AIDS and Behavior

Background Studies show 53 to 74% of women living with HIV experience postpartum ART adherence challenges. Viral load testing is a delayed indicator, highlighting the need for culturally appropriate screening tools to identify at-risk women early. This study examined the association between non-viral suppression and constructs within the AIDS Clinical Trials Group (ACTG) adherence questionnaire among women in Uganda to inform timely, targeted interventions to improve adherence. Methods The ACTG was adapted, and postpartum participants completed ACASI or Provider-Assisted Interviews (PAIs). Self-efficacy, social support, anxiety, depression, viral load, and clinical factors were analysed using mixed-effects logistic models over a 1-year period. Results Of 166 women, 21 completed ACASI and 145 PAIs. 4.2% (7/166) were not virally suppressed at baseline, and their non-suppression status was consistent throughout one year of follow-up. High self-efficacy scores were associated with 27% lower odds of viral non-suppression (Odds Ratio [OR], 0.73; 95% CI, 0.54, 0.98). High depression scores were associated with 22% higher odds of non-suppression (OR 1.22;95% (1.01,1.49). Other variables, including age, Body Mass Index, duration on ART, marital status, employment, education level, tap water, and travel time from home to clinic, were not associated with viral suppression in the covariate-adjusted analyses. Median self-efficacy and depression scores were 8 (IQR 1,9) and 1.2 (IQR 0,16), respectively. Focused group discussion data showed high acceptability and feasibility of using the ACTG adherence questionnaire in Uganda. Conclusion Lower self-efficacy and higher depression scores on the ACTG adherence questionnaire can help identify Ugandan women at risk of viral non-suppression in HIV programs. Keywords WLHIV, Antiretroviral Therapy, Adherence, Audio Computer Assisted Self Interview, Viral load

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.

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.

Introduction: Our aim was to examine the implementation of an online community-based exercise (CBE) intervention with adults living with HIV. Methods: We conducted a 12-month community-engaged intervention study with adults living with HIV in partnership with the Toronto YMCA, Canada. We conducted a two phased intervention study involving Phase 1) Intervention: participants were asked to exercise three times/week, supervised every two weeks with online personal coaching, and attend monthly online educational sessions (6-months), and Phase 2) Follow-Up: participants were asked to continue exercising thrice weekly, independently (6-months). We assessed engagement in physical activity (PA) weekly, and body composition, strength, physical function, and flexibility outcomes every two months (bimonthly) across both phases (12-months). We used segmented regression to assess the change in outcomes within and between phases to assess adoption, effect and maintenance of the intervention. Results: Of the 32 participants who initiated, 22 (69%) completed the intervention; and 18 (56%) completed the follow-up. The majority identified as men (69%), median age was 53 years (25th, 75th percentiles: 43, 60), with a median of 3 (1,7) concurrent health conditions. Median number of coaching sessions attended was 10/13 (77%). Participant engagement in [&ge;]30min of moderate or vigorous physical activity in the past week increased from 3.24 days at baseline (95%CI:2.69, 3.79) to 3.36 days (95%CI:2.83,3.89) at the end of intervention to 3.35 days (95%CI:2.81,3.89) at end of follow-up [overall mean increase of 0.11 days (95%CI: 0.02,0.20)]. During the intervention, there were significant mean decreases for weight (-1.31kg), body mass index (BMI) (-0.40kg/m2), and waist circumference (-2.92cm); and mean increases for push-ups (+7.11 in a minute), plank time (+38.13 sec), sit-to-stand (+2.86 times in 30 sec), and sit-and-reach (+3.47 cm). There were no changes in muscle mass, body fat percent and fat free mass. During the follow-up phase, there were additional significant mean decreases in body weight (-1.52 kg), BMI (-0.50 kg/m2) and sit-to-stand (+1.52 times in 30 sec). Conclusions: Participants demonstrated increases in physical activity and improvements in strength, weight, body composition, physical function, and flexibility with the online CBE intervention, some of which were sustained at the end of the study. Future research should incorporate strategies to enhance engagement in physical activity among adults with HIV.

Background African immigrants in the United States bear a disproportionate HIV burden, with incidence approximately sixfold higher than the general population, yet remain largely absent from targeted prevention research. HIV vulnerability among this population is mediated through relationship and family systems that are restructured by migration, reorganizing household composition, gender norms, trust, and communication patterns through which prevention engagement occurs. Despite this, migration has rarely been examined as a force that transforms the relational contexts shaping engagement with HIV testing, HIV self-testing (HIVST), and pre-exposure prophylaxis (PrEP). Methods The MiST-Pathways Study will use a sequential mixed-methods, community-based pilot design among first-generation African immigrant adults (ages 18-50) residing in New York and Massachusetts. The study will proceed in three phases: Aim 1 will use semi-structured interviews (n = 15) and a structured survey (n = 75) to identify relationship typologies and migration-related relational mechanisms influencing HIV prevention engagement; Aim 2 will employ Palava Hut Conversations (PHC) (an African-centered deliberative method) with up to 30 participants to co-develop and prioritize relationship-tailored intervention components; and Aim 3 will conduct a proof-of-concept assessment of the prioritized component using a single-group pre-post design (n = 24), incorporating surveys and cognitive interviews to assess feasibility, acceptability, and preliminary evidence of mechanism activation. All activities will be conducted virtually via Zoom and WhatsApp, with eligibility screening administered through REDCap. The study has been approved by the University at Buffalo Institutional Review Board (STUDY00010347) and registered at ClinicalTrials.gov (NCT07565584). Discussion This protocol outlines the planned evaluation of a sequentially designed, community-engaged pilot study to examine how migration reshapes relational contexts that influence HIV prevention decision-making among African immigrants. Findings will inform the development of culturally grounded, relationship-tailored prevention strategies and the design of a future, larger-scale intervention study.

BackgroundStigma remains a pervasive barrier to curbing the spread of human immunodeficiency virus (HIV) among adolescents and young adults in Lima, Peru. Social media offers a promising avenue for scalable, youth-centered stigma reduction, but few interventions have been rigorously evaluated in this context. ObjectiveWe evaluated the potential of a social media campaign to reduce perceived HIV-related stigma among young adults living with HIV. This involved a sequential explanatory mixed-methods study, including a randomized evaluation, followed by focus groups to understand the findings. Methods150 young adults (aged 18-29 years) living with HIV (YLWH) were randomized to receive information on social media from one of the following: (1) the control account; (2) the control account and the social media campaign accounts (Instagram and TikTok); or (3) the control account, the campaign accounts, and the accounts of participating influencers. Perceived stigma was measured via pre- and post-campaign surveys using Spanish versions of the abridged Berger HIV Stigma Scale and the Stigma Stress Scale. Focus groups and interviews were conducted with a purposive sample of participants to contextualize quantitative results. Qualitative data were analyzed using Framework Analysis. ResultsMean changes in HIV Stigma and Stigma Stress scores were small and not statistically significant. Post-hoc as-treated analyses supported these findings. Fidelity to intervention allocation was low to moderate, depending on the metric considered. Qualitative data suggested that the campaign positively impacted participants perceived stigma and that personal circumstances, crossover, frequency of exposure to content, and issues related to completing study questionnaires contributed to the lack of meaningful change in stigma scores. ConclusionsWhile quantitative data did not support that exposure to a social media campaign led to meaningful reductions in HIV-related stigma, qualitative data suggested that the campaign had a positive impact and that limitations in the study design, together with external factors, may have obscured benefits in quantitative analyses.

Background: Pre-exposure prophylaxis (PrEP) has demonstrated a significant reduction in HIV infections among men who have sex with men (MSM), however, low medication adherence hinders its preventative effectiveness. Traditional approaches, such as health education and face-to-face inquiry (HEF), have demonstrated certain efficacy in improving PrEP adherence. However, these methods are resource-intensive and often plagued by delays, rendering timely and precise interventions challenging. This randomized controlled trial aims to assess the effectiveness of an intervention comprising AI-chatbot for PrEP (PrEP-bot) and Smart pillbox (SPB) (PrEP-bot-SPB) strategy to improve PrEP adherence among MSM compared to HEF.Methods and analysis: A three-arm, multicenter, open-lable RCT will be conducted with Chinese MSM [&ge;]18 years. A total of 300 participants will be recruited through three sources, including hospitals, community-based organizations (CBOs) and peer referral in five cities: Shenzhen, Beijing, Qingdao, Hangzhou and Zhengzhou. After completing baseline survey, participants will be randomized evenly into interventions or control groups: the PrEP-bot group, the PrEP-bot-SPB group, and the HEF control group. Participants in the PrEP-bot group will be granted access to an AI-chatbot agent through WeChat. This agent will: 1) generate personalized PrEP medication plans; 2) provide medication reminders and PrEP-related health check-ups notifications; 3) inquire about missed doses to deliver tailored interventions; 4) answer participant questions about PrEP using guideline-based knowledge. Participants in the PrEP-bot-SPB group will receive both the SPB and the PrEP-bot interventions. SPB could delivers medication reminders. Participants in HEF group will receive a health education pamphlet introducing PrEP and knowledge related to PrEP medication adherence at baseline and face-to-face inquiry every three months. Outcomes will be assessed for both short-term and medium-to-long-term effects. The primary objective is the effectiveness in improving PrEP adherence measured by self-report, Eight-Item Morisky medication adherence scale (MMAS-8) and concentration of Tenofovir in dried blood spots (DBS) (PrEP adherence [&ge;]90%) at 3 months follow-up. Secondary outcomes include: 1) effectiveness in preventing HIV infection measured by HIV-self test (HIVST); 2) effectiveness of PrEP-related health check-ups; 3) the effectiveness, feasibility, acceptability, and user satisfaction with the PrEP-bot; 4) effectiveness in improving PrEP adherence at 6-month, 9-month and 12-month follow-up periods. All participants will receive quarterly follow-up visits during the 12-month study period. Intention-to-treat analysis and per protocol set (PPS) analysis will be used.Results: Recruitment and enrollment of participants began in January 2026 and is currently ongoing.Discussion: This study is expected to establish a novel AI-based intervention model for PrEP, providing innovative strategies for HIV control among MSM populations. If the PrEP-bot is proven non-inferior to HEF, it could offer users real-time, precise, and personalized interventions while simultaneously addressing PrEP-related inquiries and health check-ups reminders. Importantly, this approach would achieve significant reductions in resource requirements for implementation and maintenance and be more cost-effective. With the ongoing advancement of AI technologies, PrEP-bot holds substantial promise for widespread implementation in PrEP adherence, potentially revolutionizing HIV prevention for MSM in China through this innovative intervention modality.Trial registration: ChiCTR2500111280 (Chinese Clinical Trial Registry). Date of registration: 29 October 2025.

Transgender women are routinely recruited for HIV prevention research and describe feeling over-researched, undervalued, and disconnected from the benefits of research. Research fatigue refers to the adverse impacts of research participation from the volume, frequency, or intensity of research engagement. Research beneficence, an underdeveloped construct, refers to perceptions that research participation is empowering, appreciated, and beneficial to individuals and communities. This study sought to develop and psychometrically evaluate a research fatigue and beneficence scale and examine associations with cohort retention and study procedures among transgender women in the US and Puerto Rico. We developed a novel 7-item measure of research fatigue and beneficence informed by prior literature and qualitative work with transgender women. We assessed internal consistency reliability, factor structure, convergent and divergent validity, and predictive validity with 6-month study retention outcomes and procedures among 2189 transgender women enrolled in a US nationwide cohort (April 2023-December 2024) for the full 7-item research fatigue and beneficence scale, a 4-item research beneficence subscale, and a single-item research fatigue measure. Research beneficence items demonstrated good internal consistency (0.78) and excellent model fit. Research fatigue and beneficence varied by race/ethnicity with participants of color reporting both greater empowerment and greater concerns about community-level benefits. The item "I feel that I am asked to participate in research too frequently" was associated with lower 6-month retention, greater survey missingness, and preference for less invasive HIV testing modalities. Findings highlight multiple dimensions of research experience and the need for reduced participant burden, culturally tailored study designs, and intentional dissemination efforts to improve participant-centered research practices.

Background: Advanced HIV disease (AHD) remains a major contributor to HIV-related morbidity and mortality despite widespread antiretroviral therapy (ART) access in sub-Saharan Africa. Although treatment-related adverse drug reactions (ADRs) may compromise treatment outcomes, evidence on the relationship between AHD and ADR occurrence remains limited. This study aimed to determine the prevalence and identify factors associated with AHD, characterize treatment-related ADR and assess the association between AHD and ADR occurrence among people living with HIV receiving ART in Dar es Salaam, Tanzania. Methods: We conducted a multicenter cross-sectional study among 1,513 people living with HIV receiving ART at selected HIV care and treatment clinics in Dar es Salaam, TanzaniaFor this adolescent/adult cohort, AHD was operationally defined as WHO clinical stage III/IV disease and/or baseline CD4 count <200 cells/mm3. Treatment-related ADRs were defined as participant-reported and/or clinically documented ART-related adverse events identified during routine HIV care, including both current and retrospectively reported events. Modified Poisson regression with robust standard errors was used to estimate crude and adjusted risk ratios (RRs) with 95% confidence intervals (CIs). Results: Among 1,508 participants with sufficient information for classification, 961 (63.7%) had AHD. Factors independently associated with AHD included age [&ge;]50 years (aRR 1.10, 95% CI 1.01-1.20), underweight nutritional status (aRR 1.17, 95% CI 1.00-1.35), and concomitant medication use (aRR 1.19, 95% CI 1.03-1.37), while DTG-based ART was associated with lower AHD prevalence (aRR 0.78, 95% CI 0.68-0.90). Overall, 569 participants (38.0%) reported at least one ADR. Composite AHD was not independently associated with ADR occurrence (aRR 0.95, 95% CI 0.82-1.11), but baseline CD4 <200 cells/mm3 was associated with increased ADR risk (aRR 1.20, 95% CI 1.02-1.41). Comorbidity (aRR 1.66, 95% CI 1.42-1.93) was the strongest correlate of ADR occurrence. Conclusion: AHD remains highly prevalent among people living with HIV receiving ART in Tanzania. While composite AHD was not independently associated with ADR occurrence, severe immunosuppression, comorbidity burden, and concomitant medication exposure were associated with increased ADR risk. These findings suggest that immunologic severity and broader clinical complexity may be more informative predictors of ART-related toxicity than composite syndromic AHD classification alone. Strengthened early diagnosis, differentiated advanced HIV care, integrated pharmacovigilance strategies, and routine medication risk assessment are needed.

BackgroundDespite scale-up of antiretroviral therapy (ART), children living with HIV (CLHIV) and children who are HIV-exposed-but-uninfected (CHEU) are at an increased risk of poor growth outcomes compared to children HIV-unexposed-and-uninfected (CHUU). Few studies quantify the magnitude of growth deficits extending into school age in sub-Saharan Africa (SSA). This study examined the impact of perinatal HIV exposure and infection on the growth trajectory of school-aged children in Nigeria. MethodsWithin a prospective cohort, 569 children aged 3-11 years were recruited from pediatric clinics in Nigeria and matched by age and sex based on their exposure or infection status. School-aged children were observed across three time-points at 6-month intervals, during which anthropometric measures, CD4 count, and maternal factors were collected. Z-scores for height-for-age (HAZ), weight-for-age (WAZ), and body-mass-index-for-age (BAZ) were calculated using WHO standards. Longitudinal linear regression analyses using generalized estimating equations (GEE), adjusted for maternal and child covariates, were conducted to compare growth outcomes across groups. ResultsGrowth Z-scores declined until approximately age 8, after which they gradually increased. Across all visits, CLHIV consistently and independently demonstrated lower Z-scores (WAZ ({beta} = -1.04, p <0.001); HAZ ({beta} = -0.67, p <0.001)), followed by CHEU with intermediate but significant impairments (WAZ ({beta} = -0.35, p <0.01); HAZ ({beta} = -0.38, p <0.01)) compared to CHUU. ConclusionStunting remains unacceptably high in CLHIV and CHEU in SSA. The findings suggest a need for immediate paradigm shifts to address persistent growth deficits despite ART and beyond infancy.

Evidence-informed situation analyses are critical for HIV programming, yet primary data collection is often resource-intensive and time-consuming. Approaches that leverage existing evidence while generating locally grounded insights are needed to inform context-appropriate interventions. We applied the Synthesised Narrative Exploration (SNE) approach in two districts in Inhambane province, southern Mozambique, to inform an HIV project through assessing key dynamics affecting HIV prevention, treatment, and care for women and children. SNE combines structured synthesis of existing country-specific literature with qualitative validation and contextualisation through focus group discussions and semi-structured interviews. Findings from 16 peer-reviewed studies and two national reports were synthesised into short narratives and discussed with 83 community members and key stakeholders. Qualitative data were thematically analysed and validated through community and stakeholder consultations. Study participants confirmed many well-documented barriers across the maternal and infant HIV care cascade and added local insights. Known pre-pregnancy barriers such as limited preconception HIV testing and low ART uptake were confirmed, while strong fertility expectations, low levels of pregnancy planning, gendered decision-making, and fear of partner abandonment following HIV status disclosure were highlighted as factors shaping engagement with HIV services. The participants confirmed barriers during pregnancy reported in earlier studies, including delayed antenatal care initiation and limited male partner involvement, and added the role of household power hierarchies, particularly the influence of mothers-in-law, in shaping HIV testing, disclosure, and ART adherence. Widely documented postpartum disengagement from care was explained by difficulties sustaining non-disclosure and the loss of socially acceptable reasons for continued clinic attendance. The participants proposed locally grounded strategies to address the barriers, including strengthened couple counselling and engagement of influential family members such as mothers-in-law. By integrating existing evidence in a qualitative enquiry, SNE enables efficient generation of contextually rich insights directly relevant to intervention design, offering an approach for strengthening HIV programmes.

Introduction Viral load monitoring is central to assessing antiretroviral therapy (ART) effectiveness, yet timely access remains challenging in resource-constrained settings. Point-of-care (POC) triage tests may improve ART monitoring efficiency by identifying clients requiring confirmatory viral load testing while reducing unnecessary testing among those likely to be virally suppressed. We explored perceptions of integrating a POC triage test that measures interferon-gamma-induced protein 10 (IP-10) - a chemokine strongly correlated with HIV viral load - into routine ART monitoring among people living with HIV (PLHIV) on ART, healthcare providers, and HIV programme stakeholders. Methods This qualitative study was nested within a clinical evaluation of the IP-10 POC triage test in two primary healthcare facilities in Maputo Province, Mozambique (2023-2024). We conducted three rounds of interviews with PLHIV on ART who underwent IP-10 testing, and one-off interviews with healthcare providers and HIV programme stakeholders across different health system levels. PLHIV were purposively sampled to capture diverse IP-10 and viral load outcomes. Interviews explored experiences of ART monitoring, perceptions of the IP-10 POC test, and implementation considerations. Data were analysed thematically using an inductive-deductive approach. Results Routine viral load monitoring was widely valued and understood as essential for treatment adherence and effectiveness, but participants described barriers including laboratory delays, access challenges, and health system constraints. The IP-10 POC triage test was broadly acceptable; same-day results were perceived to reduce anxiety, support adherence, and enable timely clinical decision-making. Providers and stakeholders emphasised its potential to improve monitoring efficiency by prioritising clients who require confirmatory viral load testing and adherence support. Concerns were raised regarding test accuracy and the need to maintain confirmatory viral load testing, underscoring the importance of clear communication and client education. Successful implementation would require training, workflow integration, and quality assurance. Conclusions An IP-10 POC triage test could strengthen ART monitoring by enabling same-day identification of clients requiring confirmatory viral load testing and targeted adherence support. By reducing unnecessary viral load testing for virally suppressed clients, it may contribute to more efficient monitoring and support differentiated care approaches. Careful integration into existing ART monitoring algorithms will be critical to maximise impact.

Introduction: Adolescent girls and young women (AGYW) in southern Africa are disproportionately affected by HIV. Despite increasing availability of HIV pre-exposure prophylaxis (PrEP), uptake and sustained use remain low. Existing service delivery models may not adequately meet the needs of AGYW, particularly in remote settings. We conducted a discrete choice experiment (DCE) to assess preferences for PrEP service delivery among AGYW living in Lesotho, a country with one of the highest HIV incidence rates globally. Methods: The DCE was conducted among AGYW (16-24 years) in two districts in Lesotho. Participants completed a series of binary choice tasks comparing hypothetical PrEP service delivery scenarios defined by six attributes: service location, provider type, provider characteristics, provider confidentiality, PrEP product type, and the combination of additional prevention services offered. Preferences were analysed using mixed logit and latent class models. Results: A total of 537 AGYW (median age 19 years, IQR 17-22) were included. Provider confidentiality was the strongest driver of choice, with non-confidential providers significantly less preferred ({beta} = -0.58; 95% CI -0.69 to -0.46). Compared with nurses, services delivered by ComBaCaL CHWs were preferred (0.17; 0.01 to 0.33), while those provided by doctors were less preferred (-0.15; -0.30 to 0.00). Younger female providers were preferred over older female providers (0.20; 0.04 to 0.36). Compared with the daily oral pill, both the 2-monthly injectable (-0.24; -0.39 to -0.08) and the vaginal ring (-1.02; -1.20 to -0.82) were less preferred. Differences in preferences were observed across age groups and districts. Latent class analysis identified two preference profiles, indicating variation in preferences for delivery and product characteristics. Conclusions: Preferences for PrEP delivery among AGYW in Lesotho were strongly influenced by provider confidentiality. Among some AGYW, there was openness to decentralised delivery, particularly through CHWs and community-based models, which may reduce access barriers in remote settings. Product preferences were varied, and not all options were acceptable. Differences by age group and district indicate that no single delivery model will meet all needs. Building on the current standard of care, offering acceptable options in accessible and confidential ways may support PrEP uptake.

IntroductionViral load (VL) testing is the recommended approach for monitoring antiretroviral therapy (ART) effectiveness, while guidelines recommend targeted CD4 testing after ART initiation. This study examined trends in VL and CD4 testing frequencies, as well as the relationship with AIDS diagnosis and mortality among people with HIV in the Asia-Pacific region. MethodsWe included adults enrolled in the Treat Asia HIV Observational Database (TAHOD) between 2003-2018 who had been on ART for [&ge;]1 year. VL and CD4 testing rates were analysed using Poisson regression models. Associations between testing frequency and AIDS diagnosis or mortality were evaluated using Fine and Gray competing risk regression. ResultsAmong 8,446 patients, VL testing rates remained steady at 1 per person-year (PYS) between 2003-2018. Increased VL testing was associated with more frequent CD4 testing (>2 tests in the previous year; IRR=1.57, 95%CI 1.53-1.60), later follow-up years (2008-2012: IRR=1.15, 95%CI 1.12-1.18; 2013-2015: IRR=1.07, 95%CI 1.04-1.10), older age (31-40 years: IRR=1.06, 95%CI 1.03-1.08; 41-50 years: IRR=1.08, 95%CI 1.05-1.11; >50 years: IRR=1.07, 95%CI 1.03-1.11), higher current VL (401-1000 copies/mL: IRR=1.16, 95%CI 1.09-1.24; >1000 copies/mL: IRR=1.07, 95%CI 1.04-1.11), initial ART regimen (NRTI+PI: IRR=1.07, 95%CI 1.04-1.10; other combinations: IRR=1.11, 95%CI 1.05-1.17), and higher country income levels (upper-middle: IRR=2.17, 95%CI 2.11-2.23; high: IRR=3.14, 95%CI 3.03-3.26). CD4 testing rates decreased from 2.04 to 1.06/PYS over the same period. Lower CD4 testing frequency was associated with HIV exposure mode (MSM: IRR=0.94, 95%CI 0.92-0.96; IDU: IRR=0.93, 95%CI 0.90-0.97; other/unknown: IRR=0.90, 95%CI 0.87-0.93), higher current CD4 (201-350 cells/{micro}L: IRR=0.95, 95%CI 0.93-0.97; 351-500 cells/{micro}L: IRR=0.89, 95%CI 0.87-0.91; >500 cells/{micro}L: IRR=0.85, 95%CI 0.83-0.87) and receiving an NRTI+PI first-line combination (IRR=0.96, 95% CI 0.94-0.98). VL and CD4 testing frequencies were not significantly associated with AIDS diagnosis. However, having > 2 CD4 tests in the previous year was associated with higher mortality risk. ConclusionThe trends in the rates for CD4 and VL testing in the region between 2003-2018 were significantly affected by demographic, clinical and socio-economic factors. Recognizing these factors is critical to optimizing differentiated monitoring strategies and improving outcomes for PWH in the region.

Background: Young women in Ghana (18-35 years) remain disproportionately affected by HIV due to intersecting structural and social challenges, including stigma, gendered power dynamics, and limited access to women-centered prevention services. Although HIV self-testing (HIVST) and pre-exposure prophylaxis (PrEP) are effective biomedical prevention strategies, uptake among young Ghanaian women remains low. Barriers include limited awareness, persistent stigma, and a lack of culturally relevant, youth-responsive prevention approaches. The WISE WOMAN study aims to address these gaps by developing and piloting a women-centered HIV prevention intervention co-created with young women in Ghana. Methods: This protocol describes a pilot implementation study of a women-centered HIV prevention intervention that will be delivered via WhatsApp. The intervention is informed by community-based participatory research and human-centered design approaches to enhance cultural relevance and responsiveness to young womens lived experiences. The study will enroll 50 young women aged 18-35 years who will participate in a four-week WhatsApp-based intervention designed to increase HIV prevention knowledge, reduce stigma, and support engagement with HIVST and PrEP. Implementation outcomes, including feasibility, acceptability, and appropriateness, will be assessed using mixed methods. Quantitative data will be collected through baseline and post-intervention surveys, including the PIERS-22 engagement scale, and will be analyzed using descriptive statistics and paired comparisons. Qualitative data from group interactions and post-intervention interviews will be analyzed using thematic analysis. The study has received ethical approval from the University at Buffalo Institutional Review Board (STUDY00009328) and the Ensign Global College Ethics Committee (IRB/EL/AF-02/2025) and is registered at ClinicalTrials.gov (NCT07003789). Discussion: This protocol outlines the design and methods for a digitally delivered, women-centered HIV prevention intervention grounded in participatory approaches. The planned pilot study will generate critical implementation evidence on the feasibility, acceptability, and appropriateness of a WhatsApp-based, co-designed intervention, informing future adaptation, scale-up, and integration of culturally grounded HIV prevention strategies for young women in Ghana and similar settings.

Background: Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool, yet uptake and adherence remain low in Kenya despite integration into national HIV prevention plans since 2017. Intimate partner violence (IPV) is a prevalent HIV-related syndemic that presents barriers to PrEP engagement. While IPV's impact on women's PrEP use has been documented, less is known about IPV prevalence among men and its association with PrEP eligibility. This study aimed to determine IPV prevalence and explore correlates among PrEP-eligible men and women in coastal Kenya. Methods: This secondary analysis used data from the "Tambua Mapema Plus" trial conducted at six healthcare facilities in coastal Kenya among HIV-negative participants who were sexually active in the last 6 weeks and PrEP-eligible based on Kenya's Rapid Assessment Screening Tool. IPV was assessed through screening questions covering physical, verbal, and sexual violence experiences. Participants with ongoing IPV were excluded for safety. Among 1,500 intervention participants, 638 (402 women, 236 men) met PrEP eligibility criteria. Modified Poisson regression with robust standard errors was used to identify factors associated with IPV. Results: Overall, 24.1% reported lifetime IPV exposure, with 5.6% reporting past-month IPV. Women experienced higher rates of verbal (14.9% vs 11.0%), physical (15.2% vs 9.7%), and sexual IPV (11.2% vs 6.4%). Participants who had children (adjusted risk ratio [ARR]=2.09, 95%CI 1.32?3.32) or engaged in sex work (ARR=1.81, 95%CI 1.13?2.80) had increased IPV risk. In multivariable analysis, women with children had higher IPV risk (ARR=2.30, 95%CI 1.29?4.24), while men engaging in sex work had elevated risk (ARR=2.37, 95%CI 1.15?4.68). Discussion: IPV prevalence was substantial. Sex work emerged as a risk factor for both sexes, while having children increased risk among women. High IPV prevalence among PrEP-eligible individuals underscores the need for integrated IPV risk assessment in PrEP programs to improve HIV prevention effectiveness in Kenya.

Introduction: People with long-term virologically suppressed HIV (PWH) experience chronic inflammation. Beneficial effects such as lower levels of inflammation were reported for cannabis-based medicine but data on the safety of standardized low-dose full-spectrum cannabidiol (CBD) are limited. Methods: This double-blind randomized placebo-controlled trial (NCT05306249) included 80 ART-treated PWH with undetectable viremia (median time on efficient ART 14 years, median age 54 years), encompassing 30% women. Participants received 1 mg/kg CBD oil twice daily (full-spectrum, THC <0.3%) or placebo for 12 weeks plus a 4 week follow-up. Primary trial endpoint (autophagy gene expression) will be described elsewhere; here we evaluate the treatment impact on prespecified safety outcomes such as hemodynamic with electrocardiograms, HIV immunovirological parameters and comprehensive assessments of liver and kidney functions, performed using standard blood tests. Mixed-effects models adjusted for baseline age, sex, BMI, CD4 count and duration of viral suppression assessed longitudinal changes. Results: Of 80 randomized participants, 35 PWH in CBD and 37 in placebo groups completed week 12. No clinically meaningful differences emerged in creatinine, aminotransferases (ALT, AST), or conjugated bilirubin. Total bilirubin decreased in the CBD arm vs placebo (mixed effect model considering time, group and time*group, adjusted for covariates p=0.046). In exploratory sex-stratified analysis, a significant difference starting at week 12 (-8.0 bpm [95% CI -15.6; -0.4], p=0.0425) and persisting at week 16 (-7.9 bpm [95% CI -14.6; -1.3], p=0.0191) evidences a lower heart rate in men belonging to the CBD group compared to the placebo group; no change in females. There was no change in plasma viral load, cell-associated HIV-DNA levels and CD4/CD8 ratio. Discussion: Low-dose full-spectrum GMP-certified CBD was well tolerated over 12 weeks in virally suppressed people with HIV. Observed reductions in total bilirubin and male heart rate are exploratory and warrant confirmation in adequately powered trials incorporating inflammatory biomarkers and pharmacokinetics.

Background Interruptions in HIV care pose a major challenge to achieving HIV control goals in many countries, with 30% of clients who initiate antiretroviral therapy (ART) in South Africa experiencing an interruption of >28 days during their first six months on treatment. South Africa introduced revised guidelines in 2023 to improve outcomes during this early treatment period, but guideline compliance remains incomplete and gaps in the support provided to both clients and providers to optimize service delivery and health outcomes. Protocol BRIDGE (Behavioral Risk Identification and Decision Guidance for Engagement) is a mixed-methods evaluation of a package of light-touch, low-cost interventions aimed at improving the experiences of both clients and providers of care, increasing compliance with the 2023 guidelines, supporting clients to remain in care, and ultimately reducing the incidence of missed visits during the early treatment period. Components of the BRIDGE Retention Toolkit include an intervention navigator to help clients self-assess areas of vulnerability for disengagement from care and identify appropriate interventions; client roadmap to explain the treatment journey for the early treatment period; WhatsApp-based counseling tool for clients; guideline reference for providers; and tracing job aids. The tookit will be piloted at 6-8 public sector primary health facilities for a one-month period. The primary outcome will be the probability of returning less than 28 days late for the next scheduled clinic visit, assessed using electronic medical record data for the pilot and comparison sites. Pilot outcomes will be compared to both their own probabilities prior to the pilot and to probabilities from comparable non-pilot facilities. Implementation outcomes to be assessed using qualitative interview data from both clients and providers will include reach, implementation fidelity, adoption (uptake), costs, feasibility, appropriateness, and acceptability. Discussion The evaluation will assess the implementation and preliminary effectiveness of a set of interventions designed to improve client outcomes during the early HIV treatment period. If some or all of the BRIDGE tools are found to be helpful and/or are associated with a reduction in missed clinic visits, they will comprise a readily scalable and affordable intervention to help address a major barrier in large-scale HIV treatment programs.

BackgroundSustained retention in care supports continuous access to antiretroviral therapy, routine clinical monitoring, and long-term viral suppression. ObjectiveTo compare the effectiveness of interventions for improving retention in care among people living with HIV (PLHIV). DesignSystematic review and network meta-analysis Data sourcesPubMed, Embase, CINAHL, PsycINFO, Web of Science, and the Cochrane Library from 1995 to December 2024. Eligibility criteriaRandomised controlled trials (RCTs) evaluating interventions to improve retention in care, viral load suppression, or quality of life (QoL) among PLHIV, compared with standard of care (SoC) or other interventions. Data extraction and synthesisPairs of reviewers independently screened studies, extracted data, and assessed risk of bias using ROBUST-RCT. We conducted a fixed-effect frequentist network meta-analysis and rated interventions categories relative to SoC based on effect estimates effects and the certainty of evidence.. Dichotomous outcomes were summarized as odds ratios (ORs) with 95% confidence intervals (CIs), and continuous outcomes as mean differences (MDs) with 95% CI. ResultsEighty-four trials enrolling 107 137 PLHIV evaluated 13 intervention categories. For retention in care, five interventions supported by moderate or high certainty evidence proved superior to SoC: multi-month dispensing (OR 2.02, 95% CI 1.32 to 3.09), task shifting (OR 1.94, 95% CI 1.42 to 2.66), differentiated service delivery (OR 1.47, 95% CI 1.22 to 1.76), behavioural counselling (OR 1.36, 95% CI 1.21 to 1.54), and supportive interventions (OR 1.31, 95% CI 1.11 to 1.55). For viral load suppression, two interventions supported by moderate or high certainty evidence proved superior to SoC: task shifting (OR 2.07, 95% CI 1.25 to 3.43) and behavioural counselling (OR 1.34, 95% CI 1.11 to 1.67). Across outcomes, no intervention demonstrated convincing superiority over other active interventions. ConclusionsAmong 13 intervention categories, only a subset provided moderate or high-certainty evidence of superiority to the standard of care, and no superiority to other interventions. Persistent evidence gaps for key populations, diverse settings, and long-term outcomes support the need for context-sensitive and patient-centred interventions. RegistrationPROSPERO CRD42024589177 Strengths and limitations of this study[tpltrtarr] This systematic review followed Cochrane methods and was reported in accordance with PRISMA-NMA guidelines. [tpltrtarr]The network meta-analysis integrated direct and indirect evidence to compare multiple intervention categories within a single framework. [tpltrtarr]Risk of bias and certainty of evidence were assessed using ROBUST-RCT and the GRADE approach for network meta-analysis, respectively. [tpltrtarr]Some networks were sparse, and limited representation of key populations and long-term follow-up constrained the strength and generalisability of inferences.

IntroductionHIV testing for children of women living with HIV (WLHIV) is an efficient method of diagnosing HIV in children. We analyzed pooled data from 13 Population-based HIV Impact Assessments (PHIA) conducted from 2015 through 2019 to determine the gap in diagnosing HIV in children of WLHIV. MethodsIn each PHIA, children younger than 15 years in a subset of households were sampled for HIV testing. Mother-reported responses on childs status were linked to maternal interviews and biomarker data. Analysis was restricted to children whose mothers were alive, older than 15 years and aware of their HIV-positive status prior to the survey. We calculated weighted proportions of children who were never previously tested and proportion of children living with HIV (CLHIV) with no evidence of antiretroviral treatment (ART) use (categorized as newly diagnosed). Survey weights were pooled across all PHIAs to account for survey design and nonresponse. ResultsOf 4,234 WLHIV, 3,436 were aware of their HIV status and had at least one child (n=6,173) for whom responses were obtained. Of the 6,173 children, 43.5% (n=2,371) were reported as never been tested. Overall, 5,500 children provided blood for HIV testing during the survey. Newly diagnosed test positivity was 1.7% (90/5,191); 2.9% (61/2,120) among those with reported unknown HIV status and 0.9% (29/3,071) among those with reported HIV negative status. Among children with reported HIV positive status, 94.5% were confirmed by survey testing and of these, 91% had antiretrovirals (ARVs) detected. ConclusionsOver 40% of children of WLHIV who were aware of their HIV positive status had never been tested for HIV. HIV positivity ranged between 0.9% to 2.9% while 9.0% of children known to be HIV positive were not on ART. The study calls for renewed efforts to enhance testing of children and treatment linkage for those diagnosed with HIV.