{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:18:29Z","timestamp":1755217109816,"version":"3.43.0"},"reference-count":33,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T00:00:00Z","timestamp":1750896000000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>In Malawi, where HIV prevalence remains high at 6.7%, post\u2010exposure prophylaxis (PEP) has been implemented as one of the HIV prevention strategies. However, there is limited data on the characteristics of PEP users and HIV seroconversion. Using national routine HIV testing services (HTS) programme data, we described the demographic characteristics and risk of exposure to HIV for HTS clients reporting PEP use and determined HIV seroconversion rates among those with baseline HIV\u2010negative results.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a descriptive cross\u2010sectional study of individuals aged 2 years and older accessing HTS who reported PEP use. A subset was included in a retrospective cohort to determine HIV seroconversion rates. The risk of exposure to HIV was classified as high, ongoing, low and not assessed. HTS encounters data were extracted from a national HTS data repository. Some HTS clients had multiple HTS encounters. Descriptive statistics were reported for the study populations and Poisson regression model with an offset was used to estimate HIV seroconversion rates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between November 2022 and July 2023, there were 21,298 HTS encounters where PEP use was reported any time prior. Of the 21,298 encounters, 1847 (8.7%) HTS clients with a baseline HIV\u2010negative status were included in the cohort study component. The median follow\u2010up time was 30 days (interquartile range 30\u201361). Of the 1847 HTS clients, 1055 (57.1%) were males and 928 (50.2%) were aged 20 and 29 years. A total of 329 (17.8%) HTS clients reported a high\u2010risk HIV exposure event in the past 3 months, 581 (31.5%) had an ongoing risk of exposure to HIV, 892 (48.3%) had low risk of exposure to HIV and 45 (2.4%) assessment was not done. Overall, five individuals seroconverted, yielding a seroconversion rate of 2.08 (0.87\u22124.99) per 100 person\u2010years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The majority of PEP users were young adults and males. A sizeable proportion had an ongoing risk of exposure to HIV. The HIV seroconversion rate was high. Targeted efforts should focus on promoting condom use, encouraging partner testing and expanding access to PEP for those with ongoing HIV exposure.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26473","type":"journal-article","created":{"date-parts":[[2025,6,26]],"date-time":"2025-06-26T13:21:38Z","timestamp":1750944098000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Characteristics of individuals who received post\u2010exposure prophylaxis and HIV seroconversion in Malawi: an analysis of national routine HIV testing data"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8247-1273","authenticated-orcid":false,"given":"Hannock","family":"Tweya","sequence":"first","affiliation":[{"name":"International Training and Education Center for Health (I\u2010TECH) Lilongwe Malawi"},{"name":"Department of Global Health University of Washington Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiwonge","family":"Chimpandule","sequence":"additional","affiliation":[{"name":"International Training and Education Center for Health (I\u2010TECH) Lilongwe Malawi"},{"name":"Directorate of HIV\/AIDS, STI and Viral Hepatitis (DHA) Ministry of Health Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William","family":"Wu","sequence":"additional","affiliation":[{"name":"Quantitative Engineering Design (QED.ai) Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leah","family":"Goeke","sequence":"additional","affiliation":[{"name":"Quantitative Engineering Design (QED.ai) Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhouyun","family":"Zheng","sequence":"additional","affiliation":[{"name":"Quantitative Engineering Design (QED.ai) Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stone","family":"Mbiriyawanda","sequence":"additional","affiliation":[{"name":"Directorate of HIV\/AIDS, STI and Viral Hepatitis (DHA) Ministry of Health Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Masina","sequence":"additional","affiliation":[{"name":"Directorate of HIV\/AIDS, STI and Viral Hepatitis (DHA) Ministry of Health Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Washington","family":"Ozitiosauka","sequence":"additional","affiliation":[{"name":"Directorate of HIV\/AIDS, STI and Viral Hepatitis (DHA) Ministry of Health Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martha","family":"Muyaso","sequence":"additional","affiliation":[{"name":"International Training and Education Center for Health (I\u2010TECH) Lilongwe Malawi"},{"name":"Directorate of HIV\/AIDS, STI and Viral Hepatitis (DHA) Ministry of Health Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Drabko","sequence":"additional","affiliation":[{"name":"Quantitative Engineering Design (QED.ai) Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dominik","family":"Bilicki","sequence":"additional","affiliation":[{"name":"Quantitative Engineering Design (QED.ai) Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jiehua","family":"Chen","sequence":"additional","affiliation":[{"name":"Quantitative Engineering Design (QED.ai) Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rose","family":"Nyirenda","sequence":"additional","affiliation":[{"name":"Directorate of HIV\/AIDS, STI and Viral Hepatitis (DHA) Ministry of Health Lilongwe Malawi"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andreas","family":"Jahn","sequence":"additional","affiliation":[{"name":"International Training and Education Center for Health (I\u2010TECH) Lilongwe Malawi"},{"name":"Department of Global Health University of Washington Seattle Washington USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,26]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"The urgency of now: AIDS at a crossroads.Geneva:Joint United Nations Programme on HIV\/AIDS;2024."},{"key":"e_1_2_11_3_1","unstructured":"World Health Organization.Prevention.Department of Global HIV Hepatitis and Sexually Transmitted Infections Programmes;2024."},{"volume-title":"Guidelines for HIV post\u2010exposure prophylaxis","year":"2024","author":"Kennedy C","key":"e_1_2_11_4_1"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0000000000000505"},{"key":"e_1_2_11_6_1","unstructured":"Malawi Ministry of Health.Clinical management of HIV in children and adults: Malawi integrated clinical HIV guidelines.2nd edition.2014. Available from:https:\/\/dms.hiv.health.gov.mw\/link\/3xmvrbm0"},{"key":"e_1_2_11_7_1","unstructured":"Malawi Ministry of Health and Population.Malawi guidelines for clinical management of HIV in children and adults.5th edition.2022. Available from:https:\/\/dms.hiv.health.gov.mw\/link\/ih4m1z0g"},{"key":"e_1_2_11_8_1","unstructured":"ScanForm: scalable data collection and analysis from handwritten documents. By Quantitative Engineering Design (QED.ai).2023. Available from:https:\/\/scanform.qed.ai"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-018-1121-z"},{"key":"e_1_2_11_10_1","unstructured":"HIV syphilis and hepatitis B integrated rapid testing and counselling guidelines and standard operating procedures.Malawi Ministry of Health;2023."},{"key":"e_1_2_11_11_1","unstructured":"Consolidated guidelines on person\u2010centred HIV strategic information: strengthening routine data for impact.Geneva:World Health Organization;2022."},{"key":"e_1_2_11_12_1","unstructured":"QED.ai. ScanForm [Internet]. [cited 2024 Oct 10]. Available from:https:\/\/about.scanform.qed.ai\/"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1590\/s1679-49742021000200017"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1590\/S2237\u201096222024V33E2023642.en"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/1545109710397893"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.21106\/ijma.311"},{"issue":"8","key":"e_1_2_11_17_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0134286","article-title":"Associated risk factors of STIs and multiple sexual relationships among youths in Malawi","volume":"10","author":"Wilson CN","year":"2015","journal-title":"PLoS One"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/13691050903556316"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.4172\/2155\u20106113.1000730"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-023-01651-7"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/10538712.2014.888119"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-018-1121-z"},{"key":"e_1_2_11_23_1","unstructured":"Government of Malawi.National Referral Pathways Guidance Notes.2020. Available at:https:\/\/intdev.tetratecheurope.com\/wp\u2010content\/uploads\/2022\/02\/7.\u2010Referral\u2010Pathways\u2010Booklet\u2010English.pdf"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-011-9892-3"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAI.0b013e31813e62f8"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1136\/oemed-2011-100382.341"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1177\/1757177417746733"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1071\/SH10063"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/00126334-200404150-00010"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2016.0062"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jana.2018.02.004"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/QCO.0000000000000340"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jadohealth.2008.01.002"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.108.3.339"}],"container-title":["Journal of the International AIDS Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jia2.26473","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T05:42:08Z","timestamp":1754372528000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jia2.26473"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":33,"journal-issue":{"issue":"S1","published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1002\/jia2.26473"],"URL":"https:\/\/doi.org\/10.1002\/jia2.26473","archive":["Portico"],"relation":{},"ISSN":["1758-2652","1758-2652"],"issn-type":[{"type":"print","value":"1758-2652"},{"type":"electronic","value":"1758-2652"}],"subject":[],"published":{"date-parts":[[2025,6]]},"assertion":[{"value":"2024-10-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-04-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-06-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e26473"}}