Laura M. Bogart

Objectives: Data on diabetes screening and monitoring, within HIV care programmes in sub‐Saharan Africa, remain limited. This study describes the quality of diabetes screening and management among people living with HIV with comorbid hypertension receiving care at facilities participating in the InterCARE trial in Botswana. Methods: We conducted a cross‐sectional analysis of adults aged 20–75 years with a documented diabetes diagnosis at enrolment in InterCARE (January–September 2023). All participants were people living with HIV with hypertension receiving routine HIV clinic care. Descriptive statistics were used to summarize baseline characteristics and key diabetes care indicators, including glycated haemoglobin (HbA1c), low‐density lipoprotein (LDL) cholesterol and blood pressure (BP), and their level of control. Results: Of 4655 InterCARE participants, 138 (3.0%) had a prior diabetes diagnosis. In this diabetes subgroup, 69.6% were female ( n = 99), and the median age was 58 years (IQR 52–64). Among the 87 participants receiving diabetes treatment, 80.0% ( n = 70) were on oral agents and 20.0% ( n = 17) on insulin‐based therapy. Glycaemic and LDL monitoring had been performed in only 5.1% and 2.2% of participants, respectively. Blood pressure control (BP n = 75.1%), only 28.6% ( n = 2) had glycaemic control (HbA1c <7%); however, interpretation is limited by the small number of HbA1c measurements. Lipid control could not be assessed due to insufficient data. Among participants without diabetes, documented screening was rare (17/4517; 0.3%). Conclusion: Diabetes care among people living with HIV ith hypertension in Botswana is suboptimal with major gaps in screening and metabolic monitoring. These findings highlight broader challenges in the delivery of integrated chronic disease care within HIV services. Strengthening the integration of non‐communicable disease care into HIV programmes, including routine diabetes screening and cardiometabolic risk management, is urgently needed to improve health outcomes and reduce the burden of cardiovascular and other chronic complications among people living with HIV.

South Africa has the largest HIV epidemic globally, with 8 million children and adults living with HIV(Johnson et al., 2025). As South Africa’s estimated total population is approximately 64.7 mill...

Introduction: Cervical cancer prevalence and incidence are high in sub-Saharan Africa, especially in Uganda, where screening rates are low, despite government policy recommending screening for all women aged 25-49 every three years. Most prior research focuses on client-related barriers to screening, including women’s fears about the screening procedure, lack of partner support, and community-level stigma. Fewer studies elaborate on inner context factors related to health care systems, facilities, and providers. The aim of this study was to use qualitative methods to explore inner context factors that may affect cervical cancer screening in Uganda. Methods: We recruited 20 health care facility administrators, 6 providers of cervical cancer screening, 2 district health officers, 2 division medical officers, and one government health official for key informant interviews, and 69 women (31 screened and 38 not screened for cervical cancer) for focus group discussions. Participants were recruited from four health care facilities that varied by urbanicity and funding source: one urban public facility, one urban private non-profit facility, one rural public facility, and one rural private non-profit facility. Results: Inner context themes emerged around infrastructure needs (insufficient space, equipment, and supplies) and staffing issues (inadequate staff quantity and training), which contributed to lower quality of care (e.g., long wait-times; painful, rushed exams). Women described privacy concerns as well as discomfort with male and young providers. Women with HIV were prioritized for screening based on funding streams and inability to serve all women given infrastructure and staffing issues. Despite barriers, many stakeholders were committed to providing cervical cancer screening services, and many women saw the value of screening. Conclusion: This study identified inner context barriers related to resource shortfalls, which affected quality of care. Low cost solutions are needed to improve health care readiness and increase reach of cervical cancer screening in Uganda.

Background: Adolescent girls and young women (AGYW) in sub-Saharan Africa face a disproportionate burden of gender-based violence (GBV), HIV risk, and mental health challenges. Despite the demonstrated effectiveness of psychological interventions such as problem-solving therapy (PST), there is limited evidence on culturally adapted models for GBV-exposed AGYW that concurrently address HIV and mental health, particularly in settings with constrained mental health infrastructure. Objective: This study outlines the protocol for a randomized controlled trial evaluating Mpata Yathu , a church-based adaptation of the Friendship Bench intervention, which delivers lay counselor-led PST to AGYW with a history of GBV in Lusaka, Zambia. Methods: A hybrid implementation-effectiveness type 1 randomized controlled trial (intervention and waitlist control arms) will be conducted among 90 AGYW, aged 15 to 24, per arm with moderate depressive symptoms, lifetime GBV exposure, and HIV risk or diagnosis. The intervention comprises six individual PST sessions delivered over 3 months in church spaces. Implementation outcomes (feasibility, acceptability, fidelity), common mental disorder (CMD) symptoms (primary outcome), and exploratory outcomes (depression, anxiety, PTSD, HIV engagement, GBV attitudes, childhood adversity, coping self-efficacy) will be assessed at baseline, 3, and 6 months. The trial is powered to detect changes in CMD symptoms only. Mixed-methods data will inform feasibility, intervention refinement, and hypotheses regarding mental health as a mediator of HIV outcomes. Process evaluations will use the Consolidated Framework for Implementation Research (CFIR). Conclusions: This trial will assess the potential of church-based PST to address the intersecting burdens of GBV, HIV, and mental health among AGYW in Zambia. Findings will offer insights into leveraging trusted community institutions (e.g., church and religious settings) for mental health and HIV care delivery in low-resource settings. Trial registration: ClinicalTrials.gov NCT07132905. Prospectively registered on August 13, 2025. clinicaltrials.gov/study/NCT07132905.

In Uganda, where HIV prevalence remains above 5% among those aged 15 and older, we conducted a randomized controlled trial of Game Changers , an 8-session peer-facilitated group intervention that empowers people living with HIV (PLHIV) to engage in HIV prevention advocacy with their social network members (“alters”). A total of 210 index PLHIV participants (105 intervention, 105 control) and 599 alters were enrolled; assessments were conducted at baseline and 6-, 12-, and 18-months post-baseline. Intention-to-treat repeated measures regressions indicated significant intervention effects on reduced internalized stigma and increased HIV prevention advocacy, prevention advocacy self-efficacy, and disclosure among index participants. In within-intervention group analyses, alters exposed to prevention advocacy showed higher likelihoods of HIV testing and condom use. Game Changers had direct psychosocial benefits for index participants, and indirect benefits for improved HIV prevention behaviors among alters. Implementation research is needed to determine conditions under which Game Changers is most effective. NCT05098015, Registered 2021-10-18.

Transgender and/or nonbinary (TNB) youth experience substantial stigma and discrimination in comparison to cisgender peers. While family support can buffer negative psychological effects of stigma and discrimination, TNB youth experience lower levels of family support. Family-level and narrative-based interventions are understudied strategies for addressing this challenge. We conducted a pilot test of the feasibility and acceptability of the Trans Teen and Family Narratives (TTFN) Conversation Toolkit, an online, narrative-based intervention for families of TNB youth. Participants included seven mental health providers (MHPs), nine TNB youth ages 13–21 years, and 21 parents/caregivers and siblings in the United States. TNB youth participants included two girls, three boys, and four nonbinary youth. Of 28 Caregivers, siblings, and MHPs, 16 were cisgender women. Most participants were White. We conducted surveys from 2021–2022 at multiple timepoints (baseline, end-of-testing, and 3- and 6-month follow-ups) and conducted interviews at end-of-testing. We analyzed interviews using immersion/crystallization and thematic analysis. Major themes included: 1) external and intrapersonal factors affecting toolkit usage, 2) participant experiences of character identification within toolkit content, and 3) participant recommendations. At end-of-testing, 24 of 34 retained participants watched six or more of the toolkit’s eight digital stories and 28 used the toolkit for the expected amount of time. The TTFN Conversation Toolkit is a feasible and acceptable tool for TNB youth and families. The toolkit may serve as a resource to enhance clinical practice and mitigate the impacts of a harmful sociopolitical climate on TNB youth mental health.

Latino gay, bisexual, and other men who have sex with men (LGBMSM) are disproportionally affected by HIV in the U.S. We tested a culturally tailored community-based group HIV prevention intervention (“ Siempre Seguiré ”) for immigrant LGBMSM that uses cognitive behavior therapy to address coping with intersectional stigma and medical mistrust. A total of 289 immigrant LGBMSM were randomized (144 control, 145 intervention) and completed surveys at baseline and 4-, 8-, and 12-months (79% retained). Intention-to-treat repeated-measures regressions indicated significant intervention effects on higher HIV testing and reduced internalized Latino and sexual minority stigma, anticipated HIV stigma, stigmatizing PrEP beliefs, and medical mistrust. Intervention cost-effectiveness was $876 per 10% increase in HIV testing per participant, which improved to $600 excluding fidelity and recruitment costs (which would likely be minimal for implementation). To expedite efforts to end the HIV epidemic, research is needed to determine strategies to implement, disseminate, and sustain Siempre Seguiré .

Background: Adolescent girls and young women (AGYW) in sub-Saharan Africa face a disproportionate burden of gender-based violence (GBV), HIV risk, and mental health challenges. Despite the demonstrated effectiveness of psychological interventions such as problem-solving therapy (PST), there is limited evidence on culturally adapted models for GBV-exposed AGYW that concurrently address HIV and mental health, particularly in settings with constrained mental health infrastructure. Objective: This study outlines the protocol for a randomized controlled trial evaluating Mpata Yathu, a church-based adaptation of the Friendship Bench intervention, which delivers lay counselor-led PST to AGYW with a history of GBV in Lusaka, Zambia. Methods: A hybrid implementation-effectiveness type 1 randomized controlled trial (intervention and waitlist control arms) will be conducted among 90 AGYW, aged 15 to 24, per arm with moderate depressive symptoms, lifetime GBV exposure, and HIV risk or diagnosis. The intervention comprises six individual PST sessions delivered over three months in church spaces. Implementation outcomes (feasibility, acceptability, fidelity), common mental disorder (CMD) symptoms (primary outcome), and exploratory outcomes (depression, anxiety, PTSD, HIV engagement, GBV attitudes, childhood adversity, coping self-efficacy) will be assessed at baseline, 3, and 6 months. The trial is powered to detect changes in CMD symptoms only. Mixed-methods data will inform feasibility, intervention refinement, and hypotheses regarding mental health as a mediator of HIV outcomes. Process evaluations will use the Consolidated Framework for Implementation Research (CFIR). Conclusions: This trial will assess the potential of church-based PST to address the intersecting burdens of GBV, HIV, and mental health among AGYW in Zambia. Findings will offer insights into leveraging trusted community institutions (e.g., church and religious settings) for mental health and HIV care delivery in low-resource settings. Trial Registration Number:Pending. The study will be registered prospectively on ClinicalTrials.gov. The WHO Trial Registration Data Set will be completed and submitted with ClinicalTrials.gov registration prior to trial launch. Protocol version: July 2025, Version 1.0; this trial is projected to begin September 2025 and end April 2026