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Introduction: In recent decades, there has been a proliferation of mobile health (mHealth) interventions to address public health challenges such as HIV/AIDS. Hence, there is a need for standardizing the report of mHealth interventions and frameworks to enable effective knowledge sharing and promote developments. This study aims to review publications on mobile applications used for antiretroviral therapy (ART) adherence among people living with HIV (PLHIV) to evaluate their compliance with the standard reporting guideline by the WHO., Method: A comprehensive search of published literature was conducted on PubMed, PubMed Central, and MEDLINE databases. We selected randomized controlled trials reporting mobile applications used to improve ART adherence among PLHIV. Only studies published in the last 10 years and the English language were included. Each selected study was reviewed by two independent reviewers against the standard 16-item checklist developed by the WHO., Results: A total of 16 studies were included in the review. Most of the studies were conducted in the United States of America (n = 7). Only 4 (25%) of the studies reported more than 70% (11/16) of the items on the standard reporting checklist by WHO. More than 80% of the studies reported the intervention content (n = 15) and intervention delivery (n = 13). The least reported items were; interoperability/Health Information Systems (HIS) context (n = 2), infrastructure (population level such as electricity, internet connectivity, etc.) (n = 4), and cost assessment (n = 4). However, these are important factors that ensure the sustainability and usability of mHealth intervention, especially in low- and middle-income countries., Conclusion: Most mHealth interventions promoting ART adherence did not comply with the standard reporting guideline. The lack of standardization of mHealth interventions may be responsible for increased siloed mobile applications. Hence, there is a need for global adoption of the checklist by Ministries of Health, international organizations, journals, and relevant authorities., Competing Interests: Declarations. Ethics approval and consent to participate: This study was based exclusively on secondary data; hence, no ethical approval and informed consent were required. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objectives: Identifying the barriers and facilitators for Chadian youth (aged 15-24 years) along the pathway of access to HIV information and health services., Study Design: Qualitative descriptive study., Study Setting: The study was conducted in N'Djamena, Chad, with 20 high schools purposefully selected based on participation in a Blue Cross Chad (BCC) peer-to-peer education programme., Participants: A total of four focus groups, each consisting of 12 participants, stratified by gender and BCC programme participation (two each among participating and non-participating high schools), were conducted., Methods: A descriptive qualitative study using thematic analysis of content was conducted. The qualitative software ATLAS.ti V.22 was used to organise and code the data., Results: Five main categories of barriers and facilitators for HIV information and health services were identified, including (1) societal expectations and norms; (2) power dynamics; (3) social networks; (4) peer-education programmes; and (5) bypassing the system. Barriers and facilitators to information information-seeking and access to health services were observed at individual, community and system levels. High school students expressed that access to information and health services were important when it comes to HIV and AIDS prevention and treatment. Societal expectations and power dynamics were identified as key barriers, while trust through social networks and peer-education programmes were key facilitators to accessing information and health services., Conclusion: This study allowed for the identification of both barriers and facilitators of HIV information and health-seeking in the context of N'Djamena, Chad. Our findings highlight the importance of comprehensive community- and youth-led approaches that are youth-friendly and youth-centric and are needed to effectively communicate HIV information., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Anti-retroviral therapy (ART) simplification strategies are needed for treatment-experienced people with HIV (PWH) and multidrug-resistant viruses. These individuals are commonly treated with boosted ART regimens and are thereby at risk for harmful drug-drug interactions (DDI). In this trial, we aim to assess the efficacy of the combination doravirine, dolutegravir and lamivudine (DOR/DTG/3TC) among people with a history of virological failure who receive boosted ART., Methods and Analysis: B-Free is a multistage, randomised, multicentre, open-label, non-inferiority trial, embedded within the Swiss HIV Cohort Study and conducted in collaboration with cohorts of PWH in the Netherlands and France. Cohort participants with a history of ART change due to virologic failure and who maintain HIV virologic suppression with an ART regimen consisting of a pharmacological booster and at least two drugs from classes other than nucleoside reverse transcriptase inhibitors are included. Patients with major drug resistance mutations against DTG or DOR and individuals with chronic hepatitis B virus infection are not eligible for the study. Individuals are randomised 1:1 to either receiving co-formulated DTG/3TC and DOR once daily or continuing their boosted ART regimen. The primary outcome is the proportion of individuals lacking virologic control (HIV-RNA ≥50 cp/mL) at 48 weeks, according to the Food and Drug Administration snapshot algorithm. Changes in DDI burden (assessed using a DDI score), treatment satisfaction (assessed using the HIV Treatment Satisfaction Questionnaire), quality of life and mental health represent key secondary outcomes. Additional secondary outcomes include the proportion of individuals developing new resistance-associated mutations and changes in quality of life and mental health. In a qualitative substudy, we will conduct semistructured interviews with a subset of participants to assess their expectations and experiences towards HIV treatment and clinical research in general. Enrolling 210 individuals will provide 80% power to demonstrate non-inferiority, defined as less than 8% absolute increase in loss of viral suppression in individuals randomised to DOR/DTG/3TC (one-sided type I error rate of 0.025)., Ethics and Dissemination: The study was approved by the competent ethics committees (reference number BASEC 2023-01060) and the regulatory authority Swissmedic (reference number 701655) in Switzerland before the enrolment of the first participant. Approval by the European Medicines Agency and local ethical committees in the Netherlands and France will be obtained prior to including participants in these countries. Participant's written informed consent is obtained by the investigators before enrolment. The results of all major B-Free study outcomes will be submitted to peer-reviewed journals that enable Open Access publication., Trial Registration Number: Swiss National Clinical Trials Portal (SNCTP000005686, registered on 06 November 2023) and Clinicaltrials.gov (NCT06037564, registered on 07 September 2023)., Competing Interests: Competing interests: BS reports financial support for travel grants from Gilead Sciences and ViiV Healthcare and for advisory boards from Gilead Sciences and MSD, paid to his institution. GW has received research grants from Gilead Sciences and Roche Diagnostics, as well as fees for advisory boards and lectures from ViiV Healthcare, MSD, Roche Diagnostics and Gilead Sciences (all paid to his institution). MC’s institution received research grants and expert opinion fees from Gilead Sciences, MSD and ViiV Healthcare. DLB received money paid to himself outside of the submitted work for advisory boards and lectures from the companies Gilead Sciences, MSD, Pfizer and ViiV Healthcare and money for a research grant from the company ViiV Healthcare. The institution of EB received study grants from Merck and Gilead Sciences; it also received travel grants and fees for EB participation to advisory boards from Gilead Sciences, Merck, ViiV Healthcare, Pfizer AG, Moderna, AstraZeneca, AbbVie and Eli Lilly. DH received fees for consultancies from AstraZeneca, Bavarian Nordic, Gilead Sciences, UCB and ViiV Healthcare, a travel grant from Gilead Sciences, and institutional funding from AstraZeneca, Gilead Sciences, GSK, A. Menarini, MSD and ViiV Healthcare. MvdV has received research grants and fees for participation in advisory boards from Gilead Sciences, MSD and ViiV Healthcare, all paid to his institution. MS reports financial support for travel grants from Gilead Sciences and for advisory boards from Gilead Sciences, MSD and ViiV Healthcare, paid to his institution. AR received research grants from Gilead Sciences, paid to his institution; travel expenses from Gilead Sciences and Pfizer, paid to his institution; and honoraria for advisory board consultations from MSD and Moderna, paid to his institution. PS’s institution has received travel grants, congress and advisory fees from ViiV Healthcare and Gilead Sciences unrelated to this work. All other authors report no conflicts of interest., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Traditional complementary and alternative medicine (TCAM) are products and practices that differ from conventional allopathic medicine. There continues to be an increase in the use of these methods of treatment in developed and developing countries worldwide. This often owes to the perceived ability of these treatment methods to cure chronic medical conditions like HIV. However, TCAM use among PLHIV may be associated with reduced compliance with antiretroviral medications, resulting in poor viral load suppression and increased risk for opportunistic infections. The concomitant use of antiretroviral drugs and TCAM practices may be influenced by some sociodemographic and health-related factors., Objective: To determine the prevalence of TCAM use and examine the sociodemographic and health-related factors associated with its use among PLHIV on antiretroviral medications at the Infectious Disease unit of Korle-Bu Teaching Hospital in Ghana., Methods: A cross-sectional study was conducted among attendants at an adult HIV clinic. 420 study participants were selected by systematic sampling. Data related to TCAM use, sociodemographic and health-related factors were collected using a standardized questionnaire and patient chart review. Multivariate logistic regression model was used to determine the association between TCAM use, sociodemographic and health-related factors., Results: Of the 420 study participants, majority were female (76.2%) and urban community dwellers (77.9%). 77.4% of participants had been diagnosed with HIV for [Formula: see text] 5 years and had been on anti-retroviral medications for more than 5 years. The prevalence of TCAM use among PLHIV was 25.2%. No sociodemographic or HIV-related health factor was significantly associated with TCAM use in the study population., Conclusion: TCAM use was high among PLHIV. No sociodemographic or health-related factor was found to be associated with TCAM use. Further studies employing a qualitative approach using key informant interviews and focused group discussions are needed to explore reasons for its use. Care providers and policy-makers should look beyond sociodemographic and health-related factors in addressing TCAM use among PLHIV., Competing Interests: Declarations. Ethics approval and consent to participate: The Korle Bu Teaching Hospital Institutional Review Board (IRB) reviewed and approved the study protocol on 27th May,2020. (Protocol number KBTH-IRB /00047/2020). All study methods were carried out in accordance with relevant guidelines and regulations including the Declaration of Helsinki. Informed consent was obtained from all study subjects. Consent for publication: N/A. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

A 54-year-old man with treated HIV developed a subacute deterioration of speech, mobility and cognition. Cerebrospinal fluid (CSF) analysis showed a raised protein and a discordant CSF HIV RNA paired with plasma HIV RNA, confirming the diagnosis of CSF HIV RNA escape syndrome. It is important to consider this diagnosis in people with treated HIV who develop new neurological symptoms., Competing Interests: Competing interests: JU has received honoraria for participation in advisory boards and preparing non-promotional educational materials for Gilead Sciences, GSK and ViiV Healthcare., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Black cisgender women (hereafter referred to as "women") experience one of the highest incidences of HIV among all populations in the United States. Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, but uptake among women is low. Despite tailored strategies for certain populations, including men who have sex with men and transgender women, Black women are frequently overlooked in HIV prevention efforts. Strategies to increase PrEP awareness and use among Black women are needed at multiple levels (ie, community, system or clinic, provider, and individual or patient)., Objective: This study aimed to identify barriers and facilitators to PrEP uptake and persistence among Black cisgender women and to map implementation strategies to identified barriers using the CFIR (Consolidated Framework for Implementation Research)-ERIC (Expert Recommendations for Implementing Change) Implementation Strategy Matching Tool., Methods: We conducted a secondary analysis of previous qualitative studies completed by a multidisciplinary team of HIV physicians, implementation scientists, and epidemiologists. Studies involved focus groups and interviews with medical providers and women at a federally qualified health center in Chicago, Illinois. Implementation science frameworks such as the CFIR were used to investigate determinants of PrEP use among Black women. In this secondary analysis, data from 45 total transcripts were analyzed. We identified barriers and facilitators to PrEP uptake and persistence among cisgender women across each CFIR domain. The CFIR-ERIC Implementation Strategy Matching Tool was used to map appropriate implementation strategies to address barriers and increase PrEP uptake among Black women., Results: Barriers to PrEP uptake were identified across the CFIR domains. Barriers included being unaware that PrEP was available (characteristics of individuals), worrying about side effects and impacts on fertility and pregnancy (intervention characteristics), and being unsure about how to pay for PrEP (outer setting). Providers identified lack of training (characteristics of individuals), need for additional clinical support for PrEP protocols (inner setting), and need for practicing discussions about PrEP with women (intervention characteristics). ERIC mapping resulted in 5 distinct implementation strategies to address barriers and improve PrEP uptake: patient education, provider training, PrEP navigation, clinical champions, and electronic medical record optimization., Conclusions: Evidence-based implementation strategies that address individual, provider, and clinic factors are needed to engage women in the PrEP care continuum. Tailoring implementation strategies to address identified barriers increases the probability of successfully improving PrEP uptake. Our results provide an overview of a comprehensive, multilevel implementation strategy (ie, "POWER Up") to improve PrEP uptake among women., International Registered Report Identifier (irrid): RR2-10.1371/journal.pone.0285858., (©Amy K Johnson, Samantha A Devlin, Maria Pyra, Eriika Etshokin, Kelly Ducheny, Eleanor E Friedman, Lisa R Hirschhorn, Sadia Haider, Jessica P Ridgway. Originally published in JMIR Formative Research (https://formative.jmir.org), 15.11.2024.)

Architect-HIV Ag/Ab combo chemiluminescence assay is globally recognized for its sensitivity but has a notable false-positive rate. In this study, we aim to evaluate the performance of a new cost-effective screening alternative, the chemiluminescence Ag/Ab combo assay (CL-900i-HIV) from Mindray, China. We selected 195 archived samples categorized according to the INNO-LIA™ HIV I/II, the gold standard confirmatory assay. These samples included true positive (n = 38; positive by Architect-HIV & INNO-LIA-HIV), true negative (n = 101; negative by Architect-HIV & INNO-LIA-HIV), false positive (n = 20; positive by Architect-HIV & negative by INNO-LIA-HIV), and indeterminate results (n = 26). We tested all samples using the Mindray CL-900i-HIV and all positive Architect-HIV samples (n = 80) were confirmed by PCR. Compared to INNO-LIA™ HIVI/II line immunoassay confirmatory assay, Mindray CL-900i-HIV demonstrated a sensitivity of 100% (95% CI 90.7-100), specificity of 100% (95% CI 97.0-100), overall percent agreement (OPA) of 100% (95% CI 97.7-100.0), and perfect agreement with the INNO-LIA confirmatory assay (κ = 1.00). Additionally, Mindray's CL-900i-HIV exhibited a significantly lower false-positive rate (8.75%) compared to Architect-HIV's (55%). Mindray CL900i demonstrated high sensitivity and very low false-positive rate, thus, has the potential to serve as an excellent, cost-effective surrogate for HIV screening, overcoming the limitations of existing automated assays., Competing Interests: Declarations Competing interests All kits of the Mindray CL-900i-HIV Ag/Ab combo assay used in this study were received from Mindray as in-kind support to Dr. Gheyath. However, it is important to note that Mindray had no influence or involvement in the study design, data collection, analysis, interpretation, or the decision to publish the results., (© 2024. The Author(s).)

Introduction: By 2030, an estimated 42% of the world's adolescent girls and young women (AGYW) will live in sub-Saharan Africa (SSA), where a quarter of AGYW pregnancies are undesired and AGYW represent 75% of new HIV infections. Most AGYW in SSA use short-acting contraceptive methods, including many who rely solely on condoms, which results in variable patterns of protection against undesired pregnancies and HIV. Dynamics of contraceptive use and HIV prevention efforts are poorly understood but the DYnamics of Contraception in Eswatini study will contribute to the understanding of the complex relationship between sexual behaviours, risk perception and HIV and pregnancy prevention., Methods and Analysis: All AGYW 18-24 years who participated in a 2021 nationally representative, population-based (face-to-face) HIV survey, consented to future research and provided a mobile phone number will be contacted for enrolment. Consenting AGYW will complete a baseline questionnaire and be surveyed biweekly for 2 years. The three objectives of the study are to (1) investigate how changing individual context (schooling, income, residential mobility) impact contraceptive use; (2) examine the relationship between pregnancy desires and contraceptive use and (3) test whether changes in a woman's perception of her HIV risk changes her probability of contraceptive use and HIV protective behaviours. Data collection will take place from March 2024 to March 2026 via computer-assisted telephone interviews. During recruitment (March-April 2024), two interviewers called 794 AGYW, of whom 326 completed the baseline questionnaire (41%) and 321 consented to biweekly follow-up (40% American Association for Public Opinion Research response rate #1). Analyses will mainly use hybrid within-between logistic regression models., Ethics and Dissemination: This protocol was reviewed and approved by the Eswatini National Health Research Review Board in 2024 and Columbia University Medical Center Institutional Review Board in 2023. Findings from the study will inform the Eswatini Ministry of Health approaches to mitigating undesired pregnancies and HIV among AGYW. Second, few examples exist of high-frequency longitudinal data collection in SSA, and this study will contribute to the survey method knowledge. Finally, the rich dataset will available for secondary data analysis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Globally, long-distance truck drivers' (LDTDs) risk of exposure to HIV infections is higher compared with other populations in transit. Thus, several HIV prevention interventions have been implemented, though to a narrower extent compared with other most at-risk populations. Consequently, the effectiveness of such interventions is not well understood. Therefore, a review is warranted to inform policymakers on the most effective HIV prevention interventions targeted for LDTDs., Methods and Analysis: The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines were followed. Original peer-reviewed interventional studies involving LDTDs of either gender aged above 18 years, and reporting findings on HIV prevention interventions from any part of the world will be included. Non-empirical research studies like systematic reviews, literature reviews and scoping reviews will be excluded. A comprehensive search will be done from PubMed, Cumulated Index to Nursing and Allied Health Literature and other five databases to identify eligible studies. The Rayyan online platform will be used for the screening of titles and abstracts. For the meta-analysis, a random-effects meta-analysis using the ' metafor ' package in R software will be done. Where specific studies may not report adequate data for meta-analysis, their findings will be presented qualitatively. The Cochrane Collaboration tool and Joanna Brigs Checklist will be used to assess the quality and risk of bias in the included studies., Ethics and Dissemination: A formal ethical approval is not required for this systematic review and meta-analysis. The findings will be presented at scientific conferences and published in open-access peer-reviewed journals to reach policymakers, stakeholders and the scientific community., Prospero Registration Number: CRD42024505542., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Psoriasis is a chronic, inflammatory systemic condition mediated by T-lymphocyte activation. In patients with concomitant human immunodeficiency virus (HIV) infection, treatment of psoriasis remains a therapeutic challenge due to disruptions in the immune system targeting the quality and quantity of T-cell counts. Limited data exists on the knowledge of the utilization and tolerance of small-molecule and biologic therapies used for psoriasis in HIV-positive (HIV +) individuals. This study aims to provide an updated review detailing reports of efficacy and safety trends currently reported in the literature. A systematic review of PubMed, Cochrane, and Embase databases between January 2018 and April 2024 was performed, which included original investigations, reviews, case reports, and series of reported individuals with a prior diagnosis of psoriasis, and either a previous, or novel diagnosis of HIV during initiation of treatment. 19 articles with 24 cases were included in this review, including treatments apremilast (n = 5), adalimumab (n = 1), etanercept (n = 2), ustekinumab (n = 4), secukinumab (n = 5), ixekizumab (n = 2), brodalumab (n = 1), guselkumab (n = 1), and risankizumab (n = 3). Treatments were effective at improving cutaneous symptoms of psoriasis in all cases and 2 cases reported alleviation of psoriatic arthritis. Adverse events were seldom reported and were managed without interruption of medication. Higher evidence research is necessary to objectively determine the efficacy and safety profiles of these therapies in HIV + individuals., Competing Interests: Declarations Conflicts of interest The authors declare no competing interests. Ethical approval This is a systematic review study. No ethics approval is required., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

US President's Emergency Plan for HIV/AIDS has been credited with saving 25 million lives in sub-Sahara Africa and, as such, constitutes a preeminent US foreign policy achievement of the twenty-first century. However, the implementation of effective HIV/AIDS pharmacological interventions remains a challenge in rural Kenyan communities. Of particular importance are patient retention and care engagement and their interaction with age disparities that are sensitive to different socioeconomic contexts, as well as time-in-treatment. For the first time, we perform an intermediation and triple interaction intent-to-treat secondary analysis on a social network-based randomized controlled trial. We hypothesize that the temporal interactions of critical demographic features with a treatment/control indicator variable may significantly explain patient retention and that these results are intermediated by social network phenomena. We find that not only does extended time-in-treatment significantly improve primary outcomes, but the threefold interaction along with age and treatment itself is sufficiently flexible to fit the data remarkably well without unnecessary elaboration, an effect that is mediated via internalized stigma. This strongly suggests that patient retention varies by age group. Rather than deploying one-size-fits-all solutions, foreign and public policymakers should invest in research that considers how interventions might be optimized for different ages.Trial registration Clinical Trial Number. NCT02474992 (note: the main trial report was published here https://doi.org/10.1371/journal.pone.0255945 .) Date of submission: June 6, 2015., (© 2024. The Author(s).)

Background: Pre-exposure prophylaxis (PrEP) is a highly effective, safe and acceptable intervention for preventing HIV infection. However, identifying individuals who could best benefit from PrEP remains a significant challenge. Existing HIV risk assessment tools vary in performance depending on context. This systematic review aims to synthesise evidence on their diagnostic performances to predict incident HIV infection., Methods and Analysis: This protocol is informed and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Protocols. We will search MEDLINE (Ovid), Embase (Ovid) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases (January 1998-May 2024) for observational and relevant interventional studies assessing the diagnostic performance of HIV risk tools to predict incident HIV for PrEP eligibility. There will be no restrictions on study language or location. Two reviewers will conduct the search, data extraction and risk of bias assessment using the Johanna Briggs Institute Critical Appraisal Checklist for Diagnostic Studies. Standardised templates will be used in Covidence for data extraction. We will conduct a meta-analysis if appropriate, otherwise, a narrative review. We will use the PRISMA guidelines to guide reporting., Ethics and Dissemination of Research: Ethical approval is not required as data is publicly available. This review will inform updates to Canadian HIV PrEP guidelines and guide healthcare professionals in using HIV risk assessment tools for identifying PrEP candidates. Findings will be presented at guideline panel meetings and submitted for publication in a peer-reviewed journal and conferences., Prospero Registration Number: CRD42024543975., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Long-acting cabotegravir/rilpivirine (LA-CAB/RPV) was approved for use in virally suppressed patients with human immunodeficiency virus (HIV) in January 2021. While this was a paradigm shift for many patients living with HIV, as LA-CAB/RPV was the first injectable complete regimen for the treatment of HIV, several patient populations, including those lacking virologic suppression, have not been able to easily access this advance in science and care., Summary: In this article, we provide an update on 2 patients from our previous report and describe one further patient who experienced treatment failure following initiation of LA-CAB/RPV. Additionally, we review reports published to date of the clinical outcomes of patients with viremia who have accessed LA-CAB/RPV in the setting of baseline resistance-associated mutations (RAMs) to either component and any resulting RAMs at virologic failure. On the basis of this evidence, we recommend that hybrid or all-injectable regimens be considered for patients who have struggled with adherence to oral antiretroviral therapy or have partial or full resistance to one component of LA-CAB/RPV., Conclusion: The case series reported here adds to literature supporting the notion that LA-CAB/RPV can be successfully used in patients who are viremic., (© American Society of Health-System Pharmacists 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Understanding the psychosocial factors influencing self-management behaviors among people living with HIV/AIDS (PLWHA) is crucial for effective medical interventions and improving their quality of life. However, few studies have explored the psychosocial mechanisms influencing self-management behaviors among PLWHA in China. This study, conducted in accordance with STROBE guidelines, uses SEM to explore the roles of social support, self-efficacy, and self-esteem in predicting self-management behaviors among Chinese PLWHA., Methods: From March 2023 to July 2023, a convenience sample of 282 PLWHA, recruited from one designated AIDS hospital and one Centers for Disease Control and Prevention in Sichuan Province, China, was surveyed. Data were collected via four validated self-report scales (the Social Support Rating Scale, the General Self-Efficacy Scale, the Self-Esteem Scale, and the HIV/AIDS Patient Self-Management Scale). Structural equation modeling was used to assess the relationships among social support, self-efficacy, self-esteem, and self-management behaviors., Results: The new model demonstrated acceptable fit parameters (χ 2 /df = 2.15, GFI = 0.96, AGFI = 0.93, CFI = 0.93, IFI = 0.94, RMSEA = 0.05). The direct effect of social support on self-management behaviors was significant (β = 0.117, P < 0.05). In addition, self-efficacy and self-esteem played significant mediating roles in the influence of social support on self-management behaviors, accounting for 38.73% and 22.79% of the total effect, respectively. Moreover, they served as chain mediators, contributing 9.80% to the total effect., Conclusions: These findings contribute to our understanding of the psychosocial dynamics influencing self-management behavior in Chinese PLWHA and have broader implications for populations in other countries. Targeted interventions that enhance social support, self-efficacy, and self-esteem could be applied in various cultural contexts to improve self-management practices among PLWHA globally., (© 2024. The Author(s).)

Background: Self-management (SM) is the gold standard of care and is the direct active participation of patients in their disease management. Condition-specific factors, physical and social environment, individual and family, and the process of SM are factors that influence SM in people living with human immunodeficiency virus (PLHIV). Poor SM leads to high retroviral infection transmission, mortality, and morbidity. Objective: This study was aimed at assessing SM and its associated factors among PLHIV at the University of Gondar Comprehensive Specialized Hospital (UOGCSH), Northwest Ethiopia. Methods: A cross-sectional study was conducted using a systematic random sampling technique at the UOGCSH from May 20 to July 30, 2022. The data were collected using a previously validated tool and were entered and analyzed using Statistical Package for Social Sciences Version 25. A binary logistic regression analysis was used to identify factors associated with poor SM. The statistical significance was considered at a p value < 0.05. Result: Of 419 PLHIV, the median (IQR) SM score was 39 (9), and above half (52.6%, 95% CI: 48%-57%) of them had poor SM. Being unemployed (AOR = 2.49, 95%CI = 1.19, 5.19), living alone (AOR = 2.16, 95%CI = 1.12, 4.17), unfamiliar with the management of HIV-related symptoms (AOR = 3.59, 95%CI = 2.08, 6.20), poor social support (AOR = 3.02, 95%CI = 1.54, 5.93), poor self-efficacy (AOR = 3.04, 95%CI = 1.83, 5.06), and unsupported by the adherence support group (AOR = 17.17, 95%CI = 8.37, 35.22) were significantly associated with poor SM. Conclusion: The majority of PLHIV had poor SM. This study supports the findings of individual family SM theory and previously published studies regarding factors affecting SM. The government, hospital, adherence support groups, and PLHIV should work on modifiable sociodemographic, condition-specific, and process of SM to improve SM of PLHIV., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 Abdisa Gemedi Jara et al.)

The gut microbiome has a pivotal function in human immunodeficiency virus (HIV). However, the associated alterations in the gut microbiome-host interaction are unknown. Herein, we aimed to investigate the gut microbiota and fecal metabolites in people living with HIV (PLWH). We collected stool samples from 70 PLWH and 34 healthy controls (HCs) and carried out 16S rRNA gene sequencing and analyzed the metabolites using liquid chromatography-mass spectrometry. Firmicutes , Proteobacteria , Actinobacteriota , and Bacteroidota were the most abundant phyla in both groups. Among genera, the level of Escherichia - Shigella was upregulated significantly in the PLWH group, whereas in the HC group, Bacteroides spp. were upregulated. Prediction of microbial function indicated significant reductions in alanine, aspartate, glutamate, and histidine metabolism. Furthermore, a comparison of the fecal metabolites between the HC and PLWH groups identified 38 differentially abundant metabolites in four differentially enriched human metabolic pathways. According to Spearman correlation analysis, there are close relationships between four differentially abundant microbiota members and five differentially abundant fecal metabolites, which might influence particular human metabolic pathways. Our findings provide a basis for further experimental investigation of the contribution of the gut microbiota and its associated metabolites to HIV/AIDS, providing a novel perspective for the further study of HIV/AIDS.IMPORTANCEGrowing evidence demonstrates that the gut microbiota is associated with HIV. This study investigated changes in the gut microbiota and fecal metabolites in PLWH. We identified 38 differentially abundant metabolites in four differentially enriched human metabolic pathways. Moreover, close relationships were noted between the four differentially abundant microbiota members and five differentially abundant fecal metabolites, which might influence particular human metabolic pathways. Thus, to benefit PLWH, potential pathobionts could be reduced (e.g., g&#95; Enterococcus ); probiotics could be increased (e.g., g&#95; Faecalibacterium and g&#95; Agathobacter ); or certain metabolites (e.g., N-acetyl-L-phenylalanine and trehalose) could be reduced by changes in diet or the use of nutritional supplements. Our results provide insights into the interaction between the gut microbiota and the host, identifying possible targets that might be beneficial for PLWH., Competing Interests: The authors declare no conflict of interest.

Background: With the ageing of people living with HIV/AIDS (PLWHA), the prevalence of chronic comorbidities, especially hyperglycaemia, is increasing among elderly PLWHA. Antiretroviral therapy (ART) is associated with fasting plasma glucose (FPG) levels. This study aimed to investigate both short-term and long-term FPG characteristics and trends across different ART regimens in elderly Chinese PLWHA., Methods: This retrospective cohort study, based on hospital treatment information, classified ART regimens as this retrospective cohort study used hospital treatment data. ART regimens are classified into three categories: non-nucleoside reverse transcriptase inhibitors (NNRTIs) based, protease inhibitors (PIs) based and integrase strand transfer inhibitor (INSTIs) based. Propensity score matching was applied to control for confounding factors. Follow-up FPG characteristics were then described, and a generalised linear mixed model was employed to estimate FPG trends under different regimens within 1-year and 5-year periods following ART initiation., Results: Participants had an average age of 58.28 years, with 75.02% male. FPG increased following ART initiation, with the most significant rise within 1 year of ART, followed by stabilisation. The FPG increase within 1 year was slower in the PIs-based group compared with the NNRTIs-based group ( β =-0.08, 95% CI -0.15 to -0.01), while there was a higher prevalence of diabetes within 5 years of ART (31.55% vs 22.33%, standardised difference=0.357). The FPG increase within 1 year of ART did not differ between NNRTIs-based and INSTIs-based groups ( β =-0.01, 95% CI -0.20, 0.18)., Conclusion: Our study highlights that elderly Chinese PLWHA experience an increase in FPG levels, particularly during the first year of ART, with variations observed across different ART regimens. The higher long-term prevalence of diabetes in the PIs-based regimen group emphasises the need for tailored glucose management strategies. Routine glucose monitoring and proactive management are crucial for preventing and controlling diabetes in this population, particularly given the long-term metabolic risks associated with ART., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

For research on HIV/AIDS, it is important to elucidate the complex viral-host interaction, host dependency factors (HDFs), and restriction factors. However, the regulatory network of HIV-resistance-related factors remains not well understood. Therefore, we integrated four publicly available HIV-related transcriptome datasets, along with three datasets on HIV-infection-related DNA methylation, miRNA, and ChIP-seq, to predict the factors influencing HIV resistance and infection. Our approach involved differential analysis, functional annotation, and protein-protein interaction network analysis. Through comprehensive analyses, we identified 25 potential HIV-resistance-related genes (including shared EGF ) and 24 HIV-infection-related hub genes (including shared JUN ). Additionally, we pinpointed five key differentially methylated genes, five crucial differentially expressed microRNAs, and five significant pathways associated with HIV resistance. We mapped the potential regulatory pathways involving these HIV-resistance-related factors. Among the predicted factors, RHOA, RAD51, GATA1, IRF4, and CXCL8 have been validated as HDFs or restriction factors. The identified factors, such as JUN, EGF, and PLEK, are potential HDFs or restriction factors. This study uncovers the gene signatures and regulatory networks associated with HIV-1 resistance, suggesting potential targets for the development of new therapies against HIV/AIDS.

Introduction: Increasing evidence indicates the benefits of patient and public involvement (PPI) in medical research, and PPI is increasingly expected by funders and publishers. We conducted a mapping review of studies reporting examples of PPI implementation in HIV research, and developed an online evidence map to guide HIV researchers., Methods: We systematically searched Medline and Embase up until 18 August 2024, including search terms with variations for PPI and HIV. We extracted information from identified studies in duplicate and analysed the data descriptively and qualitatively to describe types of PPI models and reported benefits, challenges, and mitigation strategies. This study was co-initiated and co-led by people living with HIV., Results: We identified 17 studies reporting PPI in HIV research between 1992 and August 2024. Most PPI examples informed prospective clinical studies, but also qualitative research, questionnaire development, research priority setting and surveys. Ten studies described the number and characteristics of PPI members involved. We observed four PPI models, from a model that solely engaged PPI members for a specific task to a model whereby PPI representatives were integrated into the study team with decision-making authority. Benefits reported included wider dissemination of research results, better understanding of research material and results, and higher levels of trust and learning between researcher and communities. The most commonly reported challenges were the lack of specific resources for PPI, differing levels of knowledge and expertise, concern about HIV status disclosure, and lack of diversity of the PPI team. Uneven power dynamics, tensions, and differing expectations between stake-holder groups were also frequently noted., Conclusions: This mapping review summarizes published examples of PPI in HIV research for various phases of research. There is a clear need to strengthen the reporting on PPI processes in HIV research, for example by following the Guidance for Reporting Involvement of Patients and the Public (GRIPP) 2 guidelines, and developing guidance on its hands-on implementation. We embedded PPI from study inception onwards, which potentially pre-empted some of the challenges reported in the reviewed examples. The resulting online evidence map is a starting point to guide researchers on integrating PPI into their own research., (© 2024 The Author(s). Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)

Objective: The study aimed to investigate the impact of COVID-19 on the cascade of HIV care for people living with HIV (PLHIV) in Ethiopia., Design: A retrospective longitudinal study., Setting: The study was conducted in North Showa Zone, Ethiopia, from pre-COVID-19 (January 2018-December 2019) and during COVID-19 (January 2020-December 2021)., Participants: We identified 61901 records from 3925 PLHIV, of which 23 848 were recorded during the pandemic., Main Outcome Measure: We investigated indicators from four stages of the HIV care cascade, including HIV screening and diagnosis, HIV care, HIV treatment and HIV disease progression, according to a WHO framework. The indicator changes were assessed with incidence rate ratios (IRRs)., Results: For HIV screening and diagnosis, the monthly number of HIV tests experienced a 46% decline from 2520 to 1361 since the pandemic (IRR 0.553; 95% CI 0.546 to 0.561). For HIV care, the monthly number of consultations was reduced by 49.6% (from 1582 to 798) since the pandemic (IRR 0.591; 95% CI 0.581 to 0.601). Similarly, the monthly number of viral load tests was reduced by 42.8% (IRR 0.614; 95% CI 0.581 to 0.650). For HIV treatment, the number of antiretroviral therapy (ART) initiations was reduced by 27.8% and the number of ART adherence by 52.5% since the pandemic. For HIV disease progression, the monthly number of PLHIV achieving viral suppression was reduced by 61.6%, while HIV-related deaths doubled during the pandemic., Conclusion: The study highlights pandemic-induced disruptions in the cascade of care for PLHIV. Targeted interventions are necessary to protect PLHIV in public health emergencies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Since the mid-2010s, slamsex-sexualized drug use involving intravenously injecting meth-has rapidly emerged in metropolitan gay communities as a sociosexual practice necessitating harm reduction interventions. However, its impact on gay men's sociosexual lives and HIV technologies is not well understood. This paper addresses this gap by investigating two intertwined temporal dimensions of slamsex, viewing it as a form of slow edgework in post-AIDS Taiwan., Methods: Ethnographic research was conducted in Taiwan between 2022 and 2024, involving 30 interviews with gay men who practice slamsex and 7 HIV/AIDS NGO representatives. Semi-structured interviews focused on slamming events, covering their edge, transition, and healthcare network., Results: Findings reveal paradoxes within edgework, demonstrating that slamsex can be both extreme and risky, as well as slow and mundane. Participants navigated state surveillance and the materiality of syringes through meticulous risk calculations and digital-savvy strategies for acquiring clean syringes. The practice involved risk and a networked economy of care services provided by other injectors. In response to HIV technologies (PrEP and viral load disclosure), gay men in this study normalized HIV/AIDS while developing a sense of vulnerability to their own infection., Conclusion: In the era of HIV/AIDS normalization, slamsex as slow edgework underscores the need for temporally and spatially nuanced discussions on drug policy. This study highlights the importance of culturally tailored interventions that consider slow, networked interactions to provide harm reduction for men on the chemsex scene, as well as the needs for more evidence-based, non-discriminatory research on queer sexual health and drug studies., Competing Interests: Declaration of competing interest The author declared no conflicts of interest to this article's research, authorship, and/or publication., (Copyright © 2024 Elsevier B.V. All rights reserved.)

AIDS remains a significant global health challenge since its emergence in 1981, with millions of deaths and new cases every year. The CCR5 ∆32 genetic deletion confers immunity to HIV infection by altering a cell membrane protein crucial for viral entry. Stem cell transplants from homozygous carriers of this mutation to HIV-infected individuals have resulted in viral load reduction and disease remission, suggesting a potential therapeutic avenue. This study aims to investigate the relationship between genetic ancestry and the frequency of the CCR5 ∆32 mutation in Colombian populations, exploring the feasibility of targeted donor searches based on ancestry composition. Utilizing genomic data from the CÓDIGO-Colombia consortium, comprising 532 individuals, the study assessed the presence of the CCR5 ∆32 mutation and examined if the population was on Hardy-Weinberg equilibrium. Individuals were stratified into clusters based on African, American, and European ancestry percentages, with logistic regression analysis performed to evaluate the association between ancestry and mutation frequency. Additionally, global genomic databases were utilized to visualize the worldwide distribution of the mutation. The findings revealed a significant positive association between European ancestry and the CCR5 ∆32 mutation frequency, underscoring its relevance in donor selection. African and American ancestry showed negative but non-significant associations with CCR5 ∆32 frequency, which may be attributed to the study's limitations. These results emphasize the potential importance of considering ancestry in donor selection strategies, reveal the scarcity of potential donors in Colombia, and underscore the need to consider donors from other populations with mainly European ancestry if the CCR5 ∆32 stem cell transplant becomes a routine treatment for HIV/AIDS in Colombia., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Opioid overdose deaths in the U.S. have risen dramatically in the past decade, largely due to the surge in illicitly manufactured fentanyl. Injection drug use is a known risk factor for HIV, further complicating the long-term consequences of opioid use. The baseline prevalence of HIV among adults in the US is 0.46 %. The primary purpose of this study was to determine the prevalence and risk factors of HIV among patients presenting to the emergency departments (ED) with an acute opioid overdose., Methods: This study is a prospective observational cohort study from the ToxIC Fentalog Study group. Patients age 18 years of age or older are included if they present to one of 10 participating U.S. hospitals in 9 states between September 2020 and May 2023 with a suspected opioid overdose and had waste serum available after routine laboratory testing. Clinical data is collected from the medical record and patient serum is sent for comprehensive toxicologic analysis via liquid chromatography quadrupole time-of-flight mass spectroscopy to detect the presence of over 1200 substances including illicit opioids, novel synthetic opioids, medications, and adulterants. Logistic multivariable regression was performed to examine the association between demographic, behavioral, and serum toxicology data with risk factors and HIV status., Results: Among the total cohort (n=1690), 1062 cases had known HIV status (62.8 % of total sample). Among patients with a known HIV status, 60 (5.6 % [95 % CI: 4.2 %, 7.0 %]) were HIV positive. Patients with HIV reported stimulant use more frequently (13.3 %) than those without HIV (6.8 %; p=0.003). After controlling for confounding, bipolar psychiatric history was a significant independent predictor of HIV positivity (aOR: 1.08; 95 % CI: 1.02, 1.13) in this population., Conclusions: In this large multicenter cohort, the prevalence of HIV for ED patients with illicit opioid overdose was 9 times higher than that expected by the general population. Bipolar disorder appears to be a novel risk factor for HIV positivity in this patient population., Competing Interests: Declaration of Competing Interest There are no financial, litigational, or other conflicts of interest to disclose., (Copyright © 2024. Published by Elsevier B.V.)

The journey towards ending AIDS epidemic in Bangladesh by 2030 is ambitious yet achievable. Although Bangladesh has always had a low rate of HIV among its general population, it remains one of seven countries in Asia and the Pacific where new HIV cases are rising. This study evaluates the effectiveness of HIV programmatic strategies and investment scenarios using the AIDS Epidemic Model (AEM) from 2023 to 2030, focusing on optimizing resource allocation and interventions. The findings indicate that without improved program effectiveness, new HIV infections will increase to 1,382 by 2030, failing to meet the targets of the Global AIDS Strategy 2021-2026. If Bangladesh improves its HIV program effectiveness according to the Global AIDS Strategy 2021-2026, the NSP and Global AIDS Strategy targets could significantly lower new infections and AIDS-related deaths and increase treatment coverage to meet Ending AIDS targets. The NSP targets could reduce new HIV infections to under 275 annually and achieve treatment goals by 2030. The study reveals that NSP targets are the most cost-effective, offering the highest benefit-cost ratio, highlighting the urgent need to enhance HIV prevention program effectiveness, particularly among key populations, to achieve both public health and economic benefits.

Pregnant and lactating persons in sub-Saharan Africa face a heightened risk of HIV acquisition, due to biological and behavioral factors, combined with limited access to prevention and treatment services. Oral pre-exposure prophylaxis (PrEP) and the dapivirine vaginal ring are promising tools for HIV prevention, and the ring's recent approval in multiple African countries represents a significant advancement in expanding access to HIV prevention. In a nested qualitative study within the MTN-042 trial, we explored the acceptability of study products among pregnant persons in the second and early third trimesters. Interviews were conducted privately, using a semi-structured guide with 77 participants, in participants' preferred language. Topics explored included product acceptability (using the theoretical framework of acceptability), user experience, satisfaction, disclosure, community attitudes, and sexual activity during pregnancy. Interview transcripts were analyzed using Dedoose software. We observed positive attitudes among participants towards the study products, which they found generally user-friendly, despite the added complexities of using them during pregnancy. Participants recognized that consistent and correct use would provide protection for both them and their unborn children. Although initial concerns existed, most of these worries dissipated over time, with study staff support and increased product use experience. These findings emphasize the importance of continued surveillance, support, and education to ensure the successful rollout of new HIV prevention measures during pregnancy., (© 2024. The Author(s).)

Migrants often encounter heightened health risks during crises. We analysed the disparities in the burden of HIV between Japanese nationals and international migrants in Japan by comparing new HIV infections, AIDS cases, and HIV-related deaths between 2018-2019 (pre-COVID-19) and 2020-2021 (during the COVID-19 pandemic). Between 2018 and 2021, 4,705 new HIV infections were reported in Japan (2,813 Japanese nationals and 522 international migrants). Additionally, 1,370 AIDS cases (1,188 Japanese nationals, 182 international migrants) were recorded, representing 29.1% of the total. Comparative analysis of HIV incidence and mortality rates between Japanese nationals and international migrants indicates elevated disparities: During the COVID-19 pandemic, the HIV incidence rate among Japanese nationals decreased from 1.8 to 1.5 cases/100,000 people, while the rate among international migrants remained high at 12.8 cases/100,000 people. The AIDS incidence also increased for international migrants from 2.8 to 3.8 per 100,000 people, while Japanese nationals maintained a low at 0.5 per 100,000 people. International migrants living with HIV experienced a significantly younger age at death due to HIV-related illness (coefficient = -11.7, p  < .01). The COVID-19 pandemic may have exacerbated the disparities with more international migrants living with HIV being diagnosed late and with less precise reporting. Investment in more equitable HIV care is warranted.

Objective: This study aimed to conduct a psychometric evaluation of the Adherence to Refills and Medications Scale (ARMS) among patients with HIV/AIDS in Indonesia., Methods: Psychometric analysis was conducted at 2 hospitals and 7 public health centers at the voluntary counseling and testing clinic. Content validity was measured by assessing the relevance and clarity of each ARMS item. Construct validity was also assessed. Reliability was evaluated using internal consistency and test-retest reliability., Results: This study involved 11 experts in the assessment of the content validity and 240 participants in the estimation of the construct validity. All ARMS items were generally considered easy to understand and relevant, with scale-level content validity index based on the average method (S-CVI/Ave) of 0.9 (>0.78) and item-level content validity index (I-CVI) in the range from 0.5 to 1 for the relevance level and S-CVI/Ave of 0.95 (>0.78) and I-CVI in the range from 0.8 to 1 for the clarity level. Two items (numbers 2 and 3) were revised based on experts' suggestions to enhance comprehension. Confirmatory factor analysis supported 2 subscales: adherence to taking medications and adherence to refilling prescriptions. Good reliability was supported by internal consistency (Cronbach's α 0.793) and test-retest reliability (intraclass correlation coefficient 0.722) for the overall adherence score., Conclusions: The Indonesian version of ARMS is a valid and reliable medication adherence scale when used in Indonesian patients with HIV/AIDS., Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section., (Copyright © 2024 International Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights reserved.)

Studies have reported lower incidence of prostate cancer in men living with HIV compared with men without HIV for reasons that remain unclear. Lower prostate cancer screening in men living with HIV could explain these findings. We describe receipt of prostate-specific antigen (PSA) test each calendar year by HIV status in Medicaid beneficiaries enrolled in 14 U.S. states, 2001-2015. A total of 15,299,991 Medicaid beneficiaries aged 18-64 with ≥7 months of continuous enrollment were included in analyses. HIV diagnosis and PSA tests were identified using non-drug claims. Incidence rate ratios comparing receipt of PSA test by HIV status adjusted for age, race/ethnicity, state of residence, calendar year, comorbid conditions, benign prostatic conditions, and receipt of testosterone-replacement therapy were estimated using Poisson regression. Models were also stratified by state, and estimates were pooled using random-effects meta-analysis to account for heterogeneity by state. Models were additionally stratified by age and race/ethnicity. There were 42,503 PSA tests over 314,273 person-years and 1,669,835 PSA tests over 22,023,530 person-years observed in beneficiaries with and without HIV, respectively. The incidence of PSA test was slightly lower in men living with HIV than men without HIV (incidence rate ratio [IRR] = 0.98; 95% confidence interval [CI]: 0.97, 0.99) when adjusting for state. In the pooled estimate, the rate was higher among men living with HIV (IRR = 1.11; 95% CI: 0.97, 1.27). Pooled estimates indicated approximately equal or higher rates of PSA test in men living with HIV compared with men without HIV across models stratified by age and race/ethnicity groups. Findings do not support the hypothesis that differences in prostate cancer screening explain differences in incidence by HIV status.

Existing studies examining resilience among sexual minority men (SMM) have been limited by only analyzing 1 level of resilience. We therefore investigated the impact of multiple levels of resilience on the bidirectional relationship between loneliness and depression symptoms among older SMM. Loneliness, depression symptoms, and multilevel resilience scores were collected across 3 time points (October 2016 to March 2017 [T1]; October 2017 to March 2018 [T2]; and October 2018 to March 2019 [T3]) among 1,264 SMM aged 40 years and older living with and without HIV. Longitudinal mediation models were used to test the mediating effect of the multilevel resilience factors at T2 on the bidirectional relationship between loneliness and depression symptoms, adjusting for sociodemographic covariates. The multilevel resilience factors were negatively associated with loneliness and depression symptoms at T1. The individual-level global resilience factor was associated with decreased odds of depression symptoms (odds ratio [OR] = 0.50; 95% CI, 0.32-0.78), while the interpersonal-level relationship confidence (OR = 0.43; 95% CI, 0.24-0.77) and reliability (OR = 0.36; 95% CI, 0.15-0.84) factors were associated with decreased odds of loneliness at T3. The total effect of loneliness at T1 on depressive symptoms at T3 was β = 0.20 (95% CI, 0.11-0.28) and was reduced to β = 0.08 (95% CI, -0.04 to 0.20) after the inclusion of the multilevel resilience factors. The total effect of depressive symptoms at T1 on loneliness at T3 was similar (β = 0.21; 95% CI, 0.13-0.28) with the direct effect of β = 0.01 (95% CI, -0.08 to 0.11) after the inclusion of the multilevel resilience factors. Regarding specific indirect effects, individual-level global resilience (depression symptoms at T3 only) as well as the interpersonal-level relationship reliability and confidence (loneliness at T3 model only) factors were statistically significant. Multilevel resilience factors mediated the bidirectional relationship between loneliness and depression symptoms. Mental health interventions should consider implementing resilience-informed strategies that mitigate depression symptoms and loneliness among older SMM., (© 2024. The Author(s).)

Objectives: Alcohol consumption is not uncommon among people with HIV (PWH) and may exacerbate HIV-induced intestinal damage, and further lead to dysbiosis and increased intestinal permeability. This study aimed to determine the changes in the fecal microbiota and its association with alcohol consumption in HIV-infected patients., Methods: A cross-sectional survey was conducted between November 2021 and May 2022, and 93 participants were recruited. To investigate the alterations of alcohol misuse on fecal microbiology in HIV-infected individuals, we performed 16s rDNA gene sequencing on fecal samples from the low-to-moderate drinking (n = 21) and non-drinking (n = 72) groups., Results: Comparison between groups using alpha and beta diversity showed that the diversity of stool microbiota in the low-to-moderate drinking group did not differ from that of the non-drinking group (all p > 0.05). The Linear discriminant Analysis effect size (LEfSe) algorithm was used to determine the bacterial taxa associated with alcohol consumption, and the results showed altered fecal bacterial composition in HIV-infected patients who consumed alcohol; Coprobacillus, Pseudobutyrivibrio, and Peptostreptococcaceae were enriched, and Pasteurellaceae and Xanthomonadaceae were depleted. In addition, by using the Kyoto Encyclopedia of Genes and Genomes (KEGG), functional microbiome features were also found to be altered in the low-to-moderate drinking group compared to the control group, showing a reduction in metabolic pathways (p = 0.036) and cardiovascular disease pathways (p = 0.006)., Conclusion: Low-to-moderate drinking will change the composition, metabolism, and cardiovascular disease pathways of the gut microbiota of HIV-infected patients., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Environmental exposure to toxic chemicals including cadmium (Cd), lead (Pb), and mercury (Hg), are known risk factors for cardiovascular (CVD) and kidney disease. In people living with HIV (PLWH), CVD and kidney disease are the leading cause of death. Neither traditional risk factors nor markers of HIV infection fully explain such an increased risk. It is of paramount importance to establish the epidemiology of toxic chemicals exposure in PLWH, to inform screening and prevention interventions in this vulnerable population. This cross-sectional study compares toxic chemical levels (T-Cd, T-Pb, and T-Hg) among PLWH and HIV-uninfected adults in Northwestern Tanzania. A total of 495 PLWH and 505 HIV-uninfected subjects were analyzed. Spearman's rank correlations were used to examine the relationship between toxic chemical elements by HIV status. Linear regression models were used to determine the association between exposures and outcomes of interest among study participants. In both PLWH and HIV-uninfected adults, blood T-Cd, T-Pb, and T-Hg levels were frequently found at levels above the reference value of 5, 50, and 20 μg/L, respectively. Overall, factors associated with blood toxic chemical levels included vegetable servings per week, obesity, untreated water sources, use of alcohol, and HIV. Among PLWH, weekly vegetable intake provided a protective effect against T-Cd (Coeff = -0.03, 95%CI = -0.06, -0.01) and T-Pb (Coeff = -0.05, 95%CI = -0.09, -0.01) exposure among PLWH. Alcohol intake (Coeff = 0.10, 95%CI = 0.06, 0.13), obesity (Coeff = 0.08, 95%CI = 0.02, 0.13), longer duration to indoor smoke exposure (Coeff = 0.003, 95%CI = 0.001, 0.004), and HIV infection (Coeff = 0.11, 95%CI = 0.07, 0.15) were associated with increased individuals blood T-Hg levels. Individuals in northwestern Tanzania, including PLWH, have high blood levels for T-Cd, T-Pb, and T-Hg. Factors associated with higher blood levels include water sources, obesity, use of alcohol, exposure to indoor smoke, and HIV infection., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Studies have elucidated that heart failure (HF) in people living with HIV manifests differently when compared with HF cases in the general population. This cohort aimed to examine the mortality risk factors, including biological and social factors, as well as suitable medical interventions to prevent death in this population., Participants: The New York City Health+Hospitals HIV Heart Failure (NYC4H) cohort encompassed records from 11 major hospital sites. Adult individuals with confirmed HIV and HF were recruited from either inpatient or clinic hospital visits between July 2017 and June 2022. The first follow-up period began on the date of the first clinical encounter until June 2023, and the second follow-up period extended between July 2022 and October 2023., Findings to Date: In total, 1044 patients were enrolled in the study. The cohort comprised 657 (62.9%) males and 387 (37.1%) females. The average age was 61.6 years at baseline and the average follow-up time was 3.8 years. Overall, a total of 259 (24.8%) deaths were identified, of which 193 occurred in the first follow-up period (enrolling date to June 2022) and 66 during the second follow-up period (June 2022 to October 2023). The most common comorbidities within this population were hypertension (75.3%), chronic obstructive pulmonary disease (39.2%), type II diabetes mellitus (40%) and hyperlipidaemia (35.7%). The most common social adversities were polysubstance use (31.13%), mental health-related issues (20.7%) and lack of family support (14.5%). 601 (57.6%) patients had encountered at least one and more than one social adversity in their lifetime., Future Plans: Currently, nutritional notes from licensed dietitians and right and left heart catheterisation reports are under review. We are scheduled to complete the data collection for the comprehensive third follow-up period, which includes follow-up psychosocial evaluations, by the end of 2025. In addition, we intend to conduct annual follow-ups for specific high-risk groups, such as individuals with pulmonary hypertension, those facing higher social adversities and participants with poor HIV control., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: In South Africa, women disproportionately bear the burden of intimate partner violence (IPV), HIV or AIDS, and poor mental health., Objective: This study investigated parenting practices among women affected by IPV, HIV and poor mental health syndemics., Study Setting: The study was conducted in two sites, a peri-urban area and a rural area in Mpumalanga, South Africa., Study Design: A qualitative research design using a narrative approach with in-depth interviews supported by arts-based methods was used. Data were analysed thematically using MAXQDA (2022)., Participants: 20 women aged 20-60 who screened positive for HIV, IPV and/or poor mental health in a larger three-generational cohort study were selected., Results: Living with the syndemics exacerbated socioeconomic challenges that often translated into an inability to meet basic child needs. Socioeconomic challenges also led to more harsh parenting practices among women living with IPV-Mental Health and HIV-Mental Health syndemics. Due to lack of trust from family members, women living with the HIV-Mental Health-IPV syndemic were often separated from their children. These women exhibited less harsh parenting practices than the women in the other syndemic groups when they did see their children. A history of childhood trauma, leading to overprotective parenting, was common across the groups except for the IPV-Mental Health group. Women in the IPV-Mental Health group often had strained relations with their children's fathers, affecting their engagement and connection with their children., Conclusion: The study underlines challenges experienced by women with IPV-Mental Health, HIV-Mental Health and HIV-Mental Health-IPV syndemics. The overlap of these epidemics strains women's relationships and affects women's parenting practices detrimentally resulting in an inadequate provision for children's needs., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Introduction: Evaluation of implementation strategies is core to implementation trials, but implementation strategies often deviate from the original plan to adjust to the real-world conditions. The optimal approach to track modifications to implementation strategies is unclear, especially in low-resource settings. Using data from an implementation trial for people who inject drugs (PWID) with HIV in Vietnam, we describe the tracking of implementation strategy modifications and present findings of this process., Methods: SNaP (Systems Navigation and Psychosocial Counseling) is a hybrid type-III effectiveness-implementation randomized controlled trial aiming to scale up the evidence-based intervention, integrated systems navigation and psychosocial counseling, for PWID with HIV in Vietnam. Forty-two HIV testing sites were randomized 1:1 to a standard or tailored arm. While the standard arm (SA) received a uniform package of strategies, implementation strategies for the tailored arm (TA) were tailored to address specific needs of each site. The central research team also met monthly with the TA to document how their tailored strategies were implemented over time. Five components were involved in the tracking process: describing the planned strategies; tracking strategy use; monitoring barriers and solutions; describing modifications; and identifying and describing any additional strategies., Results: Our approach allowed us to closely track the modifications to implementation strategies in the tailored arms every month. TA sites originally identified 27 implementation strategies prior to implementation. During implementation, five strategies were dropped by four sites and two new strategies were added to twelve sites. Modifications of five strategies occurred at four sites to accommodate their changing needs and resources. Difficulties related to the COVID-19 pandemic, low number of participants recruited, high workload at the clinic, lack of resources for HIV testing and high staff turnover were among barriers of implementing the strategies. A few challenges to tracking modifications were noted, including the considerable amount of time and efforts needed as well as the lack of motivation from site staff to track and keep written documentations of modifications., Conclusions: We demonstrated the feasibility of a systematic approach to tracking implementation strategies for a large-scale implementation trial in a low-resource setting. This process could be further enhanced and replicated in similar settings to balance the rigor and feasibility of implementation strategy tracking. Our findings can serve as additional guidelines for future researchers planning to report and track modifications to implementation strategies in large, complex trials., Trial Registration: clinicaltrials.gov ID: NCT03952520 (first posted 2019-05-16)., (© 2024. The Author(s).)

Objectives: The objective of this study is to examine the zonal-wide load undetectable state and predictors among children and adolescents living with HIV at South Gondar health institutions, 2023., Design: A retrospective cohort study., Setting: South Gondar Health Institutions, Northwest, Ethiopia., Participants: We recruited 430 children and adolescents living with HIV who had a follow-up at the antiretroviral therapy (ART) clinic at health institutions from 1 June 2016 to 30 April 2023., Outcome Measures: The primary outcome measure of this study was the viral load undetectable state estimation. Moreover, the study assessed the median time viral load undetectable state and its predictors by the Cox-proportional hazard model. Data were entered into Epi-data V.4.2 and exported to STATA V.17 statistical software for analysis., Results: The mean follow-up period was 8.5 (95% CI 8.1 to 8.9)±4.4 SD months, overall yielding 9151 person-month observations. At the end of the follow-up, 369 (85.8%, 95% CI 82.6% to 88.8%) of the children and adolescents achieved the viral load undetected state. Moreover, the overall median survival time to develop viral load undetectable state was found to be 6 months.The viral load undetected state in children and adolescents who have a cluster of differentiation 4 (CD4) count above the threshold level was 2.8 times higher than those in children and adolescents with a CD4 count lower than the threshold level (adjusted HR (AHR) 2.8 (95% CI 1.5, 5.3)). Likewise, the viral load undetected state in children and adolescents who have a good level of ART adherence was 2.0 times higher than those children and adolescents with a fair/poor level of ART adherence (AHR 2.0 (95% CI 1.1, 3.9)). Moreover, children and adolescents who had nutritional status ≥-2 Z score increased a viral load undetected state by 2.3 times as compared with children and adolescents with nutritional status <-2 Z score (AHR 2.3 (95% CI 1.3, 4.0)). Furthermore, children and adolescents who had no treatment failure increased a viral load undetected state by 2.1 times as compared with children and adolescents who had treatment failure (AHR 3.0 (95% CI 1.1, 4.0)., Conclusion: The lower proportion of individuals achieving an undetectable viral load compared with the target set by the WHO strategic plan (95-95-95 target by 2025), highlights the need for targeted interventions and improved HIV management strategies. Factors such as CD4 count, ART adherence, nutritional status and treatment failure play a significant role in achieving viral load undetectable state. Healthcare providers better prioritise these factors through comprehensive care and support. The study emphasises the importance of aligning efforts with the WHO strategic plan to meet targets and improve treatment outcomes. Therefore, stakeholders better address the identified predictors to enhance care and support for this vulnerable population., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Youths with HIV/AIDS encounter a variety of unique challenges that impact their physical, mental, emotional, and social well-being. These challenges and experiences differ across settings, populations, cultures, and the broader socio-economic and political contexts. This study focuses on exploring the life challenges, experiences, and coping mechanisms of youths living with HIV/AIDS in public hospital facilities in southwest Ethiopia., Methods and Study Approach: The study was conducted in two regional states of Ethiopia. Using a phenomenological study approach, researchers focused on purposefully selected youths living with HIV/AIDS in public hospital facilities. Data were gathered through life history and in-depth interview techniques, delving deeply into the participants' lived experiences and feelings about the challenges of living with HIV/AIDS. The study population consisted of youths with HIV/AIDS who were currently using antiretroviral medication in two selected public hospitals. A total of 12 participants were employed and completed the study., Results: The findings indicated that youths with HIV/AIDS face complex life challenges, influenced by psychological, emotional, and social factors. These intertwined challenges impact their self-management, treatment adherence, and ability to create and maintain healthy social relationships and roles. Many youths avoid social interactions and do not seek the necessary social support, believing they are unworthy of respect and care. Consequently, they may live in despair and constant fear of rejection, lacking the social support they desperately need. Substance abuse is prevalent among these youths due to the psychosocial, biological, emotional, and material aspects of their experiences., (© 2024. The Author(s).)

Aim: This study aimed to assess the impact of Mobile health (M-health) on medication time adherence among people living with HIV/AIDS (PLWHA)., Methods: The study included all PLWHA who were receiving care at the Federal University Teaching Hospital Owerri (FUTH) and Imo State Specialist Hospital (ISSH) Umugumma during the study duration. The test group (FUTH) received a 2-way text message sent three times a week and a once-a-week phone call, while the control group (ISSH) received only the standard care., Findings: The result shows that the adherence was higher among PLWHA in the test group compared to those in the control group (P = 0.000, χ2 = 168.62, 95% confidence interval (CI): 7.22 to 16.19)., Conclusion: M-health intervention significantly improved the medication time adherence among the participants in the test group compared to those in the control group., (© 2024. The Author(s).)

Background: Despite antiretroviral treatment (cART), aging people living with HIV (PWH) are more susceptible to neurocognitive impairment (NCI) probably due to synergistic/additive contribution of traditional cerebrovascular risk factors. Specifically, transmigration of inflammatory CD16+ monocytes through the altered blood brain barrier (BBB) may exacerbate cerebral small vessel disease (CSVD), a known cause of vascular cognitive impairment., Methods: PWH on cART (n=108) and age, sex, and Reynold's cardiovascular risk score-matched uninfected individuals (PWoH, n=111) were enrolled. This is a longitudinal observational study but only cross-sectional data from entry visit are reported. Neuropsychological testing and brain magnetic resonance imaging (MRI) were performed. CSVD was diagnosed by Fazekas score ≥1. Flow cytometric analyses of fresh whole blood were conducted to evaluate circulating levels of monocyte subsets (classical, intermediate, and non-classical) and markers of monocyte activation (CCR2, CD40, PSGL-1, TNFR2 and tissue factor). ELISAs were used to measure sCD14, ICAM, and Osteoprotegerin. Two-way analysis of variance (ANOVA), and linear regression models were performed to study the effects of HIV status, CSVD status, and their interaction to outcome variables such as cognitive score. Two-sample t-tests and correlation analyses were performed between and within PWoH with CSVD and PWH with CSVD participants., Results: PWH with CSVD (n=81) had significantly lower total cognitive scores, higher levels of NCMs and soluble CD14 and intracellular adhesion molecule 1 (ICAM-1) as compared to PWoH with CSVD group (n=68). sCD14 and ICAM1 were positively correlated with each other indicating that monocyte and endothelial activation are associated with each other. Cognition was negatively correlated with NCMs, especially in the PWH with CSVD group. Among other blood biomarkers measured, osteoprotegerin levels showed mild negative correlation with cognitive performance in individuals with CSVD irrespective of HIV status., Conclusions: Elevated levels of NCMs may contribute to neuroinflammation, CSVD and subsequent cognitive impairment. This finding is of particular relevance in aging PWH as both HIV and aging are associated with increased levels of NCMs. NCMs may serve as a potential biomarker to address these comorbidities. Further longitudinal studies are needed to evaluate whether changes in NCM levels are associated with changes in CSVD burden and cognitive impairment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Singh, Uddin, Covacevich Vidalle, Sutton, Boodoo, Peterson, Tyrell, Tivarus, Wang, Sahin, Zhong, Weber, Wang, Qiu, Maggirwar and Schifitto.)

Background: Alcohol is a major public health problem in pregnant women due to its harmful effects on pregnancy and adverse birth outcomes. Therefore, assessing the prevalence and the factors associated with hazardous alcohol consumption among HIV-positive women is important for early identification and intervention and implementation of rehabilitation centres in healthcare settings in order to prevent maternal adverse birth outcomes., Objective: The aim of this study was to assess the prevalence of hazardous alcohol consumption and the associated factors among HIV-positive pregnant women attending public hospitals in Northwest Ethiopia., Design and Study Setting: A facility-based, cross-sectional study was conducted among 401 HIV-positive pregnant women attending public hospitals in Northwest Ethiopia from 7 February to 7 April 2021., Participants: From a total calculated sample size of 423, 401 HIV-positive pregnant women who had a follow-up with selected hospitals' prevention of mother-to-child transmission (PMTCT) clinics completed the interview (17 participants refused to provide information and 5 terminated the interview in the middle of it due to serious illness)., Main Outcome Measures: The main outcome measure of this study was hazardous alcohol consumption assessed using the Fast Alcohol Screening Test. Bivariate and multivariable binary logistic regressions were used to identify factors associated with hazardous alcohol consumption. Statistically significant associations were set at p<0.05., Results: The overall prevalence of hazardous alcohol consumption among HIV-positive pregnant was found to be 7.7% (95% CI 5.2, 10.5). After adjusting for possible confounders, history of mental illness (adjusted OR (AOR)=3.10; 95% CI 1.19, 8.05), having comorbid psychological distress (AOR=4.39; 95% CI 1.57, 12.30), non-disclosure of HIV status to partner (AOR=3.28; 95% CI 1.21, 8.84) and poor medication adherence (AOR=2.82; 95% CI 1.20, 6.62) were significantly associated with hazardous alcohol use., Conclusions and Recommendations: The overall prevalence of hazardous alcohol consumption among HIV-positive pregnant women was high, especially among pregnant women who had a history of mental illness. Poor medication adherence, non-disclosure of HIV status to partner and having comorbid psychological distress are the main factors associated with hazardous alcohol consumption. Early detection and appropriate interventions to prevent hazardous alcohol consumption should be promoted at PMTCT clinics., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Peer support is a promising and significant way for people living with HIV (PLWH) to improve their health outcomes. Matching PLWH with HIV peer volunteers can effectively stimulate and mobilize the function of peer support in health management. We develop the online platform Aspark, which features a precision matching function for PLWH and volunteers. This protocol provides a comprehensive overview of the randomized controlled trial design based on Aspark., Method: A parallel randomized controlled trial using block randomization will be conducted at the Beijing YouAn Home of Loving Care. The intervention group (n = 70) will have access to all 12 features of Aspark, including precise volunteer matching, health management tools, drug interaction queries, and medication reminders. The control group (n = 70) will have access to two features of informational support on Aspark. The outcomes of both groups will be evaluated at baseline and at 3, 6, 9, and 12 months after platform registration. The primary outcome is perceived social support. The secondary outcomes include mental symptoms, quality of life, self-efficacy, medication adherence, and health behaviors. Linear mixed models or generalized linear mixed models will be applied to test the intervention effects., Discussion: The Aspark trial is a randomized controlled trial designed to examine the influence of a mobile health (mHealth) application that integrates peer support and precision matching to strengthen social support for PLWH in China. This trial has the potential to significantly enhance social support for PLWH while also optimizing the delivery of peer support services and fully mobilizing the role of peer support in the overall health management of PLWH., Trial Registration: Clinical registration number: ChiCTR2300077454., (© 2024. The Author(s).)

Peptide-based inhibitors represent a promising approach for the treatment of HIV-1, offering a range of potential advantages, including specificity, low toxicity, and the ability to target various stages of the viral lifecycle. This review outlines the current state of research on peptide-based anti-HIV therapies, highlighting key advancements and identifying future research directions. Over the past few years, there has been significant progress in developing synthetic peptide-based drugs that target various stages of the viral life cycle, including entry and replication. These approaches aim to create effective anti-HIV therapies. Additionally, peptides have proven valuable in the development of anti-HIV vaccines. In the quest for effective HIV vaccines, discovering potent antigens and designing suitable vaccine strategies are crucial for overcoming challenges such as low immunogenicity, safety concerns, and increased viral load. Innovative strategies for vaccine development through peptide research are, therefore, a key focus area for achieving effective HIV prevention. This review aims to explore the strategies for designing peptides with anti-HIV activity and to highlight their role in advancing both therapeutic and preventive measures against HIV.

Background: Periodontal health in men with HIV remains understudied, despite suggestions of associations between HIV infection and gingival pocketing, periodontal attachment loss, and gingival inflammation. As antiretroviral therapy (ART) has improved the quality of life for people living with HIV (PLWH), aging-related risk factors and comorbidities, including periodontitis, have emerged. This study aims to assess alveolar bone height, gingival crevicular fluid (GCF) cytokines, and periodontal disease activity in men with and without HIV., Methods: Ninety-three men (50 HIV+, 43 HIV-) aged 35-70 years were recruited from Columbia University Irving Medical Center clinics. Periodontal examination, GCF collection, and intraoral radiographs were collected. Statistical analysis was conducted with t-tests for continuous variables and chi-squared tests for categorical variables., Results: While no significant differences were observed in bleeding on probing, clinical attachment loss and pocket depths, men with HIV exhibited significantly greater alveolar crestal height on radiographs compared to men without HIV (HIV + 3.41+/-1.35 mm, HIV- 2.64+/-1.01 mm; p = 0.004), reflecting greater alveolar bone loss., Conclusions: Men living with HIV demonstrate increased alveolar bone loss compared to those without HIV, possibly mediated by elevated IL6 levels. These results underscore the importance of comprehensive oral health management in PLWH and highlight the need for further research understanding the mechanisms linking HIV infection, cytokine dysregulation, and periodontal health., (© 2024. The Author(s).)

During the 2022 mpox outbreak, our study conducted 30 interviews with a recruited sample of Chicago gay men (age 18+) during June-September to investigate their experiences of mpox, HIV/AIDS, and COVID-19. Participants were interviewed with a semi-structured guide about gay sexual identity and social experiences; HIV/AIDS, ART, and PrEP; and COVID-19 behaviors and vaccination. All 30 interview respondents had been fully vaccinated for COVID-19 and expressed minimal COVID-19 vaccine hesitancy. All the men living with HIV in our study were on ART with HIV well controlled. A majority of HIV- participants (70%) were on PrEP, with participants universally aware of PrEP benefits. Additionally, most participants had already received at least one shot of the Jynneos mpox vaccine, with many interviewees enduring long lines, sometimes at multiple locations, before vaccination in primarily gay social spaces. These Chicago gay men demonstrated widespread enthusiasm for mpox vaccination as a disease prevention strategy and most of them had already been vaccinated despite significant barriers. The enthusiasm of the participants in our study emerged within a medical landscape shaped by both COVID-19 vaccination and HIV/AIDS-related health interventions including ART and PrEP, which may have helped instill increased medical trust among this population. Our study suggests that out urban gay men may comprise a distinctive minority population with increased medical trust due to specific social, sexual, and historical experiences., (© 2024. The Author(s).)

Nonhuman primate (NHP) studies that utilize simian immunodeficiency virus (SIV) to model human immunodeficiency virus (HIV-1) infection have proven to be powerful, highly informative research tools. However, there are substantial differences between SIV and HIV-1. Accordingly, there are numerous research questions for which SIV-based models are not well suited, including studies of certain aspects of basic HIV-1 biology, and pre-clinical evaluations of many proposed HIV-1 treatment, prevention, and vaccination strategies. To overcome these limitations of NHP models of HIV-1 infection, several groups have pursued the derivation of a minimally modified HIV-1 (mmHIV-1) capable of establishing pathogenic infection in macaques that authentically recapitulates key features of HIV-1 in humans. These efforts have focused on three complementary objectives: (1) engineering HIV-1 to circumvent species-specific cellular restriction factors that otherwise potently inhibit HIV-1 in macaques, (2) introduction of a C chemokine receptor type 5 (CCR5)-tropic envelope, ideally that can efficiently engage macaque CD4, and (3) correction of gene expression defects inadvertently introduced during viral genome manipulations. While some progress has been made toward development of mmHIV-1 variants for use in each of the three macaque species (pigtail, cynomolgus, and rhesus), model development progress has been most promising in pigtail macaques (PTMs), which do not express an HIV-1-restricting tripartite motif-containing protein 5 α (TRIM5α). In our work, we have derived a CCR5-tropic mmHIV-1 clone designated stHIV-A19 that comprises 94% HIV-1 genome sequence and replicates to high acute-phase titers in PTMs. In animals treated with a cell-depleting CD8α antibody at the time of infection, stHIV-A19 maintains chronically elevated plasma viral loads with progressive CD4+ T-cell loss and the development of acquired immune-deficiency syndrome (AIDS)-defining clinical endpoints. However, in the absence of CD8α+ cell depletion, no mmHIV-1 model has yet displayed high levels of chronic viremia or AIDS-like pathogenesis. Here, we review mmHIV-1 development approaches, the phenotypes, features, limitations, and potential utility of currently available mmHIV-1s, and propose future directions to further advance these models.

Background: Understanding the frequency of violence experienced by female sex workers (FSWs) and how violence contributes to HIV transmission can help improve HIV programs., Methods: Using recent recommendations for modelling structural factors and associated causal pathways, we developed a HIV transmission dynamic model for FSWs and their clients in Mombasa, Kenya, mechanistically representing three types of violence (sexual violence, SV; physical violence, PV; police assault and arrest, PAA). Each type of violence affects HIV transmission through key mediators (condom non-use, HIV testing). We parameterized the model using data from a cross-sectional study of FSWs aged 15-24 recruited from a systematic geographical mapping sampling frame in Mombasa, Kenya (Cheuk E et al., Frontiers in Reproductive Health 2(7), 2020). Using this model, calibrated (and cross-validated) to HIV epidemiological and violence outcomes, we estimated the incidence of violence episodes, the contribution of violence to the HIV epidemic measured by the transmission population-attributable fraction, and the potential impact of possible violence interventions., Results: The median estimated incidence of PAA in 2023 among FSWs who had not previously experienced that type of violence was 0.20 (95% credible interval: 0.17-0.22) per person-year (ppy), about double the incidence of SV and PV (0.10 (0.09-0.11), 0.11 (0.09-0.12), respectively). The incidence of violence was higher among FSWs who had previously experienced violence: the incidence of recurrent PV was 2.65 (1.82-3.37) ppy, while the incidence of recurrent SV and PAA were 1.26 (0.80-1.67) and 1.37 (0.94-1.74 ppy, respectively. In this setting, we estimated that a median of 35.3% (3.4-55.8%) infections in FSWs and clients combined over the next 10 years may be due to all types of violence (and mediators), mainly through reduced condom use in FSWs who have ever experienced SV (34.6% (2.4-55.5%)). Interventions that prevent future violence without mitigating the effects of past violence may only prevent 8.8% (0.8-14.0%) infections over 10 years., Conclusions: FSWs in Mombasa experience violence frequently. In this population, we find that addressing sexual violence, including mitigating the effects of past violence, is potentially important in reducing HIV transmission in this population. However, the wide uncertainty range shows longitudinal studies are needed to strengthen the evidence of the influence of violence on HIV risk behavior. We find that the recommendations for modelling structural factors provide a useful framework for describing the model., (© 2024. The Author(s).)

Background: One month of daily rifapentine + isoniazid (1HP) is an effective, ultrashort option for tuberculosis prevention in people with human immunodeficiency virus (HIV). However, rifapentine may decrease antiretroviral drug concentrations and increase the risk of virologic failure. AIDS Clinical Trials Group A5372 evaluated the effect of 1HP on the pharmacokinetics of twice-daily dolutegravir., Methods: A5372 was a multicenter, pharmacokinetic study in people with HIV (≥18 years) already on dolutegravir-containing antiretroviral therapy with HIV RNA <50 copies/mL. Participants received daily rifapentine/isoniazid (600 mg/300 mg) for 28 days as part of 1HP. Dolutegravir was increased to 50 mg twice daily during 1HP, and intensive pharmacokinetic sampling was performed on day 0 (before 1HP) and on the final day of 1HP treatment., Results: Thirty-two participants (41% female; 66% Black/African; median [Q1, Q3] age, 42 [34, 49] years) were included in the pharmacokinetic analysis; 31 had HIV RNA <50 copies/mL at the end of 1HP dosing. One participant had an HIV RNA of 160 copies/mL at day 28, with HIV RNA <50 copies/mL upon repeat testing on day 42. The median (Q1, Q3) dolutegravir trough concentration was 1751 ng/mL (1195, 2542) on day 0 versus 1987 ng/mL (1331, 2278) on day 28 (day 28:day 0 geometric mean ratio, 1.05 [90% confidence interval, .93-1.2]; P = .43). No serious adverse events were reported., Conclusions: Dolutegravir trough concentrations with 50 mg twice-daily dosing during 1HP treatment were greater than those with standard-dose dolutegravir once daily without 1HP. These pharmacokinetic, virologic, and safety data provide support for twice-daily dolutegravir use in combination with 1HP for tuberculosis prevention., Clinical Trials Registration: NCT04272242., Competing Interests: Potential conflicts of interest. A.F.L. has contracts for clinical research unrelated to this work from Gilead, ViiV, and Merck; consulting fees from ViiV. A.A. reports grants from Gilead, ViiV, Roche, GSK and MSD unrelated to this work. S.S. reports grants from ViiV unrelated to the present work. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background: Adolescence is commonly perceived as a distinct and typically healthy stage of life. However, in regions with a high prevalence of HIV, like Ethiopia, numerous adolescents are contracting the virus. Upon testing and diagnosis, they encounter care-related issues, particularly barriers and facilitators of the healthcare transition from adolescent to adult clinics. Hence, the study aimed to investigate the barriers and facilitators influencing the transition of adolescents living with HIV (ALWHs) in the resource-limited settings of Southern Ethiopia., Methods: The research employed a phenomenological study design with a qualitative methodology. Purposive sampling was used to gather data through in-depth interviews (IDIs) and focus group discussions (FDGs) involving ALWHs and their parents. The data analysis followed Van Manen's principles., Results: Following Van Manen's guidelines, the data analysis revealed a conceptual framework with two major themes: "Barriers" and "Facilitators". The theme barrier was derived from three sub-themes including behavioral barriers, social barriers, and system barriers in the transition. The theme facilitator was derived from four sub-themes including self-acceptance as an adult, a desire to experience new things, a supportive family, and friendly healthcare services. The study identified three levels of factors influencing the transition into adult clinics: individual, family/peer, and healthcare-related factors. The barriers to transition included lack of knowledge, being in a romantic relationship, psychosocial struggles, perceiving us as immature, stigma, negative peer pressure, lack of timely disclosure, absence of transition guidelines, disrespectful treatment, and absence of separate clinics. On the other hand, facilitators such as self-acceptance as an adult, desire for new experiences, family support, informed support and promising outcomes, flexible appointment scheduling, and psycho-social support groups were found to improve the transition process and enhance the overall well-being of adolescents living with HIV., Conclusion: The study highlights the complex transition process for ALWHs into adult healthcare. Barriers such as lack of knowledge, stigma, and disrespectful treatment pose challenges during this critical period. Conversely, facilitators like self-acceptance, family support, and youth-friendly healthcare services can enhance the transition experience and well-being of ALWHs. Collaborative efforts among ALWHs, families, and healthcare providers are crucial for successful transitions and improved health outcomes. Separated clinics catering to the unique needs of ALWHs are recommended to address privacy concerns., (© 2024. The Author(s).)

Background: Evidence-based and evidence-informed interventions designed to address gaps in the HIV care continuum have the potential to improve HIV care and treatment. However, inadequate organizational readiness can derail intervention uptake, prevent the integration of interventions, and contribute to suboptimal HIV treatment outcomes. This study sought to understand organizational readiness to implement bundled interventions for Black women with HIV and inform facilitators and barriers to implementation., Methods: We conducted a mixed methods readiness assessment across 12 sites participating in the Black Women First (BWF) initiative to gauge preparedness to implement bundled interventions. Readiness was assessed using the organizational readiness for implementing change (ORIC) scale, and two open-ended questions examined facilitators and barriers. Associations between participant and organizational level factors were evaluated using linear models with clustering by site at baseline, 6- and 12-months. Pre-implementation interviews were conducted with staff virtually and transcripts were managed in NVivo. Directed content analysis was used to explore implementation barriers and facilitators., Findings: Sites demonstrated high levels of organizational readiness at baseline; overall organizational readiness for implementing change (ORIC) (mean 56.4, median 59, interquartile range [IQR] 5) and subscales of the ORIC change efficacy (mean 32.4, median 35, IQR 4), change commitment (mean 24, median 25, IQR 1), which is consistent with willingness and capability to implement bundled interventions for Black women with HIV. Organizational readiness remained high at 6- and 12-month follow-up periods. Staff role was significantly associated with organizational readiness (p = 0.007), change efficacy (p = 0.006), and change commitment (p = 0.020) at 6 months. Qualitative analysis indicated strategic planning and assessment (e.g., team coordination and the development of workflows to support implementation); organizational change through network weaving across silos within the organization, and communications systems that engage external partners, as well as resources available for hiring and training, supported readiness. Collaborative leadership and organizational buy-in, staff motivation, and partnerships facilitated implementation processes., Conclusions: Organizations in the BWF initiative have high levels of organizational readiness reflecting willingness and capability to implement bundled interventions for Black women with HIV. Future research should examine the relationship between readiness and clinical outcomes., (© 2024. The Author(s).)

Background: In the contemporary landscape, college students have emerged as a demographic increasingly vulnerable to AIDS. Recognizing that heightened awareness and progressive attitudes toward HIV are pivotal in its prevention, this study was conceived with the intent to meticulously evaluate the level of HIV understanding amongst college students, gauge their sentiments toward people living with HIV (PLHIV), and scrutinize factors influencing these perceptions., Method: This study used an anonymous online questionnaire to collect data through a cross-sectional survey. The sample size for the survey was 4,193 students from four colleges and universities in Xuzhou City, Jiangsu Province, China, covering a variety of demographic characteristics. The survey focused on students' level of knowledge related to HIV and their attitudes toward PLHIV. The study used descriptive statistics to describe the demographic characteristics of the sample, chi-square tests to examine differences within categorical variables, and logistic regression to investigate the associations between knowledge levels and attitudes., Results: A total of 4,193 university students were surveyed, among whom the majority (96.85%) demonstrated a high level of knowledge related to AIDS. Moreover, 55.52% of the participants reported positive attitudes toward individuals with AIDS. The multiple regression analysis revealed that female students (OR = 0.49, p  < 0.001), those enrolled in medical programs (OR = 1.56, p  = 0.014), students of Han Chinese ethnicity (OR = 2.46, p  = 0.009), and individuals with fewer romantic involvements (OR = 1.57, p  < 0.001) possess greater HIV/AIDS awareness. Moreover, lower grade levels (OR = 1.12, p  < 0.001), reduced monthly living costs (OR = 1.14, p  = 0.014), lack of sexual experience (OR = 0.75, p  = 0.015), and a higher degree of HIV/AIDS knowledge (OR = 1.617, p  = 0.007) were positively correlated with supportive attitudes toward PLHIV., Conclusion: Overall, the awareness rate of college students in Xuzhou City about HIV/AIDS infection awareness is high. However, only about half of the university students have positive attitudes toward PLHIV. In order to ensure that a thorough understanding of HIV/AIDS is matched by positive attitudes, it is important to implement targeted educational measures aimed at bridging the gap between knowledge and attitudes toward HIV/AIDS in order to develop a more informed and empathetic student body., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Li, Wu, Gao, Zhang and Yin.)

Objective: In high HIV-burden countries like Uganda, financing and resource allocation for HIV services have rapidly evolved. This study aimed to employ time-driven activity-based costing (TDABC) to examine the allocation of resources and associated costs for HIV care throughout the country., Design: A cross-sectional study., Setting: This study was conducted at 31 health facilities throughout Uganda: 16 level III health centres, 10 level IV health centres and 5 district hospitals., Participants: 1119 persons receiving HIV services in 2020., Methods: We conducted TDABC to quantify costs, resource consumption and duration of service provision associated with antiretroviral therapy, prevention of mother-to-child transmission, HIV counselling and testing (HCT), voluntary medical male circumcision (VMMC) and pre-exposure prophylaxis. We also quantified disparities in resource consumption according to client-level and facility-level characteristics to examine equity. Fixed-effects multivariable regression analyses were employed to inspect factors associated with service costs and provider-client interaction time., Results: The mean cost of services ranged from US$8.18 per visit for HCT to US$32.28 for VMMC. In terms of disparities, those in the Western region received more provider time during visits compared with other regions (35 more minutes, p<0.001); and those receiving care at private facilities received more provider time compared with public facilities (13 more minutes, p=0.02); and those at level IV health centres received more time compared with those at level III (12 more minutes, p=0.01). Absent consumables, services for older adults (US$2.28 higher, p=0.02), those with comorbidities (US$1.44 higher, p<0.001) and those living in the Western region (US$2.88 higher, p<0.001) were more expensive compared with younger adults, those without comorbidities and those in other regions, respectively. Inclusive of consumables, services were higher-cost for individuals in wealthier households (US$0.83 higher, p=0.03) and those visiting level IV health centres (US$3.41 higher, p=0.006) compared with level III., Conclusions: Costs and resources for HIV care vary widely throughout Uganda. This variation requires careful consideration: some sources of variation may be indicative of vertical and horizontal equity within the health system, while others may be suggestive of inequities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)