p>Craig J Heck</p><p>Cristina Pimenta</p><p>Cuc Tran</p><p>Curtis Chan</p><p>Dadong Wu</p><p>Darrell Tan</p><p>Dawn Goddard-Eckrich</p><p>Deanna Kerrigan</p><p>Debbie Humphries</p><p>Debrah Boeras</p><p>Denton Callander</p><p>Diego Cecchini</p><p>Dion Carleen Allen</p><p>Divya Ramani Bhamidipati</p><p>Dominic Reeds</p><p>Dominique Medaglio</p><p>Donn Colby</p><p>Dumbani Kayira</p><p>Dunstan Achwoka</p><p>Dusita Phuengsamran
《国际艾滋病学会杂志》（jas）在此感谢为本刊2024年的论文评审做出贡献的同行评审人员，以及指导早期职业研究人员评审工作的资深科学家。您的时间和专业知识对维护本出版物的质量至关重要，我们感谢您的参与。我们还要感谢JIAS编辑委员会成员、副编辑、统计委员会和伦理委员会成员在评估和审查提交的文章方面所做的宝贵贡献。Kenneth Mayer、fannette Sohn、marl<e:1> Bras、执行编辑aaloke ModyAbhishek Reddy MogiliAbiye kalaiva adiatma yudiditiva aditya SinghAkarin hiransuthik akshay sharana SharpAlana T brennex de vouxAlexandra CalmyAlison CastleAlison KutywayoAlison RoxbyAlissa DavisAliza门罗- wiseallanise CloeteAmit AchhraAmy MedleyAmy郑andrew David ForsythAndrew MujugiraAndrew WizniaAngela bengtssonangela ColbersAngela HutchinsonAnn gottertannabshteynannabwringanna klicperaannyeung annaliese M. LimbAnne NeilanAntons莫扎列夫斯基apostolos BeloukasAriane van der straterman arturo M. OngkekoAssel terlikbayeva奥黛丽·佩蒂芙阿瓦·阿瓦洛斯·富士达芭芭拉·a·弗里德兰beatrice WamutiBenjamin BrownBenjamin Ryan PhelpsBindiya MeggiBluma BrennerBrendan HarneyBrian HonermannBrian T FoleyBridget HaireBright OforiBrittany MooreBrooke E NicholsBruno spirekatlin E. KennedyCarlos CáceresCarlos E. Rodriguez-DiazCarol StrongCaroline A. bulstracoline DeSchachtCarolyn ChuCaryl FeldackerCatherine GodfreyCatherine凯瑟琳·欧瑞尔凯瑟琳·佛得角·哈希姆塞德里克·比恩·冈德·香达·姆瓦姆·查尔斯·宋科斯·陈成·翁辰奈·姆兰杜·洪成林·谢丽尔·凯斯·约翰逊克洛伊·a·蒂斯达尔·克里斯·科林斯·克里斯蒂安·格罗夫·克里斯蒂安·斯蒂尔森·克里斯蒂安·诺斯特林格·克里斯托弗·詹姆斯·霍夫曼·康妮·克雷格·J·海克·克里斯蒂娜·皮门塔克·特朗·柯蒂斯·钱德拉·乌达雷尔·戈达德·埃克里奇·迪安娜·克里根·黛比·汉弗里斯·黛布拉·博伊拉斯·丹顿·卡兰德·迭戈·切奇尼·卡琳·艾伦·迪维亚·拉玛尼·巴米迪亚·多米尼克·里德·多米尼克MedaglioDonn ColbyDumbani KayiraDunstan AchwokaDusita PhuengsamranDvora Joseph davebiere Clara HerbertsonEdmon ObatEdsel SalvanaEdy nacarapeiichi N KodamaElijah KakandeElise LankiewiczElizabeth Ellen tolleyeliot RaizesElwin elzette RousseauEmilia JalilEmily HyleEmma KalkEmmanuel S BajaEnrique SaldarriagaErin ferenchickiugenia L. SieglerFekadu adugnfelipe CazeiroFelix AbunaFrances玛丽CowanFrancois CholetteFrancoise RenaudFumiyo nakagawa加布里埃尔ChamieGabriela PattenGemma OberthGeoff加内特·格哈德·瑟隆·古德温·古古斯卡·古德勒克·威利·利亚特格雷戈里·f·古古斯卡·格雷戈里·M·卢卡斯·哈比布·拉玛汉娜·叶琳·齐默尔曼汉诺克·特威亚·哈伦·穆拉海莉·坎宁安海伦·比格雷夫·海利·哈维娜·海伦·哈维娜·海伦·哈维娜·海伦·哈拉瓦娜·海伦·莫拉娜·汉娜·齐默尔曼·海曼·斯科特·阿姆斯特朗·艾萨克·波哥大·艾萨克·基诺·艾萨克·基诺·伊斯梅尔律师·阿里耶森·奥卢索拉·阿西巴J·彼得·菲格罗·雅各布·布莱斯达尔·奎奎琳·皮纳尔杰克·迈克尔·普雷伊·詹姆斯·卡鲁奇·詹姆斯·穆迪·简·卡阿米·珍妮特·斯雷杰森·杰森·迈克尔·巴查·贾斯珀·S。李让-皮埃尔·罗蒂杰布·琼斯詹妮弗·弗斯科詹妮弗·J·卡罗尔詹妮弗·M·贝鲁斯詹妮弗·曼-戈赫·詹妮弗·舍伍德杰里米·罗斯杰西卡·E·哈伯尔·加维·赫杰奇·多沃德吉尔·T·奥查扎克吉莉安·平蒂耶·贾尼·范·奥斯特霍特约翰·乔斯卡森约翰·范·奥斯特霍特乔纳森·M·格兰德乔纳森·默里·金乔纳森·欧杜梅格乌约瑟夫·拉马兰吉约瑟夫·马托夫何塞·拉蒙·布兰科乔伊·中托亚·克莱尔·德廷格朱莉娅·马库斯朱莉娅·罗赫朱利安·阿东朱莉·杜蒙朱莉普尔维茨朱莉·v·苏德维茨-索莫吉朱利安·布里松克·拉维茨·卡伊姆·布里松克·卡西姆·布尔吉凯特·巴尼豪斯凯特·威尔逊凯瑟琳·克里普克凯蒂·威廉姆斯·卡特琳娜·弗朗西丝·奥布雷克·康达利·康达利·弗里伯恩·肯尼斯·穆瓦尼·阿克肖·邦德凯文·奥卡拉汉·卡迪贾·阿德莱·金AGJ·罗米金德·柏利·胡克·金伯利·PowersKiran保罗·科哈鲁·卢卢·查亚姆·康巴坦德·斯科姆·斯托亚诺夫斯基·克里斯汀·巴尔特拉斯·库巴扎·库巴沙-哈拉哈莱·彭霍洛维茨·艾伦·布莱茨·劳拉lorenzettilariw . ChangLatasha ElopreLaura packelaurencircircionelaurenm . HillLeigh M. McClartyLena AndersenLeonardo Rabena estaciolieslie A EnaneLila A sheirinseyde VosLindsey Marie filiatreaulinla legkostplora SabinLouis Masankha BandaLucia taramasolucere ChimoyiLuh Putu Lila wulandarlyda Stranix-ChibandaLynn matthewynne WilkinsonMagdalene WaltersMahoudo BonouMaitreyi SahuMakella CoudrayMakobu KimaniManogar SiregarManya马格努斯玛丽亚·格拉齐
{"title":"A thank you note to our peer reviewers (2024)","authors":"Kenneth H. Mayer,&nbsp;Annette H. Sohn,&nbsp;Marlène Bras","doi":"10.1002/jia2.70017","DOIUrl":"https://doi.org/10.1002/jia2.70017","url":null,"abstract":"&lt;p&gt;The &lt;i&gt;Journal of the International AIDS Society&lt;/i&gt; (JIAS) would like to express our gratitude to the peer reviewers who contributed to reviewing articles for the journal in 2024, and to those senior scientists who have mentored early career researchers in reviewing.&lt;/p&gt;&lt;p&gt;Your time and expertise are crucial to upholding the quality of this publication, and we are thankful for your engagement.&lt;/p&gt;&lt;p&gt;We also wish to extend our appreciation to the JIAS Editorial Board members, Deputy Editors, Statistical Committee and Ethical Committee members for their valuable contributions in assessing and reviewing submitted articles.&lt;/p&gt;&lt;p&gt;Kenneth Mayer, co-Editor-in-Chief&lt;/p&gt;&lt;p&gt;Annette Sohn, co-Editor-in-Chief&lt;/p&gt;&lt;p&gt;Marlène Bras, Executive Editor&lt;/p&gt;&lt;p&gt;Aaloke Mody&lt;/p&gt;&lt;p&gt;Abhishek Reddy Mogili&lt;/p&gt;&lt;p&gt;Abiye Kalaiwo&lt;/p&gt;&lt;p&gt;Adiatma Yudistira&lt;/p&gt;&lt;p&gt;Aditya Singh&lt;/p&gt;&lt;p&gt;Akarin Hiransuthikul&lt;/p&gt;&lt;p&gt;Akshay Sharma&lt;/p&gt;&lt;p&gt;Alana Sharp&lt;/p&gt;&lt;p&gt;Alana T Brennan&lt;/p&gt;&lt;p&gt;Alex de voux&lt;/p&gt;&lt;p&gt;Alexandra Calmy&lt;/p&gt;&lt;p&gt;Alison Castle&lt;/p&gt;&lt;p&gt;Alison Kutywayo&lt;/p&gt;&lt;p&gt;Alison Roxby&lt;/p&gt;&lt;p&gt;Alissa Davis&lt;/p&gt;&lt;p&gt;Aliza Monroe-Wise&lt;/p&gt;&lt;p&gt;Allanise Cloete&lt;/p&gt;&lt;p&gt;Amit Achhra&lt;/p&gt;&lt;p&gt;Amy Medley&lt;/p&gt;&lt;p&gt;Amy Zheng&lt;/p&gt;&lt;p&gt;Andrew David Forsyth&lt;/p&gt;&lt;p&gt;Andrew Mujugira&lt;/p&gt;&lt;p&gt;Andrew Wiznia&lt;/p&gt;&lt;p&gt;Angela Bengtson&lt;/p&gt;&lt;p&gt;Angela Colbers&lt;/p&gt;&lt;p&gt;Angela Hutchinson&lt;/p&gt;&lt;p&gt;Ann Gottert&lt;/p&gt;&lt;p&gt;Anna Bershteyn&lt;/p&gt;&lt;p&gt;Anna Bowring&lt;/p&gt;&lt;p&gt;Anna Downie&lt;/p&gt;&lt;p&gt;Anna Klicpera&lt;/p&gt;&lt;p&gt;Anna Yeung&lt;/p&gt;&lt;p&gt;Annaliese M. Limb&lt;/p&gt;&lt;p&gt;Anne Neilan&lt;/p&gt;&lt;p&gt;Antons Mozalevskis&lt;/p&gt;&lt;p&gt;Apostolos Beloukas&lt;/p&gt;&lt;p&gt;Ariane van der Straten&lt;/p&gt;&lt;p&gt;Arman Oganisian&lt;/p&gt;&lt;p&gt;Arturo M. Ongkeko&lt;/p&gt;&lt;p&gt;Assel Terlikbayeva&lt;/p&gt;&lt;p&gt;Audrey Pettifor&lt;/p&gt;&lt;p&gt;Ava Avalos&lt;/p&gt;&lt;p&gt;Ayako Fujita&lt;/p&gt;&lt;p&gt;Barbara A. Friedland&lt;/p&gt;&lt;p&gt;Beatrice Wamuti&lt;/p&gt;&lt;p&gt;Benjamin Brown&lt;/p&gt;&lt;p&gt;Benjamin Ryan Phelps&lt;/p&gt;&lt;p&gt;Bindiya Meggi&lt;/p&gt;&lt;p&gt;Bluma Brenner&lt;/p&gt;&lt;p&gt;Brendan Harney&lt;/p&gt;&lt;p&gt;Brian Honermann&lt;/p&gt;&lt;p&gt;Brian T Foley&lt;/p&gt;&lt;p&gt;Bridget Haire&lt;/p&gt;&lt;p&gt;Bright Ofori&lt;/p&gt;&lt;p&gt;Brittany Moore&lt;/p&gt;&lt;p&gt;Brooke E Nichols&lt;/p&gt;&lt;p&gt;Bruno Spire&lt;/p&gt;&lt;p&gt;Caitlin E. Kennedy&lt;/p&gt;&lt;p&gt;Carlos Cáceres&lt;/p&gt;&lt;p&gt;Carlos E. Rodriguez-Diaz&lt;/p&gt;&lt;p&gt;Carol Strong&lt;/p&gt;&lt;p&gt;Caroline A. Bulstra&lt;/p&gt;&lt;p&gt;Caroline DeSchacht&lt;/p&gt;&lt;p&gt;Carolyn Chu&lt;/p&gt;&lt;p&gt;Caryl Feldacker&lt;/p&gt;&lt;p&gt;Catherine Godfrey&lt;/p&gt;&lt;p&gt;Catherine Koss&lt;/p&gt;&lt;p&gt;Catherine Orrell&lt;/p&gt;&lt;p&gt;Catherine Verde Hashim&lt;/p&gt;&lt;p&gt;Cedric Bien-Gund&lt;/p&gt;&lt;p&gt;Chanda Mwamba&lt;/p&gt;&lt;p&gt;Charles Ssonko&lt;/p&gt;&lt;p&gt;Chen Seong Wong&lt;/p&gt;&lt;p&gt;Chenai Mlandu&lt;/p&gt;&lt;p&gt;Chenglin Hong&lt;/p&gt;&lt;p&gt;Cheryl Case Johnson&lt;/p&gt;&lt;p&gt;Chloe A. Teasdale&lt;/p&gt;&lt;p&gt;Chris Collins&lt;/p&gt;&lt;p&gt;Christian Grov&lt;/p&gt;&lt;p&gt;Christian Stillson&lt;/p&gt;&lt;p&gt;Christiana Noestlinger&lt;/p&gt;&lt;p&gt;Christopher James Hoffmann&lt;/p&gt;&lt;p&gt;Connie Celum&lt;/p&gt;&lt;p&gt;Craig J Heck&lt;/p&gt;&lt;p&gt;Cristina Pimenta&lt;/p&gt;&lt;p&gt;Cuc Tran&lt;/p&gt;&lt;p&gt;Curtis Chan&lt;/p&gt;&lt;p&gt;Dadong Wu&lt;/p&gt;&lt;p&gt;Darrell Tan&lt;/p&gt;&lt;p&gt;Dawn Goddard-Eckrich&lt;/p&gt;&lt;p&gt;Deanna Kerrigan&lt;/p&gt;&lt;p&gt;Debbie Humphries&lt;/p&gt;&lt;p&gt;Debrah Boeras&lt;/p&gt;&lt;p&gt;Denton Callander&lt;/p&gt;&lt;p&gt;Diego Cecchini&lt;/p&gt;&lt;p&gt;Dion Carleen Allen&lt;/p&gt;&lt;p&gt;Divya Ramani Bhamidipati&lt;/p&gt;&lt;p&gt;Dominic Reeds&lt;/p&gt;&lt;p&gt;Dominique Medaglio&lt;/p&gt;&lt;p&gt;Donn Colby&lt;/p&gt;&lt;p&gt;Dumbani Kayira&lt;/p&gt;&lt;p&gt;Dunstan Achwoka&lt;/p&gt;&lt;p&gt;Dusita Phuengsamran","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144635267","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}
引用次数: 0
Cost and clinical flow of point-of-care urine tenofovir testing for treatment monitoring among people living with HIV initiating ART in South Africa 在南非开始抗逆转录病毒治疗的艾滋病毒感染者中用于治疗监测的即时尿替诺福韦检测的成本和临床流量
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-14 DOI: 10.1002/jia2.70004
Melody Wang, Pravikrishnen Moodley, Mlungisi Khanyile, Elliot Bulo, Makhosazane Zondi, Keshani Naidoo, Yukteshwar Sookrajh, Jienchi Dorward, Monica Gandhi, Nigel Garrett, Paul K. Drain, Monisha Sharma

Introduction

Point-of-care (POC) urine tenofovir (TFV) tests can provide timely information regarding antiretroviral therapy (ART) adherence to support management of HIV treatment in clinics. However, there are limited data on the costs and feasibility of integrating POC testing into HIV clinics in sub-Saharan Africa. We characterized clinic flow and implementation costs of POC adherence testing for persons initiating ART in HIV care clinics in South Africa.

Methods

We conducted a microcosting within a randomized controlled implementation trial of POC TFV test in government clinics in Durban, South Africa (STREAM HIV). Time-and-motion observation was conducted between 1st March and 31st December 2022, to assess staff and client time needed for POC TFV testing and counselling. We estimated both financial and economic costs for capital, clinic consumables and personnel using a provider (national government) perspective.

Results

The estimated cost of POC TFV was USD $13 per client, assuming a clinic volume of 20 individuals initiating ART per month. The largest component costs of POC TFV testing were the test strip consumables, which accounted for 53% of the test cost. The median total time of a clinic visit with a POC TFV test, starting from client registration, was 49:19 (minutes: seconds) (IQR: 29:19–89:35). TFV testing took 9:22 (IQR: 7:35–14:11), taking up 19% of the total clinic visit time, including sample collection, sample loading, TFV test processing and counselling provision based on test results. Overall, 29% of the clinic visit time included direct clinical care and assessment with a provider, with clients spending a median 14:09 (IQR: 10:35–21:22) getting vitals checked, receiving adherence monitoring via POC TFV testing, and collecting their ART refill. Waiting in line for ART took most (48%) of the clinic visit time.

Conclusions

POC TFV testing can be administered at reasonable costs, requires less than 10 minutes of healthcare provider time, and, therefore, may be feasible to implement in South African clinics. Findings can inform policy and budgetary planning for ART monitoring in South Africa and future cost-effectiveness analyses of POC TFV testing.

Clinical Trial Number

NCT04341779

护理点（POC）尿液替诺福韦（TFV）检测可及时提供有关抗逆转录病毒治疗依从性的信息，以支持诊所对艾滋病毒治疗的管理。然而，关于将POC检测纳入撒哈拉以南非洲艾滋病毒诊所的成本和可行性的数据有限。我们描述了南非艾滋病毒护理诊所对开始抗逆转录病毒治疗的人进行POC依从性检测的临床流程和实施成本。方法在南非德班政府诊所进行POC tv测试（STREAM HIV）的随机对照实施试验中进行微观成本计算。在2022年3月1日至12月31日期间进行了时间和运动观察，以评估工作人员和客户进行POC ttv检测和咨询所需的时间。我们从提供者（国家政府）的角度估计了资金、诊所耗材和人员的财务和经济成本。结果假设每月有20人接受抗逆转录病毒治疗，POC TFV的估计费用为每位患者13美元。POC ttfv检测中最大的部件成本为试纸耗材，占检测成本的53%。从客户登记开始，进行POC TFV测试的门诊就诊总时间中位数为49:19（分：秒）（IQR: 29:19-89:35）。TFV检测用时9:22 (IQR: 7:35-14:11)，占门诊总就诊时间的19%，包括采集样本、装样、TFV检测处理和根据检测结果提供咨询。总体而言，29%的门诊就诊时间包括直接临床护理和与提供者进行评估，客户花费中位数14:09 （IQR: 10:35-21:22）检查生命体征，通过POC TFV测试接受依从性监测，并收集ART补充。排队等待抗逆转录病毒治疗占门诊就诊时间的大部分（48%）。结论：POC tv检测可以以合理的费用进行，仅需不到10分钟的卫生保健提供者时间，因此在南非诊所实施可能是可行的。研究结果可以为南非抗逆转录病毒治疗监测的政策和预算规划以及未来对POC ttv检测的成本效益分析提供信息。临床试验编号NCT04341779
{"title":"Cost and clinical flow of point-of-care urine tenofovir testing for treatment monitoring among people living with HIV initiating ART in South Africa","authors":"Melody Wang,&nbsp;Pravikrishnen Moodley,&nbsp;Mlungisi Khanyile,&nbsp;Elliot Bulo,&nbsp;Makhosazane Zondi,&nbsp;Keshani Naidoo,&nbsp;Yukteshwar Sookrajh,&nbsp;Jienchi Dorward,&nbsp;Monica Gandhi,&nbsp;Nigel Garrett,&nbsp;Paul K. Drain,&nbsp;Monisha Sharma","doi":"10.1002/jia2.70004","DOIUrl":"https://doi.org/10.1002/jia2.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Point-of-care (POC) urine tenofovir (TFV) tests can provide timely information regarding antiretroviral therapy (ART) adherence to support management of HIV treatment in clinics. However, there are limited data on the costs and feasibility of integrating POC testing into HIV clinics in sub-Saharan Africa. We characterized clinic flow and implementation costs of POC adherence testing for persons initiating ART in HIV care clinics in South Africa.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a microcosting within a randomized controlled implementation trial of POC TFV test in government clinics in Durban, South Africa (STREAM HIV). Time-and-motion observation was conducted between 1st March and 31st December 2022, to assess staff and client time needed for POC TFV testing and counselling. We estimated both financial and economic costs for capital, clinic consumables and personnel using a provider (national government) perspective.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The estimated cost of POC TFV was USD $13 per client, assuming a clinic volume of 20 individuals initiating ART per month. The largest component costs of POC TFV testing were the test strip consumables, which accounted for 53% of the test cost. The median total time of a clinic visit with a POC TFV test, starting from client registration, was 49:19 (minutes: seconds) (IQR: 29:19–89:35). TFV testing took 9:22 (IQR: 7:35–14:11), taking up 19% of the total clinic visit time, including sample collection, sample loading, TFV test processing and counselling provision based on test results. Overall, 29% of the clinic visit time included direct clinical care and assessment with a provider, with clients spending a median 14:09 (IQR: 10:35–21:22) getting vitals checked, receiving adherence monitoring via POC TFV testing, and collecting their ART refill. Waiting in line for ART took most (48%) of the clinic visit time.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>POC TFV testing can be administered at reasonable costs, requires less than 10 minutes of healthcare provider time, and, therefore, may be feasible to implement in South African clinics. Findings can inform policy and budgetary planning for ART monitoring in South Africa and future cost-effectiveness analyses of POC TFV testing.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Trial Number</h3>\u0000 \u0000 <p>NCT04341779</p>\u0000 </section>\u0000 </div>","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144624425","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}
引用次数: 0
Abstract Supplement Abstracts from IAS 2025, the 13th IAS Conference on HIV Science, 13 – 17 July, Kigali, Rwanda & Virtual IAS 2025，第13届IAS艾滋病科学会议，7月13日至17日，卢旺达基加利和Virtual
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-14 DOI: 10.1002/jia2.26518
{"title":"Abstract Supplement Abstracts from IAS 2025, the 13th IAS Conference on HIV Science, 13 – 17 July, Kigali, Rwanda & Virtual","authors":"","doi":"10.1002/jia2.26518","DOIUrl":"https://doi.org/10.1002/jia2.26518","url":null,"abstract":"","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S4","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26518","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144615533","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}
引用次数: 0
Persistent sex disparities in access to dolutegravir-based antiretroviral therapy in Latin America and the Caribbean: results from a retrospective observational study using data from 2017 to 2022 拉丁美洲和加勒比地区在获得以曲地韦为基础的抗逆转录病毒治疗方面持续存在性别差异：一项使用2017年至2022年数据的回顾性观察性研究结果
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-09 DOI: 10.1002/jia2.26470
Fernanda F. Fonseca, Paridhi Ranadive, Bryan E. Shepherd, Flavia G. F. Ferreira, Maria F. Rodríguez, Daisy M. Machado, Vanessa Rouzier, Diana Varela, Fernanda Maruri, Peter Ribeiro, Beatriz Grinsztejn, Sandra Wagner Cardoso, Valdiléa G. Veloso, Jessica L. Castilho, Emilia M. Jalil, CCASAnet

Introduction

Despite its reversal in July 2019, the World Health Organization warning issued in May 2018 of potential teratogenicity associated with dolutegravir (DTG) may have produced persistent sex disparities in access to DTG. We compared DTG uptake of people with HIV (PWH) by sex in Latin America and the Caribbean (LAC) and its potential impact on virologic outcomes.

Methods

We evaluated DTG initiation among antiretroviral therapy (ART)-naïve and -experienced cisgender PWH ≥16 years of age after DTG availability in Brazil (February/2017), Chile (August/2019), Haiti (November/2018) and Honduras (December/2018). Time was divided into pre- (before May/2018), during- (May/2018−July/2019) and post- (after July/2019) warning periods. We examined interactions of sex, age and calendar era with multivariable modified Poisson regression models and Cox proportional hazard models for the outcomes of DTG initiation among ART-naïve and ART-experienced PWH, respectively, and HIV RNA <50 copies/ml in the first year of therapy among ART-naïve PWH, adjusting for site and tuberculosis.

Results

Among 4622 ART-naïve PWH, 3853 (83%) initiated DTG. ART-naïve females aged 16–49 years were less likely to initiate DTG compared to males of the same age both in the pre/during-warning (adjusted prevalence ratio [aPR]: 0.75 [95% confidence interval (95% CI): 0.71−0.80]) and in the post-warning periods (aPR: 0.97 [95% CI: 0.95−1.00]). Among 16,154 ART-experienced PWH, 9236 (57%) initiated DTG. ART-experienced females 16–49 years were less likely to initiate DTG compared to males of the same age in the pre/during-warning (adjusted hazard ratio [aHR]: 0.69 [95% CI: 0.66−0.73]) and post-warning periods (aHR: 0.79 [95% CI: 0.70−0.90]). This sex difference was not observed among older ART-experienced females and males pre/during-warning (aHR: 1.06 [95% CI: 0.99−1.14]). Compared to starting ART without DTG, DTG-based ART use was associated with a higher likelihood of HIV RNA suppression in the first year (aPR = 1.10 [95% CI: 1.04−1.16]). In the post-warning period, females aged 16–49 years had a likelihood of viral suppression similar to males of the same age (aPR: 1.03 [95% CI: 0.96−1.10]), which did not change after adjusting for DTG use (aPR: 1.03 [95% CI: 0.97−1.11]).

Conclusions

Despite the updated guidelines recommending DTG for all PWH, there are persistent sex disparities in the access to DTG in LAC, especially among females wit

世界卫生组织于2018年5月发布了与多替重力韦（DTG）相关的潜在致畸性警告，尽管该警告于2019年7月得到逆转，但可能导致在获得多替重力韦方面存在持续的性别差异。我们比较了拉丁美洲和加勒比地区（LAC）艾滋病毒感染者（PWH）的DTG摄入量及其对病毒学结果的潜在影响。方法：在巴西（2017年2月）、智利（2019年8月）、海地（2018年11月）和洪都拉斯（2018年12月），我们评估抗逆转录病毒治疗(ART)-naïve和无经验的顺性别PWH≥16岁患者在DTG可用后的DTG启动情况。时间分为预警前（2018年5月之前）、预警期间（2018年5月- 2019年7月）和预警后（2019年7月之后）。我们使用多变量修正泊松回归模型和Cox比例风险模型分别检测了ART-naïve和art经历的PWH中DTG起始的结果，以及ART-naïve PWH中治疗第一年HIV RNA & 50拷贝/ml的结果，并对部位和结核病进行了调整。结果4622例ART-naïve PWH中，3853例（83%）启动了DTG。ART-naïve与同龄男性相比，16-49岁女性在预警前/预警期间（调整患病率比[aPR]: 0.75[95%可信区间（95% CI）： 0.71 - 0.80]）和预警后（aPR: 0.97 [95% CI: 0.95 - 1.00]）更不可能启动DTG。在16,154例有art经验的PWH中，9236例（57%）开始了DTG。与同龄男性相比，16-49岁接受过art治疗的女性在预警前/预警期间（校正风险比[aHR]: 0.69 [95% CI: 0.66 - 0.73]）和预警后（aHR: 0.79 [95% CI: 0.70 - 0.90]）更不可能开始DTG。在经历过art治疗的老年女性和预警前/预警期间的男性中没有观察到这种性别差异（aHR: 1.06 [95% CI: 0.99−1.14]）。与不使用DTG的开始ART相比，使用DTG为基础的ART与第一年HIV RNA抑制的可能性更高相关（aPR = 1.10 [95% CI: 1.04−1.16]）。在预警期后，16-49岁女性的病毒抑制可能性与同龄男性相似（aPR: 1.03 [95% CI: 0.96−1.10]），在调整DTG使用后，aPR: 1.03 [95% CI: 0.97−1.11])没有变化。结论：尽管最新的指南推荐所有PWH患者使用DTG，但LAC患者在使用DTG方面存在持续的性别差异，尤其是育龄女性。
{"title":"Persistent sex disparities in access to dolutegravir-based antiretroviral therapy in Latin America and the Caribbean: results from a retrospective observational study using data from 2017 to 2022","authors":"Fernanda F. Fonseca,&nbsp;Paridhi Ranadive,&nbsp;Bryan E. Shepherd,&nbsp;Flavia G. F. Ferreira,&nbsp;Maria F. Rodríguez,&nbsp;Daisy M. Machado,&nbsp;Vanessa Rouzier,&nbsp;Diana Varela,&nbsp;Fernanda Maruri,&nbsp;Peter Ribeiro,&nbsp;Beatriz Grinsztejn,&nbsp;Sandra Wagner Cardoso,&nbsp;Valdiléa G. Veloso,&nbsp;Jessica L. Castilho,&nbsp;Emilia M. Jalil,&nbsp;CCASAnet","doi":"10.1002/jia2.26470","DOIUrl":"https://doi.org/10.1002/jia2.26470","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Despite its reversal in July 2019, the World Health Organization warning issued in May 2018 of potential teratogenicity associated with dolutegravir (DTG) may have produced persistent sex disparities in access to DTG. We compared DTG uptake of people with HIV (PWH) by sex in Latin America and the Caribbean (LAC) and its potential impact on virologic outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We evaluated DTG initiation among antiretroviral therapy (ART)-naïve and -experienced cisgender PWH ≥16 years of age after DTG availability in Brazil (February/2017), Chile (August/2019), Haiti (November/2018) and Honduras (December/2018). Time was divided into pre- (before May/2018), during- (May/2018−July/2019) and post- (after July/2019) warning periods. We examined interactions of sex, age and calendar era with multivariable modified Poisson regression models and Cox proportional hazard models for the outcomes of DTG initiation among ART-naïve and ART-experienced PWH, respectively, and HIV RNA &lt;50 copies/ml in the first year of therapy among ART-naïve PWH, adjusting for site and tuberculosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 4622 ART-naïve PWH, 3853 (83%) initiated DTG. ART-naïve females aged 16–49 years were less likely to initiate DTG compared to males of the same age both in the pre/during-warning (adjusted prevalence ratio [aPR]: 0.75 [95% confidence interval (95% CI): 0.71−0.80]) and in the post-warning periods (aPR: 0.97 [95% CI: 0.95−1.00]). Among 16,154 ART-experienced PWH, 9236 (57%) initiated DTG. ART-experienced females 16–49 years were less likely to initiate DTG compared to males of the same age in the pre/during-warning (adjusted hazard ratio [aHR]: 0.69 [95% CI: 0.66−0.73]) and post-warning periods (aHR: 0.79 [95% CI: 0.70−0.90]). This sex difference was not observed among older ART-experienced females and males pre/during-warning (aHR: 1.06 [95% CI: 0.99−1.14]). Compared to starting ART without DTG, DTG-based ART use was associated with a higher likelihood of HIV RNA suppression in the first year (aPR = 1.10 [95% CI: 1.04−1.16]). In the post-warning period, females aged 16–49 years had a likelihood of viral suppression similar to males of the same age (aPR: 1.03 [95% CI: 0.96−1.10]), which did not change after adjusting for DTG use (aPR: 1.03 [95% CI: 0.97−1.11]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Despite the updated guidelines recommending DTG for all PWH, there are persistent sex disparities in the access to DTG in LAC, especially among females wit","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 7","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26470","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589606","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}
引用次数: 0
The need to differentiate at re-engagement: lessons from South Africa and Zimbabwe's re-engagement algorithms 重新接触时需要区分：来自南非和津巴布韦重新接触算法的教训
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-07 DOI: 10.1002/jia2.26466
Lynne S. Wilkinson, Helen Bygrave, Musa Manganye, Chiedza Mupanguri, Anna Grimsrud
<p>As HIV epidemics mature, effectively addressing interruptions in antiretroviral therapy (ART) becomes increasingly critical to reducing morbidity, mortality and transmission [<span>1-3</span>]. Prolonged disengagement from ART places significant demands on health systems, including the need to manage advanced HIV disease (AHD), higher rates of hospitalisation and preventable new HIV acquisitions.</p><p>Disengagement from HIV care is the result of individual, interpersonal and/or structural vulnerabilities combined with life disruptions, such as unexpected travel, that impact a person's ability to remain in care [<span>4, 5</span>]. Fortunately, many individuals are self-motivated to return to care. However, their timely re-engagement often depends on removing barriers and introducing valued facilitators [<span>6, 7</span>]. Data from Malawi and South Africa show that the majority of people attempt return within 3 months of missing a scheduled appointment, but more country-specific time-to-return data is needed [<span>8, 9</span>].</p><p>Disengagement occurs across the HIV care cascade, with proportionally more people disengaging during early ART but greater numbers disengaging thereafter. In mature, generalised HIV epidemics, disengagement is common among all population groups, reinforcing the need for broad, scalable approaches that improve re-engagement outcomes [<span>3</span>].</p><p>Re-engagement involves two main intervention categories: tracing to encourage return, and enhancing the return experience to reduce interruption length and repeat disengagement [<span>5</span>]. This viewpoint focuses on the latter by removing barriers and adapting service delivery to support re-engagement.</p><p>HIV programmes must first recognise that ART interruptions are common and prioritise facilitating easy, quick and sustained re-engagement [<span>3</span>]. Some individuals fear returning due to concerns about disappointing healthcare workers and experiencing punitive actions [<span>6, 10, 11</span>]. Respectful care for returning clients can reduce fear and promote timely return. Re-engagement guidance should emphasise same-day ART provision, avoiding multiple visits [<span>7</span>] or transfer documentation collection [<span>11</span>]. Long waiting times and penalisation for missed appointments should be monitored and penalisation [<span>6, 7</span>]. People re-engaging in care commonly previously struggled with frequent appointments, inconvenient locations and long wait times. Accelerating access to less-intensive differentiated service delivery (DSD) can reduce client burden and help prevent future interruptions [<span>6, 7</span>]. Frequent clinical visits should be reserved for when clinically necessary.</p><p>Ministries of health are starting to implement guidance on managing people returning to care, focusing on respectful care and a shift away from one-size-fits-all intensified clinical management, with its monthly appointments and multiple
随着艾滋病毒流行的成熟，有效解决抗逆转录病毒治疗（ART）中断问题对于降低发病率、死亡率和传播变得越来越重要[1-3]。长期脱离抗逆转录病毒治疗对卫生系统提出了重大要求，包括需要管理晚期艾滋病毒疾病、更高的住院率和可预防的新发艾滋病毒感染。脱离艾滋病毒护理是个人、人际和/或结构脆弱性与生活中断（如意外旅行）相结合的结果，这些因素影响了一个人继续接受护理的能力[4,5]。幸运的是，许多人都是自我激励回到护理。然而，他们的及时重新参与往往取决于消除障碍和引入有价值的促进者[6,7]。来自马拉维和南非的数据显示，大多数人在错过预定的约会后3个月内试图返回，但需要更多具体国家的返回时间数据[8,9]。脱离治疗发生在整个艾滋病毒护理级联中，在早期抗逆转录病毒治疗期间脱离治疗的人数比例更高，但此后脱离治疗的人数更多。在成熟的、普遍的艾滋病毒流行病中，脱离接触在所有人口群体中都很普遍，因此需要采取广泛的、可扩展的办法，以改善重新参与的结果[10]。重新参与包括两个主要的干预类别：追踪以鼓励返回，以及增强返回体验以减少中断时间和重复脱离。该观点通过消除障碍和调整服务交付以支持重新参与来关注后者。艾滋病毒规划必须首先认识到抗逆转录病毒治疗中断是常见的，并优先考虑促进容易、快速和持续的重新参与。一些人害怕返回，因为担心失望的医护人员和经历惩罚行动[6,10,11]。尊重和照顾回头客可以减少恐惧，促进及时回头客。重新参与指导应强调当天提供抗逆转录病毒治疗，避免多次访问bb1或转移文件收集bb1。长时间的等待和错过预约的惩罚应该受到监控和惩罚[6,7]。以前，重新接受治疗的人通常要面对频繁的预约、不方便的地点和漫长的等待时间。加速获得低密集差异化服务交付（DSD）可以减轻客户负担，并有助于防止未来的中断[6,7]。频繁的临床访问应保留到临床需要时。卫生部正在开始实施关于管理重返护理人员的指导，重点是尊重护理，并从千篇一律的强化临床管理转变为每月预约和多次坚持咨询会议。区分护理路径可以识别那些只是“迟到”的患者，没有或只有短暂的治疗中断，以及可以继续常规护理的患者，包括在DSD模型中。他们还确定了那些需要进一步评估的人。回报的两个关键评估指导进一步区分。首先，临床稳定性，通过机会性感染、精神健康问题、多动症或脱离接触前病毒载量升高的迹象来评估。第二，错过预约后的时间，这表明潜在的中断持续时间和AHD风险。为了说明这些规划考虑是如何应用的，我们重点介绍了南非和津巴布韦的国家再参与算法——这两个国家最早在国家指导方针中正式确定了差异化的再参与途径——为其他国家提供了宝贵的经验。如图1所示。南非对“重新聘用”的定义是：缺席一次约会，身体不适，或逾期28天以上。他们的算法（图A）区分了常规护理和再参与护理[12]。迟到28天或更少的人继续或参加DSD模型。病毒载量测试计划保持不变。那些错过预约超过28天或自认为身体不适的人接受临床评估，除非临床指示，否则在同一天继续或重新开始抗逆转录病毒治疗。临床不稳定的个体，无论中断时间长短，都需要重复CD4检测以确定AHD，并根据需要确定随访计划。临床稳定的个体自错过预约后的时间进行评估，对于那些错过预约超过90天的人需要进行CD4检测。那些迟到29-90天的人的处理方式与迟到28天或更短时间的人类似。临床不稳定组和“延迟超过90天”组都需要在3个月后进行随访病毒载量检测，并在3个月后重新进行抗逆转录病毒治疗，除非需要早期临床护理。一个月后，如果他们被压制，他们就会被录取。 在9个卫生设施试点的早期版本表明，参与的领导、提供者的同情和与现有工作流程的一致是成功采用bbb的关键。津巴布韦将重新接触定义为在错过访问后停止抗逆转录病毒治疗。每个重新参与的人都需要进行临床评估，以区分临床稳定和不稳定（B组）[14]。对于临床稳定的个体，延迟少于3个月的患者在7天内重新开始，并在接受依从性咨询会议后（重新）入组DSD模型。病毒载量测试时间表保持不变。临床不稳定个体包括身体不适、过去12个月内病毒载量升高或有重大社会心理挑战的个体。如果最后一次病毒载量超过1000拷贝/毫升，他们需要随访CD4，并根据临床需要调整预约时间表。对于所有延迟3个月以上的个体，重复CD4计数以评估AHD。CD4细胞计数高于200细胞/mm3的患者遵循标准的ART启动计划，在1、3和6个月后进行随访临床检查，之后进行病毒载量测试。在随后的访问中，被抑制的个体被提供DSD模型，包括6个月的ART补充。在对70个设施的AHD筛查部分的评估中，23%的重新参与的客户接受了CD4检测，其中41%的被检测者CD4 &lt；200 / mm3。工作人员短缺和商品限制带来了挑战，特别是在护理点CD4检测方面，而经过算法使用培训的设施则更有信心地进行了筛查。南非和津巴布韦基于算法的差异化再参与途径提供了可扩展的方法，以促进有效和持久的重返护理。通过加速获得延长的ART补充和低强度的DSD，确保对个人生活的干扰最小化，这些方法减轻了临床稳定客户的负担，同时确保对包括AHD在内的临床需求增加的患者进行必要的监督。重要的是，他们确保再参与过程以人为本，重点是提高返回体验和减少可能导致长期或未来中断的障碍。这些适应性强的方法使医疗保健系统能够满足个人需求，同时优化资源，以扩大人口覆盖范围。作者声明他们没有利益冲突。这个解说的概念是由LSW， HB和AG开发的。LSW写了初稿。所有作者都贡献并批准了最终版本。
{"title":"The need to differentiate at re-engagement: lessons from South Africa and Zimbabwe's re-engagement algorithms","authors":"Lynne S. Wilkinson,&nbsp;Helen Bygrave,&nbsp;Musa Manganye,&nbsp;Chiedza Mupanguri,&nbsp;Anna Grimsrud","doi":"10.1002/jia2.26466","DOIUrl":"https://doi.org/10.1002/jia2.26466","url":null,"abstract":"&lt;p&gt;As HIV epidemics mature, effectively addressing interruptions in antiretroviral therapy (ART) becomes increasingly critical to reducing morbidity, mortality and transmission [&lt;span&gt;1-3&lt;/span&gt;]. Prolonged disengagement from ART places significant demands on health systems, including the need to manage advanced HIV disease (AHD), higher rates of hospitalisation and preventable new HIV acquisitions.&lt;/p&gt;&lt;p&gt;Disengagement from HIV care is the result of individual, interpersonal and/or structural vulnerabilities combined with life disruptions, such as unexpected travel, that impact a person's ability to remain in care [&lt;span&gt;4, 5&lt;/span&gt;]. Fortunately, many individuals are self-motivated to return to care. However, their timely re-engagement often depends on removing barriers and introducing valued facilitators [&lt;span&gt;6, 7&lt;/span&gt;]. Data from Malawi and South Africa show that the majority of people attempt return within 3 months of missing a scheduled appointment, but more country-specific time-to-return data is needed [&lt;span&gt;8, 9&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Disengagement occurs across the HIV care cascade, with proportionally more people disengaging during early ART but greater numbers disengaging thereafter. In mature, generalised HIV epidemics, disengagement is common among all population groups, reinforcing the need for broad, scalable approaches that improve re-engagement outcomes [&lt;span&gt;3&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;Re-engagement involves two main intervention categories: tracing to encourage return, and enhancing the return experience to reduce interruption length and repeat disengagement [&lt;span&gt;5&lt;/span&gt;]. This viewpoint focuses on the latter by removing barriers and adapting service delivery to support re-engagement.&lt;/p&gt;&lt;p&gt;HIV programmes must first recognise that ART interruptions are common and prioritise facilitating easy, quick and sustained re-engagement [&lt;span&gt;3&lt;/span&gt;]. Some individuals fear returning due to concerns about disappointing healthcare workers and experiencing punitive actions [&lt;span&gt;6, 10, 11&lt;/span&gt;]. Respectful care for returning clients can reduce fear and promote timely return. Re-engagement guidance should emphasise same-day ART provision, avoiding multiple visits [&lt;span&gt;7&lt;/span&gt;] or transfer documentation collection [&lt;span&gt;11&lt;/span&gt;]. Long waiting times and penalisation for missed appointments should be monitored and penalisation [&lt;span&gt;6, 7&lt;/span&gt;]. People re-engaging in care commonly previously struggled with frequent appointments, inconvenient locations and long wait times. Accelerating access to less-intensive differentiated service delivery (DSD) can reduce client burden and help prevent future interruptions [&lt;span&gt;6, 7&lt;/span&gt;]. Frequent clinical visits should be reserved for when clinically necessary.&lt;/p&gt;&lt;p&gt;Ministries of health are starting to implement guidance on managing people returning to care, focusing on respectful care and a shift away from one-size-fits-all intensified clinical management, with its monthly appointments and multiple","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S3","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26466","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144574130","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}
引用次数: 0
首页 上一页 下一页 尾页
类型
全部 化学•材料 生命科学 医学 物理 工程技术 环境•农林 材料科学 地球科学 法学 管理学 化学 环境科学与生态学 计算机科学 教育学 经济学 农林科学 人文科学 生物学 数学 物理与天体物理 心理学 综合性期刊 其他 工业工程 理学 历史学 农学 文学 信息工程
数据库
全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley
期刊
Journal of the International AIDS Society
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
﹀
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整，为了账户安全，请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号：604180095
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们：info@booksci.cn
Book学术提供免费学术资源搜索服务，方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1