Stephane Wen-Wei Ku

1. Two-year CD4 count recovery was a strong predictor for long-term mortality. 2. Community-based efforts should be maintained despite HIV interventions becoming more digital. 3. Community-based support for health autonomy is needed. 4. Higher prevalence of adverse birth outcomes was observed among women living with HIV not on ART.

1. Martin-Iguacel et al. found late presenters, defined as a CD4 count <350 cells/mm3 at ART initiation, had higher mortality risk if the immune recovery failed to increase CD4 count >500 cells/mm3 after two years in the PISCIS cohort. People with InSTI-based ART regimen in the first two years had better outcome. 2. Wirtz et al. presented results from a cohort of mixed digital and site-based modes with more than 1,300 transgender women enrolled in the eastern and southern US. High HIV incidence and mortality were found in the cohort, with even higher rates of both outcomes in the site-based mode. 3. Ganesan et al. assessed individual and community-level risk factors for late diagnosis among newly-diagnosed people living with HIV from nine African countries. Apart from male gender and older age, health decision made by spouse but not by the individual had higher odds of late HIV diagnosis. 4. Using Malawi Birth Defects Surveillance data, Bello et al. found higher prevalence of adverse birth outcomes among women living with HIV (WLHIV) not on ART, compared to those on ART or those without HIV. There was elevated prevalence of birth defects and NTD among WLHIV on ART, though not statistically significant.

1. The PISCIS cohort data support positioning InSTI-based ART as preferred regimens as recommended by current guidelines. 2. Along with HIV prevention, multi-level interventions that address social and structural contexts are also important to decrease premature death for transgender women. 3. Gender norms experienced at the community-level may have inhibited health agency. Future interventions should be designed to overcome both individual and community-level barriers. 4. Whether ART was associated with birth defects and NTD remained unknown from the preliminary results. Further analyses with adjusting for ART regimen and timing of ART exposure will be planned.