Introduction: The COVID-19 pandemic has impacted global health service delivery, including provision of HIV services. Countries with high HIV burden are balancing the need to minimize interactions with health facilities to reduce the risk of COVID-19 transmission, while delivering uninterrupted essential HIV prevention, testing and treatment services. Many of these adaptations in resource-constrained settings have not adequately accounted for the needs of pregnant and breastfeeding women, infants, children and adolescents. We propose whole-family, tailored programme adaptations along the HIV clinical continuum to protect the programmatic gains made in services. Discussion: Essential HIV case-finding services for pregnant and breastfeeding women and children should be maintained and include maternal testing, diagnostic testing for infants exposed to HIV, index testing for children whose biological parents or siblings are living with HIV, as well as for children/adolescents presenting with symptoms concerning for HIV and comorbidities. HIV self-testing for children two years of age and older should be supported with caregiver and provider education. Adaptations include bundling services in the same visit and providing testing outside of facilities to the extent possible to reduce exposure risk to COVID-19. Virtual platforms can be used to identify vulnerable children at risk of HIV infection, abuse, harm or violence, and link them to necessary clinical and psychosocial support services. HIV treatment service adaptations for families should focus on family based differentiated service delivery models, including community-based ART initiation and multimonth ART dispensing. Viral load monitoring should not be a barrier to transitioning children and adolescents experiencing treatment failure to more effective ART regimens, and viral load monitoring for pregnant and breastfeeding women and children should be prioritized and bundled with other essential services. Conclusions: Protecting pregnant and breastfeeding women, infants, children and adolescents from acquiring SARS-CoV-2 while sustaining essential HIV services is an immense global health challenge. Tailored, family friendly programme adaptations for case-finding, ART delivery and viral load monitoring for these populations have the potential to limit SARS-CoV-2 transmission while ensuring the continuity of life-saving HIV case identification and treatment efforts.

Background: HIV care continuum outcomes deteriorate among people returning from incarceration. Interventions to improve care outcomes postincarceration have been characterized by substantial heterogeneity in approach, outcome metrics, and results. A large number of recently published interventions have not been systematically reviewed. Methods: We searched peer reviewed and scholarly databases for published and gray literature describing interventions to improve HIV care continuum outcomes among individuals released from prison or jail. We systematically screened quantitative and qualitative intervention reports published through 2018, then extracted and analyzed study data using a classification scheme that we developed for categorizing intervention levels and strategies. Results: We included 23 reports from the peer-reviewed literature, 2 from gray literature, and 2 from conference abstracts (27 total). Seventeen studies were classified as individual level, 3 as biomedical level, 2 as organizational level, and 5 as multilevel. Nine studies were randomized controlled trials, 4 of which reported power calculations. Fifteen studies were quasiexperimental; one was a case study. Eleven studies were conducted in prisons, 7 in jails, and 9 in both prisons and jails. Of 11 studies reporting hypothesis tests, 5 found statistically significant effect sizes on primary outcomes. Conclusions: Interventions that demonstrate postrelease improvements in clinic attendance and viral suppression include patient navigation strategies, especially involving peer support, and substance use treatment strategies.

ObjectiveTo evaluate the evidence on the effectiveness of vaginal microbicides in preventing HIV transmission in women.MethodsSystematic review through a comprehensive search of relevant electronic databases for eligible randomised controlled trials (RCTs) published through June 2019. Two authors independently screened titles and abstracts according to eligibility criteria, then extracted data and assessed risk of bias of included studies. We conducted a random‐effects meta‐analysis of risk ratios (RR) of HIV infection and assessed heterogeneity using chi‐squared and I2 tests. Sources of heterogeneity were investigated through subgroup analysis, publication bias was assessed using funnel plots, and certainty of evidence was graded using GRADEPro software.ResultsWe included 18 RCTs which enrolled 40,048 sexually active, HIV‐negative, non‐pregnant women, aged 16 years and older, mainly from sub‐Saharan Africa. The intravaginal ring containing dapivirine significantly reduced HIV risk by 29% (RR 0.71, 95% CI: 0.57–0.89; 2 RCTs, 4,564 women, moderate certainty of evidence). Estimates of effect of tenofovir 1% (RR 0.83, 95% CI: 0.65–1.06), nonoxynol‐9 (RR 1.15, 95% CI: 0.93–1.42), cellulose sulphate (RR 1.16, 95% CI: 0.61–2.21), SAVVY (RR 1.34, 95% CI: 0.69–2.59), Carraguard (RR 0.89, 95% CI: 0.71–1.10), BufferGel (RR 1.02, 95% CI: 0.71–1.46), 0.5% PRO2000 (RR 0.88, 95% CI: 0.60–1.28) and 2% PRO2000 (RR 0.81, 95% CI: 0.58–1.12) failed to reach statistical significance; each had low certainty of evidence.ConclusionThe long‐acting intravaginal ring containing dapivirine significantly reduced risk of HIV transmission in women by 29%. The remaining microbicides had no evident effect.

The UNAIDS 95-95-95 strategy to reach HIV epidemic control by 2030 calls for 95% of all persons living with HIV (PLHIV) to know their status; 95% of diagnosed PLHIV to be receiving antiretroviral treatment; and 95% of PLHIV receiving antiretroviral treatment to be virally suppressed (defined as <200 copies of HIV per mL of blood).