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Data-informed Stepped Care (DiSC) to improve adolescent and young adult HIV care outcomes in Kenya: a cluster randomized trial 数据知情的阶梯式护理（DiSC）改善肯尼亚青少年和年轻人艾滋病毒护理结果：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 : 2025-07-07 DOI: 10.1002/jia2.26501
Pamela Kohler, Wenwen Jiang, Jacinta Badia, James Kibugi, Jessica Dyer, Julie Kadima, Dorothy Oketch, Kristin Beima-Sofie, Sarah Hicks, Barbra A. Richardson, Irene Inwani, Seema K. Shah, Kawango Agot, Grace John-Stewart

Introduction

Systematic use of data-driven tools to allocate care services based on needs, including differentiated care for stable individuals and intensive care for those with higher risk, may improve retention and viral suppression in adolescents and young adults living with HIV (AYLHIV).

Methods

This cluster randomised trial in western Kenya tested a data-informed stepped care intervention that assigned AYLHIV to four intensities of care according to need. AYLHIV at 12 intervention facilities underwent step assignment at each visit; those at lowest risk were offered differentiated models of service delivery (DSD), and those with risk factors more intensive services. AYLHIV at control sites received standard care. AYLHIV were followed for 12 months. Clinical and viral load data were abstracted from medical records. The primary outcome was the proportion of missed visits (defined as > 30 days late for scheduled visit). Secondary outcomes included loss to follow-up, viral non-suppression and assignment to DSD (multi-month refills or pharmacy fast-track visits). Mixed effects regression was clustered by individual and facility and adjusted for outcomes during the pre-enrolment period and baseline variables that differed by arm.

Results

Between April and July 2022, 1911 AYLHIV ages 10–24 were enrolled (control: 1016, intervention: 895, 1708.8 person-years). Median age was 17, and 1512 (79.5%) were in school. Characteristics were balanced by arm, except for a higher proportion coming to the clinic alone in control arm (68.5% vs. 61.1%, p = 0.04). At intervention facilities, using the DiSC tool, 574 (64.6%) AYLHIV were assigned to DSD, 122 (13.7%) to standard care, 100 (11.3%) to mental health and retention counselling, and 92 (10.4%) to intensive case management. Missed visits were 8.5% in intervention versus 8.3% in control (adjusted risk ratio [aRR]: 1.04, 95% CI: 0.89−1.20); viral non-suppression (7.7% vs. 9.7%, aRR 0.79 95% CI: 0.54−1.16) and antiretroviral therapy adherence (92.8% vs. 94.6%, aRR 0.98 95% CI: 0.94−1.02) were similar between arms. AYLHIV in the intervention arm received more fast-track visits (aRR 1.21, 95% CI: 1.01−1.46). Intervention facilities experienced fewer scheduled appointments compared to control (aRR: 0.95, 95% CI: 0.91−0.98, p = 0.004).

Conclusions

Overall, missed visits and non-suppression were infrequent (< 10%) and did not decrease with the DiSC interventi

系统地使用数据驱动的工具，根据需求分配护理服务，包括对病情稳定的个体进行差异化护理，对风险较高的个体进行重症监护，可能会改善感染艾滋病毒（AYLHIV）的青少年和年轻人的滞留和病毒抑制。方法：在肯尼亚西部进行的这组随机试验测试了一种数据知情的阶梯式护理干预，该干预根据需要将AYLHIV分配到四种护理强度。在12个干预设施的AYLHIV在每次访问时进行分步分配；为风险最低的人提供差异化的服务提供模式（DSD），为有风险因素的人提供更密集的服务。控制点的AYLHIV接受标准治疗。随访12个月。临床和病毒载量数据从病历中提取。主要结果是未就诊的比例(定义为>；预定访问时间晚30天)。次要结局包括随访失败、病毒无抑制和分配到DSD（多月补充或药房快速通道访问）。混合效应回归按个体和机构进行聚类，并根据入组前的结果和不同组的基线变量进行调整。结果于2022年4月至7月共入组1911例10-24岁的AYLHIV患者（对照组：1016例，干预组：895例，1708.8人年）。平均年龄为17岁，1512人（79.5%）在上学。除了对照组中单独来诊所的比例更高（68.5%比61.1%,p = 0.04），各组的特征都是平衡的。在干预设施中，使用DiSC工具，574例（64.6%）AYLHIV被分配到DSD， 122例（13.7%）被分配到标准护理，100例（11.3%）被分配到精神健康和保留咨询，92例（10.4%）被分配到强化病例管理。干预组的失诊率为8.5%，对照组为8.3%（校正风险比[aRR]: 1.04, 95% CI: 0.89 ~ 1.20）；病毒无抑制（7.7% vs. 9.7%, aRR 0.79 95% CI: 0.54 ~ 1.16）和抗逆转录病毒治疗依从性（92.8% vs. 94.6%, aRR 0.98 95% CI: 0.94 ~ 1.02）在两组之间相似。干预组的AYLHIV患者获得了更多的快速通道就诊（aRR 1.21, 95% CI: 1.01−1.46）。与对照组相比，干预机构的预约预约较少（aRR: 0.95, 95% CI: 0.91 - 0.98, p = 0.004）。结论：总体而言，漏诊和非抑制发生率较低(<；10%)，且不随DiSC干预而降低。DiSC干预增加了对差异化服务的分配，而没有增加漏诊或病毒无抑制。
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引用次数: 0
Scale of differentiated service delivery implementation in HIV care facilities in low- and middle-income countries: a global facility survey 中低收入国家艾滋病毒护理机构实施差异化服务的规模：一项全球设施调查
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-07 DOI: 10.1002/jia2.26477
Nathalie Verónica Fernández Villalobos, Fabrice Helfenstein, Vohith Khol, Christella Twizere, Mayara Secco, Barbara Castelnuovo, Jacqueline Huwa, Thierry Tiendredbeogo, C. William Wester, Siew Moy Fong, Gad Murenzi, Yanink Caro-Vega, Rita Elias Lyamuya, Idiovinio Rafael, Djimon Marcel Zannou, Kathy Petoumenos, Dominique Mahambou Nsonde, Jorge Pinto, Kara Wools-Kaloustian, Carolyn Bolton Moore, Ounoo Elom Takassi, Sasisopin Kiertiburanakul, Rogers Ajeh Awoh, Shamim M. Ali, Geoffrey Fatti, Karen Malateste, Elizabeth Zaniewski, Marie Ballif, the International epidemiology Databases to Evaluate AIDS

Introduction

In 2016, the World Health Organization recommended differentiated service delivery (DSD) as a client-centred approach to simplify HIV care in frequency and intensity, thus reducing the clinic visit burden on individuals and HIV programmes. We describe the scale of DSD implementation among HIV facilities in low- and middle-income countries (LMICs) in Latin America, Africa and the Asia-Pacific before the COVID-19 pandemic.

Methods

We analysed facility-level survey data from HIV care facilities participating in the International epidemiology Databases to Evaluate AIDS consortium in 2019. We used descriptive statistics to summarise the availability of DSD, multi-month dispensing (MMD) and DSD for HIV treatment models. We explored factors associated with DSD implementation using multivariable models.

Results

We included 175 facilities in the Asia-Pacific (n = 30), Latin America (n = 8), Central Africa (n = 21), East Africa (n = 74), Southern Africa (n = 28) and West Africa (n = 14). Overall, 133 facilities (76%) reported implementing DSD. Of these, 91% offered DSD for HIV treatment, 61% for HIV testing and 59% for antiretroviral therapy (ART) initiation. The most common duration of ART refills for clinically stable clients was 3MMD, (70%), followed by monthly (14%) and 6MMD (10%). Facility-based individual models were the most frequently available DSD for the HIV treatment model (82%), followed by client-managed group models (60%). Out-of-facility individual models were available at 48% of facilities. Facility-based individual models were particularly common among facilities in East (92%) and Southern Africa (96%). Facilities in medium and high HIV prevalence countries, and those with 3MMD, were more likely to implement DSD.

Conclusions

In 2019, DSD was available in most HIV care facilities globally but was not evenly implemented across regions and HIV services. Most offered facility-based DSD for HIV treatment models and 3MMD for clinically stable clients. Efforts to expand DSD for HIV testing and ART initiation and to offer longer MMD can improve long-term retention in care of people living with HIV in LMICs, while further alleviating the operational burden on healthcare services. These findings from the pre-COVID-19 era underline the need for strengthening DSD in HIV care, which remains at the centre of current efforts towards client-centred care.

2016年，世界卫生组织建议将差异化服务提供作为一种以客户为中心的方法，以简化艾滋病毒护理的频率和强度，从而减轻个人和艾滋病毒规划的诊所就诊负担。我们描述了在2019冠状病毒病大流行之前，拉丁美洲、非洲和亚太地区低收入和中等收入国家（LMICs）艾滋病毒设施实施DSD的规模。方法分析2019年参与国际流行病学数据库评估艾滋病联盟的艾滋病毒护理机构的设施级调查数据。我们使用描述性统计来总结DSD，多月分配（MMD）和艾滋病治疗模型的DSD的可用性。我们使用多变量模型探讨了与DSD实施相关的因素。结果我们纳入了亚太地区（n = 30）、拉丁美洲（n = 8）、中非（n = 21）、东非（n = 74）、南部非洲（n = 28）和西非（n = 14）的175家医院。总体而言，133个设施（76%）报告实施了DSD。其中，91%为艾滋病毒治疗提供DSD， 61%为艾滋病毒检测提供DSD， 59%为开始抗逆转录病毒治疗（ART）提供DSD。临床稳定的患者最常见的抗逆转录病毒治疗持续时间为3MMD(70%)，其次是每月（14%）和6MMD（10%）。基于设施的个体模型是HIV治疗模型中最常用的DSD(82%)，其次是客户管理的群体模型（60%）。48%的设施提供设施外的个人模型。在东部（92%）和南部非洲（96%）的设施中，以设施为基础的个体模式尤为普遍。在艾滋病毒中高流行国家的设施，以及那些有300万名艾滋病患者的设施，更有可能实施DSD。2019年，全球大多数艾滋病毒护理机构都可以提供DSD，但在各地区和艾滋病毒服务机构之间的实施并不均匀。大多数机构为HIV治疗模型提供基于设施的DSD，为临床稳定的客户提供3MMD。努力扩大艾滋病毒检测和抗逆转录病毒治疗的DSD，并提供更长的MMD，可以改善中低收入国家对艾滋病毒感染者的长期护理，同时进一步减轻医疗保健服务的业务负担。这些来自covid -19前时代的发现强调了加强艾滋病毒护理中的可持续发展的必要性，这仍然是当前以客户为中心的护理工作的核心。
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引用次数: 0
Preferences for TB treatment and support delivery models among people living with TB in Eastern Cape, South Africa: a discrete choice experiment 南非东开普省结核病患者对结核病治疗的偏好和支持交付模式：一项离散选择实验
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-07 DOI: 10.1002/jia2.26506
Michael Strauss, Gavin George, Emma Lansdell, Kuhle Fiphaza, Andrew Medina-Marino, Joseph Daniels

Introduction

South Africa has one of the highest incidence rates of notified tuberculosis (TB) in the world. Achieving TB control requires strengthening treatment and support services. The implementation of differentiated delivery models can be used to improve service quality and enhance retention in care. This study aimed to identify treatment and support delivery preferences among people on TB treatment, specifically examining gender differences, to inform the development of differentiated care models for improving engagement and retention in TB treatment services.

Methods

A binary, unlabelled, fractional factorial design discrete choice experiment (DCE) was used to investigate preferences for TB treatment adherence support and service delivery. Attributes included who provides the support, how and where support is delivered, medication collection location and frequency of clinic visits. The DCE was administered to individuals who were currently on or recently completed TB treatment, and to those at-risk for being lost-to-care. Data from 284 individuals for the DCE were collected from March to August 2022. Mixed effects logistic regression models were used as primary analysis tools. Latent class analysis (LCA) was used to explore heterogeneity in preference structures.

Results

Compared to standard clinic-based treatment collection, participants preferred collecting their treatment from a mobile community-based location (ß = 0.231; 95% CI: 0.08–0.39), clinic-based fast-tracked pick-ups (ß = 0.539; 95% CI: 0.38–0.70) or home delivery (ß = 0.563; 95% CI: 0.37–0.75). Participants also significantly preferred support offered monthly compared to once-off (ß = 0.167; 95% CI: 0.01–0.32). Furthermore, participants preferred face-to-face support over group (ß = –0.142; 95% CI: –0.27 to –0.02) or phone-based (ß = –0.222; 95% CI: –0.36 to –0.09) support models. LCA revealed three classes with statistically similar preference structures; Class 1 (62%) preferred community-based treatment delivery and support services; Class 2 (28%) preferred clinic-based support and treatment delivery services; and Class 3 (10%), preferred self-selected peer navigator or nurse delivered, and group models of support and prioritised the location of medication pickups, with a preference for any model other than standard clinic collection.

Conclusions

Though preference structures did not differ by gender, respondents revealed strong prefere

南非是世界上通报结核病发病率最高的国家之一。实现结核病控制需要加强治疗和支持服务。差异化交付模式的实施可用于改善服务质量和提高护理留用率。本研究旨在确定人们对结核病治疗的治疗和支持提供偏好，特别是检查性别差异，为制定差异化护理模式提供信息，以提高结核病治疗服务的参与度和保持性。方法采用二元、无标记、分数因子设计离散选择实验（DCE）来调查结核病治疗依从性支持和服务提供的偏好。属性包括谁提供支持，如何以及在哪里提供支持，药物收集地点和诊所访问的频率。DCE适用于目前正在接受或最近完成结核病治疗的个人，以及有失去护理风险的个人。从2022年3月到8月收集了284名DCE参与者的数据。混合效应logistic回归模型作为主要分析工具。使用潜类分析（LCA）探讨偏好结构的异质性。结果与标准的基于临床的治疗收集相比，参与者更倾向于从流动的社区收集治疗(ß = 0.231；95% CI: 0.08-0.39)，基于临床的快速通道拾取(ß = 0.539；95% CI: 0.38-0.70)或家庭分娩(ß = 0.563；95% ci: 0.37-0.75)。与一次性支持相比，参与者也明显更喜欢每月提供的支持(ß = 0.167；95% ci: 0.01-0.32)。此外，参与者更喜欢面对面的支持，而不是群体支持(ß = -0.142；95% CI: -0.27至-0.02)或基于手机(ß = -0.222；95% CI: -0.36至-0.09)支持模型。LCA揭示了三个具有统计相似偏好结构的阶层；第一类（62%）偏爱社区治疗和支持服务；第2类（28%）偏爱以诊所为基础的支持和治疗提供服务；第3类（10%），偏好自我选择同伴导航员或护士交付，以及支持和优先取药地点的小组模式，偏好除标准诊所收集之外的任何模式。尽管偏好结构没有性别差异，但受访者对差异化服务提供模式表现出强烈的偏好。未来的结核病治疗和支持干预措施必须包括诊所和社区的护理和支持模式，以确保结核病患者能够最大限度地获得结核病治疗和支持服务。
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引用次数: 0
Build, do not dismantle: leveraging a differentiated service delivery approach for broader health impact amidst funding changes 建设，而不是拆除：在资金变化中利用差异化的服务提供方法，产生更广泛的卫生影响
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-07 DOI: 10.1002/jia2.26514
Anna Grimsrud, Charles B. Holmes, Linda Sande
<p>“<i>It is so easy to break down and destroy. The heroes are those who make peace and build</i>.”—Nelson Mandela</p><p>We received over 100 abstracts in response to this supplement's call for evidence to advance the scale-up of differentiated service delivery (DSD) beyond HIV treatment. However, since January 2025, the global context for HIV service delivery has shifted dramatically.</p><p>A steep, sudden reduction in United States government funding has jeopardised HIV services in many high-burden countries [<span>1</span>]. The closure of United States Agency for International Development (USAID) and termination of President's Emergency Plan for AIDS Relief (PEPFAR) programming delivered through USAID partners [<span>2</span>] marks more than a bureaucratic reshuffle—it signals the potential unravelling of critical components of the global HIV response.</p><p>While a State Department waiver was intended to provide clarification to allow for life-saving humanitarian assistance, it failed to deliver, resulting in widespread disruption of HIV services, including life-saving treatment [<span>3</span>]. The punative choices reflected in the waiver also reveal a fundamental shift in the scope of U.S. support going forward. The cessation of most pre-exposure prophylaxis (PrEP) programmes (except for pregnant and breastfeeding women), removal of earmarked funding for key populations and orphans and vulnerable children, and the elimination of HIV survey, surveillance and community-led monitoring activities underscore the magnitude of the shift. These changes threaten to dismantle the very structures built to make HIV care more efficient, client-centred and resilient. Among them is DSD—an approach that has transformed HIV services and remains key to sustaining and expanding access amid shrinking resources.</p><p>Prior to 20 January 2025, DSD had been scaled and integrated into national guidance, especially in Eastern and Southern Africa. Data from the Coverage, Quality and Impact Network (CQUIN) network of 21 countries in Sub-Saharan Africa show that by 2023, a median of 76% of people on antiretroviral therapy (ART) accessed treatment through a less-intensive DSD model [<span>4</span>]. Multi-month dispensing (MMD) of ART, which expanded during COVID-19 [<span>5</span>], is an enabler of DSD. Scale-up of MMD has continued, with 45% of people on ART supported by PEPFAR outside of South Africa, or 6.67 million people, receiving 6MMD in July−September 2023 (personal communication, Lauren Bailey). The potential savings from DSD include cost and resource savings from less frequent clinic visits, both for clients and the health system [<span>6, 7</span>], and can increase human resource capacity [<span>8</span>].</p><p>During COVID-19, the World Health Organization (WHO) recommended DSD components to support uninterrupted access to services: MMD of ART, MMD and prescribing of PrEP, scaled provision of HIV self-testing and ART distribution through community d
“它很容易分解和破坏。英雄是那些缔造和平和建设的人。——纳尔逊·曼德拉我们收到了100多份摘要，这些摘要响应了本期增刊呼吁的证据，以推动扩大艾滋病毒治疗以外的差异化服务提供（DSD）的规模。然而，自2025年1月以来，艾滋病毒服务提供的全球环境发生了巨大变化。美国政府资金突然大幅减少，危及了全球许多高负担国家的艾滋病服务。美国国际开发署（USAID）的关闭和由USAID合作伙伴提供的总统艾滋病紧急救援计划（PEPFAR）项目的终止不仅标志着官僚机构的重组，而且标志着全球艾滋病应对工作的关键组成部分可能出现解体。虽然国务院的豁免是为了提供澄清，以便提供挽救生命的人道主义援助，但它未能实现，导致艾滋病毒服务大面积中断，包括挽救生命的治疗[3]。豁免中所反映的惩罚性选择也揭示了美国未来支持范围的根本转变。大多数暴露前预防（PrEP）规划（孕妇和哺乳期妇女除外）的停止，取消了为重点人群、孤儿和弱势儿童提供的专项资金，以及取消了艾滋病毒调查、监测和社区主导的监测活动，这些都突显了这一转变的重要性。这些变化有可能破坏为使艾滋病毒护理更有效、以客户为中心和更有弹性而建立的结构。其中包括dsd，这一方法改变了艾滋病毒服务，在资源不断减少的情况下，仍然是维持和扩大可及性的关键。在2025年1月20日之前，特别是在东部和南部非洲，发展可持续发展已被扩大并纳入国家指导。覆盖撒哈拉以南非洲21个国家的覆盖、质量和影响网络（CQUIN）的数据显示，到2023年，接受抗逆转录病毒治疗（ART）的人中有76%通过强度较低的DSD模式获得治疗。在2019冠状病毒病疫情期间扩大的ART的多月分配（MMD）是DSD的推动者。MMD的规模继续扩大，在南非以外的地区，45%接受抗逆转录病毒治疗的人，即667万人，在2023年7月至9月期间接受了600万MMD治疗（个人通信，Lauren Bailey）。DSD的潜在节省包括减少门诊就诊次数所节省的成本和资源，对客户和卫生系统都是如此[6,7]，并且可以增加人力资源能力bb0。在2019冠状病毒病期间，世界卫生组织（世卫组织）推荐了DSD组成部分，以支持不间断地获得服务：抗逆转录病毒药物的烟雾防治、烟雾防治和PrEP处方、大规模提供艾滋病毒自我检测以及通过社区分发点分发抗逆转录病毒药物。虽然这些因素仍然相关，但目前的趋势正在朝着错误的方向发展——抗逆转录病毒治疗的补充时间正在缩短[10,11]，社区分发点被拆除，随着卫生保健工作者（尤其是非专业干部）资金的减少，群体模式逐步淘汰。这份增刊比以往任何时候都更加及时和相关。DSD以客户需求为中心，这种灵活性在经济紧缩的时代是必不可少的。面对资金削减，DSD提供的不是后备计划，而是前瞻性战略。自近10年前制定以来，DSD一直专注于以客户为中心，基于这样一种假设，即那些临床稳定且懂治疗的人可以不那么频繁地就诊，并且在需要的时候会寻求治疗。本署奉行自我照顾原则，并确保在需要加强照顾时提供资源。关键是，DSD不是hiv特异性的。它为管理艾滋病毒感染者的其他慢性疾病和合并症提供了一个可扩展的框架。在当今资源受限的环境中，以客户为中心、效率、灵活性等原则不仅相关，而且至关重要。我们不应拆除可持续发展框架，而应在此基础上为未来的艾滋病毒综合服务提供模式提供支持。本补充说明了DSD如何能够超越持续的艾滋病毒治疗。它可以成为综合慢性护理的基础，脆弱系统的复原力模型，以及保护关键人群不掉队的机制。DSD提供了一种将人置于中心并从头开始建立卫生系统的方法——高效、公平和可持续。增刊包括四个关键主题的研究。第一个主题是艾滋病毒治疗与综合其他卫生需求的可持续发展。本部分的文章探讨了如何使用DSD提供综合护理，例如，将HIV治疗与高血压或糖尿病管理相结合。kiggundu et al. [14], Hickey et al.[14]和Pascoe et al. 3篇论文。 [16] -强调将高血压和艾滋病毒护理纳入DSD模式的成功。在乌干达，Kiggundu等人随机选取了一些诊所，在其HIV DSD模型中实施高血压筛查和治疗[14]。大量艾滋病病毒感染者未确诊高血压，在3164名艾滋病病毒和高血压患者中，85%是新诊断的。提出了一项混合方法研究，结论是整合是可行的和适应性的，促进了资源的可用性和同步的艾滋病毒和高血压就诊。在南非，Pascoe等人审查了该国已经采用的综合DSD方法，评估了18个公共部门诊所中艾滋病毒和高血压患者就诊和配药间隔的一致性。结果突出了与设施访问和药物提取的高度一致性，分别为94%和95%，并且没有增加共病客户的访问负担。在肯尼亚和乌干达的SEARCH研究中，Hickey等人提出了一种利用现有卫生部工作人员整合艾滋病毒和非传染性疾病护理bbb的替代方法。它们显示了卫生部社区卫生工作者如何能够在社区一级有效地提供艾滋病毒和高血压综合服务，并与附近的卫生设施建立积极联系。南非夸祖鲁-纳塔尔省的Sahu等人描述了艾滋病毒感染者中慢性疾病风险的严重程度[10]。在以社区为基础的抗逆转录病毒治疗模式中，近四分之一的参与者吸烟（24%），患有高血压（23%），一半（50%）肥胖。这些数据突出表明，迫切需要预防和治疗艾滋病毒感染者的慢性疾病。令人鼓舞的是，将艾滋病毒护理与常见合并症结合起来的机会越来越多，可行性也越来越高。第二个主题探讨了如何将可持续发展战略方法应用于其他慢性病，其中有两篇关于结核病的可持续发展战略的论文，从艾滋病毒服务提供中吸取教训，为设计和扩大提供信息。在离散选择实验（DCE）中，Strauss等人发现南非东开普省的结核病患者对DSD有强烈的偏好，有三种偏好——基于社区的、基于诊所的和群体模式[18]。Ferroussier-Davis等人介绍了乌干达通过不同的DSD模式获得护理和治疗的结核病患者的结果，证明了设施和社区DSD模式在艾滋病毒感染范围之外的可行性。第三个主题是将DSD模型扩展到经常被忽视的人群的需要和实际潜力。在Hicks等人的研究中，在肯尼亚实施风险评估工具以适应对感染艾滋病毒的青少年和年轻人的护理的结果表明，可以向感染艾滋病毒的青少年和年轻人提供低强度模型，而不会增加随访或病毒非抑制bb0的损失。在柬埔寨艾滋病毒流行率较低的环境中，Yam等人强调，在COVID-19期间实施的社区抗逆转录病毒治疗提供模式在减少艾滋病毒感染者身体健康状况下降方面具有成本效益。Bothma等人介绍了医疗工作者向跨性别客户交付DSD模型的经验[10]。由于跨性别客户在标准服务提供机构寻求治疗时仍然面临负面经历，因此它们表明需要量身定制的跨性别服务。这一证据在当前供资重点转移的环境下尤其重要，这对为关键人群提供以人为本的服务构成了重大威胁。来自澳大利亚的另一项DCE评估了同性恋、双性恋和其他男男性行为者的偏好，并强调了提供性健康和预防服务的不同偏好。除了Ong等人的工作外，PrEP的DSD是本增刊的最后一个主题，也是Musheke等人和Owidi等人的研究重点[24,25]。在赞比亚，Musheke等人强调了通过PrEP服务的分散化，将PrEP扩大到赞比亚的少女和年轻妇女。同样，Owidi等人提出了以药房为基础的PrEP规划的客户和提供者的
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引用次数: 0
“A cure might help, but it won't erase it all”: a qualitative study of policy challenges and priorities for long-term survivors of HIV in the United States “治愈可能会有所帮助，但它不会消除一切”：一项关于美国长期艾滋病幸存者的政策挑战和优先事项的定性研究
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-03 DOI: 10.1002/jia2.70006
Ali Ahmed, Jeff Taylor, Rachel Lau, Joyce Ching-Jung Lai, Sithara Deshan Diunugala, Michael Louella, Thomas J. Villa, William Freshwater, Dawn Averitt, Maile Karris, Jeff Berry, Lynda Dee, Karine Dubé

Introduction

Long-term survivors (LTS) of HIV, including individuals diagnosed before the availability of effective antiretroviral therapy (ART), have played a pivotal role in shaping the HIV response. Despite an increase in their number in the United States, their unique medical, social and economic challenges remain underrepresented in HIV policy and research, particularly in the context of HIV cure advancements. While an HIV cure may alleviate ART-related burdens, LTS fear unintended consequences, including the potential loss of critical social benefits, economic support and healthcare access. This study explores the policy priorities of LTS, addressing their current unmet needs and the broader implications of an HIV cure.

Methods

We conducted qualitative interviews with 32 LTS across diverse racial, gender and geographic backgrounds, recruited through community-based organizations and research networks from 2023 to 2024. Using inductive thematic analysis, we identified key policy concerns and recommendations based on participants’ lived experiences. Data collection continued until thematic saturation was reached.

Results

LTS emphasized four pressing policy domains: (1) Persistent Healthcare Disparities: Participants reported fragmented Medicare and Medicaid coverage, limited access to essential services (e.g. dental, vision and mental healthcare), and ongoing stigma and discrimination in healthcare settings. (2) Social and Economic Precarity: Housing instability, financial insecurity and employment barriers disproportionately affect LTS, many of whom face systemic barriers to re-entering the workforce. (3) Policy Implications of an HIV Cure: Participants voiced concerns that an HIV cure, while promising, could result in disqualification from disability and social assistance programmes, exacerbating socio-economic vulnerabilities. (4) Structural Reforms for LTS Inclusion: LTS underscored the urgent need for their direct involvement in HIV research, policy development and decision-making to ensure equitable, community-driven solutions.

Conclusions

Policymakers must address comprehensive healthcare access, economic stability and social protections for LTS of HIV. HIV cure research must not undermine existing benefits or widen disparities. Ensuring LTS representation in decision-making is critical to developing equitable policies that safeguard their wellbeing before and after a cure.

艾滋病毒长期幸存者（LTS），包括在获得有效抗逆转录病毒治疗（ART）之前被诊断出来的个体，在形成艾滋病毒反应方面发挥了关键作用。尽管他们在美国的人数有所增加，但在艾滋病毒政策和研究中，特别是在艾滋病毒治疗进展的背景下，他们独特的医疗、社会和经济挑战仍然没有得到充分体现。虽然治愈艾滋病毒可能减轻与抗逆转录病毒治疗有关的负担，但LTS担心意想不到的后果，包括可能失去关键的社会福利、经济支持和医疗保健机会。本研究探讨了LTS的政策重点，解决了他们目前未满足的需求以及治愈艾滋病毒的更广泛影响。方法我们对32名不同种族、性别和地理背景的LTS进行了定性访谈，这些LTS是在2023年至2024年间通过社区组织和研究网络招募的。通过归纳主题分析，我们根据参与者的生活经验确定了关键的政策关注点和建议。数据收集一直持续到专题饱和为止。结果LTS强调了四个紧迫的政策领域：(1)持续的医疗保健差距：参与者报告了支离破碎的医疗保险和医疗补助覆盖范围，获得基本服务（例如牙科，视力和精神保健）的机会有限，以及医疗保健环境中持续的耻辱和歧视。(2)社会和经济不稳定：住房不稳定、金融不安全和就业障碍对低收入人群的影响尤为严重，他们中的许多人在重新进入劳动力市场时面临系统性障碍。(3)艾滋病治愈的政策影响：与会者表示担心，艾滋病治愈虽然有希望，但可能导致残疾和社会援助计划的资格丧失，加剧社会经济脆弱性。(4)结构改革：LTS强调迫切需要直接参与艾滋病研究、政策制定和决策，以确保公平、社区驱动的解决方案。决策者必须解决艾滋病毒感染者获得全面医疗保健、经济稳定和社会保护的问题。艾滋病毒治愈研究绝不能破坏现有的益处或扩大差距。确保LTS在决策中的代表性对于制定公平的政策，保障他们在治疗前后的福祉至关重要。
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引用次数: 0
PrEP preferences and early acceptability of injectable cabotegravir among pregnant and lactating people in Cape Town, South Africa: findings from the PrEPared to Choose study 南非开普敦孕妇和哺乳期人群对注射卡波特韦的PrEP偏好和早期可接受性：来自“准备选择”研究的结果
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-02 DOI: 10.1002/jia2.26492
Nafisa Wara, Carey Pike, Elzette Rousseau, Pippa Macdonald, Pakama Mapukata, Bryan Leonard, Keitumetse Lebelo, Risa Hoffman, Catherine Orrell, Linda-Gail Bekker, Dvora Joseph Davey
<div> <section> <h3> Introduction</h3> <p>Providing pregnant and lactating people (PLP) with choice in HIV pre-exposure prophylaxis (PrEP) methods, including long-acting injectable cabotegravir (CAB-LA), may mitigate barriers to effective PrEP use. We evaluated PrEP preferences and acceptability among PLP offered CAB-LA versus oral PrEP in South Africa.</p> </section> <section> <h3> Methods</h3> <p>The PrEPared to Choose study in Cape Town, South Africa, enrolled young people ages 15–29 at one public clinic and one community-based mobile clinic. Using informed choice counselling, participants were offered oral PrEP or CAB-LA, with the option to switch methods at follow-up visits over 18 months. We report baseline CAB-LA and oral PrEP initiations among PLP in the study, acceptability of their initial choice within 3 months of enrolment and theoretical preferences regarding PrEP methods that may become available to PLP. We report descriptive statistics and use Chi-square and Fisher's exact to compare responses by initiated PrEP method and pregnancy status.</p> </section> <section> <h3> Results</h3> <p>From February to August 2024, we enrolled 58 PLP (<i>n</i> = 30 pregnant, <i>n</i> = 28 breastfeeding). Median age 23 years (IQR 19.5−26). Of 30 pregnant participants, 23 (77%) initiated CAB-LA and seven (23%) oral PrEP; among 28 breastfeeding participants, 25 (89%) initiated CAB-LA and three (11%) oral PrEP. Of enrolled PLP, 36 (62%, <i>n</i> = 13 pregnant, <i>n</i> = 23 breastfeeding) completed the acceptability survey. Of these, 83% (<i>n</i> = 12/13 pregnant, <i>n</i> = 20/23 breastfeeding) chose and received CAB-LA, and the remaining (<i>n</i> = 4) chose and received oral PrEP. PLP who received CAB-LA reported liking its ease of use (69%; <i>n</i> = 22/32) and long-acting protection (44%; <i>n</i> = 14/32). Half of CAB-LA users disliked side effects (e.g. injection site pain), although 41% of PLP (<i>n</i> = 13/32) described no CAB-LA dislikes. Almost all (97%; <i>n</i> = 31/32) PLP currently using CAB-LA were interested in continuing CAB-LA, and all PLP using oral PrEP reported interest in trying CAB-LA in the future. Eighty-six percent of surveyed PLP (<i>n</i> = 31/36) did not want to try the dapivirine vaginal ring.</p> </section> <section> <h3> Conclusions</h3> <p>PLP in South Africa had a strong preference for CAB-LA over oral PrEP, and CAB-LA was found to be highly acceptable. Further research is needed to evaluate the effect of offering choice of PrEP methods, including CAB-LA, on PrEP continuation among PLP.</p> </section>
为孕妇和哺乳期人群提供艾滋病毒暴露前预防（PrEP）方法的选择，包括长效注射卡波特韦（CAB-LA），可能会减轻有效使用PrEP的障碍。我们评估了南非提供CAB-LA和口服PrEP的PLP对PrEP的偏好和可接受性。方法“准备选择”研究在南非开普敦的一家公立诊所和一家社区流动诊所招募了15-29岁的年轻人。使用知情选择咨询，参与者被提供口服PrEP或CAB-LA，并在18个月的随访中选择切换方法。我们报告了研究中PLP的基线CAB-LA和口服PrEP开始，他们在入组3个月内的初始选择的可接受性以及关于可能适用于PLP的PrEP方法的理论偏好。我们报告了描述性统计数据，并使用卡方和Fisher精确值来比较初始PrEP方法和妊娠状态的反应。结果从2024年2月至8月，我们招募了58名PLP （n = 30名孕妇，n = 28名母乳喂养）。中位年龄23岁（IQR 19.5−26）。在30名怀孕参与者中，23名（77%）开始使用CAB-LA， 7名（23%）口服PrEP；在28名母乳喂养的参与者中，25名（89%）开始使用caba - la， 3名（11%）开始口服PrEP。在纳入的PLP中，36名（62%,n = 13名孕妇，n = 23名母乳喂养）完成了可接受性调查。其中，83% （n = 12/13孕妇，n = 20/23母乳喂养）选择并接受caba - la，其余（n = 4）选择并接受口服PrEP。接受caba - la的PLP报告喜欢其易于使用(69%；N = 22/32)和长效保护(44%；N = 14/32)。一半的CAB-LA使用者不喜欢副作用（例如注射部位疼痛），尽管41%的PLP （n = 13/32）没有描述CAB-LA不喜欢。几乎所有(97%；n = 31/32)目前使用CAB-LA的PLP有兴趣继续使用CAB-LA，所有使用口服PrEP的PLP报告有兴趣在未来尝试CAB-LA。86%的受访PLP （n = 31/36）不想尝试达匹维林阴道环。结论南非PLP患者对CAB-LA的偏好高于口服PrEP， CAB-LA可接受度高。提供PrEP方法选择（包括CAB-LA）对PLP患者持续PrEP的影响有待进一步研究。
{"title":"PrEP preferences and early acceptability of injectable cabotegravir among pregnant and lactating people in Cape Town, South Africa: findings from the PrEPared to Choose study","authors":"Nafisa Wara,&nbsp;Carey Pike,&nbsp;Elzette Rousseau,&nbsp;Pippa Macdonald,&nbsp;Pakama Mapukata,&nbsp;Bryan Leonard,&nbsp;Keitumetse Lebelo,&nbsp;Risa Hoffman,&nbsp;Catherine Orrell,&nbsp;Linda-Gail Bekker,&nbsp;Dvora Joseph Davey","doi":"10.1002/jia2.26492","DOIUrl":"https://doi.org/10.1002/jia2.26492","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;Providing pregnant and lactating people (PLP) with choice in HIV pre-exposure prophylaxis (PrEP) methods, including long-acting injectable cabotegravir (CAB-LA), may mitigate barriers to effective PrEP use. We evaluated PrEP preferences and acceptability among PLP offered CAB-LA versus oral PrEP in South Africa.&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;The PrEPared to Choose study in Cape Town, South Africa, enrolled young people ages 15–29 at one public clinic and one community-based mobile clinic. Using informed choice counselling, participants were offered oral PrEP or CAB-LA, with the option to switch methods at follow-up visits over 18 months. We report baseline CAB-LA and oral PrEP initiations among PLP in the study, acceptability of their initial choice within 3 months of enrolment and theoretical preferences regarding PrEP methods that may become available to PLP. We report descriptive statistics and use Chi-square and Fisher's exact to compare responses by initiated PrEP method and pregnancy status.&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;From February to August 2024, we enrolled 58 PLP (&lt;i&gt;n&lt;/i&gt; = 30 pregnant, &lt;i&gt;n&lt;/i&gt; = 28 breastfeeding). Median age 23 years (IQR 19.5−26). Of 30 pregnant participants, 23 (77%) initiated CAB-LA and seven (23%) oral PrEP; among 28 breastfeeding participants, 25 (89%) initiated CAB-LA and three (11%) oral PrEP. Of enrolled PLP, 36 (62%, &lt;i&gt;n&lt;/i&gt; = 13 pregnant, &lt;i&gt;n&lt;/i&gt; = 23 breastfeeding) completed the acceptability survey. Of these, 83% (&lt;i&gt;n&lt;/i&gt; = 12/13 pregnant, &lt;i&gt;n&lt;/i&gt; = 20/23 breastfeeding) chose and received CAB-LA, and the remaining (&lt;i&gt;n&lt;/i&gt; = 4) chose and received oral PrEP. PLP who received CAB-LA reported liking its ease of use (69%; &lt;i&gt;n&lt;/i&gt; = 22/32) and long-acting protection (44%; &lt;i&gt;n&lt;/i&gt; = 14/32). Half of CAB-LA users disliked side effects (e.g. injection site pain), although 41% of PLP (&lt;i&gt;n&lt;/i&gt; = 13/32) described no CAB-LA dislikes. Almost all (97%; &lt;i&gt;n&lt;/i&gt; = 31/32) PLP currently using CAB-LA were interested in continuing CAB-LA, and all PLP using oral PrEP reported interest in trying CAB-LA in the future. Eighty-six percent of surveyed PLP (&lt;i&gt;n&lt;/i&gt; = 31/36) did not want to try the dapivirine vaginal ring.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;PLP in South Africa had a strong preference for CAB-LA over oral PrEP, and CAB-LA was found to be highly acceptable. Further research is needed to evaluate the effect of offering choice of PrEP methods, including CAB-LA, on PrEP continuation among PLP.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 ","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26492","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524761","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
Strategies for implementing long-acting cabotegravir for PrEP in US clinics serving Black women: interim healthcare provider findings from the EBONI study 在美国为黑人妇女服务的诊所实施长效卡波特韦PrEP的策略：EBONI研究的中期医疗保健提供者发现
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-02 DOI: 10.1002/jia2.26497
Katherine L. Nelson, Tammeka Evans Cooper, Yolanda Lawson, Dylan Baker, Satish Mocherla, Megan Dieterich, Theo Hodge, Alftan Dyson, Denise Sutherland-Philips, Heidi Swygard, Lisa Petty, Peter Jeffery, Kenneth Sutton, Courtney Peasant Bonner, Sara M. Andrews, Samantha Chang, Piotr Budnik, Kimberly Smith, Annemiek de Ruiter, Maggie Czarnogorski, Nanlesta Pilgrim
<div> <section> <h3> Introduction</h3> <p>Long-acting cabotegravir (CAB LA) is the first LA agent approved for HIV pre-exposure prophylaxis. EBONI (NCT05514509) is a Phase 4 implementation study evaluating the implementation of CAB LA delivery to Black cis- and transgender (cis-and-trans) women in clinics located in the United States, including infectious disease (ID), primary care (PC) and women's health (WH) clinics. We present interim perspectives, considerations and strategies from healthcare professionals’ (HCPs’) experiences during the initial implementation stages of administering CAB LA.</p> </section> <section> <h3> Methods</h3> <p>From August 2022 to June 2024, through quantitative surveys (prior to implementation [baseline] and Month 4 [M4]) and/or structured qualitative interviews (M4), HCPs provided their perceptions and experiences of integrating CAB LA in their clinical settings that served Black cis-and-trans women. Monthly implementation monitoring (IM) calls were also conducted. Survey data were analysed using descriptive statistics. Qualitative and IM data were coded and analysed using a Framework Analysis approach grounded in the Consolidated Framework for Implementation Research.</p> </section> <section> <h3> Results</h3> <p>Ninety-two HCPs across 20 sites completed baseline and M4 surveys; 57% were cisgender female and 43% were Black. HCPs across clinic types developed innovative approaches to support CAB LA implementation, with few HCPs (< 10%) reporting concerns about practice preparation. Initial HCP considerations related to patient adherence, insurance verification and patient identification reduced by M4 (absolute % reduction: 5–14%; 5–9%; and 4–12%, respectively). HCPs across clinic types serving Black women reported successful implementation strategies, including addressing medical mistrust and patient miseducation, staff training and reminder or tracking systems. Useful implementation strategies unique to clinic types included using electronic medical records to document whether patients were offered CAB LA (PC), designating specific days for administering injections (WH) and creating time for discussion with patients (ID).</p> </section> <section> <h3> Conclusions</h3> <p>A range of strategies across clinics that routinely serve Black cis-and-trans women were used to support CAB LA implementation. Implementing CAB LA in clinical settings can be bolstered by addressing population-specific concerns, increasing staff/patient education about CAB LA and modifying clinical flows. Lessons learned in EBONI can help suppor
长效卡博特韦（CAB LA）是首个被批准用于HIV暴露前预防的LA药物。EBONI （NCT05514509）是一项4期实施研究，评估在美国诊所（包括传染病（ID）、初级保健（PC）和妇女健康（WH）诊所）向黑人顺性和跨性别（cis-and-trans）妇女提供CAB LA的实施情况。我们从医疗保健专业人员（HCPs）在管理CAB LA的初始实施阶段的经验中提出临时观点、考虑因素和策略。方法从2022年8月至2024年6月，通过定量调查（实施前[基线]和第4个月[M4]）和/或结构化定性访谈（M4）， HCPs提供了他们在为黑人顺性和变性女性服务的临床环境中整合CAB LA的看法和经验。还进行了每月执行监测电话。调查数据采用描述性统计进行分析。定性数据和IM数据使用基于实施研究统一框架的框架分析方法进行编码和分析。结果20个站点的92名HCPs完成了基线和M4调查；57%是顺性别女性，43%是黑人。不同临床类型的HCPs开发了支持CAB LA实施的创新方法，但很少有HCPs (<；10%)报告对练习准备的关注。与患者依从性、保险验证和患者识别相关的初始HCP考虑减少了M4(绝对减少百分比：5-14%；5 - 9%;和4-12%)。为黑人妇女服务的不同类型诊所的HCPs报告了成功的实施策略，包括解决医疗不信任和患者错误教育，员工培训和提醒或跟踪系统。诊所类型特有的有用实施策略包括使用电子病历记录是否向患者提供了CAB LA （PC）、指定注射的具体日期（WH）和创造与患者讨论的时间（ID）。结论：常规服务黑人顺性和变性女性的诊所采用了一系列策略来支持CAB LA的实施。在临床环境中实施CAB - LA可以通过解决特定人群的问题、增加工作人员/患者关于CAB - LA的教育和修改临床流程来加强。在EBONI中吸取的经验教训可以帮助支持黑人顺性和变性妇女未来的融合，并为各种临床环境提供有价值的见解。ClinicalTrials.gov编号NCT05514509
{"title":"Strategies for implementing long-acting cabotegravir for PrEP in US clinics serving Black women: interim healthcare provider findings from the EBONI study","authors":"Katherine L. Nelson,&nbsp;Tammeka Evans Cooper,&nbsp;Yolanda Lawson,&nbsp;Dylan Baker,&nbsp;Satish Mocherla,&nbsp;Megan Dieterich,&nbsp;Theo Hodge,&nbsp;Alftan Dyson,&nbsp;Denise Sutherland-Philips,&nbsp;Heidi Swygard,&nbsp;Lisa Petty,&nbsp;Peter Jeffery,&nbsp;Kenneth Sutton,&nbsp;Courtney Peasant Bonner,&nbsp;Sara M. Andrews,&nbsp;Samantha Chang,&nbsp;Piotr Budnik,&nbsp;Kimberly Smith,&nbsp;Annemiek de Ruiter,&nbsp;Maggie Czarnogorski,&nbsp;Nanlesta Pilgrim","doi":"10.1002/jia2.26497","DOIUrl":"https://doi.org/10.1002/jia2.26497","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;Long-acting cabotegravir (CAB LA) is the first LA agent approved for HIV pre-exposure prophylaxis. EBONI (NCT05514509) is a Phase 4 implementation study evaluating the implementation of CAB LA delivery to Black cis- and transgender (cis-and-trans) women in clinics located in the United States, including infectious disease (ID), primary care (PC) and women's health (WH) clinics. We present interim perspectives, considerations and strategies from healthcare professionals’ (HCPs’) experiences during the initial implementation stages of administering CAB LA.&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;From August 2022 to June 2024, through quantitative surveys (prior to implementation [baseline] and Month 4 [M4]) and/or structured qualitative interviews (M4), HCPs provided their perceptions and experiences of integrating CAB LA in their clinical settings that served Black cis-and-trans women. Monthly implementation monitoring (IM) calls were also conducted. Survey data were analysed using descriptive statistics. Qualitative and IM data were coded and analysed using a Framework Analysis approach grounded in the Consolidated Framework for Implementation Research.&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;Ninety-two HCPs across 20 sites completed baseline and M4 surveys; 57% were cisgender female and 43% were Black. HCPs across clinic types developed innovative approaches to support CAB LA implementation, with few HCPs (&lt; 10%) reporting concerns about practice preparation. Initial HCP considerations related to patient adherence, insurance verification and patient identification reduced by M4 (absolute % reduction: 5–14%; 5–9%; and 4–12%, respectively). HCPs across clinic types serving Black women reported successful implementation strategies, including addressing medical mistrust and patient miseducation, staff training and reminder or tracking systems. Useful implementation strategies unique to clinic types included using electronic medical records to document whether patients were offered CAB LA (PC), designating specific days for administering injections (WH) and creating time for discussion with patients (ID).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A range of strategies across clinics that routinely serve Black cis-and-trans women were used to support CAB LA implementation. Implementing CAB LA in clinical settings can be bolstered by addressing population-specific concerns, increasing staff/patient education about CAB LA and modifying clinical flows. Lessons learned in EBONI can help suppor","PeriodicalId":201,"journal":{"name":"Journal of the International AIDS Society","volume":"28 S2","pages":""},"PeriodicalIF":4.6,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jia2.26497","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524763","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
Finally, PrEP choices! But will clients ever have a choice? 最后，准备工作的选择！但客户有选择吗？
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-02 DOI: 10.1002/jia2.26505
Kimberly E. Green, Kenneth Ngure, Robyn Eakle, Nittaya Phanuphak, Jason Reed
<p>Ten years after the World Health Organization (WHO) recommended tenofovir disoproxil fumarate-based oral pre-exposure prophylaxis (PrEP) as an additional HIV prevention option, the world is, or rather should be, on the cusp of a biomedical HIV prevention choice revolution. Although oral PrEP scale-up started slow, particularly in low- and middle-income countries, uptake grew exponentially in Africa and elsewhere to 3.5 million people by 2023 [<span>1</span>]. The end of 2024 represented a convergence of excellence in HIV prevention science, large-scale country and community leadership in designing and delivering differentiated PrEP services, and visionary financing and programmatic commitment by the President's Emergency Fund for AIDS Relief (PEPFAR) and the Global Fund for AIDS, TB and Malaria (GFATM). By December 2024, two additional products, the dapivirine vaginal ring and long-acting injectable cabotegravir (CAB-LA), were newly available in 10 and 12 countries, respectively, and the PURPOSE-1 and -2 trials on a longer-acting injectable, lenacapavir (LEN), reported astounding near-perfect efficacy in preventing HIV [<span>2</span>].</p><p>Why is choice in PrEP products so anticipated? Several studies have measured substantial unmet PrEP need across populations and geographies when oral PrEP was the only option available. Unmet need is inclusive of those that report intention to start PrEP and/or who report risk factors but who remain PrEP naïve; those that discontinue PrEP but report continued need for PrEP; and individuals using oral PrEP but who prefer a different PrEP product type (e.g. a longer-acting option). These studies—such as PrEP APPEAL in the Asia-Pacific and a discrete choice study among women and girls in Kenya, Eswatini and South Africa—measured substantial unmet PrEP need among populations surveyed and preference for a long-acting product over oral PrEP [<span>3-5</span>]. Their authors theorized that where a choice in PrEP products was on offer, unmet need would be reduced, PrEP uptake and continuation would be increased, and HIV incidence would fall.</p><p>As CAB-LA and the ring were introduced into the PrEP method mix in countries like Brazil, South Africa and the United States, fairly consistent real-world PrEP uptake trends emerged indicating a pattern of strong preference for long-acting injectable PrEP (from 68% to 83% of individuals), and more modest preferences for oral PrEP (17–26%), and the ring (under 5% where included as a PrEP option) [<span>6-8</span>]. The Dynamic Choice HIV Prevention study in Kenya and Uganda found when services were optimized to provide product choice and service flexibility, PrEP uptake more than doubled. Offering a choice of both CAB-LA and oral PrEP resulted in 70% of participants opting for any biomedical HIV prevention compared to 13% in the standard of care arm—a 56% difference [<span>9</span>]. While in Brazil, 83% of participants opted for CAB-LA over oral PrEP as part of the ImPr
在世界卫生组织（世卫组织）推荐以富马酸替诺福韦二氧吡酯为基础的口服暴露前预防（PrEP）作为一种额外的艾滋病毒预防选择十年后，世界正处于，或者更确切地说，应该处于一场生物医学艾滋病毒预防选择革命的尖端。尽管口服预防PrEP的推广起步缓慢，特别是在低收入和中等收入国家，但到2023年，非洲和其他地方的接受人数呈指数增长，达到350万人。2024年底体现了艾滋病毒预防科学方面的卓越成果、大规模国家和社区在设计和提供差异化PrEP服务方面的领导作用，以及总统艾滋病紧急救援基金（PEPFAR）和全球艾滋病、结核病和疟疾基金（GFATM）富有远见的融资和规划承诺。到2024年12月，另外两种产品，达匹维林阴道环和长效注射用卡波特韦（CAB-LA），分别在10个和12个国家上市，长效注射用lenacapavir （LEN）的PURPOSE-1和2试验报告了惊人的近乎完美的预防HIV感染的疗效。为什么人们对PrEP产品的选择如此期待？几项研究测量了在口服PrEP是唯一可用选择的情况下，人群和地区大量未满足的PrEP需求。未满足的需求包括报告有意开始PrEP和/或报告危险因素但仍在进行PrEP的人naïve；停用PrEP但报告仍需继续使用PrEP的患者；以及使用口服PrEP但更喜欢其他PrEP产品类型（例如长效选择）的个人。这些研究——如亚太地区的PrEP APPEAL和肯尼亚、斯瓦蒂尼和南非妇女和女孩的离散选择研究——测量了被调查人群中大量未满足的PrEP需求，以及对长效产品的偏好超过口服PrEP[3-5]。他们的作者推测，在提供PrEP产品选择的地方，未满足的需求将减少，PrEP的吸收和持续将增加，艾滋病毒发病率将下降。随着CAB-LA和环式PrEP在巴西、南非和美国等国家被引入到PrEP方法组合中，现实世界中出现了相当一致的PrEP使用趋势，表明对长效注射PrEP的强烈偏好（从68%到83%的个体），对口服PrEP（17-26%）和环式PrEP的偏好较为温和（在作为PrEP选项时低于5%）[6-8]。在肯尼亚和乌干达开展的动态选择艾滋病毒预防研究发现，当服务得到优化以提供产品选择和服务灵活性时，预防措施的使用率增加了一倍以上。提供CAB-LA和口服PrEP两种选择导致70%的参与者选择任何生物医学艾滋病毒预防，而标准护理组的这一比例为13%，差异为56%。而在巴西，作为ImPrEP CAB研究的一部分，83%的参与者选择CAB- la而不是口服PrEP，选择CAB- la的人中有42%报告在前一个月没有使用过艾滋病毒预防。CAB-LA组的PrEP覆盖率为95%，而口服PrEP组为48 - 58%，使用CAB-LA的人群中没有艾滋病毒传播，而选择口服PrEP的人群的发病率在每100人年1.0至1.5人之间。重要的是，PrEP的选择也可能具有成本效益——最近在南非进行的一项建模工作发现，在口服PrEP的同时引入LEN具有成本效益，因为两者结合起来有可能更迅速地解决未满足的PrEP需求并减少新的艾滋病毒感染。毫无疑问，作为实现全民健康覆盖的总体努力的一部分，提供预防措施的选择是扩大预防覆盖面和实现到2030年降低艾滋病毒发病率的全球目标的一项非常有希望的战略。当前面临的挑战是，在当前金融危机的背景下，国内卫生资金在COVID大流行后已经受到限制，美国政府突然大规模终止对公共卫生和研究的捐助资金再次震惊。最终，放弃预防措施和对长效产品的需求将导致艾滋病毒发病率和成本的增加。全球卫生界准备加快口服和长效PrEP的选择，并推动以前难以捉摸的艾滋病毒新感染病例的下降。我们会交货吗？作者声明没有利益冲突。KEG设想了提出的想法。初稿由KEG撰写，所有其他作者修改和编辑了随后的草稿。所有作者都审阅了提交的最终稿。
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引用次数: 0
“People have options”: a qualitative study of experiences and influences of PrEP choice among women in South Africa “人们有选择”：对南非妇女选择预防PrEP的经验和影响的定性研究
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-02 DOI: 10.1002/jia2.26462
Siphokazi Dada, Faith Mary Musvipwa, Fatima Abegail Cholo, Melanie Pleaner, Alison Kutywayo, Vusile Butler, Catherine Elizabeth Martin, Saiqa Mullick
<div> <section> <h3> Introduction</h3> <p>Long-acting injectable cabotegravir and dapivirine vaginal ring were recently introduced in South Africa through demonstration projects, providing additional HIV prevention options to oral pre-exposure prophylaxis (PrEP). PrEP choice marks a pivotal moment in HIV prevention, potentially increasing PrEP uptake and use by offering women a choice of methods best suited to their individual needs. Understanding experiences of PrEP choice in real-world settings is critical to informing the introduction of PrEP choice at scale. This study, embedded within an implementation science study introducing new PrEP methods, explores women's experiences of PrEP choice counselling, and factors influencing PrEP choice.</p> </section> <section> <h3> Methods</h3> <p>Between April and May 2024, we conducted 12 focus group discussions with a sub-set of 126 women (18–57 years) enrolled in a parent cohort study delivering PrEP choice at six fixed and three roving mobile clinics in three areas of South Africa. Cohort participants are HIV-negative men and women ≥ 15 years interested in HIV prevention services. At the time of data collection, non-pregnant and lactating women ≥ 18 years enrolled in the cohort were provided PrEP choice counselling and offered a choice of oral PrEP or dapivirine vaginal ring. Discussions explored women's experiences of PrEP choice counselling and influences of PrEP choice. They were audio recorded, transcribed verbatim and translated into English for thematic analysis.</p> </section> <section> <h3> Results</h3> <p>Women reported positive choice counselling experiences, particularly when it was supplemented by pamphlets, demonstration rings and pelvic models. Participants valued learning about alternative PrEP methods and appreciated friendly healthcare providers who answered their questions. Privacy and emotional support were also crucial. However, negative experiences included the use of complex scientific jargon and insufficient information on PrEP's potential drawbacks. PrEP choices were mainly influenced by concerns about intravaginal products, distrust of new methods, prior oral PrEP experiences, and partner and family opinions.</p> </section> <section> <h3> Conclusions</h3> <p>These findings will guide strategies for PrEP delivery, emphasizing provider training, effective counselling tools and tailored communication. Women valued clear, jargon-free information, visual aids and a welcoming environment, which supported open dialogue. The influence of prior oral PrEP experiences on PrEP choice highli
南非最近通过示范项目引进长效注射卡博特韦和达匹维林阴道环，为口服暴露前预防提供了额外的艾滋病毒预防选择。预防措施的选择标志着艾滋病毒预防的关键时刻，通过为妇女提供最适合其个人需求的方法选择，有可能增加预防措施的接受和使用。了解在现实环境中选择预防措施的经验对于大规模采用预防措施至关重要。本研究是一项实施科学研究的一部分，该研究介绍了新的PrEP方法，探讨了妇女在PrEP选择咨询方面的经验，以及影响PrEP选择的因素。方法在2024年4月至5月期间，我们对126名妇女（18-57岁）进行了12次焦点小组讨论，这些妇女参加了一项父母队列研究，在南非三个地区的六个固定诊所和三个流动流动诊所提供PrEP选择。队列参与者为艾滋病毒阴性的男性和女性，年龄≥15岁，对艾滋病毒预防服务感兴趣。收集数据时，≥18岁的非怀孕和哺乳期妇女接受PrEP选择咨询，并可选择口服PrEP或达匹维林阴道环。讨论了妇女PrEP选择咨询的经验和PrEP选择的影响。它们被录音，逐字抄录并翻译成英语以供专题分析。结果妇女报告积极的选择咨询经验，特别是当它补充了小册子，示范环和盆腔模型。参与者重视学习替代性PrEP方法，并感谢友好的医疗保健提供者回答他们的问题。隐私和情感支持也很重要。然而，负面的经历包括使用复杂的科学术语和对PrEP潜在缺点的信息不足。对阴道内产品的担忧、对新方法的不信任、既往口服PrEP经验以及伴侣和家人意见是影响PrEP选择的主要因素。结论这些发现将指导PrEP的实施策略，强调提供者培训、有效的咨询工具和量身定制的沟通。妇女们重视清晰、无行话的信息、视觉辅助和支持公开对话的友好环境。先前口服预防措施经验对预防措施选择的影响突出表明，需要针对具体问题和偏好进行咨询。
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引用次数: 0
HIV-1 testing in the context of expanding PrEP modalities 扩大预防措施方式背景下的HIV-1检测
IF 4.6 1区 医学 Q2 IMMUNOLOGY
Journal of the International AIDS Society
Pub Date : 2025-07-02 DOI: 10.1002/jia2.26491
Urvi M. Parikh, Jana L. Jacobs, Njambi Njuguna, Kristine Torjesen, John W. Mellors

Introduction

Multiple effective antiretroviral-based pre-exposure prophylaxis (PrEP) modalities for HIV-1 prevention are now available or under investigation but their safe rollout requires implementable HIV-1 testing strategies that accurately identify rare cases of HIV-1 acquisition. Current PrEP testing guidelines and testing algorithms in PrEP studies are varied, using single or combinations of rapid antibody-based diagnostic testing, qualitative or quantitative nucleic acid testing, and/or sample collection for retrospective analyses with sensitive research assays for HIV-1 nucleic acid detection. The objective of this commentary is to summarize current and alternative HIV testing approaches for PrEP implementation to guide best practices for individual programmes.

Discussion

Diagnosing HIV-1 in PrEP users is challenging because (1) rarity of breakthrough HIV-1 in individuals on PrEP that increases the risk of a false-positive test; (2) modification of acute HIV infection by PrEP; and (3) PrEP delivery in community settings with inadequate testing infrastructure. Current best practices indicate the use of rapid diagnostic tests or self-testing as recommended by national testing algorithms and the World Health Organization (WHO). The use of nucleic acid testing such as plasma HIV-1 RNA polymerase chain reaction may allow earlier detection of HIV-1 but feasibility and risk of false positive are downsides. Sensitive tests to detect single-copy HIV-1 RNA in plasma and integrated proviral DNA in blood mononuclear cells may be important methods to resolve ambiguous HIV-1 diagnosis in research settings. Delayed diagnoses could lead to drug resistance emergence under long-acting PrEP selection, whereas single unconfirmed false-positive tests could create diagnostic challenges in users of long-acting PrEP. The cost, feasibility and positive predictive value of HIV tests are important considerations for PrEP programmes.

Conclusions

Optimal strategies to detect HIV-1 acquisition among users of different PrEP modalities are evolving. While new guidance from the WHO recommends HIV-1 testing by serological assays or self-testing with PrEP use, feasible plans for clinical management of rare cases of breakthrough on PrEP and ambiguous diagnoses are still needed. The data from PrEP studies and scale-up will help us assess the value of different tests and testing approaches for their inclusion in HIV detection algorithms across PrEP modalities.

针对HIV-1的多种有效的基于抗逆转录病毒的暴露前预防（PrEP）模式现已可用或正在研究中，但其安全推广需要可实施的HIV-1检测策略，以准确识别罕见的HIV-1感染病例。目前PrEP研究中的PrEP检测指南和检测算法各不相同，使用单一或组合基于抗体的快速诊断检测、定性或定量核酸检测和/或样品收集进行回顾性分析，并采用敏感的研究分析方法进行HIV-1核酸检测。本评论的目的是总结目前和替代的预防措施实施艾滋病毒检测方法，以指导个别规划的最佳做法。在PrEP使用者中诊断HIV-1是具有挑战性的，因为(1)在PrEP患者中很少有突破性的HIV-1，这增加了假阳性检测的风险；(2) PrEP对急性HIV感染的修饰作用；(3)在检测基础设施不足的社区环境中提供预防措施。目前的最佳做法表明，按照国家检测算法和世界卫生组织（世卫组织）的建议，使用快速诊断检测或自我检测。核酸检测的使用，如血浆HIV-1 RNA聚合酶链反应，可能允许早期检测HIV-1，但可行性和假阳性的风险是缺点。检测血浆中单拷贝HIV-1 RNA和血液单核细胞中整合前病毒DNA的敏感试验可能是解决研究环境中HIV-1诊断不明确的重要方法。在选择长效PrEP时，延迟诊断可能导致耐药性的出现，而单次未经证实的假阳性检测可能给长效PrEP使用者带来诊断挑战。艾滋病毒检测的成本、可行性和阳性预测值是PrEP规划的重要考虑因素。结论在不同PrEP方式的使用者中检测HIV-1感染的最佳策略正在演变。虽然世卫组织的新指南建议通过血清学检测或使用PrEP进行自我检测来检测HIV-1，但仍然需要制定可行的计划，对PrEP取得突破的罕见病例和诊断不明确的病例进行临床管理。来自PrEP研究和扩大规模的数据将帮助我们评估不同检测和检测方法的价值，以便将其纳入跨PrEP模式的艾滋病毒检测算法。
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