Sheri D. Weiser

Extreme weather events (EWEs) can significantly impact HIV prevention and treatment efforts. However, operational definitions of EWE exposure vary greatly in studies of their effects. This systematic review of the literature on EWEs and HIV-related outcomes characterizes conceptual approaches for defining EWE exposures and summarizes their associations with subsequent HIV prevention and treatment outcomes. We searched PubMed, Web of Science, Embase, PsycINFO and UC ProQuest on September 25, 2024. Peer-reviewed studies that connected an EWE exposure to an HIV-related outcome(s) among people living with HIV or at high risk of acquiring HIV met inclusion criteria. We compared data sources and operational definitions for EWE exposures, examined outcomes, and summarized the direction of exposure-outcome associations. Of the 2,943 identified studies, 85 met inclusion/exclusion criteria. Data sources for EWE exposures included primary empirical measures (e.g. weather station data) and secondary indicators (e.g. government notices). Droughts (37/85) and hurricanes (31/85) were the most frequently studied EWEs. Increased food/water insecurity and higher-risk sexual behavior were common outcomes for studies of drought, while changes in care engagement and HIV prevention were common outcomes for studies of hurricanes. Of the 50 studies with quantitative analytic designs, 20 used spatially varying exposures and 3 included a measure of individual exposure experience. Most studies found that EWEs were associated with worse HIV-related outcomes. To elucidate these associations, we recommend using spatially varying measures to better account for heterogeneity of exposure across individuals and landscapes as well as consistent reporting of exposure definitions to support synthesis and meta-analysis.

Since the onset of the HIV pandemic in sub-Saharan Africa (SSA), widowhood has been significantly associated with HIV prevalence [1–7]. In recent population-based HIV impact assessments in several ...

Introduction: 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. Methods and analysis: 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. Ethics and dissemination: 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. Trial registration number: NCT06659315 .

Climate change-related severe weather events are heavily impacting regions with the highest prevalence of HIV, creating additional vulnerabilities for already vulnerable populations. Little is understood about how people perceive or experience the mechanisms by which extreme weather events affect the health of people living with HIV (PLHIV). We conducted a qualitative study using in-depth, semi-structured interviews with 40 PLHIV enrolled in a cluster randomized clinical trial that included 8 pairs of health facilities in rural Western Kenya, who were 18 years or older, receiving ART for > 6 months; had moderate to severe food insecurity; and practiced smallholder farming with access to surface water or aquifers. Intervention participants received a loan to purchase an irrigation pump and farming inputs and were provided climate-responsive, sustainable agriculture and financial literacy training. This study did not evaluate the impacts of the clinical trial. We aimed to understand participant perceptions of how climate change impacted their HIV health, and associated pathways for these impacts. Interviews were transcribed, translated, and double coded using an inductive-deductive-abductive thematic content approach. Almost all participants noted that droughts, flooding, and elevated temperatures had serious negative impacts on their health and wellbeing. Extreme weather negatively impacted their health via five key pathways, with the first being most prominent: (1) decreases in agricultural yields and income; (2) increased food insecurity and undernutrition; (3) medication non-adherence, missed clinic visits, and infrastructure erosion; (4) increased infections, and (5) displacement and forced migration. Several pathways were interrelated, with decreased agricultural yields and income being proximal to most other pathways. Participants perceived pathways by which severe weather negatively impacted their HIV health, and these pathways were bi-directional and reinforcing. Food and livelihood sources were devastated, and housing and infrastructure were negatively affected, causing a cascade of nutrition and health vulnerabilities. Understanding the contexts in which PLHIV are vulnerable to impacts of climate change will be essential to establish climate-responsive policies that can interrupt the pathways identified here. Cross-sector collaboration between the Kenyan Ministries of Agriculture and Health to develop climate-responsive policies to support PLHIV should be prioritized. The clinical trial start date was June 23, 2016. Trial Registration: Registered with ClinicalTrials.gov Identifier: NCT02815579.

Introduction: Interventions that address household-level factors, including food insecurity (FI) and poverty, may reduce HIV risk and improve sexual and reproductive health (SRH) among adolescent girls and young women (AGYW). Methods: This cluster randomised controlled trial in Kenya assessed AGYW living in households of adults enrolled in Shamba Maisha (SM). SM was a multisectoral agricultural livelihood intervention designed to improve HIV health. At the trial end, we used linear and logistic regressions to compare differences between the intervention and control arms in FI, and mental health among AGYW-caregiver pairs and SRH outcomes among the AGYW, accounting for clusters with robust standard errors. We also conducted a secondary analysis among 15–19 years whose caregivers were SM participants. Results: The study enrolled 241 AGYW-caregiver pairs (n=131 intervention). The median age of AGYW was 15 years old (IQR: 14–17 years old). At endline, AGYW in intervention households had less FI (OR: 0.45, 95% CI 0.21 to 0.97; p=0.04), lower depressive symptomatology (OR: 0.53; 95% CI 0.24 to 1.15, p=0.11) and no difference in unprotected sex (OR: 1.16; 95% CI 0.63 to 2.16; p=0.63) compared with those in control households. In the secondary analysis, intervention AGYW had higher body mass index (β: 1.25; SE: 0.32; p=0.002), fewer symptoms of depression (OR: 0.42; 95% CI 0.21 to 0.84; p=0.01) and anxiety (OR: 0.23, 95% CI 0.05 to 1.11; p=0.07), and less sexual intimate partner violence (IPV) (OR: 0.28; 95% CI 0.08 to 0.91; p=0.03) than control AGYW. Intervention arm caregivers had less FI than those in the control arm (OR: 0.05; 95% CI 0.0047 to 0.54; p=0.014). Conclusions: An agricultural livelihood intervention among adults living with HIV improved FI, mental health and IPV outcomes among AGYW in their households. These findings will guide the scale-up of an agricultural livelihood intervention for HIV-affected households with AGYW in sub-Saharan Africa. Trial registration number: NCT03741634 .

Background: About 2.4% of Kenyan people (approximately 1.3 million people) are living with HIV. Despite advances in antiretroviral therapy, men continue to experience disproportionately poor engagement in HIV care due to entrenched masculine norms, stigma, and lack of tailored interventions. Mobile health (mHealth) platforms offer a promising strategy to improve care engagement, but evidence on its implementation and impact among men living with HIV is limited. Objective: This study aims to assess the implementation and potential effects of the Nishauri mHealth intervention on HIV care and treatment outcomes among men in Western Kenya. Specifically, it seeks to (1) analyze its effects on HIV care engagement and treatment outcomes, (2) explore the role of masculine identity in modifying acceptability and uptake, and (3) identify barriers and facilitators of adoption, use, and sustainment. Methods: We will use a mixed methods design combining a stepped-wedge cluster approach and a pre- and postimplementation assessment across 4 health facilities in Homa Bay County, Kenya. Approximately 347 men receiving HIV treatment who own a smartphone will be enrolled. The stepped-wedge design will sequentially introduce the intervention across the 4 facilities in 2-month intervals following baseline assessments, allowing each site to serve as its own control. Surveys will collect data on sociodemographics, masculinity, intervention acceptability and uptake, and HIV clinical outcomes using validated measures. Intervention effects on pre- and postbinary outcomes will be assessed using the McNemar test, while generalized estimating equations ( α =.05; β =.2; 95% CI) will account for clustering and repeated measures in the stepped-wedge analysis. Focus group discussions (n=5-6) will be conducted with men living with HIV, health care providers, and app developers to explore barriers and facilitators of implementation and adoption. Focus group discussions will be audio-recorded, transcribed, coded, and analyzed thematically. Results: This study received institutional review board approval in July 2025 and was registered on ClinicalTrials.gov in August 2025. Recruitment began in September 2025 and concluded in November 2025. A total of 307 men living with HIV were recruited across the 4 clinics for the pre- and postquantitative assessment. Preliminary findings will describe implementation outcomes and early effects on HIV care engagement. Conclusions: This trial will use a stepped-wedge design to evaluate the implementation and effects of the Nishauri mHealth intervention on antiretroviral therapy adherence and clinic attendance among men in Homa Bay County. By examining both clinical outcomes and the influence of masculine norms on intervention uptake, it will provide robust evidence on the effectiveness of mHealth strategies tailored for men in low-resource, high–HIV-burden settings. Findings will inform the design, scalability, and optimization of similar interventions by identifying key implementation barriers and facilitators.

Conceptual diagram showing socioecological drivers in the first column. They include environmental stressors, infrastructural inadequacies, and socioeconomic deprivations with corresponding images. One bold arrow points from these three drivers toward dimensions of water insecurity, which include availability, access, and quality. The arrow shows that socioecological drivers shape the manifestation of water insecurity. A final bold arrow from the three dimensions points to potential downstream links to HIV treatment interruptions, water-related illnesses, and psychosocial distress among people with HIV (PWH). Socioecological drivers shape the availability, access, and quality dimensions of household and communal water insecurity among PWH in the Lake Victoria region, Kenya. Downstream impacts on HIV and mental health are shown as conceptual pathways informed by existing literature and were not directly measured in this study. Despite progress in HIV management, resource insecurities continue to threaten the gains of antiretroviral therapy among people with HIV in resource-limited settings. Water insecurity, common in areas with high HIV burden, remains an underexplored barrier to optimal HIV care. This study assessed socioecological drivers and dimensions as determinants of water insecurity among 434 adults with HIV receiving care in public hospitals in a high HIV prevalence region of western Kenya. We used the 12-item Household Water Insecurity Experiences Scale and found a water insecurity prevalence of 64.3% among participants, with 22.4% having severe water insecurity (score ≥24). Drought (96.8%), poverty (90.3%), and poor infrastructure (90.1%) were frequently cited drivers, while affordability (82.4%), flooding (85.4%), and microbial contamination (75.7%) were common dimensions. Female participants had nearly four-fold higher odds of water insecurity (AOR = 3.65, 95% CI: 2.02–6.58), and temporary housing structures (AOR = 3.10, 95% CI: 1.75–5.51) and larger households (AOR = 1.23 per additional person, 95% CI: 1.09–1.39) further increased vulnerability. Water contamination and distant sources were also independent predictors. Water insecurity among PWH in Kisumu County is severe, multidimensional, and gendered, demanding integrated, multisectoral, and climate-resilient interventions within HIV care.

BACKGROUND Approximately 1.3 million people are living with HIV in Kenya. Despite advances in antiretroviral therapy (ART), men continue to experience disproportionately poor engagement in HIV care due to entrenched masculine norms, stigma, and lack of tailored interventions. Mobile health (mHealth) platforms offer a promising strategy to improve care engagement, but their effectiveness remains under-evaluated particularly among men. However, evidence on its implementation and impact among men living with HIV is limited. OBJECTIVE This study aims to assess the implementation and potential effects of the Nishauri mHealth intervention on HIV care and treatment outcomes among men in western Kenya. Specifically, it seeks to- (1) analyze its potential effects on HIV care and treatment outcomes; (2) explore the role of masculine identity in modifying its acceptability and uptake; and, (3) identify barriers and facilitators of its adoption, utilization and sustainment. METHODS We will use mixed-methods design with a stepped wedge and pre-post implementation approaches across four health facilities in Homa Bay County, Kenya—a region with the country’s highest HIV prevalence (16.2%). The study will enroll approximately 347 men receiving HIV treatment who own a smartphone. Surveys will collect socio-demographics, masculinity, intervention acceptability, uptake, and HIV clinical outcomes data using validated scales. The intervention will be sequentially introduced across the facilities over an eight-month period, and we will assess visit attendance and pharmacy refill data using clinical records. Focus group discussions (5-6) will be conducted with (approximately 6) application developers, healthcare providers, and men living with HIV who are on ART to explore barriers and facilitators to adoption, utilization, and sustainment. Audio-recorded FGDs will be transcribed, coded, and analyzed thematically using Dedoose. McNemar’s test will compare pre-post binary outcomes, and Generalized Estimating Equations (α= .05, β= .2, 95% CI) will be used to assess the intervention’s effect via the stepped wedge design, accounting for repeated measures and clustering. RESULTS This study received initial Institutional Review Board approval in July 2025, and was registered on ClinicalTrials.gov in August 2025. Recruitment began in September 2025 and is scheduled to conclude in November 2025. Preliminary findings will describe implementation outcomes and early effects on HIV care engagement. CONCLUSIONS This trial will use a stepped wedge design to evaluate the implementation and effects of Nishauri mHealth intervention on ART adherence and clinic attendance among men living with HIV in Homa Bay County. By examining both clinical outcomes and the influence of masculine norms on intervention uptake, it will provide robust evidence on the effectiveness of mHealth strategies tailored for men in low-resource, high-burden settings. Findings from this study will inform the design and scalability of the trial by identifying key implementation barriers and facilitators critical to optimizing intervention delivery and impact. CLINICALTRIAL Clinical Trials.gov NCT07116538; https://clinicaltrials.gov/study/ NCT07116538

Introduction: As the HIV epidemic stabilises in Sub-Saharan Africa with effective antiretroviral therapy, cardiometabolic disorders (CMDs) remain the next major challenge for people living with HIV. Relationship dynamics and spousal support are important for the medical management of single diseases such as HIV, yet little is known about how couples manage the complexity of multiple competing health conditions and their synergistic effects on health. The Healthy Hearts study aimed to develop a conceptual model of dyadic management of HIV and CMDs, inform interventions for couples in Sub-Saharan Africa, and ultimately improve clinical practice and disease management for HIV and CMD comorbidities. Methods and analysis: This study will enrol 250 couples who have at least one partner living with HIV and CMD (either hypertension or diabetes) for a prospective observational cohort study. Patients will be recruited from HIV and CMD clinics in Zomba and Blantyre, Malawi. Couples will attend four study visits at quarterly intervals over 12 months. Both partners are given interviewer-administered surveys and complete a clinical assessment. Regression techniques will be used to test associations between key constructs in our conceptual model, including communal coping, multimorbidity illness perceptions, relationship quality, psychosocial health, disease management (eg, adherence to lifestyle advice and medications) and disease outcomes (eg, viral suppression and CMD control). Findings will be used to identify elements to target in a couple-based intervention for CMD and HIV. Ethics and dissemination: This study was approved by the University of California, San Francisco (HRPP (Human Research Protection Program); Protocol number 20–32126), and the National Health Sciences Research Committee of Malawi (Protocol number 21/04/2677). The results will be disseminated at local community meetings and conferences focused on relationships, CMDs and HIV and published in scientific journals.