30 APRIL 2021 VOLUME 23 ISSUE 17

Scotland was the first country in the UK and one of the first in the world to provide PrEP via sexual health clinics as a standard provision of its national health service. In January this year, it became only the second place in the world, after New South Wales in Australia, to be able to show that the introduction of PrEP had led to a significant fall in HIV infections, not only in gay and bisexual men taking PrEP, but also in men who did not, proving that PrEP could have real population-level effectiveness in preventing HIV.

Despite having less access to gender-affirming care, Black and Latino trans teens and young adults were much more likely to have ever received an HIV test and more likely to have heard of pre-exposure prophylaxis (PrEP) than white youth, according to a national survey published in LGBT Health.

The government has come under the spotlight for releasing to Kenyans antiretroviral drugs that were phased out years back due to their adverse side effects on patients.

Mozambique has played such an inspirational role in the history of our continent that arriving to this vibrant and beautiful country has always been a great joy. But on my last visit earlier this month, while so happy to be reunited with Mozambicans, I also shared in their pain and frustration at the humanitarian crisis from the conflict in Cabo Delgado. As UN Under-Secretary-General, and as the leader of the UN’s work to beat AIDS, I came to Mozambique to express my solidarity with Mozambicans, and to learn how best we can strengthen our support for them. At this painful time for Mozambique, we the United Nations are with its people.

It’s been a while since there was a strong milestone in the development of an effective HIV vaccine. Just last year, a large-scale trial of a promising HIV vaccine candidate was halted after the vaccine failed. But with the extraordinary success we’re seeing with COVID-19 vaccines, it’s not surprising that the positive results of a recent HIV vaccine trial have ignited wild enthusiasm. While movement by the research community in the direction of an HIV vaccine is good news, it’s important to understand exactly what the trial’s results mean, and what they do not.

People who miss appointments or stop taking their treatment often report being treated badly by healthcare workers when they return to health facilities. This fear of being reprimanded discourages people from going back to the clinic to seek support and receive their treatment, argues Spotlight.

The COVID-19 pandemic has not only re-emphasised the importance of well designed randomised clinical trials but also highlighted the need for large-scale clinical trials structured according to a master protocol in a coordinated and collaborative manner. There is also a need for structures and incentives to enable faster data sharing of anonymised datasets, and a need to provide similar opportunities to those in high-income countries for clinical trial research in low-resource regions where clinical trial research receives considerably less research funding.

The findings showed that trial closure is a complex process for HIV positive participants which includes three phases: the pre-closure, trial-closure, and post-trial phases. The model highlights a range of different needs of research participants and suggests specific and person-centred interventions that can be delivered at different phases with the aim of improving health outcomes and experiences for trial participants in low income settings during trial closure. Further research needs to be done to verify the model in other contexts and for other conditions.

These findings highlight the importance of designing and implementing condom promotion programs for MSM who engage in anal intercourse with specific sections that consider the acquisition of assertive skills and reduce the risks associated with a perceived invulnerability to HIV.

On-demand PrEP medication is more conducive to adherence. Preventive management should focus on MSMMs who are students at school, those who occasionally use condoms, and those with poor HIV knowledge. Improving threat perception and susceptibility, and controlling and reducing the response cost can effectively improve PrEP adherence, and the subsequent application of protective motivation theory (PMT) during intervention research can provide a reference for HIV prevention in MSMM.

Significant progress has been made with regards to reaching the UNAIDS first 90 target. In this context achieving the first 90 target is feasible but there is a need for additional interventions to reach the males especially youth including those with no education or low levels of education.

Late ART initiation for PMTCT and lack of postpartum infant prophylaxis are still the most important risk factors to explain MTCT in the era of universal access. Improved early attendance at antenatal care, early ART initiation, and enhancing the continuum of care especially for single mothers is crucial for MTCT elimination in Rwanda.

It is plausible that DREAMS lowered HIV incidence among YWSS in two Zimbabwean cities, but our evaluation provides weak statistical evidence for impact and suggests any reduction in incidence was lower than the anticipated 40 percent decline. We identified changes to some important ‘pathways to impact’ variables, including condom use.

This review summarizes available information about the potential for long-acting therapy to improve adherence for some patients and outlines associated opportunities and challenges with the implementation of long-acting therapy for the treatment and prevention of HIV.

These results are consistent with a role for neutralizing antibodies in controlling viral replication and preventing the decline of CD4+ T lymphocytes. Importantly, in patients with 3S-specific antibodies, neutralizing titers were inversely correlated with viral RNA levels and proviral DNA levels. Moreover, patients with 3S and/or EC26-specific antibodies showed a 1.9-fold higher tier 2 neutralization score than patients without antibodies suggesting that 3S and/or EC26-specific antibodies contribute to neutralization breadth and potency in HIV-1 infected patients.

In the short term, we recommend that research ethics committees (RECs) should amend their application forms in particular to better ‘trigger’ researchers to thoughtfully plan sound stakeholder engagement. In the longer term, we recommend that RECs' documents be better harmonised internally regarding their stance on stakeholder engagement.

Participants were more likely to be taking PrEP if they received PrEP information from a healthcare provider and endorsed STI-related risk compensation. Conversely, PrEP uptake was less likely among those with concerns about medication use and adherence. While there were no racial/ethnic differences in PrEP uptake, there were differences in correlates of PrEP use for White participants and participants of color. To facilitate PrEP uptake, clinicians should provide PrEP education and screen all patients for PrEP candidacy. Additionally, public health messaging must reframe HIV “risk”, highlight benefits of STI testing, and emphasize the importance of preventive healthcare for SMM.