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Introduction: Tracing patients lost to follow-up (LTFU) from HIV care is widely practiced, yet we have little knowledge of its causal effect on care engagement. In a prospective, Zambian cohort, we examined the effect of tracing on return to care within 2 years of LTFU. Methods: We traced a stratified, random sample of LTFU patients who had received HIV care between August 2013 and July 2015. LTFU was defined as a gap of >90 days from last scheduled appointment in the routine electronic medical record. Extracting 2 years of follow-up visit data through 2017, we identified patients who returned. Using random selection for tracing as an instrumental variable (IV), we used conditional two-stage least squares regression to estimate the local average treatment effect of tracer contact on return. We examined the observational association between tracer contact and return among patient sub-groups self-confirmed as disengaged from care. Results: Of the 24,164 LTFU patients enumerated, 4380 were randomly selected for tracing and 1158 were contacted by a tracer within a median of 14.8 months post-loss. IV analysis found that patients contacted by a tracer because they were randomized to tracing were no more likely to return than those not contacted (adjusted risk difference [aRD]: 3%, 95% CI: -2%, 8%, p = 0.23). Observational data showed that among contacted, disengaged patients, the rate of return was higher in the week following tracer contact (IR 5.74, 95% CI: 3.78-8.71) than in the 2 weeks to 1-month post-contact (IR 2.28, 95% CI: 1.40-3.72). There was a greater effect of tracing among patients lost for >6 months compared to those contacted within 3 months of loss. Conclusions: Overall, tracer contact did not causally increase LTFU patient return to HIV care, demonstrating the limited impact of tracing in this program, where contact occurred months after patients were LTFU. However, observational data suggest that tracing may speed return among some LTFU patients genuinely out-of-care. Further studies may improve tracing effectiveness by examining the mechanisms underlying the impact of tracing on return to care, the effect of tracing at different times-since-loss and using more accurate identification of patients who are truly disengaged to target tracing. Keywords: causality; HIV; instrumental variable; lost to follow-up; retention in care; tracing, 1 I INTRODUCTION Consistent engagement in HIV care is critical for patient health [1-5] and achieving global epidemic control targets [6]. Retention is challenging, however, with approximately one-third of patients [...]

The COVID-19 pandemic and subsequent mitigation measures led to social disruption and negative economic shocks for a large proportion of Uganda's population. The social and economic consequences of COVID-19 on Ugandan men's sexual behaviours, including transactional sex relationships, are unclear. We conducted in-depth interviews between November 2021–February 2022 with 26 men in a high HIV prevalence region of Uganda. Data were analysed thematically to understand how sexual relationships, including transactional sex, were impacted by COVID-19. We found that COVID-19 mitigation measures had far-reaching social and economic impacts on most respondents, particularly those employed in the informal economy. Men described experiencing job loss, food insecurity and restricted mobility, which limited opportunities to provide for and meet with transactional sex partners. Inability to provide financial resources meant that men could not form new transactional sex relationships and men who could no longer provide for their existing transactional sex partners consistently reported relationship dissolution. Men who reported stable employment during the pandemic described few changes in transactional sex relationships. Similarly, men in non-transactional relationships did not report relationship dissolution despite decreased financial provision. Further research should assess the potential short- and long-term impacts of COVID-19 mitigation measures on transactional sex relationships. [ABSTRACT FROM AUTHOR]

The Evidence Project conducts systematic reviews and meta-analyses of HIV behavioral interventions, behavioral aspects of biomedical interventions, combination prevention strategies, modes of service delivery, and integrated programs in low- and middle-income countries. Here, we present the overall protocol for our reviews. For each topic, we conduct a comprehensive search of five online databases, complemented by secondary reference searching. Articles are included if they are published in peer-reviewed journals and present pre/post or multi-arm data on outcomes of interest. Data are extracted from each included article by two trained coders working independently using standardized coding forms, with differences resolved by consensus. Risk of bias is assessed with the Evidence Project tool. Data are synthesized descriptively, and meta-analysis is conducted when there are similarly measured outcomes across studies. For over 20 years, this approach has allowed us to synthesize literature on the effectiveness of interventions and contribute to the global HIV response. [ABSTRACT FROM AUTHOR]

This study examined how individual, relational and environmental factors related to adolescent demand for HIV voluntary counseling and testing (VCT). A cross-sectional survey among randomly selected 16-19-year-olds in Ndola, Zambia, covered individual (e.g., HIV knowledge), environmental (e.g., distance), and relational factors (e.g., discussed VCT with family). Multivariate regression analysis compared 98 respondents who planned to test for HIV within the year with 341 respondents who did not. Discussing HIV testing with family members was strongly associated with planning to test (odds ratio [OR] = 6.1; 95% confidence interval [CI] = 2.24-16.58). VCT discussions with sex partners (OR = 3.64; 95% CI = 1.13-11.71) and with friends (OR = 2.61; 95% CI = 1.34-5.08) were also associated with HIV testing plans. Significant individual factors were having ever had sex (OR = 2.33; 95% CI = 1.41-3.84) and HIV risk perception (OR = 2.71; 95% CI = 1.51-4.88). Relational and individual factors strongly correlated with VCT demand, supporting the need to examine these factors when implementing and evaluating adolescent VCT strategies.

This review systematically examined the effectiveness of 24 mass media interventions on changing human immunodeficiency virus (HIV)-related knowledge, attitudes and behaviors. The intervention studies were published from 1990 through 2004, reported data from developing countries and compared outcomes using (i) pre- and post-intervention data, (ii) treatment versus control (comparison) groups or (iii) post-intervention data across levels of exposure. The most frequently reported outcomes were condom use (17 studies) and knowledge of modes of HIV transmission (15), followed by reduction in high-risk sexual behavior (eight), perceived risk of contracting HIV/acquired immunodeficiency syndrome (AIDS) (six), interpersonal communication about AIDS or condom use (six), self-efficacy to negotiate condom use (four) and abstaining from sexual relations (three). The results yielded mixed results, and where statistically significant, the effect size was small to moderate (in some cases as low as 1-2% point increase). On two of the seven outcomes, at least half of the studies did show a positive impact of the mass media: knowledge of HIV transmission and reduction in high-risk sexual behavior. Further rigorous evaluation on comprehensive programs is required to provide a more definitive answer to the question of media effects on HIV/AIDS-related behavior in developing countries. (Contains 3 tables and 2 figures.)

Little data exist on how 15-to-24-year-old perinatally infected youth living with HIV (p-YLHIV) learn their HIV status, and how those disclosure experiences may relate to current viral suppression (VS). Cross-sectional analyses were conducted using baseline data from a randomized controlled trial testing a peer mentoring program in Ndola, Zambia. Analyses were restricted to self-reported p-YLHIV to assess associations between disclosure experiences and VS using logistic regression models, adjusted for sex, age, time on treatment and enrolment site. Of 198 p-YLHIV, 55% knew their HIV status by age 12. The odds of VS was 3.43 greater among p-YLHIV who learned their HIV status through a healthcare provider (HCP) and caregiver together compared to learning from either a HCP or caregiver alone [95% CI:1.02,11.54]. P-YLHIV who had people to talk with about living with HIV after disclosure were twice as likely to have VS compared to peers who did not [OR: 1.87, 95% CI: 1.0, 3.45]. These findings highlight the importance of disclosure support and having a HCP-caregiver team handle disclosure with perinatally infected children and youth, indicating strong service delivery opportunities that may support future VS in youth. Future studies should examine youth peer mentors living with HIV's support during disclosure processes. [ABSTRACT FROM AUTHOR]

Objective To examine the relationship between condom social marketing programmes and condom use. Methods Standard systematic review and meta-analysis methods were followed. The review included studies of interventions in which condoms were sold, in which a local brand name(s) was developed for condoms, and in which condoms were marketed through a promotional campaign to increase sales. A definition of intervention was developed and standard inclusion criteria were followed in selecting studies. Data were extracted from each eligible study, and a meta-analysis of the results was carried out. Findings Six studies with a combined sample size of 23 048 met the inclusion criteria. One was conducted in India and five in sub-Saharan Africa. All studies were cross-sectional or serial cross-sectional. Three studies had a comparison group, although all lacked equivalence in sociodemographic characteristics across study arms. All studies randomly selected participants for assessments, although none randomly assigned participants to intervention arms. The random-effects pooled odds ratio for condom use was 2.01 (95% confidence interval, CI: 1.42-2.84) for the most recent sexual encounter and 2.10 (95% CI: 1.51-2.91) for a composite of all condom use outcomes. Tests for heterogeneity yielded significant results for both meta-analyses. Conclusion The evidence base for the effect of condom social marketing on condom use is small because few rigorous studies have been conducted. Meta-analyses showed a positive and statistically significant effect on increasing condom use, and all individual studies showed positive trends. The cumulative effect of condom social marketing over multiple years could be substantial. We strongly encourage more evaluations of these programmes with study designs of high rigour. Objectif Etudier la relation entre les programmes de marketing social du preservatif et l'utilisation du preservatif. Methodes On a recouru a des methodes de meta-analyse et d'examen systematique standard. L'examen comprenait des etudes d'interventions dans le cadre desquelles des preservatifs etaient vendus, un ou des noms de marque locale etaient developpes pour les preservatifs, et les preservatifs etaient commercialises par le biais d'une campagne de promotion visant a augmenter les ventes. Une definition de l'intervention a ete elaboree et des criteres d'inclusion standard ont ete appliques dans la selection des etudes. Les donnees ont ete extraites de chaque etude eligible, et une meta-analyse des resultats a ete effectuee. Resultats Six etudes, avec une taille d'echantillon combinee de 23 048, ont rempli les criteres d'inclusion. Une etude a ete effectuee en Inde et cinq en Afrique subsaharienne. Toutes les etudes etaient transversales ou transversales en serie. Trois etudes disposaient d'un groupe de comparaison, mais aucune n'avait d'equivalent en termes de caracteristiques sociodemographiques entre segments de l'etude. Toutes les etudes choisissaient aleatoirement les participants aux evaluations, mais aucune ne designait aleatoirement les participants aux segments d'intervention. Le rapport des cotes regroupe a effets aleatoires pour l'utilisation du preservatif etait de 2,01 (intervalle de confiance de 95%, IC: 1,42-2,84) pour la derniere relation sexuelle et de 2,10 (IC de 95%: 1,51-2,91) pour un compose de tous les resultats d'utilisation du preservatif. Les tests d'heterogeneite ont donne des resultats significatifs pour les deux meta-analyses. Conclusion La base probante de l'effet du marketing social du preservatif sur l'utilisation du preservatif est faible, car peu d'etudes rigoureuses ont ete menees. Les meta-analyses ont montre un effet positif et statistiquement significatif sur l'utilisation accrue du preservatif, et toutes les etudes individuelles ont montre des tendances positives. L'effet cumulatif du marketing social du preservatif sur plusieurs annees pourrait etre considerable. Nous encourageons fortement de nouvelles evaluations de ces programmes avec des plans d'etude tres rigoureux. Objetivo Examinar la relacion entre los programas de comercializacion social del preservativo y el uso del mismo. Metodos Se aplicaron diversos metodos de meta-analisis y de examen sistematico estandar. El examen incluyo estudios sobre intervenciones en las que se vendieron preservativos, en las que se desarrollaron una o varias marcas locales para los preservativos y en las que los preservativos se comercializaron mediante una campana promocional para aumentar las ventas. Para seleccionar los estudios, se desarrollo una definicion de intervencion y se siguieron unos criterios de inclusion estandar. Se obtuvieron datos de todos los estudios que cumplian los requisitos y se realizo un meta-analisis de los resultados. Resultados Seis estudios con un tamano muestral combinado de 23 048 cumplieron los criterios de inclusion. Uno se realizo en India y cinco en Africa Subsahariana. Todos los estudios fueron transversales o transversales seriados. Tres de ellos contaron con un grupo de comparacion, si bien todos ellos carecieron de equivalencia en las caracteristicas sociodemograficas dentro de las ramas del estudio. Todos los estudios seleccionaron a sus participantes para las evaluaciones de manera aleatoria, aunque ninguno asigno aleatoriamente participantes para las diversas ramas de intervencion. La razon de posibilidades acumulada de efectos aleatorios para el uso del preservativo fue del 2,01 (Intervalo de confianza, IC del 95%: 1,42-2,84) para el encuentro sexual mas reciente y del 2,10 (IC del 95%:1,51-2,91) para el conjunto de todos los resultados del uso del preservativo. Las pruebas de heterogeneidad arrojaron resultados significativos para ambos meta-analisis. Conclusion La evidencia del efecto de la comercializacion social del uso de preservativo es reducida porque se han realizado pocos estudios rigurosos sobre el tema. Los meta-analisis mostraron un efecto positivo y estadisticamente significativo sobre el aumento en el uso del preservativo. Ademas, todos los estudios individuales mostraron tendencias positivas. El efecto acumulativo de la comercializacion social del preservativo durante muchos anos podria ser considerable. Alentamos encarecidamente la realizacion de evaluaciones de estos programas con modelos de estudio de elevado rigor., Introduction The social marketing of condoms began in earnest in developing countries in tandem with global family planning efforts and was dramatically expanded as an early response to the global [...]

: The recognition and fulfilment of the sexual and reproductive health and rights (SRHR) of all individuals and couples affected by HIV, including HIV‐serodiscordant couples, requires intervention strategies aimed at achieving safe and healthy pregnancies and preventing undesired pregnancies. Reducing risk of horizontal and vertical transmission and addressing HIV‐related infertility are key components of such interventions. In this commentary, we present challenges and opportunities for achieving safe pregnancies for serodiscordant couples through a social ecological lens. At the individual level, knowledge (e.g. of HIV status, assisted reproductive technologies) and skills (e.g. adhering to antiretroviral therapy or pre‐exposure prophylaxis) are important. At the couple level, communication between partners around HIV status disclosure, fertility desires and safer pregnancy is required. Within the structural domain, social norms, stigma and discrimination from families, community and social networks influence individual and couple experiences. The availability and quality of safer conception and fertility support services within the healthcare system remains essential, including training for healthcare providers and strengthening integration of SRHR and HIV services. Policies, legislation and funding can improve access to SRHR services. A social ecological framework allows us to examine interactions between levels and how interventions at multiple levels can better support HIV‐serodiscordant couples to achieve safe pregnancies. Strategies to achieve safer pregnancies should consider interrelated challenges at different levels of a social ecological framework. Interventions across multiple levels, implemented concurrently, have the potential to maximize impact and ensure the full SRHR of HIV‐serodiscordant couples., Introduction For HIV‐serodiscordant couples who desire a child, access to acceptable and appropriate healthcare services and programmes, including for the prevention of vertical and horizontal HIV transmission and assisted reproductive [...]

Achieving the 95-95-95 UNAIDS targets requires meeting the needs of adolescents, however we lack evidenced-based approaches to improving adolescent adherence to antiretroviral therapy (ART), increasing viral suppression, and supporting general wellbeing. We developed Family Connections as a group intervention for adolescents and their adult caregivers and conducted a randomized controlled trial in Ndola, Zambia to test feasibility and acceptability. Fifty pairs (n = 100) of adolescents (15–19 years and on ART ≥ 6 months) and their caregivers were randomly assigned either to the intervention consisting of 10 group sessions over 6 months, or to a comparison group, which received the usual care. Each pair completed baseline and endline surveys, with adolescents also undergoing viral load testing. Of the 24-intervention adolescent/caregiver pairs, 88% attended at least eight group sessions. Most adolescents (96%) and all caregivers would recommend Family Connections to peers. Adolescent viral failure decreased but did not significantly differ by study group. Adolescents in the intervention group showed a greater reduction in HIV-related feelings of worthlessness and shame than the comparison group. The feasibility, acceptability, and the positive trend toward significantly reducing internalized stigma, generated by this Family Connections pilot study, contributes valuable data to support adolescent/caregiver approaches that use peer groups. [ABSTRACT FROM AUTHOR]