Barriers and Facilitators of Oral PrEP Uptake Against HIV Among Selected Priority Populations: A Global Perspective.

SIMPLIFYing cystic fibrosis treatment in a post-modulator era.

Oral PrEP promotion is a key aspect of combination prevention efforts to increase opportunities for HIV prevention among adolescent girls and young women (AGYW) who are at higher risk of infection. Research suggests that communication efforts often adopt an individualistic decision-making approach that is devoid of the multiple influences that impact young women’s HIV preventative choices. Schools and educators are increasingly being identified as key role players and influencers of decision making among young women. The promotion of PrEP uptake among AGYW of school going age, thus requires an exploration of perceptions of educators about the related benefits and barriers to PrEP uptake among school girls. A qualitative study using a purposive sampling method was used to sample 6 high schools in Vulindlela, a district with the highest HIV incidents among AGYW in KwaZulu-Natal. Semi-structured interviews were conducted with a total of twelve Life Orientation educators and senior staff members from the 6 selected high schools. The data was transcribed and analysed thematically using the culture-centred approach. The findings suggested that educators acknowledged the benefits of PrEP in curbing HIV infection rates among young women. However, these benefits were clouded by barriers and concerns around minimal, or poor condom use as a result of oral PrEP use which could promote promiscuity and minimalise efficacy. These findings highlight the need for more contextual community-driven communication strategies around PrEP, and emphasise the value of a community-centred approach that promotes dialogue among key role players, like educators, to further enhance PrEP communication.

BackgroundAmong patients with type 2 diabetes, insulin intensification to achieve glycemic targets occurs less often than clinically indicated. Barriers to intensification are not well understood. We present patients’ baseline characteristics from MOSAIc, a study investigating patient-, physician-, and healthcare environment-based factors affecting insulin intensification and subsequent health outcomes.MethodsMOSAIc is a longitudinal, observational study following patients’ diabetes care in 18 countries: United Arab Emirates (UAE), Argentina, Brazil, Canada, China, Germany, India, Israel, Italy, Japan, Mexico, Russia, Saudi Arabia, South Korea, Spain, Turkey, United Kingdom, United States. Eligible patients are age ≥18, have type 2 diabetes, and have used insulin for ≥3 months with/without other antidiabetic medications. Extensive baseline demographic, clinical, and psychosocial data are collected at baseline and regular intervals during the 24-month follow-up. We conducted descriptive analyses of baseline data.ResultsFour thousand three hundred forty one patients met eligibility criteria. Patients received their type 2 diabetes diagnosis 12 ± 8 years prior to baseline visit, yet patients in developing countries were younger than in developed countries (e.g., UAE, 55 ± 10; Germany = 70 ± 10). Saudi Arabians had the highest HbA1c values (9.0 ± 2.2) and Germany (7.5 ± 1.4) among the lowest. Most patients in 5 (28 %) of the 18 countries did not use an oral antidiabetic drug. Over half of patients in fourteen (78 %) countries exclusively used basal insulin; most Indian and Chinese patients exclusively used mixed insulin.ConclusionsMOSAIc’s baseline data highlight differences in patient characteristics across countries. These patterns, along with physician and healthcare environment differences, may contribute to the likelihood of insulin intensification and subsequent clinical outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12902-015-0044-z) contains supplementary material, which is available to authorized users.

Liquid crystalline cubosomes are self-assembly of aqueous lipid and surfactant mixture. They are discrete and sub-micron in size. It is an innovative lipid-based nanosystem resembling well-known vesicular systems including niosomes and liposomes. Cubic phases incorporate lipophobic, amphiphilic and hydrophilic, components through the utilization of a rounded bi-continuous lipid bilayer and water channels. Cubosomes contain lipids such as phytantriol (PHYT) and glycerol monooleate (GMO) which are amphiphilic in nature that are diffused in water and structured in 3-D as a “honeycomb” structure with suitable stabilizer (Poloxamer 407). Cubosomes are generated by mostly two techniques i.e., top-down, bottom-up methods. UV spectrophotometer, X-ray scattering, transmission electron microscopy, and photon correlation spectroscopy are used to characterize and evaluate cubosomes. They are commonly used in the administration of oral, ophthalmic, transdermal, and chemotherapeutic drugs. The liquid crystalline phase and bicontinuous cubic form nanoparticles are thoroughly discussed in this paper. In the current review search criterion used parameters affecting cubosomes bi-continuous lipid bilayer by top-down and bottom-up methods mostly. The sources referred from peer-reviewed recognized journals. Keywords used as filters were cubosomes, amphiphilic lipids, top-down, bottom-up, bicontinuous, GMO, and phytantriol (PHYT). For the purpose of a comprehensive update literature review over a range (1976–2023) has been conducted on the recent developments cubosomes system.

BackgroundSeveral studies have demonstrated the population-level effectiveness of oral PrEP in reducing the risk of HIV infection. However, oral PrEP utilization among MSM in China remains below 1%. While existing literature has primarily focused on oral PrEP preference and willingness, there is limited exploration of the underlying factors contributing to oral PrEP cessation in China. This study aims to fill this gap by investigating the factors associated with oral PrEP cessation among MSM in China.MethodsAssisted by MSM community organizations, we collected 6,535 electronic questionnaires from 31 regions across China, excluding Taiwan, Hong Kong, and Macau. The questionnaire focused on investigating MSM's awareness, willingness, usage, and cessation of oral PrEP. Additionally, 40 participants were randomly chosen for key informant interviews. These qualitative interviews aimed to explore the reasons influencing MSM discontinuing oral PrEP.ResultsWe eventually enrolled 6535 participants. Among the 685 participants who had used oral PrEP, 19.70% (135/685) ceased oral PrEP. The results indicated that individuals spending > ¥1000 on a bottle of PrEP (aOR = 2.999, 95% CI: 1.886–4.771) were more likely to cease oral PrEP compared to those spending ≤ ¥1000. Conversely, individuals opting for on-demand PrEP (aOR = 0.307, 95% CI: 0.194–0.485) and those using both daily and on-demand PrEP (aOR = 0.114, 95% CI: 0.058–0.226) were less likely to cease PrEP compared to those using daily PrEP. The qualitative analysis uncovered eight themes influencing oral PrEP cessation: (i) High cost and low adherence; (ii) Sexual inactivity; (iii) Lack of knowledge about PrEP; (iv) Trust in current prevention strategies; (v) Poor quality of medical service and counseling; (vi) PrEP stigma; (vii) Partner and relationship factors; (viii) Access challenges.ConclusionsThe cessation of oral PrEP among MSM in China is associated with various factors, including the cost of oral PrEP medication, regimens, individual perception of HIV risk, stigma, and the quality of medical services. It is recommended to provide appropriate regimens for eligible MSM and develop tailored combinations of strategies to enhance PrEP awareness and acceptance among individuals, medical staff, and the MSM community. The findings from this study can support the refinement of HIV interventions among MSM in China, contributing to efforts to reduce the burden of HIV in this population.

Recommendations from Black and Latinx sexual minority males to include pharmacists to increase greater accessibility and OnlyFans stars to promote uptake of injectable PrEP

BackgroundSouth Africa became the first country in Africa to introduce oral PrEP in June 2016. The National Department of Health has used a phased approach to rollout, allowing for a dynamic learn-and-adapt process which will lead ultimately to scale-up. Phased rollout began with provision of oral PrEP at facilities providing services to sex workers in 2016 and was expanded in 2017, first to facilities providing services to MSM and then to students at selected university campus clinics, followed by provision at primary health care facilities. Programmatic data shows variability in initiation and continuation between these populations. This study examines factors related to PrEP initiation, continuation, and discontinuation at facilities providing services to sex workers and MSM during the national PrEP rollout.MethodsA cross-sectional survey was administered September 2017-January 2018 among clients (ages 18–62 and providers at 9 facilities implementing oral PrEP in South Africa, followed by in-depth interviews. The client survey captured PrEP initiation, continuation and discontinuation. Analysis was performed in STATA 13 for survey data and thematic analysis was performed in NViVO 11 for in-depth interview data.Results299 clients (203 from sex worker facilities, 96 from MSM facilities) participated in the survey and additionally, in-depth interviews were conducted with 29 clients. Participants self-identified as either current users (n = 94; 36.2%), past users (n = 80; 30.8%) and never users of PrEP (n = 86; 33.1%). Participants who had never used PrEP either cited not being offered PrEP by a provider (57%, n = 49) or declining PrEP (43%, n = 37) as reasons for lack of uptake. The primary reason for declining to use oral PrEP was fear of side effects (41.7%, n = 15). The primary reasons for initiating and continuing on oral PrEP were all related to perceived risk associated with sexual activity. The majority of participants (87.9%, n = 153) also noted that printed IEC materials influenced their decision to initiate PrEP. Qualitative data suggested that several clients initiated on PrEP because they wanted additional protection beyond using condoms due to challenges such as partners refusing to use condoms, having partners with unknown HIV status, having multiple partners, involvement in sex work, or having a partner living with HIV. The majority (73.8%, n = 59) of participants who discontinued oral PrEP cited side effects as the primary reason for discontinuation, followed by feeling stigmatized (18.8%, n = 15).ConclusionThis study provides valuable insights on early rollout of PrEP of how clients perceive oral PrEP and where to target efforts to improve the uptake of this highly effective HIV prevention product. By identifying strengths and areas for improvement, the ACCESS study has generated evidence that can be used to guide high quality scale-up in South Africa and may be instructive for other countries’ efforts to expand quality access to oral PrEP.

BackgroundMen in Uganda contribute significantly to new HIV infections annually yet PrEP uptake among them is low and those initiated are likely to discontinue usage. We explored the barriers and facilitators to PrEP uptake among high-risk men employed in private security services with negative HIV results after testing at workplaces in Uganda.MethodsAn explorative qualitative study comprising in-depth participant interviews. Data were collected via telephone calls and manually analyzed by inductive content analysis.ResultsFifty-six (56) men participated, 27(48.21%) had heard about PrEP, and 29(51.79%) were willing to initiate it. Four categories emerged for the facilitators of PrEP uptake including the perceived need for HIV prevention, awareness creation, availability, and sexual freedom. Six categories emerged for the barriers to PrEP uptake. These were: Inaccessibility of PrEP services, Misinformation, Knowledge deficit, Medication-related barriers, Potential for increased risky sexual behavior, and Perceptions about PrEP use.ConclusionThe findings suggest the need for healthcare providers to offer information regarding PrEP and HIV prevention services and mass sensitization campaigns to facilitate uptake. Participants recommend mass roll-out of PrEP to lower-level facilities and accessible pick-up points for men such as workplaces. The men also suggested the use of longer-acting PrEP modalities such as an injectable option or an option that is utilized specifically by the female partner. Finally, the stigma surrounding PrEP use could be reduced by the separation of PrEP and ART services at health facilities, or special pick-up days to reduce waiting times.

Integrating pre-exposure prophylaxis delivery into family planning (FP) clinics may reach women at elevated HIV risk. We evaluated population characteristics, assessed and perceived HIV risk, and preferences of women accessing real-world FP clinics. Between July 26, 2021, and July 07, 2024, we conducted a cross-sectional study nested within a pragmatic trial of PrEP delivery integrated in twelve real-world FP clinics in Kisumu Kenya (Clinical Trials.Gov: NCT04666792). Quantitative exit surveys were administered to women on randomly selected days to characterize service satisfaction, preferences, behavioral and HIV risk. HIV risk and PrEP eligibility were assessed using Kenya PrEP guidelines. Overall, 1801 participants were interviewed, representing 9.9% of women without HIV accessing the twelve clinics during the 24-month study period. Median age (IQR) was 27.0 (23.2-32.0) years, 37.0% were ≤24 years, and 77.8% were married. Nearly all women (97.5%) visited clinics for FP services; 22.5% used injectable, 19.7% oral pills, and 20.4% implants. Most women (79.1%) reported condomless sex at last sex, but two-thirds were unaware of the HIV status of the person they last had sex with. One-third (30.6%, 551/1801) were assessed to have elevated HIV risk and PrEP eligible, but 72.2% (1300/1801) reported low self-perceived HIV risk and declined PrEP. Most women (78.5%) were not using any HIV prevention strategy, including 88% of those at elevated HIV risk. Knowledge about daily oral PrEP was high (69.5%) but low for injectable PrEP (8.2%). Most women preferred long-acting PrEP, with 70.9% interested in injectables and 39.8% in monthly oral PrEP. Trust in FP providers was high (98.6%), and FP clinics were the preferred access point for HIV prevention care (81.3%). Although women at elevated HIV risk frequently visited FP clinics, 55.3% (305/551) reported low self-perceived risk and low oral PrEP uptake; FP clinics were the preferred and trusted platform for HIV prevention care.

BackgroundWomen in South Africa have a high burden of HIV infections, STIs, and unintended pregnancies. Women congregate regularly in hair salons, which may be useful venues for HIV and sexual and reproductive health (SRH) services. Our objective was to assess the uptake of PrEP and contraception in hair salons in South Africa.MethodsWe conducted a pilot cluster randomized controlled trial to evaluate uptake of a hair stylist-initiated, nurse-supported intervention offering a dynamic choice of contraception (oral or injectable), STI testing and treatment, and oral PrEP in 3 salons in urban KwaZulu-Natal. Rapid HIV testing was performed in a private area at enrollment and each PrEP dispensing. Women could receive contraception and/or oral PrEP at the initial visit or opt in at a later visit. We defined uptake as the proportion of eligible women who accepted salon-based PrEP and/or salon-based contraception at any visit. Control salon participants completed surveys and were referred to clinic. We assessed predictors of PrEP uptake among intervention participants using univariate logistic regression and multivariable logistic regression with age and potential predictors from the univariate analyses.ResultsAmong 134 participants in intervention salons, the median age was 26 years (IQR 22–29). 75% reported visiting the salon at least every 2 months. 27% were using hormonal contraception at enrollment, 31% reported a self-perceived moderate or great chance of getting HIV in the next year, 33% thought their primary sex partner had other partners, 65% did not use condoms in the past month, and 11% reported intimate partner violence (IPV). About half (49%) accepted salon-based PrEP, and 89% accepted salon-based contraception during the study. Adjusting for age, uptake of salon-based PrEP was associated with experiencing IPV (aOR 4.20, 95%CI: 1.02, 17.36).ConclusionsWhen offering a dynamic choice of integrated SRH services in urban hair salons in South Africa, we reached young women with risk factors for HIV, STIs, and unintended pregnancies. Hair salons are a novel venue for reaching young women who may not perceive themselves at risk for HIV, STIs, and unintended pregnancies.Trial RegistrationClinicaltrials.gov identifier: NCT04222504. Registered 01-08-2020.

Introduction: HIV globally is a public health challenge especially among P/BFW who are a priority population as they put at risk unborn or breastfeeding babies of HIV. Use of PREP has proven significant. However, little research literature exists which shows the uptake of PrEP among P/BFW in a low resourced country like Zambia. The purpose of this study was therefore to explore factors influencing PrEP uptake among P/BFW at Kapiri Urban Clinic in Kapiri district of the Republic of Zambia. Methods: The study approach was quantitative, a sample size of 348 participants were selected randomly. A questionnaire was applied to collect data; and STATA version 15 was used for the analysis. Results: Linear regression results show factors associated to PrEP among the study population were marital status with results suggesting a status closer to marriage reduced PrEP uptake by 0.233, higher level of education of participants reduced PrEP uptake by 0.241 and misinformation on risk Factors for PrEP reduced uptake by 0.229. Higher partner’s education increased PrEP uptake by 0.359. Conclusion: This study was successful in establishing the factors associated with PrEP among pregnant and breastfeeding women at Kapiri Urban Clinic. These were age, marital status, level of education, partner education and misinformation on risk factors and the cultural factors included perception of being HIV positive, having multiple sexual partners and being an adulterer.

It is heartening to learn from recent data in multiple settings that decreasing community viral load through "universal test and treat" (UTT) programmes is having a significant impact on HIV morbidity, mortality and the rate of new HIV infections in some settings [1-3. However, focusing only on preventing transmission from a person already living with HIV to one who is not, is only half of the equation and will by itself not "end HIV." A crucial focus remains preventing acquisition of HIV infection among people at risk. Achieving this requires that we strengthen primary HIV prevention programmes because HIV incidence declines attributable to treatment may be slower than required to meet global goals [4]; treatment as prevention may have less impact where a high proportion of transmission involves those in early stage HIV infection [5; and, critically, because it is essential that individuals and communities have the autonomy to avoid acquiring HIV if at all possible. Happily, the range of efficacious tools for primary prevention of HIV infection has increased in recent years. These include condoms, voluntary medical male circumcision, oral pre-exposure prophylaxis (PrEP), clean needles and associated drug use paraphernalia, as well as a range of behaviours, such as information sharing between partners about HIV serostatus, use of antiretroviral therapy (ART), or HIV viral load before making decisions about sex and drug-using activities. However, optimism must be tempered by the fact that, although some tools have been with us for some time, their population impact has been limited by individual, interpersonal, social (including cultural, economic and political) and structural factors. The aim of a primary HIV prevention programme is to increase the uptake and continued use of efficacious HIV prevention tools and other safe behaviours among those who may be at risk of infection. Achieving this requires strategies that are appropriate, acceptable and reach those in need. Programmers can only know how well they are doing in this regard by collecting and using data in a systematic way. This special issue of Journal of the International AIDS Society showcases current thinking on how data can be used to support decision makers in deploying their resources to maximize the impact of primary HIV prevention programmes. Formulating an HIV prevention strategy includes a range of considerations: whether and how to focus efforts to particular populations versus implementing a general population approach; which prevention tools to offer; and, the extent to which the programme should focus on strengthening motivation for HIV prevention behaviours, improving supply channels, and/or supporting the capacity of individuals to enact HIV avoidance behaviours. Data-informed insights are needed to support these decisions. The data must go beyond an assessment of where and among whom new HIV infections are occurring. Only by understanding the modifiable determinants of risk and barriers to prevention can programmers select, implement, monitor and strengthen the most appropriate interventions and policies. This is not a new call. More than 10 years ago, "know your epidemic, know your response" was positioned as a "rallying cry" for an intensified HIV prevention response [6. The need to renew this message periodically reflects the reality that the measurement challenges we face in HIV prevention are formidable, the determinants of HIV risk are multiple, complex and interacting, and the barriers to sustained behaviour change significant. It is clear that interdisciplinary research and data-driven multi-sectoral planning remain critical to strengthening primary HIV prevention. The papers in this special issue reflect the effort, innovation, and challenges faced by those who share this vision today. In responding to our call for papers on "Data-driven HIV prevention," many (though not all) of the papers attempt to operationalize an HIV prevention cascade. HIV prevention cascades are a promising framework that can be used to generate insights from data in many instances. We were pleased to see the innovation and thought reflected in the papers that provided cascade models: nevertheless, there remains work to do. As Auerbach et al. [7 outline, debates about the merits and pitfalls of HIV prevention cascades are ongoing, but there is general agreement that a standardized programme monitoring tool (like the treatment cascade) would be helpful. As the authors note, emerging consensus identifies the core steps of primary prevention cascade models for programme monitoring and research as first characterizing the priority population at risk, and then tracking motivation, access, uptake and/or effective use of prevention tools among this population. We use this prevention cascade structure to provide a brief overview of the content of this special issue. Identifying priority populations for whom primary prevention efforts are to be strengthened is the first job for any HIV prevention strategy. Rice et al. [8 reflect on a pilot of tests of recent HIV infection in diverse routine HIV testing settings in Kenya and Zimbabwe and consider the potential use of these tests to help focus prevention activities. Virkud et al. [9 generate cascades that show the need for HIV prevention to be strengthened among those who visit bars, hotels and guest houses in cross-border areas in East Africa. Sibanda et al. [10 show that new HIV infections among pregnant mothers are a critical driver of infant infections in Zimbabwe and highlight the need to strengthen prevention cascades among HIV-negative women. HIV prevention programmes seek to increase individuals' motivation to undertake behaviours that will protect them and others from HIV infection. [11 The HIV prevention cascade recognizes that the range of relevant behaviours include decisions such as to avoid sex, take PrEP, suggest condom use to a sexual partner, and be circumcised. An individual's behavioural intention is also influenced by perceived social norms. Hill et al. [12 present data from one priority population – adolescent girls and young women (AGYW) in Malawi – and carefully examine the relationships between risk perception, "epidemiological" risk, and the motivation of these young women to take PrEP. They conclude that motivation remains lower than optimal and more efforts are needed as PrEP rolls out. Similarly, Ramautarsing et al. [13 used programmatic data to document PrEP roll-out among transgender women and men who have sex with men (MSM) in Thailand. They found that the biggest gap in the cascade for both population groups was in demand: many clients who were offered PrEP did not initiate PrEP because they did not perceive themselves to be at risk for HIV acquisition. When people are motivated to use existing HIV prevention methods, lack of access to them can have population-level impacts on infection rates. The implications of poor access are shown by a modelling exercise of couples' voluntary counselling and testing programmes, which can facilitate prevention choices, in six African countries presented by Wall et al. [14 When new methods, such as PrEP, are introduced, gains in HIV prevention can be made through strengthening supply channels and breaking down access barriers; but uptake takes time and is influenced by attitudes and behaviours of providers and clients. Were et al. [15 use data from the first two years of PrEP roll-out in Kenya to construct prevention cascades and to highlight missed opportunities in PreP delivery and uptake among three priority populations – female sex workers (FSW), MSM and AGYW. For AGYW, the biggest missed opportunity was screening. For MSM and FSW, the biggest missed opportunity was that, among those who were screened and found eligible for PrEP, the majority did not initiate PrEP despite its availability. Even when people are motivated, have access to, and initiate HIV prevention measures, social and structural barriers may impede their capacity to consistently use them. Programmatic innovation in addressing these barriers remains critical. Chabata et al. [16 show that knowledge of condom efficacy is high and availability good among young women who sell sex in Zimbabwe, and yet consistent use is low, especially among those young women who recently experienced violence from a sexual partner. Holmes et al. [17 characterize the relationship environments of young women in South Africa and how these influence PrEP use/adherence, secondary distribution of HIV self-tests to partners, and of sharing information about HIV status. In a modelling study, Bershteyn et al. [18 demonstrate how implementation challenges along the prevention cascade differentially influence the population-level impacts of the use of oral PrEP and long-acting PrEP in Kenya. Wilson et al. [19 report on social and structural determinants and patterns of PrEP use among two sexual minority populations – transgender women and MSM in the United States. They find differences in the PrEP cascades for the two populations, with transgender women being more affected by social-structural issues of poverty, homelessness and unemployment than MSM. Their paper underscores the need to distinguish and specify priority populations, and to identify the particular HIV prevention gaps, barriers and approaches relevant to each. As Auerbach et al. [7 note, and the aforementioned examples attest, while the cascade model has proven to be useful for monitoring progress and gaps in HIV prevention programming in many settings, it does have limitations. Dumchev et al. [20 present an analysis of data from an integrated bio-behavioural survey in Ukraine to assess the HIV prevention cascade for people who inject drugs (PWID). They find that in their context there was little consistency between their "access to services" and "effective use" measures, given that people who inject drugs often obtain sterile syringes from sources other than the programmes being monitored. Across the papers included in this special issue, authors are striving for a strengthened feedback loop, from data to programming decisions, for primary HIV prevention to support implementers and managers to deploy the interventions that are most needed to address the determinants of risk in their settings. Most papers use existing data streams to populate their cascade models, and many identify significant measurement and interpretation challenges in operationalizing key elements of the cascade. Further innovation remains essential to strengthen our capacity to track cascades and thereby strengthen the right intervention mix. Generally, it is not feasible to create new data sources or make fundamental changes to existing data sources to inform prevention programming. However, more work would be useful to establish the extent to which minor changes to routine data systems, including further integration of qualitative enquiry, would be feasible for different settings, populations and methods that would improve the validity and utility of the cascades that can be generated. Most of the papers submitted for the special issue focussed on single methods of prevention. To some extent this may reflect the continuing siloing of programmes for different prevention methods despite the common call for combination prevention approaches [21. In principle, it is quite possible to create HIV prevention cascades for combination prevention [5 and we would encourage more attempts to do this. We would also like to see a greater effort to bring HIV prevention cascade thinking into modelling efforts that often guide programme decision making. Again, a greater focus on qualitative and participatory data enquiry that unpacks the reasons for drop offs in the cascade, could also accelerate the loop from data to programmatic improvement. We applaud the authors of the papers in this series for grappling with some thorny issues in primary HIV prevention data collection and, particularly, cascade analysis. We hope readers find this special issue helpful in their own efforts to strengthen ongoing monitoring, evaluation and advocacy of HIV prevention to meet global goals by 2030. The authors have no competing interests to declare. JRH drafted the initial manuscript. JDA provided substantial revisions and finalized the draft manuscript. All authors critically reviewed the manuscript, suggested revisions and editorial changes, and approved the final version. We thank the Editors in Chief and the team in the editorial office at the Journal of the International AIDS Society for their excellent support with this supplement. This supplement was funded by the Bill & Melinda Gates Foundation. The content is solely the responsibility of the authors and does not necessarily represent the views of the funding agency. Research contribution, by Professor James Hargreaves, was covered in part from OPP1120138 'MeSH Consortium', and the contribution by Saul Johnson was funded through Gates Foundation Investment 47698.

IntroductionPre-exposure prophylaxis (PrEP) reduces the risk of HIV infection among men who have sex with men by up to 99%. However, in real-world settings, PrEP users may exhibit risk compensation...

People with opioid use disorder (PWOUD) are at high risk of HIV infection, yet uptake of PrEP remains low in PWOUD. To understand opportunities to increase PrEP engagement, this cross-sectional study sought to examine clinical correlates of perceived PrEP use likelihood in a sample of PWOUD along the OUD Treatment Cascade. We enrolled 120 PWOUD with past-6-month injection drug use (IDU) or condomless sex in a cross-sectional survey study. Participants were recruited from sites serving PWOUD in the Boston area, including substance use disorder (SUD) treatment programs and harm reduction service providers. PWOUD characterized their substance use and treatment history, perceived risk of acquiring HIV, and likelihood of using oral and long-acting injectable (LAI) PrEP. Ordinal logistic regression and Pearson correlations were used to examine correlates of likelihood of using oral and LAI-PrEP. Contrary to hypotheses, current MOUD engagement was not associated with perceived likelihood of using oral or LAI-PrEP. More recent IDU was associated with greater likelihood of using both oral PrEP (OR = 0.98, 95% CI: 0.97, 0.99) and LAI-PrEP (OR = 0.99, 95% CI: 0.98, 1.00). PWOUD who received past-year emergency department-based SUD treatment endorsed lower likelihood of using LAI-PrEP (OR = 0.40, 95% CI: 0.19, 0.84). Among PWOUD, a greater number of sex partners was a stronger correlate of perceived risk of acquiring HIV than IDU-related risk behaviors. Results suggest opportunities to engage PWOUD at greatest HIV risk in PrEP care; findings also suggest need for education interventions to inform judgments of HIV risk among PWOUD.

IntroductionPre‐exposure prophylaxis (PrEP) services are linked to increased sexually transmitted infection (STI) diagnoses, which may facilitate PrEP uptake. We hypothesized that point‐of‐care (POC) STI testing and treatment would improve PrEP initiation and persistence.MethodsBetween September 2023 and November 2024, we conducted a single‐centre, open‐label, unblinded, randomized controlled trial among adolescent girls and young women (15−29 years old) or male partners (any age). Participants were randomized 1:1 to standard syndromic STI management (SOC) or POC testing for C. trachomatis, N. gonorrhoeae, syphilis and T. vaginalis (women only). All participants received standard HIV prevention counselling, including the offer of oral PrEP. The primary outcome was effect of POC STI testing versus syndromic management on PrEP initiation; secondary outcomes included persistence at 1 and 4 months (PrEP prescription), verified in the secondary analysis of tenofovir diphosphate (TFV‐DP) in dried blood spots (DBS) in a random subset. TFV‐DP in DBS was analysed in a subset. Analysis was intention‐to‐treat, adjusted for age and sex.ResultsWe enrolled and randomized 900 participants (452 in intervention; 448 in SOC). The mean age was 20.4 years (SD = 4.2); 48% were female. In the intervention arm, 435 received POC STI testing (96%); 25% (110 of 435 tested) were diagnosed with =>1 STIs; 84% were treated. In SOC, 7% of participants reported symptoms of STIs (31); 88% were treated (27). Overall, 64% of participants in SOC versus 62% in intervention‐initiated PrEP (RR = 0.98, 95% CI = 0.88ng women and partners1.08). In the intervention, 41% persisted on PrEP at 1 month and 25% through 4 months, compared to 46% and 19%, respectively, in SOC (aRR intervention = 1.39; 95% CI = 0.93−2.09; p = 0.08). In participants treated for STIs or syndromically, 77% initiated PrEP versus 60% untreated/diagnosed (aRR = 1.14; 95% CI = 1.02−1.27); 19% versus 14% persisted on PrEP at 4 months (aRR STI/syndrome treated = 1.41; 95% CI = 0.79−2.51). Overall, 30% of 64 DBS had any TFV‐DP levels present with no difference by study arm (RR = 0.74; 95% CI: 0.38−1.41).ConclusionsPOC STI testing did not increase PrEP initiation or 1‐month persistence but showed a moderate association with 4‐month persistence. STI treatment (syndromic or confirmed) was linked to higher PrEP uptake and persistence. Integrating STI management may improve PrEP persistence among youth.