BACKGROUND:Data on the population-scale impact of dolutegravir (DTG)-based HIV regimens in sub-Saharan Africa are extremely limited. We used data from a surveillance cohort in southern Uganda to assess viral suppression and antiretroviral (ART) resistance over 10-years alongside DTG scale-up. METHODS:Consenting participants in the population-based Rakai Community Cohort Study between August 2011 and March 2023 aged 15-49 completed questionnaires and provided samples for HIV testing, viral load quantification, and viral deep-sequencing. We collected data on DTG utilization at HIV care clinics. We estimated the prevalence of HIV suppression and ART resistance using robust Poisson regression. Bayesian logistic regression quantified associations between resistance and individual-level suppression across surveys. RESULTS:Among 8781 people with HIV (PWH), suppression increased from 57.1% (2014, 95% confidence interval [CI], 55.4%-58.8%) to 90.3% (2022, 95% CI, 89.2%-91.4%). By 2020 84.4% (95% CI, 83.7%-85.2%) and 64.6% (95% CI, 63.9%-65.3%) of men and women on ART were on DTG. Among treatment-experienced viremic PWH, any intermediate/high resistance decreased from 51.1% (95% CI, 40.7%-64.2%, 2014) to 27.9% (95% CI, 21.3%-36.5%, 2022). Two of 258 (0.8%) 2022 participants harbored intermediate/high-level DTG resistance (inQ148R, inE138K, and inG140A). inS153Y (2-fold INSTI resistance) was observed in 23/306 (7.5%) of viremic individuals, with evidence of transmission. By 2022, NNRTI/NRTI resistance was not associated with a reduction in individual-level suppression (risk ratios: 1.15, 95% HPD: 0.93-1.39; 1.14, 0.86-1.42). CONCLUSIONS:Viral suppression increased during the DTG transition with minimal emerging intermediate/high-level resistance. Falling resistance among treatment-experienced PWH underscores the role of ART adherence in reducing viremia. The emergence of inS153Y justifies continued surveillance.

INTRODUCTION:Prior studies showed that some female bar workers (FBWs) may engage in sex work in Africa. However, population-level data on HIV burden among FBWs in African settings are rare. METHODS:We used five survey rounds of data (2011-2020) from the Rakai Community Cohort Study, a population-based HIV surveillance cohort in 36 inland agrarian/trading communities (HIV prevalence∼12%) and four Lake Victoria fishing communities(∼40%) in southern Uganda. Women reporting bar work as a primary or secondary occupation were identified and compared to non-FBWs. Primary outcomes included HIV seropositivity, incident infection, viral suppression (<200copies/ml) among women with HIV, and population prevalence of viremia. Prevalence ratios (PRs) and incidence rate ratios (IRRs) were estimated using Poisson regression with 95% confidence intervals (CIs). RESULTS:Among 23,556 female participants contributing 52,708 person-visits, 1,205(5.1%) self-identified as FBWs, who had significantly higher baseline HIV seroprevalence than non-FBWs (51.9%vs.18.5%;PR=2.81,95%CI=2.64-2.95). There were 356 incident infections over 39,228 person-years. HIV incidence among FBWs was 2.49/100 person-years compared to 0.87 among non-FBWs (age-adjusted IRR=3.64,95%CI=2.33-5.42). While HIV viral suppression was similar among participants living with HIV regardless of FBW status, the population prevalence of HIV viremia was 1.69 times higher among FBWs (95%CI=1.38-2.08). Among 179 HIV-seronegative FBWs surveyed in 2018-2020, 79.9%(143/179) were aware of PrEP, while only 13.4%(24/179) had ever used it, with just 2.8%(5/179) current users. CONCLUSIONS:FBWs in Uganda experience substantially higher HIV burden and acquisition risk compared to the general population. Prevention strategies tailored to the occupational context of bar work, including prioritization of HIV service delivery and access to oral and long-acting injectable PrEP, may substantially reduce HIV incidence among FBWs and their sexual partners.

Health and illness experiences are positioned within social and cultural contexts. Understanding the mental health and psychological distress of people living with HIV in highly affected communities is critical to addressing their needs and to ensure programming and interventions are targeted and appropriate. Grounded in the ethnomedical theoretical perspective, we conducted qualitative interviews to understand the experience and expression of psychological distress by people living with HIV in Rakai, Uganda. Participants included adults living with HIV (n = 20), health workers (counselors, peer health workers, nurses, n = 10), and key informants (n = 12). Interviews were audio recorded, transcribed/translated, coded, and analyzed using thematic analysis. Two idioms of distress, okweraliikirira (worry/apprehension) and okwenyamira (deep/many thoughts/lots of thoughts), were described as impacting people living with HIV. Both idioms were said to be alleviated by social support or counseling, but if left unaddressed could lead to more severe mental health problems and poor ART adherence. People living with HIV understand their psychological distress through culturally specific idioms; such distress can have deleterious impacts on well-being. Incorporating idioms of distress into screening and treatment for people living with HIV may improve identification of individuals in need and overall health services to address this need.

Although social relationships impact health and social dynamics play a key role in shaping HIV vulnerability, results from intentional efforts to build or strengthen social relationships have not been synthesized to understand if and how such interventions work to prevent HIV in low- and middle-income countries (LMICs). We conducted a systematic review of HIV prevention interventions implemented in LMICs, published between 2010 and 2022, that used pre/post or multi-arm methods to evaluate interventions that focused on building/strengthening social relationships to impact HIV-related outcomes. We searched PubMed, CINAHL, EMBASE, Sociological Abstracts, and PsycInfo on August 16, 2022, complemented by hand-searching and secondary reference searching. We used a standardized form for data abstraction and assessed risk of bias using the Evidence Project tool. Results were synthesized narratively, and studies were classified in an emergent typology based on the function of social tie building within the intervention. Fifty-one articles presenting results from 28 studies met the inclusion criteria and were included. Within these studies, we identified five types of social tie interventions, including community-wide social mobilization (“collaboration”, n = 3), formation of collectives to address both upstream and downstream health-related factors (“collectivization”, n = 13), forming or strengthening groups to enhance peer support and build skills (“clubs”, n = 4), expanding personal networks among individuals (“companionship”, n = 2), and strengthening ties between heterogeneous groups/non-peers (“connections”, n = 2). Four studies addressed two or more types of social ties strengthening and were classified as “cross-cutting.” Across these categories, most studies found that interventions were associated with some positive health-related changes, such as reduced HIV incidence, increased condom use, and increased health service utilization. However, some interventions fell short of their stated goals, especially those striving to impact upstream social and structural factors. Overall, results suggest that social ties can be intentionally altered to effect change; however, disparate contexts and implementation dynamics likely contributed to variation seen across outcomes and impact. Inconsistent measurement of social ties and use of theory made it challenging to determine whether interventions were explicitly trying to alter ties, and if so, to what extent tie building/strengthening impacted intervention effectiveness. To continue advancing our understanding of social tie interventions, more efforts are needed to operationalize theory, measure social tie constructs, describe intervention context and implementation outcomes, and apply innovative study designs.

There is limited population-level data on the pre-exposure prophylaxis (PrEP) care continuum in eastern Africa. Here, we assessed the PrEP care continuum following PrEP rollout in a Ugandan community with ~40% HIV seroprevalence. We used cross-sectional population-based data collected between September 3 and December 19, 2018 from a Lake Victoria fishing community in southern Uganda to measure levels of self-reported PrEP awareness, ever-use, and discontinuation following 2017 PrEP rollout via a U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)-supported phased implementation program. Our analysis included HIV-seronegative persons reporting having ever received an HIV test result. We examined associations between demographic, behavioral, and health utilization factors with each outcome using age-adjusted modified Poisson regression. There were 1,401 HIV-seronegative participants, of whom 1,363 (97.3%) reported ever receiving an HIV test result. Median age was 29 years (IQR: 23–36), and 42.3% (n = 577) were women. Most (85.5%; n = 1,166/1363) participants reported PrEP awareness, but few (14.5%; n = 197/1363) reported ever using PrEP. Among 47.7% (375/786) of men and 29.3% (169/577) of women PrEP-eligible at time of survey, 18.9% (n = 71/375) and 27.8% (n = 47/169) reported ever using PrEP, respectively. Over half (52.3%, n = 103/197) of those who had ever used PrEP, self-reported current use. In this Lake Victoria fishing community, there were low levels of PrEP use despite high levels of PrEP awareness and eligibility, particularly among men. Efforts that enhance awareness of HIV risk and increase PrEP accessibility may help increase PrEP use among HIV-seronegative persons in African settings with high HIV burden.

Background:HIV remains a significant global public health challenge, disproportionately affecting adolescent girls and young women (AGYW). Uganda has adopted different strategies of HIV Testing Services (HTS) to improve access and utilization, but the uptake of these services by AGYW is still low. This study explored barriers, facilitators, and preferences for HTS among AGYW in Rakai district, Central, Uganda. Methods:This qualitative study employed in-depth interviews with 24 purposively selected AGYW aged 15-24 years who had used HTS at least once in the past year. Participants were drawn from diverse backgrounds based on age, residence (fishing or mainland communities), schooling, employment, and marital status. Data were analyzed thematically using both inductive and deductive approaches in Atlas.ti software. Results:Key barriers to HTS uptake varied by age and residency. Adolescent girls aged 15-19 years, especially those in school, expressed strong fear of blood-based testing and discomfort with invasive procedures, while young women aged 20-24 years emphasized long waiting times, provider attitudes, and confidentiality concerns, particularly in public facilities. AGYW from fishing communities reported heightened stigma and privacy challenges in public facilities, making them more reliant on discreet mobile and outreach services. In contrast, mainland residents favored private facilities for their efficiency. Facilitators across all groups included mobile HTS and community outreaches, which improved accessibility and reduced logistical barriers to utilization. Younger adolescents preferred saliva-based, less invasive tests, while older participants favored facility-based testing for the professional support it offered. Preferences also varied across provider characteristics: married and older AGYW favored experienced adult providers, while younger participants, particularly in mainland areas, expressed comfort with male providers seen as more empathetic. Conclusion:HTS strategies should offer a diverse range of service delivery options that reflect the varied preferences and needs of AGYW by age and residency. Expanding mobile testing, offering less invasive options, ensuring confidentiality, and improving provider interactions are critical for increasing HTS uptake in high-risk settings like Rakai.

INTRODUCTION:In Africa, migrants are more likely to be living with HIV and HIV viremic than nonmigrants, but less is known about HIV outcomes among nonmigrants living in households with migrants. We compared HIV outcomes in nonmigrating persons in households with and without migration. METHODS:We analyzed cross-sectional data collected between August 2016 and May 2018 from nonmigrating participants aged 15-49 years in the Rakai Community Cohort Study in Uganda. Migrant households were classified as those reporting ≥1 member moving into or out of the household since the prior survey. HIV serostatus was determined using a validated testing algorithm, and viremia defined as >1000 copies/mL. Modified Poisson regression was used to estimate prevalence ratios between household migration and HIV outcomes. Analyses were stratified by gender, direction of migration (into/out of household), and relationship between nonmigrants and migrants (eg, spouse). RESULTS:There were 14,599 nonmigrants (52% women) and 4415 (30%) lived in a household with ≥1 migrant. Of these, 972 (22%) had migrant spouses, 1102 (25%) migrant children, and 875 (20%) migrant siblings. Overall, HIV prevalence and viremia did not differ between nonmigrants in households with and without migration. However, in stratified analyses, nonmigrant women with migrant spouses were significantly more likely to be HIV seropositive compared with nonmigrant women with nonmigrant spouses [adjusted prevalence ratio: 1.44, 95% confidence interval: 1.21 to 1.71]. Conversely, nonmigrant mothers living with HIV who had migrant children were less likely to be viremic (adjusted prevalence ratio: 0.34, 95% confidence interval: 0.13 to 0.86). CONCLUSIONS:Nonmigrating women with migrating spouses are more likely be living with HIV, and may benefit from additional HIV support services.

BACKGROUND:Adolescent girls' and young women's (AGYW) heightened HIV vulnerability has been understudied in West and Central Africa, where AGYW account for 1 in 5 new HIV diagnoses. Identifying contextually specific drivers of AGYW's HIV risk can help tailor HIV prevention programming to AGYW in the region. METHODS:We pooled data from nationally representative HIV-seroprevalence surveys for sexually active AGYW in Cameroon and Côte d'Ivoire. We used latent class analysis to partition past-year sexual partnerships into discrete typologies based on 6 relationship characteristics: cohabitation, known partner HIV status, condom use at last sex, age mixing (≥5-year age disparity), transactional sex, and likelihood of having sex again. Mixture modeling with cluster-robust standard errors then assessed differences in AGYW's HIV seropositivity by partnership type. RESULTS:Overall, 5482 AGYW reported 6389 past-year sexual partners. Four distinct partnership types emerged from LCA: Type 1 (Cohabiting, Age-Disparate Partners: ∼46%); Type 2 (Non-Cohabiting, Similar-Aged Partners: ∼15%); Type 3 (One-Off, Age-Disparate Partners: ∼30%); and Type 4 (Non-Cohabiting, Permanent, Age-Disparate Partners: ∼9%). AGYW reporting One-Off, Age-Disparate Partners and Non-Cohabiting, Permanent, Age-Disparate Partners exhibited significantly ( P < 0.05) elevated adjusted odds of HIV seropositivity relative to AGYW reporting Cohabiting, Age-Disparate Partners and Non-Cohabiting, Similar-Aged Partners, respectively. CONCLUSIONS:AGYW reported heterogeneous partnerships that were differentially associated with HIV seropositivity, suggesting discrete relationship characteristics may confer differential HIV acquisition risks among AGYW. Delivery of HIV prevention (ie, long-acting injectable pre-exposure prophylaxis) and diagnostic (ie, HIV self-testing) technologies should be prioritized among AGYW with older, nonpermanent partners, where HIV burdens appear most pronounced.

Background:Female bar or sex workers (FBSWs) in Eastern Africa experience a high burden of HIV. However, there is limited population-level data on HIV seroprevalence, incidence, and viral suppression among their male partners. Methods:Men who had sex with FBSWs in the past year were identified through longitudinal population-based HIV surveillance in southern Uganda between 2013 and 2020. Surveillance was conducted over four surveys in four Lake Victoria fishing communities (HIV seroprevalence~40%) and 37 inland agricultural and trading communities (~12%). Primary outcomes included laboratory-confirmed HIV seropositivity, incident infection, and viral suppression (<200 copies/mL). Prevalence and incidence rate ratios (PR, IRR) were estimated using univariable and multivariable Poisson regressions with 95% confidence intervals (95%CIs). Findings:17,438 male participants contributed 35,273 visits, with 2,420 (13.9%) reporting FBSW partners at ≥1 study visit. Men with FBSW partners tended to be older, have less education and lower incomes, and be previously married compared to those without. HIV seroprevalence was significantly higher among men with FBSW partners (vs. without FBSW partners) in both inland (21.0%vs.7.5%; PR=2.79,95%CI=2.41-3.23) and fishing communities (38.6%vs.23.0%; PR=1.67,95%CI=1.53-1.84). Overall, 154 HIV incident events occurred over 27,396 years of participant follow-up. HIV incidence was also higher among men with FBSW partners than those without (1.93vs.0.44/100 person-years; IRR=4.37,95%CI=3.04-6.16). Among men with HIV, viral suppression was similar among those with and without FBSW partners. However, the population prevalence of HIV viremia was 1.6 times higher (95%CI=1.41-1.84) among men with FBSW partners due to a higher background seroprevalence of HIV. Interpretation:Men in Uganda frequently report sex with FBSWs, which is associated with a significantly higher risk of HIV acquisition. Tailored HIV prevention strategies, including the promotion and uptake of PrEP, are essential to reduce the HIV burden in this population. Funding:National Institute of Allergy and Infectious Diseases, National Institutes of Health.

Background Studies have shown that clients accept the self-collection of samples for sexually transmitted infection testing (SCS/STI testing), and at-home service delivery is a promising approach to expand diagnosis. However, few studies have examined client values surrounding service delivery in low-resource settings. This formative research study explores clients' service delivery values and preferences for at-home SCS/STI testing in rural Uganda. Methods We conducted semi-structured interviews with 36 adults - 15 males and 21 females - who self-collected a sample for STI testing in Rakai, Uganda, as part of the Rakai Community Cohort Study. After self-collection, participants were asked for their preferences on various at-home service delivery components, including: (1) requesting/receiving testing materials, (2) sending samples to the laboratory, (3) receiving results, and (4) receiving treatment; as well as various service delivery models. We also conducted interviews with nine key informants to contextualize results. Using the framework method, we identified key preferences across all participants, and stratified by gender. Results Participants most valued an at-home SCS/STI testing program that offered timely service, as well as health professionals' expertise. Clients also valued privacy/confidentiality; certainty that processes were completed correctly; access to services/resources; and ownership/responsibility for their own health. Although these values were expressed by both genders, access, privacy/confidentiality and ownership/responsibility were more prominent among females. Conclusions Our findings suggest a potential role for at-home SCS/STI testing in this population, as long as key client values are addressed. Program implementers will need to consider how to balance convenience for clients with professional support.

Background:There is a substantial evidence base documenting the impact of gender-affirming care on health outcomes among transgender (trans) and gender-diverse people globally, but this rapidly growing body of evidence has not been comprehensively synthesized. Methods:We conducted a systematic review of studies examining outcomes, values and preferences, and costs of gender-affirming care. Protocols were registered in PROSPERO (CRD42024539078 and CRD42024569628). We searched CINAHL, Cochrane Central, Embase, LILACS, PsycINFO, PubMed, and grey literature sources for studies published between 1 January 2018 and 31 March 2024. The outcomes review included data from randomized controlled trials and longitudinal studies that compared health outcomes among adults (age 18+) who received gender-affirming care to those who did not. We synthesized data by subtype (e.g. psychosocial, hormone therapy, surgical) and by study design, using GRADE evidence profiles. We assessed risk of bias with the Cochrane ROB2 and ROBINS-I tools. We summarized values and preferences data qualitatively and provided confidence ratings using GRADE CERQual, and narratively summarized cost data. Findings:Twenty-eight studies, including four randomized controlled trials and 24 longitudinal studies, evaluated health outcomes following gender-affirming care. Moderate to very low certainty evidence from these studies suggests gender-affirming care may improve quality of life, stigma, utilization of health services, and mental health. No studies identified significant negative outcomes or harms. An additional 87 values and preferences studies, six of which also provided cost data, found that gender-affirming care is acceptable and affordable, although costs vary by type of care. Interpretation:Gender-affirming care may improve critical outcomes, including quality of life, among trans and gender-diverse adults who seek this care. Additional data from prospective controlled studies would enhance the evidence base to comprehensively document the impact of gender-affirming care on physical and mental health outcomes. Funding:World Health Organization through a grant from the Elton John AIDS Foundation and the Bill and Melinda Gates Foundation.

Background. A substantial proportion of persons on antiretroviral therapy (ART) considered lost to follow-up have actually transferred their human immunodeficiency virus (HIV) care to other facilities. However, the relationship between facility switching and virologic outcomes, including viral rebound, is poorly understood. Methods. We used data from 40 communities (2015-2020) in the Rakai Community Cohort Study to estimate incidence of facility switching and viral rebound. Persons aged 15-49 years living with serologically confirmed HIV who self-reported ART use and contributed >= 1 follow-up visit were included. Facility switching and virologic outcomes were assessed between 2 consecutive study visits (ie, index and follow-up visits, interval of approximately 18 months). Those who reported different HIV treatment facilities between index and follow-up study visits were classified as having switched facilities. Virologic outcomes included viral rebound among individuals initially suppressed (<200 copies/mL). Multivariable Poisson regression was used to estimate associations between facility switching and viral rebound. Results. Overall, 2257 persons who self-reported ART use (median age, 35 years; 65% female, 92% initially suppressed) contributed 3335 visit-pairs and 5959 person-years to the analysis. Facility switching was common (4.8 per 100 person-years; 95% confidence interval [CI], 4.2-5.5) and most pronounced in persons aged <30 years and fishing community residents. Among persons suppressed at their index visit (n = 2076), incidence of viral rebound was more than twice as high in persons who switched facilities (adjusted incidence rate ratio = 2.27; 95% CI, 1.16-4.45). Conclusions. Facility switching was common and associated with viral rebound among persons initially suppressed. Investments in more agile, person-centered models for mobile clients are needed to address system inefficiencies and bottlenecks that can disrupt HIV care continuity.

Due to the high prevalence of childhood obesity, it is imperative to assess the relationship children's access to food retailers and obesity. However, the influence of methodological decisions on these associations has been understudied. We examined relationships between different measures of geospatial food environment (using 4 data sources, and 2 data processing methods), and BMI in a sample of low-income children in Baltimore, Maryland. The choice of data sources and data processing methods produced large differences in estimates of children's exposures to certain store types, such as supermarket-like stores, but had less impact on associations with BMI z-scores.

Mental health is conceptualized differently across cultures, making cross-cultural validation of screening tools critical. In Uganda, we used cognitive interviewing to assess and adapt three scales for measuring psychological distress: the Thinking a Lot Questionnaire, the Patient Health Questionnaire 9 (PHQ-9), and the Hopkins Symptoms Checklist (HSCL). We recruited 12 people living with HIV from the Rakai Community Cohort Study (RCCS) and interviewed seven potential users of the scales (four RCCS survey interviewers and three local health workers). Data were analyzed systematically using a team-based matrix approach. The HSCL was generally well understood, with minor clarifications needed. The Thinking a Lot Questionnaire was also well understood, though differences between “how much” and “how often” required specificity. Both included local idioms of distress from prior adaptations. The PHQ-9 performed less well, with many questions interpreted variably or showing unclear local applicability, especially among people living with HIV. For example, questions about trouble concentrating were misunderstood, focusing on examples like newspapers rather than the broader issue of concentration. Future research should explore the validity and utility of commonly used instruments as mental health research expands in Africa.

BACKGROUND:Key populations are disproportionately affected by HIV, viral hepatitis (VH), and sexually transmitted infections (STIs) and face barriers to care. Peer navigation programs are widely used, but evidence supporting their use has not been synthesized. SETTING:Peer navigation programs for sex workers, men who have sex with men, people who inject drugs, prisoners, and trans and gender diverse people globally. METHODS:To inform World Health Organization guidelines, we conducted a systematic review of effectiveness, values and preferences, and cost studies published between January 2010 and May 2021. We searched CINAHL, PsycINFO, PubMed, and EMBASE; screened abstracts; and extracted data in duplicate. The effectiveness review included randomized controlled trials and comparative observational studies evaluating time to diagnosis or linkage to care, treatment initiation, treatment retention/completion, viral load, cure, or mortality. We assessed risk of bias and summarized findings in GRADE evidence profiles. Values and preferences and cost data were summarized descriptively. RESULTS:Four studies evaluated the effectiveness of peer navigators for key populations. All were focused on HIV; none were designed for VH or STIs. These studies showed mixed effects on linkage to care, treatment retention/completion, and viral load; no studies measured treatment initiation, cure, or mortality. Two values and preferences studies with community-based organization staff and health workers suggested peer navigators for key populations were acceptable and valued, although continued challenges remained. No cost studies were identified. CONCLUSIONS:Although limited, available studies provide moderate certainty evidence for benefits of HIV/VH/STI peer navigation programs for key populations. Further evaluations are needed.

Social capital, defined as the nature of the social relationship and the resources embedded within the social network of an individual or community, influences how individuals within a group interact and collaborate within their communities or organizations. While it is acknowledged that social capital can be drawn from as a coping strategy to mitigate financial stress, there is a notable absence of the lived experience in the literature on how social capital influences households to tap resources from their social network. We have investigated the role of social capital in healthcare financing in rural Uttar Pradesh, India, highlighting the challenges faced by households in managing healthcare expenses. We took a qualitative research approach, conducting in-depth interviews with 24 households in the Hardoi District of Uttar Pradesh in August 2017 to explore participants’ lived experience of accruing support from their community during their healthcare crisis. Data analysis followed a thematic content analysis approach. The study finds that households leverage social capital for both financial and non-financial support during health crises. Social networks, trust, and community cohesion play critical roles in resource acquisition. However, overreliance on social capital can be coercive, leading to inequity, privacy invasion, and dependency. Though social capital serves as a crucial resource of support in healthcare emergencies, its unequal distribution and potential for misuse highlight the need for more structured health financing policies in India. The findings underscore the importance of integrating community-driven resources into broader health financing strategies, considering local social structures and community dynamics.

Female sex workers (FSW) are highly mobile, which may result in reduced access to and use of health services and increased risk for poor health outcomes, particularly for those living with HIV. Mobility includes spatial, temporal, and social elements that are not fully captured by quantitative measures. We conducted two rounds of in-depth interviews with FSW living with HIV in Iringa, Tanzania (n = 20), and Santo Domingo, Dominican Republic (n = 20), to describe mobility experiences and compare mobility narratives across settings. We integrated a thematic analysis of all interviews with a narrative analysis of a subset of 10 information-rich interviews (five in each country) with women who had recently traveled, for sex work or another reason, outside of their hometown. Across narratives, FSW living with HIV traveled locally or to seasonal destinations, for short and long periods. Social factors influencing mobility included economic drivers; risk of arrest, harassment, or violence; anonymity and/or familiarity; social relationships; and clients’ mobility. Spatial, temporal, and social factors intersected in unique ways in FSW’s mobility experiences, yet distinct mobility typologies were evident across settings and destinations. Together, mobility narratives of FSW living with HIV can inform quantitative research on mobility typologies in Tanzania, the Dominican Republic, and elsewhere. With the potential for economic circumstances, climate change, and other emergencies to increase people’s mobility around the world, researchers and practitioners can learn from the lived experiences of FSW to inform whether and how to tailor and improve the accessibility of HIV care and treatment interventions based on spatial, temporal, and social characteristics of mobility.

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

Abstract Background Herpes simplex virus type 2 (HSV-2) is an incurable sexually transmitted infection associated with increased risk of acquiring and transmitting human immunodeficiency virus (HIV). HSV-2 is highly prevalent in sub-Saharan Africa, but population-level estimates of incidence are sparse. Methods We measured HSV-2 prevalence from cross-sectional serological data among adults aged 18–49 years in 2 south-central Uganda communities (fishing, inland). We identified risk factors for seropositivity, then inferred age patterns of HSV-2 with a Bayesian catalytic model. Results HSV-2 prevalence was 53.6% (n = 975/1819; 95% confidence interval, 51.3%–55.9%). Prevalence increased with age, was higher in the fishing community, and among women, reaching 93.6% (95% credible interval, 90.2%–96.6%) by age 49 years. Factors associated with HSV-2 seropositivity included more lifetime sexual partners, HIV positive status, and lower education. HSV-2 incidence peakied at age 18 years for women and 19–20 years for men. HIV prevalence was up to 10-fold higher in HSV-2–positive individuals. Conclusions HSV-2 prevalence and incidence were extremely high, with most infections occurring in late adolescence. Interventions against HSV-2, such as future vaccines or therapeutics, must target young populations. Remarkably higher HIV prevalence among HSV-2–positive individuals underscores this population as a priority for HIV prevention.