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BackgroundHIV and drug-susceptible tuberculosis (DS-TB) co-infection severely affects adolescents and young adults (10-24 years), leading to a significant infectious disease burden, yet this age group remains overlooked. This study assessed the 1990-2021 global, regional, and national disease burden of HIV and DS-TB co-infection with a specific focus on adolescents and young adults (10-24 years).MethodsThe Global Burden of Diseases, Injuries, and Risk Factors Study 2021 (GBD 2021) estimates disaggregated by HIV status and TB drug susceptibility. Number and rates of the incidence, prevalence, and mortality of HIV and DS-TB co-infection from 1990 to 2021 at the global, regional, and national level among individuals aged 10-24 years were collected from GBD 2021. Trends were analyzed by sex and Sociodemographic Index (SDI).ResultsIn 2021, over 100 000 new cases and nearly 20 000 deaths were recorded globally, with the highest burden in low-SDI regions and Southern Africa. Globally, all metrics initially increased, then declined after reaching their peak. Higher disease burden occurred in females than in males.ConclusionHIV and DS-TB co-infection remains a critical public health challenge for adolescents and young adults. Greater attention must be directed to prevention, treatment, and care among adolescents and young adults. The study reported the incidence, prevalence, and mortality of HIV and drug-susceptible tuberculosis (DS-TB) co-infection in people aged 10-24 years. Global data were used to better understand global trends and better control and prevent the spread of the disease.Plain Language SummaryWhy was the study done? HIV and drug-susceptible tuberculosis (DS-TB) co-infection imposes many adverse clinical outcomes on adolescents and young adults, leading to a significant infectious disease burden. However, there is a persistent trend of neglect concerning individuals aged 10-24 years. We aimed to identify the global, regional, and national disease burden of HIV and DS-TB co-infection in 10 to 24 years old from 1990 to 2021. What did the researchers do? We used data from the 2021 Global Burden of Disease Study to look at how often young people aged 10 to 24 around the world got, had, or died from HIV and DS-TB co-infection between 1990 and 2021. We further analyzed global trends by sex and a measure of a country's development level (Sociodemographic Index or SDI). What did the researchers find? In 2021, HIV and DS-TB co-infection caused 102,712 new cases, 184,481 prevalent cases, and 19,214 deaths globally in people aged 10 to 24 years. Overall, the rates of new cases, prevalent cases, and deaths related to HIV and DS-TB co-infection first went up over time, but then started going down. Young people in the world's least developed regions (Low SDI) and specifically in Southern Africa faced the highest rates of this double infection and death. The burden of these diseases was also higher on young women and girls than on young men and boys. What do the findings mean? This study has identified that HIV and DS-TB co-infection is still a serious health problem for 10 to 24 years old worldwide. We need to improve prevention, treatment, and care for this disease, with special focus on young people in this age group.

Adolescents and young people (AYP) experience a disproportionate burden of both mental health conditions and HIV, particularly in low- and middle-income countries (LMICs)-nations classified by the World Bank as having lower or middle economies. Mental health problems such as depression, anxiety, and substance use increase HIV (Human Immunodeficiency Virus that attacks the human immune system and leads to various illnesses when untreated) risk, and negatively affect treatment adherence and outcomes. However, mental health remains insufficiently integrated into HIV research and programming. Evidence on how mental health services are operationally integrated into HIV prevention and treatment for this population is limited and fragmented. This scoping review mapped existing evidence on the integration of mental health services into HIV treatment programs for AYP in LMICs, guided by PRISMA-ScR (a guideline used for reporting scoping reviews in research) and the Person-Concept-Context framework, a framework used to define specific research question in research. In this case, the population was adolescents and young people (10-24 years) receiving HIV prevention or treatment services, the concept referring to the integration of mental health interventions such as screening, assessment and counseling within HIV services, and the context focused on low- and middle-income countries (LMICs). PubMed, MEDLINE, Scopus and PsycINFO databases were searched for studies published between 2014 and 2024. Eligible studies reported mental health screening, assessment, treatment, or referral within HIV services for AYP in LMICs. Two reviewers independently screened studies, assessed full texts, and extracted data. Of 634 records identified, ten (10) studies met the inclusion criteria. All were conducted in Sub-Saharan Africa and primarily used qualitative or pilot designs. Four integration approaches were identified: routine mental health screening within HIV services, task-shifting to trained lay providers, peer-led and community-based psychosocial support, and culturally adapted, youth-centered psychological interventions. Common barriers included stigma, low mental health literacy, limited training and supervision, staffing constraints, and weak referral systems. Existing evidence is limited, remains exploratory, preliminary, and largely focused on feasibility and implementation experiences, suggesting that integrating mental health services within adolescent HIV care in LMICs may be feasible and acceptable when approaches are contextually adapted and participatory.

Chemsex, sexual activity under the influence of psychoactive substances, remains a major public health concern for men who have sex with men (MSM) globally. In Malaysia's conservative context, the convergence of chemsex and HIV transmission presents complex challenges. This narrative review examines how the Covid-19 pandemic and extended lockdown disrupted HIV services and intensified psychosocial stressors, amplifying chemsex, HIV, and mental health issues among Malaysian MSM. A systematic search of international databases (2018-2025) identified relevant studies through keyword screening of articles, abstracts, and full texts. The Covid-19 lockdown exacerbated psychosocial stressors such as isolation and minority stress, altered chemsex patterns, and increased drug use. Disruption of HIV testing and treatment delayed diagnoses and potentially heightened transmission, while PrEP uptake remained low (18.3%) despite awareness. The pandemic intensified syndemic interactions concerning chemsex, HIV, and mental health. Urgent, integrated, person-centered intervention is needed to address this multifaceted crisis. The Synergistic Impact of Covid-19 Lockdown on Sexualized Drug Use and HIV on Malaysian Men Who Have Sex with Men: A ReviewPlain Language SummaryChemsex is sexual activity under the influence of drugs such as methamphetamine. This behaviour, common among men who have sex with men (MSM), increases the risk of HIV infection and mental health issues. In Malaysia, where strict laws and social stigmas exist around homosexuality and drug use, makes it difficult for MSM to access support and healthcare.This review explores how the Covid-19 pandemic and Malaysia's lockdowns affected chemsex practices and HIV trends among Malaysian MSM. The Lockdown limited social contact and increased social isolation, which amplified pre-existing issues that caused many MSM to turn to chemsex as a way to cope. These heightened feelings of stress led to increased drug use and riskier sexual practices (including injecting methamphetamine). Younger Malaysian MSM are affected by these trends that potentially carry lasting effects, and many do not surface until advanced stages of addiction and/or HIV.HIV testing and treatment services were disrupted during the Covid-19 lockdown, resulting in late diagnoses and potentially higher chances of HIV transmission. Only 18% of Malaysian MSM used pre-exposure prophylaxis (PrEP) as HIV prevention despite increased awareness.The overlapping health issues of Covid-19, chemsex, mental health, and HIV form a complex synergy that worsened during the pandemic. The findings highlight an urgent need for integrated health services that combine addiction intervention, mental health support, and HIV prevention strategies that are tailored to the MSM community. More comprehensive programs that integrate harm reduction, recovery, and prevention methods are needed to mitigate the issues concerning chemsex. Educating healthcare providers on MSM-specific issues is essential to reducing stigma and supporting them effectively.

While improvements have been made across the HIV care continuum in South Africa, gaps remain. Relationship-focused couples-based approaches may be one avenue to improve HIV-related outcomes for men and women. Prior couples-based studies have been found to improve several HIV care and treatment outcomes in this context, but few have considered viral suppression as the primary outcome. We aimed to compare a couples-based motivational-interviewing intervention delivered to couples to similar content delivered to men and women in couples separately. We will test the efficacy of this approach in a randomised controlled trial. Our goal is to enrol 270 heterosexual couples for this trial, with at least one partner living with HIV. Couples will be randomised into one of two arms, stratified by couples' HIV status. The intervention arm, Simunye ('We are one' in isiZulu), will provide two sessions of motivational information and skills regarding HIV-related behaviours to couples together, along with relationship-focused content and skills. The content is based on Partner Steps (P-steps), a couples-focused adaptation of Life Steps, an evidence-based programme shown to improve adherence and viral suppression. The control group will receive two sessions as individuals, with similar HIV-related information but without relationship-focused content. Participants will be followed up at 6, 12 and 18 months postrandomisation. The baseline questionnaire will include measures of relationship domains such as satisfaction and communication, and measures pertaining to HIV and reproductive health (eg, fertility intentions, HIV knowledge and risk perception, and sexual behaviour), and mental health (eg, depression symptoms). The primary outcome is viral suppression, based on dried blood spots. Secondary outcomes will include other aspects of treatment engagement. We will also examine hypothesised mediators of intervention participation, for example, relationship dynamics. Primary analyses will use a multilevel modelling approach, which will feature planned time-averaged comparisons of postbaseline measurements across the intervention and control groups to test the primary hypothesis. The analysis will account for the dyadic nature of the data, for example, participants nested within couples. This trial was approved by the Institutional Review Board (IRB) at the Human Sciences Research Council in South Africa, protocol number 2/27/01/21, and the IRB at the University of Michigan (HUM 00203672). Human subjects' concerns or adverse events will be reported to both IRBs and the Data Safety and Monitoring Board. We will disseminate findings to community members and stakeholders via community meetings, as well as by conference presentations and publications in peer-reviewed journals. Clinicaltrials.gov Protocol Registration NCT05231707 registered on 8 February 2022. Protocol version 2.0, 31 October 2025.

Perinatal depression is a common, yet understudied, mental health disorder among women and contributes to poor engagement in prevention of mother-to-child transmission (PMTCT) of HIV in sub-Saharan Africa. Male partners are positioned to provide critical forms of social and economic support during pregnancy and postpartum, and also may contribute to women's stress, depression and anxiety through intimate partner violence and withholding of social support. Despite the critical role of men in pregnancy outcomes and HIV prevention, few interventions have engaged men around women's depressive symptoms, nutrition and health, and engagement in PMTCT. We will conduct a pilot trial of Mphatso, a couple-based intervention based on problem-solving therapy with couple relationship skills to reduce depressive symptoms in perinatal women, improve food insecurity and prevent HIV transmission to the infant. We will employ a two-arm pilot randomised controlled trial in the Zomba district of Malawi to assess the feasibility and acceptability of Mphatso (meaning 'gift' or the child) and explore health impacts on depressive symptoms, PMTCT engagement and food insecurity. We will enrol 60 pregnant women in the second or third trimester who are living with HIV and meet criteria for probable depression based on the Edinburgh Postnatal Depression Scale and their male partners. Couples will be randomised to receive either five sessions of Mphatso (problem-management skills plus health education and relationship skills) or enhanced usual care. Feasibility and acceptability outcomes will include session attendance rates, satisfaction levels and retention at 3 months and 6 months postpartum. Exploratory analyses using regression models including time and treatment arm will be conducted to explore effects on the mothers' and fathers' depressive symptoms, adherence to PMTCT (antiretroviral therapy, nevirapine use, HIV testing and exclusive breastfeeding) and food insecurity. The pilot trial has been approved by the University of California, San Francisco (Human Research Protection Program (HRPP); Protocol Number 23-40685), and the study has also been approved by the National Health Sciences Research Committee in Malawi (NHSRC; Protocol Number 24/05/4431). Results will be disseminated to study participants, health officials, policymakers, community leaders and care providers, as well as through presentations at conferences and publications in peer-reviewed journals. NCT06659315.

Adolescents living with HIV (ALHIV) face unique psychosocial and structural challenges affecting ART adherence and engagement in care. Despite Zambia's expansion of adolescent-friendly HIV services, adolescents continue to experience poorer adherence and treatment outcomes than adults, including lower viral suppression and retention in care and limited understanding remains around the experiences of ALHIV and their caregivers. This study explored multilevel factors influencing ART adherence in Lusaka district from the perspectives of ALHIV and their caregivers. We conducted an exploratory qualitative study on psychosocial, behavioral, and structural factors influencing ART adherence and experiences of HIV services among ALHIV in Lusaka, Zambia. Between February and July 2025, 35 in-depth interviews (20 ALHIV who were already aware of their HIV status and engaged in long-term care and 15 caregivers) were conducted across six health facilities (four PHC and two first-level facilities). Interviews were held in English or Nyanja, audio-recorded, transcribed, and analyzed using ATLAS.ti v24. A hybrid inductive-deductive approach, informed by the socioecological model, guided coding. Themes were organized in an analytical matrix showing multilevel influences on adherence, including emotional burden, stigma, support systems, and structural barriers. Trustworthiness was ensured through triangulation, peer debriefing, and iterative codebook development. The themes identified spanned intrapersonal (individual), interpersonal, organizational/institutional, community, and structural/policy-level factors influencing ART adherence, alongside participant-generated cross-cutting recommendations to strengthen adolescent HIV service delivery. Many adolescents struggled with stigma, emotional distress, and challenges of consistent medication adherence, while others adapted through acceptance, spirituality, and counseling. Supportive relationships with family, peers, and healthcare workers fostered adherence, but stigma, school challenges, inconsistent caregiving, and limited privacy remained significant barriers. Socioeconomic issues, such as transport costs, hindered treatment continuity. Helpful strategies included routine-building, reminders, and increased health literacy. Participants recommended improving adolescent-friendly services by integrating mental health support, strengthening provider communication, expanding peer networks, and reactivating support groups to better support ART adherence among ALHIV. Addressing psychological, social, service delivery, and structural barriers such as coordination between schools and the health system is vital to improving ART adherence among ALHIV in Zambia. A multilevel approach is needed to support sustainable treatment outcomes.

IntroductionLong-acting injectable antiretroviral therapy (LAI-ART), especially cabotegravir plus rilpivirine, is primarily recommended as a switch option for virally suppressed individuals and may improve adherence, privacy, and treatment satisfaction. Contemporary international guidance notes a restricted, closely monitored role for selected viraemic patients with persistent adherence challenges. Feasibility in low-resource systems remains uncertain. We explored perceived feasibility and acceptability of LAI-ART among HIV care providers and regulatory stakeholders in Pakistan.MethodsWe conducted semistructured in-depth interviews with 17 providers and stakeholders from ART centers, tertiary hospitals, the National AIDS Control Program, and a community-based organization in Islamabad and Rawalpindi. Interviews were audio recorded, transcribed, translated, and analyzed using reflexive thematic analysis.ResultsParticipants viewed LAI-ART as promising for improving adherence, treatment fatigue, confidentiality, and workflow. Barriers included travel distance, needle phobia, missed dose risks, staffing constraints, cold chain and storage needs, infrastructure limitations, and weak biomedical waste management.ConclusionStakeholders expressed cautious interest in LAI-ART while highlighting significant structural, financial, and sociocultural barriers. Participants emphasized that phased pilot implementation, sustainable financing, cultural acceptability, integration into differentiated service delivery, and stronger counselling and digital support would be necessary to support future introduction. Are Long-Acting HIV Injections Feasible and Acceptable in Pakistan? A Qualitative StudyPlain Language SummaryThis study explored whether long acting HIV injections could be introduced in Pakistan and whether they would be acceptable to those involved in HIV care and regulation. We interviewed 17 key informants, including physicians, pharmacists, counsellors, nurses, and regulatory stakeholders. Participants viewed long acting injectable treatment positively and believed it could improve adherence, privacy, and treatment satisfaction. However, they identified important barriers, including long travel distances, needle phobia, missed dose risks, staffing shortages, cold chain and storage needs, infrastructure limitations, and biomedical waste management gaps. They recommended phased pilots, strong financing, culturally acceptable delivery models, and better counselling and digital support before wider rollout.

Short-cycle antiretroviral therapy (ART), comprising 5 days on and 2 days off treatment, offers the potential for ART-free weekends, reduced toxicity, and improved quality of life for adolescents living with HIV, who typically have worse treatment outcomes than other age groups. We aimed to compare the efficacy and safety of short-cycle ART containing tenofovir disoproxil fumarate-lamivudine-dolutegravir with continuous ART in adolescents living with HIV in Africa. We conducted an open-label, randomised, parallel, two-arm, non-inferiority trial (BREATHER Plus) in five clinical research centres across Kenya, South Africa, Uganda, and Zimbabwe. Adolescents (aged &#x2265;12 years to <20 years) with an HIV-1 viral load of less than 50 copies per mL over the previous 12 months and no documented history of treatment failure were eligible for inclusion. Participants were randomly assigned (1:1) by use of permuted blocks to either short-cycle ART or continuous ART, stratified by clinical centre and mode of HIV acquisition (vertical vs horizontal or other). Participants received a daily oral fixed-dose combination of tenofovir disoproxil fumarate (300 mg), lamivudine (300 mg), and dolutegravir (50 mg); those assigned to short-cycle ART could choose their two consecutive days off (ie, Friday and Saturday or Saturday and Sunday). The primary outcome was confirmed viral rebound (the first of two consecutive viral load measurements &#x2265;50 copies per mL) by week 96, analysed by intention to treat in all participants with viral load data after baseline assessment by use of adjusted Kaplan-Meier estimated proportions. The non-inferiority margin and confidence level depended on the event rate in the continuous ART group (an 8% margin with 99% CI for a 5% event rate). This trial is registered with ISRCTN (85058577), and follow-up is complete. Between June 29, 2022, and May 10, 2023, 470 adolescents living with HIV were randomly assigned to either short-cycle ART (239 [51%]) or continuous ART (231 [49%]). 263 (56%) participants were female and 207 (44%) were male. Median follow-up was 117 weeks (IQR 108-120). 23 participants in the short-cycle ART group and 11 in the continuous ART group had confirmed viral rebound by 96 weeks, with an estimated probability of confirmed HIV-1 RNA of at least 50 copies per mL of 9&#xb7;9% (95% CI 6&#xb7;4-14&#xb7;3) in the short-cycle ART group versus 4&#xb7;8% (2&#xb7;6-7&#xb7;8) in the continuous ART group. With an estimated difference of 5&#xb7;1% (99% CI -0&#xb7;8 to 11&#xb7;5; bootstrap p=0&#xb7;034), an 8% higher rate of confirmed virological rebound in the short-cycle ART group was not rejected, and the rate of confirmed virological rebound was significantly higher in the short-cycle ART group than in the continuous ART group. By the end of follow-up, 16 serious adverse events in 15 participants were reported in the short-cycle ART group (including one death unrelated to HIV or ART) and 22 serious adverse events in 16 participants in the continuous ART group. BREATHER Plus findings demonstrate that short-cycle ART with tenofovir disoproxil fumarate-lamivudine-dolutegravir should not be recommended for adolescents living with HIV receiving standard-of-care, routine viral load monitoring every 6-12 months. European and Developing Countries Clinical Trials Partnership, and UK Medical Research Council.

Integrating clinical programs and services is a cost-effective approach that can improve health and system outcomes. This review aimed to provide an overview of the benefits and challenges of integrated programs for HIV, hepatitis B and C, and STI services worldwide and provide recommendations for research and practice. This scoping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched electronic databases PubMed, Scopus, and Web of Science until May 2025 to extract relevant studies. Additionally, we reviewed reputable grey literature sources, such as WHO and UNAIDS, and references from included publications for further relevant articles. Studies that had eligible criteria were included. We applied a narrative approach to report the findings through an inductive approach. Out of 19,516 initially identified studies, 118 were selected. The benefits and challenges of integration were classified into six categories: integrated service delivery, medical information and technology, human resources, health outcomes, collaboration and partnerships, and financial/physical resources. The significant benefits of these classifications include improved health outcomes, cost-effectiveness, enhanced efficiency, prevention of transmission, use of comprehensive care, reduction of time for receiving necessary services, increased knowledge and awareness, and improved cooperation. However, integration has some challenges, including the need for sufficient infrastructure, budget, human resources, and the potential for increased stress and work pressure on employees. Prioritizing health is key to national development, requiring policies and resources for cost-effective patient and community benefits. This scoping review highlights the feasibility and advantages of integrating services for HIV, hepatitis B and C, and STIs. Our findings strongly support policymakers in prioritizing the planning and implementation of these integrated programs. An evidence-informed integration framework is needed to guide these actions effectively.

This study aimed to explore the treatment decision-making experiences of older patients with cancer, their family caregivers, and healthcare providers. A qualitative study was conducted using focus group interviews at a tertiary hospital in South Korea. The groups were divided into patients with cancer (aged 75 and older), family caregivers, and healthcare providers. Eight patients, 11 caregivers, and 10 healthcare providers participated in the study. The interviews were transcribed and thematically analyzed to identify key themes across the three groups. Patients, family caregivers, and healthcare providers shared interrelated yet distinct perspectives on treatment decisions for older adults with cancer. Patients wanted to maintain life and quality of life but felt anxious about side effects and often deferred decisions to physicians or family. Caregivers sought to reduce suffering and protect dignity by gathering information and relying on the guidance of physicians. Healthcare providers focused on safety and shared decisions, considering preferences, prognosis, and function, but faced challenges due to time limits and the lack of age-specific guidelines. This study highlight the complex nature of treatment decisions for older adults with cancer, shaped by emotional, relational, and clinical influences across patients, families, and clinicians. Findings emphasize the need for personalized, ethically sensitive approaches that respect the unique values of this population. Improving decision-making in geriatric oncology requires better interdisciplinary coordination, age-specific protocols, and practical support for caregivers. Tailored decision aids can help older adults make informed, value-aligned choices that reflect both medical needs and personal priorities.

To evaluate the safety and efficacy of VPM1002 and Immuvac in reducing the incidence of microbiologically confirmed tuberculosis (TB; pulmonary TB and extrapulmonary TB), development of latent TB infection, and immunogenicity. Phase 3 randomised clinical trial (PreVenTB trial). 18 sites across six states of India. 12&#x2009;717 healthy household contacts (aged &#x2265;6 years) of patients with a smear positive TB test. Participants were randomly assigned in a 1:1:1 ratio (using block randomisation with variable sample size) to receive an intradermal injection of VPM1002, Immuvac, or placebo in both arms. After one month, a second dose was administered in one arm to 11&#x2009;829 healthy participants. The primary outcome was efficacy against confirmed TB (pulmonary TB and extrapulmonary TB) over 38 months of follow-up. Secondary outcomes were development of latent TB infection, adverse and serious adverse events, efficacy in predefined age groups, and immunogenicity. Exploratory outcomes were efficacy when considering tuberculin skin test status, and post hoc analyses of efficacy in participants aged 6-14 and according to body mass index. 252 and 227 participants developed microbiologically confirmed TB in modified intention-to-treat and per protocol groups, respectively. The per protocol analysis showed 65 (1.68%), 80 (2.09%), and 82 (2.13%) participants developed TB in the VPM1002, Immuvac, and placebo groups, respectively. Of these, 12 (0.31%), 16 (0.42%), and 24 (0.62%) developed extrapulmonary TB in the VPM1002, Immuvac, and placebo groups, respectively. In the per protocol analysis, VPM1002 showed vaccine efficacy of 21.4% (95% confidence interval (CI) -8.9% to 43.2%), 19.5% (-14.6% to 43.4%), and 50.4% (0.8% to 75.2%) against all TB, pulmonary TB, and extrapulmonary TB, respectively. Immuvac showed vaccine efficacy of 33.2% (-25.9% to 64.5%) against extrapulmonary TB. VPM1002 and Immuvac showed vaccine efficacy of 64.9% (-2% to 90.1%) and 66.3% (1.9% to 90.5%) against extrapulmonary TB in participants with tuberculin skin test positivity. Both vaccines were well tolerated with mild local reactions in about a third of participants. VPM1002 and Immuvac induced Mycobacterium tuberculosis specific polyfunctional CD4+ T cells. Post hoc analyses showed vaccine efficacy of 64.6% (95% CI 16.3% to 85.1%) against all forms of TB, 62.1% (3.0% to 85.2%) against pulmonary TB, and 77.6% (-3.7% to 95.2%) against extrapulmonary TB in participants aged 6-14 years in the VPM1002 group. Both vaccines were safe but did not show any efficacy against all forms of microbiologically confirmed TB or pulmonary TB. VPM1002 showed considerable efficacy against extrapulmonary TB. Both vaccines showed efficacy against extrapulmonary TB in participants who had a positive tuberculin skin test. Clinical Trials Registry India CTRI/2019/01/017026.

Previous research suggests that 14.4% of the general population is affected by tinnitus. For some of those affected, the ear noise is bothersome or associated with severe distress. There are various treatment options such as cognitive behavioral therapy (CBT), sound therapy, or hearing aids. In addition to browser-based online interventions, mobile apps have been introduced as novel treatment approaches. Previous studies have identified several apps aimed at supporting users with tinnitus. Yet, knowledge about the content of tinnitus apps is limited. This study aimed to provide an overview of apps specifically developed for tinnitus by analyzing general app characteristics, as well as app content, focusing on intervention components and behavior change techniques (BCTs). A systematic search using 7 search terms (eg, tinnitus and ear noise) was conducted in the Google Play Store and the Apple App Store. Apps designed specifically for tinnitus and available in German or English met the inclusion criteria. Two independent trained raters assessed general app characteristics (eg, age group and costs) using the app description section of the German version of the Mobile App Rating Scale. In addition, raters analyzed app content using the BCT taxonomy (v1) and a list of typical intervention components in tinnitus treatment. Differences in ratings were discussed, and a third trained rater was consulted if no consensus was reached. A total of 1198 apps were identified in the systematic search. Of those, 69 apps were included in the final analysis. Fifty-two apps were available for free, 23 of which offered in-app purchases. Among the 17 paid apps, costs ranged between &#x20ac;0.69 (US $0.81) and &#x20ac;450 (US $527) per 12 months. Fifty-eight of 69 apps provided sounds (eg, white noise and nature sounds). Many apps assessed tinnitus characteristics (n=38) and provided information about tinnitus (n=27). The most frequently used BCTs were "instruction on how to perform the behavior" (n=25; eg, audio instructions for relaxation techniques), "feedback on behavior" (n=11), "behavioral practice/rehearsal" (n=11), "information about health consequences" (n=11), "information about emotional consequences" (n=11), and "prompts/cues" (n=11). The number of BCTs implemented varied widely across apps (0-18 per app). Most tinnitus apps offer sound-based interventions (eg, white noise and nature sounds). Notably, CBT elements (eg, cognitive restructuring, attention training, and relaxation training) are implemented less frequently, despite CBT being recommended in tinnitus treatment guidelines. Further research on the efficacy of tinnitus apps is needed. Transparent reporting of intervention techniques may help clarify mechanisms of action and support the replication of effective interventions. Given the large number of readily accessible apps, this study provides an overview relevant to both researchers and health care professionals.

HIV/AIDS remains a significant public health challenge, with many individuals developing advanced HIV disease despite the scale-up of antiretroviral therapy worldwide. Determinants related to sociodemographics, clinical practice and laboratory service associated with advanced HIV disease are not well known in sub-Saharan Africa, such as Ethiopia. This study examines the potential sociodemographics and clinical practice of determinants of advanced HIV disease among adults on antiretroviral therapy in the West Oromia Region, Ethiopia. A hospital-based retrospective study was employed. The Raosoft online sample calculator was used to estimate a sample of 544 patient medical records in the study. A systematic sampling technique was used to select participants who met the inclusion criteria from three purposively selected public hospitals between January 2017 and December 2021. Descriptive statistics were applied to the dataset after it was cleaned and validated in EpiData, and the final analysis was performed in SPSS Version 29. Bivariate and multivariate logistic regression models were used to analyse sociodemographic and clinical practice factors associated with advanced HIV disease, with p < 0.05. The study revealed sociodemographic and clinical practice determinants associated with advanced HIV disease among adults, which includes male sex (adjusted odds ratio [AOR]&#x2009;=&#x2009;1.85 and 95% confidence interval [CI] 1.18-2.90), the presence of HIV signs and symptoms (AOR&#x2009;=&#x2009;2.83 [95% CI 1.74-4.61]) and OIs (AOR&#x2009;=&#x2009;3.44 [95% CI 2.01-5.92]) at the time of antiretroviral therapy enrolment, bedridden and ambulatory health conditions (AOR&#x2009;=&#x2009;3.58 [95% CI 1.76-7.31]), and low CD4 cell count of less than 200&#x2009;cells/mm3 accounted for 127 (36.5%) at treatment initiation while having CD4 test results at baseline data collections participants (AOR&#x2009;=&#x2009;1.97 [95% CI 1.20-3.23]), and 84 (37%) of those delayed ART initiation (AOR&#x2009;=&#x2009;1.75 [95% CI 1.08-2.83]). 42 (7.7%) had ART on&#x2009;&#x2264;&#x2009;1-7&#x2009;days and 143 (26.3%) in >&#x2009;7&#x2009;days. These significantly correlated with the development of advanced HIV disease or OIs at a p value of <&#x2009;0.05 among this study population. Only 359 (66%) had same-day ART. The findings highlight the importance of early HIV diagnosis and initiation of antiretroviral therapy, adherence to treatment regimens and monitoring for OIs in the prevention and management of advanced HIV disease. Therefore, the study calls for male-targeted interventions, strengthening the capacity of healthcare providers, and a review of protocols for early HIV diagnosis and care to enhance patient health outcomes.

Advanced care planning (ACP) can reduce hospitalizations, increase quality of life, and align treatment with patient wishes, while lowering healthcare costs. However, healthcare providers' discomfort, lack of training, and patient anxiety may hinder ACP. Furthermore, disparities exist among minority and low-income groups. Growing research highlights the need for standardized definitions and broader implementation, especially post-COVID-19, incorporating digital tools, economic impacts, ethics, and family roles to improve ACP worldwide. This study aims to update and synthesize knowledge from all published systematic reviews from the past ten years, focusing on ACP-related interventions. We conducted a comprehensive search across PubMed, Cochrane, and Scopus, including only English-language, peer-reviewed systematic reviews published between 2015 and 2025. We employed rigorous screening, dual-reviewer validation, and quality-assessment tools, and synthesized evidence on intervention effectiveness across diverse populations and settings to identify effective ACP strategies. Of the deduplicated 7513 records, 61 reviews met the inclusion criteria. For older adult patients, structured conversations reduce unnecessary aggressive treatments and align end-of-life care with preferences. Among racial groups, peer support and palliative consultations boost ACP completion. Patient-centric interventions include video decision aids and web tools, whereas provider-centric interventions include conversation guides, reminder systems, electronic coordination platforms, and facilitator training. ACP is an ongoing process tailored to patient preferences, requiring efforts to address stigmatized conversations, especially in minority communities and severe illnesses. Emphasis on research into digital tools, policy incentives, infrastructure, and family support is essential. Bridging research and practice will improve outcomes and patient-centered end-of-life care. This article describes an umbrella review of 61 systematic reviews on advanced care planning-related interventions. The analysis indicates that the reviews covered interventions focusing on both facility and community-based individuals and had a specific population or disease focus. The articles covered both patient and provider-centric interventions.

IntroductionDiagnosing and treating tuberculosis (TB) infection are critical to reducing TB mortality among people with HIV (PLHIV). Blood-based screening using QuantiFERON-TB Gold Plus (QFT+) and shorter-course TB preventive therapy (TPT) regimens such as 3-month weekly isoniazid and rifapentine (3HP) hold promise to improve TB outcomes.MethodsWe conducted 38 qualitative interviews to explore implementation challenges and solutions related to QFT+ use and TPT uptake among PLHIV participating in the PREVINE-TB study in Brazil and utilized thematic analysis.ResultsClinic and provider implementation innovations and examples of positive deviance helped explain quantitative differences in QFT+ use and TPT uptake between cities including predetermination of eligible patients for QFT+ screening based on nurse review of electronic medical records, specialized TB clinics, the use of TPT Champions, and digital communication.ConclusionsClinic and provider innovations can support QFT+ use and TPT uptake to improve TB outcomes, including in the context of health systems challenges. IntroductionDiagnosing and treating tuberculosis is critical to reducing TB mortality among people with HIV. Easier screening approaches and shorter-course TB preventive therapy regimens hold promise to improve TB outcomes.MethodsWe conducted 38 qualitative interviews to explore implementation challenges and solutions for these newer innovative screening and prevention of TB among people living with HIV participating in a clinical trial in Brazil. We used thematic analysis of the interviews.ResultsClinic and provider implementation innovations helped explain quantitative differences in newer screening and preventive therapy approaches that were observed between cities. These included: predetermination of eligible patients for screening based on nurse review of electronic medical records, specialized TB clinics, the use of TPT Champions, and digital communication strategies.ConclusionsClinic and provider innovations can support the use and uptake of innovative screening methods and prevention of TB regimens to improve TB outcomes.

Unstable housing has been shown to undermine health and exacerbate health inequities, including by limiting access to HIV prevention and treatment services among people living with HIV (PLHIV), the majority of whom are gay, bisexual, and other men who have sex with men (GBMSM). Assessing the outcomes of housing policies can inform evidence-based housing and homelessness prevention efforts in the US. To examine the association between homelessness and antiretroviral therapy (ART) use among GBMSM in the US and whether this association is moderated by the Housing Opportunities for People Living with HIV/AIDS (HOPWA), a federal housing program for PLHIV. This study was a cross-sectional analyses of 2017 to 2023 American Men's Internet Survey (AMIS) data, a nationwide online survey. State-level HOPWA funding per person was estimated using collated secondary data. Participants were AMIS respondents who self-reported living with HIV and their treatment status. Homelessness was self-reported as living on the street, in a shelter, in a single-room occupancy hotel, or in a car in the past 12 months. Current ART use among PLHIV was the primary outcome. Associations between homelessness and ART use were estimated using multilevel mixed-effects logistic regression, stratified by state-level HOPWA funding per person. Among 58&#x202f;108 AMIS respondents, 4911 (8.5%) self-reported living with HIV and were included in analyses (4709 [95.9%] were aged &#x2265;25 years, 1339 [27.3%] were Black, 357 [7.3%] were Hispanic, and 1421 [28.9%] were White). Homelessness was associated with lower ART use (adjusted odds ratio [aOR], 0.51; 95% CI, 0.30-0.85). In states with at- or below-median HOPWA funding, homelessness was associated with decreased ART use (aOR, 0.43; 95% CI, 0.21-0.91). In higher-funded states, there was no association (aOR, 0.61; 95% CI, 0.30-1.27). Homelessness is associated with reduced current ART use among GBMSM living with HIV. This association was not present in states with higher per-person HOPWA funding, suggesting that housing investments may mitigate barriers to HIV treatment. Taken together, these findings provide preliminary evidence of the positive health outcomes of HOPWA, underscoring the need for further research on how to optimize its effectiveness.

Juvenile and infant nonhuman primate models are critical for advancing pediatric HIV prevention and cure research but present unique biological and logistical challenges. Studies in juvenile Rhesus macaque must address seasonal breeding constraints, genetic diversity, limited tissue access, infant rearing complexities and age-specific drug dosing and anesthesia considerations. Neonatal immune systems differ markedly from adults, exhibiting heightened plasticity, rapid CD4+ T cell turnover and evolving antibody responses, suggesting a narrow window in early life when antiretroviral therapy may limit viral reservoir formation and support durable remission. To improve rigor and reproducibility, structured quality management systems were applied to non-GxP research, enhancing data integrity, and traceability. In this framework, once-weekly oral Islatravir provided complete protection against repeated low-dose vaginal challenge with SIVmac251, preventing viremia, seroconversion, and detectable proviral DNA. Standardized assays, centralized laboratories, and robust statistical design were emphasized to maximize translational impact.

ObjectivesThe purpose of this study was to determine the prevalence of type 2 diabetes, hypertension, and mental health conditions among female sex workers with HIV in Santo Domingo, Dominican Republic.MethodsWe conducted a cross-sectional survey, blood draw, and medical exam with women (n&#x2009;=&#x2009;200) recruited by peer navigators. We determined prevalence and used multivariable logistic regression to assess the relationship between conditions.ResultsMean participant age was 46.1 years (SD: 9.15). Most participants (89.0%) were virally suppressed. Diabetes prevalence was 7.0% and hypertension was 63.0%. Nearly half reported moderate-to-severe depressive symptoms (46.0%) and over half (65.8%) anxiety. Women with moderate-to-severe depressive symptoms were over 4 times more likely to be virally unsuppressed (adjusted odds ratio [aOR]=4.17 [95% CI: 1.37-12.68]) and over 3 times more likely to have diabetes (aOR=3.45 [95% CI: 1.00-11.91]).ConclusionFindings indicate the need for holistic, integrated healthcare models to address multiple health conditions and support overall wellbeing. Understanding the Burden of HIV, Noncommunicable Diseases, and Mental Health Conditions Among Female Sex Workers with HIV in the Dominican RepublicPeople with HIV are aging and increasingly developing noncommunicable chronic diseases (NCDs), which are leading causes of death in Latin America and the Caribbean. We conducted a study with female sex workers with HIV in Santo Domingo, Dominican Republic to determine the prevalence of type 2 diabetes, hypertension, and mental health conditions. We used statistical analysis to describe the levels of each condition and determine the relationship between mental health conditions, viral suppression, and NCDs. Mean participant age was 46.1 years (SD: 9.15). Nearly all participants (89.0%) were virally suppressed. Diabetes prevalence was 7.0% and hypertension was 63.0%. Nearly half reported moderate-to-severe depressive symptoms (46.0%) and over half (65.8%) anxiety. Women with moderate-to-severe depressive symptoms were over 4 times more likely to be virally unsuppressed (adjusted odds ratio [aOR]=4.17 [95% CI: 1.37-12.68]) and over 3 times more likely to have diabetes (aOR=3.45 [95% CI: 1.00-11.91]). Findings indicate the need for holistic, integrated healthcare models to address multimorbidity and support overall wellbeing. Future research is needed to develop and test such models.

To examine HIV care attrition patterns and risk factors among adolescent girls and young women (AGYW) enrolled in prevention of mother-to-child transmission of HIV (PMTCT) services in Tanzania. Prospective cohort study. The study was conducted in three regions of Tanzania: Kagera, Tabora and Dar es Salaam across 543 public and private health facilities. A total of 10&#x2009;147 pregnant and postpartum AGYW living with HIV attending PMTCT services between 1 January 2018 and 31 December 2020 were included in this study and followed prospectively until they were censored at the last appointment date or 31 December 2023, whichever was earlier. The primary outcome was time to HIV care attrition, defined as death, discontinuation of antiretroviral treatment (ART) or loss to follow-up (LTFU). LTFU was defined as failure to attend a scheduled clinic appointment and being absent from care for &#x2265;90 consecutive days following a missed appointment among non-transfers. Kaplan-Meier analyses were used to estimate time to first attrition. The Anderson-Gill proportional hazard model estimated the risk factors for repeated care interruptions, adjusted for baseline characteristics and stratified by ART status at PMTCT enrolment. A total of 3259 attrition events were observed, of which 79% occurred within the first year, with the median time to first attrition of 4 months (IQR: 1-8), 96.3% were due to LTFU. Over two-thirds of first-year attrition occurred among AGYW newly started on ART at PMTCT enrolment, who had more than twice the attrition rate of those already on ART (28.6 vs 11.2 per 100-person-years). Of AGYW lost to follow-up, 44.8% returned to care and 20.9% experienced subsequent attrition. Among AGYW new on ART, attrition was higher in those enrolled late in their third trimester (adjusted HR (aHR) 1.20; 95% CI 1.01 to 1.42)&#x2009;versus those in the first trimester and lower during the postpartum period (aHR 0.58; 95% CI 0.43 to 0.79). In AGYW already on ART, attrition rate was higher among adolescents 18-19 years (aHR 1.37; 95% CI 1.13 to 1.66)&#x2009;and those enrolled late; during the second (aHR 1.41; 95% CI 1.16 to 1.72)&#x2009;and third trimesters (aHR 1.57; 95% CI 1.23 to 2.00)&#x2009;or post partum (aHR 1.36; 95% CI 1.09 to 1.70) compared with the first trimester. AGYW with early-stage HIV, on second-line regimens and attending facilities with fewer AGYW, had a lower attrition rate in contrast to comparison groups. AGYW newly started on ART at PMTCT enrolment are more likely to have early and recurring dropout. Given the cyclical nature of HIV care engagement, tailored and repeated interventions are needed to support continuous retention and re-engagement for pregnant and postpartum AGYW with HIV.