Women with HIV (WWH) experience early onset menopause and symptoms may impact antiretroviral therapy (ART) adherence. Vaginal estradiol is safe and effective for treatment of the genitourinary syndrome of menopause (GSM) but has not been studied in WWH. The study objective was to test whether vaginal estradiol would improve GSM symptoms in menopausal WWH. Menopausal WWH were randomized 1:1 to 12-weeks of open-label vaginal estradiol (n=25) versus no treatment (n=26). Participants had at least one GSM vulvovaginal symptom in the month prior (dryness, itching, irritation, soreness, or dyspareunia) and clinical atrophy. The primary outcome was difference in mean symptom severity (scale 0-3) defined by the composite vaginal symptom index (VSI) between baseline and week 12. Changes in severity of participants' most bothersome symptom (MBS), vaginal maturation index (VMI), vaginal microbiome, and mucosal immune mediators were assessed. Results were compared by paired t-test or Wilcoxon signed rank tests; a mixed effect model examined differences in VSI improvement between groups. Mean age was 59 years, 78% self-reported as Black, and all were on ART. Both groups had significant reductions in VSI, however the magnitude was significantly greater in the estradiol group (p<0.0001). Estradiol and younger age were associated with VSI improvement. VMI and MBS improved significantly only in the estradiol group. There were no significant changes in the microbiome or mucosal mediators. The favorable response to estradiol suggests that treatment perhaps initiated earlier may be beneficial for GSM in WWH and should be studied in larger clinical trials.

In India, despite significant advancements in Antiretroviral Therapy (ART), stigma and discrimination remain major barriers for people living with HIV (PLHIV), often hindering ART adherence and compromising treatment outcomes. This study aimed to assess the determinants and contributing factors of HIV-related stigma among PLHIV in Mizoram, a northeastern state with one of the highest HIV prevalence rates in the country. A cross-sectional study was conducted among 300 PLHIV attending the ART Center, in Aizawl, Mizoram. Descriptive statistics, Chi-square tests, and binary logistic regression were used to assess factors associated with stigma and treatment adherence. A total of 300 PLHIV were enrolled in the study, comprising 176 (58.7%) males and 124 (41.3%) females. In the internalized stigma domain, males experienced significantly higher stigma compared to females (aOR = 2.394, CI = 1.294-4.426, p = 0.005). In the felt-normative stigma domain, participants aged 41-50 years reported higher stigma levels compared to aged 51 years and above (aOR = 0.329, CI = 0.110-0.985, p = 0.047). Regarding medication adherence, 208 (69.3%) participants demonstrated optimal adherence to ART, while 92 (30.7%) had sub-optimal adherence. Most PLHIV in our study reported low to moderate stigma across domains. To reduce HIV related stigma among PLHIV, one should prioritize patient centric counselling, educational interventions in the form of mass communication, printed media etc., to ensure their psychological well-being and to create educational awareness involving the community and healthcare professionals to promote more positive thoughts on HIV which will reduce HIV related stigma in the society.

People living with HIV and beginning antiretroviral therapy (ART) often struggle with medication adherence and attending appointments due to multi-level challenges such as depression symptoms, substance use, stigma and disclosure, food insecurity, health system challenges, transportation challenges, and gender inequity. The SUSTAIN trial seeks to improve initiation adherence through multiple monitoring and support interventions in three clinics in Mitchells Plain township, Cape Town, South Africa. We qualitatively explored the multi-level challenges impacting adherence at the individual, interpersonal, and structural levels among 60 study participants within the first six months after initiation on ART. The in-depth interview sample was selected purposively based on participant experiences with at least one of these factors reported through a baseline survey, gender, and age. We conducted a content analysis and utilized syndemic theory to understand the synergistic effects of multiple adherence challenges. To manage their HIV diagnosis, participants described positive and negative coping mechanisms, including how substance use affected adherence particularly on big event days (e.g., birthdays, holidays, or funerals). Participants described fears of stigma motivat decisions on disclosure of their HIV status and decreased potential social support, possibly reducing motivation to adhere to ART. Gender inequity reinforced experiences with and perceptions of stigma and disclosure. Participants indicated that food insecurity resulted in feelings of shame when associated with perceived larger appetites due to ART use and with lack of employment. Participants described both positive and negative ways the health system impacted their adherence and retention in care, citing information provided by clinic staff, clinician attitudes, and clinic operations. Misunderstandings regarding the strict timing of ART dose-taking (often from lack of clear information or counselling by clinicians) meant participants often had limited competence to make decisions about their dosing schedule and how to best integrate treatment into their daily lives. Participants described a notable fear of commuting to and from clinics due to dangerous and difficult paths on which muggings occurred frequently; women were at particular risk of violence. Often, participants mentioned multiple factors simultaneously affecting adherence, with additive or synergistic effects. Syndemic factors affecting ART adherence exist across multiple levels. Enhanced adherence counseling, designed as a behavior change intervention, might help PLWH cope with individual adherence barriers and support strategizing about ways to mitigate or overcome structural barriers. Continued efforts by government and implementers to address health system, gender inequity, and security challenges could further support ART adherence.

US youth with HIV (YHIV) face challenges to antiretroviral therapy (ART) adherence and care engagement. Understanding YHIV healthcare costs is essential for healthcare payers and for evaluating the cost-effectiveness of youth-focused interventions. Using the CEPAC-Adolescent microsimulation model, we simulated YHIV cohorts, including those with HIV acquired perinatally (15%) and non-perinatally (85%), aged 13-24 years, in care and prescribed ART. We projected undiscounted life expectancy from model start; per-person and population-level (n = 24,626) lifetime HIV-related healthcare costs (discounted at 3% annually) from a health payer perspective. YHIV were projected to live 47.4 life-years after model start, with discounted lifetime HIV-related healthcare costs of $685,000/person ($1,404,000/person undiscounted). Overall, this population would accrue $16.9 billion in discounted HIV-related care costs over their lifetimes. ART medication would comprise most costs (74%), followed by routine HIV-related clinical care (22%), which would be most costly during the time spent at low CD4 counts. ART prices were the most impactful input; generic prices could reduce total lifetime costs by 62% ($264,000/person discounted). We projected that US YHIV in care aged 13-24 years would incur nearly $17 billion in lifetime HIV-related healthcare costs. While total costs would increase with improved HIV-related care due to longer life expectancy, monthly costs would be highest during time spent at lower CD4 counts. ART costs would drive lifetime HIV-related healthcare costs for YHIV. Efforts to decrease ART prices and interventions to improve HIV care engagement and support consistent ART use could reduce HIV care costs and improve health outcomes for YHIV.

Introduction In South Africa (SA), 22.6% of cisgender women aged 15-49 are living with HIV; of these, one in three are pregnant. Perinatal adherence to antiretroviral therapy (ART) is critical to prevent mother to child transmission (MTCT) of HIV. However, there are numerous barriers to adherence (e.g., pregnancy/postpartum physical symptoms, poor mental health, low social support, structural barriers). In the US, digital pill systems (DPS; i.e., ingestible radiofrequency sensors integrated into gelatin capsules that over-encapsulate medications) have been used to measure adherence to preexposure prophylaxis (PrEP) among men who have sex with men. Interventions that incorporate DPS may facilitate ART adherence and reduce risk of MTCT in SA, but preliminary acceptability has not yet been explored in this context. Methods Thirty pregnant (n=15) and postpartum (n=15) women living with HIV who reported ART adherence challenges were introduced to DPS and completed qualitative interviews. Qualitative data were analyzed via rapid qualitative analysis. Results Participants reported that they missed approximately 3.0 (SD=2.1) ART doses in the past 30 days. Most participants found the overall DPS concept and its components to be acceptable, including ingesting a radiofrequency sensor and wearing a digital pill Reader, which collects adherence data from the digital pill and relays it to a smartphone via a linked app, as a lanyard. They suggested that DPS would improve their adherence and increase accountability to prevent HIV transmission to their infants. Participants who disclosed their HIV status to close friends and family viewed wearing the Reader for several minutes a day to be acceptable and appreciated that providers could access adherence data. They also expressed that the smartphone app would provide helpful reminders to collect and take their ART. However, for both pregnant and postpartum participants, the primary barrier to likely use of the DPS for themselves or others was the risk of involuntary HIV status disclosure by wearing the visible Reader. Discussion Future research should explore ideal Reader systems to facilitate use among this population in SA, especially among persons who report low ART adherence or have unsuppressed HIV RNA when presenting for antenatal care.

Veterans with HIV/AIDS (VWH) frequently report alcohol misuse, which can impact antiretroviral therapy (ART) adherence and lead to poorer clinical outcomes. The TRAC (Tracking and Reducing Alcohol Consumption) intervention was developed to help VWH reduce alcohol use and its associated consequences. TRAC is delivered via mobile device, incorporates eight counseling sessions based in cognitive behavioral therapy and motivational interviewing, and utilizes mobile surveys and breathalyzers for daily monitoring of alcohol and ART use. We conducted a pilot randomized waitlist-controlled trial (N = 50). Participants were allocated to an immediate intervention group (N = 26), which received the TRAC intervention and completed twice-daily monitoring of alcohol and ART use for 8 weeks, or to a waitlist-control (n = 24), which started TRAC after 8 weeks. Participants provided ratings of intervention sessions and completed questionnaires assessing alcohol use, ART adherence, and treatment self-efficacy at baseline, 8, 16, and 24 weeks. Analyses included correlations and descriptive statistics for examining feasibility and acceptability, difference-in-differences analyses to compare changes between groups at the 8-week timepoint, matched pair tests to assess changes in alcohol use during the intervention, and general linear models to investigate long-term effects on outcomes with a pooled sample. Results indicated high feasibility and acceptability: 84% of participants were retained through the intervention and all follow-ups, average intervention session ratings were 9.6 (out of 10), and participants completed a median of 85% and 78% of mobile surveys and breathalyzer readings, respectively. While not statistically significant due to low power, there was a trend of decreased binge drinking episodes and fewer missed HIV medication doses in the intervention group compared to control. When pooling data among participants from both groups to examine long-term effects, TRAC was associated with reductions in several drinking-related outcomes. High acceptability and feasibility, as well as preliminary evidence that the intervention may reduce alcohol use relative to control, suggest that the TRAC intervention is promising for VWH and warrants further evaluation in a randomized controlled trial with adequate power to detect effects. If shown to be efficacious, TRAC has potential to be a highly scalable and acceptable intervention for delivery among VWH. This study was registered on ClinicalTrials.gov, #NCT03746600. Registration date: 09/24/2018.

Adherence to antiretroviral therapy (ART) is vital for controlling the viral load and disease progression in people living with HIV. Previous reviews on ART adherence among youths living with HIV (YLHIV) are outdated and lack coverage of youth populations. A systematic review and meta-analysis were conducted using the WHO framework to identify factors influencing ART adherence among youth living with HIV (YLHIV). Nine electronic databases were used for studies published between January 2015 and November 2024. Eligible quantitative studies were included. A meta-analysis using a random-effects model was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). A systematic review of 45 studies revealed ART adherence rates ranging from 20% to 93.8% (mean: 69.34%), which were primarily assessed via self-reported measures with a 95% threshold for good adherence. The meta-analysis identified significant factors across WHO dimensions affecting adherence. Socioeconomically, older age is associated with poorer ART adherence (OR = 0.86, 95% CI: 0.79-0.95), and higher education improved adherence (OR = 3.68, 95% CI: 1.70-7.95), whereas parental death reduced it (OR = 0.32, 95% CI: 0.18-0.57). Patient-related factors positively associated with adherence included HIV knowledge (OR = 2.35, 95% CI: 1.82-3.03) and self-efficacy (OR = 2.81, 95% CI: 1.58-4.99), whereas HIV stigma (OR = 0.61, 95% CI: 0.47-0.79) and depression (OR = 2.01, 95% CI: 1.16-3.50 for nonadherence) had negative impacts. Clinical factors benefiting adherence included viral load suppression (OR = 4.28, 95% CI: 1.63-11.26), whereas comorbidities (OR = 0.43, 95% CI: 0.32-0.59) reduced it. Therapy-related barriers included increased pill burden (OR = 0.36, 95% CI: 0.29-0.45) and medication side effects (OR = 0.36, 95% CI: 0.20-0.65). Healthcare system facilitators included positive patient-provider relationships (OR = 1.76, 95% CI: 1.35-2.29) and adult accompaniment (OR = 1.75, 95% CI: 1.32-2.32), whereas barriers included longer travel times (OR = 0.58, 95% CI: 0.39-0.86) and missed appointments (OR = 0.44, 95% CI: 0.31-0.63). Optimal adherence to ART is crucial for achieving effective viral suppression and enhancing the quality of life of youths living with HIV. Understanding the facilitators of and obstacles to ART among YLHIVs could be beneficial in designing interventions to increase ART adherence. CRD42023441441.

Young people living with HIV bear a disproportionate burden of depression, which is associated with poor HIV outcomes. Problem-solving therapy (PST) has been shown to be effective for depression management and can be delivered with fidelity by nonspecialists, especially in resource-limited settings. PST is designed to equip individuals to manage the impact of stressful life events on their mental health. Change My Story is a narrative digital game designed to improve PST engagement among young people living with HIV in Nigeria. This trial will evaluate the impact of PST alone or PST with Change My Story on mental health outcomes among young people living with HIV in Nigeria. We will conduct a pilot hybrid implementation-effectiveness randomized controlled trial with 80 young people living with HIV (aged 16-24 years) in Nigeria with depression (9-item Patient Health Questionnaire [PHQ-9] ≥9) over 3 months. Participants will be randomized to receive PST with or without Change My Story. All participants will engage in weekly PST sessions for 6 weeks delivered by trained nonspecialists (clinic HIV adherence counselors). At 6 and 10-12 weeks, scores on PHQ-9 will determine the frequency of PST sessions during the remaining intervention period. Primary implementation outcomes, including engagement, satisfaction, feasibility, acceptability, and appropriateness from the participant perspective, will be assessed using validated scales, programmatic data, and focus group discussions at 3 months. Secondary clinical outcomes will assess changes in depressive symptoms, psychological distress, functional disability, antiretroviral therapy adherence, and HIV viral suppression at 3 and 6 months. Implementation outcomes (all but engagement and satisfaction) will be assessed through validated scales and focus group discussions from the implementer perspective at baseline and 6 months. This study is funded by the US National Institutes of Health (funding commenced on March 8, 2024), institutional review board approval was received on April 15, 2024, and recruitment and data collection began in June 2025. Thus far, we have screened 103 youths and enrolled 23 participants. Among enrolled participants, 15 (65%) were male; 1 (4%) had a PHQ-9 score ≥17, and 6 (26%) had suicidal thoughts. We anticipate recruitment will be completed by January 2026 and follow-up by June 2026. We will assess our hypotheses that PST with Change My Story is feasible, acceptable, and appropriate and that individuals receiving PST integrated with Change My Story will have greater engagement, satisfaction, and depression remission compared to those receiving PST alone. This pilot randomized controlled trial attempts to establish preliminary data on the feasibility, acceptability, appropriateness, and efficacy of task-shifted PST and supplementary mobile health technology on improving HIV and mental health outcomes among young people living with HIV in Nigeria. These findings may serve as a basis for future large-scale interventions. ClinicalTrials.gov NCT06389565; https://clinicaltrials.gov/study/NCT06389565. PRR1-10.2196/74199.

Introduction: HIV monitoring in resource-limited settings is often hindered by diagnostic barriers that compromise patient outcomes. Although viral load testing is the gold standard, cluster of differentiation (CD)4 count monitoring remains common due to cost and accessibility limitations. Case Presentation: The author presents the case of a 38-year-old male in Ecuador who is HIV-positive and undergoing long-term antiretroviral therapy. Despite sustained high adherence, the patient exhibited marked CD4 count variability. A sharp decline 23 months after initial diagnosis (Month 23), followed by a recovery 2 months later (Month 25), raised concerns over laboratory discrepancies and transient clinical conditions. Discussion: The case highlights the multifactorial nature of CD4 variability, encompassing laboratory quality control, medication supply chains, and biological stressors. A review of the literature supports the role of systemic challenges in such variability, especially in low-resource settings. Conclusion: Reliable immunological monitoring requires stringent diagnostic protocols, robust healthcare integration, and attention to clinical context, even in patients with stable antiretroviral therapy adherence.

To control spending, some state Medicaid agencies "cap" the number of prescriptions that a beneficiary can fill each month, presenting a potential barrier to medication adherence for people with chronic health conditions. To evaluate the association between Medicaid prescription drug cap policies and antiretroviral therapy (ART) adherence among people living with HIV, we compared beneficiaries in four states with caps to beneficiaries in eight states without caps during the period 2016-19. In three of four cap states, cap status was associated with a 9percent relative reduction in the percentage of days covered by ART over the course of twelve months compared to noncap states, and a 24percent relative reduction in the likelihood of achieving optimal ART adherence (90percent or higher) over the course of twelve months. The association was stronger for people with higher baseline ART adherence or more baseline comorbidities. We also identified racial and ethnic disparities, where the magnitude of ART adherence reduction associated with caps was significantly greater for Black and Hispanic people than for White people. Medicaid prescription drug cap policies appear to be both a potential source of racial and ethnic disparity and an impediment to achieving clinical targets for optimal ART adherence among people with HIV.

Research linking substance use with HIV risk behaviors and antiretroviral therapy adherence is typically based on self-reported data. However, studies in high-income countries show that men who have sex with men (MSM) often underreport substance use when compared to objective biological testing. Such comparisons have not been conducted among MSM in sub-Saharan Africa. We compared self-reported and objectively measured substance use among MSM participating in HPTN 075, a multi-site observational cohort study conducted in Kenya, Malawi, and South Africa. Urine samples (n = 734) from 382 participants were tested for the alcohol metabolite ethyl glucuronide and 43 other substances. These tests detect alcohol use in the prior 48-72h and other substances up to 7 days earlier, depending on the drug. Of the 734 samples, 159 (21.7%) tested positive for ethyl glucuronide. Self-reported alcohol use was available for 97.5% of these cases and confirmed in 141 (91.0%) of them. Sixty samples (8.2%) tested positive for at least one of the 43 other substances. Self-report data were available for 95.0% of those, but use was acknowledged in only 19 (33.3%) cases. These findings suggest that alcohol use is generally reported accurately, while drug use is substantially underreported-likely due to legal prohibitions and social stigma. Incorporating objective substance testing alongside self-reports is recommended to improve the accuracy of substance use measurement in behavioral and clinical HIV research, especially in contexts where stigma or criminalization may inhibit disclosure.

Improving antiretroviral therapy (ART) adherence among adolescents living with HIV (ALHIV) improves outcomes, but with resource implications. We conducted a cost-effectiveness analysis extrapolating the costs and benefits of a community-based peer-support intervention (Zvandiri) among ALHIV in Zimbabwe. We used a de-novo multistate Markov decision-analytic model that simulated Zvandiri lifetime costs and benefits on viral suppression, death rates, life-years (LY) and quality-adjusted-life-years (QALYs) gained from the healthcare system perspective. We estimate the incremental cost-effectiveness ratio (ICER) per LY and QALY gained and compare the ICER to proposed cost-effectiveness thresholds of $500 and $700 per LY or QALY gained. We explore parameter uncertainty using probabilistic sensitivity analyses. Cohort-microsimulation suggests that after 40 years under SoC, 21% of 280 ALHIV will have undetectable viral-load (VL), 12% will have low VL (<1000 copies/mL), 10% will have high VL (≥1000 copies/mL) and 57% would have died. With Zvandiri, ART adherence improves, decreasing annual probability of virological failure or death. After 40 years, 65% will have undetectable viral load, 23% low VL, 3% high VL and 9% would have died. Zvandiri results in 1,345 LYs gained at incremental cost of $500,587, yielding a discounted ICER of $372 per LY gained. Zvandiri also results in 1,246 QALYs at incremental cost of $123,645, yielding a discounted ICER of $99 per QALY. The ICER is highly sensitive to programme costs, health-related utilities, and the discount rate. Zvandiri is a cost-effective intervention for reducing virological failure and death in ALHIV. Our analysis likely underestimates the full benefits of the intervention by not accounting for reductions in HIV transmissions resulting from higher virological suppression observed in full transmission models.

Increased risk of neuropsychiatric adverse events with dolutegravir-based antiretroviral therapy during pregnancy: Findings from a prospective cohort study.

Antiretroviral therapy (ART) has dramatically reduced HIV-related morbidity and mortality worldwide, but adherence remains a critical challenge, particularly in Sub-Saharan Africa. In Somalia, where HIV prevalence is low but health systems are fragile, little is known about the lived experiences of people living with HIV (PLHIV) regarding ART adherence. A qualitative study was conducted at ART clinic In Mogadishu Somalia between March-August 2024. A total of 22 adult PLHIV and 12 healthcare providers (8 ART nurses and 4 case managers) participated. Purposive sampling was used to recruit participants; Data were collected through 30 in-depth interviews and 4 focus group discussions using semi-structured guides. Interviews were audio-recorded, transcribed, translated, and thematically analyzed using NVivo software, with emerging themes classified into barriers and facilitators of adherence. Barriers to adherence included stigma and discrimination, religious and cultural beliefs (such as reliance on prayer or holy water), economic hardship (transport costs, food insecurity), health system challenges (stock-outs, long waiting times, confidentiality concerns), and psychological factors (depression, denial). Facilitators included strong family and social support, religious coping that motivated adherence, positive patient-provider relationships, peer support networks, and personal motivation and resilience, particularly among patients committed to living for their children. Illustrative quotes highlighted the daily struggles and strategies patients employed to remain in care. ART adherence in Somalia is shaped by complex interactions between socio-cultural, economic, psychological, and health system factors. Interventions that reduce stigma, integrate mental health services, strengthen health systems, provide economic and food support, and leverage religious and peer networks are essential. Collaborating with traditional and religious leaders may further improve acceptance and sustainability of ART programs.

ABSTRACT Antiretroviral therapy (ART) is essential for HIV treatment, yet maintaining high adherence remains challenging in resource-limited settings. Mobile health (mHealth) interventions offer a scalable approach to support adherence. This meta-analysis evaluated the effectiveness of mHealth interventions in improving ART adherence and clinical outcomes among people living with HIV (PLHIV) in low- and middle-income countries. Eight databases were searched through February 2025, and randomised controlled trials (RCTs) evaluating mHealth interventions were included. Risk of bias was assessed using the Cochrane tool, and random-effects models were applied. Seventeen RCTs (n = 2172) met the inclusion criteria. mHealth interventions significantly improved ART adherence compared with standard or alternative approaches (OR = 2.03; 95% CI: 1.44–2.86; p<0.0001). Subgroup analyses indicated moderating effects of geographic region (χ² = 8.84, p = 0.01) and country income level (χ² = 6.44, p = 0.04), with the greatest adherence benefits observed in the Americas (OR = 5.46; 95% CI: 2.20–13.57) and in upper-middle-income countries (OR = 3.45; 95% CI: 1.69–7.06). mHealth interventions also improved viral suppression (OR = 2.27; 95% CI: 1.18–4.36). Although CD4 count improvements were noted, sensitivity analysis suggested this effect was not robust. Overall, mHealth interventions show promise for strengthening ART adherence in resource-limited settings, while further research should explore contextual factors influencing effectiveness.

Precancerous and suspicious cervical cancer lesions refer to abnormal changes in cervical cells that may develop into malignancy if left untreated. Women living with Human Immunodeficiency Virus (HIV) face a significantly higher burden of AIDS-defining malignancies, particularly invasive cervical cancer. Their risk of developing cervical cancer is approximately six times greater than that of HIV-negative women. Despite the elevated risk, there is limited evidence in understanding the prevalence of cervical lesions among women living with HIV (WLHIV) who undergo cervical cancer screening in Ethiopia. This gap underscores the need for further research to inform targeted interventions and improve health outcomes for these high-risk populations. A facility-based cross-sectional study was conducted among 583 adult WLHIV in the Awi Zone, Northwest Ethiopia. Both primary and secondary data were collected between January and May 2023 to address the study objectives. Data were entered into Epidata version 4.6 and exported to SPSS version 26 for analysis. A bivariable and multivariable binary logistic regression model was fitted to identify factors associated with the outcome variable. Statistical significance was determined at a p-value of less than 0.05 and a 95% confidence interval (CI). The magnitude of precancerous and/or suspicious cervical cancer lesions (PCCLs) among women living with HIV was 24.9% (95% CI: 21.3-28.1%). The likelihood of developing precancerous and suspicious cervical cancer lesions was higher among individuals with a baseline CD4 + cell count of < 200 cells/mm³ (AOR = 3.82, 95% CI: 2.44-5.39), a history of sexually transmitted infections other than HIV (AOR = 3.97; 95% CI: 1.97-5.70), use of oral contraceptives (AOR = 2.18; 95% CI: 1.40-3.40), having two or more sexual partners (AOR = 2.86; 95% CI: 1.79-4.55), fair adherence to antiretroviral therapy (ART) (AOR = 2.81; 95% CI: 1.39-5.64), and poor ART adherence (AOR = 3.25; 95% CI: 1.87-7.43). In this study, a relatively high prevalence of precancerous lesions was found among WLHIV compared to previous studies in Ethiopia. Behavioral, clinical, and reproductive health-related factors were linked to the occurrence of the disease. These findings underscore the importance of giving special attention to high-risk women through targeted screening and preventive interventions.

Antiretroviral therapy (ART) adherence behavior is heterogeneous among adolescents and young adults (AYAs) with HIV and influenced by individual and interpersonal psychosocial factors. The primary objective of this study is to characterize ART adherence phenotypes and psychosocial symptom clusters, as related to ART adherence and HIV viral load suppression. This analysis included 60 AYAs with HIV enrolled in an ART adherence support clinical trial. Self-reported ART adherence at baseline, 12-weeks, and 24-weeks was used to define four ART adherence phenotypes: consistently high adherence (YY), early-only adherence (YN), late-only adherence (NY), and consistently low adherence (NN). Symptom clusters were empirically derived from baseline psychosocial measures, including adherence self-efficacy, ART knowledge, HIV stigma, psychological distress (depression, anxiety, trauma), and social support. Linear mixed-effects models were used to examine psychosocial symptom outcomes at three timepoints (baseline, 12-weeks, and 24-weeks) and across groups with different adherence or viral load phenotypes. Using hierarchical clustering, four distinct clusters were identified, underscoring heterogeneity of psychosocial symptoms and patterns of ART and viral suppression. Findings from this analysis are among the first known characterizations of ART adherence phenotypes and psychosocial symptom clusters among AYAs with HIV. Heterogeneity in clusters underscores the need to examine other factors, such as resilience, not captured in the present study. Overall, these study findings contribute to improved understanding of the multi-level psychosocial influences of ART adherence and viral load suppression.

BackgroundWomen who inject drugs (WID) face multifaceted challenges and remain one of the most invisible and vulnerable HIV-impacted populations, disproportionately affected by stigma, health disparities, and structural inequalities. Accurate population size estimation and analysis of the HIV care continuum among this group are crucial for effective programmatic planning. This study aims to describe the main characteristics of the WID participants in the southern region of Mozambique, analyze the self-reported progress towards the 2nd and 3rd targets of the 95-95-95 framework (ART uptake and viral suppression), and estimate the size of this population.MethodsWe conducted a cross-sectional study using a three-source capture-recapture (3 S-CRC) method to estimate the population size of WID in the southern provinces of Mozambique, covering Maputo City, Maputo Province, Gaza, and Inhambane. A separate structured survey was administered during each round to gather socio-demographic and HIV-related information, and the survey results from the first encounter of each participant were used for descriptive results to avoid double or triple reporting from recapture encounters. The HIV care cascade was analyzed, focusing on the second 95% (those aware of their HIV status and currently on antiretroviral therapy (ART) and the third 95% (viral suppression among those on ART), based on self-reported status. Non-parametric Bayesian modeling was applied for estimation, based on the 2022 country population projections. Data were analyzed using R software.ResultsA total of 159 WID were enrolled in Maputo City, 239 in Maputo Province, 29 in Gaza, and 168 in Inhambane. The majority in Maputo City (54.7%), Maputo Province (52.7%), and Inhambane (73.2%) were aged 25–31. Nearly 90% of WID reported engaging in sex work. The HIV care continuum analysis revealed significant gaps in ART uptake and adherence, with Maputo City and Inhambane in particular falling well below the UNAIDS 95-95-95 targets, at 61.0% and 78.9% of self-reported HIV-positive WID reporting current ART treatment, respectively. In all provinces, self-reported viral suppression rates were below the 95% target. The median population size estimation was 240 (173–411; 0.05–0.13% of the adult female population aged 18–49) for Maputo City, 1160 (557-2491; 0.08–0.37%) for Maputo Province, 40 (29–78; 0.01–0.02%) for Gaza, and 650 (381-1083; 0.09–0.27%) for Inhambane.ConclusionThis study provides the first population size estimates for WID in Mozambique and identifies critical gaps in the HIV care continuum. The insights gained underscore the urgent need for focused, comprehensive health services to address the complex needs of WID and inform public health planning. Improving efforts to meet global HIV targets and enhance health outcomes for WID in Mozambique may lead to progress in addressing challenges and achieving better public health outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12954-025-01342-5.

Stroke among people with HIV (PWH) has been linked to initiating or reinitiating antiretroviral therapy (ART) within six months.1,2,3 We examined this association in a large prospective cohort. We conducted a descriptive interim analysis of data from the ongoing AVALON study investigating stroke in PWH (NIH-1R21TW012384-01A1). Over 12 months (September 2024–August 2025), we included all PWH presenting with neuroimaging-confirmed acute/subacute stroke (imaging within three weeks of symptom onset) to Western Cape public sector hospitals with brain imaging facilities (n = 10). We identified 605 PWH with stroke. Median age was 44 years (interquartile range [IQR] 36–54), with 51% female at birth (Table 1). Ischaemic stroke comprised 85% of cases, mostly involving the middle cerebral artery territory (63%). Previous stroke (&gt; 4 weeks before current) was evident in 17%. At presentation, 76% were on ART for a median 8.2 years (IQR 3.8–11.9), most commonly tenofovir/lamivudine/dolutegravir (73%). ART was initiated/reinitiated within six months prior to stroke in 24.4%, with a median of 68 days (IQR 26–119) from initiation/reinitiation to stroke. ART adherence derived from pharmacy refills was 57% in the preceding six months. The most recent median viral load was &lt; 50 copies/mL (IQR &lt; 20–6777), measured a median of 85 days (IQR 4–420) before stroke. We report the largest South African cohort of PWH with stroke to date. Participants were young, on currently recommended ART, and 28% had no comorbidities. A quarter initiated/reinitiated ART within six months of stroke, supporting previous reports suggesting a potential immune reconstitution-like syndrome.

HIV stigma negatively impacts antiretroviral therapy (ART) adherence in adults, but this relationship remains underexplored within the context of early adulthood. We examined manifestations of stigma and their associations with ART interruptions among young (18-24 years) and older (25 + years) people living with HIV (PLHIV) in Zimbabwe. This analysis utilized cross-sectional data from the 2021 PLHIV Stigma Index 2.0, implemented by the Zimbabwe National Network of PLHIV in partnership with Global Network of People Living with HIV, The International Community of Women Living with HIV, and UNAIDS. Treatment interruptions were defined as ever interrupting or stopping HIV treatment. Internalized, anticipated, and enacted stigma scores were categorized as "no", "low", "moderate" and "high". Modified Poisson regression models estimated associations between categorized stigma scores and treatment interruptions, with age-stratified analyses among young and older adults. Among 1347 PLHIV who ever initiated ART, 20.9% of young adults and 10.3% of older adults reported treatment interruptions. Experiences of internalized stigma (56.3% versus 41.7%, p < 0.01) and anticipated stigma (73.9% versus 51.8%, p < 0.01) were higher among young adults compared to older adults. Increasing levels of internalized stigma were associated with higher lifetime incidence of treatment interruptions compared to no stigma (low: adjusted risk ratio(aRR)1.67, 95%CI 1.08-2.58, moderate: aRR2.58, 95%CI 1.72-3.87, high: aRR3.54, 95%CI 2.11-5.94). Similar associations were observed with anticipated stigma (low: aRR2.24, 95%CI 1.49-3.36, moderate: aRR3.21, 95%CI 1.82-5.66, high: aRR4.88, 95%CI 2.75-8.67). Treatment interruptions were associated with high (versus no) enacted stigma (aRR 2.75, 95%CI 1.19-6.32). Young adults living with HIV in Zimbabwe reported twice the lifetime incidence of treatment interruptions and greater levels of internalized and anticipated stigma compared to older adults. The associations between stigma and treatment interruptions highlight the opportunity for interventions that address stigma for young adults, which may optimize treatment adherence during early adulthood.