{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:34:48Z","timestamp":1792424088571,"version":"4.5.0"},"reference-count":29,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T00:00:00Z","timestamp":1756857600000},"content-version":"vor","delay-in-days":2,"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":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Key populations (KP), including men who have sex with men, people who inject drugs, sex workers, transgender people and people in closed settings, are disproportionately affected by HIV and face structural and legal barriers to care. While community\u2010led responses are central to reaching KP, services are often disease\u2010specific and disconnected from national primary healthcare (PHC) systems. PHC, defined by WHO as a whole\u2010of\u2010society approach to delivering integrated and person\u2010centred services, is rarely designed to meet the broader health needs of KP, who also experience high burdens of non\u2010communicable diseases, mental health conditions and violence. This paper describes three service delivery models, supported by PEPFAR, that integrate HIV and PHC services for KP in Vietnam, Nigeria and Eswatini.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The three models are community\u2010led, client\u2010centred, and tailored to KP health and social needs. Each integrates HIV services\u2014including testing, antiretroviral therapy, viral load monitoring, pre\u2010exposure prophylaxis (PrEP) and advanced HIV disease management\u2014alongside broader PHC services such as mental healthcare, sexual and reproductive health, non\u2010communicable disease screening and tuberculosis services. All models include structural and community\u2010based interventions such as gender\u2010based violence support, stigma reduction, peer navigation and economic empowerment. These services are delivered in safe, trusted spaces by multidisciplinary teams including peer and clinical providers. While the models demonstrate alignment with PHC principles (accessibility, cultural competence, continuity and community empowerment), challenges remain related to integration within national health systems, financing and provider training. Recent U.S. global health policy shifts, including reductions in funding for KP\u2010specific programming and limited PrEP access, pose additional threats to programme sustainability and client trust.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Integrated models of HIV and PHC for KP can improve access, engagement and health outcomes across a range of services. They represent promising approaches for addressing intersecting health and structural needs, particularly in settings where stigma and criminalization persist. Sustained progress will require inclusion of KP in PHC policies and planning, protection of community\u2010led services and domestic financing strategies that ensure continuity in the face of shifting donor priorities.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.70027","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T05:59:13Z","timestamp":1756965553000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Integrating HIV and primary healthcare for key populations: community\u2010led models from Vietnam, Nigeria and Eswatini"],"prefix":"10.1002","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8172-6626","authenticated-orcid":false,"given":"Megan","family":"Coleman","sequence":"first","affiliation":[{"name":"HIV Technical Advisor for Key Populations  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Akolo","sequence":"additional","affiliation":[{"name":"FHI 360  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Acapel","family":"Mbanusi","sequence":"additional","affiliation":[{"name":"Key Population Activist  Abuja Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bhekizitha","family":"Sithole","sequence":"additional","affiliation":[{"name":"FHI 360  Mbabane Eswatini"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George K.","family":"Siberry","sequence":"additional","affiliation":[{"name":"Columbia University Irving Medical Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Schowen","sequence":"additional","affiliation":[{"name":"Technical Advisor HIV Services  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deborah","family":"Goldstein","sequence":"additional","affiliation":[{"name":"Technical Advisor HIV Services  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,3]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"Aidsfonds.Fast\u2010track or off track? 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