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The global HIV response has made tremendous progress but is entering a new phase with additional challenges. Scientific innovations have led to multiple safe, effective, and durable options for treatment and prevention, and long-acting formulations for 2-monthly and 6-monthly dosing are becoming available with even longer dosing intervals possible on the horizon. The scientific agenda for HIV cure and remission strategies is moving forward but faces uncertain thresholds for success and acceptability. Nonetheless, innovations in prevention and treatment have often failed to reach large segments of the global population (eg, key and marginalised populations), and these major disparities in access and uptake at multiple levels have caused progress to fall short of their potential to affect public health. Moving forward, sharper epidemiologic tools based on longitudinal, person-centred data are needed to more accurately characterise remaining gaps and guide continued progress against the HIV epidemic. We should also increase prioritisation of strategies that address socio-behavioural challenges and can lead to effective and equitable implementation of existing interventions with high levels of quality that better match individual needs. We review HIV epidemiologic trends; advances in HIV prevention, treatment, and care delivery; and discuss emerging challenges for ending the HIV epidemic over the next decade that are relevant for general practitioners and others involved in HIV care.

In Asia, Thailand was one of the earliest countries to begin a national HIV treatment programme for children in the mid-2000s, and now ∼1800 adults >18 years of age are estimated to be living with perinatal HIV—with the oldest in their third decade (Thai National AIDS Program, 2022 data). The latter even has certification processes for cardiologists seeking to provide “adult congenital” care, together with clinical practice guidelines (American Heart Association and American College of Cardiology, European Society of Cardiology) [ 15]. National programmes have confidence in the rigorous approaches taken to formulate this guidance, which has primarily been through the World Health Organization, and routinely adopted them.

COVID-19 has rapidly emerged as a global public health threat with infections recorded in nearly every country. Responses to COVID-19 have varied in intensity and breadth, but generally have included domestic and international travel limitations, closure of non-essential businesses, and repurposing of health services. While these interventions have focused on testing, treatment, and mitigation of COVID-19, there have been reports of interruptions to diagnostic, prevention, and treatment services for other public health threats. We conducted a scoping review to characterize the early impact of COVID-19 on HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. A scoping literature review was completed using searches of PubMed and preprint servers (medRxiv/bioRxiv) from November 1st, 2019 to October 31st, 2020, using Medical Subject Headings (MeSH) terms related to SARS-CoV-2 or COVID-19 and HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. Empiric studies reporting original data collection or mathematical models were included, and available data synthesized by region. Studies were excluded if they were not written in English. A total of 1604 published papers and 205 preprints were retrieved in the search. Overall, 8.0% (129/1604) of published studies and 10.2% (21/205) of preprints met the inclusion criteria and were included in this review: 7.3% (68/931) on HIV, 7.1% (24/339) on tuberculosis, 11.6% (26/224) on malaria, 7.8% (19/183) on sexual and reproductive health, and 9.8% (13/132) on malnutrition. Thematic results were similar across competing health risks, with substantial indirect effects of the COVID-19 pandemic and response on diagnostic, prevention, and treatment services for HIV, tuberculosis, malaria, sexual and reproductive health, and malnutrition. COVID-19 emerged in the context of existing public health threats that result in millions of deaths every year. Thus, effectively responding to COVID-19 while minimizing the negative impacts of COVID-19 necessitates innovation and integration of existing programs that are often siloed across health systems. Inequities have been a consistent driver of existing health threats; COVID-19 has worsened disparities, reinforcing the need for programs that address structural risks. The data reviewed here suggest that effective strengthening of health systems should include investment and planning focused on ensuring the continuity of care for both rapidly emergent and existing public health threats.

The Journal of the International AIDS Society (JIAS) would like to express our gratitude to the peer reviewers who contributed to reviewing articles for the journal in 2023. Kenneth Mayer, co-Editors-in-Chief Annette Sohn, co-Editors-in-Chief Marlène Bras, Executive Editor Aaloke Mody Adam Trickey Adekemi Sekoni Aditi Ramakrishnan Aditya Subhash Khanna Alana T. Brennan Albert Liu Alex Dubov Alex Keuroghlian Alex Viguerie Alexander Adia Alexandra C. Vrazo Allan Maleche Allanise Cloete Allison McFall Amelia M. Stanton Amy Zheng Anatole Menon-Johansson Andrea Jane Low Andrew Hill Andrew McAuley Andrew Prendergast Angela Bengtson Aniruddha Hazra Ann Gottert Anna Bershteyn Anna Grimsrud Anthony Fojo Antons Mozalevskis Anupam Garrib Aoife Doyle April D. Kimmel Ariane van der Straten Ashley Lacombe-Duncan Augustine Talumba Choko Bankole Olatosi Benjamin Brown Benjamin H. Chi Bernadette Kina Kombo Bernard Surial Bill G. Kapogiannis Bindiya Meggi Brandon Guthrie Brenda Hoagland Brennan Cebula Brian Zanoni Bronwyn Elizabeth Bosch Brooke E. Nichols Bruce Richman Caitlin Dugdale Camille Cioffi Carla Pires Carmen Logie Carol S. Camlin Carol Strong Caroline De Schacht Caroline Foster Carolyn Bolton-Moore Carolyn Lauckner Catherine Godfrey Catherine Lesko Cheryl Case Johnson Chris Collins Christian Kraef Christina Psaros Chutima Suraratdecha Claudia Estcourt Clemens Benedikt Collins Iwuji Daisuke Mizushima Daniel Fierer Danielle Resar Darrell Tan David Allen Roberts David B. Hanna David Dunn David Hoos David V. Glidden Dean Murphy Deanna Kerrigan Debrah Boeras Denis Nash Denise Jacobson Didier Ekouevi Dobromir Dimitrov Donn Colby Doris Chibo Dorlim Antonio Moiana Uetela Dvora Joseph Davey Edinah Mudimu Elaine J. Abrams Elenore P. Bhatraju Elijah Kakande Elizabeth T. Knippler Elliot Raizes Elona Toska Emily Chasco Emily Hyle Emma Kalk Erica N. Browne Erin Graves Erin Wilson Estevão P. Nunes Esther C. Atukunda Fiona Burns Florence Anabwani Francoise Renaud Fumiyo Nakagawa Gabriel Chamie Gbolahan Ajibola Gene Morse George Ayala George Siberry Gesine Meyer Rath Giang Thi Hoang Gillian Dougherty Giuliana Jacqueline Morales Guan-Jhou Chen Habib Ramadhani Halima Dawood Hanne Zimmermann Heather Bailey Heather Pines Heather-Marie Schmidt Helena Rabie Homaira Hanif Hong Chen Ian Hodgson J. Joseph Lawrence Jack DeHovitz Jack Stone Jacklyn D. Foley James Ayieko James Carlucci Jane Tomnay Jason W. Mitchell Jasper S. Lee Javier Rodriguez-Centeno Jean de Dieu Tapsoba Jean-Pierre Routy Jennifer Cocohoba Jennifer M. Belus Jennifer Sherwood Jeremy Penner Jerome Timothy Galea Jessica E. Haberer Jessica J. Justman Jienchi Dorward Jing Zhang Joel Msafiri Francis Joep J. Van Oosterhout John Chiosi John M. Humphrey John Stover Jonathan Ross Jose A. Bauermeister Joseph Kagaayi Julia Raifman Julia Rohr Julie Pulerwitz Junko Tanuma K. Rivet Amico Kai J. Jonas Kaitlyn Atkins Karin Hatzold Karl Technau Karsten Lunze Kassem Bourgi Kate Wilson Katerina Christopoulos Katherine Horton Kathleen MacQueen Kathrine Meyers Katrina Frances Ortblad Kawango Agot Kelika Konda Kelli O'Laughlin Kerry Mangold Kim A. G. J. Romijnders Kim Steegen Kimberly Hook Kimberly Powers Kostyantyn Dumchev Kristen A. Stafford Landon Myer Lara Vojnov Larry W. Chang Laura Beres Laura C. Nyblade Laura Oyiengo Laura Waters Lawrence Long Lee Fairlie Linda J. Koenig Lisa Lynn Abuogi Lisa O'Brien Lise Jamieson Lorena de la Mora Lori Miller Louise Kuhn Luann Hatane Luis Sagaon-Teyssier Lynda Myra Oluoch Lynne Wilkinson Maarten Reitsema Madeleine Goldstein Marguerite Thorp Mariano Kanamori Marilyn Lake Mario Enrico Canonico Marjorie Opuni Mark Sonderup Mary Ann Davies Mary Jane Rotheram-Borus Mary Jo Trepka Mary Tumushime Mathieu Maheu-Giroux Matthew Hogben Matthew D. Hickey Maxime Inghels Megan Rose Curtis Mehri McKellar Mélanie Plazy Melissa Mugambi Melissa Schnure Michael Traeger Michele Montandon Michele P. Andrasik Michelle Ann Bulterys Milosz Parszewski Minh Le Mmamapudi Kubanje Molly Rosenberg Monisha Sharma Moses H. Bateganya Mostafa Dianatinasab Musonda Simwinga Nancy Puttkammer Natalia Lorna Laufer Natella Rakhmanina Nathan P. Ford Navindra E. Persaud Nelson Kalema Ngai-sze Wong Nicolette M. du Plessis Nikki Cockern Nikos Pantazis Nivedita Bhushan Nobubelo Ngandu Nomathemba Chwoneso Chandiwana Norma Ware Nyikadzino Mahachi Obinna Ikechukwu Ekwunife Ola Farid Jahanpour Olga Morozova Oliver T. Stirrup Pablo Noel Perez Guzman Pamela Bachanas Parastu Kasaie Patience Nyakato Peter F. Rebeiro Peter Havens Phillip Keen Pierre DeBeaudrap Poyao Huang Praphan Phanuphak Priscilla Ruvimbo Tsondai Rachel Gruver Radhika Sundararajan Rebecca Zimba Rena Patel Reshmie Ramautarsing Richard Harding Robert Remien Robin MacGowan Roger Detels Roger Ying Romain Palich Rose Pollard Kaptchuk Rupa Patel Sajida Julius Kimambo Samantha Yeager Samuel A. Jenness Sarah B. Puryear Sarah Bernays Sarah K. Calabrese Sarah-Jane Anderson Scholastic Ashaba Scott Dryden-Peterson Serena Rajabuin Seth Frndak Sharmistha Mishra Sharon Louise Hillier Sheetal Kassim Shelley N. Facente Shenaaz Pahad Sheree Renae Schwartz Sherrie Kelly Shobna Sawry Sinead Delany-Moretlwe Siobhan Crowley Sita Lujintanon Siyang Xia Solange Baptiste Sophie J. S. Pascoe Souleymane Diabate Steffanie Strathdee Stella Zawedde Muyanja Stephan Rabie Stephen Okoboi Steven Meanley Steven Safren Susan Blair Timberlake Susan Buchbinder Susan Marie Graham Susanne Dam Nielsen Sylivia Nalubega Sylvie Deuffic-Burban Sylvie Naar Takashi Muramatsu Tali Cassidy Tampose Mothopeng Tamsin Kate Phillips Tanuja N. Gengiah Taraz Samandari Tessa Goetghebuer Thanyawee Puthanakit Thiago S. Torres Thibaut Davy-Méndez Thomas Sumner Thorkild Tylleskär Tiffany R. Phillips Todd M. Pollack Tom Ellman Tonderai Mabuto Tonia Poteat Tracey Naledi Tristan J. Barber Unmesha Roy Paladhi Valentina Cambiano Van Nghiem Venkatraman Chandra-Mouli Vincent J. Wong Vincent Joseph Tukei Virginia A. Fonner Virginia Macdonald Virginia McKay Vita W. Jongen Vundli Ramokolo Vuyolwethu Magasana Weiming Tang Whitney Irie Yijia Li Yogan Pillay Yong Gun Lee Zabrina Brumme Zixin Wang

Background Depression and anxiety can greatly impact the overall health of a person living with HIV (PLHIV). Management of mental health disorder should be an integral part of HIV care. The Collaborative Care Model (CoCM) is an evidence-based model of care that integrates mental health in primary care. This study aimed to assess the acceptability and feasibility of implementing the CoCM for depression and anxiety in HIV clinics in the Philippines using HIV counsellors as care managers. Methods We conducted a descriptive qualitative study by facilitating focus group discussions ( n  = 7) and key informant interviews ( n  = 18) with 53 HIV and mental health stakeholders, including PLHIV ( n  = 20), HIV counsellors ( n  = 11), physicians ( n  = 10), clinic heads ( n  = 4), policy makers ( n  = 4), and mental health providers ( n  = 4) from August 2021 to March 2022. Participants were recruited from 17 HIV clinics in the Philippines. We employed a thematic analysis using the Consolidated Framework for Implementation Research (CFIR) domains as themes. Results Almost all PLHIV participants were men (95%), with a mean age of 28 years. The other stakeholders had a mean age of 44 and had worked in their field for an average of 8 years. Overall, 58% were women. Factors that influenced the acceptability of the CoCM included the possibility of increased access to mental health services with a more holistic care team. Perceived barriers included inadequate numbers of psychiatrists, an overburdened and understaffed HIV workforce, low mental health knowledge among HIV providers, and implementation cost. Perceived facilitators were willingness of HIV providers to provide care and knowledge of HIV counselling. Conclusion We found the CoCM to be acceptable among study participants. Recommendations included capacity building for HIV providers, collaborations within and across clinics to facilitate access to psychiatrists, clear management protocols, and pilot testing. Mental health and HIV care coverage within national policies should be amended to allow for non-mental health specialists to provide low-intensity therapies. Closer partnerships among HIV and mental health policy makers would improve integration implementation.

Introduction Young adults with perinatally acquired HIV (YA‐PHIV) are facing transitions to adult life. This study assessed health risk behaviours (including substance use), mental health, quality of life (QOL) and HIV treatment outcomes of Thai YA‐PHIV. Methods A cross‐sectional study was conducted in Thai YA‐PHIV aged 18–25 years who were enrolled in a prospective cohort study at five tertiary paediatric HIV care centres in Thailand. Study data were obtained through face‐to‐face interviews from November 2020 to July 2021. Assessments were performed for alcohol use (Alcohol Use Disorders Identification Test; AUDIT), smoking (Fagerstrom Test for Nicotine Dependence), drug/substance use (Drug Abuse Screening Test; DAST‐10), depression (Patient Health Questionnaire for Adolescents; PHQ‐A), anxiety (Generalized Anxiety Disorder; GAD‐7) and QOL (World Health Organization QOL Brief‐Thai). HIV treatment outcomes were extracted from the National AIDS Program database. Results Of 355 YA‐PHIV, 163 (46%) were males: their median age was 21.7 (interquartile range, IQR 20.2–23.5) years. There were 203 YA‐PHIV (58%) who reported ever having sex; 141 (40%) were sexually active in the past 6 months, of whom 86 (61%) reported 100% condom use. Overall, 49 (14%) met the criteria for harmful alcohol use; 28 (7.9%) were alcohol dependent. Sixty (17%) were current smokers and 37 (11%) used drugs/substances. The frequency of moderate up to severe symptoms for depression was 18% and for anxiety was 9.7%. Their overall QOL was good in 180 (51%), moderate in 168 (47%) and poor in five (1.4%). There were 49 YA‐PHIV (14%) with CD4 <200 cells/mm3 and 85 (24%) with virologic non‐suppression (HIV‐RNA >200 copies/ml). On multivariate analyses, the highest education at the primary to high school or vocational school levels (adjusted odds ratio [aOR] 2.02, 95% CI 1.40–3.95, p 0.04), harmful alcohol use (aOR 2.48, 95% CI 1.24–4.99, p 0.01), alcohol dependence (aOR 3.54, 95% CI 1.51–8.31, p <0.01) and lifetime suicidal attempt (aOR 2.66, 95% CI 1.11–6.35, p 0.03) were associated with non‐suppression. Conclusions Regular screening for alcohol use and mental health, including suicidality, would be useful to identify YA‐PHIV who need more intensive psychosocial support or referral services to ensure they can achieve and maintain a high QOL into adult life.

Despite improvements in HIV testing and earlier antiretroviral therapy (ART) initiation in children living with HIV through the years, a considerable proportion start treatment with advanced disease. We studied characteristics of children and adolescents living with HIV and their level of immunodeficiency at ART initiation using data from a multi-country Asian cohort. We included children and adolescents who were ART-naïve and <18 years of age at ART initiation from 2011 to 2020 at 17 HIV clinics in six countries. Incidence rates of opportunistic infections (OIs) in the first two years of triple-drug ART (≥3 antiretrovirals) was also reported. Competing risk regression analysis was performed to identify factors associated with first occurrence of OI. In 2,027 children and adolescents (54% males), median age at ART initiation increased from 4.5 years in 2011–2013 to 6.7 in 2017–2020, median CD4 count doubled from 237 cells/μl to 466 cells/μl, and proportion of children who initiated ART as severely immunodeficient decreased from 70% to 45%. During follow-up, 275 (14%) children who received triple-drug ART as first treatment and had at least one clinic visit, developed at least one OI in the first two years of treatment (9.40 per 100 person-years). The incidence rate of any first OI declined from 12.52 to 7.58 per 100 person-years during 2011–2013 and 2017–2020. Lower hazard of OIs were found in those with age at first ART 2–14 years, current CD4 ≥200 cells/μl, and receiving ART between 2017 and 2020. The analysis demonstrated increasing number of children and adolescents starting ART with high CD4 count at ART start. The rate of first OI markedly decreased in children who started ART in more recent years. There remains a clear need for improvement in HIV control strategies in children, by promoting earlier diagnosis and timely treatment.

Chronic hepatitis C virus (HCV) infection contributes to substantial morbidity and mortality among adults living with HIV. Cascades of HCV care support monitoring of program performance, but data from Asia are limited. We assessed regional HCV coinfection and cascade outcomes among adults living with HIV in care from 2010-2020. Patients ≥18 years old with confirmed HIV infection on antiretroviral therapy (ART) at 11 clinical sites in Cambodia, China, India, Indonesia, South Korea, Thailand and Vietnam were included. HCV- and HIV-related treatment and laboratory data were collected from those with a positive HCV antibody (anti-HCV) test after January 2010. An HCV cascade was evaluated, including proportions positive for anti-HCV, tested for HCV RNA or HCV core antigen (HCVcAg), initiated on HCV treatment, and achieved sustained virologic response (SVR). Factors associated with screening uptake, treatment initiation, and treatment response were analyzed using Fine and Gray's competing risk regression model. Of 24,421 patients, 9169 (38%) had an anti-HCV test, and 971 (11%) had a positive result. The proportion with positive anti-HCV was 12.1% in 2010-2014, 3.9% in 2015-2017, and 3.8% in 2018-2020. From 2010 to 2014, 34% with positive anti-HCV had subsequent HCV RNA or HCVcAg testing, 66% initiated HCV treatment, and 83% achieved SVR. From 2015 to 2017, 69% with positive anti-HCV had subsequent HCV RNA or HCVcAg testing, 59% initiated HCV treatment, and 88% achieved SVR. From 2018 to 2020, 80% had subsequent HCV RNA or HCVcAg testing, 61% initiated HCV treatment, and 96% achieved SVR. Having chronic HCV in later calendar years and in high-income countries were associated with increased screening, treatment initiation or achieving SVR. Older age, injecting drug use HIV exposure, lower CD4 and higher HIV RNA were associated with reduced HCV screening or treatment initiation. Our analysis identified persistent gaps in the HCV cascade of care, highlighting the need for focused efforts to strengthen chronic HCV screening, treatment initiation, and monitoring among adult PLHIV in the Asia region.

Introduction We assessed the long‐term HIV‐related health outcomes of young adults with perinatally acquired HIV (PHIV) compared with those who acquired HIV through sexual transmission in the Asia‐Pacific region. Methods We conducted a cross‐sectional study using data from three paediatric and adult cohorts within the International epidemiology Databases to Evaluate AIDS (IeDEA) Asia‐Pacific consortium. This study included data from 12 countries, collected between 1991 and 2021. Young adults with available data who had been on antiretroviral therapy (ART) for at least 1 year were included. Analyses were conducted at ages 18 and 25 years and compared by route of HIV acquisition. Factors associated with viral suppression (<200 copies/ml) at age 25 were identified using logistic regression. Results There were 1333 individuals included at age 18 (96% with PHIV: 46% male) and 305 at age 25 (27% with PHIV; 75% male). Compared to those with sexually acquired HIV at age 18, those with PHIV had a longer median duration of ART (10 vs. 4 years, p<0.001), higher current CD4 count (606 vs. 462 cells/mm3, p = 0.001), were shorter (height 158 vs. 166 cm, p<0.001), with more hypercholesterolemia (20% vs. 5%, p = 0.031) and hypertriglyceridemia (29% vs. 6% mg/dl, p = 0.003). At age 25, differences in duration of ART (15 vs. 3 years, p<0.001), male height (165 vs. 173 cm, p = 0.009) and proportion with hypertriglyceridemia (38% vs. 15%, p = 0.002) were observed. HIV viral suppression did not vary by mode of acquisition (89% vs. 87% at age 18; 91% vs. 85% at age 25). At age 25, living in Thailand (adjusted odds ratio [AOR] 6.05, 95% confidence interval [CI] 1.95−18.80) and use of integrase inhibitor‐based regimens (AOR 5.20, 95% CI 1.62−16.65) or protease inhibitor‐based regimens (AOR 2.62, 95% CI 1.01−6.79) were associated with viral suppression. Conclusions Young adults with PHIV who survived to ages 18 and 25 were more likely to have stunted growth but had similar viral suppression to those with sexually acquired HIV in our regional cohorts. However, viral suppression rates remained lower for all relative to the UNAIDS goal of 95%, and measures to improve treatment outcomes are needed for young adults.

IntroductionTuberculosis (TB) is a leading infectious cause of death globally. It is the most common opportunistic infection in people living with HIV, and the most common cause of their morbidity and mortality. Following TB treatment, surviving individuals may be at risk for post-TB lung disease. The TB Sentinel Research Network (TB-SRN) provides a platform for coordinated observational TB research within the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium.Methods and analysisThis prospective, observational cohort study will assess treatment and post-treatment outcomes of pulmonary TB (microbiologically confirmed or clinically diagnosed) among 2600 people aged ≥15 years, with and without HIV coinfection, consecutively enrolled at 16 sites in 11 countries, across 6 of IeDEA’s global regions. Data regarding clinical and sociodemographic factors, mental health, health-related quality of life, pulmonary function, and laboratory and radiographic findings will be collected using standardised questionnaires and data collection tools, beginning from the initiation of TB treatment and through 12 months after the end of treatment. Data will be aggregated for proposed analyses.Ethics and disseminationEthics approval was obtained at all implementing study sites, including the Vanderbilt University Medical Center Human Research Protections Programme. Participants will provide informed consent; for minors, this includes both adolescent assent and the consent of their parent or primary caregiver. Protections for vulnerable groups are included, in alignment with local standards and considerations at sites. Procedures for requesting use and analysis of TB-SRN data are publicly available. Findings from TB-SRN analyses will be shared with national TB programmes to inform TB programming and policy, and disseminated at regional and global conferences and other venues.