Objectives Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool, yet uptake among women remains low, particularly for Black cisgender women. We aimed to identify determinants of PrEP implementation in OB/GYN residency clinic settings and develop an OB/GYN training program for a combined-care PrEP model in preparation for pilot testing. Methods We conducted a qualitative descriptive study using semi-structured, CFIR-guided qualitative interviews with OB/GYN residents, OB/GYN residency faculty, and PrEP providers in New Orleans, Louisiana. We then presented the findings in provider working group sessions to obtain feedback on the training program and adapt the program based on suggested modifications. Results We conducted 12 interviews and 2 working group meetings. Participants perceived OB/GYN residents would be highly compatible PrEP providers given their focus on sexual health. They also identified provider barriers including limited knowledge, time constraints, and care discontinuity due to resident rotation blocks. Working group providers emphasized the need for practical training resources, clear clinical protocols, and a designated PrEP champion. Conclusion Participants and working group providers viewed OB/GYN resident clinics as an acceptable setting for implementing and piloting a PrEP program. We finalized the scalable, provider-informed training model—“Start the Conversation”—to support PrEP integration into routine OB/GYN care at resident clinics.
Objectives This study compared men who have sex with men (MSM) who lived with HIV (LWHIV) and tuberculosis to MSM LWHIV without tuberculosis and estimated tuberculosis incidence among MSM-LWHIV over 25-years. Methods Data from the Israeli national tuberculosis and HIV registries between 2000 and 2025 were cross-matched by patients’ identifiers to compare MSM LWHIV and tuberculosis to other MSM LWHIV older than 15 years. They were followed up from HIV-diagnosis until they developed TB, died, left Israel or end-2025. Results Of 3,018 MSM LWHIV who were followed-up for 30,617 person-years, 16 (0.5%) developed tuberculosis, compared with 244 (6.6%) non-MSM LWHIV, corresponding to 5 and 70 cases per 10,000 person-years, respectively (P<0.01). MSM LWHIV and tuberculosis were more commonly non-Israeli born, had lower CD4-counts and not been treated with antiretroviral therapy than MSM LWHIV without tuberculosis. Tuberculosis in MSM was diagnosed within a median of 2.4 years after HIV (range 0-10), and 8 (50.0%) were diagnosed concomitantly with HIV and tuberculosis. Contact tracing revealed one household exposure, while nine (52.9%) probably acquired tuberculosis while originating/visiting high-tuberculosis settings. Conclusions Tuberculosis incidence among MSM LWHIV is very low. Tuberculosis was probably acquired while originating/visiting endemic countries. Routine HIV-testing of patients with tuberculosis is recommended.
The use of Artificial Intelligence (AI) technologies such as ChatGPT in patient healthcare-seeking behaviour raises important questions about their role in HIV counselling. This letter presents an exploratory qualitative evaluation of ten commonly asked HIV-related patient questions posed to ChatGPT (GPT-4, OpenAI), with responses recorded verbatim and evaluated for depth, clinical nuance, and appropriateness. While responses were largely accurate, they lacked counselling depth and clinical nuance required for individualised patient counselling. These platforms offer accessibility and anonymity, which may benefit people living with HIV seeking sensitive information. However, overreliance on AI-generated responses poses risks of misinformation. The safe and effective incorporation of ChatGPT into HIV counselling practice requires a collaborative approach with physicians, AI developers, and regulatory bodies.
Plain Language Summary HIV care works best when people can continue testing, treatment, follow-up, and support without interruption. However, people affected by conflict, displacement, migration, and fragile health systems often face serious barriers to HIV services. When people are forced to move, they may lose access to clinics, medicines, health records, laboratory tests, and trusted health workers. This can interrupt antiretroviral treatment, delay viral load monitoring, and increase the risk that people living with HIV are left behind. This letter argues that the global goal of ending AIDS by 2030 should not be measured only by national averages or overall treatment targets. It should also ask whether refugees, internally displaced persons, migrants, mobile populations, and people living in insecure areas can continue HIV prevention, treatment, and care. The letter proposes that countries and donors should include crisis-affected populations in HIV plans, provide emergency antiretroviral medicine refills, use portable health records, strengthen cross-border referrals, pre-position HIV supplies in high-risk areas, and support community-led services. Ending AIDS should mean that people are not excluded from care because they live through conflict, displacement, or health-system disruption.
Background We aimed to compare 10-year CVD risk and echocardiographic abnormalities between people living with HIV (PLWH) with immunological non-response (INR) and those with immunological response (IR), and to explore associated factors. Methods This cross-sectional study enrolled 260 PLWH with INR and 260 age- and gender-matched PLWH with IR as controls. All participants underwent echocardiography, and their CVD risk was assessed using the Framingham Risk Score (FRS). Results Compared to controls, the study group had significantly higher 10-year CVD risk (11.86% vs 9.51%, P <0.05) and a greater prevalence of echocardiographic abnormalities (83.5% vs 74.2%, P =0.01). A longer treatment duration, larger waist circumference, prolonged prothrombin time, lower education level, and carotid plaque presence were all significantly associated with increased CVD risk. Within the study group, age and lower CD19+ levels correlated with a higher rate of echocardiographic abnormalities. An interaction between age and immune reconstitution status on CVD risk was observed ( P <0.001). Conclusions Poor immune reconstitution is associated with increased CVD risk and subclinical cardiac abnormalities, particularly among older PLWH. These findings underscore the need for targeted cardiovascular screening in this vulnerable population.
IntroductionHIV testing is vital for early detection and treatment linkage, yet uptake among children remains a global challenge. The 2016 Ethiopian Demographic and Health Survey (EDHS) revealed low HIV testing prevalence in children under 15 years old, with significant urban-rural disparities. This study analyzes these disparities and their contributing factors using EDHS data.MethodsA cross-sectional analysis of the 2016 EDHS was conducted using STATA version 17.0. Chi -square tests were used to assess the associations between HIV testing uptake and independent variables, while multivariate decomposition analysis was used to analyze the factors associated with the urban-rural disparities of pediatric HIV testing uptake. Statistical significance was declared, at p-values < 0.05, with 95% confidence intervals reported. The results were presented using text, tables, and figures.ResultsThe overall prevalence of pediatric HIV testing uptake was 18.61% (95% CI: 18.15%-19.07%), with significantly higher uptake in urban areas (35.66%) compared to rural areas (14.91%) (p < 0.001). A multivariate decomposition analysis revealed a substantial urban-rural disparity (0.21, p < 0.001), of which 50.34% was explained by differences in population characteristics, while 49.66% was due to differences in the effects of these characteristics. Key contributors to the disparity included household wealth, maternal education, child age, family size, premarital HIV testing, and consent refusal.Conclusion and RecommendationThis study revealed a significant urban-rural disparity in pediatric HIV testing uptake, largely explained by differences in population characteristics. Thus, family size and parental education, were found to contribute to increased disparities. Conversely, premarital HIV testing, refusal of consent, and older maternal age demonstrated effects that influenced and, in some cases, reduced the observed gap. The findings suggest the need for targeted, equity-focused interventions to reduce urban-rural disparities in pediatric HIV testing.
Adolescent girls and young women (AGYW) are among the high-risk groups for new HIV infection, particularly in Sub-Saharan Africa (SSA). HIV testing is an entry path to HIV care and treatment and is crucial in ending the HIV epidemic by 2023. Despite the availability of HIV Testing Services (HTS) in most SSA countries, including Tanzania, most AGYW are undiagnosed HIV or have ongoing HIV exposure. This study explored the enablers for and barriers to the uptake of HTS among AGYW aged 15-24 in northern Tanzania. This qualitative study was conducted between 4 th October and 30 th November 2024 in the Kilimanjaro Region, northern Tanzania. We included AGYW attending four purposively selected Care and Treatment (CTC) sites. Four Focused Group Discussions (FGDs) (two for 15-19 years and 20-24 years, respectively) were conducted using a semi-structured interview guide to explore perceived enablers for and barriers to the uptake of HTS among AGYW. Data were analyzed using thematic content analysis, and findings were presented narratively, using verbatim quotes. A total of 32 AGYW participated in the FGDs, more than half (53%) were aged 20- 24 years old and had primary education, and 63% (n = 20/32) were still in school. Perceived enablers that may facilitate the uptake of HTS include small blood samples collected, trust of a sexual partner, confidentiality of HIV test results, and existing social support. Other perceived enablers were the provider-centred HIV approach, comprehensive HIV education, health benefits of ARV use, and antenatal care as an entry point to HTS. Perceived barriers to HTS uptake include lack of HTS knowledge, being asymptomatic, fear of HIV test results, spiritual healing beliefs, being visible at the health facility, and anticipated stigma. Other perceived barriers were the provider’s negative attitudes, long waiting times, lack of confidentiality of HIV test results, and transport costs. This calls for a multifaceted, client-centred intervention that strengthens the perceived enablers and simultaneously addresses the perceived barriers to create an enabling environment for uptake of HTS among AGYW.
Background Probable HIV dementia (PHD) remains a significant complication among people living with HIV(PLWH), particularly in resource-limited settings where access to comprehensive neurocognitive assessment is limited . This study investigated the association between AST-to-ALT ratio and PHD among PLWH on Dolutegravir-based antiretroviral therapy (DTG-based ART). Methods We conducted a secondary analysis using a dataset generated from hospital-based cross-sectional study that consecutively recruited 235 PLWH on DTG-based ART at St. Francis Nsambya Hospital in Kampala, Central Uganda. PHD was defined as International HIV Dementia Scale score ≤10. Results PHD prevalence was 22.1% (52/235; 95% CI: 17.3–27.9) and increased across AST-to-ALT ratio tertiles (13%, 23%, and 31%; p=0.023). Participants in the second and third tertiles had higher odds of PHD (aOR=2.85, 95% CI: 1.13–7.15; p=0.026 and aOR=4.28, 95% CI: 1.75–10.45; p=0.001). Each 0.5-unit increase in the AST-to-ALT ratio increased the odds of PHD by 40% (aOR=1.40, 95% CI: 1.02–1.92; p=0.036). An AST-to-ALT ratio cutoff of 1.26 showed modest discrimination for PHD (AUC=0.622), with 73% sensitivity, 51% and specificity, 29%. Conclusion A higher AST-to-ALT ratio is a potentially useful screening predictor for PHD in PLWH on DTG-based ART in resource limited settings, pending validation in larger prospective studies.
BackgroundCommunity-based ART service delivery brings HIV care closer to clinically stable clients and may improve outcomes while reducing burdens on patients and health facilities. However, evidence from low income setting remains limited.MethodsInstitution based retrospective follow-up study was conducted from 422 adult ART users selected by simple random sampling. Data were analyzed using STATA 15. Multivariable Cox proportional hazards regression identified predictors of treatment outcomes.ResultsThe cumulative incidence of good ART treatment outcome was 81.99% (95% CI: 77.98-85.54%). Median survival time was 11 months (IQR: 5-12). Missing ART doses reduced survival by 54% (AHR=0.46; 95% CI: 0.22-0.95). Good retention in care (AHR=1.58), tuberculosis prophylaxis (AHR=1.38), and adequate drug supply (AHR=1.39) significantly improved survival.ConclusionTreatment outcomes were suboptimal. Strengthening retention, tuberculosis prophylaxis, drug supply, and adherence support could improve survival.
Background HIV-associated lipodystrophy, a complication of combined antiretroviral therapy (CART), causes significant physical and psychological distress in people living with HIV (PLWH), compromising treatment adherence. Tesamorelin, a growth hormone-releasing hormone (GHRH) analogue, has emerged as a therapeutic option. Objective To systematically evaluate the efficacy and safety of tesamorelin in HIV-infected individuals with lipodystrophy receiving CART, incorporating GRADE assessment. Methods We searched PubMed, https://ClinicalTrials.gov , and Scopus from inception to February 9, 2026, for randomized controlled trials evaluating tesamorelin in HIV-associated lipodystrophy. Mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models with heterogeneity assessed by I 2 . Results Four RCTs (909 patients) were included. Tesamorelin 2mg significantly reduced visceral adipose tissue (MD= -21.47, 95%CI[-34.73,-8.22],I 2 =74%,p=0.002), waist circumference (MD-1.61cm,95% CI[-2.28,-0.95],I 2 =0%,p<0.00001), trunk fat (MD-1.20kg, 95%CI[-1.47,-0.93],I 2 =0%,p<0.00001), and increased lean body mass (MD1.42kg,95% CI[1.13,1.71],I 2 =0%,p<0.00001). Modest lipid improvements occurred in total cholesterol (MD-0.16mmol/L,95%CI[-0.27,-0.06],I 2 =0%,p=0.003). Growth hormone-related adverse effects and higher discontinuation rates (RR2.25,95%CI[0.98,5.17],p=0.06) were observed. Conclusions Tesamorelin demonstrates efficacy in reducing visceral adiposity in PLWH with lipodystrophy on CART. However, limited data on long-term safety, optimal dosing strategies, and durability of treatment effects warrant caution. Future research should evaluate extended treatment duration, dose-response relationships, and patient-reported outcomes to establish comprehensive clinical utility.
Objective Black sexual minority men (SMM) in the United States experience disproportionate HIV burden and lower engagement across the HIV Continuum of Care (HIV-CoC), partly due to intersecting stigmas. Structural interventions addressing these barriers remain limited. Methods We developed This is Your Moment (TiYM), a culturally-grounded media campaign designed to mitigate stigma and encourage engagement in care for Black SMM in Atlanta, Georgia. To inform implementation, we conducted focus groups with 63 stakeholders from six clinics and community-based organizations (March-October 2023), guided by the Consolidated Framework for Implementation Research. Transcripts were analyzed thematically. Results Participants described TiYM as highly acceptable, engaging, and relatable. Facilitators included alignment with organization priorities; ease of QR code integration; potential to improve health literacy and reduce stigma. Barriers included concerns about inclusivity and unintended disclosure. Conclusion Key partners perceived TiYM as having strong implementation potential, while identifying barriers for refinement and implementation strategy.
Background This study examined the relationship between oral health and oral sexual behaviour among people living with HIV/AIDS (PLWHA) in Ibadan, Nigeria. Methods This was cross-sectional analysis of baseline screening data collected as part of the Epigenetics of Oral HPV and Associated Oral/Oropharyngeal Cancer Study in PLWHA. Information on socio-demographics, lifestyle, oral health practices, oral sexual behaviour, and HPV awareness was collected. Oral sexual behaviour (giving or receiving) was the outcome variable. Chi-square or Fisher’s exact tests, and multivariable logistic regression were used to identify associated factors. Results Overall, the prevalence of oral sexual behaviour was 15.9%, with higher prevalence in males (33.3%) than females (8.7%). Smoking increased the odds of oral sexual behaviour among males and females, while other associated factors differed by the sex of participants. Conclusion Oral sexual behaviour is common among PLWHA in Nigeria. Integration of oral health and behavioural risk assessment into HIV care may reduce HPV transmission.
Introduction Ongoing internal conflicts in Ethiopia have increased women’s exposure to gender-based violence (GBV), placing them at greater risk of mental distress. Although the Ethiopian Ministry of Health, in collaboration with multiple stakeholders, has implemented interventions to address the mental health needs of GBV survivors, synthesized evidence on the prevalence of mental distress and its associated factors remains limited. Therefore, this systematic review and meta-analysis aimed to estimate the pooled prevalence of mental distress and identify factors associated with mental distress among women who have experienced GBV in Ethiopia. Method We conducted a systematic review and meta-analysis by searching major databases, including PubMed, Scopus, Wiley Online Library, African Journals Online, Web of Science, and ScienceDirect, from January 1, 2026, to February 1, 2026. Google Scholar was also searched. Data were extracted using a standardised Excel form and analysed using STATA version 11. Forest plots, Cochran’s Q test, and subgroup analyses were used to assess heterogeneity. Publication bias was evaluated using funnel plots and Egger’s regression test. A random-effects model was applied to estimate the pooled prevalence of mental distress. Result The pooled prevalence of mental distress among women who experienced gender-based violence in Ethiopia was 62.38% (95% CI: 54.18, 70.57) among 5510 study participants. Lack of formal education(AOR:2.43,95%CI:1.79,3.31),being widowed or separated, rural residence(AOR: 2.10, 95% CI: 1.59,2.76), low monthly income (AOR:2.44,95%CI: 1.49,4.00), exposure to stressful life events(AOR:2.15, 95% CI: 1.03, 23.38), and a family history of mental illness (AOR: 4.56, 95% CI: 2.54,8.21), husbanded substance abused(AOR:2.64,95%CI:1.86,3.75), strong social support (AOR: 0.37, 95% CI: 0.22, 0.61) were identified factors for mental distress. Conclusion Mental distress is highly prevalent among women who experience gender-based violence in Ethiopia. Lack of formal education, rural residence, low income, husband’s substance abuse, having social support, and a family history of mental illness were identified as factors for mental distress. There is an urgent need to strengthen integrated and targeted interventions to address this substantial psychological burden. Strengthening community and family-based social support systems should be prioritised given their strong protective effect.
Objective This study aimed to identify determinants of late ART initiation among adults living with HIV in public health facilities of West Guji Zone, Oromia, Ethiopia. Methods Unmatched case–control study was conducted among 226 adults living with HIV (113 cases and 113 controls) selected by simple random sampling. Data was collected using an interviewer-administered questionnaire and analyzed using SPSS version 25. Multivariable logistic binary regression was used to identify determinants of late ART initiation. Results Late ART initiation was associated with inability to read and write (AOR = 6.21, 95% CI: 2.32–7.98), rural residence (AOR = 4.26, 95% CI: 1.23–14.74), fear of job loss (AOR = 8.43, 95% CI: 6.72–20.05), lack of family support (AOR = 7.28, 95% CI: 1.90–12.19), absence of intention to protect family members (AOR = 6.16, 95% CI: 4.15–12.97), visiting traditional healers (AOR = 5.24, 95% CI: 1.51–13.40), and contact with commercial sex workers (AOR =5.59, 95% CI: 4.07–13.80). Conclusions Delayed ART initiation was driven by interacting sociodemographic, psychosocial, and behavioral factors. Addressing social disadvantages, fear-related concerns, weak family support, and reliance on non-formal care pathways is essential to promote timely initiation of ART.
Introduction Long-acting injectable cabotegravir (CAB-LA) is highly efficacious as PrEP and could increase PrEP coverage, though uptake has been limited. Methods We surveyed healthcare professionals regarding experiences with CAB-LA implementation in the United States. We used descriptive statistics to summarize perceived barriers and Fisher’s exact tests to assess for factors associated with CAB-LA availability and use. Results Among respondents, 71% (51/72) reported their clinic site offered CAB-LA though only 44% (20/45) reported having prescribed it. The most common perceived barriers were concerns about insurance coverage (38/45, 84%), logistics (35/45, 78%), lack of requests (32/45, 71%), concern for missed injections (17/25, 68%), and cost (16/25, 64%). A majority (30/45, 67%) felt that lack of training was a barrier. Availability and prescribing did not vary by demographic or patient panel characteristics (p-values>0.05). Conclusions Healthcare professionals’ perceived barriers to CAB-LA uptake suggest need for improved implementation strategies, specifically surrounding cost, logistics, and education.
IntroductionBreastfeeding in women living with HIV remains controversial despite effective antiretroviral therapy (ART), as a small residual transmission risk persists even with viral suppression, leading to divergent global recommendations.MethodsWe performed a narrative review and policy analysis of randomized trials, international guidelines, and national recommendations (2010-2025), focusing on breastfeeding policies, maternal ART, infant prophylaxis, and monitoring strategies across settings.ResultsEvidence from resource-limited settings shows maternal ART during breastfeeding reduces transmission and improves HIV-free survival, supporting WHO recommendations for breastfeeding with ART and infant prophylaxis. In high-income countries, breastfeeding is often discouraged due to safe alternatives, though some guidelines now allow it under strict viral suppression and close monitoring. Observational studies suggest transmission is rare when suppression is maintained.ConclusionsDifferences in guidance mainly reflect risk tolerance and ethics rather than evidence. Breastfeeding may be considered a conditional option within structured clinical pathways.
Background Routine viral load testing (VLT) is critical for monitoring HIV treatment effectiveness, yet adherence to annual testing and patient engagement remain suboptimal, particularly among women. We evaluated a peer educator–supported, patient-initiated VLT approach in Dar es Salaam, Tanzania. Methods In 2024, a two-arm cluster-randomized trial was conducted across six public HIV clinics. Intervention sites implemented a 4–6-month peer-supported program promoting patient-initiated VLT, while control sites continued routine care. Data from adult PLHIV were analyzed using regression models. Results Among 567 participants, 14.8% had not tested within 12 months, with higher non-testing among men (19.7% vs. 12.2%, p=0.019). Intervention sites showed higher mean numbers tested for men (65 vs. 26) and women (146.4 vs. 57). Although patient-initiated testing was infrequent overall (2.8%), the intervention arm demonstrated higher odds of patient-initiated viral load testing than the control arm (aOR=4.69; 95% CI: 1.30–16.95). Conclusion Peer-supported strategies improved patient-initiated VLT and female engagement but require stronger health system support.
Background Accessing HIV prevention and treatment remains difficult throughout the United States (US). With the shortage of infectious disease physicians, increasing the number of clinicians offering HIV Pre-Exposure Prophylaxis (PrEP), HIV Post-Exposure Prophylaxis (PEP), and Test & Treat (T&T) is imperative. This exploratory project created a consolidated algorithm for HIV treatment and prevention that simplifies care for US providers with limited resources or experiences. Methods The algorithm was designed for PrEP, PEP, and treatment initiation using published guidelines from multiple clinical bodies. Three medications were included in the algorithm: tenofovir disoproxil fumarate, emtricitabine, and dolutegravir. US medical students completed an eight-question pretest unassisted then repeated questions with the algorithm to test the algorithm’s functionality. Questions included clinical scenarios on HIV testing, PrEP, PEP, and T&T. Pearson’s chi-squared compared pre vs post-test scores; total scores (number of items correct) were analyzed using Paired Wilcoxon signed rank test. Results 97 students from 13 medical schools completed pre and post-test questions. Correctness increased from 3 of 8 (pretest) to 7 of 8 (post-test) (p< 0.001). All questions saw statistically significant improvement in correctness when assisted by the algorithm including correctly prescribing PEP, selecting appropriate labs for PrEP initiation, and screening patients with prior cabotegravir-based PrEP using HIV RNA quantitative (p<0.001 for all). Conclusions This algorithm improved medical students’ abilities to accurately answer HIV clinical care questions about HIV prevention and treatment. Further studies are needed to understand the algorithm’s effect in clinical settings and how to implement it in practice.
BackgroundTuberculosis is a major communicable disease and the leading cause of death among people living with HIV/AIDS, accounting for nearly 40% of AIDS-related deaths. This study assessed the incidence and predictors of tuberculosis among adults receiving antiretroviral therapy in Central Gondar Zone, Northwest Ethiopia, from December 2016 to January 2022.MethodsA multicenter retrospective follow-up study was conducted among 488 adult HIV-positive individuals on antiretroviral therapy. Data were collected using an Android-based mobile application and analyzed using a Cox proportional hazards model. Variables with p < 0.05 were considered significant predictors.ResultsThe tuberculosis incidence rate was 2.87 per 100 person-years (95% CI: 2.22-3.70). Increased risk was associated with opportunistic infections (Adjusted Hazard Ratio (AHR)=3.16), poor antiretroviral therapy (ART) adherence (Adjusted Hazard Ratio (AHR)=3.53), and family size ≥5 (AHR=2.36). Isoniazid preventive therapy (IPT) reduced tuberculosis risk (AHR≈0.26-0.29).ConclusionTuberculosis incidence was relatively low. Poor adherence, opportunistic infections, and large family size increased risk, while isoniazid use was protective.
Background In the United States, Southern HIV service organizations (SHSOs) are well-positioned to deliver evidence-based interventions for people living with HIV. However, SHSO leaders often lack the necessary implementation leadership skills. This exploratory study evaluates changes in SHSO leaders’ implementation leadership skills after participation in a capacity-building program. Methods Data were collected as part of the pre-/post-program evaluation from SHSO leaders who participated in a capacity-building program. Results Participant data (n=98) were analyzed using two-way repeated measures ANOVA to examine changes in Implementation Leadership Scale (ILS) scores pre-/post-program participation. Within-subjects effects showed an overall significant difference in ILS scores between pre/post. Between-subjects effects showed no significant differences between programs on ILS scores. Within-subjects effects showed a significant interaction between time and program type on ILS scores. Results of the multivariate Wilks’ lambda test also showed a significant time-by-program interaction on ILS scores. Conclusion Findings underscore the significance of equity-centered capacity-building efforts in bolstering the implementation leadership skills of organizational leaders and the need for continued investment in SHSOs.
