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1 | INTRODUCTION The global community has established ambitious goals for expanding coverage of antiretroviral treatment (ART) and reducing new HIV infections to end AIDS as a public health threat [...], Introduction: HIV planning requires granular estimates for the number of people living with HIV (PLHIV), antiretroviral treatment (ART) coverage and unmet need, and new HIV infections by district, or equivalent subnational administrative level. We developed a Bayesian small-area estimation model, called Naomi, to estimate these quantities stratified by subnational administrative units, sex, and five-year age groups. Methods: Small-area regressions for HIV prevalence, ART coverage and HIV incidence were jointly calibrated using subnational household survey data on all three indicators, routine antenatal service delivery data on HIV prevalence and ART coverage among pregnant women, and service delivery data on the number of PLHIV receiving ART. Incidence was modelled by district-level HIV prevalence and ART coverage. Model outputs of counts and rates for each indicator were aggregated to multiple geographic and demographic stratifications of interest. The model was estimated in an empirical Bayes framework, furnishing probabilistic uncertainty ranges for all output indicators. Example results were presented using data from Malawi during 2016-2018. Results: Adult HIV prevalence in September 2018 ranged from 3.2% to 17.1% across Malawi's districts and was higher in southern districts and in metropolitan areas. ART coverage was more homogenous, ranging from 75% to 82%. The largest number of PLHIV was among ages 35 to 39 for both women and men, while the most untreated PLHIV were among ages 25 to 29 for women and 30 to 34 for men. Relative uncertainty was larger for the untreated PLHIV than the number on ART or total PLHIV. Among clients receiving ART at facilities in Lilongwe city, an estimated 71% (95% CI, 61% to 79%) resided in Lilongwe city, 20% (14% to 27%) in Lilongwe district outside the metropolis, and 9% (6% to 12%) in neighbouring Dowa district. Thirty-eight percent (26% to 50%) of Lilongwe rural residents and 39% (27% to 50%) of Dowa residents received treatment at facilities in Lilongwe city. Conclusions: The Naomi model synthesizes multiple subnational data sources to furnish estimates of key indicators for HIV programme planning, resource allocation, and target setting. Further model development to meet evolving HIV policy priorities and programme need should be accompanied by continued strengthening and understanding of routine health system data. Keywords: Bayesian statistics; HIV estimates; joint modelling; routine data; small-area estimation

We present a case of a 13-year-old patient with a distinct tumor with both granular cell and perineurial elements, located on the lower lip. The patient presented with a long-standing lip mass that was clinically felt to most likely represent a mucocele. Following surgical excision, histopathological examination revealed a well-circumscribed tumor composed of granular cells with positive S100 protein staining and spindled cells positive for EMA and GLUT-1, confirming mixed neuroectodermal and perineurial origin. This is the first case documenting a perineurial-granular cell hybrid tumor in a patient under 18 years old, and the first to be reported in the head and neck. This case expands our understanding of hybrid PNSTs, emphasizing the importance of considering diverse clinical presentations, especially in the context of rare pediatric occurrences in atypical locations. [ABSTRACT FROM AUTHOR]

1 | INTRODUCTION The Joint United Nations Programme on HIV/AIDS (UNAIDS) has set a target for 90% of people on ART to have viral load suppression (VLS) by 2020 [1] [...], Introduction: The global target for 2020 is that [greater than or equal to]90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) will achieve viral load suppression (VLS). We examined VLS and its determinants among adults receiving ART for at least four months. Methods: We analysed data from the population-based HIV impact assessment (PHIA) surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017). PHIA surveys are nationally representative, cross-sectional household surveys. Data collection included structured interviews, home-based HIV testing and laboratory testing. Blood samples from PLHIV were analysed for HIV RNA, CD4 counts and recent exposure to antiretroviral drugs (ARVs). We calculated representative estimates for the prevalence of VLS (viral load Results: We included 9200 adults receiving ART of whom 88.8% had VLS and 11.2% had NVL including 8.2% who experienced VF and 3.0% who interrupted ART. Younger age, male sex, less education, suboptimal adherence, receiving nevirapine, HIV non-disclosure, never having married and residing in Zimbabwe, Lesotho or Zambia were associated with higher odds of NVL. Among people with NVL, marriage, female sex, shorter ART duration, higher CD4 count and alcohol use were associated with lower odds for VF and higher odds for interrupted ART. Many people with VF (44.8%) had CD4 counts Conclusions: Countries are approaching global VLS targets for adults. Treatment support, in particular for younger adults, and people with higher CD4 counts, and switching of people to protease inhibitor- or integrase inhibitor-based regimens may further reduce NVL prevalence. Keywords: HIV; ARV; viral suppression; 90-90-90 targets; second-line ART; sub-Saharan Africa

INTRODUCTION As of 2020, Eastern and Southern Africa (ESA) account for approximately 20.7 million people living with human immunodeficiency virus (PLHIV), resulting in 55% of all infections globally and 44% [...], : Introduction: Hazardous alcohol use (HAU), defined as a pattern of alcohol consumption that increases the risk of harmful consequences for the user or others, is associated with an elevated risk of human immunodeficiency virus (HIV) infection and poor health outcomes. We describe the association between people living with HIV (PLHIV) who report HAU and key HIV indicators. Gaps in current literature in estimating HAU on HIV outcomes at the regional level of Eastern and Southern Africa still exist and our analysis aims to address this issue. Methods: We used weighted pooled data (2015?2017) from the nationally representative Population?based HIV Impact Assessments among adults who provided written consent aged 18?59 years from Eswatini, Malawi, Namibia, Tanzania, Zambia and Zimbabwe. We estimated differences in the prevalence of HIV infection and The Joint United Nations Programme on HIV and AIDS (UNAIDS) 90?90?90 indicators between PLHIV by HAU status using log?binomial regression, stratified by sex. HAU was determined using the Alcohol Use Identification Test?Consumption. Results: Among the 9755 women and 4444 men who tested HIV positive, 6.6% of women and 21.8% of men engaged in HAU. Women who reported HAU were more likely to be HIV positive (adjusted prevalence ratio [aPR] = 1.31, 95% CI: 1.18?1.46) compared to those who did not report HAU. For the UNAIDS 90?90?90 targets, women who engaged in HAU were more likely to be unaware of their HIV?positive status (aPR = 1.22, 95% CI: 1.01?1.47) and not on antiretroviral therapy (ART) (aPR = 1.73, 95% CI: 1.26?2.37). Men who engaged in HAU were more likely to be unaware of their HIV?positive status (aPR = 1.56, 95% CI 1.39?1.76) and not on ART (aPR = 1.72, 95% CI: 1.30?2.29). No difference in viral load suppression, defined as Conclusions: PLHIV who engage in HAU were more likely to have suboptimal outcomes along the HIV care continuum when compared to those who did not engage in HAU. Targeted interventions, such as alcohol screening for HAU in HIV testing and treatment settings and HIV prevention efforts in alcohol?based venues, may help countries reach HIV epidemic control by 2030.

Introduction Of an estimated 33.4 million people living with human immunodeficiency virus (HIV) infections worldwide, approximately 22.4 million live in sub-Saharan Africa and, of these, 1.5 million live in Kenya. [...], Objective To provide guidance for male circumcision programmes in Kenya by estimating the population of uncircumcised men and investigating the association between circumcision and infection with the human immunodeficiency virus (HIV), with particular reference to uncircumcised, HIV-uninfected men. Methods Data on men aged 15 to 64 years were derived from the 2007 Kenya AIDS Indicator Survey, which involved interviews and blood collection to test for HIV and herpes simplex virus 2 (HSV-2). The prevalence of HIV infection and circumcision in Kenyan provinces was calculated and the demographic characteristics and sexual behaviour of circumcised and uncircumcised, HIV-infected and HIV-uninfected men were recorded. Findings The national prevalence of HIV infection in uncircumcised men was 13.2% (95% confidence interval, Cl: 10.8-15.7) compared with 3.9% (95% CI: 3.3-4.5) among circumcised men. Nyanza province had the largest estimated number of uncircumcised, HIV-uninfected men (i.e. 601 709), followed by Rift Valley, Nairobi and Western Province, respectively, and most belonged to the Luo ethnic tribe. Of these men, 77.8% did not know their HIV status and 33.2% were HSV-2-positive. In addition, 65.3% had had unprotected sex with a partner of discordant or unknown HIV status in the past 12 months and only 14.7% consistently used condoms with their most recent partner. However, only 21.8% of the uncircumcised, HIV-uninfected men aged 15 to 19 years were sexually active. Conclusion The Kenyan male circumcision strategy should focus on the provinces with the highest number of uncircumcised, HIV-uninfected men and target young men before or shortly after sexual debut. [TEXT NOT REPRODUCIBLE IN ASCII.] Programmes de circoncision masculine au Kenya: lecons tirees de l'enquete de 2007 sur les indicateurs du SIDA au Kenya Objectif Conseiller des programmes de circoncision masculine au Kenya en estimant le nombre d'hommes non circoncis et en recherchant l'association entre la circoncision et l'infection par le virus de l'immunodeficience humaine (VIH), avec une reference particuliere aux hommes non circoncis et non infectes par le VIH. Methodes Des donnees sur des hommes ages de 15 a 64 ans ont ete obtenues de l'enquete de 2007 sur les indicateurs du SIDA au Kenya, impliquant des entretiens et des prises de sang afin de rechercher la presence du VIH et du virus de l'herpes simplex 2 (VHS-2). La prevalence de l'infection par le VlH et la circoncision dans les provinces kenyanes a ete calculee, et les caracteristiques demographiques ainsi que le comportement sexuel des hommes circoncis et non circoncis, des hommes infectes et non infectes par le VIH ont ete enregistres. Resultats La prevalence nationale de l'infection par le VIH chez les hommes non circoncis s'elevait a 13,2% (intervalle de confiance de 95%, IC: 10,8-15,7) par rapport a un pourcentage de 3,9% (IC de 95%: 3,3-4,5) chez les hommes circoncis. La province de Nyanza presentait l'estimation du plus grand nombre d'homme non circoncis et d'hommes non infectes par le VIH (601 709), suivie de la vallee du Rift, de Nairobi et de la province occidentale, respectivement, dont la plus grande partie appartenait a la tribu ethnique des Luo. Chez ces hommes, 77,8% ne connaissaient pas leur seropositivite et 33,2% etaient positifs au VHS-2. De plus, 65.3% d'entre eux avaient eu des rapports sexuels non proteges avec une partenaire de statut HIV inconnu ou discordant au cours des 12 derniers mois, et seuls 14,7% d'entre eux utilisaient constamment des preservatifs avec leur derniere partenaire. Cependant, seuls 21,8% des hommes non circoncis et non infectes par le VIH ages de 15 a 19 ans etaient sexuellement actifs. Conclusion La strategie de circoncision des hommes kenyans doit s'orienter sur les provinces presentant le plus grand nombre d'hommes non circoncis et non infectes par le VIH, mais aussi cibler les jeunes hommes avant ou peut de temps apres leur premiere experience sexuelle. [TEXT NOT REPRODUCIBLE IN ASCII.] Los programas de circuncision masculina en Kenia: lecciones de la Encuesta de indicadores del SIDA en Kenia 2007 Objetivo Proporcionar orientacion para las programas de circuncision masculina en Kenia calculando la poblacion de hombres circuncidados e investigando la relacion entre la circuncision y la infeccion con el virus de la inmunodeficiencia humana (VIH), haciendo alusion especial a las hombres no circuncidados ni infectados par el VIH. Metodos Las datos acerca de las hombres con edades comprendidas entre 15 y 64 anos se obtuvieron de la Encuesta de indicadores del SIDA en Kenya del ano 2007, que incluyo entrevistas y la recogida de muestras de sangre para realizar las pruebas del VIH y del virus del herpes simple de tipo 2 (VHS-2). Se calculo la prevalencia de la infeccion par el VIH y la circuncision en las provincias de Kenia y se registraron las caracteristicas demograficas y el comportamiento sexual de las hombres circuncidados y no circuncidados, infectados y no infectados con el VIH. Resultados La prevalencia nacional de la infeccion par VIH en las hombres circuncidados fue del 13,2% (intervalo de confianza del 95%, IC: 10,8 -15,7) comparada con el 3,9% (IC 95%: 3,3 - 4,5) entre los hombres circuncidados. La provincia de Nyanza tuvo el mayor numero estimado de hombres no circuncidados y no infectados par el VIH (esto es, 601 709), seguida par la provincia Rift Valley, Nairobi y la provincia Occidental, respectivamente, y la mayoria de ellos pertenecia a la tribu etnica Luo. De esos hombres, el 77,8% no canada su estado serologico y el 33,2% estaba infectado con el VHS-2. Ademas, el 65,3% habia mantenido relaciones sexuales sin proteccion con una pareja serodiscordante o que no canada su estado serologico en las ultimos 12 meses y solo el 14,7% habia empleado preservativos de manera sistematica con su pareja mas reciente. No obstante, solo el 21,8% de las hombres circuncidados e infectados par el VIH con edades entre los 15 y las 19 anos era sexualmente activo. Conclusion La estrategia de circuncision masculina en Kenya deberia centrarse en las provincias con el mayor numero de hombres no circuncidados y no infectados por el VIH y dirigirse a las hombres jovenes antes o poco despues de la primera relacion sexual.

Objectives: Data on long‐term HIV‐free survival in breastfeeding, HIV‐exposed infants (HEIs) are limited. The National Evaluation of Malawi's Prevention of Mother‐to‐Child Transmission (PMTCT) Program (NEMAPP), conducted between 2014 and 2018, evaluated mother‐to‐child transmission (MTCT) and infant outcomes up to 24 months postpartum. Methods: We enrolled a nationally representative cohort of HEIs at 54 health facilities across four regional strata in Malawi and used multivariable Cox regression analysis to investigate the risk of adverse outcomes (HIV transmission, infant death and loss to follow‐up) to 24 months postpartum. Models, controlling for survey design, were fitted for the total cohort (n = 3462) and for a subcohort that received maternal viral load (VL) monitoring (n = 1282). Results: By 24 months, in 3462 HEIs, weighted cumulative MTCT was 4.9% [95% confidence interval (CI) 3.7–6.4%], 1.3% (95% CI 0.8–2.2%) of HEIs had died, 26.2% (95% CI 24.0–28.6%) had been lost to follow‐up and 67.5% (95% CI 65.0–70.0%) were alive and HIV‐free. Primiparity [weighted adjusted hazard ratio (aHR) 1.6; 95% CI 1.1–2.2; parity 2–3: weighted aHR 1.5; 95% CI 1.2–1.9], the mother not disclosing her HIV status to her partner (no disclosure: weighted aHR 1.3; 95% CI 1.1–1.6; no partner: weighted aHR 0.7; 95% CI 0.5–0.9), unknown maternal ART start (weighted aHR 2.0; 95% CI 1.0–3.9) and poor adherence (missed ≥ 2 days of ART in the last month: weighted aHR 1.7; 95% CI 1.2–2.2; not on ART: weighted aHR 1.7; 95% CI 1.0–2.7) were associated with adverse outcomes by 24 months. In the subcohort analysis, risk of HIV transmission or infant death was higher among HEIs whose mothers started ART post‐conception (during pregnancy: weighted aHR 3.2; 95% CI 1.3–7.7; postpartum: weighted aHR 12.4; 95% CI 1.5–99.6) or when maternal viral load at enrolment was > 1000 HIV‐1 RNA copies/mL (weighted aHR 15.7; 95% CI 7.8–31.3). Conclusions: Infant positivity and infant mortality at 24 months were low for a breastfeeding population. Starting ART pre‐conception had the greatest impact on HIV‐free survival in HEIs. Further population‐level reduction in MTCT may require additional intervention during breastfeeding for women new to PMTCT programmes. Pre‐partum diagnosis and linkage to ART, followed by continuous engagement in care during breastfeeding can further reduce MTCT but are challenging to implement. [ABSTRACT FROM AUTHOR]