AIDS and Behavior

BackgroundWomen comprise 19% of new HIV infections in the U.S. Many women, particularly women of color, are unaware of pre-exposure prophylaxis (PrEP) as an HIV prevention option. We conducted a pilot randomized controlled trial (RCT) to assess feasibility and acceptability of a theory-based, contextually-relevant behavioral intervention, Just4Us, to promote PrEP initiation and adherence among women in New York City and Philadelphia. MethodsEligibility criteria included: cisgender women, aged 18-55, not living with HIV, not currently taking PrEP, and meeting PrEP eligibility guidelines. Participants were randomized 3:1 to the Just4Us Education and Activities (E&A) arm or to the Information arm (Info); all were provided with PrEP information and a referral list. E&A arm participants received an individually-delivered session with a counselor-navigator, who provided information, motivation enhancement, skills-building, problem-solving, and referrals. Between baseline and 3-month follow-up, E&A arm participants received phone calls to support linkage to care and text-messages to promote adherence. Feasibility and acceptability were assessed. ResultsEighty-three women were enrolled (61 intervention; 22 Info); 79% were Black, 26% Latina, exceeding diversity and enrollment targets. Attendance rate for the initial E&A and Info intervention session was 100%. Three-month retention rate was high at 90%. E&A arm participants reported feeling "very satisfied/satisfied with the following: overall session, 95%; discussion with counselor-navigator, 97%; tablet activities, 95%; text-messaging set-up, 93%.; and video, 90%. Among Info and E&A arms, 78% felt the session length was just right, and 95% stated that they would recommend/strongly recommend Just4Us to others. ConclusionsThe pilot RCT demonstrated feasibility and acceptability of the Just4Us E&A intervention, a promising intervention to increase uptake of PrEP among cisgender women. The team was able to recruit, implement the interventions with a high degree of fidelity, and retain the target number of PrEP-eligible socially disadvantaged women. Overall, participant feedback indicated they were generally very satisfied with their intervention.

ObjectiveThe aim of this systematic review is to provide some evidence on the use of mobile phone communication for improving ARV adherence during pregnancy, as well as to investigate whether text messaging on mobile phones could improve follow-up in HIV-exposed infants. MethodsWe did a systematic review and meta-analysis, using CENTRAL (Cochrane Central Register of Controlled Trials), Scopus, MEDLINE via PubMed, Web of Science, and CINAHL to search for studies in English published between 5 may 2016 to May 2021 that assessed the effects of mobile phone in HIV-infected pregnant women. We used MetaPro version 3.0 to compute the OR and RR and their 95%CI. We performed random-effects model meta-analysis for estimating pooled outcomes. ResultsNine studies were included in the meta-analysis. The pooled maternal post-partum retention was (OR 2.20, 95%CI: 1.55 - 3.13, I2 = 53.20%, P < 0.001). In the same line, the pooled odds of ART uptake was (OR 1.5, 95%CI: 1.07-2.11, I2 =0%, P = 0.020) and we found statistically significant impact of mobile phone on HIV testing at 6 weeks and above among HIV exposed children (OR 1.89, 95%CI: 1.04 - 3. 48, I2 = OR 1.89, 95%CI: 1.04 - 3. 48, I2 =88.04%, P = 0.032). ConclusionIn comparison to our previous review, this updated review focuses on moderate evidence for mobile phone communication in HIV-infected pregnant women. The results showed that using a mobile phone improved maternal post-partum retention, ART uptake, and infant HIV testing at 6 weeks and older.

BackgroundAdolescents with perinatally acquired HIV in India experience a high burden of stigma and mental health distress alongside gendered social constraints that limit participation in supportive programs. While physical activity-based psychosocial interventions show promise for improving adolescent mental health, little is known about how gender norms and intersecting vulnerabilities shape engagement and outcomes among this population. This study examined gender-specific patterns of participation and associations with mental health in a peer-led running intervention in southern India using intersectionality and self-determination theory. MethodsWe conducted a convergent parallel mixed-methods evaluation between March-April 2024 among 150 adolescents and young adults with perinatally acquired HIV enrolled in a physical activity intervention (Positive Running) in Karnataka and Tamil Nadu. Surveys assessed sociodemographic characteristics, viral suppression, intervention adherence, and common mental health disorders using validated screening tools for depression (PHQ-9) and anxiety (GAD-7). Gender-disaggregated comparisons used Fishers exact tests, and logistic regression estimated prevalence odds ratios for common mental health disorders by intervention adherence. Qualitative data included four age- and gender-stratified focus group discussions (n=28) with participants, and four in-depth interviews with peer implementers. Transcripts were thematically analyzed using grounded theory and Braun & Clarkes framework. ResultsAmong 150 participants (100 males, 50 females; median age 17 years [IQR 15-19]), 91% were virally suppressed. Mean adherence to the intervention was 64%, with high attendance ([&ge;]65%) significantly lower among females than males (20% vs 57%, p<0.001). Overall, 59% screened positive for at least one common mental health disorder; with higher prevalence among females than males for depression (66% vs 43%, p=0.009), and for any mental health condition (72% vs 52%, p=0.022). Higher intervention adherence was associated with lower odds of common mental disorder overall (OR 0.44, 95% CI 0.23-0.85). In age-adjusted, gender-stratified analyses, this association was significant among males (aOR 0.33, 95% CI 0.14-0.75) but not among females. Qualitative findings identified gendered barriers to participation, including restrictive norms, modesty expectations, stigma toward women in sport, and limited decision-making autonomy. Self-determination theory-informed analyses highlighted how structured training, peer mentorship, and visible female role models supported autonomy, competence, and relatedness, while also revealing constraints that attenuated mental health gains for girls. ConclusionsPeer-led, community-embedded physical activity interventions are feasible among adolescents and young adults with perinatally acquired HIV and may confer mental health benefits, though participation effects are gender-differentiated. Findings underscore the need for gender-responsive, autonomy-supportive program designs that address intersectional vulnerabilities to ensure equitable mental health impact, particularly for adolescent girls and young women.

IntroductionGood nutrition in People Living with HIV (PLHIV) has a good influence on treatment outcomes and in turn a better quality of life. Despite, the significant role it plays, many patients have limited access to Nutritional Assessment Counselling and Support (NACS). We evaluated undernutrition in people living with HIV and associated factors in Muchinga Province, Zambia, from October 2019 to March 2020. Material and MethodsThis was secondary analysis of routine program data of HIV-positive clients on ART enrolled at EQUIP-supported health facilities in Muchinga. Undernutrition was determined using body mass index (BMI) calculations and classified as undernutrition (<18.5 kg/m2), normal (18.5 - 24.9 kg/m2) or over-nutrition (overweight, 25 - 29.9 kg/m2 and obese, 25 - 29.9 kg/m2). Multivariate-adjusted odds ratios (aOR) were used to assess factors associated with undernutrition. ResultsOf the 506 eligible clients under NACS, the mean age was 34.9 years {+/-} 13.5SD, with 251 (approximately 50%) between the ages of 21 - 39 years. More than half (67%) were females, 284 (56%) were urban residents, and 180 (35.6 %) were unemployed. The majority (approximately 71%) were on the TLE regimen with a median duration on ART treatment of [~]3 years (IQR=1- 6). There were 233 (46%) who had a normal BMI, 191 (37.7%) who had under-nutrition, and 82 (16.2%) who had over-nutrition (9.7% overweight: 6.5% obesity). Clients in the urban area (aOR= 2.0; 95%CI: 1.28 - 3.1), unemployed (aOR= 2.4 (1.18-4.69)2.4; 95%CI: 1.18 - 4.69), married (aOR= 2.3; 95%CI: 1.26 - 4.38) and being on TLD (aOR= 2.8; 95%CI: 1.23 - 6.23) were more likely to be under-nourished. ConclusionNACS played a vital role in identifying HIV-positive clients who required more specialized care for improved clinical health outcomes. There is a need to strengthen HIV and nutrition integration in low-resourced countries with high HIV burden for improved treatment outcomes and quality of life.

BackgroundThe prevalence of HIV is higher in the transgender population. Recently, the preexposure prophylaxis (PrEP) intervention has been proven successful in reducing HIV acquisition in trials among men who have sex with men (MSM), and heterosexual couples. This research aims to investigate the adherence to PrEP by HIV-negative transgender women (TW). MethodsWere followed the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA Statement. Research in WoS, Ovid, Scopus, MEDLINE, and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases for studies that involved HIV-negative TW population and focused on their adherence to PrEP intervention and condom use after the treatment. Results11 studies were included. TW sample sizes were low in comparison to the total sample, which often included men who have sex with men (MSM) population. The participation and adherence to the intervention was low compared to MSM, and it was measured mainly by self-report (72.7%) or by Tenofovir-diphosphate (TFV-DP)/ Emtricitabine triphosphate (FTC-TP) dried blood spot (DBS) (45.5%). ConclusionsIt is important to increase awareness and explain the effect of PrEP on feminizing hormone therapy at the beginning of the trials. Nevertheless, the low adherence may be affected by the interaction between drugs and the barriers faced to use the health services.

BackgroundThe Teaching, Raising, And Communicating with Kids (TRACK) intervention full-scale longitudinal efficacy trial was published in 2021 and was based on a previously successful pilot intervention published in 2011. The TRACK intervention assists mothers living with HIV (MLH) with serostatus disclosure to their young children. In the publication reporting the full-scale trial, TRACK MLH were four times more likely to disclose their HIV serostatus than controls, with the rate increasing to six times more likely applying GEE logistic regression. Intervention MLH showed improvements in communication, social support, family routines, and disclosure self-efficacy; they also demonstrated decreased anxiety and better physical and mental health scores; and their children reported significantly more decline in worry than controls. MethodsThis preprint presents recent analyses showing increases in the reported HIV disclosure rates over and above those reported in the full-scale trial, due to additional follow-up datapoints received after the 2021 publication. ResultsFor MLH in the intervention group, disclosure is 37.6% compared to 34.1% from the 2021 publication, and 12.1% in the control condition compared to 11%. Odds of disclosing if participants were in the intervention group are 4.39 (95% CI. = 2.0, 9.5) compared to 4.20 (95% CI. = 1.8, 9.3), with the intervention group 30% more likely to disclose compared to the 28% reported in 2021. Regarding site disclosure rates for the intervention group, the California disclosure rate is 43.6% compared to 35.9% previously reported; Georgias site rate remained unchanged. ConclusionsThese updates are now included in our final analysis dataset and show the intervention was more successful than previously reported.

BackgroundHeavy drinking among People Living With HIV (PLWH) reduces antiretroviral adherence and worsens health outcomes. Lengthy interventions to reduce drinking and improve adherence are not feasible in most HIV primary care settings, and patients seldom follow referrals to outside treatment. Utilizing visual and video features of smartphone technology, we developed and tested HealthCall as an electronic (smartphone) means of increasing patient involvement in brief intervention to reduce drinking and improve medication adherence without making unfeasible demands on providers. MethodsAlcohol-dependent patients at a large urban HIV clinic were randomized to one of three groups: (1) Motivational Interviewing (MI) plus HealthCall (n=39), (2) NIAAA Clinicians Guide (CG) plus HealthCall (n=38), or (3) CG-only (n=37). Baseline interventions targeting drinking reduction and medication adherence were [~]25 minutes, with brief (10-15 min) booster sessions at 30 and 60 days. HealthCall involved daily use of the smartphone for 3-5 min/day, covering drinking, medication adherence, and other aspects of the prior 24 hours. Our outcome, assessed at 30 and 60 days, and 3, 6 and 12 months, was ART adherence (using unannounced phone pill-count method; possible adherence scores: 0%-100%). Analysis: generalized linear mixed models with pre-planned contrasts. ResultsStudy retention was excellent (85%-94% across timepoints) and unrelated to treatment arm or patient characteristics. ART adherence was generally high throughout follow-up, with some decline by 12 months. Although both CG+HealthCall and MI+HealthCall evidenced benefits early in follow-up, by 6 months, ART adherence was 11% better among patients in CG+HealthCall than in CG-only (p=0.03) and 9% better than among patients in MI+HealthCall (p=0.07). Efficacy differed slightly by gender (p=.09). ConclusionHealthCall paired with CG resulted in better ART adherence than CG alone. MI+HealthCalls early benefits diminished over time. Given the importance of ART adherence and drinking reduction among PLWH, and the low costs and time required for HealthCall, pairing HealthCall with brief interventions within HIV clinics merits widespread consideration.

IntroductionEffective health communication is important for promoting adherence to antiretroviral therapy (ART). During counselling sessions with people living with HIV (PLHIV) who are initiating or re-initiating ART, we assessed whether a simple visual aid using bead bottles to explain the concept of viral suppression resulted in changes in HIV treatment literacy. MethodsAt three public sector clinics in KwaZulu-Natal KZN) province, South Africa, we enrolled adults who tested HIV-positive and were newly initiating ART or re-engaging in HIV care. Trained HIV counsellors used bottles with coloured beads ("B-OK bottles") to explain concepts related to viral load, viral suppression, and undetectable=Untransmittable (U=U). We assessed participants knowledge, attitudes, and perceptions about ART before and after counselling. ResultsBetween November 2022 and January 2023, we enrolled 80 PLHIV. Participants median age was 32 years (IQR: 24-41) and 58% were male. After receiving counselling with the B-OK bottles, understanding of U=U increased from 6% to 99% and understanding of viral suppression increased from 20% to 99%. Confidence in the protective effects of ART increased (64% to 100% for ones own health; 58% to 94% for transmission to partners) and was observed among participants both initiating ART and re-engaging in care. The number of participants agreeing that viral suppression means their sexual partners are safe from HIV even without condoms increased from 14% to 93% p-value =0.0. However, 65% still expressed worry that ART does not completely eliminate the risk of sexually transmitting HIV. ConclusionsUse of B-OK bottles during ART counselling was acceptable and increased HIV treatment literacy. While there was no significant effect on level of confidence in complete elimination of transmission risk when virally suppressed, we observed a significant reduction in concern about transmitting HIV and an increase in confidence in the protective effects of ART. Clinical Trial Number (SANCTR)DOH-27-092022-8067

BackgroundLow uptake and high discontinuation rates remain major obstacles to realizing the potential of Pre-Exposure Prophylaxis (PrEP) in changing the trajectory of the HIV epidemic in sub-Saharan Africa. Evidence on how PrEP could be successfully delivered has thus far mainly focused on key target groups rather than the general adult population. Set in the HIV-hyperendemic country of Lesotho, which is currently rolling out PrEP for the general adult population, this study aimed to determine stakeholders views on which are the most important barriers and most promising interventions to achieving high PrEP uptake and continuation. Methods and findingsWe conducted a card sorting and ranking exercise with 155 local stakeholders to identify key barriers and interventions. Stakeholders were a purposive sample of PrEP policy makers and implementing partners (n=7), healthcare providers (n=51), and end-users (n=97). End-users included adults who were currently using PrEP (n=55), formerly using PrEP (n=36), and were offered PrEP by a healthcare provider but declined (n=6). Participants sorted pre-selected interventions and barriers to PrEP coverage into three piles - most, somewhat, and least important. After sorting, participants ranked interventions and barriers in the "most important" piles in ascending order of significance. Ranked preferences were analyzed as voting data to identify the smallest set of candidates for which each candidate in the set would win a two-candidate election against any candidate outside the set. Participants viewed a lack of PrEP awareness as the most important barrier to PrEP uptake for women, and a fear of HIV testing for men. Community-based HIV testing was ranked as the most promising intervention to improve PrEP uptake for both men and women. Perceived or experienced stigma was seen as an important barrier for PrEP continuation for both men and women, with an additional important barrier for men being daily activities that compete with the time or mental bandwidth needed to take a daily pill. Adherence counseling and multi-month PrEP prescriptions were seen as the most promising interventions to improve PrEP continuation. ConclusionsOur findings suggest community-based activities that generate PrEP demand (community-based HIV testing and mass media campaigns), reinforced with facility-based follow-up (counseling and multi-month prescription) could be promising interventions to improve PrEP uptake and continuation in PrEP programs that are aimed at the general adult population. The views of the wide range of stakeholders that participated in this study could provide a useful starting point for design and implementation choices of PrEP delivery programs for the general adult population.

BackgroundAs infant feeding guidelines in the United States evolve to include shared decision-making approaches for pregnant and postpartum people with HIV (PP-PWH), lactation consultants (LCs) play an increasingly critical role in providing informed, compassionate support for breastfeeding/chestfeeding. However, limited knowledge and persistent stigma may hinder their preparedness and willingness to support PP-PWH in achieving their feeding goals. MethodsWe conducted a cross-sectional mixed-methods survey among 207 certified LCs in the United States and Canada. Quantitative data assessed HIV-related knowledge, stigma, and willingness to support breastfeeding in PP-PWH using adapted and validated instruments. Qualitative data from open-ended responses were thematically analyzed using the Health Stigma and Discrimination Framework. ResultsParticipants demonstrated high general HIV knowledge (Mean = 9.29/10) but only moderate HIV breastfeeding knowledge (Mean = 10.8/21). Those with recent experience supporting PP-PWH in breastfeeding had significantly higher HIV breastfeeding knowledge (p < 0.001). Stigma levels were generally low, but stigma was significantly associated with more restrictive attitudes toward breastfeeding (p < 0.001). Qualitative findings revealed that LC willingness to support PP-PWH was shaped by perceived risks, personal comfort levels, professional ethics, understanding of transmission prevention, and systemic supports. Many emphasized respect for parental autonomy, nonjudgmental care, and the need for updated education and policy clarity. ConclusionLCs are motivated to support PP-PWH but face knowledge gaps and institutional barriers that must be addressed. Integrating targeted education, stigma reduction strategies, and peer-supported tele-lactation models may enhance LC confidence and improve equitable, person-centered care for families affected by HIV.

We piloted a Motivational Interviewing (MI) training program for lay counsellors in South Africa (SA) to assess its impact on retention and viral suppression among newly diagnosed individuals living with HIV (PLHIV) at 12 months post-diagnosis. We randomized eight primary healthcare clinics (PHC) in Johannesburg to either the intervention clinics (n=4) where all lay counsellors were supported for 12 months before the PLHIV enrolment or the standard of care (n=4 clinics). Overall, 548 adults ([&ge;] 18 years) PLHIV were recruited after HIV diagnosis from March 2020 to August 2021 (n=291 intervention, n=257 control). We conducted Poisson regression modelling to assess the intervention effect on patient attendance status (out of care - being [&ge;]28 days late for the last appointment) and viral suppression (<50 copies/ml) at 12 months, reporting risk ratios (RR) with 95% confidence intervals (CIs). Of the 548 eligible participants enrolled, 56.3% were [&ge;]28 days late (52.9% intervention vs 60.9% controls, RR 0.9, 95% CI: 0.7-1.0). Retention at 12 months positively correlated with baseline counselor MI skill levels (Cultivating change talk, RR 1.6, 95%CI: 1.1-2.5; Softening sustain talk, RR 1.5, 95%CI: 0.8-2.9; Empathy, RR 1.4, 95%CI: 1.0-1.8; Partnership RR 1.5, 95%CI: 1.2-1.9). Among those retained at 12 months, 65.3% of intervention participants were virally suppressed compared to 49.3% controls (RR 1.3, 95%CI: 1.0-1.7). Compared to control participants, the intervention group reported more positive counseling experiences, fewer concerns about HIV disclosure (RR 0.8 for high vs low-medium concerns, 95% CI: 0.7-1.0) and ART (RR 0.8, 95% CI: 0.7-1.0), and were more likely to express high confidence to take treatment in public (47.4% vs 28.8%, RR 1.4, 95% CI: 1.0-1.8) after counselling.

BACKGROUNDSouth Africa rolled out Universal Test-and-Treat (UTT) in 2016, extending treatment eligibility to all persons living with HIV (PLHIV). Through this study, we sought to understand the experience of people living with HIV in the UTT era in South Africa. METHODSIn May 2021, we conducted in-depth interviews (IDI) (N = 27) with adult ([&ge;] 18 years) PLHIV referred by HIV counsellors at three peri-urban primary healthcare clinics. We also conducted three focus group discussions (FGDs) (N = 27) with adult PLHIV recruited from clinics or from civil society organisations through snowball sampling. Follow-up interviews were conducted with 29 IDI and FGD participants, to gain a deeper understanding of their journey living with HIV. Participants were asked to reflect on their HIV diagnosis, what their HIV status meant to them in light of the UTT era and how, if at all, being HIV-positive affected their lives. Interviews and focus group discussions were audio-recorded, transcribed, translated to English, and analysed thematically. RESULTSThe study included 4 men and 23 women recruited from clinics and 12 men and 16 women recruited from civil society (total N= 54). Participants reported that PLHIV could live a long life with antiretroviral therapy (ART) and that ART was widely accessible. However, they reported that HIV elicited feelings of guilt and shame as a sexually transmitted disease. Participants used the language of "blame" in discussing HIV transmission, citing their own reckless behaviour or blaming their partner for infecting them. Participants feared transmitting HIV to others and felt a responsibility to avoid transmission. To manage transmission anxieties, participants avoided sexual relationships, chose HIV-positive partners, and/or insisted on using condoms. Many participants feared - or had previously experienced - rejection by their partners due to their HIV status and reported hiding their medication, avoiding disclosure to their partners, or avoiding relationships altogether. Most participants also reported having low to no knowledge about treatment-as-prevention (TasP). Participants who were aware of TasP expressed less anxiety about transmitting HIV to others and greater confidence in having relationships. CONCLUSIONDespite the normalization of HIV as a chronic disease, PLHIV still experience transmission anxiety and fears of rejection by their partners. Disseminating information on treatment-as-prevention could reduce the psychosocial burdens of living with HIV, encourage open communication with partners, and remove barriers to HIV testing and treatment adherence.

Developing a safe, effective HIV vaccine remains important for the control of the epidemic. However, the development and testing of such a vaccine faces a range of social and behavioural challenges including potential stigmatisation, leading to non-disclosure of trial participation. We explored disclosure of participation in an HIV PrEP and vaccine trial to understand its effect on participant engagement. Between 22 September 2021 and 8 August 2023, 5% (30) of individuals in an HIV vaccine trial (PrEPVacc trial [NCT04066881]) were purposively selected for repeat in-depth interviews at 2, 6 and 12 months of participation in the trial. Forty-five other individuals took part in six focus group discussions, divided equally by gender, with each group comprising 6 to 10 participants. Experiences with vaccination, motivation to participate, and disclosure of participation were explored. Data were analysed thematically using a manual framework analysis approach. Disclosure was reported to enhance participation. Participants disclosed to friends, sexual partners, family members, and employers. Reasons for disclosure included a desire to participate openly and comfortably, to gain others support including financial and physical, and to motivate others. Men and younger participants disclosed more readily than women and older participants. Concerns like fear of being suspected of infidelity or having HIV, blame, and relationship breakages hampered disclosure. A lack of confidence in explaining what the study was about prevented disclosure, as a failure to explain attracted negative reactions including disapproval. As participants gained confidence in the study, approval and support from others improved. Participants who disclosed their participation tended to adhere to study requirements better and encountered less discomfort about taking part, or fear of potential social harm. Successful HIV vaccine trial participation calls for proactive public engagement and awareness campaigns. Disclosure by study participants to significant others about taking part could increase participation, strengthen retention and adherence.

BackgroundThe universal test-and-treat (T&T) policy has improved HIV outcomes but may influence hypertension (HTN) risk due to prolonged antiretroviral therapy (ART) exposure. We compared HTN prevalence and risk factors among PLHIV before and after T&T implementation in Zambia. MethodsA retrospective cohort study analyzed 6,409 PLHIV (2,920 pre-T&T and 3,489 post-T&T) from 12 Southern Province districts. Data on demographics, ART regimens, blood pressure, and laboratory measures were extracted from electronic (SmartCare) and paper records. Multivariable logistic regression identified HTN-associated factors (p<0.05). ResultsHTN prevalence increased from 8.8% pre-T&T to 10.2% post-T&T. Each year of age increased HTN odds by 5-6% in both cohorts (adjusted odds ratio [AOR]: 1.06 pre-T&T, 1.05 post-T&T p<0.0001). Urban residence was protective (AOR: 0.72 pre-T&T, 0.67 post-T&T p[&le;]0.041), while males had higher HTN risk than females (12.2% vs. 8.8% post-T&T p=0.0015). Post-T&T, higher hemoglobin marginally increased HTN odds (AOR: 1.08; p=0.049). INSTI-based regimens rose from 26.3% to 41.5% post-T&T but showed no significant association with hypertension on multivariate analysis. Rural residents had higher HTN prevalence (11.5% vs. 8.4% urban post-T&T p=0.0027). ConclusionsHTN prevalence increased post-T&T, and was driven by aging and potentially ART-related metabolic effects. Urban residence was unexpectedly protective, possibly due to better healthcare access. The hemoglobin-HTN link post-ART warrants further study. Strengths include a large, representative sample, though unmeasured confounders (e.g., lifestyle factors) and retrospective design limit causal inferences. Integrated HTN screening in HIV programs is critical to address this growing burden.

IntroductionParenting can be a detriment for selfcare among people living with HIV (PLWH) out of concern for their childrens futures and responsibilities that may limit attendance to health services. We explored the association between having children <20 years-old and viral suppression in PLWH. MethodsRetrospective cohort study from secondary data of PLWH enrolled at the largest HIV program in Lima between 2012-2018. We established parenthood by participant self-report children <20 years-old at enrollment, with additional data gathered for PLWH who reported a child born during the first year after enrollment. The main outcome was viral suppression (<400 copies/mL) by the end of follow-up. We conducted Cox regression analyses for repeated events, censoring at time of death or lost to follow-up. We built the final model by backward stepwise regression including potentially important variables and those with p-value [&le;] 0.20 in bivariate analyses, presenting hazard ratios (HR), adjusted HR (aHR), and 95% confidence intervals (CIs). ResultsIn 3170 PLWH, median age at enrollment was 31.6 years (range 17.9-76.1), 79.8% were men and 27.2% reported having children <20 years-old (median=2). At end of follow-up (8766.6 person-years), 534 (62.0%) were virally suppressed. In our final multivariate model, having children <20 years-old (aHR 3.53; [95% CI] 1.88 - 6.62) and the birth of a child during the first year after enrollment in the program (HR 1.81; [95% CI] 1.30 - 2.50) were independently associated with lack of viral suppression by end of follow-up. Based on health status of the PLWH, we estimated 70% and 69% of children to be at risk of maternal and paternal orphanhood, respectively. ConclusionIn our setting, being a parent was associated with lower probability of viral suppression, creating a risk of orphanhood for children of PLWH. Family support services may facilitate HIV care and help PLWH maximize viral suppression.

Background: Retention to care and viral load suppression are essential components for effective HIV management, particularly among adolescents and young adults aged 15-24 years, who remain vulnerable to treatment challenges. This study aimed to assess factors associated with poor retention in care and viral load suppression among young people receiving antiretroviral therapy (ART) at Mpilo Centre of Excellence (MCoE) in Bulawayo, Zimbabwe, with the objective to guide youth-friendly interventions and improve health outcomes. Methods: A mixed methods cross-sectional study was conducted involving 110 HIV-positive youths aged 15-24 years on ART, recruited through systematic sampling and surveyed between November and December 2024. Data was collected using structured questionnaires, focus group discussions, in-depth interviews, and key informant interviews. Quantitative data were analyzed using descriptive statistics and logistic regression models to identify factors linked to viral load suppression, while qualitative data underwent thematic analysis. Results: Viral load suppression was achieved by 68.19% of participants, who met the viral suppression criterion of <50 copies/ml. Analysis identified several significant predictors via multivariable logistic regression. Younger adolescents (15-19 years) had lower odds of achieving suppression compared to older youths (20-24 years) (Adjusted Odds Ratio [AOR]: 0.81; 95% Confidence Interval [CI]: 0.67-0.97; p=0.041), while female participants demonstrated higher suppression rates than males (AOR: 0.43; 95% CI: 0.21-0.96; p=0.032). Absence of adherence challenges to ART emerged as a strong predictor of suppression (AOR: 0.12; 95% CI: 0.03-0.72; p=0.018), and perceived lack of clinical staff support was associated with a threefold higher risk of unsuppressed viral load (AOR: 3.01; 95% CI: 1.34-7.69; p=0.046). Lower treatment self-efficacy negatively impacted suppression odds (AOR: 2.65; 95% CI: 1.11-7.83; p=0.046), and lack of friend support for clinic visits reduced the likelihood of suppression (AOR: 0.31; 95% CI: 0.09-0.89; p=0.001). Qualitative findings confirmed that persistent barriers--including stigma, limited family support, economic hardship, school and work commitments--compromised both retention and adherence among adolescents and young adults. Conclusion: Younger age, male sex, ART adherence challenges, lack of clinical staff support, and lower treatment self-efficacy were significantly associated with poor viral suppression among 15-24-year-olds at Mpilo Centre of Excellence. These findings underscore the need for tailored adolescent- and youth-friendly services, enhanced adherence support, and improved treatment literacy to strengthen retention in care and viral suppression. Addressing these factors is critical for advancing progress towards UNAIDS 95-95-95 targets and reducing HIV transmission among Zimbabwean youth.

IntroductionUnsuppressed viral load during antiretroviral therapy (ART) is associated with health decline and HIV transmission. Being overweight or obese increases the risk of non-communicable diseases, increasing the risk of multimorbidity in people living with HIV. Both ART effectiveness and obesity have been shown to be affected by socioeconomic, psychological and health related factors, but their interrelationships in South Africans living with HIV are not well known. MethodsThis was a secondary analysis of data from a randomised controlled trial of depression management in 2002 adults receiving ART. We investigated the effects of sociodemographic characteristics, comorbidities, depression symptoms (Patient Health Questionnaire-9 (PHQ-9)), functional disability (WHODAS-2.0), AIDS-related stigma and ART adherence on viral load non-suppression (viral load [&ge;]1000 copies/ml) and on body mass index (BMI), at baseline (baseline) and on changes 12 months later, using longitudinal mixed effect logistic and linear regression models. Potentially confounding covariates were selected and adjusted for using least absolute shrinkage and selection operator (LASSO) inference. ResultsPeople with viral load non-suppression at baseline were more likely to be male, younger and to earn lower income. Health characteristics associated with viral load non-suppression at baseline were previous tuberculosis, having been on ART for less than 6 months or more than 10 years, and self-reported non-adherence to ART. Higher disability score and ART duration <6 months or >10 years at baseline were associated with an increasing likelihood of viral load non-suppression 12 months later. Higher BMI at baseline was associated with being female, being married, earning higher income and hypertension, no history of tuberculosis and not having viral load non-suppression. BMI increased from baseline to follow-up, and younger age was associated with a greater increase in BMI 12 months later. Depression symptom scores and stigma scores were not associated with viral load non-suppression or BMI. ConclusionsViral load non-suppression was associated with lower BMI, most likely due to its effects on HIV-related illness. Viral load non-suppression and BMI were both associated with a variety of sociodemographic factors, while viral load non-suppression was also associated with disability and ART non-adherence. These findings together indicate subgroups of people with HIV who most need improved ART access and adherence support. Neither outcome was associated with severity of depression symptoms or self-reported stigma. ClinicalTrials.gov (NCT02407691), Pan African Clinical Trials Registry (201504001078347), South African National Clinical Trials Register (SANCTR) (DOH-27-0515-5048, NHREC 4048).

BackgroundChildren and adolescents (0 - 15 years) living with HIV (ACLHIV) in low-resource settings face individual, household, and systemic challenges to engagement and retention in HIV care and antiretroviral treatment (ART) adherence. As a result, ACLHIV register poorer care and treatment outcomes. We describe care retention outcomes and factors that influence them among ACLHIV enrolled in ART in Cameroon. MethodsWe explored trends in two-year follow-up and sociodemographic and clinical factors associated with retention in care among ACLHIV living in the Center and East Regions. We retrospectively analyzed anonymized medical records (n = 1,319) from a cohort of all ACLHIV initiating ART for a three-year period between October 1, 2019, to September 30, 2022. Data were obtained from electronic medical records from 66 HIV treatment sites. Trends in retention in care among ACLHIV on ART were described using Kaplan-Meier survival estimates. Cox proportional analysis was performed to identify factors associated with retention in care. ResultsRetention in care among ACLHIV in both regions at months 6, 12, 18, and 24 was 86.2%, 82.6%, 79.8%, and 77.2%, respectively. After 24 months, retention was higher in the Center Region (83.1%) compared to the East Region (71.5%). In adjusted regression models, female ACLHIV were more likely to be retained in care in the Center Region but less likely in the East Region compared to boys after 24 months. Clinical treatment factors, such as current use of a dolutegravir and receipt of ART through differentiated service delivery models, were associated with a considerably reduced risk of loss to follow-up. Unexpectedly, we found that very young children (<5 years) were less likely to be retained in care than older adolescents (5-15 years), which could be partially explained by local context of care. ConclusionThis study suggests that Cameroon is lagging behind targets for HIV retention in care for ACLHIV. More effective and targeted clinical and social behavioral interventions are needed to address barriers to long term engagement in care by ACLHIV. Targeted research studies and improved data-driven, process monitoring is needed to determine other underlying factors that lead to sub-optimal care retention outcomes among this sub-population.

BackgroundAdolescents and young adults with perinatally acquired HIV (APHIV) face complex psychosocial and structural challenges that may undermine resilience, a modifiable psychosocial determinant of treatment engagement, and health outcomes. Evidence on peer-led interventions targeting resilience among APHIV in South Asia remains limited. We evaluated resilience and its correlates among participants in the ImPossible Fellowship, a peer-led mentorship intervention in India. MethodsWe conducted a cross-sectional evaluation of 216 APHIV following completion of the 24-month ImPossible Fellowship in southern India in 2024. Surveys administered by trained youth investigators assessed sociodemographic, educational, and clinical characteristics. Resilience was measured using the Child and Youth Resilience Measure-Revised (CYRM-R), a validated multidimensional tool capturing personal and relational resilience dimensions. Low resilience was defined as CYRM-R threshold score [&le;]33rd percentile. Multivariate logistic regression identified independent correlates of low resilience, and sensitivity analyses explored alternative CYRM-R thresholds. ResultsParticipants had a mean age of 18.7 years (range 9-24); 50% had no surviving parents, and 43% lived in child care institutions. Median resilience scores were high (74, Interquartile range [IQR] 69-78), and 91% achieved viral suppression. In multivariate analyses, three factors were independently associated with low resilience: loss of both parents (adjusted odds ratio [aOR] 4.35, 95% CI 2.09-9.06), school discontinuation (aOR 2.43, 95% CI 1.10-5.34), and self-reported communication barriers at HIV clinics (aOR 5.83, 95% CI 2.69-12.64). These associations were consistent across sensitivity analyses at alternative resilience thresholds. At the most stringent threshold of low resilience (CYRM-R score [&le;]15th percentile), unsuppressed viral load also emerged as a significant correlate, suggesting that treatment failure may be concentrated among those with the most severely compromised resilience. ConclusionsAPHIV participating in a peer-led mentorship program demonstrated high overall resilience and viral suppression, but also revealed addressable vulnerabilities mapping to specific programmatic priorities. Peer-led models offer a promising foundational platform; however, complementary structural and psychosocial enhancements targeting these modifiable determinants are essential to optimize outcomes for those facing the greatest cumulative adversity.

IntroductionLess adherence to antiretroviral treatment (ART) has been found among people suffering from HIV (PWH) with comorbid mental disorders like depression and alcohol use in Mozambique, a Sub-Saharan African country. However, less is explored with regards to other mental disorders. MethodsThis study assessed the association of multiple mental disorders and adherence to ART based on the data from primary/tertiary health care facilities in Maputo and Nampula, Mozambique. We administered a sociodemographic questionnaire, Mini International Neuropsychiatric Interview (MINI) Plus 4.0.0 adapted for use in Mozambique to assess mental conditions, and a 3-item self-report to measure ART adherence. ResultsOut of 1469 participants, 409 were HIV positive (self-report), with an average age of 36.7 years (SD=9.8), and 30.4% were male. The most common mental disorders were major depressive disorder (27.34%) followed by psychosis (22.03%), suicidal ideation/behavior (15.44%), and alcohol-use disorder (8.35%). Higher levels of non-adherence to ART [(Mean Difference=1.19, 95% CI: 1.04, 1.37)] and the likelihood of missing at least one dose in the last 30 days (OR=3.06, 95% CI: 2.00, 4.67) were found in participants with any mental disorder compared to those without a mental disorder. The highest levels of non-adherence were observed among those with drug use disorders and panic disorder. ConclusionsIn Mozambique, PWH with any co-occurring mental conditions had a lower probability of ART adherence. Integrating comprehensive mental health assessment and treatment and ART adherence interventions tailored to PWH with co-occurring mental disorders is necessary to attain optimal ART adherence and reach the UNAIDS ART target.