AIDS and Behavior

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.

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.

BackgroundLoss to follow-up (LTFU) undermines the success of antiretroviral therapy (ART) programs, especially in high HIV prevalence regions like Njombe, Tanzania. Understanding factors influencing LTFU is critical to enhance patient retention. AimTo assess the prevalence and predictors of LTFU among people living with HIV (PLHIV) receiving ART in Njombe, Tanzania, from 2017 to 2021 MethodsWe conducted a retrospective cohort study using the National Care and Treatment Clinic (CTC2) database, defining LTFU as absence from care for 180 days or more. Logistic regression identified factors associated with LTFU. Data were cleaned using Microsoft Excel and analyzed using IBM SPSS Statistics version 26. Descriptive statistics were used to summarize demographic and clinical characteristics, and logistic regression was used to identify independent predictors of LTFU ResultsOf the 37,642 PLHIV initiated on ART, 13,411 (35.6%) were LTFU during the five-year study period. The highest annual incidence of LTFU occurred in 2020 (n = 4,069), coinciding with the onset of the COVID-19 pandemic. District-level disparities were substantial: Wangingombe recorded the highest disengagement prevalence (46.7%), while Makete recorded the lowest (23.7%). Multivariable analysis revealed that gender and age were not independent predictors of attrition (p > 0.05). However, significant associations with LTFU were observed for lower pharmacy refill adherence, marital status (single and divorced), and district of residence. Notably, patients in Wangingombe had more than double the odds of LTFU compared to those in Njombe (AOR 2.09; 95% CI: 1.95-2.24), whereas the 2021 initiation cohort demonstrated a significantly lower risk of disengagement (AOR 0.25; 95% CI: 0.22-0.28). ConclusionLTFU remains a critical challenge in the Njombe Region. Targeted interventions, including strengthened pharmacy refill monitoring, district-specific strategies, and psychosocial support for PLHIV, are essential to improve retention and sustain progress toward national HIV treatment goals.

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.

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.

BackgroundHIV exposed infants (HEIs) are at a higher risk of infant mortality compared to their counterparts who are not HIV exposed. Early Infant Diagnosis (EID) is the critical first step in reducing HIV-related infant mortality through prompt identification of HIV-infected infants and subsequent initiation of antiretroviral therapy. However, there is limited information on Uptake of EID and factors associated with its timely completion among HIV exposed infants. Therefore, this study aimed at determining the uptake of EID and factors associated with its timely completion among HIV exposed infants at Lira Regional Referral Hospital (LRRH). MethodsThe study was a retrospective cohort of 252 HEIs born in the period of 1st January 2021 to 31st December 2021 chosen through consecutive sampling. Data abstraction tools were used to collect data on uptake of 1st, 2nd, 3rd DNA-PCR and final rapid test from mother-baby pair files and EID register. The main outcome was Uptake of EID and classified as timely and untimely according to the PMTCT guideline. Data was analyzed using descriptive statistics and generalized estimating equations (GEE) with poisson family, log link and unstructured correlation structure. ResultsThe timely uptake of EID among HIV exposed infants at 4-6 weeks, 9 months, 6 weeks after cessation of breastfeeding and 18 months were 80.1% (95% CI:74.5-84.7), 84.2% (95% CI:79.0-88.3), 3.7% (95% CI:2.0-7.0) and 78.8% (95% CI:73.2-83.6) respectively. Having cotrimoxazole given was associated with timely completion of EID [aRR=2.974, 95% CI (1.45-6.10)] ConclusionUptake of EID among HEIs was sub-optimal, below the Ministry of Healths 90% target. Timely cotrimoxazole administration was associated with EID completion,

HIV testing remains the primary entry point to HIV prevention, treatment, and care. Although Zambia has made substantial progress in its HIV response, men remain less consistently reached by HIV testing services. This study assessed trends and determinants of HIV testing uptake among men aged 15-59 years in Zambia using repeated nationally representative survey data. We pooled mens data from the Zambia Demographic and Health Surveys (ZDHS) conducted in 2007, 2013/14, 2018, and 2024. The outcome was HIV testing uptake, defined as ever tested for HIV and received results (DHS variable mv781). Analyses accounted for the complex survey design using sampling weights in Stata 14.2. Trends were examined using weighted proportions and design-adjusted chi-square tests. Determinants were assessed using multilevel logistic regression with men nested within clusters, reporting adjusted odds ratios (AORs) and 95% confidence intervals (CIs). HIV testing uptake increased markedly from 20.7% (2007) to 62.9% (2013/14) and peaked at 77.4% (2018), with a modest decline in 2024 (73.5%); differences across survey years were statistically significant (p<0.05). In the fully adjusted model, survey year remained a strong predictor of testing compared with 2007 (2013/14 AOR 6.91, 95% CI 5.62-8.49; 2018 AOR 13.85, 95% CI 11.21-17.12; 2024 AOR 7.24, 95% CI 5.86-8.95). Older age was associated with higher odds of testing (25-34 AOR 3.51; 35-49 AOR 3.08; 50-59 AOR 1.65 vs 15-24). Rural residence was associated with lower testing (AOR 0.82, 95% CI 0.72-0.93). Higher education showed a strong gradient (primary AOR 1.55; secondary/higher AOR 4.19 vs none). Married men (AOR 4.33, 95% CI 3.56-5.27) and employed men (AOR 1.32, 95% CI 1.17-1.49) had higher odds of testing. Significant regional differences persisted after adjustment. HIV testing uptake among men in Zambia rose substantially from 2007 to 2018 and remained high in 2024, though gaps persisted among younger men, rural residents, and selected provinces. Targeted, male-friendly strategies especially for younger and rural men and geographically tailored programming are needed to sustain gains and reduce inequities in HIV testing.

IntroductionDespite improvements in treatment for people living with HIV (PWH), adherence remains a challenge for many. In this study we aimed to identify preferences for daily pill or long-acting injectable (LAI) antiretroviral therapy (ART) and for possible treatment package features, among PWH enrolled in Ryan White HIV/AIDS Program Part A (RWPA) Medical Case Management (MCM) programs. MethodsParticipants were recruited from six MCM programs from across the New York RWPA eligible metropolitan area (the five boroughs of New York City and Rockland, Putman, and Westchester counties). We developed a discrete choice experiment (DCE) with four attributes: (1) Type of ART Medication (daily pills or LAI), (2) Service Location and Mode, (3) Support, and (4) Rewards. We used an alternative-specific design in which the levels for the last three attributes were dependent on levels within the first (Type of ART). Latent class multinomial logit analysis (LCA) was used for preference estimation and hypothesis-free investigation of preference heterogeneity. ResultsFrom June 2022 through January 2023, 200 New York RWPA MCM clients completed the DCE. We selected a two-group LCA solution. A majority of participants had a higher preference for LAI regimens compared to daily pills (n=114 [57%] versus n=86 [43%]). Those who preferred LAI ART were younger (median age 49 versus 58.5 years, p<0.001), less likely to identify as straight/heterosexual (69% versus 82%, p=0.03), and more likely to identify as Latino/a (54% versus 30%; p<0.001). Preferences for service locations/mode, supports, and rewards were similar across LCA groups. Participants who preferred LAI ART were more likely to have heard of LAI ART before the survey (59% versus 41%, p=0.012). Overall, only 4% of participants self-reported having tried LAI ART. ConclusionsAssessing preferences among groups under-represented in clinical trials is essential to effective and equitable real-world implementation of innovative treatment options. Our study found that there were distinct groups that differed in their preferred ART regimen type and that New York RWPA MCM clients had limited familiarity with LAI ART. To inform regimen selection, we began pilot-testing educational materials and a patient-provider decision-making tool in 2023.

BackgroundAdolescent girls and young women (AGYW) are disproportionately vulnerable to HIV. Despite expanded HIV testing services (HTS), the majority of AGYW remain unaware of their HIV status. This study aimed to assess determinants of HIV testing uptake among AGYW in mainland Tanzania before and after stratifying by age group (15-19 and 20-24 years) using data from three national surveys conducted over time. MethodologyA cross-sectional secondary data analysis was conducted using data from the Tanzania HIV Impact Surveys (2016/17 and 2022/23), obtained from the Population-based HIV Impact Assessment on 23/04/2025. Data analysis was performed using STATA version 17. Modified Poisson regression models were used to identify factors associated with HIV testing uptake before and after stratifying by age group (15-19 and 20-24 years). Results were presented using the adjusted prevalence ratio (APR) with a 95% confidence interval. ResultsHIV testing uptake among adolescents remained 40% in the years 2016/17 and 2022/23, while it increased from 86% to 90% among young women, respectively. Key factors consistently associated with higher prevalence of HIV testing uptake included being in a union, cohabiting, or formerly married; having secondary or higher education levels; and a history of sexually transmitted infections (STIs). ConclusionHIV testing uptake among AGYW in Tanzania has improved over time, with significant disparities between adolescents and young women. These findings highlight the need for age-specific strategies, intensifying adolescent-focused interventions while sustaining efforts among young women and reinforcing integrated reproductive health and HIV services.

IntroductionFor differentiated models of care (DMOCs) that support client-centred HIV treatment (ART) in South Africa, a key next step in achieving integration is aligning clinic visits and medication dispensing for HIV treatment with other health needs like family planning. We assessed alignment between ART medication and family planning supply collection visits among DMOCs in South Africa. MethodsWe analysed self-reported data collected between September-December 2024 from women living with HIV (18-49 years, on ART [&ge;]6 months) at 24 public healthcare facilities in four provinces (Gauteng, Mpumalanga, KwaZulu-Natal, and Eastern Cape). Participants were enrolled from four service delivery models: conventional care not eligible for DMOC (CN), conventional care eligible for DMOC but not enrolled (CE), facility pickup points (FAC-PuP), and external pickup points (EXT-PuP). Surveys assessed contraceptive use, visit alignment for injectable (Depo-Provera & Nur-Isterate) and oral contraceptive users, and how misaligned visits affected family planning adherence. ResultsAmong 843 eligible women, 57% (460/843) reported current contraception use, with Depo-Provera being the most common (44%). Contraceptives users were younger (median 35 vs 38 years) and had slightly less ART experience (median 7 vs 8 years) than non-users. Contraceptive use varied by DMOC: CN (52%), CE (60%), FAC-PuP (63%), and EXT-PuP (50%). Half (131/260) of women using oral contraceptives or injectables collected their contraceptive and ART products on different days, with EXT-PuP showing the lowest level of alignment. Primary reasons for non-use were personal choice and beliefs (38%), followed by pregnancy-related factors (26%). Analysis of unmet family planning need in a subsample of 299 women found 22% had unmet need. ConclusionThe findings reveal a high proportion of misalignment between ART and family planning services across models of care. Aligning ART and family-planning guidelines and services will promote ART and contraceptive adherence and reduce the burden on clients, maintaining the benefits of differentiated models and promoting integration of multi-condition service delivery.

COVID-19 disrupted global health service delivery, particularly among children and adolescents living with HIV (CALHIV), increasing the risk of poor treatment adherence. This study assessed the impact of the COVID-19 pandemic on WHO-recommended early warning indicators (EWIs) of HIV drug resistance (HIVDR) among CALHIV. We conducted a descriptive, longitudinal, retrospective study among children (0-9 years) and adolescents (10-19 years) receiving antiretroviral therapy (ART) in five health facilities in the Littoral region of Cameroon. Seven EWIs were monitored: ART attrition, viral load (VL) suppression, VL coverage, appropriate second VL, ARV medicine stock-outs, antiretroviral drug refills at the pharmacy, and appropriate switch to second-line ART. EWI were collected from January 2018 to December 2021 and classified as "poor," "fair," or "desirable" according to WHO criteria. Trend analyses were performed using Pearsons Chi-squared test with Yates correction in R (version 4.1.1). In 2021, 817 participants were included, comprising 214 children and 603 adolescents. Overall performance was poor for most EWIs in both age groups, except for ART attrition and VL coverage, which showed desirable performance across years. A slight improvement in most indicators was observed between 2018 and 2019, followed by a significant decline in 2020 (p<0.001), coinciding with strict COVID-19 restrictions, and a subsequent improvement in 2021 (p<0.01) as mitigation measures were eased. Despite this recovery, children consistently experienced worse outcomes, including higher ART attrition (9.4% vs 4.4%, p<0.05), lower VL suppression (75.3% vs 82.1%, p<0.05), and poorer access to confirmatory VL testing (15.1% vs 69.5%, p<0.001). Overall, the COVID-19 pandemic negatively affected HIV service delivery during its early phase, although the health system demonstrated adaptive capacity one year later. Targeted public health actions are therefore needed to prevent their long-term effects and improve treatment outcomes in this vulnerable population, especially among children.

BackgroundChildren who are HIV-exposed uninfected (HEU) show greater morbidity and mortality than HIV-unexposed children (HUU). In this study we investigate sex differences in growth, infection rates and antibody response among HEU and HUU infants. MethodsThe study enrolled 107 pregnant women with HIV and 103 pregnant women without HIV with follow-up of their infants from birth to 12 months of age. Study measures assessed included growth parameters, the prevalence of children with overt disease symptoms as reported by the mother, PCR-based assessment of infections (cytomegalovirus (CMV), respiratory syncytial virus (RSV), rhinovirus, influenza A & B, rotavirus and malaria) as well as antibody profile to CMV, RSV and enterovirus infections. ResultsCompared to male HUU, male HEU infants had lower Height-for-age-z-scores ({beta} -0.75; P=0.047) in mixed-effect model accounting for age. Additionally, they showed transiently lower Weight-for-age-z-scores at 3 months (1.07 vs 0.05, P=0.04), with higher risk of rhinorrhea (RR=2.29, P=0.02) and lower enterovirus titers at birth (P=0.0066). Female HEU showed transiently higher stunting at 6 months (0% vs 21%; P=0.01) and lower CMV viremia at 6 months, with elevated CMV antibody titers at 3 months (P=0.04) compared to female HUU. With prevalence ranging from 25%-61%, CMV and Rhinovirus infections were dominant in all groups. HEU and HUU exhibited similar antibody decay and acquisition patterns for CMV, RSV, and Enterovirus across both sexes. ConclusionHEU infants show transient sex-based differences in growth, infection and immune profiles raising the relevance for considering sex as a key parameter to assess infant health.

BackgroundRetention in HIV care is associated with higher rates of antiretroviral treatment adherence and viral suppression, as well as lower risk of AIDS-related morbidity and mortality. However, the multidimensional nature of retention complicates measurement standardization, limiting comparability and global evaluation. This study explored how HIV stakeholders define and assess retention, aiming to develop a patient-centred and conceptually robust understanding to inform research and practice. MethodsWe conducted a qualitative study using Interpretive Description (ID) methodology, an applied qualitative approach designed to generate practice-relevant knowledge in health research. We purposively sampled 20 stakeholders representing diverse areas of expertise and geographic regions across World Bank country income classifications. We conducted, video-recorded, and transcribed in-depth, semi-structured interviews. Using constant comparative analysis (CCA), we identified recurring, convergent, and contradictory patterns. ResultsThe analysis identified five overarching themes. The first two, exploratory themes, included: Patient-Centred Understanding of Retention in HIV Care, which captured how stakeholders conceptualized retention in their respective contexts, and Operationalization of Retention Measures, which explored the key components used to measure retention. The next two, explanatory themes, included Purpose-Driven Definitions of Retention, which described how retention measures were selected based on their intended use; and Building Capacity through Shared Understanding and Integrated Action, which emphasized retention as a cyclical, interconnected process dependent on collaboration between patients and health systems. The final, prescriptive theme, Advancements Shaping Retention, reflected stakeholders shared vision of improving retention through innovations in HIV treatment and technology. ConclusionsThe findings suggest that stakeholders operationalize retention measures in line with specific objectives and individual health goals, while remaining attentive to contextual realities. Retention measures should remain flexible and patient-centred, rather than relying on a single rigid standard.

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.

BackgroundFemale sex workers (FSW) are a key population for HIV prevention and care. Increasing evidence suggests that social and structural barriers are key drivers of HIV transmission. This global systematic review assesses whether experiencing violence is associated with worse HIV outcomes among FSW. Methods and FindingsWe searched MEDLINE, Embase, and PsycINFO databases for studies published from January 1st, 2010 to February 10th, 2025 assessing the impact of violence on HIV outcomes among FSW, without restriction to language and study design. Some studies had multiple estimates due to reporting on multiple outcomes or exposures of interest. We pooled data from eligible studies using multi-level random-effects meta-analyses to quantify associations between recent (past year) or lifetime exposure to violence (physical, sexual, emotional/psychological and/or financial) and HIV outcomes (prevalent and incident HIV infection, HIV testing, ART use, ART adherence, and viral suppression) among FSW. We preferentially used adjusted estimates over unadjusted estimates if both were available. We included 91 studies with 221 estimates, comprising 179,727 FSWs in 37 countries. We found higher odds of prevalent HIV infection among FSWs with recent (pooled odds ratio (pOR):1.33; 95%CI:1.17-1.51; I2:64%; n=73 estimates) and lifetime (pOR:1.36; 95%CI:1.24-1.49; I2:38%; n=67) experiences of violence. Recently experiencing violence was associated with reduced odds of ART use (pOR:0.78; 95%CI:0.64-0.94; I2:8%; n=17). Lifetime exposure to violence was associated with reduced odds of viral suppression (pOR:0.88; 95%CI:0.79-0.98; I2:20%; n=6). There was no evidence of associations between violence and HIV incidence, HIV testing and ART adherence. ConclusionsExperiencing violence may increase HIV transmission risk and worsen HIV treatment outcomes among FSW. HIV interventions for FSWs must address violence as a structural determinant of HIV.

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.

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.