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Adolescents and young adults (15–24 yrs.) have poorer HIV clinical outcomes than adults. Despite this, there is minimal data on individual-level factors such as self-efficacy towards antiretroviral adherence among perinatally infected adolescents living with HIV in sub-Saharan Africa. Our study examined the interaction between antiretroviral treatment adherence self-efficacy and other psychosocial factors among adolescents receiving care in Nairobi, Kenya. We enrolled perinatally infected Adolescent Living with HIV (ALWHIV) 16–19 yrs. who were accessing care routinely at the HIV clinic. We measured self-reported ART adherence (7-day recall) and defined optimal adherence as >95%, and conducted a regression analysis to identify independently associated factors. Mediation analysis explored interactions between the psychosocial variables. We enrolled 82 ALWHIV median age 17 (IQR 16,18) who had been on ART for a median age of 11 yrs. (IQR 7,13). Sixty-four per cent (52) of the ALWHIV reported optimal adherence of >95%, and 15% reported missing doses for three or more months. After controlling for the other covariates, self-esteem, high viral load and an adherence level > 95% were significantly associated with adherence self-efficacy. Self-esteem was significantly associated with adherence self-efficacy and social support (p

In cross-border areas of East Africa, sexual networks include partnerships across resident, migrant, and mobile populations, and risky behaviors can coincide with fragmented health services given the challenges of cross-border coordination. Among those most at risk are female sex workers (FSWs). We map HIV prevalence among FSWs in 14 cross-border areas, estimate associations between FSW characteristics and HIV and undiagnosed HIV, and estimate progress towards the UNAIDS 90-90-90 targets. The 2016-2017 East Africa Cross-Border Integrated Health Study recruited 4040 women; 786 were classified as FSWs. Overall HIV prevalence among FSWs was 10.8% (95% CI 8.2%, 13.3%), though area-specific estimates varied considerably. Among FSWs living with HIV, 46.1% (95% CI 33.2%, 59.0%) knew their status, 80.6% (95% CI 66.3%, 94.9%) of FSWs who knew their status were on ART, and 84.8% (95% CI 66.1%, 100.0%) of FSWs on ART were virally suppressed. Results indicate a need for expanded HIV testing.

Nationally representative household surveys of the general population can provide critical assessments of the status of HIV epidemics and the impact of national HIV programs. With lessons learned from earlier surveys, PEPFAR has supported HIV-focused surveys in high burden countries to measure known HIV status, access to HIV treatment, and viral suppression, and, by using novel HIV recency assays, to estimate HIV incidence. The results from the initial population-based HIV impact assessments have transformed global HIV programming, demonstrating unexpected progress in population viral suppression and the persistent burden of high HIV incidence among adolescent girls and young women. The findings highlight the importance of tailoring programs to engage men more effectively in HIV testing and treatment. The collection of manuscripts summarized in this overview of the Supplement describe the methods and selected key findings from the initial population-based HIV impact assessment surveys. Taken together, the efforts described in these manuscripts have advanced survey and laboratory capacity and guided HIV programs toward the goal of ending the global epidemic.

In 2011, the South African HIV treatment eligibility criteria were expanded to allow all tuberculosis (TB) patients lifelong ART. The impact of this change on TB mortality in South Africa is not known. We evaluated mortality in all adults (≥ 15 years old) treated for drug-susceptible TB in South Africa between 2009 and 2016. Using a Cox regression model, we quantified risk factors for mortality during TB treatment and present standardised mortality ratios (SMR) stratified by year, age, sex, and HIV status. During the study period, 8.6% (219,618/2,551,058) of adults on TB treatment died. Older age, male sex, previous TB treatment and HIV infection (with or without the use of ART) were associated with increased hazard of mortality. There was a 19% reduction in hazard of mortality amongst all TB patients between 2009 and 2016 (adjusted hazard ratio: 0.81 95%CI 0.80–0.83). The highest SMR was in 15–24-year-old women, more than double that of men (42.3 in 2016). Between 2009 and 2016, the SMR for HIV-positive TB patients increased, from 9.0 to 19.6 in women, and 7.0 to 10.6 in men. In South Africa, case fatality during TB treatment is decreasing and further interventions to address specific risk factors for TB mortality are required. Young women (15–24-year-olds) with TB experience a disproportionate burden of mortality and interventions targeting this age-group are needed.

Why do some countries rapidly adopt policies suggested by scientific consensus while others are slow to do so? Through a mixed methods study, we show that the institutional political economy of countries is a stronger and more robust predictor of health policy adoption than either disease burden or national wealth. Our findings challenge expectations in scholarship and among many international actors that policy divergence is best addressed through greater evidence and dissemination channels. Our study of HIV treatment policies shows that factors such as the formal structures of government and the degree of racial and ethnic stratification in society predict the speed with which new medical science is translated into policy, while level of democracy does not. This provides important new insights about the drivers of policy transfer and diffusion and suggests new paths for practical efforts to secure adoption of ‘evidence-based’ policies.

Objective — to study the relation of death in tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) and central nervous system (CNS) tuberculosis with the following factors: 1) baseline CD4+ T-lymphocyte count, cells/µL, at the beginning of treatment; 2) the level of viral load at the beginning of treatment; 3) resistance to antimycobacterial drugs (R, HR, HR + others) or its absence at the beginning of treatment; 4) age of patients; 5) gender of patients. Materials and methods. 55 cases of neurological TB-IRIS were analyzed. These patients were treated and observed during the 1 year in anti-tuberculosis facilities in Kyiv and Kyiv region in 2017—2019. All patients received ART in accordance with the HIV treatment protocols adopted in Ukraine. Treatment of tuberculosis was carried out taking into account the susceptibility of the pathogen to antimycobacterial therapy according to the standard of tuberculosis treatment adopted in Ukraine. The logistic regression model construction method was used to analyze. A multifactor model for predicting the risk of death in neurological TB-IRIS was built. Results and discussion. After calculations, two factor signs were identified, associated with the risk of death: the baseline level of CD4+ lymphocytes in 1 μl of blood at the beginning of treatment and the level of viral load (copies of HIV RNA in 1 μl) at the beginning of treatment. Conclusions. It was found that the risk of death in TB-IRIS with tuberculous lesions of the CNS is significantly associated (p < 0.05) with the following factors: 1) the level of CD4+ lymphocytes in 1 μl at the beginning of treatment; 2) the level of viral load at the beginning of treatment (copies of HIV RNA in 1 μl).

Adherence to antiretroviral treatment (ART) is crucial for a successful HIV treatment. Unfortunately, it is estimated that 45% of persons living with HIV (PLWH) have poor adherence to ART. To provide health care professionals and PLWH with effective tools for supporting adherence, researchers have investigated the effectiveness of psychosocial interventions to enhance adherence to ART. In this paper, interventional studies, systematic reviews, and meta-analyses that examine ART adherence interventions for PLWH are reviewed. Despite a diverse and wide-ranging assortment of ART adherence interventions, consistent lessons have been learned. Theory-based behavioral interventions are more likely to be effective than non-theory-based interventions, and interventions should be tailored to those most at risk for poor adherence. Digital and mobile ART adherence interventions have the potential to improve dissemination and implementation of evidence-based treatments, both domestically and abroad. There is great variability among interventions in terms of quality, intervention, sample, measures, and outcome characteristics. However, even with this variability, systematic reviews and meta-analyses have demonstrated that psychosocial interventions can improve ART adherence.

El desarrollo de nuevos medicamentos antirretrovirales, con mejor perfil de seguridad y efectividad además de posología que facilita la adherencia, lleva a actualizar la recomendación actual de mejor tratamiento antirretroviral en pacientes viviendo con VIH/SIDA que van a recibir este tratamiento por primera vez, en el marco de la Guía de Práctica Clínica para Colombia.

Chronic medical conditions often necessitate regular testing for proper treatment. Regular testing of all afflicted individuals may not be feasible due to limited resources, as is true with HIV monitoring in resource-limited settings. Pooled testing methods have been developed in order to allow regular testing for all while reducing resource burden. However, the most commonly used methods do not make use of covariate information predictive of treatment failure, which could improve performance. We propose and evaluate four prediction-driven pooled testing methods that incorporate covariate information to improve pooled testing performance. We then compare these methods in the HIV treatment management setting to current methods with respect to testing efficiency, sensitivity, and number of testing rounds using simulated data and data collected in Rakai, Uganda. Results show that the prediction-driven methods increase efficiency by up to 20% compared with current methods while maintaining equivalent sensitivity and reducing number of testing rounds by up to 70%. When predictions were incorrect, the performance of prediction-based matrix methods remained robust. The best performing method using our motivating data from Rakai was a prediction-driven hybrid method, maintaining sensitivity over 96% and efficiency over 75% in likely scenarios. If these methods perform similarly in the field, they may contribute to improving mortality and reducing transmission in resource-limited settings. Although we evaluate our proposed pooling methods in the HIV treatment setting, they can be applied to any setting that necessitates testing of a quantitative biomarker for a threshold-based decision.

A large proportion of HIV infections among men who have sex with men occur within primary partnerships, however, there is a lack of research focused on serodiscordant male couples. We used baseline data collected as part of Project Stronger Together-a randomized controlled trial to improve treatment outcomes among 155 serodiscordant male couples. We described engagement in HIV care/prevention using the HIV treatment cascade and PrEP care continuum. Among partners living with HIV, 86.5% were linked to care, 77.4% retained in care, 81.3% prescribed ART, 60.7% adherent, and 67.7%virally suppressed. Among HIV-negative partners, 62.6% were willing to take PrEP, 48.4% had ever taken PrEP, and 26.5% were adherent to PrEP. Black partners living with HIV had lower odds of being virally suppressed compared to White partners. Our findings provide evidence to suggest designing programs to address the racial disparities in viral suppression, addressing barriers to HIV prevention/treatment, and improving PrEP education.

Despite access to nationally supplied antiretroviral treatment, viral load suppression rates remain suboptimal in the Dominican Republic. Counseling and support services are available but mainly targeted to those identified as having the most need. At Clínica de Familia La Romana (CFLR) in La Romana, all patients undergo a structured baseline interview including exploration of expected barriers to care. We conducted a retrospective cohort study of a random sample of patients at CFLR with treatment initiation between 1 January 2015 and 1 December 2017 to determine if self-identified barriers to HIV care predict viral load suppression. Viral load suppression occurred in 63% of the 203 patients evaluated. Lack of food ( n = 19) was significantly associated with lack of viral suppression (OR 3.0, 95% CI 1.14–7.87). Nondisclosure of HIV status ( n = 24) showed evidence for a protective effect (OR 0.33; 95% CI 0.11–1.0). Further steps should be taken to address food insecurity as well as to understand associated barriers to care among individuals with food insecurity.

BACKGROUND: TB is the leading cause of mortality among people living with HIV (PLHIV), for whom isoniazid preventive therapy (IPT) has a proven mortality benefit. Despite WHO recommendations, countries have been slow in scaling up IPT. This study describes processes, challenges, solutions, outcomes and lessons learned during IPT scale‐up in Kenya.METHODS: We conducted a desk review and analyzed aggregated Ministry of Health (MOH) IPT enrollment data from 2014 to 2018 to determine trends and impact of program activities. We further analyzed IPT completion reports for patients initiated from 2015 to 2017 in 745 MOH sites in Nairobi, Central, Eastern and Western Kenya.RESULTS: IPT was scaled up 75‐fold from 2014 to 2018: the number of PLHIV covered increased from 9,981 to 749,890. The highest percentage increases in the cumulative number of PLHIV on IPT were seen in the quarters following IPT pilot projects in 2014 (49%), national launch in 2015 (54%), and HIV treatment acceleration in 2016 (158%). Among 250,069 patients initiating IPT from 2015 to 2017, 97.5% completed treatment, 0.2% died, 0.8% were lost to follow‐up, 1.0% were not evaluated, and 0.6% discontinued treatment.CONCLUSIONS: IPT can be scaled up rapidly and effectively among PLHIV. Deliberate MOH efforts, strong leadership, service delivery integration, continuous mentorship, stakeholder involvement, and accountability are critical to program success.

Human immunodeficiency virus (HIV) causes acquired immunodeficiency syndrome (AIDS), which is a serious health threat worldwide. One of its core enzymes, reverse transcriptase (RT), is a target for HIV inhibition. A number of bioactive compounds have been successfully used for HIV treatment. However, HIV rapidly mutates, and long-term treatment can cause drug-resistant strains. Therefore, new inhibitors are required to overcome this problem. In this study, the aqueous, ethanolic and hexane crude extracts of 19 edible and medicinal mushrooms, which are widely grown and available commercially in Thailand, were screened against HIV-1 RT. The results showed that the water extracts of A. blazei and I. obliquus, the ethanol extracts of I. obliquus and P. igniarius and the hexane extract of I. obliquus exhibited strong anti-HIV-1 RT activity with IC50 values of 1.92 ± 0.15, 4.39 ± 0.79, 6.17 ± 0.76 and 7.75 ± 246 µg/ml, respectively. These mushrooms have the potential for HIV treatment, and further study on identification of the bioactive compounds against HIV-1 RT should be performed.

A team of health care stakeholders and researchers collaboratively developed a qualitative model and graphic representation of the continuum of HIV care in Vancouver to inform delivery of antiretroviral therapy and other HIV health services. The model describes the patient journey through the HIV care continuum, including states of infection, health services, and care decisions. We used a Unified Modelling Language (UML) activity diagram to capture patient and provider activities and to guide the construction of a UML state machine diagram. The state machine diagram captures model agent states in a formalism that facilitates the development of system dynamics or agent-based models. These quantitative models can be applied to optimizing the allocation of resources, and to evaluate potential strategies for improved patient care and system performance. The novel approach of combining UML diagrams we present provides a general method for modelling capacity ­­­management strategies within complex health systems.

Stigma impedes HIV treatment in multiple ways, including diminished engagement in care, refusing ART, and concealing ART to evade stigma. This study disentangled the degree to which intentionally not taking ART to evade stigma influences overall non-adherence to ART. Patients receiving ART at a community clinic in Cape Town, South Africa (N = 288) completed confidential surveys of demographic and health characteristics, stigma-avoidance non-adherence, and non-stigma-related predictors of non-adherence. Results found nearly half of participants (48%) had forgone taking their ART in social settings. Hierarchically structured regression models showed that alcohol use, medication concerns, and internalized HIV stigma significantly predicted ART non-adherence, accounting for 9.9% of the variance. Stigma-avoidance non-adherence explained an additional 2.6% of the variance in ART non-adherence. The current findings extend previous research to show that stigma-avoidance independently contributes to ART non-adherence, including over and above depression and alcohol use.

Identificar o perfil sociodemográfico dos agentes penitenciários da 8ª Delegacia Penitenciária Regional de Santa Cruz do Sul – RS, e identificar seus conhecimentos, suas atitudes e práticas em relação à tuberculose e ao HIV. Realizou-se um estudo transversal prospctivo a partir de dados obtidos através de questionário autoaplicável baseado no método Knowledge, Attitude and Practice (KAP). Dos 185 participantes, 72,4% eram homens, 26,5% eram mulheres. 54,9% classificaram a tuberculose como grave, 96,1% acreditam que é curável, 86,9% gostariam de mais informações sobre tuberculose. 58,5% dos entrevistados nunca realizou um teste rápido para HIV, 17,2% não sabem se uma pessoa em tratamento para HIV tem menos risco de transmitir o vírus, 26,6% afirmaram ter usado preservativo na última relação sexual. Os resultados obtidos demostraram que os conhecimentos, as atitudes e as práticas dos a Identificar o perfil sociodemográfico dos agentes penitenciários da 8ª Delegacia Penitenciária Regional de Santa Cruz do Sul – RS, e identificar seus conhecimentos, suas atitudes e práticas em relação à tuberculose e ao HIV. Realizou-se um estudo transversal prospctivo a partir de dados obtidos através de questionário autoaplicável baseado no método Knowledge, Attitude and Practice (KAP). Dos 185 participantes, 72,4% eram homens, 26,5% eram mulheres. 54,9% classificaram a tuberculose como grave, 96,1% acreditam que é curável, 86,9% gostariam de mais informações sobre tuberculose. 58,5% dos entrevistados nunca realizou um teste rápido para HIV, 17,2% não sabem se uma pessoa em tratamento para HIV tem menos risco de transmitir o vírus, 26,6% afirmaram ter usado preservativo na última relação sexual. Os resultados obtidos demostraram que os conhecimentos, as atitudes e as práticas dos agentes penitenciários em relação à tuberculose e ao HIV são satisfatórios, porém, percebe-se que as práticas sexuais não são condizentes com os conhecimentos demonstrados. gentes penitenciários em relação à tuberculose e ao HIV são satisfatórios, porém, percebe-se que as práticas sexuais não são condizentes com os conhecimentos demonstrados.

Objective To characterize the factors associated with HIV treatment failure (HIVTF) from reported pharmacovigilance data in Africa. Materials and methods This is an observational pharmacovigilance analysis of the safety data of HIVTF available in the WHO International Pharmacovigilance database "VigiBase®". We used the Standardized MedDRA Queries (SMQ) to identify all the terms corresponding to HIVTF. To identify all relevant molecules and classes of antiretroviral therapy, we used the Anatomic, Therapeutic, and Chemical classification. We presented results as a percentage or an adjusted Reporting Odds Ratio (aROR) with a 95% confidence interval (95% CI). Results HIVTF was more reported in Africa compared to the rest of the world with 19.1% (18.1% - 20.1%) corresponding to 1206 of all 6304 HIVTF reports. Among all the 37 WHO country members in Africa, South Africa was the main source of origin for these HIVTF reports with 86.8% (84.9% - 88.7%). Compared to adults, children and adolescents were the most population groups affected by HIVTF, aROR = 2.7, (95% CI) 1.7 - 4.2 and aROR = 7.9, (95% CI) 4.5 - 13.9, respectively. Conclusion South Africa was the leading country of the reporting of HIVTF in Africa. The proportion of HIVTF was higher in both HIV-infected children and adolescents than in adults. There is a need for the improvement of medical care for children and adolescents with HIV infection in Africa.

South Africa has the largest HIV burden and treatment program in the world. Diversion of HIV prevention and treatment medication for recreational use-or nonmedical use for psychoactive effects-is a public health concern globally and in South Africa. Few South African studies examine recreational use of HIV antiretrovirals (ARVs). The objective of this article is to evaluate the prevalence of recreational ARV use and to identify risk and protective factors associated with use. Data are drawn from a cross-sectional household survey of

The goal of HIV treatment is viral suppression as it is linked with improved health outcomes and decreased risk of viral transmission. We assessed the sociodemographic, behavioral, and patient-provider interaction associations with viral suppression with an administered survey to HIV-seropositive women in the metropolitan Washington, DC, site of the Women's Interagency HIV Study (WIHS) between 2017 and 2018. Logistic and mixed models were used to explore related factors between HIV viral suppression groups and HIV treatment self-efficacy, respectively. Higher HIV treatment self-efficacy and disclosure concerns were positively associated with viral suppression, while illicit drug use had a negative association. In mixed models, more health care provider trust was associated with higher HIV treatment self-efficacy, while depressive symptoms were associated with lower HIV treatment self-efficacy. Depression, illicit substance use, and HIV treatment self-efficacy are potentially modifiable factors that can influence viral suppression. Implementation studies are needed to determine whether interventions to manage depression or self-efficacy and improve trust in health care providers will influence treatment outcomes.

We study a joint model where logistic regression is applied to binary longitudinal data with a mismeasured time-varying covariate that is modeled using a mechanistic nonlinear model. Multiple random effects are necessary to characterize the trajectories of the covariate and the response variable, leading to a high dimensional integral in the likelihood. To account for the computational challenge, we propose a stochastic expectation-maximization (StEM) algorithm with a Gibbs sampler coupled with Metropolis–Hastings sampling for the inference. In contrast with previous developments, this algorithm uses single imputation of the missing data during the Monte Carlo procedure, substantially increasing the computing speed. Through simulation, we assess the algorithm’s convergence and compare the algorithm with more classical approaches for handling measurement errors. We also conduct a real-world data analysis to gain insights into the association between CD4 count and viral load during HIV treatment.

OBJECTIVES Empirical time trends in HIV prevalence in female sex workers (FSWs) are helpful to understand the evolving HIV epidemic, and to monitor the scale-up, coverage, and impact of ongoing HIV prevention and treatment programmes. DESIGN Serial HIV prevalence study. METHODS We analyzed time trends in HIV prevalence in FSWs accessing services at seven Sex Worker Outreach Programme (SWOP) clinics in Nairobi from 2008 to 2017 (N = 33 560). The Mantel--Haenszel test for trend and independent samples Kruskal--Wallis test were used to analyze categorical and continuous variables, respectively. Multivariable binomial regression was used to estimate prevalence ratios/year, adjusting for several covariates. RESULTS HIV prevalence decreased over time in all age groups. This was particularly evident among FSWs less than 25 years of age; HIV was 17.5% in 2008-2009, decreasing to 12.2% in 2010-2011, 8.3% in 2012-2013, 7.3% in 2014-2015, and 4.8% in 2016-2017 (P

We have tracked belief in the effectiveness of HIV treatment as prevention (TasP) among Australian gay and bisexual men (GBM) since 2013. National, online cross-sectional surveys of GBM were conducted every 2 years during 2013–2019. Trends and associations were analyzed using multivariate logistic regression. Data from 4,903 survey responses were included. Belief that HIV treatment prevents transmission increased from 2.6% in 2013 to 34.6% in 2019. Belief in the effectiveness of TasP was consistently higher among HIV-positive participants than other participants. In 2019, higher levels of belief in TasP were independently associated with university education, being HIV-positive, using pre-exposure prophylaxis, knowing more HIV-positive people, being recently diagnosed with a sexually transmitted infection (STI) and use of post-exposure prophylaxis. Belief that HIV treatment prevents transmission has increased substantially among Australian GBM, but remains concentrated among HIV-positive GBM, those who know HIV-positive people, and GBM who use antiretroviral-based prevention.

Transgender women (TGW) experience high prevalence of depression worldwide.This study analyzed the prevalence and correlates of depressive symptoms among 61 HIV + TGW (age: M = 29.87 years, SD = 6....

BackgroundSouth Africa, with one of the highest HIV prevalences in the world, introduced the universal test and treat (UTT) programme in September 2016. Barriers to sustained viral suppression may include drug resistance in the pre-treated population, non-adherence, acquired resistance; pharmacokinetics and pharmacodynamics, and concurrent use of alternative treatments.ObjectiveThe purpose of this review is to highlight potential challenges to achieving sustained viral load suppression in South Africa (SA), a major expectation of the UTT initiative.MethodologyThrough the PRISMA approach, published articles from South Africa on transmitted drug resistance; adherence to ARV; host genetic factors in drug pharmacokinetics and pharmacodynamics, and interactions between ARV and herbal medicine were searched and reviewed.ResultsThe level of drug resistance in the pre-treated population in South Africa has increased over the years, although it is heterogeneous across and within Provinces. At least one study has documented a pre-treated population with moderate (> 5%) or high (> 15%) levels of drug resistance in eight of the nine Provinces. The concurrent use of ARV and medicinal herbal preparation is fairly common in SA, and may be impacting negatively on adherence to ARV. Only few studies have investigated the association between the genetically diverse South African population and pharmacokinetics and pharmacodynamics of ARVs.ConclusionThe increasing levels of drug resistant viruses in the pre-treated population poses a threat to viral load suppression and the sustainability of first line regimens. Drug resistance surveillance systems to track the emergence of resistant viruses, study the burden of prior exposure to ARV and the parallel use of alternative medicines, with the goal of minimizing resistance development and virologic failure are proposed for all the Provinces of South Africa. Optimal management of the different drivers of drug resistance in the pre-treated population, non-adherence, and acquired drug resistance will be beneficial in ensuring sustained viral suppression in at least 90% of those on treatment, a key component of the 90-90-90 strategy.

Considering the effects of immune response and drug therapy on HIV treatment, an HIV mathematical control model with CTLs immune response is therefore proposed, where the delay of virus invasion and impulsive drug therapy are introduced. By utilizing the comparison theorem, differential inequality theories and analytic method, the threshold values for the existence and global stability of the virus-free periodic solution, and the uniform persistence of disease without CTLs immune response are studied. Numerical simulations are performed to illustrate the main theoretical results and the feasibility of drug therapy. Our theoretical results suggest that long-term and standardized medication can prolong the infection process and spread of the virus, or suppress the virus concentration below the detectable level.

We propose an inverse probability of censoring weighted (IPCW) bagging (bootstrap aggregation) pre-processing that enables the application of any machine learning procedure for classification to be used to predict the cause-specific cumulative incidence, properly accounting for right-censored observations and competing risks. We consider the IPCW area under the time-dependent ROC curve (IPCW-AUC) as a performance evaluation metric. We also suggest a procedure to optimally stack predictions from any set of IPCW bagged methods. We illustrate our proposed method in the Swedish InfCareHIV register by predicting individuals for whom treatment will not maintain an undetectable viral load for at least 2 years following initial suppression. The R package stackBagg that implements our proposed method is available on Github.

This study describes long-term viral load (VL) trajectories and their predictors among women living with HIV (WLWH), using data from Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment (SHAWNA), an open prospective cohort study with linkages to the HIV/AIDS Drug Treatment Program. Using Latent Class Growth Analysis (LCGA) on a sample of 153 WLWH (1088 observations), three distinct trajectories of detectable VL (≥50 copies/ml) were identified: ‘sustained low probability of detectable VL’, characterized by high probability of long-term VL undetectability (51% of participants); ‘ high probability of delayed viral undetectability’, characterized by a high probability VL detectability at baseline that decreases over time (43% of participants); and ‘ high probability of detectable VL’, characterized by a high probability of long-term VL detectability (7% of participants). In multivariable analysis, incarceration (adjusted odds ratio (AOR) = 3.24; 95%CI:1.34–7.82), younger age (AOR = 0.96; 95%CI:0.92–1.00), and lower CD4 count (AOR = 0.82; 95%CI:0.72–0.93) were associated with ‘ high probability of delayed viral undetectability’ compared to ‘sustained low probability of detectable VL.’ This study reveals the dynamic and heterogeneous nature of WLWH’s long-term VL patterns, and highlights the need for early engagement in HIV care among young WLWH and programs to mitigate the destabilizing impact of incarceration on WLWH’s HIV treatment outcomes.

A growing body of research is beginning to elucidate reasons people living with HIV (PLWHIV) might prefer oral daily antiretroviral treatment (ART) compared with emerging long-acting ART (LA-ART) or HIV remission strategies under investigation. Our objective is to provide qualitative insights into the reasons why PLWHIV might prefer one of these HIV control therapies over others. From May to August 2018, we implemented a semistructured cross-sectional survey of PLWHIV in the United States to better understand patient preferences around various HIV treatment and remission options. Using free text, respondents were asked to explain why they preferred one HIV control option over the other two. We analyzed responses to the open-ended survey questions on reasons for preferring oral daily ART versus LA-ART versus HIV remission strategies using conventional content analysis. The results showed that PLWHIV preferred oral daily ART because of its familiarity and known safety and efficacy profile, whereas those who preferred LA-ART would value the convenience it offers. Finally, HIV remission strategies would be preferred to avoid taking ART altogether. The qualitative results provide insights into reasons why PLWHIV in the United States might prefer oral daily ART versus novel therapies. More importantly, they provide information to better align HIV virological control strategies with end-user perspectives. To make informed choices around evolving HIV therapeutics, PLWHIV and HIV care providers would benefit from decision tools to better assess options and trade-offs. More research is needed on how best to effectively support PLWHIV and HIV care providers in shared decision-making.

Introduction Understanding differences in knowledge and behaviors among men who have sex with men (MSM), men who have sex with women (MSW), and women, is critical to tailor HIV treatment. We investigated these differences among an international sample of people living with HIV (PLHIV) in 25 countries. Methods Data came from the 2019 Positive Perspectives Study, an online convenience sample of PLHIV in 25 middleand high-income countries. Participants were categorized as MSM (n=1018), MSW (n=479), or women (n=696), based on self-classified gender and sexual orientation. Descriptive and multivariable analyses were performed (p