Goodluck G. Nyondo

Background: Antiretroviral therapy (ART) intensification involves increasing the dose or frequency of existing regimens or adding agents to standard therapy. This systematic review evaluated the impact of ART intensification on selected virological and clinical outcomes among people living with HIV. Methods: We searched PubMed/MEDLINE, Embase, and Scopus for English‐language studies published from database inception to 5 July 2024. Risk of bias was assessed using Cochrane tools. This review was registered by PROSPERO registration: CRD42024565822. Results: Of 1652 identified records, 22 studies met the inclusion criteria. Virological outcomes were heterogeneous, with most strategies showing no significant improvement in viral suppression or HIV reservoir reduction. Neurocognitive outcomes were inconsistent, while immune recovery was observed in some studies. ART intensification was generally safe and well tolerated, although evidence on long‐term outcomes remains limited. Conclusions: There was no consistent evidence supporting a clear benefit of ART intensification on virological or clinical outcomes. ART intensification outcomes vary according to drug selection, patient characteristics, and treatment goals. These findings highlight the uncertainty surrounding the clinical utility of ART intensification. Further research is needed to optimize intensification strategies for specific patient populations and to better define its role in long‐term HIV management.

Hepatitis B virus (HBV) remains a significant occupational hazard for healthcare workers (HCWs), especially in low‐ and middle‐income countries (LMICs) where vaccination coverage is often suboptimal. This review examined the non‐vaccination rate against HBV among HCWs in LMICs. We conducted a systematic search across multiple databases, including PubMed/MEDLINE, Embase, Web of Science, and Scopus, for studies published from the inception up to 04 Feb 2024. Non‐vaccination (NV) was defined as the absence of any hepatitis B vaccination dose as reported by individual studies. Pooled NV rates were calculated using a random‐effects model. This review was registered in PROSPERO (CRD42024510223). The search retrieved 2990 studies, of which 62 met the eligibility criteria for the final analysis, including data from over 23,000 HCWs. The pooled prevalence of unvaccinated (zero‐dose) HBV individuals was 36.2% (95% CI: 27.7%–45.5%; I ² = 98.9%). Subgroup analysis revealed marked disparities, with the highest prevalence in low‐income countries (61.4%; 95% CI: 30.6%–85.1%; I ² = 98.7%) compared to upper‐middle‐income countries (20.4%; 95% CI: 7.8%–43.9%; I ² = 98.8%). Regionally, the burden was greatest in Africa (45.3%; 95% CI: 32.7%–58.4%; I ² = 98.9%) and lowest in Latin America (8.8%; 95% CI: 0.0%–99.9%; I ² = 92.7). This review found that more than one‐third of healthcare workers remain unvaccinated against HBV, with marked disparities across income levels and geographic regions. The consistently high heterogeneity suggests these gaps are context‐specific, highlighting the need for targeted strategies to improve vaccine uptake and equity.

Background: Resource‐limited settings face challenges in applying evidence to end the HIV/AIDS epidemic by 2030. Implementation research (IR) has emerged as a promising approach to translate evidence into practice. This review explores how IR has been utilized in sub‐Saharan Africa (SSA) to support efforts to end the HIV/AIDS epidemic. Methods: The review protocol was registered with PROSPERO (CRD42024515975). Articles were searched in PubMed, Embase, Scopus, and Web of Science, with a focus on HIV/AIDS evidence‐based intervention studies in SSA. Results: Out of the 2055 retrieved articles, 41 (2%) qualified for final analysis. The findings identify 11 key implementation strategies, including decentralized service delivery, task shifting, integrated HIV service delivery, capacity strengthening in diagnostics and treatment support, health system strengthening, promotion of pre‐exposure prophylaxis, prevention of vertical transmission, youth‐friendly services, community engagement, innovative technologies, and operational research. These approaches improved access to HIV testing, treatment, and prevention services, enhanced adherence and retention in care, and supported early diagnosis and continuity of care. However, implementation was influenced by cross‐cutting barriers such as limited resources and infrastructure, workforce constraints, inadequate training, stigma, weak coordination systems, and policy and funding limitations. Conclusion: IR provides a structured approach to identifying, adapting, and scaling effective HIV interventions within real‐world settings. The evidence highlights its role in supporting diverse strategies across health system levels while accounting for contextual barriers and facilitators. These findings highlight the importance of continued investment in IR and targeted capacity building to strengthen the effectiveness and sustainability of HIV/AIDS programs in SSA.

Despite advances in HIV treatment, the burden of viral non‐suppression (VNS) remains a treatment success concern, particularly in Sub‐Saharan African (SSA) countries. We determined the prevalence and factors associated with VNS for people living with HIV (PLHIV) receiving antiretroviral therapy (ART). This review, registered with PROSPERO (CRD42023470234), conducted an extensive search for evidence, focusing on PLHIV living in SSA on ART from the year 2000 to 19^th October 2023, across databases including PubMed/MEDLINE, Embase, Web of Science, and Scopus. A total of 2357 articles were screened, from which 32 studies met the criteria for the final analysis, involving 756,620 PLHIV of all ages. The pooled prevalance for VNS was found to be 20.0% (95% CI: 15.43%–25.52%, I² = 100%, p‐value I² = 94%, p‐value p‐value <0.05. These factors encompassed socio‐demographics such as sex, age, education level, and marital status. Additionally, aspects related to HIV care, such as the facility attended, HIV status disclosure and adherence exhibited higher odds of VNS. Suboptimal ART adherence, longer duration on ART, socio‐economic factors, lack of family and social support, presence of co‐morbidities, advanced WHO HIV clinical stage, ART regimens, lower CD4+ count, abnormal body mass index, history of treatment interruptions, and progression of HIV illness were associated with VNS. Furthermore, behavioural/psychological factors including depression, substance use, negative perceptions towards ART, experiences of abuse, alcohol use, stigma, and certain patterns of sexual behaviour were also identified as factors for VNS. The occurrence of two VNS to every ten PLHIV on ART poses a threat to the progress made towards reaching the third 95% UNAIDS target in SSA. Additionally, these findings highlight the intricate interplay of various factors, encompassing patient characteristics, behavioural patterns, sociocultural influences, and pharmacological factors, all impacting VNS among PLHIV. Recognising its multifaceted nature, we recommend designing and implementing high impact interventions to effectively address VNS in SSA.

Cerebrospinal fluid (CSF) viral escape rarely occurs when HIV is detected in the CSF, while it is undetectable in the blood plasma or detectable in CSF at levels that exceed those in the blood plasma. We conducted this review to comprehensively synthesise its clinical presentation, diagnosis, management strategies and treatment outcomes. A review registered with PROSPERO (CRD42023475311) searched evidence across PubMed/MEDLINE, Embase, Web of Science, Scopus, and Google Scholar to gather articles (case reports/series) that report on CSF viral escape in people living with HIV (PLHIV) on antiretroviral therapy (ART). The quality of studies was assessed based on the domains of selection, ascertainment, causality, and reporting. A systematic search identified 493 articles and 27 studies that include 21 case reports, and six case series were involved in the review. The studies reported 62 cases of CSF viral escape in PLHIV. The majority were men (66.67%), with a median age of 43 (range: 28–73) years. Approximately, 31 distinct symptoms were documented, mostly being cognitive dysfunction, gait abnormalities, and tremors (12.51%). Diagnosis involved blood and CSF analysis, magnetic resonance imaging, and neuropsychological assessments. Over 36 ART regimens were employed, with a focus on ART intensification; almost one‐third of the regimens contained Raltegravir (integrase strand transfer inhibitor). The outcomes showed 64.49% full recovery, 30.16% partial recovery, and 4.76% died. When neuropsychological symptoms manifest in PLHIV, monitoring for CSF viral escape is essential, regardless of plasma viral suppression. Personalised treatment strategies, particularly ART intensification, are strongly advised for optimising treatment outcomes in PLHIV diagnosed with CSF HIV escape.