HIV incidence among men who have sex with men (MSM) in China remains high, and the use of effective tools such as pre-exposure prophylaxis (PrEP) is suboptimal. Smartphone app interventions are promising yet rarely move beyond the research sphere. Rather than inventing stand-alone apps that rarely come to scale, integrating health interventions into existing multifunction apps would be a paradigm shift for research and practice.
We conducted a prospective, single-arm pilot study of an intervention platform built directly into Blued, a geosocial networking (dating) app for MSM with more than 6 million users in China. The intervention provided telePrEP care (including in-app clinician services, reimbursed laboratory testing and mailed PrEP prescriptions), health messaging, and an order platform for home HIV tests and condoms. The pilot study, in Beijing and Chengdu, compared the intervention to contemporary repeated cross-sectional comparison surveys. Primary outcomes were benchmarks for feasibility (≥30% home HIV test orders and ≥20% HIV PrEP prescriptions) and acceptability (≥71 System Usability Scale [SUS] score). Preliminary efficacy assessment compared changes in the intervention group to the repeated comparison groups with generalized estimating equations (GEE) models.
From July 2022 to December 2024, 423 people started the pilot intervention, 400 (95%) were retained at 6 months and 399 (94%) at 12 months. All primary outcomes at 12 months were significantly higher than prespecified benchmarks: 87% (366/423) ordered HIV tests, 42% (176/423) received PrEP prescriptions, and the mean SUS score was 73/100. In GEE models adjusting for group characteristics and the secular trend of the comparison groups, between baseline and 12 months, the intervention group had an absolute increase in PrEP use of 20% (95% CI: 13%–27%) and in HIV testing of 7% (95% CI: 1%–13%). There was no difference in condom use.
In this study, we found that it is feasible and acceptable to incorporate HIV prevention interventions into existing apps. This model, with encouraging preliminary efficacy data, represents a new public-private model for improving uptake of evidence-based prevention interventions. Future research should test this model in a randomized clinical trial.
The impact of pre-exposure prophylaxis (PrEP) on the US HIV-1 epidemic has not been fully maximized, potentially due to challenges in uptake, coverage, adherence and consistent use. Following the FDA (Food and Drug Adminstration) approval of twice-yearly lenacapavir, epidemiological projections are needed to understand the potential role of lenacapavir in overcoming PrEP barriers. The objective of this analysis was to estimate the impact of lenacapavir on HIV-1 incidence in the United States.
We used a static cohort model representing the US population aged 15 or older to predict the number of HIV-1 cases averted between 2026 and 2030 under different lenacapavir uptake scenarios (S1–S5) versus projected status quo 2025 PrEP use with no lenacapavir (S0). In S0 and S3, we assumed 2025 levels of PrEP use (652K total PrEP users with no lenacapavir use) for 2026–2030. In all other scenarios, we assumed PrEP use increases to 1.1 million PrEP users with 0%−100% using lenacapavir. Oral and injectable PrEP effectiveness were based on clinical trials adjusted by percent days covered in real-world use. Oral PrEP use was assumed to be zero among people who inject drugs in all scenarios.
In S1, moderate lenacapavir uptake (37% of PrEP users by 2030) averted 13,700 (95% credible interval: 10,800–18,300) new HIV-1 cases, an 8% (6%–10%) reduction in cumulative cases between 2026 and 2030 relative to S0. In S2, more rapid lenacapavir uptake (85% of PrEP users by 2030) averted 23,800 (19,100–33,700) cases. Switching all PrEP users to lenacapavir averted 22,400 (12,200–47,200) and 37,400 (26,800–61,200) cases without (S3) and with (S4) an increase in PrEP use, respectively. In S5, 9400 (4600–11,500) cases were averted if PrEP use increased but lenacapavir was not introduced. This analysis was limited as only reductions in primary acquisitions were considered in the static cohort model and the model did not account for potential future demographic or behavioural shifts.
Twice-yearly lenacapavir may impact the US HIV-1 epidemic by improving adherence and increasing the duration of protection relative to oral PrEP, leading to more consistent protection over time and reducing HIV-1 incidence.
Despite an overall recent decline of 28% in the region, AIDS-related deaths have increased among women in some Latin American countries. Low HIV risk perception among women may contribute to late diagnosis. We compared advanced HIV disease (AHD) at care enrolment between males and females in Latin America and the Caribbean.
Adults (≥18 years old) from clinical sites in the Central and South America network for HIV epidemiology who enrolled between 2003 and 2022 were stratified by sex-at-birth/HIV acquisition group as females, males with male-to-male sexual contact and heterosexual males (HMs). We classified location as within a generalized epidemic (GE: Haiti) or a concentrated epidemic (CE: Argentina, Brazil, Chile, Honduras and Mexico). We estimated the probability of AHD (AIDS diagnosis or CD4<200 cells/µL) at enrolment in care using logistic regression models, stratifying by sex-at-birth/acquisition group and CE/GE setting, adjusting for age, education level and calendar year of enrolment.
Of 47,548 people living with HIV, 51% were from GE sites (58% females), and 49% were from CE sites (20% females, 22% HMs and 58% males with male-to-male sexual contact). In GE, 27.7% of persons presented with AHD (23.5% of females; 33.3% of males), while in CE, 44.9% of persons presented with AHD (37.4% of males with male-to-male sexual contact, 47.8% of females and 61.8% of HMs). Males in GE had higher odds of AHD compared with females (aOR: 1.48 [95% CI: 1.40–1.57]). The odds of AHD decreased from 2003 to 2022 (aOR: 0.29 [95% CI: 0.26–0.33] in GE and aOR: 0.32 [95% CI: 0.29–0.36] in CE). In sex-at-birth/acquisition stratified models, in CE sites, odds decreased more in males with male-to-male sexual contact (aOR: 0.22 [95% CI: 0.19–0.25]) than in females (aOR: 0.57 [95% CI: 0.46–0.79]) and HMs (aOR: 0.47 [95% CI: 0.38–0.58]) in 2022 versus 2003.
In CE sites, the slight decreasing trend of AHD at enrolment among females and HMs contrasts with the steeper decline among males with male-to-male sexual contact. In the GE site, risk of AHD at enrolment decreased in both males and females over time. Interventions to increase awareness, improve HIV testing, and hasten linkage to care among females and HMs are needed in CE settings in addition to addressing structural and social barriers.
In South Africa, which has the world's highest prevalence of HIV, intimate partner violence (IPV) and common mental health conditions are barriers to retention in HIV treatment and achieving viral suppression. The Common Elements Treatment Approach (CETA), a cognitive-behavioural-therapy-based intervention designed for lay healthcare worker delivery, is effective in reducing mental and behavioural health problems but has not been trialled for effectiveness in improving HIV outcomes. We conducted a randomized control trial to evaluate the effectiveness of CETA in improving HIV treatment outcomes among women experiencing IPV in South Africa.
This was a single-blind trial conducted among women living with HIV on antiretroviral therapy (ART) who experienced sexual and/or physical IPV in the last 12 months and had either an unsuppressed viral load or were at risk for poor medication adherence in the past year (e.g. defaulted on treatment, late or missed clinic visit). Women were randomized 1:1 to receive either 8–12 CETA counselling sessions or weekly safety text messages. The primary outcome was viral suppression (≤50 copies/mL) (which requires retention) at 12 months after baseline, which was evaluated using routinely collected medical records. A linear regression model was estimated to calculate risk differences and 95% confidence intervals (CI).
Participants were enrolled from 11 November 2021 to 19 July 2023, with 202 women randomized to CETA and 197 randomized to the control arm. Median age was 41.0 years (interquartile range [IQR]: 34.0, 47.0) with a median time on ART of 8.2 years (IQR: 4.3, 12.5). Receiving CETA was associated with a 1-percentage point (95% CI: −0.11, 0.09) decrease in retention and viral suppression compared to the control. When restricted to individuals who completed CETA (N = 144) compared to all controls, we observed a 7-percentage point (95% CI: −0.03, 0.18) increase in retention and viral suppression.
Our estimates suggest overall there was no meaningful difference in retention and viral suppression at 12 months between individuals who received CETA compared to individuals who received the active safety control. Future work should seek to determine if CETA can be effective among those who complete the intervention.
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