Search

Oral HIV pre-exposure prophylaxis (PrEP) is a well-established product that provides a safe and highly effective way for individuals to protect themselves against HIV infection. However, hopes of a significant reduction in HIV incidence have been disappointing because of low uptake, adherence challenges to a daily pill regimen, and consistently high discontinuation rates within 6 months of initiation. Long-acting agents have been long awaited for their potential to facilitate adherence and to offer a choice between PrEP products. As the first long-acting agents enter the market, with more poised to follow, questions around how to integrate long-acting agents into oral PrEP platforms, and what the potential advantages and pitfalls of this integration will be, now need to be considered. Pre-exposure prophylaxis (PrEP) for HIV prevention is safe and effective across multiple settings, but adherence challenges and high discontinuation rates with oral pill formulations have limited its potential impact. Strategies to overcome these challenges include first the use of long-acting PrEP formulations that offer discretion and reduced dose frequency, and second the hard-won effort to make oral PrEP delivery simplified, demedicalized, and differentiated. However, together these strategies are discordant because the integration of long-acting modalities into existing oral delivery systems risks PrEP remedicalization. The introduction of long-acting agents ushers in an era of PrEP choice in which PrEP users could theoretically select the PrEP product that is most suitable, acceptable, and accessible for them. However, the question of how to implement PrEP choice remains unanswered. [ABSTRACT FROM AUTHOR]

We aimed to assess the effectiveness of a single dose of the Ad26.COV2.S vaccine (Johnson & Johnson) in health-care workers in South Africa during two waves of the South African COVID-19 epidemic. In the single-arm, open-label, phase 3B implementation Sisonke study, health-care workers aged 18 years and older were invited for vaccination at one of 122 vaccination sites nationally. Participants received a single dose of 5 × 1010 viral particles of the Ad26.COV2.S vaccine. Vaccinated participants were linked with their person-level data from one of two national medical insurance schemes (scheme A and scheme B) and matched for COVID-19 risk with an unvaccinated member of the general population. The primary outcome was vaccine effectiveness against severe COVID-19, defined as COVID-19-related admission to hospital, hospitalisation requiring critical or intensive care, or death, in health-care workers compared with the general population, ascertained 28 days or more after vaccination or matching, up to data cutoff. This study is registered with the South African National Clinical Trial Registry, DOH-27-022021-6844, ClinicalTrials.gov, NCT04838795, and the Pan African Clinical Trials Registry, PACTR202102855526180, and is closed to accrual. Between Feb 17 and May 17, 2021, 477 102 health-care workers were enrolled and vaccinated, of whom 357 401 (74·9%) were female and 119 701 (25·1%) were male, with a median age of 42·0 years (33·0–51·0). 215 813 vaccinated individuals were matched with 215 813 unvaccinated individuals. As of data cutoff (July 17, 2021), vaccine effectiveness derived from the total matched cohort was 83% (95% CI 75–89) to prevent COVID-19-related deaths, 75% (69–82) to prevent COVID-19-related hospital admissions requiring critical or intensive care, and 67% (62–71) to prevent COVID-19-related hospitalisations. The vaccine effectiveness for all three outcomes were consistent across scheme A and scheme B. The vaccine effectiveness was maintained in older health-care workers and those with comorbidities including HIV infection. During the course of the study, the beta (B.1.351) and then the delta (B.1.617.2) SARS-CoV-2 variants of concerns were dominant, and vaccine effectiveness remained consistent (for scheme A plus B vaccine effectiveness against COVID-19-related hospital admission during beta wave was 62% [95% CI 42–76] and during delta wave was 67% [62–71], and vaccine effectiveness against COVID-19-related death during beta wave was 86% [57–100] and during delta wave was 82% [74–89]). The single-dose Ad26.COV2.S vaccine shows effectiveness against severe COVID-19 disease and COVID-19-related death after vaccination, and against both beta and delta variants, providing real-world evidence for its use globally. National Treasury of South Africa, the National Department of Health, Solidarity Response Fund NPC, The Michael & Susan Dell Foundation, The Elma Vaccines and Immunization Foundation, and the Bill & Melinda Gates Foundation. [ABSTRACT FROM AUTHOR]

Young women remain disproportionately affected by the HIV epidemic in South Africa. Clinical trials have shown that the dapivirine vaginal ring (DVR) is safe and effective at reducing HIV infection in women. In March 2022, the South African Health Products Regulatory Authority approved the use of the DVR in women aged 18 years and older who are unable or unwilling to use oral pre-exposure prophylaxis, as an additional choice for preventing HIV in women at substantial risk. Modelling studies have suggested that the DVR could have a substantial impact if prioritized for women at substantial risk of HIV or women aged 22-29 years. The licensing of the DVR in South Africa is a milestone event that brings the first long-acting and woman-controlled HIV prevention method another step closer to reaching the people who need it. As South Africa prepares its introduction, it is critical to examine the unmet need for HIV prevention and to review the clinical trial data that led to the DVR's approval. [ABSTRACT FROM AUTHOR]

Introduction: Antiretroviral‐based pre‐exposure prophylaxis (PrEP) is today an established, effective and safe method of HIV prevention used in multiple countries worldwide by a broad range of populations at risk of HIV infection. Biomedical innovations are critical in supporting the primary prevention of HIV; however, their potential can only be maximized if end‐user challenges are recognized, described and used to develop next‐generation models. Discussion: First‐generation PrEP, a daily oral pill, is highly efficacious, discreet and affords users the ability to commence and conclude treatment rapidly. However, consistent daily adherence and persistence is challenging, especially among younger populations, due in part to side effects, the risk of stock‐outs and a lack of pill storage options. Second‐generation PrEP, longer acting agents that require less frequent dosing, could overcome such challenges. Agents that have shown efficacy in clinical trials include a monthly vaginal ring and PrEP injectables to be administered every 8 weeks, while products in development include 6 monthly injectables, oral therapy that uses monthly rather than daily pills, implants and the potential for long‐acting passive immunization. Conclusions: Second‐generation PrEP agents will have the potential to offer improved adherence and less frequent reminders once they have undergone further development and the delivery systems that will best support them have been established. In order to pursue global UNAIDS targets of reducing new HIV infections to fewer than 500,000 annually by 2025, and to ensure that all people have access to prevention options that meet their specific prevention needs, both early and next‐generation PrEP options are needed. [ABSTRACT FROM AUTHOR]

Background: HIV prevention programmes that include pre-exposure prophylaxis (PrEP) for men who have sex with men (MSM) and transgender women (TGW) in South Africa have not been widely implemented. Objectives: The authors examined oral PrEP uptake, adherence, and adverse events among HIV-uninfected MSM and TGW to inform intervention acceptability and feasibility. Method: In 2015, MSM and TGW in two South African cities were offered a comprehensive package of HIV prevention services, including daily oral PrEP, and were followed for one year. Different models of PrEP delivery were used at each site. Adherence was measured using self-report and pill-count data and tenofovir-diphosphate (TFV-DP) concentrations. Results: Among 135 participants who were eligible for PrEP, 82 (61%) initiated PrEP, of whom 67 (82%) were on PrEP at study end. Participants were on PrEP for a median of 294 out of 314.5 possible days (93% protected days). The median time from PrEP initiation to discontinuation or study end was 305 days (interquartile range: 232–325 days). Across the follow-up time points, 57% – 72% of participants self-reported taking protective levels of PrEP and 59% – 74% were adherent to PrEP as indicated by pill counts. Fewer (≤ 18%) achieved protective TFV-DP concentrations of ≥ 700 fmol/punch in dried blood spots. Side effects, while typically mild, were the most commonly cited reason by participants for early PrEP discontinuation. Conclusion: Many MSM and TGW initiated and maintained PrEP, demonstrating that PrEP can be successfully delivered to South African MSM and TGW in diverse programmatic contexts. Biologic adherence measures suggest MSM and TGW may experience challenges taking PrEP regularly. Counselling for coping with side effects and motivating daily pill taking is recommended to support South African MSM and TGW in achieving protection with PrEP.. [ABSTRACT FROM AUTHOR]

Background: In low-middle income countries (LMICs), such as South Africa, there is an urgent need to strengthen reproductive health care (RHC) services, and improve testing for sexually transmitted infections (STIs). Self-testing, self-sampling and e- Health platforms are potential affordable, accessible tools to achieve this and require further exploration. We have recently reviewed programmatic, ethical and economic considerations for implementations of self-testing/self-sampling point-of-care tests for STIs, including HIV, in the context of LMICs. Despite demonstrable efficacy, many available tests are not currently available in LMICs, including South Africa, and the regulatory framework to oversee these need to be developed. Here, we aimed to evaluate online self-testing and self-sampling service providers available in South Africa, as a mapping exercise to support development of national regulatory guidelines. Methods: South African e-Health providers of STI tests (including both self-sampling and self-testing) were identified by searching Google (Nov 2022 to Jan 2023). Information on tests and associated services were collected from various websites, with further information obtained from providers via an online survey. This information was compared with South African Health Products Regulatory Authority (SAHPRA) and Health Professions Council of South Africa (HPCSA) standards for existing diagnostics and STI management. Results: Thirty-four individual tests were identified, of which 30 were self-tests and four were selfsampling tests, available from nine unique service providers (Table 1). These included tests for HIV (8/34), syphilis (6/34), herpes simplex virus (HSV) (5/34), Chlamydia trachomatis (4/34), Neisseria gonorrhoeae (4/34), Hepatitis B (2/34), Hepatitis C (3/34) and 2 multiplexed tests that included Trichomonas vaginalis, C. trachomatis and N. gonorrhoeae. Most were either antigen-based (12/34) or antibody-based rapid tests (13/34), and required blood (14/34). Only 5/34 required urogenital sampling, while 11/34 did not state the sample type required. Of the 34 tests, 56% were manufactured in South Africa, with the mean cost per service being 20 United States Dollars (range: 1- 62 USD). Conclusion: e-Health and self-testing for STIs are available in South Africa and offer an important approach to improving care. This exercise will aid national policymakers in drafting guidelines for management and regulation of STI self-tests and e- Health providers in South Africa. [ABSTRACT FROM AUTHOR]

A cornerstone of HIV prevention clinical trials is providing a combination prevention package to all trial participants. The elements included in that standard of care (SoC) package evolve as new prevention modalities are developed. Pre-exposure prophylaxis (PrEP) was recommended by the World Health Organization for persons at high risk of acquiring HIV, but not all countries immediately adopted those recommendations. The South African Medical Research Council (SAMRC) convened a summit to discuss issues relating to SoC and PrEP in HIV prevention clinical trials taking place in lower- to middle-income countries (LMIC). Policymakers, regulators, ethicists, experts in law, researchers, representatives of advocacy groups, and the HIV Vaccine Trials Network (HVTN) presented a framework within which SoC principles could be articulated. A group of subject matter experts presented on the regulatory, ethical, scientific, and historic framework of SoC in clinical trials, focusing on PrEP in South Africa. Summit participants discussed how and when to include new HIV treatment and prevention practices into existing clinical guidelines and trial protocols, as well as the opportunities for and challenges to scaling up interventions. The summit addressed challenges to PrEP provision, such as inconsistent efficacy amongst different populations and various biological, virological, and immunological explanations for this heterogeneity. Advocates and community members propagated the urgent need for accessible interventions that could avert HIV infection. The meeting recommended supporting access to PrEP in HIV prevention trials by (1) developing PrEP access plans for HIV vaccine trials, (2) creating a PrEP fund that would supply PrEP to sites conducting HIV prevention trials via a central procurement mechanism, and (3) supporting the safety monitoring of PrEP. This report summarizes the presentations and discussions from the summit in order to highlight the importance of SoC in HIV prevention clinical trials. [ABSTRACT FROM AUTHOR]

Large-scale deployment of COVID-19 vaccines will seriously affect the ongoing phases 2 and 3 randomised placebo-controlled trials assessing SARS-CoV-2 vaccine candidates. The effect will be particularly acute in high-income countries where the entire adult or older population could be vaccinated by late 2021. Regrettably, only a small proportion of the population in many low-income and middle-income countries will have access to available vaccines. Sponsors of COVID-19 vaccine candidates currently in phase 2 or initiating phase 3 trials in 2021 should consider continuing the research in countries with limited affordability and availability of COVID-19 vaccines. Several ethical principles must be implemented to ensure the equitable, non-exploitative, and respectful conduct of trials in resource-poor settings. Once sufficient knowledge on the immunogenicity response to COVID-19 vaccines is acquired, non-inferiority immunogenicity trials-comparing the immune response of a vaccine candidate to that of an authorised vaccine-would probably be the most common trial design. Until then, placebo-controlled, double-blind, crossover trials will continue to play a role in the development of new vaccine candidates. WHO or the Council for International Organizations of Medical Sciences should define an ethical framework for the requirements and benefits for trial participants and host communities in resource-poor settings that should require commitment from all vaccine candidate sponsors from high-income countries. [ABSTRACT FROM AUTHOR]

Background: Daily doses of pre-exposure prophylaxis (PrEP) can reduce the risk of acquiring HIV by more than 95 %. In sub-Saharan Africa, adolescent girls and young women (AGYW) are at disproportionately high risk of acquiring HIV, accounting for 25 % of new infections. There are limited data available on implementation approaches to effectively reach and deliver PrEP to AGYW in high HIV burden communities.Methods: We explored the feasibility and acceptability of providing PrEP to AGYW (aged 16-25 years) via a community-based mobile health clinic (CMHC) known as the Tutu Teen Truck (TTT) in Cape Town, South Africa. The TTT integrated PrEP delivery into its provision of comprehensive sexual and reproductive health services (SRHS). We analyzed data from community meetings and in-depth interviews with 30 AGYW PrEP users to understand the benefits and challenges of PrEP delivery in this context.Results: A total of 585 young women started PrEP at the TTT between July 2017 - October 2019. During in-depth interviews a subset of 30 AGYW described the CMHC intervention for PrEP delivery as acceptable and accessible. The TTT provided services at times and in neighborhood locations where AGYW organically congregate, thus facilitating service access and generating peer demand for PrEP uptake. The community-based nature of the CMHC, in addition to its adolescent friendly health providers, fostered a trusting provider-community-client relationship and strengthened AGYW HIV prevention self-efficacy. The integration of PrEP and SRHS service delivery was highly valued by AGYW. While the TTT's integration in the community facilitated acceptability of the PrEP delivery model, challenges faced by the broader community (community riots, violence and severe weather conditions) also at times interrupted PrEP delivery.Conclusions: PrEP delivery from a CMHC is feasible and acceptable to young women in South Africa. However, to effectively scale-up PrEP it will be necessary to develop diverse PrEP delivery locations and modalities to meet AGYW HIV prevention needs. [ABSTRACT FROM AUTHOR]

New HIV infections continue relentlessly in southern Africa, demonstrating the need for a vaccine to prevent HIV subtype C. In South Africa, the country with the highest number of new infections annually, HIV vaccine research has been ongoing since 2003 with collaborative public-private-philanthropic partnerships. So far, 21 clinical trials have been conducted in South Africa, investigating seven viral vectors, three DNA plasmids, four envelope proteins, five adjuvants and three monoclonal antibodies. Active vaccine candidates have spanned subtypes A, B, C, E and multi-subtype mosaic sequences. All were well tolerated. Four concepts were investigated for efficacy: rAd5-gag/pol/nef showed increased HIV acquisition in males, subtype C ALVAC/gp120/MF59 showed no preventative efficacy, and the trials for the VRC01 monoclonal antibody and Ad26.Mos4.HIV/subtype C gp140/ aluminum phosphate are ongoing. Future trials are planned with DNA/viral vector plus protein combinations in concert with pre-exposure prophylaxis, and sequential immunization studies with transmitted/founder HIV envelope to induce broadly neutralizing antibodies. Finally, passive immunization trials are underway to build on the experience with VRC01, including single and combination antibody trials with an antibody derived from a subtype-C-infected South African donor. Future consideration should be given to the evaluation of novel strategies, for example, inactivated-whole-virus vaccines. [ABSTRACT FROM AUTHOR]

Background: While several studies have assessed the associations between biological factors and tuberculosis (TB) transmission, our understanding of the associations between TB transmission and social and economic factors remains incomplete. We aimed to explore associations between community TB transmission and socio-economic factors within a high TB-HIV burdened setting.Methods: We conducted a cross-sectional molecular epidemiology study among adult patients attending a routine TB clinic. Demographic and clinical data were extracted from TB registers and clinical folders; social and economic data were collected using interviewer-administered questionnaires; Mycobacterium tuberculosis isolates were genotyped and classified as clustered/non-clustered using IS6110-based Restriction Fragment Length Polymorphism. Composite "social" and "economic" scores were generated from social and economic data. Data were analyzed using StataCorp version 15.0 software. Stratified, bivariable analyses were performed using chi-squared. Wilcoxon signed rank tests; univariable and multivariable logistic regression models were developed to explore associations in the social, economic, traditional and composite TB risk factors with TB transmission.Results: Of the 505 patient Mtb  strains, 348(69%) cases were classified as clustered and 157(31%) were non-clustered. Clustered cases were more likely to have lived longer in the study community, (odds ratio [OR] = 1.05, 95% Confidence interval [C.I]:1.02-1.09, p = 0.006); in the same house (OR = 1.04, C.I: 0.99-1.08, p = 0.06); and had increased household crowding conditions (i.e fewer rooms used for sleeping, OR = 0.45, C.I:0.21-0.95, p = 0.04). Although a higher proportion of clustered cases had a low economic score, no statistically significant association was found between clustering and either the economic score (p = 0.13) or social score (p = 0.26).Conclusions: We report a novel association between Mtb transmission and prolonged stay within a high burdened community. Transmission was also associated with fewer rooms for sleeping in a household. Increased social interaction and prolonged residence in a high burdened community are important factors linked to Mtb transmission, possibly due to increased probability of higher effective contact rates. The possible importance of degrees of poverty within low socio-economic setting warrants further study. [ABSTRACT FROM AUTHOR]

Pre-exposure prophylaxis (PrEP) with antiretroviral agents to prevent human immunodeficiency virus (HIV) acquisition is now a standard of care in many countries. Pre-exposure prophylaxis at this time is in the form of oral pills only, but topical rings and long-acting injectables are under investigation.[27] Who is pre-exposure prophylaxis for? B Step 2: Test for human immunodeficiency virus status: b Human immunodeficiency virus testing is required at initiation and at least 3 monthly whilst on pre-exposure prophylaxis to confirm HIV-negative status Follow HIV testing guidelines. B Post-exposure prophylaxis to pre-exposure prophylaxis: b Individuals who frequently require post-exposure prophylaxis (PEP) for HIV exposure may benefit from PrEP. [Extracted from the article]

The article discusses the global health and strengthening the response of HIV in the period of Sustainable Development Goals (SDGs). Topics mention including improving people's health and well-being, numbers of HIV infections and AIDS-related deaths and remains of several global health challenges in people with low and middle income countries.

Adolescent girls (10-19 years) and young women (20-24 years) are a key part of the 1-8 billion people who live in fragile contexts.[1] In 2019, adolescent girls and young women comprised an estimated 10% of the population in sub-Saharan Africa but accounted for 59% of new HIV infections.[[2]] Adolescent girls and young women are disproportionally affected by HIV. On World AIDS Day in 2020, we recommend ten actions to improve the health and wellbeing of adolescent girls and young women and mitigate the effects of HIV in the context of COVID-19 or similar pandemics (panel). [Extracted from the article]

The authors comment on a study published within the issue which reviewed preexposure prophylaxis (PrEP) and examined the opportunities presented to providers in offering oral PrEP to their adolescent clients. Topics covered include ways on how oral PrEP can be introduced to prevent the risk and danger associated with sexual activity, and the opportunities presented by PrEP beyond HIV prevention and enhance sexual and reproductive health (SRH) care to adolescents.

Cape Town is unique among currently high-TB-burdened settings because detailed records are available, which span 100 years of public health attempts to bring the disease under control. Over the century, public health TB interventions were implemented which contemporarily mirrored those implemented in the industrialised cities of the Northern Hemisphere. Longitudinal observational data allow an exploration of associations between observed epidemiological changes and specific interventions. TB was never truly generalised but was consistently linked to socio-economic disadvantage. In the first half of the century TB treatment was focused on sanatorium treatment. While patients were observed to clinically improve immediately after admission, no long-term individual or public health impact was discernible. Following the introduction of chemotherapy in the 1950s, case fatality declined markedly but with less impact on non-European TB notifications. TB remains the commonest cause of natural death in the city. TB meningitis, a particularly pernicious form of the disease, frequently affecting children, peaked in the 1940s followed by a 100-fold decline and remains at low levels. In contrast, childhood TB also peaked in the 1940s but has returned to rates higher than those reported 100 years ago. High childhood TB rates are indicative of ongoing transmission and the recent HIV epidemic has further exposed failure to control TB transmission. While Cape Town TB has waxed and waned over the decades, TB rates remain among the highest in the world and are at levels recorded 100 years ago. A fundamental question is, why have public health measures failed to control TB? [ABSTRACT FROM AUTHOR]

Cape Town is unique among currently high-TB-burdened settings because detailed records are available, which span 100 years of public health attempts to bring the disease under control. Over the century, public health TB interventions were implemented which contemporarily mirrored those implemented in the industrialised cities of the Northern Hemisphere. Longitudinal observational data allow an exploration of associations between observed epidemiological changes and specific interventions. TB was never truly generalised but was consistently linked to socio-economic disadvantage. In the first half of the century TB treatment was focused on sanatorium treatment. While patients were observed to clinically improve immediately after admission, no long-term individual or public health impact was discernible. Following the introduction of chemotherapy in the 1950s, case fatality declined markedly but with less impact on non-European TB notifications. TB remains the commonest cause of natural death in the city. TB meningitis, a particularly pernicious form of the disease, frequently affecting children, peaked in the 1940s followed by a 100-fold decline and remains at low levels. In contrast, childhood TB also peaked in the 1940s but has returned to rates higher than those reported 100 years ago. High childhood TB rates are indicative of ongoing transmission and the recent HIV epidemic has further exposed failure to control TB transmission. While Cape Town TB has waxed and waned over the decades, TB rates remain among the highest in the world and are at levels recorded 100 years ago. A fundamental question is, why have public health measures failed to control TB? [ABSTRACT FROM AUTHOR]

Archbishop Tutu was already losing strength and fighting several health challenges by that time, but he agreed, with the caveat that should he not be able to attend in person, he would provide a pre-taped video address. His Grace, Archbishop Emeritus of Cape Town, Desmond M. Tutu, was a man known most for his unforgettable leadership in the struggle against the Apartheid regime in his beloved South Africa. Archbishop Tutu imagined the Rainbow Nation to come, and helped lead his oppressed, often grieving, and sometimes deeply (and justifiably) enraged people to envision a brighter, more tolerant future. [Extracted from the article]

The article provides information on the journal which deals with unsolved challenges to the implementation of the pre-exposure prophylaxis (PrEP) program worldwide as part of combination with HIV prevention. It examines the future of PrEP among transgender women, with an emphasis on the important role of gender affirmation in research and clinical practice. It also discusses the prevention of HIV among adolescents with oral PrEP.

Background: This was the first microbicide trial conducted in Africa to evaluate an antiretroviral-containing vaginal ring as an HIV prevention technology for women. Objectives: The trial assessed and compared the safety, acceptability and adherence to product use of a 4-weekly administered vaginal ring containing the antiretroviral microbicide, dapivirine, with a matching placebo ring among women from four countries in sub-Saharan Africa. Methods: 280 Healthy, sexually active, HIV-negative women, aged 18 to 40 years were enrolled with 140 women randomised to a dapivirine vaginal ring (25 mg) and 140 women to a matching placebo ring, inserted 4-weekly and used over a 12-week period. Safety was evaluated by pelvic examination, colposcopy, clinical laboratory assessments, and adverse events. Blood samples for determination of plasma concentrations of dapivirine were collected at Weeks 0, 4 and 12. Residual dapivirine levels in returned rings from dapivirine ring users were determined post-trial. Participant acceptability and adherence to ring use were assessed by self-reports. Results: No safety concerns or clinically relevant differences were observed between the dapivirine and placebo ring groups. Plasma dapivirine concentrations immediately prior to ring removal were similar after removal of the first and third ring, suggesting consistent ring use over the 12-week period. No clear relationship was observed between the residual amount of dapivirine in used rings and corresponding plasma concentrations. Self-reported adherence to daily use of the vaginal rings over the 12-week trial period was very high. At the end of the trial, 96% of participants reported that the ring was usually comfortable to wear, and 97% reported that they would be willing to use it in the future if proven effective. Conclusions: The dapivirine vaginal ring has a favourable safety and acceptability profile. If proven safe and effective in large-scale trials, it will be an important component of combination HIV prevention approaches for women. Trial Registration: ClinicalTrials.gov [ABSTRACT FROM AUTHOR]

The Southern African HIV Clinicians Society published its first set of oral pre-exposure prophylaxis (PrEP) guidelines in June 2012 for men who have sex with men (MSM) who are at risk of HIV infection. With the flurry of data that has been generated in PrEP clinical research since the first guideline, it became evident that there was a need to revise and expand the PrEP guidelines with new evidence of safety and efficacy of PrEP in several populations, including MSM, transgender persons, heterosexual men and women, HIV-serodiscordant couples and people who inject drugs. This need is particularly relevant following the World Health Organization (WHO) Consolidated Treatment Guidelines released in September 2015. These guidelines advise that PrEP is a highly effective, safe, biomedical option for HIV prevention that can be incorporated with other combination prevention strategies in Southern Africa, given the high prevalence of HIV in the region. PrEP should be tailored to populations at highest risk of HIV acquisition, whilst further data from studies in the region accrue to guide optimal deployment to realise the greatest impact regionally. PrEP may be used intermittently during periods of perceived HIV acquisition risk, rather than continually and lifelong, as is the case with antiretroviral treatment. Recognition and accurate measurement of potential risk in individuals and populations also warrants discussion, but are not extensively covered in these guidelines. [ABSTRACT FROM AUTHOR]

Background: The implementation of collaborative TB-HIV services is challenging. We, therefore, assessed TB treatment outcomes in relation to HIV infection and antiretroviral therapy (ART) among TB patients attending a primary care service with co-located ART and TB clinics in Cape Town, South Africa.Methods: In this retrospective cohort study, all new TB patients aged ≥ 15 years who registered and initiated TB treatment between 1 October 2009 and 30 June 2011 were identified from an electronic database. The effects of HIV-infection and ART on TB treatment outcomes were analysed using a multinomial logistic regression model, in which treatment success was the reference outcome.Results: The 797 new TB patients included in the analysis were categorized as follows: HIV- negative, in 325 patients (40.8 %); HIV-positive on ART, in 339 patients (42.5 %) and HIV-positive not on ART, in 133 patients (16.7 %). Overall, bivariate analyses showed no significant difference in death and default rates between HIV-positive TB patients on ART and HIV-negative patients. Statistically significant higher mortality rates were found among HIV-positive patients not on ART compared to HIV-negative patients (unadjusted odds ratio (OR) 3.25; 95 % confidence interval (CI) 1.53-6.91). When multivariate analyses were conducted, the only significant difference between the patient categories on TB treatment outcomes was that HIV-positive TB patients not on ART had significantly higher mortality rates than HIV-negative patients (adjusted OR 4.12; 95 % CI 1.76-9.66). Among HIV-positive TB patients (n = 472), 28.2 % deemed eligible did not initiate ART in spite of the co-location of TB and ART services. When multivariate analyses were restricted to HIV-positive patients in the cohort, we found that being HIV-positive not on ART was associated with higher mortality (adjusted OR 7.12; 95 % CI 2.95-18.47) and higher default rates (adjusted OR 2.27; 95 % CI 1.15-4.47).Conclusions: There was no significant difference in death and default rates between HIV-positive TB patients on ART and HIV negative TB patients. Despite the co-location of services 28.2 % of 472 HIV-positive TB patients deemed eligible did not initiate ART. These patients had a significantly higher death and default rates. [ABSTRACT FROM AUTHOR]

The article provides information on studies regarding human immunodeficiency virus (HIV) risk, prevention, and treatment among adolescents and young adults. Topics discussed include combination prevention packages and pre-exposure prophylaxis (PrEP) for young key populations, concerns faced by youth on HIV testing in low- and high-income country settings, and comprehensive health services for young key populations.

Adolescents and young adults are at increased risk for HIV due to the many developmental, psychological, social, and structural transitions that converge in this period of the lifespan. In addition, adolescent deaths resulting from HIV continue to rise despite declines in other age groups. There are also young key populations (YKPs) that bear disproportionate burdens of HIV and are the most vulnerable, including young men who have sex with men (MSM), transgender youth, young people who inject drugs, and adolescent and young adult sex workers. As a society, we must do more to stop new HIV infections and untimely HIV-related deaths through both primary and secondary prevention and better management approaches. Using an interwoven prevention and treatment cascade approach, the starting point for all interventions must be HIV counselling and testing. Subsequent interventions for both HIV-negative and HIV-positive youth must be 'adolescent-centred,' occur within the socio-ecological context of young people and take advantage of the innovations and technologies that youth have easily incorporated into their daily lives. In order to achieve the global goals of zero infections, zero discrimination and zero deaths, a sustained focus on HIV research, policy and advocacy for YKPs must occur. [ABSTRACT FROM AUTHOR]

Adolescents and young adults are at increased risk for HIV due to the many developmental, psychological, social, and structural transitions that converge in this period of the lifespan. In addition, adolescent deaths resulting from HIV continue to rise despite declines in other age groups. There are also young key populations (YKPs) that bear disproportionate burdens of HIV and are the most vulnerable, including young men who have sex with men (MSM), transgender youth, young people who inject drugs, and adolescent and young adult sex workers. As a society, we must do more to stop new HIV infections and untimely HIV-related deaths through both primary and secondary prevention and better management approaches. Using an interwoven prevention and treatment cascade approach, the starting point for all interventions must be HIV counselling and testing. Subsequent interventions for both HIV-negative and HIV-positive youth must be ''adolescent-centred,'' occur within the socio-ecological context of young people and take advantage of the innovations and technologies that youth have easily incorporated into their daily lives. In order to achieve the global goals of zero infections, zero discrimination and zero deaths, a sustained focus on HIV research, policy and advocacy for YKPs must occur. [ABSTRACT FROM AUTHOR]

Sex work occurs in many forms and sex workers of all genders have been affected by HIV epidemics worldwide. The determinants of HIV risk associated with sex work occur at several levels, including individual biological and behavioural, dyadic and network, and community and social environmental levels. Evidence indicates that effective HIV prevention packages for sex workers should include combinations of biomedical, behavioural, and structural interventions tailored to local contexts, and be led and implemented by sex worker communities. A model simulation based on the South African heterosexual epidemic suggests that condom promotion and distribution programmes in South Africa have already reduced HIV incidence in sex workers and their clients by more than 70%. Under optimistic model assumptions, oral pre-exposure prophylaxis together with test and treat programmes could further reduce HIV incidence in South African sex workers and their clients by up to 40% over a 10-year period. Combining these biomedical approaches with a prevention package, including behavioural and structural components as part of a community-driven approach, will help to reduce HIV infection in sex workers in different settings worldwide. [ABSTRACT FROM AUTHOR]

Background: Factors associated with Mycobacterium tuberculosis (Mtb) strain success over time in high burdened communities are unknown.Methods: Mtb isolates collected over 10 years from sputum-positive tuberculosis (TB) patients resident in the study site underwent IS6110-based restriction fragment length polymorphism analysis. Clinical, demographic and social data were extracted from clinic records and interviewer-administered questionnaires. Strains were defined as persistently successful, transiently successful or unsuccessful based on the average number of cases per year and their continued presence over time.Results: Genotyping data were available on 789 TB cases. Of the 311 distinct Mtb strains (≥6 bands) identified, 247 were categorized as unsuccessful strains, 12 transiently successful and 10 persistently successful strains. Strain success was not associated with age, gender, antiretroviral use or social factors. Persistently successful strains were less likely to be drug-resistant compared with transiently successful strains [odds ratio (OR): 0.13; 95% confidence interval (CI): 0.04 - 0.5]. Persistently successful strains were positively associated with host HIV-infection compared with unsuccessful strains, but this finding was not robust in sensitivity analyses.Conclusions: Pathogen characteristics appear to play a greater role in Mtb strain success compared with social or host factors. This study supports the need for further investigations into the role of pathogen characteristics in strain success. [ABSTRACT FROM AUTHOR]

As a tireless scholar, James was a Professor of Medicine, the past Chair of Medicine at the University of Zimbabwe (UZ), where he maintained a diverse and expansive interest in HIV research including antiretroviral therapy, prevention, opportunistic infections and perinatal infection. IAS - the International AIDS Society - alongside the HIV community, mourn the untimely loss of Professor James Gita Hakim, MBChB, MMed, MMedSci, FRCP, PGDipHPE to COVID-19-related complications [1]. Author information Dr Adeeba Kamarulzaman, IAS President and Professor of Medicine at the Faculty of Medicine at the University of Malaya. [Extracted from the article]

Background: Compared to women, South African men are less likely to know their HIV status (78% vs. 89%), have suppressed viral loads (82% vs. 90%), or access HIV prevention services. To achieve epidemic control where heterosexual sexual behavior drives transmission, interventions to improve the uptake of HIV testing services (HTS) and prevention services must also target cis-gendered, heterosexual men. There is limited understanding of these men's needs and wants with regards to accessing pre-exposure prophylaxis (PrEP). Methods: Adult men (≥ 18 years) from a peri-urban community in Buffalo City Municipality were offered community-based HTS. Those who received a negative HIV test result were offered community-based, same-day oral PrEP initiation. Men initiating PrEP were invited to participate in a study exploring men's HIV prevention needs and reasons for initiating PrEP. An in-depth interview guide, developed using the Network-Individual-Resources model (NIRM), explored men's perceived HIV acquisition risk, prevention needs, and preferences for PrEP initiation. Interviews were conducted by a trained interviewer in isiXhosa or English, audio-recorded and transcribed. Thematic analysis was used, guided by the NIRM to generate findings. Results: Twenty-two men (age range 18–57 years) initiated PrEP and consented to study participation. Men reported elevated HIV acquisition risk associated with alcohol use and condom-less sex with multiple partners as facilitators driving PrEP initiation. They anticipated social support from family members, their main sexual partner and close friends for their PrEP use, and discussed other men as important sources of support for PrEP initiation. Nearly all men expressed positive views of people using PrEP. Participants believed HIV testing would be a barrier for men interested in accessing PrEP. Men recommended that access to PrEP be convenient, rapid, and community-based (i.e., not clinic-based). Discussion: Self-perceived risk for HIV acquisition was a major facilitator for men's PrEP initiation. Although men expressed positive perceptions of PrEP users, they noted that HIV testing may be a barrier to PrEP initiation. Finally, men recommended convenient access points to facilitate PrEP initiation and sustained use. Gender-responsive interventions tailored to men's needs, wants, and voices will facilitate their uptake of HIV prevention services, and help to end the HIV epidemic. [ABSTRACT FROM AUTHOR]

The prevalence of non-communicable diseases (NCDs) is increasing in South Africa, in part due to poor nutrition, physical inactivity, and obesity. We characterized the habits and understanding of diet, exercise, and obesity among people with HIV (PWH) taking antiretroviral therapy (ART). We conducted a cross-sectional study of ART-experienced PWH attending an HIV community health center near Cape Town, South Africa. We included PWH currently prescribed ART, older than 21y, and not pregnant. We collected demographic and clinical information and interviewed participants regarding their behaviors and knowledge related to diet, physical activity, and obesity. From March 2015 – February 2016, we enrolled 458 participants. Self-reported diets were low in nutritional diversity: 202 reported eating only starch and protein without vegetable/fruit in the prior 24 h. Although most participants (96%) acknowledged that exercise had health benefits, only 215 participants engaged in daily 30-minute walking or exercise. One quarter of participants recognized nocontributors to obesity, and almost 20% identified no health problems associated with obesity. Participants had diets low in nutritional diversity, modest exercise habits, and limited understanding of the impact of obesity on health. Further understanding of barriers to improving diet and exercise and reducing obesity are essential, especially as PWH age. [ABSTRACT FROM AUTHOR]

The number of products that can provide pre-exposure prophylaxis (PrEP) for HIV prevention is expanding, with three now approved in South Africa (oral Tenofovir-based PrEP, injectable Cabotegravir, and a Dapivirine-based vaginal ring) and more in the development pipeline. Although highly effective and safe, oral PrEP products have not reduced HIV incidence in South Africa to the extent seen in other countries, primarily due to adherence challenges, rapidly diminishing persistence over time, and insufficient scale-up of PrEP service delivery. The Dapivirine vaginal ring, which provides 1-month-long protection, provides women with a new and discreet choice for PrEP; however, it is Cabotegravir long-acting (CAB LA) that is anticipated to land the largest impact. Administered as an intramuscular injection given every 2 months, CAB LA is safe, highly efficacious, and expected to become available in South Africa in late 2023. Yet, clinical and implementation questions remain, including the need to understand and characterise breakthrough HIV infections amongst CAB LA users, knowledge of how to package each PrEP product in a new context of PrEP choice, and how to avoid the remedicalisation of PrEP access following extensive efforts to make oral PrEP delivery differentiated and community based. [ABSTRACT FROM AUTHOR]

In a Perspective, Linda-Gail Bekker and Glenda Gray discuss HIV vaccine development. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editors discuss various reports published within the issue on topics including access to and policy developments regarding pre-exposure prophylaxis (PrEP), barriers to combining PrEP with HIV prevention strategies in Latin America, and the potential role of PrEP among young people in the U.S. and South Africa.

An introduction is presented in which the authors discuss various reports within the issue on topics including the policy development in lower-middle income countries, the implementation of pre-exposure prophylaxis (PrEP) for HIV, and role played by PrEP among young people.

Background Tuberculosis (TB) transmission rates are exceptionally high in endemic TB settings. Adolescence represents a period of increasing TB infection and disease but little is known as to where adolescents acquire TB infection. We explored the relationship between residential exposure to adult TB cases and infection in children and adolescents in a South African community with high burdens of TB and HIV. Methods TB infection data were obtained from community, school-based tuberculin skin test (TST) surveys performed in 2006, 2007 and 2009. A subset of 2007 participants received a repeat TST in 2009, among which incident TB infections were identified. Using residential address, all adult TB cases notified by the community clinic between 1996 and 2009 were cross-referenced with childhood and adolescent TST results. Demographic and clinic data including HIV status were abstracted for TB cases. Multivariate logistic regression models examined the association of adult TB exposure with childhood and adolescent prevalent and incident TB infection. Results Of 1,100 children and adolescents included in the prevalent TB infection analysis, 480 (44%) were TST positive and 651 (59%) were exposed to an adult TB case on their residential plot. Prevalent TB infection in children aged 5-9 and 10-14 years was positively associated with residential exposure to an adult TB case (odds ratio [OR]:2.0, 95% confidence interval [CI]: 1.1-3.6 and OR:1.5, 95% CI: 1.0-2.3 respectively), but no association was found in adolescents ⩾15 years (OR:1.4, 95% CI: 0.9-2.0). HIV status of adult TB cases was not associated with TB infection (p = 0.62). Of 67 previously TST negative children, 16 (24%) converted to a positive TST in 2009. These incident infections were not associated with residential exposure to an adult TB case (OR: 1.9, 95% CI: 0.5-7.3). Conclusions TB infection among young children was strongly associated with residential exposure to an adult TB case, but prevalent and incident TB infection in adolescents was not associated with residential exposure. The HIV-status of adult TB cases was not a risk factor for transmission. The high rates of TB infection and disease among adolescents underscore the importance of identifying where infection occurs in this age group. [ABSTRACT FROM AUTHOR]

Globally, there are 5 million young people aged 15-24 years living with HIV, and many more millions are at risk for HIV acquisition. Compelling research questions exist that require the involvement of young people and other vulnerable populations in HIV-related research in diverse settings around the world. Despite this, there remains a reluctance to involve adolescent participants, including young women, in clinical research. Complex and, at times, contradictory legal and ethical requirements can be a challenge. Ethical benchmarks can be applied to ensure that research meets high-level standards and is planned for appropriately. [ABSTRACT FROM AUTHOR]

Background Mobile phone text messaging (SMS) has the potential to promote adherence to tuberculosis treatment. This systematic review aims to synthesize current evidence on the effectiveness of SMS interventions in improving patients' adherence to tuberculosis treatment. Methods We searched electronic databases (PubMed, EMBASE, Science Citation Index), reference lists of relevant articles, conference proceedings, and selected websites for eligible studies available by 15 February 2013; regardless of language or publication status. Two authors independently screened selected eligible studies, and assessed risk of bias in included studies; resolving discrepancies by discussion and consensus. Results We identified four studies that compared the outcomes of the SMS intervention group with controls. Only one of the four studies was a randomized controlled trial. This was conducted in Argentina and the SMS intervention did not significantly improve adherence to tuberculosis treatment compared to self-administration of tuberculosis treatment (risk ratio [RR] 1.49, 95% confidence intervals [CI] 0.90 to 2.42). One of the non-randomized studies, conducted in South Africa, which compared SMS reminders to directly observed therapy short course (DOTS) reported similar rates of tuberculosis cure (62.35% vs. 66.4%) and treatment success (72.94% vs. 69.4%). A second study from South Africa, utilized SMS reminders when patients delayed in opening their pill bottles and reported increased tuberculosis cure (RR 2.32, 95% CI 1.60 to 3.36) and smear conversion (RR 1.62, 95% CI 1.09 to 2.42) rates compared to DOTS. In the third non-randomized study, conducted in Kenya, use of SMS reminders increased rates of clinic attendance on scheduled days compared to standard care (RR 1.56, 95% CI 1.06 to 2.29). Using the GRADE approach, we rate the quality of the evidence as low, mainly because of the high risk of bias and heterogeneity of effects across studies. Conclusions This systematic review indicates that there is a paucity of high-quality data on the effectiveness of SMS interventions for improving patients' adherence to tuberculosis treatment. The low quality of the current evidence implies that further studies (in particular randomized trials) on the subject are needed. In the interim, if the intervention is implemented outside research settings an impact evaluation is warranted. [ABSTRACT FROM AUTHOR]

To review the current state of knowledge on the prevention of sexual transmission of HIV in adolescents and to highlight the existing gaps and priority areas for future research.A disproportionate burden of HIV infections falls on adolescents, a developmental stage marked by unique neural, biological, and social transition. Successful interventions are critical to prevent the spread of HIV in this vulnerable population.We summarized the current state of research on HIV prevention in adolescents by providing examples of successful interventions and best practices, and highlighting current research gaps.Adolescent interventions fall into 3 main categories: biomedical, behavioral, and structural. The majority of current research has focused on individual behavior change, whereas promising biomedical and structural interventions have been largely understudied in adolescents. Combination prevention interventions may be particularly valuable to this group.Adolescents have unique needs with respect to HIV prevention, and, thus, interventions should be designed to most effectively reach out to this population with information and services that will be relevant to them. [ABSTRACT FROM AUTHOR]

The article offers a discussion on the clinical care for men who have sex with men (MSM). It mentions that MSM require special health care needs due to internalization of society related to homosexuality which results in depression and other adverse outcomes. It also discusses the need of developing clinical care programs for MSM by the health care providers to deal with these health disparities. INSETS: Search strategy and selection criteria;Key messages.

The article assesses the factors applied on antiretroviral therapies (ARTs) for patients co-infected with tuberculosis (TB) and HIV. The World Health Organization and the U.S. Department of Health and Human Services devised guidelines stating that ART must be done during a TB treatment within 8 weeks. The guidelines were assessed based on various tests including the AIDS Clinical Trials Group study 5164, and Starting Antiretroviral Therapy in three Time Points in Tuberculosis.

Antiretroviral therapy (ART) has been proposed as an intervention for reducing tuberculosis (TB) burdens in areas with high HIV prevalence. However, little data is available on the impact of ART on population-level TB.Trends in adult TB case fatality and notifications were assessed before and during increasing ART coverage in a well-defined periurban community, from 1997 to 2008. Mean changes in TB rates were measured using linear autoregression models. ART coverage increased from 1% in 2003 to 5%, 13%, and 21% of HIV-infected population in 2004, 2005, and 2008, respectively.From 1997 to end of 2004 TB notification rates increased by an average of 187 cases/100,000/year (P < 0.001), reaching a peak of 2536/100,000 in 2005. From 2005 to 2008, TB notification rates declined by approximately 202 cases/100,000/year (P < 0.001). TB rates were initially stable in HIV-uninfected individuals, but declined moderately from 2005. TB rates declined in HIV-infected adults from 6513/100,000 in 2005 to 4741/100,000 in 2008. The predominant decline in TB notifications occurred among HIV-infected patients receiving ART (1156 cases/100,000/year) and was less marked in those not receiving ART (416cases/100,000/year). Similarly, TB case fatality was constant for HIV-uninfected individuals, but declined in HIV-infected individuals from 23% in 2002 to 8% in 2008 (P = 0.01).In this community heavily affected by both HIV and TB epidemics, rapid and high ART coverage was associated with significant reductions in TB notifications and TB-associated case fatality. [ABSTRACT FROM AUTHOR]

Background: Understanding of the transmission dynamics of tuberculosis (TB) in high TB and HIV prevalent settings is required in order to develop effective intervention strategies for TB control. However, there are little data assessing incidence of TB infection in adolescents in these settings. Methods: We performed a tuberculin skin test (TST) and HIV survey among secondary school learners in a high HIV and TB prevalence community. TST responses to purified protein derivative RT23 were read after 3 days. HIVinfection was assessed using Orasure® collection device and ELISA testing. The results of the HIV-uninfected participants were combined with those from previous surveys among primary school learners in the same community, and force of TB infection was calculated by age. Results: The age of 820 secondary school participants ranged from 13 to 22 years. 159 participants had participated in the primary school surveys. At a 10 mm cut-off, prevalence of TB infection among HIV-uninfected and first time participants, was 54% (n = 334/620). HIV prevalence was 5% (n = 40/816). HIV infection was not significantly associated with TST positivity (p = 0.07). In the combined survey dataset, TB prevalence was 45% (n = 645/1451), and was associated with increasing age and male gender. Force of infection increased with age, from 3% to 7.3% in adolescents ≥20 years of age. Conclusions: We show a high force of infection among adolescents, positively associated with increasing age. We postulate this is due to increased social contact with infectious TB cases. Control of the TB epidemic in this setting will require reducing the force of infection. [ABSTRACT FROM AUTHOR]

Tuberculosis (TB) has proven to be difficult to control in regions with a high prevalence of human immunodeficiency virus (HIV) infection. We previously described high prevalence of HIV infection among adults (23%) and rapidly escalating TB notification rates in a peri-urban township, Site-M in Cape Town, South Africa. The combination of delineated boundaries, a well-characterized population, centralized TB record keeping, and high levels of HIV testing make this population uniquely suited for TB epidemiologic and transmission studies. The driver of the HIV and TB coepidemic appears to be a high annual risk of Mycobacterium tuberculosis infection in this community. A high annual risk of M. tuberculosis infection may be the result of unrecognized infections coupled with intense social interaction and crowding. New non-facilitybased interventions will be required, with emphasis on community-based case finding and contact tracing to decrease the infective TB pool. There is a need for better understanding of the transmission dynamics of TB and the intensity of social interactions, which have exacerbated an HIV and TB epidemic in this community of hyperendemicity. [ABSTRACT FROM AUTHOR]

To explore the relationship between human immunodeficiency virus (HIV) and Mycobacterium tuberculosis genotypes, we performed IS6110-based restriction fragment- length polymorphism analysis on M. tuberculosis culture specimens from patients with smear-positive tuberculosis in a periurban community in South Africa from 2001 through 2005. Among 151 isolates, 95 strains were identified within 26 families, with 54% clustering. HIV status was associated with W-Beijing strains (P = .009) but not with clustering per se. The high frequency of clustering suggests ongoing transmission in both HIV-negative and HIV-positive individuals in this community. The strong association between W-Beijing and HIV infection may have important implications for tuberculosis control. [ABSTRACT FROM AUTHOR]

Background. Tuberculin skin test surveys are routinely used to test for tuberculosis (TB) infection in communities, but there are few data from tuberculin skin test surveys from countries in which both TB and human immunodeficiency virus (HIV) infection are prevalent. Methods. We conducted a tuberculin skin test survey among 831 school-going children aged 5-17 years in a community that was experiencing an increase in the prevalence of TB and HIV infection. Responses to purified protein derivative RT23 were measured 3 days after the test was administered to determine tuberculin skin test results. Results. The prevalence of tuberculin skin test results positive for TB (i.e., an induration ⩾10 mm in diameter in response to the skin test) ranged from 26.2% among children aged 5-8 years to 52.5% among children aged 14-17 years. The overall annual risk of infection was 4.1% using a 10-mm cutoff and 2.0% using a 17.4-mm cutoff. Annual risks of infection were constant across age groups. This is consistent with the finding that TB incidence remained the same in children (Pp.48) from 1999 through 2005, although total TB incidence and adult TB (determined by sputum smear test) incidence increased in this community during the same period (P ! .001). Conclusions. The annual risk of infection is high in the community. It appears that HIV infection-associated TB is not a major influence on the annual risk of infection and that TB transmission from adults to children may be associated with a subset of TB cases in the community. An improved understanding of TB transmission patterns is urgently needed help the implementation of novel strategies for reducing the annual risk of infection in this setting. [ABSTRACT FROM AUTHOR]

Abstract: The first HIV/AIDS vaccines are likely to be expensive and limited in supply, and developing countries with generalized HIV/AIDS epidemics will need to distribute the limited vaccine stock in a manner that is both efficient and practical. This analysis compares seven strategies for distributing an HIV/AIDS vaccine in different South African sub-populations, using a mathematical model. If vaccination is not coupled with HIV screening, vaccination of 16-year olds in school is likely to be the most efficient strategy for averting HIV infections in the short term. If coupled with screening, vaccination of sex workers and patients seeking STD treatment would be more efficient, but these gains in efficiency would have to be weighed against the practical challenges associated with vaccinating ‘high risk’ groups and conducting screening. [Copyright &y& Elsevier]

In 2018, at the 22nd International AIDS Conference (AIDS 2018), the International AIDS Society (IAS)-Lancet Commission "Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals" laid out a bold vision for expansion of the HIV agenda with greater engagement and synergy between the movements for universal health care, non-communicable diseases, and more integrated responses to the pandemics of HIV, tuberculosis, and malaria.[[1]] Our vision was challenging for many across these vital domains. As the largest global health conference worldwide, we must address the COVID-19 pandemic and the IAS is compelled to offer our platform to the global health community. 97, 2019, 170 70A 4 WHO Coronavirus disease 2019 (COVID-19) situation report - 99. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200428-sitrep-99-covid-19.pdf?sfvrsn=119fc381%5f2 April 28, 2020, 5 J Hargreaves, C Davey, Group for lessons from pandemic HIV prevention for the COVID-19 response Three lessons for the COVID-19 response from pandemic HIV. [Extracted from the article]