Journal of the International AIDS Society

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.

Introduction Understanding provider preferences for the design of HIV treatment packages could enhance the implementation of programs to support the adoption of long-acting injectable antiretroviral therapy (LAI ART) by people living with HIV who are interested in initiating this treatment modality. Methods We recruited providers from New York City (NYC), Rockland, Putman, and Westchester County Ryan White Part A Medical Case Management (MCM) programs to complete a discrete choice experiment (DCE) containing twelve tasks with two alternatives and an opt-out option, with additional survey questions about implementation readiness and choice motivations. The alternatives included four attributes--Type of ART Medication (monthly or bimonthly LAI ART), Service Location and Mode, Support for Clients, and Rewards for Clients--with 2-4 levels each. We ran latent class multinomial logit analyses (LCA) with 1-5 classes to estimate preferences and explore hypothesis-free preference heterogeneity. We estimated attribute influence using relative importances and preferences using zero-centered part-worth utilities for each level. Results One hundred seventy-seven providers completed the survey (July 2022-January 2023). About half (52%) were 40-59 years old, 72% identified as women, and the plurality (41%) identified as Latino/a. We chose the two-group LCA solution. Bimonthly LAI ART was preferred over monthly LAI ART overall and in both groups. Group 1 (n=45) preferred more traditional adherence supports (e.g., injections at the clinic by appointment, injection appointment reminders) whereas Group 2 (n=132) preferred more client-centered supports (e.g., injections at home by appointment, free transportation to injection appointments if at a clinic). Both groups preferred higher monetary value gift cards for clients for every on-time injection. The top-ranking motivations indicated that participants prioritized patient convenience over job satisfaction and administrative or financial feasibility for the agency. The scores for all implementation measures indicate readiness to implement LAI ART in both groups. Conclusions Our implementation science-focused study suggests that providers of MCM services in NYC and surrounding counties are motivated to offer services to support clients' access and adherence to LAI ART. More work is needed to understand how programs have, in fact, integrated supports for LAI ART into their services.

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.

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.

BackgroundTo promote sustainability and strengthen national ownership of Advanced HIV Disease (AHD) services, a transition was implemented across 22 health facilities in Central Malawi. This transition involved shifting responsibility for key AHD program elements, including clinical service delivery, diagnostics, provider mentorship, and reporting systems, from implementing partner-led implementation to full Ministry of Health (MoH) leadership. This evaluation assessed the impact of this transition on diagnostic coverage, TB preventive therapy (TPT) uptake, and 12-month survival outcomes. MethodsA retrospective cohort study was conducted involving all children and adults enrolled in AHD care during the pre-MoH transition (January 2020-December 2021) and post-MoH transition (January 2023-December 2024) periods. Eligibility followed national AHD criteria: CD4 count <200 cells/mm3, WHO stage 3 or 4 illness, or age <5 years. AHD clients data were abstracted from clinical records and linked across routine facility registers to assess diagnostic and treatment indicators. Kaplan-Meier survival curves, Cox proportional hazards, and Fine and Gray competing risk models were used to evaluate 6 and 12-month mortality and retention as primary outcomes. ResultsA total of 1,044 AHD clients were included (553 pre-transition; 491 post-transition) in the evaluation. Median age increased post-transition (35.9 to 38.5 years, p<0.001). CD4 testing declined (80.7% to 46.0%, p<0.001) testing uptake, while WHO staging and TB diagnostic coverage improved. TB diagnoses decreased (44.5% to 31.2%, p=0.002). TPT uptake dropped from 46.4% to 31.6% (p<0.001). Twelve-month mortality significantly declined from 9.4% to 5.5% (adjusted hazard ratio [aHR]=0.59, 95% CI: 0.37-0.94, p=0.026). Retention in care remained stable (HR=0.86, 95% CI: 0.62- 1.20, p=0.384). ConclusionsTransitioning AHD services to MoH leadership sustained key program outcomes and significantly reduced mortality. Continued mentorship and government ownership were key drivers of success. However, declines in CD4 testing and TPT coverage highlight the need for strengthened diagnostics and preventive care integration. These findings support scaling nationally-led AHD models in high-burden HIV settings.

IntroductionOn January 20, 2025, the U.S. government froze foreign assistance including for PEPFAR, though a limited waiver for "life-saving" interventions was subsequently granted. PEPFARs 2025 monitoring results, released April 17, 2026, covered only quarter 4 while an earlier inadvertent release included all four quarters. Combining both data sets, we systematically assess facility-level programmatic performance and reporting trends to quantify service disruptions accounting for reporting discrepancies. MethodsWe categorized facilities by reporting continuity across Q1 2024 and Q4 2025 (e.g. continuous, intermittent, dropped, or new) and assessed changes in service delivery by the category of health facility for key HIV treatment, testing, PMTCT, and prevention programming. We additionally analyze changes in employed human resources for health (HRH) reported by PEPFAR. ResultsPEPFAR data included 31,746 facilities and community service sites. 71.3% were classified as continuous reporters, 16.9% intermittent reporters, 2.5% community services, 3.9% dropped in 2025, and 3.1% new in 2025. Total number of people accessing HIV treatment declined modestly by -0.3%, but differed by facility category. Continuous facilities saw a 0.5% increase in people on treatment, while intermittent facilities saw a -1.7% decrease. HIV testing declined -17%. HIV diagnoses declined -13% in continuous facilities, -35% in community services, and -29% in intermittent facilities. PMTCT infant testing and diagnoses declined by -6% and -12% in continuous facilities, respectively, and -60% and -31% in intermittent facilities, respectively. PrEP initiations declined -33%. Total direct service delivery HCWs reduced -62,541 (-24%) ConclusionThese findings reveal substantial disruptions across PEPFAR service areas, with the steepest declines among intermittent and community-based delivery sites, alongside a 24% reduction in direct service delivery healthcare workers. As potentially the final data set PEPFAR will ever release, these findings represent a troubling inflection point. The dismantling of public data systems and accountability structures undermine progress and enable programmatic gaps to develop and go unnoticed that risk allowing HIV resurgence to occur over the coming years.

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 HIV remains a major public health challenge in South Africa, with gaps in early diagnosis and linkage to care driving onward transmission. Adolescent girls and young women face barriers to timely care, including stigma, privacy concerns, and limited clinic access, while healthcare providers work in resource-constrained settings with high client volumes. We evaluated the Self-Care from Anywhere (SCFA) toolkit, an AI-enabled intervention comprising an AI Companion for AGYW and a provider-facing Clinical Portal to support HIV prevention, testing, and linkage to care. The AI Companion is designed to complement and extend human-delivered services, particularly in resource constrained settings, rather than replace in-person counselling. Methods We conducted an exploratory study to assess the usability, feasibility, and acceptability of the SCFA toolkit in Gauteng Province (November 2024-May 2025). AGYW engaged with the AI Companion, and a subset completed a simulated HIV self-testing activity with AI-delivered counselling. Pre and post-intervention surveys, including the System Usability Scale (SUS), were administered. Usability testing of the Clinical Portal involved healthcare providers using the toolkit without formal training to capture first impressions. A subset of AGYW and healthcare providers participated in separate focus group discussions or in-depth interviews. Quantitative data were analysed using descriptive statistics, and qualitative data were analysed thematically. Results A total of 97 AGYW were enrolled; 75.3% had completed high school and 91.8% were unemployed or full time students. Most participants (85.6%) self-reported HIV-negative status, and 63.9% reported sexual activity in the past 12 months. The AI Companion demonstrated high usability (mean SUS 87.7, SD 12.7) and was perceived as acceptable and useful, particularly for its personalisation and confidentiality features. Healthcare providers had a mean age of 34 years (SD 6.5), with about half serving as HIV testing and screening counsellors. Most providers rated the Clinical Portal ease of use, comprehension, and client support as positive to very positive, though 23% expressed concerns regarding workflow efficiency and their ability to manage additional client volume. Providers also highlighted the Clinical Portal value for case management. Conclusion AI-powered digital health tools, such as the SCFA toolkit, show potential to enhance user engagement and support care delivery, with high usability and acceptability demonstrated among AGYW and healthcare providers. Continued user-centred refinement is essential to ensure these tools remain responsive to the evolving needs and care contexts of diverse user groups.

Objectives: This systematic review and meta-analysis (2010 - 2025) examines changes in uptake and retention rates among pregnant and postpartum women with HIV in sub-Saharan Africa as countries adopted Option B+ for preventing vertical transmission. Design and data sources: We searched PubMed, Embase, Cochrane Library, Scopus, and African Index Medicus from 10/2021 - 05/2025 for eligible studies that measured HIV care uptake or retention for pregnant/postpartum women under prevention policies before or during Option B+. Study designs were limited to cohort, case-control, cross-sectional, or interventional studies. Exclusions were white papers, commentaries, modeling, cost-effectiveness, and qualitative studies. Data extraction and synthesis: Outcomes were (i) HIV care uptake defined as initiation of ART during pregnancy or prior to initial antenatal care (ANC) visit and (ii) proportion of women retained in HIV care as defined by study authors after ART initiation (or entry to antenatal care). These were synthesized in meta-analyses stratified by policy era (pre-Option B+ vs. Option B+) at different times for different countries. Comparisons between policy eras were made using relative risk with a 95% confidence interval. Pooled retention estimates at 6- and 12-months post ART initiation used crude relative risks (RR) with 95% confidence intervals (CI). Results: Among 4,752 articles, 82 from 17 countries were included; 60 reported HIV care uptake, 31 reported retention outcomes. Pooled HIV uptake rose by 8% (RR=1.08; 95% CI:1.06-1.09) and pooled retention in HIV care rose by 46% (RR=1.46; 95% CI:1.41-1.51) after Option B+ implementation. Pooled estimates of retention in care were 36.9% (95% CI: 13.9%, 59.9%) at 6 months post ART initiation before the implementation of Option B+ and 72.7% (95% CI: 66.3%, 79.1%) after implementation. Conclusion: HIV care uptake and retention improved after Option B+ implementation in 15 countries reporting results, but retention remains suboptimal for meeting UNAIDS 95-95-95 targets.

Objectives: Quantify hazardous alcohol consumption prevalence among individuals at risk of acquiring HIV infection and its association with high-risk sexual behaviors and incident HIV in 11 Eastern and Southern African countries. Design: Secondary analysis of 16 nationally-representative household surveys (2015-2023). Methods: The study included sexually active individuals aged [&ge;]15 years. Alcohol use patterns were classified using the AUDIT-C (non-drinkers/low-risk drinkers/hazardous non-binge drinkers/hazardous binge drinkers). Outcomes included high-risk sexual behaviors, recent HIV infection, and undiagnosed HIV infection. Survey-weighted alcohol use prevalence and logistic regression were estimated by gender, adjusting for sociodemographic covariates. Model outputs were used to estimate change in incident infections when removing excess risks associated with alcohol use patterns. Results: Analyses included 251,931 participants. Across countries, 5.8%-21.1% reported hazardous binge drinking, and 3.7%-15.7% reported hazardous non-binge drinking, with large gender differences. Sexual risk behaviors increased with drinking severity among men and women. Compared with non-drinkers, alcohol use was associated with higher odds of undiagnosed HIV infection; adjusted odds ratios ranged from 1.32 (1.16-1.50) for low-risk drinkers to 1.52 (1.34-1.72) for hazardous binge drinkers among men, and 1.28 (1.13-1.46) to 1.55 (1.31-1.82) among women. Simulated removal of alcohol-associated excess risk reduced undiagnosed HIV by 15.1% (10.9%-19.4%) among men and 5.8% (4.0%-7.9%) among women. Estimates for recent HIV infection followed a similar pattern but with larger uncertainty. Conclusions: Hazardous alcohol use was associated with sexual risk and HIV infection in Eastern and Southern Africa. Reaching individuals who use alcohol with effective HIV prevention may reduce HIV acquisition risk across the region.

Medical male circumcision (MMC) is an established HIV prevention intervention, yet concerns persist that circumcised men may adopt higher-risk sexual behaviours following the procedure. Evidence from observational studies has been inconsistent, partly because many analyses do not adequately distinguish behaviours that occur before circumcision from those that occur afterward. This study assessed the association between MMC and subsequent sexual behaviours while demonstrating how population-based cross-sectional survey data can be adapted to address this temporal challenge. We analysed nationally representative data from the 2024 Zambia Demographic and Health Survey (ZDHS), including men aged 15 - 59 years who reported their circumcision status. Men who had undergone medical circumcision were compared with uncircumcised men using a matched pseudo-cohort framework that reconstructed temporal ordering based on age at circumcision. Propensity score overlap weighting was applied to improve comparability between circumcised and uncircumcised men, and odds ratios were estimated using logistic regression models incorporating overlap weights and accounting for the complex survey design. Sexual behaviour outcomes occurring after circumcision included condom non-use at last sexual intercourse, multiple sexual partners in the past 12 months, self-reported sexually transmitted infection (STI) symptoms, and composite measures of sexual risk behaviour. The analysis included 9,609 men, of whom 33.3% were medically circumcised. MMC was associated with lower odds of condom non-use at last sexual intercourse (adjusted odds ratio [aOR] = 0.75, 95% confidence interval [CI]: 0.67 - 0.85) and lower odds of reporting any sexual risk behaviour (aOR = 0.83, 95% CI: 0.72 - 0.95). No meaningful associations were observed between MMC and reporting multiple sexual partners, self-reported STI symptoms, or higher levels of composite sexual risk behaviour. In this population-based study, MMC was not associated with sexual risk compensation under routine programme conditions within the overlap population defined by the weighting scheme, supporting the behavioural safety of MMC and illustrating the value of explicitly addressing temporality when analysing behavioural outcomes using cross-sectional survey data.

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.

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.

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.

Objectives: In Latin America, up-to-date information to monitor UNAIDS 95-95-95 HIV targets in key populations, such as men who have sex with men, is limited. Elsewhere, structural homophobia restricts access to ART. Conceptual frameworks suggest that intersecting forms of violence and discrimination may negatively influence HIV care outcomes through psychosocial and structural pathways, although empirical evidence remains limited. The study aimed to assess whether sexual orientation outness and recent homophobic violence are associated with not being on ART among Latin American MSM living with HIV. Methods: This cross-sectional study is a secondary analysis of data from LAMIS-2018, including 7,609 MSM aged 18+ with an HIV diagnosis [&ge;]1 year prior from 18 Latin American countries. Participants self-reported ART status, sociodemographic characteristics, homophobic violence, and sexual orientation outness. Bivariate and multivariate logistic regressions identified those factors associated with not being on ART. Results: Nine percent of MSM with HIV were not on ART, 18% reported low sexual orientation outness, and 27% experienced homophobic violence, especially in Andean and Central American countries. Not being on ART was associated with recent homophobic violence (aPR=1.25), low outness (aPR=1.22), unemployment (aPR=1.27), and residence in the Andean subregion (aPR=1.87), Mexico (aPR=1.28), or the Southern Cone (aPR=1.45) versus Brazil. Protective factors included being older (25-39: aPR=0.72; >39: aPR=0.49), living in large cities (aPR=0.72), having a stable partner (aPR=0.78), and university education (aPR=0.74). Conclusions: Recent homophobic violence and low sexual orientation outness were associated with not being on ART among MSM in Latin America. While access varies across countries, structural factors such as stigma and violence may limit engagement in care. Addressing these barriers alongside strengthening health systems may be key to improving ART uptake and advancing progress toward the 95-95-95 targets.

Long-acting cabotegravir and rilpivirine combination (LA-CAB/RPV) is approved for HIV treatment whilst long-acting cabotegravir alone (LA-CAB) is approved for HIV prevention, both in adults. However, individuals who become pregnant might prefer to discontinue it due to lack of definitive data on safety. The aim of this study was to characterise the tail-phase maternal and fetal pharmacokinetics of LA-CAB/RPV following discontinuation at steady-state early in pregnancy. A virtual population of non-pregnant women (n = 100 per scenario) initiated intramuscular injections of LA-CAB/RPV at the approved dosage and continued maintenance dose (400/600 mg once monthly or 600/900 mg once every two months) until steady state. We simulated discontinuation at steady state after only one injection during pregnancy. Tail-phase pharmacokinetics of CAB and RPV from LA injections were characterised during gestation and until 6 months postpartum. Pharmacokinetic tails of LA-CAB/RPV were driven by the residual drug in the muscle depot which stabilised at steady state and reduced steadily upon dosing discontinuation. Upon discontinuation of the monthly dosing, predicted median (IQR) maternal plasma concentrations for LA-CAB were 415 (386-448) ng/mL at delivery and 125 (115-139) ng/mL 6 months postpartum. For LA RPV, these were 11.6 (11.0-12.6) ng/mL and 7.84 (7.30-8.49) ng/mL at delivery and 6 months postpartum, respectively. Pharmacokinetic tails of LA-CAB/RPV extend to several months postpartum, with levels falling below established minimum effective concentration in most women after gestation week 33. Potential strategies to minimise potential risks associated with LA-CAB/RPV discontinuation in this population are needed.

BackgroundTuberculosis (TB) remains a leading cause of morbidity and mortality among people living with HIV (PLHIV), who face a 12-fold higher risk of active TB reactivation than HIV-negative individuals. TB preventive therapy (TPT) is an effective intervention, yet TB/HIV co-infection persists at 40-45%, raising questions about the durability of a single course of TPT. This study assessed the time from TPT completion to TB diagnosis and predictors of early TB reactivation. MethodsWe conducted a retrospective case-only cohort study using routine data from Ugandas electronic medical record system, TB registers, and patient files at three TASO Centres of Excellence (Soroti, Mbale, Tororo). PLHIV on antiretroviral therapy (ART) diagnosed with TB after completing TPT between 2022-2024 were included. Participant characteristics and time to TB diagnosis were summarised descriptively; predictors of early TB were identified using logistic regression. ResultsAmong 670 participants, most were female (464, 69.3%) with mean age 51.6 years (SD 14.5). Newly diagnosed TB accounted for 638 (95.2%), including bacteriologically confirmed pulmonary TB (535, 79.9%), clinically diagnosed TB (123, 18.4%), and extrapulmonary TB (12, 1.8%). Overall, 548 (82.8%) participants were virally suppressed, with most on Dolutegravir-based regimens (641, 95.7%). Early TB occurred in 144 (21.5%), with average time to diagnosis 2.6 years. Multivariable analysis showed care at TASO Soroti was protective (aOR = 0.104, p < 0.001), while clinically diagnosed TB (aOR = 1.91, p = 0.007), shorter ART duration (<5 years: aOR = 3.07, p = 0.001; 5-10 years: aOR = 1.74, p = 0.018), and viral suppression (aOR = 1.87, p = 0.014) increased odds of early TB. ConclusionsTB can occur soon after TPT completion, with one in five PLHIV developing early disease particularly those with shorter ART duration despite viral suppression. Strengthening TB screening, continuous monitoring, and repeat TPT for high-risk groups may improve prevention.

Background: Cervical cancer remains a major public health challenge among women living with HIV (WLWH) in sub-Saharan Africa, where screening coverage remains suboptimal despite opportunities for integration within HIV care programs. Visual inspection with acetic acid (VIA) has been widely used as a low-cost screening approach in resource-limited settings. Methods: This cross-sectional analysis utilized prospectively collected data from Project CN001 at the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya, a CASCADE Clinical Trials Network site. WLWH aged 25-49 years receiving routine HIV care and undergoing VIA screening between March 11, 2025, and January 16, 2026, were included. Data from the REDCap and Kenya's electronic medical record system (KenyaEMR) captured sociodemographic characteristics, HIV clinical factors, VIA results, and cervical transformation zone (TZ) classification. Results: Among 857 WLWH screened with VIA, the median age was 40 years (interquartile ranges [IQR]: 34-45), and 77.2% reported a prior history of cervical cancer screening. VIA positivity was 7.4% (63/857) and was higher in women with TZ1/TZ2 than in those with TZ3. VIA positivity was also associated with higher HIV viral load, shorter time since HIV diagnosis, no cervical screening history, and younger age at screening. The proportion of women classified as TZ3 increased with age, from 39.5% among women aged 25-29 years to 67.7% among those aged 45-49 years, while the proportion classified as TZ1 decreased with increasing age. Conclusion: Integrated screening at this urban U.S. President's Emergency Plan for AIDS Relief (PEPFAR) and CASCADE-supported HIV clinic demonstrates the feasibility of integrated cervical cancer screening programs for WLWH. Age-related TZ3 predominance and VIA limitations for older women highlight the need for refined screening strategies and continued electronic platform utilization for program monitoring to support cervical cancer elimination targets.

IntroductionAcross Europe, many people with HIV are diagnosed late despite repeated contact with hospital services for HIV indicator conditions. These conditions flag a possible underlying HIV infection for which HIV testing is recommended. They provide an opportunity to identify people with HIV, yet implementation of indicator condition based testing remains insufficient in hospital practice. The #aware.hiv Europe study was developed to address this gap by embedding HIV teams into routine care to normalise HIV testing. Methods and analysis#aware.hiv Europe is a stepped-wedge cluster randomised trial in 30 hospitals across ten European countries. Five clusters of 6 hospitals each will sequentially transition from control to implementation periods when local HIV teams led by an infectious diseases specialist will be installed. Intervention activities include hospital-wide peer audit and feedback on missed testing opportunities, targeted education, stigma reduction activities, and strengthening of linkage to HIV prevention and care. Patients with predefined HIV indicator conditions are identified using International Classification of Diseases, 10th Revision (ICD-10) diagnosis codes, confirmed through manual review. The primary outcome is the change in HIV testing rate among patients with confirmed HIV indicator conditions. Secondary outcomes include HIV case detection, cascades of diagnosis, care and prevention, variation in testing practices, healthcare professional knowledge and stigma, and implementation outcomes. Analyses will use mixed effects regression models accounting for clustering and time within the stepped-wedge design. Ethics and disseminationThe study has ethical approval in all hospitals to use routinely collected clinical data under exemption from informed consent for patient level data. Results will be disseminated through peer reviewed publications, conferences, and collaboration with clinical and community partners with the goal to inform HIV testing policies. Trial registrationClinicalTrials.gov NCT06900829. https://clinicaltrials.gov/study/NCT06900829 Strengths and limitations of this study+ Large, multinational, real-world, stepped-wedge, cluster randomized trial design. + Primary outcome derived from routinely collected clinical data, using a GDPR- and GCP-compliant approach with exemption from informed consent. + Hospital-wide intervention targeting care professionals, delivered through proactive expert HIV teams across departments powered to conclude on hard HIV care cascade clinical endpoints and stigma reducing interventions. + Implementation science design informed by established frameworks (CFIR and RE-AIM) to strengthen cross-continental generalisability. - Variation in healthcare systems and baseline testing practices across countries may contribute to heterogeneity in implementation and outcomes. - Despite standardised SOPs, local clinical judgement influences the assessment of HIV indicator conditions.