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We examined the proportion and correlates of loss to follow-up (LTFU) among female entertainment and sex workers (FESWs) in a longitudinal HIV prevention intervention trial in Cambodia. The Cambodia Integrated HIV and Drug Prevention Intervention trial tested a comprehensive package of interventions aimed at reducing amphetamine-type stimulant use and HIV risk among FESWs in ten provinces. The present study estimated the proportion of women LTFU and assessed factors associated with LTFU. Logistic regression analyses were used. Of a total 596 women enrolled, the cumulative proportion of LTFU was 29.5% (n = 176) between zero- and 12-month follow-up. In multivariate analyses, women with no living children (adjusted odds ratio [AOR] 1.6; 95% confidence interval [CI]: 1.1, 2.3) and those who experienced recent food insecurity (AOR 1.7; 95%CI: 1.1, 2.7) were more likely to be LTFU. Women who were members of the SMARTgirl HIV prevention programme for ≥ 6 months compared to non-members were less likely to be LTFU (AOR 0.3; 95%CI: 0.2, 0.6). LTFU was moderately high in this study and similar to other studies, indicating a need for strategies to retain this population in HIV prevention programmes and research. Interventions aimed at stabilizing women's lives, including reducing food insecurity and creating communities of engagement for FESWs, should be considered.

ObjectiveIn 2010 the international HIV/AIDS community called on countries to take action to prevent HIV transmission among people who inject drugs (PWID). To set a baseline we proposed an "accountability matrix", focusing upon six countries accounting for half of the global population of PWID: China, Malaysia, Russia, Ukraine, Vietnam and the USA. Two years on, we review progress.DesignWe searched peer-reviewed literature, conducted online searches, and contacted experts for 'grey' literature. We limited searches to documents published since December 2009 and used decision rules endorsed in earlier reviews.ResultsPolicy shifts are increasing coverage of key interventions for PWID in China, Malaysia, Vietnam and Ukraine. Increases in PWID receiving antiretroviral treatment (ART) and opioid substitution treatment (OST) in both Vietnam and China, and a shift in Malaysia from a punitive law enforcement approach to evidence-based treatment are promising developments. The USA and Russia have had no advances on PWID access to needle and syringe programmes (NSP), OST or ART. There have also been policy setbacks in these countries, with Russia reaffirming its stance against OST and closing down access to information on methadone, and the USA reinstituting its Congressional ban on Federal funding for NSPs.ConclusionsPrevention of HIV infection and access to HIV treatment for PWID is possible. Whether countries with concentrated epidemics among PWID will meet goals of achieving universal access and eliminating new HIV infections remains unknown. As long as law enforcement responses counter public health responses, health-seeking behaviour and health service delivery will be limited.

INTRODUCTION The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates that 26 million people worldwide were receiving antiretroviral therapy (ART) for HIV treatment by the end of 2019, an increase [...], : Introduction: WHO?s 2019 report on HIV drug resistance (HIVDR) documents a high prevalence of pretreatment drug resistance (PDR) among populations initiating first?line antiretroviral therapy (ART) in low? and middle?income countries (LMIC). However, systematic evidence on the prevalence of PDR among key populations remains limited. We performed a systematic review to characterize levels of PDR in key population groups and compared them to levels of PDR in the ?general population? across different geographical regions. Methods: Ten electronic databases were searched for papers published until February 2019 that included predefined search terms. We included studies that reported the number of successfully tested genotypes and the number of genotypes with drug resistance mutations among antiretroviral therapy treatment naïve people, recently infected people, or people initiating first?line ART from key populations. To assess the prevalence of PDR for each key population, we pooled estimates using random?effects meta?analysis of proportions. Where possible, we computed the differences in the odds of PDR (any, and by drug class) present in each key population compared to the ?general population?. The I[sup.2] statistic (a measure of heterogeneity between studies) is reported. Results and discussion: A total of 332 datasets (from 218 studies) and 63,111 people with successful HIVDR genotyping were included in the analysis. The pooled prevalence estimate of any PDR was high among men who have sex with men (13.0%, 95% CI 11.0 to 14.0%, I[sup.2] = 93.19), sex workers (17.0%, 95% CI 6.0 ? 32.0, I[sup.2] = 87.31%) and people in prisons (18.0%, 95% CI 11.0 to 25.0, I[sup.2] = 70.18%), but less so among people who inject drugs (7.0%, 95% CI 5.0 to 10.0, I[sup.2] = 90.23). Overall, men who have sex with men were more likely to carry any PDR compared to the ?general population,? a finding which was statistically significant (odds ratio (OR) 1.28, 95% CI 1.13 ? 1.46, I[sup.2] 48.9%). Conclusions: High prevalence of PDR found in key populations highlights the need to increase access to effective first?line HIV treatment. The low prevalence of nucleotide reverse transcriptase inhibitor (NRTI) PDR suggests that current WHO recommendations for pre?exposure prophylaxis (PrEP) regimens will remain effective and can be scaled up to prevent new HIV infections in high?risk groups.

Introduction People who use drugs, especially by injection, are at higher risk of dying from both acute and chronic diseases, many of which are related to their drug use, than [...], Objective To systematically review cohort studies of mortality among people who inject drugs, examine mortality rates and causes of death in this group, and identify participant- and study-level variables associated with a higher risk of death. Methods Tailored search strings were used to search EMBASE, Medline and PsycINFO. The grey literature was identified through online grey literature databases. Experts were consulted to obtain additional studies and data. Random effects meta-analyses were performed to estimate pooled crude mortality rates (CMRs) and standardized mortality ratios (SMRs). Findings Sixty-seven cohorts of people who inject drugs were identified, 14 of them from low- and middle-income countries. The pooled CMR was 2.35 deaths per 100 person-years (95% confidence interval, CI: 2.12-2.58). SMRs were reported for 32 cohorts; the pooled SMR was 14.68 (95% CI: 13.01-16.35). Comparison of CMRs and the calculation of CMR ratios revealed mortality to be higher in low- and middle-income country cohorts, males and people who injected drugs that were positive for human immunodeficiency virus (HIV). It was also higher during off-treatment periods. Drug overdose and acquired immunodeficiency syndrome (AIDS) were the primary causes of death across cohorts. Conclusion Compared with the general population, people who inject drugs have an elevated risk of death, although mortality rates vary across different settings. Any comprehensive approach to improving health outcomes in this group must include efforts to reduce HIV infection as well as other causes of death, particularly drug overdose. Objectif Examiner systematiquement les etudes de cohortes de la mortalite chez les toxicomanes par injection, etudier les taux de mortalite et les causes de deces dans ce groupe, et identifier les variables, au niveau des participants et des etudes, associees a un risque accru de deces. Methodes Des criteres de recherche specifiquement adaptes ont ete utilises pour les recherches realisees sur EMBASE, Medline et PsycINFO. La litterature grise a ete identifiee par le biais de bases de donnees de litterature grise disponibles en ligne. Des experts ont ete consultes pour obtenir des donnees et des etudes supplementaires. Des meta-analyses des effets aleatoires ont ete realisees afin d'estimer les taux bruts de mortalite (TBM) groupes et les taux de mortalite standardises (TMS). Resultats Soixante-sept cohortes de personnes qui s'injectent des drogues ont ete identifiees, dont 14 appartenant a des pays a revenu faible et intermediaire. Le TBM groupe etait de 2,35 deces pour 100 personnes-annees (intervalle de confiance de 95%, IC: 2,12-2,58). Les TMS etaient indiques pour 32 cohortes, avec un TMS groupe de 14,68 (IC de 95%: 13,01-16,35). La comparaison desTBM et le calcul des taux de TMS ont revele une mortalite plus elevee parmi les cohortes des pays a revenu faible et intermediaire, les sujets masculins et les toxicomanes par injection seropositifs. Elle etait egalement plus elevee pendant les periodes d'interruption therapeutique. L'overdose et le syndrome d'immunodeficience acquise (SIDA) etaient les causes principales des deces parmi ces cohortes. Conclusion Si l'on compare avec la population globale, les personnes qui s'injectent des drogues ont un risque eleve de deces, bien que les taux de mortalite varient selon les contextes. Toute approche exhaustive visant a ameliorer les resultats de ce groupe en matiere de sante doit comprendre des efforts en vue de diminuer l'infection par le VIH, ainsi que d'autres causes de deces, notamment l'overdose. Objetivo Revisar de forma sistematica los estudios de cohortes sobre la mortalidad entre los consumidores de drogas inyectables, examinar las tasas de mortalidad y las causas de muerte en este grupo e identificar las variables relacionadas con el estudio y los participantes asociadas a un mayor riesgo de muerte. Metodos Se emplearon cadenas de busqueda adaptadas para registrar EMBASE, Medline y PsycINFO. La literatura gris se identifico por medio de bases de datos de literatura gris en linea. Se consultaron expertos a fin de obtener datos y estudios adicionales y se llevaron a cabo metaanalisis de efectos aleatorios para calcular las tasas brutas combinadas de mortalidad y las tasas de mortalidad estandarizadas. Resultados Se identificaron diecisiete cohortes de consumidores de drogas inyectables, 14 de las cuales en paises con ingresos bajos y medios. La tasa bruta combinada de mortalidad fue de 2,35 fallecimientos por cada 100 anos-persona (intervalo de confianza del 95%, IC: 2,12-2,58). Se declararon las tasas de mortalidad estandarizadas para 32 cohortes; la tasa bruta combinada de mortalidad fue de 14,68 (IC 95%: 13,01-16,35). La comparacion de las tasas brutas combinadas de mortalidad y el calculo de las proporciones de la mortalidad bruta combinada revelaron que la mortalidad fue superior en las cohortes de paises con ingresos bajos y medios, en varones y entre consumidores de drogas inyectables que dieron positivo para el virus de la inmunodeficiencia humana (VIH), asi como durante los periodos sin tratamiento. Las sobredosis y el sindrome de la inmunodeficiencia adquirida (SIDA) fueron las causas principales de muerte en las cohortes. Conclusion En comparacion con la poblacion general, los consumidores de drogas inyectables presentan un riesgo elevado de muerte, si bien las tasas de mortalidad varian en los distintos lugares. Cualquier enfoque completo para mejorar los resultados sanitarios en este grupo debera esforzarse por reducir la infeccion por VIH, asi como las otras causas de muerte, en especial, la sobredosis.

Indonesia has the third highest number of people living with HIV/AIDS (PLWH) and the greatest increase in proportion of AIDS-related mortality in the Asia Pacific region between 2005 and 2013. Longitudinal mortality data among PLWH in Indonesia are limited. We conducted a retrospective cohort study from medical records of antiretroviral treatment (ART) recipients attending Badung General Hospital (BGH) and Bali Medica Clinic (BMC) between 2006 and 2014. We explored incidence of mortality by Kaplan–Meier analysis and identified predictors using a Cox proportional hazard model. In total, 575 patients were included in the analysis; the majority were male. The overall mortality rate was 10% per year. Multivariate analysis suggested that being male (adjusted hazard ratio [aHR]: 2.74; 95% confidence interval [CI]: 1.34-5.59), having a lower education (aHR: 2.17; 95%CI: 1.31-3.61), having heterosexual (aHR: 7.40; 95% CI: 2.61-21.00) or injecting drug use (aHR: 13.20; 95% CI: 3.17-55.00) as the likely transmission risk category, starting treatment with low CD4 cell counts (aHR: 3.18; 95% CI: 1.16-8.69), and not having a treatment supervisor (aHR: 4.02; 95% CI: 2.44-6.65) were independent predictors of mortality. The mortality was high, particularly in the first three months after initiating ART. These findings highlight the need to encourage HIV testing and early diagnosis and prompt treatment. Applying aspects of BMCs targeted HIV services model in more generalised services such as BGH may be beneficial. Providing adherence support as part of ART services is key to promoting adherence to ART. [ABSTRACT FROM AUTHOR]