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Summary: Asia has the highest numbers of tuberculosis cases (60% of the global total) and has experienced a marked rise in HIV seroprevalence (22% of the global total) in key subpopulations of these highly populous nations. Thus, co-infected patients are a challenge for practitioners and public health workers alike. The U.S.–Japan Cooperative Medical Science Program is spearheading interdisciplinary collaborations in Asia to address the many outstanding research priorities for HIV–tuberculosis co-infection. There is an urgency to this agenda for many reasons, including the frequency with which tuberculosis accounts for the death of HIV-infected persons in Asia, and the continued rise of multiple drug-resistant Mycobacterium tuberculosis. We review briefly the public health situation in Asia, highlighting research questions from US–Japan–Asian partner joint meetings, and cite salient studies to indicate trends and challenges. [Copyright &y& Elsevier]

• Prevalence of HIV, HCV, and HBV, is currently rising in the countries of Central Asia and the Caucasus. • For this systematic review, we compiled reports on prevalence of HIV, HCV, and HBV among high-risk populations of Central Asia and the Caucasus. • Our review revealed reports of alarmingly high prevalences of the three infections in high risk groups, people who inject drugs, men having sex with men, prisoners, female sex workers, and migrants. • As an outcome of this study, we now know that, although countries in Central Asia and the Caucasus have taken measures to control the infections of HIV, HCV, and HBV, prevalence of all three infections remains exceedingly high among selected populations, notably PWID and MSM. Human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) are substantial public health threats in the region of Central Asia and the Caucasus, where the prevalence of these infections is currently rising. A systematic review of MEDLINE, Embase and PsycINFO was conducted with no publication date or language restrictions through October 2019. Additional data were also harvested from national surveillance reports, references found in discovered sources, and other "grey" literature. It included studies conducted on high-risk populations (people who inject drugs (PWID), female sex workers (FSW), men who have sex with men (MSM), prisoners, and migrants) in Central Asia: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan; and the Caucasus: Armenia, Azerbaijan, Georgia, and Northern Caucasus region of the Russian Federation. Wide ranges were noted for HIV prevalence: PWID 0–30.1%, MSM 0–25.1%, prisoners 0–22.8%, FSW 0–10.0%, and migrants 0.06–1.5%, with the highest prevalence of these high-risk groups reported in Kazakhstan (for PWID), Georgia (for MSM and prisoners) and Uzbekistan (for migrants). HCV prevalence also had a wide range: PWID 0.3–92.1%, MSM 0–18.9%, prisoners 23.8–49.7%, FSW 3.3–17.8%, and migrants 0.5–26.5%, with the highest prevalence reported in Georgia (92.1%), Kyrgyzstan (49.7%), and migrants from Tajikistan and Uzbekistan (26.5%). Similarly, HBV prevalence had a wide range: PWID 2.8–79.7%, MSM 0–22.2%, prisoners 2.7–6.2%, FSW 18.4% (one study), and migrants 0.3–15.7%. In Central Asia and the Caucasus, prevalence of HIV, HCV and HBV remains exceedingly high among selected populations, notably PWID and MSM. [ABSTRACT FROM AUTHOR]

Background In resource-limited rural settings, scale-up of services to eliminate mother-to-child transmission of HIV has not been as effective as in better resourced urban settings. In sub-Saharan Africa, women often require male partner approval to access and remain engaged in HIV care. Our study will evaluate a promising male engagement intervention (“Homens para Saúde Mais” (HoPS+) [Men for Health Plus]) targeting the elimination of mother-to-child transmission in rural Mozambique. Design We will use a cluster randomized clinical trial design to engage 24 health facilities (12 intervention and 12 standard of care), with 45 HIV-infected seroconcordant couples per clinic. The planned intervention will engage male partners to address social-structural and cultural factors influencing eMTCT based on new couple-centered integrated HIV services. Conclusions The HoPS+ study will evaluate the effectiveness of engaging male partners in antenatal care to improve outcomes among HIV-infected pregnant women, their HIV-infected male partners, and their newborn children. Our objectives are to: (1) Implement and evaluate the impact of male-engaged, couple-centered services on partners' retention in care, adherence to antiretroviral therapy, early infant diagnosis uptake, and mother-to-child transmission throughout pregnancy and breastfeeding; (2) Investigate the impact of HoPS+ intervention on hypothesized mechanisms of change; and (3) Use validated simulation models to evaluate the cost-effectiveness of the HoPS+ intervention with the use of routine clinical data from our trial. We expect the intervention to lead to strategies that can improve outcomes related to partners' retention in care, uptake of services for HIV-exposed infants, and reduced MTCT. [ABSTRACT FROM AUTHOR]

Abstract: In this article we systematically and critically review the Chinese and English language literature on human immunodeficiency virus (HIV)-related studies in Yunnan Province, Southwestern China. Yunnan Province had the first Chinese HIV outbreak and is still the worst affected area in the nation. Since 1989, HIV infection has extended from injecting drug users into the general population through sexual transmission. Since the economic reform of the 1980s, changed social norms and increased migration have spawned increases in HIV-related risk behaviors such as drug use and commercial sex work. A smaller size of “bridge” populations and lower sexual contact rates between persons in “bridge” and general populations may explain the slower expansion of the HIV epidemic in Yunnan compared to nearby Southeast Asian nations. In 2004, women in antenatal care had a 0.38% HIV prevalence province wide, although >1% infection rates are seen in those counties with high injection drug rates. Patterns of drug trafficking have spread the unusual recombinant HIV subtypes first seen in Yunnan to far-flung regions of China. Increased efforts of Yunnan''s HIV control program are correlated with an improved general HIV awareness, but risk behaviors continue at worrisome rates. Future efforts should focus on changing risk behaviors, including harm reduction and condom promotion, especially among the “bridge” groups. The resurgence of commercial sex work in Yunnan, and the high frequency of workers migrating into provinces far from home and family are all sociocultural factors of considerable importance for future HIV and sexually transmitted disease control in China. [Copyright &y& Elsevier]

• The number of people ≥50 years old living with HIV (PLWH) continues to increase at the era of antiretroviral therapy (ART). • There is lack of consistent evidence on the relationship between HIV infection and cognitive decline among older PLWH. • Our meta-analysis found that HIV infection is associated with an increased risk of global cognitive impairment in older adults. • The association exists in five cognitive domains of executive function, processing speed, verbal, recall, and motor/psychomotor. To synthesize evidence on the association between human immunodeficiency virus (HIV) infection and cognitive impairment in older adults. Meta-analysis. Adults aged 50 years or older. In this systematic literature review and meta-analysis, we searched PubMed, Scopus, Embase, and APA/PsycNet for studies published before July 21, 2020, that assessed the association between HIV-infection and cognitive impairment. We calculated pooled odds ratios (ORs) of cognitive impairment for people living with HIV (PLWH) and 95 % confidence intervals (CIs) using random-effect models and calculated pooled mean difference (MD) for major cognitive domains between PLWH and HIV-uninfected adults. We assessed risk of bias using the Newcastle-Ottawa scale. Of the 4432 studies identified, 21 cross-sectional studies were eligible for the meta-analysis, including 15 examining global cognitive impairment. The meta-analysis showed that older PLWH were more likely to be cognitively impaired than HIV-uninfected controls (OR = 2.44, 95 % CI = [1.69, 3.53], number of estimates (k) = 15, I2 = 71 %). This higher likelihood was shown in studies from high income countries (OR = 2.63, 95 % CI = [1.76, 3.94], k = 12, I2 = 55 %), but not from upper-middle income countries (OR = 1.96, 95 % CI = [0.26, 14.68], k = 3, I2 = 91 %). PLWH had lower scores than HIV-uninfected adults in 5 out of 7 major cognitive domains, including executive function (MD = -0.42, 95 % CI = [-0.72, -0.11], k = 5, I2 = 32 %), processing speed (MD = -0.33, 95 % CI = [-0.59, -0.08], k = 6, I2 = 16 %), verbal (MD=-0.29, 95 % CI = [-0.48, -0.10], k = 6, I2 = 0%), recall (MD = -0.24, 95 % CI = [-0.38, -0.10], k = 6, I2 = 0%) and motor/psychomotor (MD = -0.38, 95 % CI = [-0.59, -0.16], k = 5, I2 = 31 %) performance. Our meta-analysis provides empirical evidence that HIV infection is associated with an increased risk of cognitive impairment among older adults, especially in cognitive domains of executive function, processing speed, verbal, recall, and motor/psychomotor. [ABSTRACT FROM AUTHOR]

Summary: Background: In 2004, cases of HIV and syphilis were reported in an indigenous community in the Peruvian Amazon. This study sought to determine the prevalence of HIV and syphilis in four remote communities of the same indigenous ethnic group located further from an urban center than the original community, and to identify risk factors for HIV and syphilis transmission. Methods: Rapid and confirmatory tests for HIV and syphilis were performed. A questionnaire elicited demographic information, risk factors for sexually transmitted infections, and knowledge/beliefs about HIV/AIDS. Results: We collected 282 blood samples and conducted interviews with 281 (99.6%) participants. The confirmed syphilis prevalence rate was 3.2% (9/282; 3.7% (5/135) for men and 2.7% (4/147) for women). The confirmed HIV prevalence rate was 0.7% (2/282), with both infections in men who had sex with men (MSM). Self-reported MSM activity was 39.7%. There was poor knowledge about HIV infection, transmission, and prevention, and low acceptance of known prevention methods. Conclusions: HIV and syphilis are now prevalent in remote Amazonian communities of an indigenous group in Peru. Expansion of the HIV epidemic into the Amazon requires an urgent public health response. [Copyright &y& Elsevier]