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Background: New indicators of potential human immunodeficiency virus (HIV) transmission are being actively explored. We aim to categorical testing of the viral load (VL) of persons living with HIV (PLWH) in order to explore new indicators to measure the intensity of the epidemic and the effectiveness of the response in the community. Methods: A dynamic cohort study was conducted in Yining to monitor the VL of all persons living with HIV from 2017 to 2019. Different population VL (PVL) surrogate indicators were measured and the strength of the associations of different PVL surrogates with HIV incidence, antiretroviral therapy (ART) coverage, virus unsuppression, and viremia prevalence was assessed. PVL surrogate indicators were used to describe the current status of HIV transmission in different populations and communities. Results: All PVL indicators decreased from 2017 to 2019 (P < 0.05). Arithmetic mean community viral load (CVL) (r = 1.000, P = 0.006) and geometric mean CVL (r = 1.000, P = 0.001) were positively associated with HIV incidence, ART coverage and viral unsuppression (P < 0.05). CVL was higher in the male, ≤ 25 years of age, primary school or below, other household registration, other medical insurance types, other source of sample, nonmarital and noncommercial heterosexual contact, and nonmarital and commercial heterosexual contact subgroups. Community-based cross-sectional analyses showed that CVL in community 10 was positively correlated with viral unsuppression rate and viremia prevalence but negatively correlated with ART coverage rate, suggesting that the community was a hotspot for HIV epidemics. Conclusions: CVL can be used as an indicator for assessing HIV transmission and identifying high-risk populations and hotspot communities. [ABSTRACT FROM AUTHOR]

Background Pre-exposure prophylaxis (PrEP) is effective for human immunodeficiency virus (HIV) prevention in risk groups. We assessed PrEP uptake and 12-month retention among men who have sex with men (MSM) and transgender women (TGW) in Myanmar during the coronavirus disease 2019 pandemic and a political crisis. Methods Using prospectively collected data, we assessed the proportion of persons eligible, initiated and retained 12 months on PrEP. We calculated HIV and syphilis incidence among those initiated on PrEP. Predictors of compliance to scheduled visits were assessed with fractional logistic regression. Results Among 652 persons screened between July and December 2020, 85.3% were eligible and 38.8% initiated PrEP. The daily pill burden was the main reason (86.5%) for refusing PrEP. A history of HIV post-exposure prophylaxis (PEP) and having an HIV-positive partner not on anti-retroviral therapy (ART) was associated with PrEP uptake (p<0.05). The 12-month retention among those initiating PrEP was 43.0%. Age ≥25 y, a history of PEP and having an HIV-positive partner not on ART predicted better compliance with scheduled visits (p<0.05). HIV incidence among PrEP initiators was 3.1 per 100 person-years (95% confidence interval [CI] 1.3 to 7.4) and syphilis incidence was 17.6 per 100 person-years (95% CI 12.3 to 25.1). Conclusions A PrEP program for MSM and TGW in Myanmar was implemented successfully under difficult circumstances. Alternative strategies are needed addressing PrEP uptake and retention. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: The COVID-19 pandemic had great impact on HIV care and prevention worldwide, including in Brazil. We compared HIV testing, recent infection, and annualized incidence according to the COVID-19 pandemic period among cisgender men who have sex with men (MSM) and transgender women (TGW). Setting: HIV and sexually transmitted infection testing, prevention, and treatment referral service in Rio de Janeiro, Brazil. Methods: We used Maxim HIV-1 Limiting Antigen Avidity EIA as part of a recent infection testing algorithm to identify recent HIV infection cases and estimate annualized HIV incidences in the pre- (March 2018–February 2020) and post-COVID-19 pandemic onset period (March 2020–January 2022). Multivariable logistic regression model assessed factors associated with recent HIV infection. Results: Among 3814 MSM and 776 TGW, 593 (12.9%) tested positive for HIV and 119 (2.6%) were identified as having recent infection. Percentage of recent HIV infection did not differ between the COVID-19 periods. Overall annualized HIV incidence rates were 6.0% (95% confidence interval [CI]: 4.2 to 7.7) and 6.6% (95% CI: 4.3 to 9.0) in the pre- and post-COVID-19 periods, respectively. During the post-COVID-19 period, higher incidence rates were observed among TGW (8.4% [95% CI: 2.9 to 13.9]), those aged 18–24 years (7.8% [95% CI: 4.0 to 11.7]), of Black race (7.9% [95% CI: 3.8 to 12.0]), and those with <12 years of schooling (7.8% [95% CI: 4.8 to 10.8]). Compared to the pre-COVID-19 period, incidence rates were significantly higher in the post-COVID-19 period for those aged >30 years and TGW, while being lower for those with more years of schooling. Conclusion: HIV incidence estimates remain high among MSM and TGW in Brazil, especially among the most vulnerable. The consequences of the COVID-19 pandemic on the HIV epidemic will likely persist and contribute to worsening HIV outcomes. [ABSTRACT FROM AUTHOR]

HIV remains a critical global health issue, with an estimated 39.9 million people living with the virus worldwide by the end of 2023 (according to WHO). Although the epidemic’s impact varies significantly across regions, Africa remains the most affected. In the past decade, considerable efforts have focused on developing preventive measures, such as vaccines and pre-exposure prophylaxis, to combat sexually transmitted HIV. Recently, cytokine profiles have gained attention as potential predictors of HIV incidence due to their involvement in immune regulation and inflammation, presenting new opportunities to enhance preventative strategies. However, the high-dimensional, time-varying nature of cytokine data collected in clinical research, presents challenges for traditional statistical methods like the Cox proportional hazards (PH) model to effectively analyze survival data related to HIV. Machine learning (ML) survival models offer a robust alternative, especially for addressing the limitations of the PH model’s assumptions. In this study, we applied survival support vector machine (SSVM) and random survival forest (RSF) models using changes or means in cytokine levels as predictors to assess their association with HIV incidence, evaluate variable importance, measure predictive accuracy using the concordance index (C-index) and integrated Brier score (IBS) and interpret the model’s predictions using Shapley additive explanations (SHAP) values. Our results indicated that RSFs models outperformed SSVMs models, with the difference covariate model performing better than the mean covariate model. The highest C-index for SSVM was 0.7180 under the difference covariate model, while for RSF, it reached 0.8801 under the difference covariate model using the log-rank split rule. Key cytokines identified as positive predictors of HIV incidence included TNF-A, BASIC-FGF, IL-5, MCP-3, and EOTAXIN, while 29 cytokines were negative predictors. Baseline factors such as condom use frequency, treatment status, number of partners, and sexual activity also emerged as significant predictors. This study underscored the potential of cytokine profiles for predicting HIV incidence and highlighted the advantages of RSFs models in analyzing high-dimensional, time-varying data over SSVMs. It further through ablation studies emphasized the importance of selecting key features within mean and difference based covariate models to achieve an optimal balance between model complexity and predictive accuracy. [ABSTRACT FROM AUTHOR]

Estimating new HIV infections is significant yet challenging due to the difficulty in distinguishing between recent and long-term infections. We demonstrate that HIV recency status (recent versus long-term) could be determined from self-report testing history and biomarkers, which are increasingly available in bio-behavioral surveys. HIV recency status is partially observed, given the self-report testing history. For example, people who tested positive for HIV over 1 year ago should have a long-term infection. Based on the nationally representative samples collected by the Population-based HIV Impact Assessment (PHIA) Project, we propose a likelihood-based probabilistic model for HIV recency classification. The model incorporates individuals with known recency status based on testing histories and individuals whose recency status could not be determined and integrates the mechanism of how HIV recency status depends on biomarkers and the mechanism of how HIV recency status, together with the self-report time of the most recent HIV test, impacts the test results. We compare our method to logistic regression and the binary classification tree (current practice) on Malawi PHIA data, as well as on simulated data. Our model obtains more efficient and less biased parameter estimates and is relatively robust to potential reporting error and model misspecification. [ABSTRACT FROM AUTHOR]

The extent to which receptive anal intercourse (RAI) increases the HIV acquisition risk of women compared to receptive vaginal intercourse (RVI) is poorly understood. We evaluated RAI practice over time and its association with HIV incidence during three prospective HIV cohorts of women: RV217, MTN-003 (VOICE), and HVTN 907. At baseline, 16% (RV 217), 18% (VOICE) of women reported RAI in the past 3 months and 27% (HVTN 907) in the past 6 months, with RAI declining during follow-up by around 3-fold. HIV incidence in the three cohorts was positively associated with reporting RAI at baseline, albeit not always significantly. The adjusted hazard rate ratios for potential confounders (aHR) were 1.1 (95% Confidence interval: 0.8-1.5) for VOICE and 3.3 (1.6-6.8) for RV 217, whereas the ratio of cumulative HIV incidence by RAI practice was 1.9 (0.6-6.0) for HVTN 907. For VOICE, the estimated magnitude of association increased slightly when using a time-varying RAI exposure definition (aHR = 1.2; 0.9-1.6), and for women reporting RAI at every follow-up survey (aHR = 2.0 (1.3-3.1)), though not for women reporting higher RAI frequency (> 30% acts being RAI vs. no RAI in the past 3 months; aHR = 0.7 (0.4-1.1)). Findings indicated precise estimation of the RAI/HIV association, following multiple RVI/RAI exposures, is sensitive to RAI exposure definition, which remain imperfectly measured. Information on RAI practices, RAI/RVI frequency, and condom use should be more systematically and precisely recorded and reported in studies looking at sexual behaviors and HIV seroconversions; standardized measures would aid comparability across geographies and over time.

Background Methods Results Conclusions In the context of an outbreak of HIV among people who inject drugs in Glasgow, Scotland, identified in 2015, our objectives were to: (1) develop epidemiological methods to estimate HIV incidence using data linkage, and (2) examine temporal changes in HIV incidence to inform public health responses.This was a retrospective cohort study involving data linkage of laboratory HIV testing data to identify individuals with a history of drug use. Person‐years (PY) and Poisson regression were used to estimate incidence by time period (pre‐outbreak: 2000–2010 and 2011–2013; early outbreak: 2014–2016; ongoing outbreak: 2017–2019).Among 13 484 individuals tested for HIV, 144 incident HIV infections were observed from 2000 to 2019. Incidence rates increased from pre‐outbreak periods (1.00/1000 PY (95% confidence interval, CI: 0.60–1.65) in 2000–2010 and 1.70/1000 PY (95% CI: 1.14–2.54) in 2011–2013) to 3.02/1000 PY (95% CI: 2.36–3.86) early outbreak (2014–2016) and 2.35 (95% CI 1.74–3.18) during the ongoing outbreak period (2017–2019). Compared with the pre‐outbreak period (2000–2010), the incidence rates were significantly elevated during both the early outbreak (2014–16) (adjusted incidence rate ratio (aIRR) = 2.87, 95% CI: 1.62–5.09, p < 0.001) and the ongoing outbreak periods (2017–19) (aIRR = 2.12, 95% CI: 1.16–3.90, p = 0.015).Public health responses helped to curb the rising incidence of HIV infection among people with a history of drug use in Glasgow, but further efforts are needed to reduce it to levels observed prior to the outbreak. Data linkage of routine diagnostic test data to assess and monitor incidence of HIV infection provided enhanced surveillance, which is important to inform outbreak investigations and guide national strategies on elimination of HIV transmission. [ABSTRACT FROM AUTHOR]

BackgroundAccurate estimates of HIV incidence are necessary to monitor progress towards Ending the HIV Epidemic (EHE) initiative targets (90% decline by 2030). U.S. incidence estimates are derived from a CD4 depletion model (CD4 model). We performed simulation-based analyses to investigate the ability of this model to estimate HIV incidence when implementing EHE interventions that have the potential to shorten the duration between HIV infection and diagnosis (diagnosis delay).MethodsOur simulation study evaluates the impact of three parameters on the accuracy of incidence estimates derived from the CD4 model: rate of HIV incidence decline, length of diagnosis delay, and sensitivity of using CD4 + cell counts to identify new infections (recency error). We model HIV incidence and diagnoses after the implementation of a theoretical prevention intervention and compare HIV incidence estimates derived from the CD4 model to simulated incidence.ResultsTheoretical interventions that shortened the diagnosis delay (10-50%) result in overestimation of HIV incidence by the CD4 model (10-92%) in the first year and by more than 10% for the first 6 years after implementation of the intervention. Changes in the rate of HIV incidence decline and the presence of recency error had minimal impact on the accuracy of incidence estimates derived from the CD4 model.ConclusionIn the setting of EHE interventions to identify persons with HIV earlier during infection, the CD4 model overestimates HIV incidence. Alternative methods to estimate incidence based on objective measures of incidence are needed to assess and monitor EHE interventions.

Abstract Background Since June 2017, oral pre-exposure prophylaxis (PrEP) has been reimbursed in Belgium for people at substantial risk of HIV. To inform the national PrEP programme, we described sociodemographic characteristics of PrEP users, PrEP dispensing practices, testing for HIV and sexually transmitted infections (STIs; gonorrhoea, chlamydia and syphilis), and incidence of HIV and STIs. Methods Analysis of routinely collected social health insurance claims data from all individuals who were dispensed at least one PrEP prescription between June 2017 and December 2019. Using logistic regression adjusted for age, we examined associations between sociodemographic characteristics and having been dispensed PrEP only once in the first six months of PrEP use. Results Overall, 4559 individuals were dispensed PrEP. Almost all PrEP users were male (99.2%, 4522/4559), with a median age of 37 years (IQR 30–45). A minority were entitled to an increased healthcare allowance (11.4%, 514/4559). 18% (657/3636) were dispensed PrEP only once in the first six months of PrEP use. PrEP users younger than 25 years, unemployed, entitled to an increased healthcare allowance, and who initiated PrEP between January 2019 and June 2019 were more likely to have had no PrEP dispensing after initiation compared to their counterparts. The testing rates for bacterial STIs and HIV were 4.2 tests per person-year (95% CI 4.1–4.2) and 3.6 tests per person-year (95% CI 3.5–3.6), respectively. Twelve individuals were identified to have seroconverted during the study period, resulting in an HIV incidence rate of 0.21/100 person-years (95% CI 0.12–0.36). The incidence of bacterial STIs was 81.2/100 person-years (95% CI 78.7–83.8). Conclusions The study highlights challenges in PrEP persistence and a high incidence of bacterial STIs among individuals receiving PrEP. Tailored prevention support is crucial for individuals with ongoing HIV risk to optimise PrEP effectiveness. Integrated STI testing and prevention interventions within PrEP care are necessary to mitigate STI acquisition and transmission among PrEP users.

Background: Since June 2017, oral pre-exposure prophylaxis (PrEP) has been reimbursed in Belgium for people at substantial risk of HIV. To inform the national PrEP programme, we described sociodemographic characteristics of PrEP users, PrEP dispensing practices, testing for HIV and sexually transmitted infections (STIs; gonorrhoea, chlamydia and syphilis), and incidence of HIV and STIs. Methods: Analysis of routinely collected social health insurance claims data from all individuals who were dispensed at least one PrEP prescription between June 2017 and December 2019. Using logistic regression adjusted for age, we examined associations between sociodemographic characteristics and having been dispensed PrEP only once in the first six months of PrEP use. Results: Overall, 4559 individuals were dispensed PrEP. Almost all PrEP users were male (99.2%, 4522/4559), with a median age of 37 years (IQR 30–45). A minority were entitled to an increased healthcare allowance (11.4%, 514/4559). 18% (657/3636) were dispensed PrEP only once in the first six months of PrEP use. PrEP users younger than 25 years, unemployed, entitled to an increased healthcare allowance, and who initiated PrEP between January 2019 and June 2019 were more likely to have had no PrEP dispensing after initiation compared to their counterparts. The testing rates for bacterial STIs and HIV were 4.2 tests per person-year (95% CI 4.1–4.2) and 3.6 tests per person-year (95% CI 3.5–3.6), respectively. Twelve individuals were identified to have seroconverted during the study period, resulting in an HIV incidence rate of 0.21/100 person-years (95% CI 0.12–0.36). The incidence of bacterial STIs was 81.2/100 person-years (95% CI 78.7–83.8). Conclusions: The study highlights challenges in PrEP persistence and a high incidence of bacterial STIs among individuals receiving PrEP. Tailored prevention support is crucial for individuals with ongoing HIV risk to optimise PrEP effectiveness. Integrated STI testing and prevention interventions within PrEP care are necessary to mitigate STI acquisition and transmission among PrEP users. [ABSTRACT FROM AUTHOR]

Background We estimated the predictive value of rectal (bacterial sexually transmitted infection [bSTI]) pathogen detection for future HIV seroconversion among young adult sexual and gender minorities (YSGMs) assigned male at birth (AMAB). Methods Data were collected between March 2018 and August 2022 from RADAR, a longitudinal cohort study of YSGMs AMAB living in the Chicago metropolitan area (n = 1022). Rates of rectal bSTIs and the proportion of self-reported rectal bSTI symptoms are reported. We examined whether the presence of rectal bSTIs predicted HIV seroconversion using generalized estimating equations (GEEs). Results Participants tested reactive for rectal Mycoplasma genitalium (MGen), Neisseria gonorrhoeae (NG), and Chlamydia trachomatis (CT) at a rate of 20.8 (95% CI, 18.4–23.5), 6.5 (95% CI, 5.0–8.2), and 8.4 (95% CI, 6.8–10.3) cases per 100 persons, respectively. There were no statistically significant pairwise differences in self-reported rectal bSTI symptoms between participants with self-collected swabs testing nonreactive vs reactive for rectal MGen (χ2 = 0.04; P =.84), NG (χ2 = 0.45; P =.37), or CT (χ2 = 0.39; P =.46). In multivariate GEE analysis, rectal NG (adjusted odds ratio, 5.11; 95% CI, 1.20–21.77) was a statistically significant predictor of HIV seroconversion after controlling for other bSTIs, demographics, and sexual risk behavior. Conclusions Our findings provide a robust longitudinal estimation of the relationship between primarily asymptomatic rectal NG nucleic acid detection and HIV infection. These findings highlight the importance of asymptomatic screening for bSTIs and targeting biobehavioral intervention to prevent HIV infection among YSGMs with rectal bSTI agents detected. [ABSTRACT FROM AUTHOR]

Incidence estimation of HIV infection can be performed using recent infection testing algorithm (RITA) results from a cross‐sectional sample. This allows practitioners to understand population trends in the HIV epidemic without having to perform longitudinal follow‐up on a cohort of individuals. The utility of the approach is limited by its precision, driven by the (low) sensitivity of the RITA at identifying recent infection. By utilizing results of previous HIV tests that individuals may have taken, we consider an enhanced RITA with increased sensitivity (and specificity). We use it to propose an enhanced estimator for incidence estimation. We prove the theoretical properties of the enhanced estimator and illustrate its numerical performance in simulation studies. We apply the estimator to data from a cluster‐randomized trial to study the effect of community‐level HIV interventions on HIV incidence. We demonstrate that the enhanced estimator provides a more precise estimate of HIV incidence compared to the standard estimator. [ABSTRACT FROM AUTHOR]

This paper highlights the pressing need to address the HIV epidemic among adolescent boys and young men (ABYM) in sub-Saharan Africa. Despite progress in HIV prevention, ABYM still experience low diagnosis rates, treatment adherence, and linkage to care. The paper emphasizes ABYM's vulnerability due to societal norms, limited healthcare access, and economic pressures. It calls for gender-responsive interventions, including comprehensive sexual education, youth-friendly health services, community engagement, and targeted outreach. Comprehensive sexual education is pivotal in HIV prevention for ABYM, providing them with age-appropriate sexual health knowledge and safer sexual practices to reduce HIV incidence. Harmful masculine norms must be countered to promote respectful relationships, benefiting boys, men, and their partners. Inadequate access to youth-friendly health services hampers HIV prevention. Establishing spaces with confidential, non-judgmental care offering testing, counselling, circumcision, and provision of pre-exposure prophylaxis (PrEP) is essential, especially considering ABYM's unique clinic experiences. Engaging communities, leaders, educators, and peers combats stigma and discrimination. ABYM's input in intervention design, targeted outreach, and innovative technology enhances effectiveness of HIV prevention programmes. Economic factors should also be addressed. Comprehensive multi-sectoral interventions, including conditional cash transfers, effective for AGYW, could benefit ABYM. Addressing structural factors alongside behaviour change and social support is key. [ABSTRACT FROM AUTHOR]

BackgroundHighly efficacious oral pre-exposure prophylaxis (PrEP) is the global standard for human immunodeficiency virus (HIV)-1 prevention, including in clinical trials of novel PrEP agents using active-comparator designs. The analysis assessed whether incident sexually transmitted infections (STIs) can serve as a surrogate indicator of HIV-1 incidence that might occur in the absence of PrEP.MethodsWe analyzed data from 3256 women randomized to placebo groups of oral and vaginal PrEP trials (MTN-003/VOICE and MTN-020/ASPIRE). Regression modeling assessed the correlation between incident individual STIs (Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis, each considered separately) and incident HIV-1.ResultsAcross 18 sites in 4 countries (Malawi, South Africa, Uganda, Zimbabwe), STI and HIV-1 incidences were high: HIV-1 4.9, N gonorrhoeae 5.3, C trachomatis 14.5, and T vaginalis 7.1 per 100 person-years. There was limited correlation between HIV-1 incidence and incidence of individual STIs: N gonorrhoeae (r = 0.02, P = .871), C trachomatis (r = 0.49, P =

Human immunodeficiency virus infection/acquired immune deficiency syndrome (HIV/AIDS) is a global pandemic that has claimed more than 40 million lives since it was discovered in the late 1970s. In sub-Saharan Africa, including Tanzania. Different measures to combat the diseases have failed to be attained, like the UNAIDS 90-90-90 target, which aimed to reduce HIV by 2020, and it was moved to 2030. The availability of proper tools to control and monitor diseases and ensure proper early intervention is very important. Prediction of disease trends using Machine Learning (ML) models can improve speed towards attaining the UNAIDS targets by providing accurate insights into the disease trends. The performance of ML models depends on many factors, including datasets that influence the generalization of models. This study aims to suggest the best deep-learning model to predict HIV incidences in Tanzania. Four deep learning models, recurrent neural network (RNN), Gated Recurrent unit (GRU), Long Short-Term Memory (LSTM), and 2D convolution layer (CONV2D), have been studied. HIV data is collected from District Health Information System 2 (DHIS2), the national Health Management Information System (HMIS). The HIV data collected is for 26 regions in Mainland Tanzania, recorded from January 2015 to October 2022. The accuracy of the models was evaluated using three metrics: Mean absolute error (MAE), Mean absolute Percentage Error (MAPE), and mean square error (MSE). The results show that Conv2D achieved the lowest average training time for short-term predictions, while RNN records the highest accuracy with the lowest MAE for all considered cases. The GRU was the fastest for the long-term predictions, and the LSTM reported the best accuracy. [ABSTRACT FROM AUTHOR]

Background: The Amazonas state/AM and Manaus rank among the highest AIDS detection rates in Brazil. High proportion of HIV infected blood donors and transmission clusters of multidrug antiretroviral/ARV resistant viruses were described in HEMOAM blood donors, a main Amazonas public blood bank. Recent and long-term infections among previously genotyped donors are reported. Methods/materials: The recency immunoassay Lag Avidity EIA (Maxim, USA) was employed. Clinical/CD4/viral load medical file data of the main local HIV management center (FMT-HVD) and ARV treatment/ART data were reviewed. Results: Among 142 HIV-blood donors, chronic infection predominated (n = 87; 61.3 %), 79 based on LAg EIA and 8 undisclosed HIV identified in FMT-HVD records, mostly young adult, single males, 4 repeat donors, all ART-naive. Recent infections represented 30.3 % (n = 43), 39 identified by LAg EIA and 4 immunologic windows (antibody negative/NAT/RNA positive). The overall profile of recent and long-term infections was similar, including moderate rate of transmitted drug resistance/TDR, however with multiple resistance mutations to more than one ARV-class, suggesting ART/failure. Discussion: Recent/acute and undisclosed/long-term HIV infections represent blood safety alerts suggesting test-seeking behavior of at-risk populations. Early ART use in Brazil, can turn HIV diagnosis more challenging representing a blood transfusion risk in the highly endemic Brazilian Amazon.

IntroductionUnderstanding and identifying the immunological markers and clinical information linked with HIV acquisition is crucial for effectively implementing Pre-Exposure Prophylaxis (PrEP) to prevent HIV acquisition. Prior analysis on HIV incidence outcomes have predominantly employed proportional hazards (PH) models, adjusting solely for baseline covariates. Therefore, models that integrate cytokine biomarkers, particularly as time-varying covariates, are sorely needed.MethodsWe built a simple model using the Cox PH to investigate the impact of specific cytokine profiles in predicting the overall HIV incidence. Further, Kaplan-Meier curves were used to compare HIV incidence rates between the treatment and placebo groups while assessing the overall treatment effectiveness. Utilizing stepwise regression, we developed a series of Cox PH models to analyze 48 longitudinally measured cytokine profiles. We considered three kinds of effects in the cytokine profile measurements: average, difference, and time-dependent covariate. These effects were combined with baseline covariates to explore their influence on predictors of HIV incidence.ResultsComparing the predictive performance of the Cox PH models developed using the AIC metric, model 4 (Cox PH model with time-dependent cytokine) outperformed the others. The results indicated that the cytokines, interleukin (IL-2, IL-3, IL-5, IL-10, IL-16, IL-12P70, and IL-17 alpha), stem cell factor (SCF), beta nerve growth factor (B-NGF), tumor necrosis factor alpha (TNF-A), interferon (IFN) alpha-2, serum stem cell growth factor (SCG)-beta, platelet-derived growth factor (PDGF)-BB, granulocyte macrophage colony-stimulating factor (GM-CSF), tumor necrosis factor-related apoptosis-inducing ligand (TRAIL), and cutaneous T-cell-attracting chemokine (CTACK) were significantly associated with HIV incidence. Baseline predictors significantly associated with HIV incidence when considering cytokine effects included: age of oldest sex partner, age at enrollment, salary, years with a stable partner, sex partner having any other sex partner, husband's income, other income source, age at debut, years lived in Durban, and sex in the last 30 days.DiscussionOverall, the inclusion of cytokine effects enhanced the predictive performance of the models, and the PrEP group exhibited reduced HIV incidences compared to the placebo group.

Due to hotspots as development schemes that attract mobile groups, HIV/AIDS infections are the biggest health issue in communities with low awareness and safe practice, especially in smaller towns. This study examined HIV/AIDS and Antiretroviral Therapy (ART) use-related knowledge, attitude, and practice in AIDS patients. Debre Elias Health Center conducted a cross-sectional study (N=384) from June 10 to January 20, 2021. Participants were selected using systematic random sampling and interviewed using a structured questionnaire. Logistic regression calculated significance and association between dependent and independent variables. 236 (384) or 61.4% of 384 HIV patients on antiretroviral therapy were female. HIV rates increased from 2014 to 2019. Age difference was associated with patient knowledge of ART use (P=0.005). Patients’ attitudes towards HIV/AIDS and ART use were significantly correlated with age, residence, marital status, and education (P

Florida is one of the HIV epicenters with high incidence and marked sociodemographic disparities. We analyzed a decade of statewide electronic health record/claims data—OneFlorida+—to identify and characterize pre-exposure prophylaxis (PrEP) recipients and newly diagnosed HIV cases in Florida. Refined computable phenotype algorithms were applied and a total of 2186 PrEP recipients and 7305 new HIV diagnoses were identified between January 2013 and April 2021. We examined patients' sociodemographic characteristics, stratified by self-reported sex, along with both frequency-driven and expert-selected descriptions of clinical conditions documented within 12 months before the first PrEP use or HIV diagnosis. PrEP utilization rate increased in both sexes; higher rates were observed among males with sex differences widening in recent years. HIV incidence peaked in 2016 and then decreased with minimal sex differences observed. Clinical characteristics were similar between the PrEP and new HIV diagnosis cohorts, characterized by a low prevalence of sexually transmitted infections (STIs) and a high prevalence of mental health and substance use conditions. Study limitations include the overrepresentation of Medicaid recipients, with over 96% of female PrEP users on Medicaid, and the inclusion of those engaged in regular health care. Although PrEP uptake increased in Florida, and HIV incidence decreased, sex disparity among PrEP recipients remained. Screening efforts beyond individuals with documented prior STI and high-risk behavior, especially for females, including integration of mental health care with HIV counseling and testing, are crucial to further equalize PrEP access and improve HIV prevention programs. [ABSTRACT FROM AUTHOR]

BackgroundAs adolescent girls and young women (AGYW) transition to adulthood, their interaction with their social context becomes a critical consideration for HIV prevention interventions. Few studies have examined what types of community groups and community spaces might be protective for AGYW HIV acquisition and related sexual behaviors.MethodsData were obtained from HIV Prevention Trials Network 068, a longitudinal study of AGYW (age 13-20 years) in rural South Africa. Survival analyses and generalized estimating equations were used to assess whether community group membership and time spent in community spaces were associated with HIV incidence and sexual behaviors (unprotected sex, transactional sex, and having an older partner).ResultsA total of 2245 AGYW were followed up for up to 4 years. Membership in church groups [adjusted hazard ratio (aHR): 0.75, 95% confidence interval (CI): 0.53 to 0.91] and dance groups (aHR: 0.89, 95% CI: 0.80 to 0.98) and spending time at church (aHR: 0.88, 95% CI: 0.79 to 0.98) were protective for HIV infection. Conversely, spending time at taverns was associated with higher HIV incidence (aHR: 1.27, 95% CI: 1.15 to 1.41). Membership in church groups and spending time at a family member's home and at church were protective for all 3 sexual behaviors. Spending time at a boyfriend's home and taverns was risky for all 3 sexual behaviors.ConclusionsThe results suggest that community spaces and community groups that include an element of adult supervision are potentially protective, whereas spaces and groups that provide an opportunity for AGYW to interact unsupervised with boyfriends or meet new partners are potentially risky.

Monitoring key populations' progress towards UNAIDS 90-90-90 targets is essential to achieving HIV/AIDS epidemic control. Using serial cross-sectional data, we evaluated changes in HIV care continuum among people who inject drugs(PWID) and men who have sex with men(MSM) in India. Cross-sectional baseline (2012/2013) and follow-up (2016/2017) samples were recruited using respondent-driven sampling across 21 cities. All participants were tested for HIV and RNA measured in HIV-positive participants. Linear regression was used to model temporal site-level changes in continuum indicators in MSM versus PWID. At baseline, we recruited 2,544 HIV-infected PWID and 1,086 HIV-infected MSM. At follow-up, we recruited 2,517 HIV-infected PWID and 1,763 HIV-infected MSM. At baseline, there were no significant differences in continuum indicators between MSM and PWID. At follow-up, compared to PWID, the proportion of MSM reaching each care continuum indicator—awareness of status, receipt of care, ART use, viral suppression—increased by 15-33 percentage points: 78% of MSM versus 49% of PWID were aware of their status (p < 0.01); 56% of MSM versus 32% of PWID were virologically suppressed (p = 0.05). MSM showed marked improvements across the care continuum, whereas PWID lagged and may require additional intervention. Differential improvement in HIV engagement may necessitate population-specific interventions and routine surveillance to facilitate HIV elimination. [ABSTRACT FROM AUTHOR]

Objective: HIV risk prediction tools are a critical component of efforts to end the HIV pandemic. We aimed to create and validate tools for identifying individuals at highest risk of prevalent and incident HIV in an African setting. Methods: We used Logistic regression and Poisson regression to determine risk factors for HIV prevalence and incidence in a multi‐country HIV vaccine trial preparedness cohort study among individuals at high risk of HIV, and used the identified factors to create and validate tools that predict HIV risk. We also assessed the performance of the VOICE risk score in predicting HIV incidence among women in the cohort. Results: The prevalent HIV prediction tool created had good predictive ability [area under the curve (AUC) = 0.70, 95% CI 0.66–0.74]. It included the following participant variables: age, sex, recreational drug use, unprotected male‐to‐male anal sex, a sexual partner who had other partners, transactional sex and having a partner who was a long‐distance truck driver/miner. It was not possible to create a valid HIV incidence prediction tool. Participants with high VOICE risk scores (≥7) had slightly higher HIV incidence but this tool performed poorly within our study (AUC = 0.58, 95% CI 0.51–0.64: Harrell's concordance index = 0.59). Conclusion: We created a prevalent HIV prediction tool that could be used to increase efficiency in diagnosis of HIV and linkage to care in sub‐Saharan Africa. Existing incident HIV prediction tools may need modification to include context‐specific predictors such as calendar period, participant occupation, study site, before adoption in settings different from those in which they were developed. [ABSTRACT FROM AUTHOR]

In South Africa, HIV acquisition risk has been studied less in people assigned male at birth. We studied the associations between risk behaviors, clinical features and HIV incidence amongst males in two South African HIV preventive vaccine efficacy trials. We used Cox proportional hazards models to test for associations between demographics, sexual behaviors, clinical variables and HIV acquisition among males followed in the HVTN 503 (n = 219) and HVTN 702 (n = 1611) trials. Most males reported no male sexual partners (99.09% in HVTN 503) or identified as heterosexual (88.08% in HVTN 702). Annual HIV incidence was 1.39% in HVTN 503 (95% CI 0.76–2.32%) and 1.33% in HVTN 702 (95% CI 0.80–2.07%). Increased HIV acquisition was significantly associated with anal sex (HR 6.32, 95% CI 3.44–11.62), transactional sex (HR 3.42, 95% CI 1.80–6.50), and non-heterosexual identity (HR 16.23, 95%CI 8.13–32.41) in univariate analyses and non-heterosexual identity (HR 14.99, 95% CI 4.99–45.04; p < 0.01) in multivariate analysis. It is appropriate that prevention efforts in South Africa, although focused on the severe epidemic in young women, also encompass key male populations, including men who have sex with men, but also men who engage in anal or transactional sex. [ABSTRACT FROM AUTHOR]

We studied mechanisms driving gender differences in HIV incidence among 651 women and men who inject drugs (PWID) in Tijuana, Mexico, hypothesizing that sex work will mediate the association between female gender and HIV incidence. Of 43 HIV seroconversions occurring between 2011 and 2018, 8.8% were among females and 5.2% among males. HIV incidence density was significantly higher among females versus males (1.75 per 100 person years [PY], 95% CI 1.16-2.66, vs. 0.95 per 100 PY, 95% CI 0.62-1.47). Factors significantly associated with HIV seroconversion were: sex work (adjusted hazard ratio [aHR] = 2.25, 95% CI 1.05-4.80); methamphetamine injection (aHR = 2.30, 95% CI 1.12-4.73); and methamphetamine and heroin co-injection in the past six months (aHR = 2.26, 95% CI 1.23-4.15). In mediation analyses, sex work mediated a substantial proportion (84.3%) of the association between female gender and HIV incidence. Interventions should target female PWID who engage in sex work to reduce gender-related disparities in HIV incidence.

A study was conducted to investigate the district-level patterns of incidence of the human immunodeficiency virus (HIV) in Zimbabwe in the period 2005-2015 and explore variations in the relationship between covariates and HIV incidence across different districts. Demographic health survey data were analysed using hotspot analysis, spatial autocorrelation, and multi-scale geographically weighted regression (MGWR) techniques. The analysis revealed hotspots of the HIV epidemic in the southern and western regions of Zimbabwe in contrast to the eastern and northern regions. Specific districts in Matabeleland South and Matabeleland North provinces showed clusters of HIV incidence in 2005-2006, 2010-2011 and 2015. Variables studied were multiple sex partners and sexually transmitted infections (STI) condom use and being married. Recommendations include implementing targeted HIV prevention programmes in identified hotspots, prioritising interventions addressing the factors mentioned above as well as enhancing access to HIV testing and treatment services in high-risk areas, strengthening surveillance systems, and conducting further research to tailor interventions based on contextual factors. The study also emphasizes the need for regular monitoring and evaluation at the district level to inform effective responses to the HIV epidemic over time. By addressing the unique challenges and risk factors in different districts, significant progress can be made in reducing HIV transmission and improving health outcomes in Zimbabwe. These findings should be valuable for policymakers in resource allocation and designing evidence-based interventions.

ABSTRACT HIV incidence is a key measure for tracking disease spread and identifying populations and geographic regions where new infections are most concentrated. The HIV sequence population provides a robust signal for the stage of infection. Large-scale and high-precision HIV sequencing is crucial for effective genomic incidence surveillance. We produced 1,034 full-length envelope gene sequences from a seroconversion cohort by conducting HIV microdrop sequencing and measuring the genomic incidence assay’s genome similarity index (GSI) dynamics. The measured dynamics of 9 of 12 individuals aligned with the GSI distribution estimated independently using 417 publicly available incident samples. We enhanced the capacity to identify individuals with recent infections, achieving predicted detection accuracies of 92% (89%–94%) for cases within 6 months and 81% (74%–87%) for cases within 9 months. These accuracy levels agreed with the observed detection accuracy intervals of an independent validation data set. Additionally, we produced 131 full-length envelope gene sequences from eight individuals with chronic HIV infection. This analysis confirmed a false recency rate (FRR) of 0%, which was consistent with 162 publicly available chronic samples. The mean duration of recent infection (MDRI) was 238 (209–267) days, indicating an 83% improvement in performance compared to current recent infection testing algorithms. The shifted Poisson mixture model was then used to estimate the time since infection, and the model estimates showed an 88% consistency with the days post infection derived from HIV RNA test dates and/or seroconversion dates. HIV microdrop sequencing provides unique prospects for large-scale incidence surveillance using high-throughput sequencing. Importance Accurate identification of recently infected individuals is vital for prioritizing specific populations for interventions, reducing onward transmission risks, and optimizing public health services. However, current HIV-specific antibody-based methods have not been satisfactory in accurately identifying incident cases, hindering the use of HIV recency testing for prevention efforts and partner protection. Genomic incidence assays offer a promising alternative for identifying recent infections. In our study, we used microdroplet technologies to produce a large number of complete HIV envelope gene sequences, enabling the accurate detection of early infection signs. We assessed the dynamics of the incidence assay’s metrics and compared them with statistical models. Our approach demonstrated high accuracy in identifying individuals with recent infections, achieving predicted detection rates exceeding 90% within 6 months and over 80% within 9 months of infection. This high-resolution method holds significant potential for enhancing the effectiveness of HIV incidence screening for case-based surveillance in public health initiatives.

Background and Aims: People who inject drugs (PWID) have a substantial risk of acquiring human immunodeficiency virus (HIV) infection. From 1999 to 2000 in Ireland, there were 115 new HIV cases among PWID, 40% in individuals aged under 22 years. However, over the past two decades, HIV incidence has declined among PWID in western Europe, including Ireland. We investigated secular changes in HIV incidence among PWID in Ireland. Also, new HIV cases in two time‐periods 2000–09 and 2010–18 were compared by sex, age group, area of residence and country of birth. Design and Setting: Longitudinal observational study in the Republic of Ireland, 2000–18. Cases and Measurements: A total of 753 new cases of HIV in PWID were diagnosed. Diagnosis rates of HIV in PWID were calculated and changes in rates over the period were modelled. Findings: During the period 2000–18, HIV incidence among 15–29‐year‐old PWID in Ireland declined from 5.69 to 0.11 cases per 100 000, equivalent to a yearly decline of 0.22 [95% confidence interval (CI) = 0.14–0.31, P < 0.001] cases per 100 000. Among PWID aged 30–64 years, HIV incidence declined annually by 0.06 (95% CI = 0.02–0.10, P = 0.007) cases per 100 000 from 1.80 to 0.57 cases per 100 000. Comparing 2000–09 to 2010–18, there was a relative increase in HIV cases among older adults (P < 0.001), and those born outside Ireland accounted for a growing minority of cases (from 14.7 to 28.0%, P < 0.001). Changes by sex (P = 0.10) and area residence (P = 0.39) were not statistically significant. Conclusion: Since 2000, Ireland has achieved an ongoing reduction in the incidence of human immunodeficiency virus among PWID, and this is most evident among young adults. The reduction has occurred in the context of a reasonably comprehensive, health‐led and harm reduction‐orientated national drugs strategy. [ABSTRACT FROM AUTHOR]

We conducted a records-based cohort study of patients who initiated pre-exposure prophylaxis (PrEP) at a large federally qualified health center in Los Angeles, CA to characterize patterns of PrEP use, identify correlates of PrEP discontinuation, and calculate HIV incidence. Of 3121 individuals initiating PrEP between 2014 and 2017, 42% (n = 1314) were active (i.e., had a current PrEP prescription) in April 2018. HIV incidence was 0.1/100 person-years among active PrEP patients, compared to 2.1/100 person-years among patients who discontinued. Compared to patients accessing PrEP through government programs with no prescription copay, risk of discontinuation was higher among those with private insurance (ARR = 1.4, 95% CI 1.2, 1.7), or no insurance (ARR = 4.5, 95% CI 3.2, 6.4). Sixty-three percent of active PrEP patients had gaps between PrEP prescriptions, averaging one gap per year (median length = 65 days). Increasing access to free or low-cost PrEP can improve PrEP continuity.

From May 2015 to June 2018, we conducted a PrEP demonstration project at two hospitals and four community-led clinics in Bangkok and Pattaya. HIV-negative, MSM and TGW aged ≥18 years old, reporting sex without a condom, were offered daily PrEP. Participants received HIV testing and completed a computer-based questionnaire at enrollment, 6 and 12 months. We collected self-reported PrEP adherence at months 1, 3, 6, 9, and 12. We used logistic regression to determine factors associated with the decision to take PrEP and calculated HIV incidence among baseline HIV-negative participants. Of 803 participants enrolled, 349 (43.5%) started PrEP. Participants were more likely to start PrEP if they were sex workers, had moderate or high self-perceived risk of HIV, or a high PrEP-knowledge score. Participants used PrEP for a median of 6.1 months. Reported condom use increased and the number of sex partners decreased during follow-up regardless of PrEP use. Six participants not-taking PrEP acquired HIV (HIV incidence 2.2 per 100 person-years), and five taking PrEP acquired HIV (HIV incidence 2.1 per 100 person-years). All five reported taking <4 pills the weeks before study visits. [ABSTRACT FROM AUTHOR]

Background: New challenges for diagnosis of HIV infection abound, including the impact on key viral and immunological markers of HIV vaccine studies, pre-exposure prophylaxis usage and breakthrough infections, and very early initiation of anti-retroviral treatment. These challenges impact the performance of current diagnostic assays, and require suitable specimens for development and evaluation. In this article we review and describe an archive developed by the Consortium for the Evaluation and Performance of HIV Incidence Assays (CEPHIA), in order to identify the critical features required to create a centralized specimen archive to support these current and future developments. Review and Findings: We review and describe the CEPHIA repository, a large, consolidated repository comprised of over 31,000 highly-selected plasma samples and other body fluid specimen types, with over 50 purposely designed specimen panels distributed to 19 groups since 2012. The CEPHIA repository provided financial return on investment, supported the standardization of HIV incidence assays, and informed guidance and standards set by the World Health Organization and UNAIDS. Unified data from extensively characterized specimens has allowed this resource to support biomarker discovery, assay optimization, and development of new strategies for estimating duration of HIV infection. Critical features of a high-value repository include 1) extensively-characterized samples, 2) high-quality clinical background data, 3) multiple collaborations facilitating ongoing sample replenishment, and 4) sustained history of high-level specimen utilization. Conclusion: With strong governance and leadership, a large consolidated archive of samples from multiple studies provides investigators and assay developers with easy access to diverse samples designed to address challenges associated with HIV diagnosis, helping to enable improvements to HIV diagnostic assays and ultimately elimination of HIV. Its creation and ongoing utilization should compel funders, institutions and researchers to address and improve upon current approaches to sharing specimens.

IntroductionAdolescent girls and young women (AGYW) in South Africa bear a disproportionate burden of HIV. Community mobilization (CM), defined as community members taking collective action to achieve a common goal related to health, equity and rights, has been associated with increased HIV testing and condom use and has been called a 'critical enabler' for addressing the HIV epidemic. However, limited research has examined whether CM is associated with HIV incidence among AGYW.MethodsWe examine the association of CM with incident HIV among AGYW (ages 13 to 21) enrolled in the HPTN 068 cohort in the Agincourt Health and socio-Demographic Surveillance System, South Africa. This analysis includes 2292 participants residing in 26 villages where cross-sectional, population-based surveys were conducted to measure CM among 18- to 35-year-old residents in 2012 and 2014. HPTN 068 participants completed up to five annual visits that included an HIV test (2011 to 2016). Household-level data were collected from AGYW parents/guardians and census data is updated annually. Mean village-level CM scores were created using a validated community mobilization measure with seven components (social cohesion, social control, critical consciousness, shared concerns, organizations and networks, leadership and collective action). We used pooled generalized estimating equation regression with a Poisson distribution to estimate risk ratios (RR) for the association of village-level CM score and CM components with incident HIV infection, accounting for village-level clustering and adjusting for key covariates.ResultsThere were 194 incident infections over the follow-up period. For every additional standard deviation of village-level CM there was 12% lower HIV incidence (RR: 0.88, 95% CI: 0.79, 0.98) after adjusting for individual, household and community characteristics. CM components associated with lower HIV incidence included critical consciousness (RR: 0.88; CI: 0.79, 0.97) and leadership (RR: 0.87; CI: 0.79, 0.95); while not statistically significant, social cohesion (RR: 0.91; CI: 0.81, 1.01), shared concerns (RR: 0.90; CI: 0.81, 1.00), and organizations and networks (RR: 0.91; CI: 0.79, 1.03) may also play a protective role.ConclusionsThese results suggest that having strong community social resources will reduce AGYW's risk of HIV acquisition. Work to mobilize communities, focusing on building social cohesion, shared concerns, critical consciousness, and effective and accountable leadership, can fortify prevention programming for AGYW.

Supplemental Digital Content is Available in the Text. Background: A cohort of female sex workers (FSWs) was established to determine HIV prevalence and incidence, and associated factors in preparation for a phase IIb HIV vaccine and pre-exposure prophylaxis trial (PrEPVacc). Setting: A cohort of FSWs in Dar es Salaam, Tanzania. Methods: FSWs aged 18–45 years were recruited using a respondent-driven sampling method. Social demographic data, HIV risk behavioral assessments, and blood samples for testing of HIV, syphilis, hepatitis B (HBV), and hepatitis C (HCV) infections were collected at baseline and then at 3, 6, 9, and 12 months. Poisson regressions were used to estimate the prevalence ratios for factors associated with HIV prevalence and to estimate the 12-month HIV incidence rate. Results: Between October and December 2018, a total of 773 FSWs were screened for eligibility and 700 were enrolled. The baseline prevalence of HIV, syphilis, HBV, and HCV was 7.6%, 1.2%, 1.7%, and 1.0%, respectively. HIV prevalence was associated with older age, using illicit drugs, and being infected with syphilis, HBV, or HCV. Attendance at 12 months was 80% (562/700). Twenty-one FSWs seroconverted during follow-up, giving a 12-month HIV incidence rate of 3.45 per 100 person-years at risk (95% CI; 2.25–5.28/100 person-years at risk). The HIV incidence rate was higher among FSWs aged 18–24 years, FSWs who used drugs, and those diagnosed with syphilis, HBV, or HCV. Conclusion: The high HIV incidence rate and retention rate among FSWs enrolled into the cohort demonstrate that this population is suitable for participation in HIV prevention trials. [ABSTRACT FROM AUTHOR]

Introduction: Young women who sell sex (YWSS) are at heightened risk of HIV acquisition and transmission and are among the least engaged in HIV services. There is insufficient epidemiologic evidence characterizing the burden of HIV among YWSS, particularly as compared to older WSS. These data are needed to design and tailor effective HIV prevention and treatment programmes for this population. Methods: We conducted two parallel systematic reviews and meta‐analyses to define both the immediate and long‐term HIV risks for YWSS, including among women engaged in sex work, survival sex and transactional sex. In the first review, we identified and synthesized published studies of HIV incidence comparing estimates for cisgender women ≤24 years of age versus >24. In the second review, we identified and synthesized studies of HIV prevalence, comparing estimates for cisgender women who initiated selling sex <18 versus ≥18 years. In both reviews, we completed a search of four databases for articles in any language and any geographic area published from 1 January 1980 until 12 February 2021. Included articles were assessed for quality and a random effects model was used to calculate pooled effect estimates for each review. Results and Discussion: We identified 12 studies for the HIV incidence review and 18 studies for the HIV prevalence review. In a meta‐analysis, HIV incidence was elevated in younger (5.3 per 100 person‐years [PY]; 95% confidence interval [CI]: 3.5, 7.1) compared to older women (2.8 per 100 PY; 95% CI: 1.7, 3.9), although CIs overlapped. HIV prevalence among those who initiated selling sex <18 years of age (28.8; 95% CI: 18.9, 38.7) was higher than those who initiated later (20.5; 95% CI: 12.4, 28.6). Conclusions: These companion reviews offer an important perspective on the relative HIV risk of engaging in selling sex at a younger age. Our findings highlight the unique and intersectional challenges YWSS face, and the importance of ensuring that health services are tailored to meet their specific needs. Research and programming should routinely stratify data into meaningful age bands to differentiate and intervene within this population. [ABSTRACT FROM AUTHOR]

Background and Setting: The Botswana Combination Prevention Project demonstrated a 30% reduction in community HIV incidence through expanded HIV testing, enhanced linkage to care, and universal antiretroviral treatment and exceeded the Joint United Nations Programme on HIV/AIDS 90–90–90 targets. We report rates and characteristics of incident HIV infections. Methods: The Botswana Combination Prevention Project was a community-randomized controlled trial conducted in 30 rural/periurban Botswana communities from 2013 to 2017. Home-based and mobile HIV-testing campaigns were conducted in 15 intervention communities, with 39% of participants testing at least twice. We assessed the HIV incidence rate [IR; number of new HIV infections per 100 person-years (py) at risk] among repeat testers and risk factors with a Cox proportional hazards regression model. Results: During 27,517 py, 195 (women: 79%) of 18,597 became HIV-infected (0.71/100 py). Women had a higher IR (1.01/100 py; 95% confidence interval: 0.99 to 1.02) than men (0.34/100 py; 95% confidence interval: 0.33 to 0.35). The highest IRs were among women aged 16–24 years (1.87/100 py) and men aged 25–34 years (0.56/100 py). The lowest IRs were among those aged 35–64 years (women: 0.41/100 py; men: 0.20/100 py). The hazard of incident infection was the highest among women aged 16–24 years (hazard ratio = 7.05). Sex and age were significantly associated with incidence (both P < 0.0001). CONCLUSIONS: Despite an overall reduction in HIV incidence and approaching the United Nations Programme on HIV/AIDS 95–95–95 targets, high HIV incidence was observed in adolescent girls and young women. These findings highlight the need for additional prevention services (pre-exposure prophylaxis and DREAMS) to achieve epidemic control in this subpopulation and increased efforts with men with undiagnosed HIV. [ABSTRACT FROM AUTHOR]

Background: Natural hazards have become more frequent and more severe as a result of climate change. Their increasing impact has a negative effect on people's health, including mental health. The aim of this ecological study is to investigate the association between exposure to disasters triggered by natural hazards and higher sexual risk-taking behavior as measured by one of its consequences, increased human immunodeficiency virus (HIV) incidence, at the country-level, worldwide. Methods: All data were extracted from publicly available sources. Crude and adjusted linear regression models were built to explore the association between the proportion of people affected by natural hazards and HIV incidence. Multivariable models included socio-demographic variables (literacy, income and age), and therapy coverage and the healthcare access and quality index. Results: In the crude regression model, the total number of people affected by natural hazards over a 5 year time period is positively associated with HIV incidence. For every 10 new people per 100,000/year affected by natural hazards, the HIV incidence in the country was 1.5 higher per 1,000 uninfected. However, when adjusting for socio-demographic variables, the association is lost. In the fully adjusted multivariable model, only antiretroviral therapy coverage and health care access and quality were significantly positively and negatively associated with HIV incidence. No interaction was found by income groups, world regions or categories of high and low HIV prevalence. Conclusion: No association between exposure to natural hazards and increased sexual risk-taking behavior at country level worldwide was detected after accounting for socio-demographic variables. Nonetheless, countries with a higher proportion of the population affected by disasters triggered by natural hazards were also those witnessing a higher incidence rate of HIV, possibly through the mediating effect of disrupted health system coverage, highlighting the coexistence of different vulnerabilities for public health.

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Introduction: To investigate the association between individual and community‐level measures of HIV stigma and HIV incidence within the 21 communities participating in the HPTN (071) PopART trial in Zambia and South Africa. Methods: Secondary analysis of data from a population‐based cohort followed‐up over 36 months between 2013 and 2018. The outcome was rate of incident HIV infection among individuals who were HIV negative at cohort entry. Individual‐level exposures, measured in a random sample of all participants, were: (1) perception of stigma in the community, (2) perception of stigma in health settings and (3) fear and judgement towards people living with HIV. Individual‐level analyses were conducted with adjusted, individual‐level Poisson regression. Community‐level HIV stigma exposures drew on data reported by people living with HIV, health workers and community members. We used linear regression to explore the association between HIV stigma and community‐level HIV incidence. Results: Among 8172 individuals who were HIV negative and answered individual‐level stigma questions at enrolment to the cohort, there was no evidence of a statistically significant association between any domain of HIV stigma and risk of incident HIV infection. Among the full cohort of 26,110 individuals among whom HIV incidence was measured, there was no evidence that community‐level HIV incidence was associated with any domain of HIV stigma. Conclusions: HIV stigma is often cited as a barrier to the effectiveness of HIV prevention programming. However, in the setting for the HPTN 071 "PopART trial," measured stigma alone was not associated with the risk of HIV infection. [ABSTRACT FROM AUTHOR]

Introduction: Oral tenofovir disoproxil fumarate/emtricitabine pre‐exposure prophylaxis (PrEP), introduced into South Africa (SA) in 2016, has increasingly become part of HIV prevention standard of care. Given the urgent need for increased HIV prevention efforts for young women in SA, we conducted an implementation study to explore oral PrEP initiation and adherence, and the impact of oral PrEP on HIV incidence in this group. Methods: This prospective cohort study (CAPRISA 082) was conducted at two sites (urban and rural) in KwaZulu‐Natal, between March 2016 and February 2018. HIV‐negative, sexually active women, aged 18–30 years, were enrolled and followed for approximately 10 months. Oral PrEP was offered as part of a comprehensive HIV prevention package. Adherence to oral PrEP was measured using pill counts and tenofovir‐diphosphate (TFV‐DP) levels. Characteristics of oral PrEP initiators versus non‐initiators were compared using risk ratios. HIV incidence rates were measured using Poisson regression. Results: Of 425 women enrolled, 262 (62%) initiated oral PrEP. Uptake was significantly higher at the rural site compared to the urban site (78% [n = 203/259] vs. 36% [n = 59/166], respectively, p‐value<0.001). Approximately 25% and 50% had stopped using oral PrEP by 3 and 12 months post‐initiation, respectively. Median pill count adherence was 90% (interquartile range: 81–97%); however, TFV‐DP was only detected in 13% of samples tested, that is 56/431 samples from 97 (37%) participants who initiated oral PrEP. In total, 11 women seroconverted yielding an HIV incidence rate of 2.81 per 100 person‐years (95% confidence interval: 1.40–5.03). Nine of 11 seroconverters had initiated oral PrEP; however, all showed drug levels equivalent to taking one to zero tablets per week. Among women who initiated oral PrEP, >50% had discontinued using oral PrEP by study end, with side effects, such as diarrhoea, nausea, headaches and rash, being the most frequent reason for discontinuation. Conclusions: Despite moderate oral PrEP initiation and high pill count adherence, adherence as measured by TFV‐DP levels was low and early discontinuation was high. The overall HIV incidence rate was high underscoring the critical need to address barriers to oral PrEP initiation, adherence and continued use, as well as expanding HIV prevention options for young women. [ABSTRACT FROM AUTHOR]

Background: As adolescent girls and young women (AGYW) transition to adulthood, their interaction with their social context becomes a critical consideration for HIV prevention interventions. Few studies have examined what types of community groups and community spaces might be protective for AGYW HIV acquisition and related sexual behaviors. Methods: Data were obtained from HIV Prevention Trials Network 068, a longitudinal study of AGYW (age 13–20 years) in rural South Africa. Survival analyses and generalized estimating equations were used to assess whether community group membership and time spent in community spaces were associated with HIV incidence and sexual behaviors (unprotected sex, transactional sex, and having an older partner). Results: A total of 2245 AGYW were followed up for up to 4 years. Membership in church groups [adjusted hazard ratio (aHR): 0.75, 95% confidence interval (CI): 0.53 to 0.91] and dance groups (aHR: 0.89, 95% CI: 0.80 to 0.98) and spending time at church (aHR: 0.88, 95% CI: 0.79 to 0.98) were protective for HIV infection. Conversely, spending time at taverns was associated with higher HIV incidence (aHR: 1.27, 95% CI: 1.15 to 1.41). Membership in church groups and spending time at a family member's home and at church were protective for all 3 sexual behaviors. Spending time at a boyfriend's home and taverns was risky for all 3 sexual behaviors. Conclusions: The results suggest that community spaces and community groups that include an element of adult supervision are potentially protective, whereas spaces and groups that provide an opportunity for AGYW to interact unsupervised with boyfriends or meet new partners are potentially risky. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: Sexual partner characteristics are important determinants of HIV acquisition, but little is known about partner types of young men in sub-Saharan Africa. Methods: Sexually active men aged 15–24 years from 5 rounds (2005–2013) of the Rakai Community Cohort Study in Uganda reported characteristics of up to 4 past-year female partners. Partner types were identified using latent class analysis. HIV incidence rates (IRs) were calculated by partner-type combinations, and individual-level risk adjusted IR ratios (aIRRs) relative to the lowest incidence type were estimated using the Poisson regression with generalized estimating equations. Results: Young men (N = 1771) reported 4539 past-year female sexual partners. Three partner types were identified: type A: noncohabiting, student, medium duration partnerships; type B: cohabiting, nonstudent, longer duration partnerships; and type C: noncohabiting, nonstudent shorter duration partnerships. Type C partners engaged in the most HIV-related risk behaviors. Many men (29%) had more than 1 partner type/round. IR overall was 9.8/1000 person-years [95% confidence interval (CI): 4.7 to 20.6]. IR was 4.0 (95% CI: 1.2 to 12.7) for men with type A partners alone (41% of men). Relative to them, IR for those with type B partners alone (25%) was not significantly different. Men with type C partners alone (5%) had higher risk (aIRR = 3.2; 95% CI: 1.0 to 9.9), as did men with >1 partner type, including men with both type A and type B partners (12%; aIRR = 6.3; 95% CI: 2.5 to 15.9) and men with type C and other partner types (17%; aIRR = 4.3; 95% CI: 1.7 to 10.8). Conclusions: Partner-type combination was strongly associated with HIV incidence; type C partners and having more than 1 partner type were the riskiest patterns. [ABSTRACT FROM AUTHOR]

ObjectiveHIV seroconversion biomarkers are being used in cross-sectional studies for HIV incidence estimation. Bio-Rad Geenius HIV-1/2 Supplemental Assay is an immunochromatographic single-use assay that measures antibodies (Ab) against multiple HIV-1/2 antigens. The objective of this study was to determine whether the Geenius assay could additionally be used for recency estimation.DesignThis assay was developed for HIV-1/2 confirmation; however, quantitative data acquired give information on increasing concentration and diversity of antibody responses over time during seroconversion. A quantitative threshold of recent HIV infection was proposed to determine "recent" or "nonrecent" HIV infection; performance using this cutoff was evaluated.MethodsWe tested 2500 highly characterized specimens from research subjects in the United States, Brazil, and Africa with well-defined durations of HIV infection. Regression and frequency estimation were used to estimate assay properties relevant to HIV incidence measurement: mean duration of recent infection (MDRI), false-recent rate, and assay reproducibility and robustness.ResultsUsing the manufacturer's proposed cutoff index of 1.5 to identify "recent" infection, the assay has an estimated false-recent rate of 4.1% (95% CI: 2.2 to 7.0) and MDRI of 179 days (155 to 201) in specimens from treatment-naive subjects, presenting performance challenges similar to other incidence assays. Lower index cutoffs associated with lower MDRI gave a lower rate of false-recent results.ConclusionsThese data suggest that with additional interpretive analysis of the band intensities using an algorithm and cutoff, the Geenius HIV-1/2 Supplemental Assay can be used to identify recent HIV infection in addition to confirming the presence of HIV-1 and HIV-2 antibodies.

Background: A goal of the US Department of Health and Human Services' Ending the HIV Epidemic (EHE) in the United States initiative is to reduce the annual number of incident HIV infections in the United States by 75% within 5 years and by 90% within 10 years. We developed a resource allocation analysis to understand how these goals might be met. Methods: We estimated the current annual societal funding [$2.8 billion (B)/yr] for 14 interventions to prevent HIV and facilitate treatment of infected persons. These interventions included HIV testing for different transmission groups, HIV care continuum interventions, pre-exposure prophylaxis, and syringe services programs. We developed scenarios optimizing or reallocating this funding to minimize new infections, and we analyzed the impact of additional EHE funding over the period 2021-2030. Results: With constant current annual societal funding of $2.8 B/yr for 10 years starting in 2021, we estimated the annual incidence of 36,000 new cases in 2030. When we added annual EHE funding of $500 million (M)/yr for 2021-2022, $1.5 B/yr for 2023-2025, and $2.5 B/yr for 2026-2030, the annual incidence of infections decreased to 7600 cases (no optimization), 2900 cases (optimization beginning in 2026), and 2200 cases (optimization beginning in 2023) in 2030. Conclusions: Even without optimization, significant increases in resources could lead to an 80% decrease in the annual HIV incidence in 10 years. However, to reach both EHE targets, optimization of prevention funding early in the EHE period is necessary. Implementing these efficient allocations would require flexibility of funding across agencies, which might be difficult to achieve. [ABSTRACT FROM AUTHOR]

Background: Sub-Saharan Africa has the highest HIV incidence and prevalence in the world. In the past decade, mobile phone ownership has doubled, affecting social and sexual practices. Using longitudinal follow-up data, this study examined whether mobile phone ownership was associated with sexual behaviors and HIV incidence for youth and adults. Methods: The Rakai Community Cohort Study gathers demographic and sexual health information and conducts HIV testing among an open cohort in southcentral Uganda every 12-18 months. Results: Of the 10,618 participants, 58% owned a mobile phone, 69% lived in rural locations, and 77% were sexually active. Analyses were adjusted for time, location, religion, and socioeconomic status. Phone ownership was associated with increased odds of ever having had sex act for 15- to 19-year-olds [men adjusted odds ratio (AOR): 2.12, 95% confidence interval (CI): 1.78 to 2.52; women AOR: 3.20, 95% CI: 2.45 to 4.17]. Among sexually active participants, owning a phone was associated with increased odds of having 2 or more concurrent sex partners (15- to 24-year-old men AOR: 1.76, 95% CI: 1.34 to 2.32; 25 to 49-year-old men: AOR 1.81, 95% CI: 1.54 to 2.13; 25- to 49-year-old women AOR: 1.81, 95% CI: 1.32 to 2.49). For men, phone ownership was associated with increased odds of circumcision (15- to 24-year-old men AOR: 1.24, 95% CI: 1.08 to 1.41; 25- to 49-year-old men AOR: 1.12, 95% CI: 1.01 to 1.24). Phone ownership was not associated with HIV incidence. Conclusion: Although mobile phone ownership was associated with sexual risk behaviors, it was not associated with increased risk of HIV acquisition. Research should continue exploring how phones can be used for reducing sexual health risk. [ABSTRACT FROM AUTHOR]

Abstract Background Recently, more and more men who have sex with men (MSM) look for casual partners through online dating platforms in China. However, most are unable to know their partners’ HIV and other sexually transmitted diseases (STD) statuses, leading to the rapid increase in HIV infection among Chinese MSM. Effective partner notification is urgently needed to increase the risk awareness of MSM and prevent HIV and other STDs transmission. However, the traditional intervention mainly targets to the HIV-positive MSM and the effect is not promising. Our study aims to provide Internet-based partner notification, along with a series of health services for HIV-negative MSM to protect them from HIV and other STDs. Methods A pragmatic stepped wedge cluster randomized controlled trial design is used to evaluate the effectiveness of a new intervention paradigm, which aims to reduce HIV and other STDs incidences among MSM in China. Through integrating a mobile health (mHealth) service application (app) to the current HIV and other STDs prevention and control methods, the new paradigm provides partner notification of HIV, syphilis, hepatitis B, and hepatitis C statuses. A total of 6172 MSM in 16 districts of Beijing, China will be recruited and randomized to sequentially receive partner notification intervention through the app at 6-month intervals. The primary outcomes are HIV incidence and the additional cost of the intervention. The secondary outcomes include incidences of syphilis, hepatitis B, and hepatitis C, disease transmission social networks, testing adherence, knowledge of HIV and STDs control, health self-responsibility awareness, changes of high risk behaviors and other related outcomes. The generalized linear mixed models (GLMM) will be used to analyze the differences of outcomes in the control period and in the intervention period. Discussion We expect that the HIV incidence will be significantly lower and the secondary outcomes will also be improved with providing health service of partner notification through mhealth intervention. The feasible and affordable public health intervention paradigm will have implications for HIV and STDs prevention and control among MSM and other key populations. Trial registration ClinicalTrials.gov, NCT04349748 . Registered on 16 April 2020.

Antiretroviral therapy (ART) prevents HIV transmission within HIV serodiscordant couples (SDCs), but slow implementation and low uptake has limited its impact on population-level HIV incidence. Home HIV testing and counselling (HTC) campaigns could increase ART uptake among SDCs by incorporating couples' testing and ART referral. We estimated the reduction in adult HIV incidence achieved by incorporating universal ART for SDCs into home HTC campaigns in KwaZulu-Natal (KZN), South Africa, and southwestern (SW) Uganda.We constructed dynamic, stochastic, agent-based network models for each region. We compared adult HIV incidence after 10 years under three scenarios: (1) "Current Practice," (2) "Home HTC" with linkage to ART for eligible persons (CD4

Abstract INTRODUCTION HIV incidence estimates are essential to monitor the progress of prevention and control interventions. METHODS Data collected by Brazilian surveillance systems were used to derive HIV incidence estimates by age group (15-24; 25+) and sex from 1986 to 2018. This study used a back-calculation method based on the first CD4 count among treatment-naïve cases. Incidence estimates for the population aged 15 years or over were compared to Global Burden of Disease Study (GBD) estimates from 2000 to 2018. RESULTS Among young men (15-24 years), HIV incidence increased from 6,400 (95% CI: 4,900-8,400), in 2000, to 12,800 (95% CI: 10,800-15,900), in 2015, reaching incidence rates higher than 70/100,000 inhabitants and an annual growth rate of 3.7%. Among young women, HIV incidence decreased from 5,000 (95% CI: 4,200-6,100) to 3,200 (95% CI: 3,000-3,700). Men aged ≥25 years and both female groups showed significant annual decreases in incidence rates from 2000 to 2018. In 2018, the estimated number of new infections was 48,500 (95% CI: 45300-57500), 34,800 (95% CI: 32800-41500) men, 13,600 (95% CI: 12,500-16,000) women. Improvements in the time from infection to diagnosis and in the proportion of cases receiving antiretroviral therapy immediately after diagnosis were found for all groups. Comparison with GBD estimates shows similar rates for men with overlapping confidence intervals. Among women, differences are higher mainly in more recent years. CONCLUSIONS The results indicate that efforts to control the HIV epidemic are having an impact. However, there is an urgent need to address the vulnerability of young men.

Introduction: Several HIV risk scores have been developed to identify individuals for prioritized HIV prevention in sub‐Saharan Africa. We systematically reviewed HIV risk scores to: (1) identify factors that consistently predicted incident HIV infection, (2) review inclusion of community‐level HIV risk in predictive models and (3) examine predictive performance. Methods: We searched nine databases from inception until 15 February 2021 for studies developing and/or validating HIV risk scores among the heterosexual adult population in sub‐Saharan Africa. Studies not prospectively observing seroconversion or recruiting only key populations were excluded. Record screening, data extraction and critical appraisal were conducted in duplicate. We used random‐effects meta‐analysis to summarize hazard ratios and the area under the receiver‐operating characteristic curve (AUC‐ROC). Results: From 1563 initial search records, we identified 14 risk scores in 13 studies. Seven studies were among sexually active women using contraceptives enrolled in randomized‐controlled trials, three among adolescent girls and young women (AGYW) and three among cohorts enrolling both men and women. Consistently identified HIV prognostic factors among women were younger age (pooled adjusted hazard ratio: 1.62 [95% confidence interval: 1.17, 2.23], compared to above 25), single/not cohabiting with primary partners (2.33 [1.73, 3.13]) and having sexually transmitted infections (STIs) at baseline (HSV‐2: 1.67 [1.34, 2.09]; curable STIs: 1.45 [1.17; 1.79]). Among AGYW, only STIs were consistently associated with higher incidence, but studies were limited (n = 3). Community‐level HIV prevalence or unsuppressed viral load strongly predicted incidence but was only considered in 3 of 11 multi‐site studies. The AUC‐ROC ranged from 0.56 to 0.79 on the model development sets. Only the VOICE score was externally validated by multiple studies, with pooled AUC‐ROC 0.626 [0.588, 0.663] (I2: 64.02%). Conclusions: Younger age, non‐cohabiting and recent STIs were consistently identified as predicting future HIV infection. Both community HIV burden and individual factors should be considered to quantify HIV risk. However, HIV risk scores had only low‐to‐moderate discriminatory ability and uncertain generalizability, limiting their programmatic utility. Further evidence on the relative value of specific risk factors, studies populations not restricted to "at‐risk" individuals and data outside South Africa will improve the evidence base for risk differentiation in HIV prevention programmes. PROSPERO Number: CRD42021236367 [ABSTRACT FROM AUTHOR]

Point of care rapid recency testing for HIV-1 may be a cost-effective tool to identify recently infected individuals for incidence estimation, and focused HIV prevention through intensified contact tracing. We validated the Asante™ HIV-1 rapid recency® assay for use in Uganda. Archived specimens (serum/plasma), collected from longitudinally observed HIV-1 recently and long-term infected participants, were tested with the Asante HIV-1 rapid recency assay per manufacturer's instructions. Previously identified antiretroviral therapy (ART)-naive samples with known seroconversions within 6 months of follow-up were tested in independent laboratories: the Rakai Health Sciences Program (RHSP) and the Uganda Virus Research Institute HIV Reference Laboratory (UVRI-HRL). In addition, samples from participants who seroconverted within 6–18 months and samples from individuals with chronic HIV-1 infection of at least 18 months duration were classified into three categories: ART naive, ART exposed with suppressed viral loads, and ART exposed with detectable viremia. Of the 85 samples seroconverting in ≤6 months, 27 and 42 samples were identified as "recent" by the Asante HIV-1 rapid recency test at the RHSP laboratory and UVRI-HRL, corresponding to sensitivities of 32% and 49%, respectively. There was 72% agreement between the laboratories (Cohen's kappa = 0.481, 95% CI = 0.317–0.646, p < .0001). Specificity was 100% (200/200) among chronically infected ART-naive samples. The Asante HIV-1 rapid recency assay had low sensitivity for detection of recent HIV-1 infections in Uganda, with substantial interlaboratory variability due to differential interpretation of the test strip bands. Specificity was excellent. Assessment of assay performance in other settings is needed to guide decisions on test utility. [ABSTRACT FROM AUTHOR]

The aim of this study was to use data from the United Nations Global Indicators Database to analyze the trends in the HIV incidence rate among women in sub-Saharan African countries between 2000 and 2017. The HIV incidence rate is defined as the number of new HIV infections per 1,000 uninfected population, aged 15 to 49 years old. Joinpoint regression analysis was applied to identify periods when there were significant changes in the HIV incidence rate. The results show that there was a global decrease trend in the HIV incidence rates among women in sub-Saharan Africa, decreasing in all sub-Saharan African countries, except in Angola, Equatorial Guinea, and Sudan, which have remained the same, and Madagascar, where the overall trend is increasing. The joinpoint regression statistical method offers an in-depth analysis of the incidence of HIV among women in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]