Adolescents remain insufficiently addressed in the response to advanced HIV disease (AHD) in sub-Saharan Africa. Despite progress in HIV testing and antiretroviral therapy, gaps remain in early identification, integrated care, and continuity of care for adolescents at risk of severe disease. This commentary describes adolescents as a "missing middle" between pediatric and adult HIV services. It highlights how treatment interruption, fragmented services, psychosocial challenges, and weak follow-up can increase their vulnerability. We propose an adolescent-responsive AHD pathway focused on three priorities: early identification of adolescents at risk, integration of clinical and psychosocial care, and continuity after hospitalization or treatment interruption. The approach should be adapted to the available workforce, financing, technology, and health-system capacity. Strengthening these areas may help reduce preventable illness and deaths and improve retention and recovery among adolescents living with HIV in sub-Saharan Africa.
Introduction:In remote Ugandan settings, HIV care retention remains poor among men and pastoralists. Despite progress toward UNAIDS 95-95-95 targets, structural barriers, geographic isolation and stigma continue to undermine long-term retention. Case Presentation:In 2022, a male pastoralist in his early forties with heavy alcohol use presented to a rural health center in Karamoja with fever and weight loss, and was diagnosed with HIV. He declined antiretroviral therapy (ART) believing the drugs were "poisonous" and was lost to follow-up for 48 months. He re-presented in March 2026 with a one-year history of a scaly, pruritic lesion on his right hand extending to the face and neck, unresponsive to antifungal creams. Two days prior, he developed an acutely painful vesicular eruption in the right V1 trigeminal distribution, along with oropharyngeal candidiasis. CD4 count was 120 cells/μL and urine TB LAM was positive, indicating disseminated tuberculosis. While LAM is highly suggestive and warrants immediate empirical treatment, definitive diagnosis of dissemination ideally requires clinical and radiological correlation. He was treated with oral acyclovir (800 mg five times daily for 10 days), topical acyclovir, ibuprofen, intensive-phase anti-TB therapy, and fluconazole (200 mg daily for 14 days). ART was deferred for two weeks to manage acute opportunistic infections and monitor for IRIS. At two weeks, the zoster lesions had crusted, oral candidiasis cleared, and pain reduced to 2/10. ART was initiated on day 14 with village health team support. At three months, he remained adherent with no new opportunistic infections. Conclusion:Delayed ART initiation caused years of preventable suffering. This case highlights the urgent need in low-income settings for community re-engagement strategies, integrated HIV/co-infection screening, point-of-care diagnostics, and culturally tailored care. As the patient stated: "I was sick, and now I am well. The science of HIV treatment is a miracle, and I am living proof.".
Introduction:Retention in HIV pre-exposure prophylaxis (PrEP) care among key populations is crucial to realize its benefits. Evidence is scarce on retention in PrEP care outcomes and associated factors among at-risk women in sub-Saharan Africa. We, therefore, evaluated the retention outcomes in the facility-based PrEP services delivery model and their associated factors among female sex workers in the city of Tanga, Tanzania. Methods:We analyzed data of 313 female sex workers of a control arm of a pragmatic trial. Participants were followed for 16 months from 2022 to 2023. We categorized retention in care outcomes PrEP services as being early and long-term. A multivariable log-binomial regression model was used to determine factors affecting retention in PrEP services at p<0.05. Results:Early and long-term retention in PrEP care was 38.0% (95% CI: 33.25-43.04) and 11.0% (95% CI: 7.67-15.61), respectively. Having sex work as the only source of income negatively affected early retention compared to those with alternative sources of income (aRR 0.58, 95% CI: 0.36-0.94, p=0.028). Having 10-29 sexual clients/month was 34% times lower risk of being retained compared to those with less than 10 sexual clients per month (aRR 0.66, 95% CI: 0.47-0.92, p=0.014). Self-perceived "high" PrEP stigma negatively affected long-term retention compared to perceiving "low" PrEP stigma (aRR 0.16, 95% CI: 0.03-0.99, p=0.049) and self-perceived "moderate" HIV risk was associated with increased retention compared to self-perceived "high" HIV risk (aRR 5.03, 95% CI: 1.37-18.47, p=0.015). Conclusion:The retention in facility-based HIV PrEP care among female sex workers was low. Having sex work as the only source of income, having sex with 10-29 clients, and self-perceived "high" PrEP stigma negatively affected retention in PrEP care. Self-perceived "moderate" HIV risk positively affected retention in PrEP care. Establishing client-centred approaches targeting PrEP stigma and HIV risk awareness is crucial to optimize retention in facility-based PrEP services. Trial Registration:Pan African Clinical Trials Registry PACTR202003823226570.
Introduction:This cross‑sectional study examined HIV/AIDS knowledge as a determinant of preventative and self‑protective sexual behaviour. The HIV Knowledge Questionnaire-18 (HIV-KQ-18) is one of the most widely used HIV knowledge scales. The objective of this study was to test the psychometric properties of the HIV-KQ-18 in Black people in Ontario. Methods:We analyzed the data from 1302 participants who completed the HIV-KQ-18 in a study conducted among Black people in Ontario. We estimated the internal consistency of this scale using Cronbach's alpha. We analyzed the construct validity of the scale, testing hypotheses about HIV knowledge and age, education, employment status, gender, language and city using one-way ANOVA and independent sample t-tests. Results:Cronbach's alpha for the scale was 0.82 (95% CI: 0.80-0.84) suggesting good internal consistency. We observed significant differences in HIV knowledge scores across age, employment status, education, and gender. Higher HIV knowledge scores were also observed among participants residing in Toronto compared to Ottawa and among those who completed the questionnaire in English compared to French. Conclusion:The HIV-KQ-18 is a valid instrument to assess the level of HIV/AIDS knowledge among Black Ontarians, with robust internal consistency and construct validity. The HIV-KQ-18 identified important differences in HIV knowledge based on the characteristics examined, indicating the need for targeted initiatives to increase HIV-related knowledge.
Background:In recent years, HIV-associated nephropathy (HIVAN) has significantly impacted the compliance, quality of life, and treatment outcomes for patients with AIDS. This study employs CiteSpace bibliometric analysis to predict emerging topics and research trends, thereby offering clear scientific navigation and strategic recommendations for HIVAN research. Methods:We retrieved publications related to HIVAN from the Web of Science Core Collection covering the period from 2015 to 2025. Utilizing CiteSpace, we analyzed the co-occurrence network, clustering,and timeline of research trends in this field to illustrate the knowledge evolution surrounding HIVAN. Results:A total of 1,470 publications were included from 2015 to 2025. The United States maintained its dominant position in medical research, while countries such as the United Kingdom, South Africa, France, and China emerged as key contributors in the field. Prominent institutions, including the University of California system, Johns Hopkins University, and University of the London, were central to HIVAN research. Scholars such as Estrella, Michelle M. Shlipak, Michael G. and Kopp, Jeffrey B exhibited substantial academic output and garnered considerable citation attention. Leading journals, including "Clinical Infectious Diseases", "PLOS ONE" and "AIDS" served as premier venues for review articles, providing essential platforms and establishing foundations for ongoing research. The research activity and academic impact of HIVAN within the sub-discipline of nephrology currently represent prominent areas of inquiry. Conclusion:This study examined the knowledge network structure of HIVAN from 2015 to 2025 examined bibliometric analysis. Future research should focus on enhancing international collaboration, particularly in resource limited regions, to investigate various intervention strategies aimed at improving compliance, quality of life, and treatment outcomes for HIVAN patients.
