Human immunodeficiency virus (HIV) in the Middle East and North Africa (MENA) region is severely understudied despite the region’s increase in new HIV infections since 2010. A key population that is particularly affected, due to the lack of adequate knowledge and proper interventional implementation, includes people who inject drugs (PWID). Furthermore, the paucity of HIV data (prevalence and trends) worsens an already critical situation in this region. A scoping review was conducted to address the scarcity of information and to synthesize the available data on HIV prevalence rates within the key population of PWID throughout the MENA region. Information was sourced from major public health databases and world health reports. Of the 1864 articles screened, 40 studies discussed the various factors contributing to the under-reporting of HIV data in the MENA region among PWID. High and overlapping risk behaviors were cited as the most prevalent reason why HIV trends were incomprehensible and hard to characterize among PWID, followed by lack of service utilization, lack of intervention-based programs, cultural norms, lack of advanced HIV surveillance systems, and protracted humanitarian emergencies. Overall, the lack of reported information limits any adequate response to the growing and unknown HIV trends throughout the region.

Though conceptually attractive, the use of water-soluble prodrug technology to enhance oral bioavailability of highly insoluble small molecule therapeutics has not been widely adopted. In large part, this is due to the rapid enzymatic or chemical hydrolysis of prodrugs within the gastrointestinal tract, resulting in drug precipitation and no overall improvement in oral bioavailability relative to standard formulation strategies. We reasoned that an optimal water-soluble prodrug could be attained if the rate of prodrug hydrolysis were reduced to favor drug absorption rather than drug precipitation. In doing so, the rate of hydrolysis provides a pharmacokinetic control point for drug delivery. Herein, we report the discovery of a water-soluble promoiety (Sol-moiety) technology to optimize the oral bioavailability of highly insoluble small molecule therapeutics, possessing various functional groups, without the need for sophisticated, often toxic, lipid or organic solvent-based formulations. The power of the technology is demonstrated with marked pharmacokinetic improvement of the commercial drugs enzalutamide, vemurafenib, and paclitaxel. This led to a successful efficacy study of a water-soluble orally administered prodrug of paclitaxel in a mouse pancreatic tumor model.

Introduction: The syndemic framework provides a critical lens for understanding the complex interplay between HIV/AIDS, mental health (MH) conditions, and non-communicable diseases (NCDs) in Africa. This scoping review explores how these conditions converge to form a syndemic that disproportionately affects vulnerable populations – particularly people living with HIV/AIDS (PLWH). Contextual factors such as stigma, lower socioeconomic resulting in poverty, gender, resource limitations, and fragmented healthcare systems exacerbate these interrelated conditions, posing significant challenges to individuals and their health. Methods: A scoping review was conducted to examine the syndemic interactions between HIV/AIDS, MH, and NCDs across Africa. Utilizing the PRISMA-ScR framework and a predefined inclusion criterion, literature searches were conducted in the following databases: PubMed/Medline (OVID), Web of Science (all databases), Web of Science (core collection), Global Health, Cumulative Index of Allied Health Literature (CINAHL), MEDLINE OVID, Psychinfo (OVID), Psychinfo (proquest); and Psychinfo (psychnet) in March 2024. Articles were screened independently by two peer reviewers and conflicts were resolved by a third reviewer. Data were extracted to summarize study characteristics, prevalence rates, and the contextual factors that underpin syndemic interactions among HIV/AIDS, MH and NCDs. Results: An initial search retrieved 5937 articles, with 2913 articles remaining after removal of duplicates. Title and abstract screening further excluded 2706 articles. In total, 207 full-text articles were assessed, of which 17 publications were extracted and included in the review. The scoping review identified a significant prevalence of multi-morbidities amongst PLWH, particularly within hypertension, diabetes, and depression. Women and older adults were disproportionately affected, with gender and age disparities shaping health outcomes. Contextual factors such as stigma, socioeconomic barriers, and fragmented healthcare systems were consistently reported as key contributors to worsening such multi-morbidities. In many publications, NCDs and MH conditions were undiagnosed or poorly managed, complicating HIV treatment and reducing the quality of life. Individual and structural resource limitations, along with poor healthcare integration, further hindered effective care. Conclusion: This scoping review underscores the urgent need for integrated healthcare models to address the syndemic of HIV/AIDS, NCDs, and MH in Africa. Interventions should prioritize stigma reduction, capacity building, and comprehensive care to address the underlying socioeconomic determinants of health among PLWH. Strengthening healthcare systems and promoting holistic, patient-centered care is essential for reducing disparities, improving health outcomes, and achieving the Sustainable Development Goals. Future research should expand geographic and demographic coverage to capture the full scope of these syndemic relationships in diverse African contexts.

Objective: To identify innovative strategies that may increase recruitment and/or retention of groups less represented in chronic disease clinical research. Methods: A systematic review was conducted. Inclusion criteria were: (a) NIH-defined racial and ethnic minority groups and clinical research; (b) evidence-based, clinical research recruitment and/or retention strategies involving the leading causes of mortality and morbidity in the United States; (c) conducted in the United States; and (d) qualitative design. Data exploring the strategies were extracted and thematically analyzed. Results: Twenty-seven studies were included. Studies focused on cancer (70%), recruitment (93%), and perspectives from clinicians (63%). The most referenced strategies were education (44%), communication (48%), and community-based participatory research (63%). Critical themes include empowerment, transparency, trust, and sustainability. Conclusions: Strategies must prioritize the community and be implemented sustainably, where cultural humility and community-based participatory research are foundational.