Journal of the International AIDS Society

IntroductionPrompt HIV diagnosis is essential to enabling effective prevention and treatment, thereby interrupting transmission and sustain epidemic control. Strategies that could diagnose individuals during acute HIV infection (AHI), while leveraging standard systems that deliver same visit results, have potential to further enhance impact. Antibody-only (Ab) rapid diagnostic tests (RDTs), which are unable to detect AHI, remain the global standard, particularly in resource-limited settings. Ant...

BackgroundLong-acting injectable HIV pre-exposure prophylaxis (LAI-PrEP) offers potentials for expanding PrEP coverage and improving public health outcomes. This study synthesises global evidence on the prevalence and determinants of interest in and preference for LAI-PrEP among men-who-have-sex-with-men (MSM), trans* individuals, and cis-gender heterosexual women. MethodsWe conducted a global systematic review and meta-analysis, building on quantitative studies from a previous review (January ...

ObjectivesTo quantify national and regional trends in antiretroviral therapy (ART) consumption in Tanzania from 2017 to 2021 using the World Health Organisation (WHO) Defined Daily Dose (DDD) methodology and to describe shifts in regimen composition during the transition to dolutegravir-based therapy. MethodsA retrospective descriptive analysis was conducted using programmatic dispensing data from the National AIDS and Sexually Transmitted Infections Control Programme (NASHCoP). ART dispensing ...

IntroductionEconomic evaluations of HIV pre-exposure prophylaxis (PrEP) and associated implementation strategies guide evidence-based policies, programmes, and resource allocation. Since 2015, there has been an evolution in PrEP modalities, implementation strategies, and prioritization of key populations with unmet HIV prevention needs, alongside the scale-up of other HIV prevention interventions. Our systematic review describes the evolving landscape of economic evaluations of PrEP to help iden...

ASBSTRACTO_ST_ABSIntroductionC_ST_ABSWhile HIV services have scaled up dramatically under universal treatment recommendations, availability of routine laboratory services for HIV diagnosis and management, and the extent to which user fees are charged for these services, are not well documented. We described site-level availability and user fees for adult HIV laboratory testing among 238 sites in 42 countries of the International epidemiology Databases to Evaluate AIDS (IeDEA) global consortium, ...

CD4 testing is essential for identifying people with Advanced HIV Disease to enable provision of a diagnostic package (serum cryptococcal antigen testing and urine lipoarabinomannan testing) and prophylaxis. Lay providers (HIV diagnostic assistants) might be able to perform CD4 testing and advanced HIV diagnostics using lateral flow assays (LFAs). We conducted a prospective diagnostic accuracy study comparing LFA(Visitect) CD4 results performed by HIV diagnostic assistants and by laboratory tech...

BackgroundWHO 2019 HIV testing guidelines recommended a standard HIV testing strategy consisting of three consecutively HIV-reactive test results on serology assays to diagnose HIV infection. National HIV programmes in high prevalence settings currently using the strategy consisting of only two consecutive HIV-reactive tests should consider when to implement the new guideline recommendations. Methods and FindingsWe implemented a probability model to simulate outcomes of WHO 2019 and the two str...

IntroductionWorld Health Organization (WHO) updated guidelines for maternal HIV, syphilis and hepatitis B virus (HBV) testing for pregnant women, and advised on using dual HIV/syphilis rapid diagnostic tests (RDTs). We reviewed national testing guidelines to assess political support in alignment with WHO guidance and triple elimination of mother-to-child transmission (MTCT) priorities. MethodsWe reviewed national HIV-related guidelines from 46 African countries after 2010, including guidelines ...

BackgroundDolutegravir is now recommended for second-line anti-retroviral therapy (ART) in low- and middle-income countries. We compared outcomes with dolutegravir (DTG) versus the previous lopinavir/ritonavir (LPV/r) regimen in South Africa. MethodsWe used routinely collected, de-identified data from 59 South African clinics. We included people living with HIV aged [≥] 15 years with virologic failure (two consecutive viral loads [≥]1000 copies/mL) on first-line tenofovir disoproxil fumar...

BackgroundWe assessed whether participants in the EZI-PrEP study, a non-inferiority trial evaluating online and six-monthly monitoring of oral HIV pre-exposure prophylaxis (PrEP), represent the broader population of PrEP users in the Netherlands. MethodsWe conducted a cross-sectional study using routinely collected data from September 2021 to August 2022 at four sexual health centres (SHCs) in the Netherlands. Socio-demographic characteristics, sexual behaviour, and prevalence of bacterial STIs...

BackgroundThe objective of this study was to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) of the effectiveness and safety of oral Pre-Exposure Prophylaxis (PrEP) to prevent HIV. MethodsDatabases (PubMed, Embase and the Cochrane Register of Controlled Trials) were searched up to 5/7/2020. RCTs were included that compared oral tenofovir-containing PrEP to placebo, no treatment or alternative medication/dosing schedule. The primary outcome was the rate ratio...

BackgroundIn many countries in Sub-Saharan Africa, self-reported HIV testing history and awareness of HIV-positive status from household surveys are used to estimate the percentage of people living with HIV (PLHIV) who know their HIV status. Despite widespread use, there is limited empirical information on the sensitivity of those self-reports, which can be affected by non-disclosure. MethodsBayesian latent class models were used to estimate the sensitivity of self-reported HIV testing history ...

BackgroundTo reduce the high HIV incidence among key populations in Indonesia, we implemented a clinical pathway for screening, diagnosis and treatment of acute HIV infection (AHI) in sexual health clinics in Jakarta and Bali. This paper presents a cohort profile and analysis of baseline data on the study uptake, diagnostic yield, and estimated AHI prevalence and screening cascade outcomes. MethodsWe performed a baseline analysis of 1879 individuals who underwent AHI screening at three sexual h...

In 2021, The Mozambique Ministry of Health began offering HIV pre-exposure prophylaxis (PrEP) in all provinces. The number of new clients increased more than three-fold within two years. Among 51,848 new people receiving PrEP by December 2023, the largest groups were females and adolescent young adults.

IntroductionThe Global AIDS Strategy 2021-2026 calls for equitable access to HIV services for all populations. Transgender people have been marginalised and experience disproportionate risk of HIV infection in sub-Saharan Africa (SSA) and data to guide HIV programmes are severely limited. Surveillance data among cisgender men who have sex with men (cis-MSM) are comparatively abundant. We assessed whether HIV prevalence among cis-MSM was correlated with HIV prevalence among transgender women. Me...

IntroductionHIV elimination requires innovative approaches to ensure testing and immediate treatment provision. We investigated the effectiveness of conditional financial incentives on increasing linkage to HIV care in a 2x2 factorial cluster randomized controlled trial-Home-Based Intervention to Test and Start (HITS) - in rural South Africa. MethodsOf 45 communities in uMkhanyakude, KwaZulu-Natal, 16 communities were randomly assigned to the arms to receive financial incentives for home-based ...

BACKGROUNDIn sub-Saharan Africa, increased antiretroviral therapy (ART) availability has improved survival after diagnosis of Kaposi sarcoma (KS) compared to the pre-ART era, but mortality among patients with KS is still considerably higher than HIV-infected persons without KS. Furthermore, among those patients with KS who are treated initially with ART without adjunct chemotherapy and who do survive, little is known about how well they function and feel -- quality of life (QOL) -- compared to t...

IntroductionCOVID-19 posed substantial challenges for sustaining use of HIV prevention services in sub-Saharan African populations. However, data on changes in use of HIV primary prevention methods within the general population over the course of the pandemic remain scarce. We investigated these changes in east Zimbabwe. MethodsData were taken from three rounds of a large-scale open-cohort population survey conducted before (July 2018 to December 2019), during (February to July 2021), and after...

IntroductionDifferentiated service delivery (DSD) models have been widely implemented for patients who are established in HIV care. However, DSD has rarely been offered to those newly diagnosed with HIV. We conducted a study to assess the effectiveness of early fast-track care during the COVID-19 pandemic and a period of severe civil unrest at GHESKIO, in Haiti. MethodsWe conducted a pilot randomized trial among adults presenting with World Health Organization Stage 1 or 2 disease at HIV diagno...

BackgroundHIV testing and counseling is a key component of HIV prevention and the entry point into the treatment cascade, which improves for individual clinical outcomes and reduces onward HIV transmission. Current guidelines recommend at least annual testing for key populations. More frequent testing could provide health benefits, but these additional services increase the program the cost-effectiveness is not well-evaluated. MethodsWe used a compartmental mathematical model to simulate the he...