The COVID-19 pandemic threatened global HIV Test and Treat Efforts. We assessed whether it affected (1) the number of antiretroviral therapy (ART) initiations and (2) the proportion of timely ART initiations in people living with HIV (PLWH) globally.

Quasi-experimental, regression discontinuity design using routinely collected data from HIV clinics.

360 HIV care clinics across primary and secondary levels of care, participating in the International epidemiology Databases to Evaluate AIDS consortium, in 31 countries in Asia, Africa and the Americas.

177 391 PLWH (≥18 years old) who initiated ART 2 years before and 1 year after the onset of the COVID-19 pandemic in their country.

The primary outcome was the number of ART initiations per week; the secondary outcome was the proportion of timely ART initiations (ie, ART initiated within 7 days of enrolment). We assessed changes in these outcomes in the 52 weeks after compared to the 104 weeks before the pandemic onset, defined using each country’s peak Oxford Stringency Index score between January and June 2020.

Among 177 391 newly enrolled PLWH, 129 743 initiated during the pre-pandemic and 47 648 post-pandemic onset. 72.5% of ART initiations were timely pre-pandemic whereas 82.3% were during the pandemic. Absolute number of ART initiations remained stable during the pandemic period in 25 of 31 countries but decreased significantly in six countries: India (–5.0 p, 95% CI –9.2 to –0.7), Rwanda (–10.0 p, –18.6 to –1.4), Malawi (–33.4 p, –54.1 to –12.3), South Africa (–130.8 p, –188.6 to –73.1), Zimbabwe (–12.9 p, –20.0 to –5.8) and Togo (–19.6 p, –39.1 to –0.1). The proportion of timely initiations was stable in all countries except in Kenya (+4.2 pp, 95% CI +0.3 to +8.1) and in Mozambique (+2.7 pp, +0.5 to +4.9), where it increased significantly.

A deeper understanding of the factors that contributed to sustaining ART initiations, particularly in settings with stringent public health and social measures, is needed. These insights should inform preparedness strategies, resource allocation and policy development to ensure continuity of HIV services during future health emergencies, in line with World Health Organisation recommendations.

Spinal cord injury (SCI) results in debilitating sensory, functional deficits and paralysis requiring neurorehabilitation solutions. In this regard, focal muscle vibration (FMV) is an emerging neuro-rehabilitation tool that uses mechanical vibration on muscles/tendons to stimulate underlying nerves and consequently modulate neural pathways. We conducted a systematic review to understand the exact effectiveness of FMVs on the sensorimotor function and mobility/strength in the SCI population.

Systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach.

PEDro, Springer, PubMed, Science Direct, Cochrane Library and Google Scholar were searched through 15 February 2025.

We included studies adhering to the following population–intervention–comparison–outcomes (PICO) elements. Population: SCI, intervention: FMV, comparison: unexposed controls, outcome: either of sensorimotor function or mobility and strength.

Two independent reviewers used standardised methods to search, screen and code included studies. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) scale. Findings were summarised and a narrative synthesis is provided.

25 studies were included. 9 studies used FMV in the upper limb and 14 in the lower limb. The analysis includes 427 patients with SCI, with a focus on male, chronic SCI cases and a prevalence of North American studies.

Our systematic review of 25 studies, with 21 (84%) reporting positive outcomes, suggests that FMV may improve sensory perception, motor function, mobility and strength in individuals with SCIs, with benefits observed in both limbs. However, substantial heterogeneity in FMV parameters, study designs, participant characteristics and the high prevalence of serious/critical risk of bias (13/25 studies, 52%) limit definitive conclusions. Further research with optimised protocols, larger sample sizes and longitudinal designs is needed to confirm efficacy and establish clinical guidelines.