ObjectiveTo estimate the pooled prevalence and identify transmission drivers of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among incarcerated populations in sub-Saharan Africa.MethodsA systematic review and meta-analysis was conducted following a search encompassing Medical Subject Headings (MeSH) and free-text terms from database inception through February 2025. Data were synthesized from 26 studies involving 77,760 prisoners across sub-Saharan Africa. A random-effects model was used to calculate pooled prevalence estimates, assess regional variation, and evaluate odds ratios (OR) for potential transmission risk factors.ResultsThe overall pooled prevalence was 13.0% for HBV and 8.0% for HCV among prisoners. Significant regional disparities were observed, with West Africa presenting the highest HBV burden (16.3%) and East Africa showing the highest HCV burden (8.8%). Key independent predictors of infection included sharing sharp objects (OR, 1.98), tattooing (OR, 1.92), and intravenous drug use (OR, 1.38).ConclusionIncarcerated populations in sub-Saharan Africa experience a high burden of viral hepatitis driven by parenteral exposure and high-risk sexual interactions. Addressing these gaps requires targeted screening, comprehensive harm reduction, condom provision, and integrating prison health services into national elimination strategies.

Cognitive offloading refers to the process of using aids to reduce the cognitive demands of a task. A simple type of offloading-like behavior involves using cues in the environment to later aid in making a correct choice or response when this would otherwise be difficult or even impossible. This project assessed children's ability for spontaneous creation of this type of cognitive strategy use. Children three to nine years old first participated in a task that produced uncertainty surrounding the future location of a preferred toy. Children assigned different toys to four opaque cups, one of which was uniquely colored, before the cups were mixed and re-presented. To guarantee success, children had to place their preferred toy in the uniquely colored cup. Otherwise, they would have to select among three identical cups with no information about where the preferred item was hidden. No instructions were provided initially about where to place items, allowing children to formulate their own approach. Children demonstrated high levels of proficiency. Although age was not a strong indicator of overall performance, older children reached the criterion for proficiency more quickly than younger children. Children also decreased their likelihood of making errors with increased experience. However, subsequent variations of the task showed that preschool age children struggled to set up the game in such a way that an optimal strategy could be implemented. This suggests the possible lack of awareness of why a strategy works to make a task solvable and ensure success at this age.

In Tacoma, Washington, people with HIV (PWH) face significant barriers to care. This study compares viral suppression and patient-centered outcome effectiveness of co-located Ryan White (RW) and MAX (low-barrier, walk-in, engaging previously disengaged PWH with unsuppressed viral loads (VL) clinics.Mixed-methods, prospective cohort study of MAX/RW participants surveyed/interviewed at baseline, 6 and 12 months, assessing VL suppression (86 qualitative interviews coded thematically across six health/medical care domains). Eligibility criteria: VL >200 copies/mL (last 12 months), out of care ≥12 months, or facing engagement barriers. EMR VL data were collected between January 2020 and February 2025.Participants enrolled: 30 MAX and 70 RW. Viral suppression by timeline: -6 months (69.6% MAX, 78.4% RW; p = 0.4). -2.5 years (60.0% MAX, 92.1% RW; p = 0.003). MAX had higher baseline rates of housing instability (p = 0.11) and mental illness (p = 0.02) but cited immediate access, non-judgmental care, and wraparound services as being "lifesaving", with fewer unmet mental health needs and greater care access and education.Low-barrier models play a vital role in re-engaging PWH facing barriers. While RW achieved higher long-term viral suppression, MAX achieved improved trust, health literacy, and retention-foundations for long-term health. Integrated, patient-centered approaches can complement traditional care and address service gaps.

Multiple sexual partnerships (MSPs) act as a risk factor, increase vulnerability to sexually transmitted diseases, including HIV, and contribute to interconnected sexual networks that may facilitate broader transmission not only within high-risk networks but also to their partners. This study aims to estimate the prevalence of MSPs and factors associated with it among Hijra and transgender persons (H/TG) in India. This is a secondary data analysis of H/TG data from the National IBBS survey. The survey was conducted in 14 domains across 11 states of India using probability-based sampling. A total of 4345H/TG individuals were analyzed. Out of these, 3774 (86.9%) reported MSPs. Factors such as living with partners (aOR: 1.86; 95% CI: 1.32, 2.62), having first sexual intercourse before the age of 18 years (aOR: 1.44; 95% CI: 1.14, 1.82), involvement in sex work (aOR: 1.69; 95% CI: 1.27, 2.26), and having a commercial partner (aOR: 11.77; 95% CI: 4.80, 28.86) were associated with MSPs among H/TG persons. The findings of this study demonstrate that MSPs are highly prevalent among H/TG persons in India. Interventions aimed at HIV and STI prevention should move beyond individual-level behavior change approaches and incorporate network-based strategies and early sexual health education.

Adolescent girls and young women (AGYW) bear a disproportionate burden of HIV/AIDS. Pre-exposure prophylaxis (PrEP) for HIV prevention is limited to individuals identified as high risk following a prior risk assessment. However, AGYW with epidemiologically assessed HIV risk still struggle to align PrEP use with their sexual behaviors. This review examines how HIV risk and sexual behavior influence decisions to initiate, adhere to or discontinue PrEP. A search was conducted across five databases in November 2025. The search was registered in the Open Science Framework and followed PRISMA-SCR guidelines. A thematic content analysis approach was used to synthesize findings guided by the health belief model and COM-B framework. Forty-nine articles were eligible for synthesis. Knowledge of HIV risk and sexual behaviors motivated PrEP initiation and adherence. There were consistently low adherence and high discontinuation rates among AGYW with objective HIV risk behaviors. Prevention effectiveness and adherence varied with alignment and misalignment of behavioral risk and PrEP adherence. Decisions to use the vaginal ring instead of oral PrEP aligned with individual behavior. Dynamic changes in sexual behavior during PrEP use and decisions to switch to injectable PrEP where multiple alternatives are offered may be explored to support PrEP uptake and persistence.

Bone and joint disorders of the aging musculoskeletal system are conventionally treated as separate clinical entities. This disease-centered view aids diagnosis but obscures the immune, inflammatory, senescent and metabolic programs they share. This Review compares five of them, grouped by etiology rather than by age: two aging-driven remodeling disorders, osteoporosis (OP) and osteoarthritis (OA); two immune-mediated arthritides in which aging modifies rather than causes the skeletal outcome, rheumatoid arthritis (RA) and psoriatic arthritis (PsA); and one focal, largely monogenic disorder included as a boundary case, Paget's disease of bone (PDB). RA and PsA are not treated as age-related diseases; they are included because they show most directly that immune activation alone can redirect skeletal remodeling. The review is narrative and mechanism-oriented, based on a structured, auditable search (Section 2); we compare evidence across diseases rather than claim exhaustive synthesis. Skeletal aging, immunosenescence, inflammaging and lipid dysregulation converge on five nodes: the receptor activator of nuclear factor-κB ligand (RANKL)-osteoprotegerin (OPG) axis, the interleukin-17/tumor necrosis factor-α/interleukin-6 network, senescence-associated secretory phenotype (SASP) amplification, phospholipid peroxidation and ferroptosis, and Wnt-sclerostin-Dickkopf-1 (DKK-1) balance. Across diseases these nodes generate different skeletal outputs: systemic bone loss in OP; cartilage degeneration with subchondral remodeling in OA; erosion with impaired repair in RA; erosion combined with ectopic bone formation in PsA; and focal high-turnover remodeling in PDB. Disease identity, we argue, is set by the sign and relative weighting of node activity rather than by which nodes are engaged; the opposing direction of DKK-1 regulation in RA and PsA is the clearest example. Ferroptotic injury is resolved by cell type rather than treated as uniformly harmful, and PDB is retained as a comparator showing that shared-node activation is permissive rather than deterministic. Candidate biomarkers and pathway-directed therapies are summarized with their translational gaps. Every disease × mechanism combination is graded on a four-level evidence scheme (E1, established human evidence, to E4, indirect or in vitro only) defined in Section 2. A cross-disease, mechanism-informed approach may improve risk stratification, identify treatable endotypes, and guide future trials in immune-metabolic skeletal disease.