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01.
arXiv (quant-ph) 2026-06-16

Accelerating physics-informed neural networks for full waveform inversion using a hybrid quantum-classical finite-basis architecture

arXiv:2606.01110v2 Announce Type: replace-cross Abstract: Full waveform inversion (FWI) reconstructs heterogeneous material properties from receiver data but remains computationally demanding. Physics-informed neural networks (PINNs) and their domain-decomposed variants (FBPINNs) offer a mesh-free alternative but face convergence challenges when representing complex velocity fields. We present a hybrid quantum-classical FBPINN for acoustic FWI, bringing together quantum computing and classical machine learning, in which the decomposed wavefield network and the global velocity network are implemented as classical-to-quantum pipelines terminating in parameterized quantum circuits (PQCs). The PQCs are realized as differentiable JAX statevector simulators, enabling end-to-end automatic differentiation through the classical PINN, the quantum circuit, and the physics-informed loss. On a geophysical anomaly benchmark, the quantum hybrid reaches a lower L1 velocity error than the primary classical FBPINN baseline in approximately 8x fewer training iterations, despite using approximately 33% fewer trainable parameters, and it outperforms all 15 classical hyperparameter variants tested. A second benchmark (checkerboard) demonstrates the generality of the inversion pipeline, confirming that the quantum hybrid architecture can recover structured spatial variations beyond the localized anomaly benchmark. Our framework is broadly applicable to wave-based inverse problems beyond geophysics, including medical ultrasound tomography and non-destructive evaluation.

02.
arXiv (CS.CL) 2026-06-12

Authorship Attribution in Multilingual Machine-Generated Texts

As Large Language Models (LLMs) have reached human-like fluency and coherence, distinguishing machine-generated text (MGT) from human-written content becomes increasingly difficult. While early efforts in MGT detection have focused on binary classification, the growing landscape and diversity of LLMs require a more fine-grained yet challenging authorship attribution (AA), i.e., being able to identify the precise generator (LLM or human) behind a text. However, AA remains nowadays confined to a monolingual setting, with English being the most investigated one, overlooking the multilingual nature and usage of modern LLMs. In this work, we introduce the problem of Multilingual Authorship Attribution, which involves attributing texts to human or multiple LLM generators across diverse languages. Focusing on 18 languages – covering multiple families and writing scripts – and 8 generators (7 LLMs and the human-authored class), we investigate the multilingual suitability of monolingual AA methods in terms of their cross-lingual transferability, and the impact of generators on attribution performance. Our results reveal that while certain monolingual AA methods can be adapted to multilingual settings, significant limitations and challenges remain, particularly in transferring across diverse language families, underscoring the complexity of multilingual AA and the need for more robust approaches to better match real-world scenarios.

03.
arXiv (CS.LG) 2026-06-16

Dynamic Link Prediction with Temporally Enhanced Signed Graph Neural Networks

arXiv:2605.26290v2 Announce Type: replace Abstract: Temporal signed networks (TSNs) model the time evolution of cooperative and adversarial relationships that arise in applications such as social media analysis, trust and reputation systems, and financial transaction networks. While graph neural networks (GNNs) perform well for static or unsigned link prediction, effective learning in temporal signed graphs remains challenging due to the interaction of signed relations, evolving structure, and balance-theoretic constraints. To address this gap, we propose a modular temporal enhancement framework for signed GNNs that integrates historical context into otherwise static architectures. The framework introduces a Historical Context Integration Module (HCIM) that combines learnable recency-aware temporal weighting, LSTM-based embedding trajectory modeling, and multi-head temporal attention to capture both short- and long-term signed interaction dynamics. Historical information is fused with current node representations using either global or node-adaptive weighting, allowing the architecture-agnostic framework to accommodate heterogeneous temporal behaviors. We instantiate the approach on the Self-Explainable Signed Graph Transformer (SE-SGformer), preserving interpretability while extending it with temporal awareness. Experiments on real-world and synthetic TSNs, including Bitcoin OTC, Bitcoin Alpha, Reddit, and small-world network models, demonstrate consistent and statistically significant improvements over the static baseline.

04.
arXiv (CS.CV) 2026-06-18

SMART: A Flexible, Interpretable, and Scalable Spatio-temporal Brain Atlas from High-Resolution Imaging Data

We introduce SMART, a framework for learning a flexible, interpretable, and scalable spatio-temporal brain atlas from longitudinal high-resolution 3D medical images. Existing approaches to spatio-temporal atlas construction rely on black-box generative models that lack flexibility, limit interpretability, and struggle to scale to high-dimensional data. SMART addresses these challenges by learning a continuous disease-time atlas that decouples global group-wise disease dynamics from their patient-specific anatomical manifestation. Guided by anatomically inspired priors, SMART models interpretable global trajectories of regional progression along a shared disease timeline through region-specific differential equations. Global trajectories are further personalized to individual anatomies via dense diffeomorphic displacements parameterized by a flexible and scalable multi-scale Neural Cellular Automata. Evaluated on five longitudinal MRI datasets in Alzheimer's disease (ADNI-1/GO/2, OASIS-3, AIBL; > 1,300 subjects), SMART produces anatomically meaningful predictions of disease progression and achieves state-of-the-art forecasting accuracy and improved temporal consistency over adversarial and diffusion baselines. Our approach establishes a new paradigm for flexible, interpretable, and scalable modeling of spatio-temporal change in high-dimensional medical image time-series.

06.
PLOS Medicine 2026-05-13

On the evolution of the company we keep: Implications for infectious disease modeling

Authors:

by Joël Mossong Whom we meet shapes how infections spread. Where earlier focus of mathematical epidemiology was on incorporating age, more recent work has begun to reveal the importance of socioeconomic aspects for understanding and managing future epidemics. In this Perspective, Joël Mossong discusses the importance of understanding social contacts and how they have evolved for infectious disease modeling, and the need to factor in additional considerations such as ethic and socioeconomic backgrounds.

07.
arXiv (CS.CL) 2026-06-24

CANDLE: Character-level Arabic Noise Deduplication using Lightweight Encoder

Handling repeated characters in text can be tricky, since they can represent either the correct spelling of a word or informal character elongation often seen in social media posts. We present CANDLE, a lightweight system for character-level Arabic noise deduplication that addresses this challenge without relying on handcrafted rules, dictionaries, or morphological analyzers. At the heart of CANDLE is a novel application of Connectionist Temporal Classification (CTC) to this task, a formulation not previously explored for character deduplication, which frames normalization as a sequence alignment problem over a character-based encoder. Evaluated on three benchmarks spanning clean newspaper, manually curated ambiguous cases, and real-world social media text, the CTC model achieves a Sentence Error Rate (SER) as low as $5.37\%$ and consistently outperforms a classification-based baseline by a large margin. To reduce inference overhead, we distill the 6-layer CTC model into a 2-layer student, achieving a $3\times$ depth reduction with minimal performance degradation. Beyond deduplication accuracy, normalization yields a practical downstream benefit: a relative reduction in tokenizer fertility of up to $12.8\%$ across a diverse set of Arabic LLM tokenizers, directly lowering inference costs and improving context window utilization. We release all code and models publicly to support reproducibility and advance future research\footnote{https://github.com/abjadai/candle}.

08.
arXiv (CS.CV) 2026-06-24

ZeroGVC: Zero-Shot Generative Video Compression with Autoregressive Diffusion Priors

Recent generative video compression methods leverage powerful generative priors to achieve perceptually pleasing reconstructions. However, most existing approaches require additional training to adapt generative models to produce realistic reconstructions from compact representations. In this paper, we propose ZeroGVC, a zero-shot generative video compression framework that leverages pretrained autoregressive diffusion priors for low-delay video reconstruction. ZeroGVC encodes the first frame of each group of pictures (GOP) with an image codec and represents subsequent P-frames through Codebook-Guided Autoregressive Latent Compression. This design is motivated by our observation that the compression scheme of denoising diffusion codebook models is effective in few-step consistency sampling. By selecting compact combinations of reproducible codebook noise vectors, ZeroGVC steers the latent denoising trajectory toward the target P-frame while allowing the decoder to reproduce the same trajectory in only a few denoising steps. In addition, we design an optional bidirectional reference mode that mitigates error propagation by leveraging the next I-frame context without introducing any additional bitrate overhead. Extensive experiments on standard video compression benchmarks demonstrate that ZeroGVC achieves superior perceptual reconstruction quality at ultra-low bitrates without any additional training.

10.
arXiv (CS.CV) 2026-06-19

HEad and neCK TumOR (HECKTOR) 2025: Benchmark of Segmentation, Diagnosis, and Prognosis in Multimodal PET/CT

Head and neck cancers (HNC) represent a significant global health burden, with accurate tumor delineation being essential for effective radiotherapy planning. The complexity of the oropharyngeal anatomy, combined with the heterogeneous appearance of tumors on imaging, makes manual segmentation time-intensive and subject to inter-observer variability. Beyond segmentation, predicting long-term clinical outcomes, such as recurrence-free survival (RFS), and determining human papillomavirus (HPV) status from noninvasive imaging, remain challenging yet clinically valuable goals. The HECKTOR 2025 challenge addresses these needs by establishing a comprehensive benchmark for automated HNC analysis using multimodal PET/CT imaging and electronic health records. Building on previous editions (2020-2022), this challenge features an expanded multi-institutional dataset comprising over 1,100 patients from 10 centers worldwide. Participants were tasked with three complementary objectives: (1) segmenting primary gross tumor volumes (GTVp) and metastatic lymph nodes (GTVn), (2) predicting recurrence-free survival, and (3) classifying HPV status. The challenge attracted 35 registered teams, with 15 final submissions evaluated on a held-out test set. Top-performing algorithms achieved a mean Dice similarity coefficient of 0.75 for segmentation, a concordance index of 0.66 for survival prediction, and a balanced accuracy of 0.56 for HPV classification. This paper presents a comprehensive analysis of the submitted methodologies, evaluates their performance across different lesion characteristics, and discusses their implications for clinical translation in automated oncology workflows and decision support systems.

11.
arXiv (quant-ph) 2026-06-17

Practical Tests and Witnesses of Fermionic non-Gaussianity

arXiv:2605.26218v2 Announce Type: replace Abstract: Fermionic Gaussian states describe free fermions and underlie the mean-field picture of matter, from metals to superconductors; they are also efficiently simulable on classical computers. Departures from Gaussianity – the correlations produced by interactions – are therefore what make a fermionic system hard to simulate classically and useful for quantum computation, analogous to the role of magic in stabilizer-based quantum computation. Yet detecting and quantifying such non-Gaussianity at scale has remained challenging. Here we introduce practical tests and witnesses of fermionic non-Gaussianity built on fermionic antiflatness, a measure derived from the two-point covariance matrix. We estimate it with two protocols – a two-copy Bell measurement and a single-copy scheme using commuting Majorana bilinears – that determine whether a state is Gaussian or far from it at lower measurement cost than existing approaches, using only operations native to fault-tolerant hardware. For mixed states, a purity-corrected witness certifies non-Gaussianity and remains robust under strong noise; running it on the IQM quantum processor, we find that noise can both reduce and enhance non-Gaussianity. Finally, we show that preparing pseudorandom fermionic states requires extensive non-Gaussianity. Together, these tools enable the study and certification of non-Gaussian fermionic resources on present-day quantum devices.

12.
medRxiv (Medicine) 2026-06-24

The role of Mediterranean diet adherence, smoking and their interactions in epigenetic age acceleration: A cross-sectional analysis of the Airwave cohort.

Background: Epigenetic clocks are markers of biological aging that may vary in their sensitivity to environmental stressors and lifestyle modifiers. To evaluate the utility of these biomarkers as sensors of the human exposome, we investigated how they respond to two powerful and opposing exposures: smoking, a source of oxidative stress, and the antioxidant-rich Mediterranean diet. Objectives: We assessed the sensitivity of eleven epigenetic clocks to diet and smoking and evaluated whether Mediterranean diet adherence modifies associations between smoking and epigenetic aging. Methods: We analysed 928 participants (mean age 41 years, 59% male) from the Airwave Health Monitoring Study. Linear regression models assessed associations between Mediterranean Diet Score (MDS) and epigenetic age acceleration (EAA), alongside smoking status and blood cotinine. Interaction terms between smoking status and MDS were included to detect dietary attenuation of smoking-related EAA. Models were adjusted for demographic, socioeconomic, lifestyle, and psychological covariates. Results: Higher MDS was associated with lower EAA for GrimAge ({beta} = -0.07 SD; 95% CI: -0.13, -0.01) and Bernabeu ({beta} = -0.08 SD; 95% CI: -0.14, -0.02) after false discovery rate correction. Smoking was strongly associated with increased EAA, particularly for GrimAge, Bernabeu, and DunedinPACE. Among current smokers, effect sizes were greater in those with lower dietary adherence (e.g. GrimAge: 1.79 SD, 95% CI: 1.54, 2.04) compared with those with higher adherence (1.35 SD, 95% CI: 1.01, 1.68; P_interaction < 0.001). Similar attenuation patterns were observed for Bernabeu. Higher intake of fruits, vegetables, and whole grains contributed most to the attenuation of smoking-related EAA. Conclusions: Our findings indicate that certain epigenetic clocks effectively capture the tension between harmful and protective exposures within the exposome. Rather than suggesting that diet neutralises the risks of tobacco, these results demonstrate that specific clocks are sensitive enough to monitor how lifestyle factors modify molecular responses to environmental toxins. This highlights the value of second-generation clocks in quantifying biological resilience.

13.
arXiv (CS.LG) 2026-06-15

Leave-One-Out-, Bootstrap- and Cross-Conformal Anomaly Detectors

arXiv:2402.16388v4 Announce Type: replace-cross Abstract: The need for uncertainty quantification in anomaly detection systems has become increasingly important. In this context, effectively controlling Type I error rates without inflating Type II error rates in these systems can build trust and reduce costs associated with false discoveries. The field of conformal anomaly detection emerges as a promising approach for providing respective statistical and finite-sample validity guarantees through model calibration. However, reliance on calibration data imposes practical limitations, especially in low-data regimes. In this work, we formally define and evaluate leave-one-out-, bootstrap-, and cross-conformal methods for conformal anomaly detection, building on methods from the field of conformal prediction. Looking beyond the classical split-conformal approach, we show that derived methods for calculating resampling-conformal $p$-values offer a practical compromise between the data efficiency of full-conformal (transductive) approaches and the computational efficiency of split-conformal (inductive) methods. We validate derived methods and quantify their improvements for a range of one-class classifiers and datasets.

14.
arXiv (CS.CV) 2026-06-11

MARIC: Multi-Agent Reasoning for Image Classification

Image classification has traditionally relied on parameter-intensive model training, requiring large-scale annotated datasets and extensive fine tuning to achieve competitive performance. While recent vision language models (VLMs) alleviate some of these constraints, they remain limited by their reliance on single pass representations, often failing to capture complementary aspects of visual content. In this paper, we introduce Multi Agent based Reasoning for Image Classification (MARIC), a multi agent framework that reformulates image classification as a collaborative reasoning process. MARIC first utilizes an Outliner Agent to analyze the global theme of the image and generate targeted prompts. Based on these prompts, three Aspect Agents extract fine grained descriptions along distinct visual dimensions. Finally, a Reasoning Agent synthesizes these complementary outputs through integrated reflection step, producing a unified representation for classification. By explicitly decomposing the task into multiple perspectives and encouraging reflective synthesis, MARIC mitigates the shortcomings of both parameter-heavy training and monolithic VLM reasoning. Experiments on 4 diverse image classification benchmark datasets demonstrate that MARIC significantly outperforms baselines, highlighting the effectiveness of multi-agent visual reasoning for robust and interpretable image classification.

16.
medRxiv (Medicine) 2026-06-17

Accounting for Human Movement to Improve Exposure-Health Models

Background. Current exposure-health models rely on averaged, residential-based environmental exposures, failing to account for human movement. This aggregation can lead to exposure misclassification and biased exposure-response estimates, potentially distorting our understanding of the true health effects of environmental conditions. We developed exposure disaggregation regression models that explicitly account for human movement when linking environmental exposures to health outcomes. Methods. By weighting pixel-level exposures according to distance from home as a simple proxy for human movement, our model linked disaggregated environmental exposures to individual-level health outcomes. Weights were either fixed a priori or derived from a latent distance-decay power parameter learned from the data. We additionally evaluated model performance under a nonlinear exposure-response relationship. Model performance was assessed across multiple sample sizes (N = 1,114; 50,000; and 100,000). A simulation study examined parameter recovery using bias, empirical standard error (EmpSE), and credible interval coverage. As a case study, Demographic and Health Surveys (DHS) data from Albania were used to link acute respiratory infection (ARI) outcomes among children under five to pixel-level NDVI within a 3 km buffer around DHS cluster centroids, and the proposed models were applied to these data. Results. Across all models (fixed-weight, learned-weight, and restricted cubic spline models), parameter recovery improved with increasing sample size. At N = 1,114, estimates were biased and imprecise, with incorrect effect direction for exposure-response parameters (e.g., learned-weight {beta}1 bias = - 0.79; EmpSE = 2.61; coverage = 0.88). In contrast, the models accurately recovered parameters at larger sample sizes, including the latent distance-decay parameter (bias = - 0.02; EmpSE = 0.15; coverage = 0.95 at N = 100,000), demonstrating their ability to reliably learn movement-based exposure weights when sufficient data were available. Conclusion. Instead of relying on arbitrarily-sized buffers, this statistical framework provides a novel method for studying environmental exposure-health relationships whilst accounting for human movement. With sufficiently large sample sizes, it can accurately estimate the influence of disaggregated environmental exposures on individual-level health and help address exposure misclassification arising from residential-only metrics. This methodological framework remains scalable, interpretable, and adaptable to other exposures and outcomes, offering a foundation for future work that integrates richer mobility-informed exposure-health research.

17.
Nature (Science) 2026-06-08

Daily briefing: Human embryo genomes precisely altered

Authors:

The use of ‘base editing’ to precisely tweak human embryos has divided researchers. Plus, the number of lives saved by less-polluting cars in China and how to tip the world towards a sustainable future. The use of ‘base editing’ to precisely tweak human embryos has divided researchers. Plus, the number of lives saved by less-polluting cars in China and how to tip the world towards a sustainable future.

18.
arXiv (quant-ph) 2026-06-11

Polarization-Resolved Photon Statistics of Cavity Quantum Materials

arXiv:2606.11550v1 Announce Type: cross Abstract: By forming hybrid light-matter states, optical cavities offer a route for engineering material properties, however, unambiguously probing the effects of light-matter coupling remains difficult. Here, we show that the polarization-resolved statistics of photons transmitted through a cavity, measurable via $g^{(2)}$, provide one such diagnostic. By relating $g^{(2)}$ to matter correlation functions such as the Raman structure factor, we link photon bunching and antibunching to material properties. By applying this method to the stripy-to-antiferromagnetic transition in the Kitaev-Heisenberg spin model, we find that polarization-dependent patterns of bunching and antibunching encode the magnetic point-group symmetries of each phase and characterize the behavior at the phase boundary. Finally, we predict measuring $g^{(2)}$ for output photon pairs polarized orthogonal to the input field will isolate higher-order light-matter scattering processes that probe higher-order material correlations.

19.
arXiv (CS.CV) 2026-06-19

Learning When to Denoise: Optimizing Asynchronous Schedules for Latent Diffusion

Multi-representation diffusion models can improve visual synthesis by denoising complementary views of an image, but their performance depends critically on the asynchronous schedule that determines when each representation is denoised. We propose to learn this schedule. Our method formulates asynchronous flow matching over multiple representation spaces and uses a schedule-corrected objective that keeps each representation's local noising-time weights fixed as the schedule changes. We instantiate the schedule with a flexible parametric class that is convex and monotone by construction, and learn it using a fast joint probe with less than 1% additional training compute. On ImageNet 256x256, the learned schedule substantially improves both convergence speed and final quality under a matched 675M-parameter XL backbone. With AutoGuidance, our 200-epoch model reaches FID 1.05, matching the 800-epoch SFD-XL baseline with 4x less training. Training to 600 epochs further improves to FID 1.02, outperforming the 1B-parameter SFD-XXL result of FID 1.04 while using a smaller model. In the unguided setting, our 200-epoch model reaches FID 2.37, already below the best 800-epoch SFD-XL result (2.54) at 4x less training, and improves to FID 2.14 at 600 epochs. Code is available at https://github.com/bsq532087/LWD

20.
arXiv (CS.AI) 2026-06-19

JustDiag!: A Diagnostic Justification Engine for Accountable Root Cause Analysis

arXiv:2606.19407v1 Announce Type: cross Abstract: Large language models can produce fluent root cause analyses, but fluent final answers alone are insufficient evidence for accountability in high-stakes operations. In real incident response, engineers need to know what evidence supported a diagnosis, which alternatives were considered, where contradictions remained, and whether the system resolved the case or preserved uncertainty. We address this gap with JustDiag, a diagnostic justification engine for RCA that maintains an explicit process state over evidence, findings, competing hypotheses, conflicts, and next checks. We evaluated the system on 66 real-world incidents using a two-layer protocol that separately scores final-answer quality and process quality. Relative to a matched control without diagnostic justification, JustDiag achieved stronger outcome and process scores, while accepting slightly lower terminal completion due to more calibrated non-closure. These results suggest that accountable RCA requires explicit diagnostic justification artifacts and process-aware evaluation, not only fluent final answers.

21.
arXiv (math.PR) 2026-06-16

A Low-Regularity Semigroup Sewing Lemma via Quotient Structures

arXiv:2606.16164v1 Announce Type: new Abstract: We develop a low-regularity Sewing theory for the semigroup coboundary $\hat\delta=\delta-a$ associated with a strongly continuous semigroup $S$. Unlike the ordinary low-regularity Sewing problem, the semigroup setting has an intrinsic algebraic non-uniqueness below the threshold $1$, in the sense that solutions are canonical only modulo semigroup cocycles. Accordingly, the natural target is a quotient space rather than an increment space. We identify this quotient structure and construct the corresponding semigroup Sewing map. The construction uses a frozen terminal-time transform, which rewrites semigroup defects, for each terminal time, as ordinary low-regularity Sewing problems on a frozen simplex. This reduction, however, does not by itself produce a genuine semigroup increment; the main additional step is to prove that the frozen solution classes are compatible as the terminal time varies and hence assemble into a canonical quotient class for $\hat\delta$. This yields canonical classes for $0

22.
Science (Express) 2026-05-06

A 481-meter-high landslide-tsunami in a cruise ship–frequented Alaska fjord | Science

Authors: Unknown Author

Early in the morning of 10 August 2025, a >64 × 10 6 m 3 landslide struck Tracy Arm fjord in Alaska. The landslide was preconditioned by glacial retreat caused by climate change. The resulting 481 m runup megatsunami followed an initial 100-m-high breaking wave traveling >70 m s −1 . The landslide was preceded by several days of microseismicity, which increased in rate and magnitude until ~1 hour before failure. The landslide produced globally observed long-period seismic waves equivalent in size to a M5.4 earthquake. A long-period (~66 s) global seismic signal, produced by a landslide-induced seiche trapped within the fjord, persisted for up to 36 hours, the second time a days-long seiche has been thus observed. With fjord regions increasingly visited by cruise ships, and climate change making similar events more likely, this unanticipated, near-miss event highlights the growing risk from landslides and tsunamis in coastal environments.

23.
arXiv (CS.LG) 2026-06-16

On the Energy Distribution of the Galactic Center Excess' Sources

arXiv:2507.17804v2 Announce Type: replace-cross Abstract: The Galactic Center Excess (GCE) may yet herald the discovery of annihilating dark matter. Weighing against that conclusion are analyses showing evidence for dim point sources within the spatial structure of the emission. Due to technical limitations these analyses are purely spatial with all spectral information that could disentangle the excess from astrophysical backgrounds discarded. Here, we demonstrate that a neural network simulation-based inference approach can jointly analyze the spatial and spectra data. The addition is profound: energy information drives the putative point sources to be significantly dimmer, indicating either the GCE is truly diffuse in nature or made of an exceptionally large number of sources. Quantitatively, for our best fit background model, the excess is essentially consistent with Poisson emission as predicted by dark matter. If due to point sources, our median prediction is $\mathcal{O}(10^5)$ sources, or more than 35,000 at 90\% confidence, both orders of magnitude larger than the hundreds preferred by earlier point-source analyses of the GCE, although variations allowed by background systematics could reduce the required number of sources by roughly an order of magnitude.

24.
Nature (Science) 2026-06-09

Scientists have a bad case of AI FOMO, <i>Nature</i> poll reveals

Authors:

Almost half of the scientists who responded said that they feel broadly negative towards artificial intelligence, but they think that some tools are better than others. Almost half of the scientists who responded said that they feel broadly negative towards artificial intelligence, but they think that some tools are better than others.

25.
medRxiv (Medicine) 2026-06-22

''Circumstantial Determinants'': An Efficient Approach to Reaching People in Need of HIV Prevention?

HIV prevention and testing programmes primarily reach people who self-refer or attend routine health services. Higher-risk individuals are missed if they are healthy, under-estimate their risk of infection or under-report sexual risk-behaviours. We assess a new approach to address limitations in existing programmes by targeting HIV services on ''Circumstantial Determinants'' (CDs) of HIV risk - the social circumstances, settings, and norms associated with behaviours that increase risk of HIV acquisition. Data on potential CDs and sexual behaviour were collected in a population survey in Zimbabwe in 2018/19 (N=9141). HIV-negative individuals reporting [&ge;] 1 sexual risk-behaviours were defined as the 'priority population' for HIV prevention. For each sex, six circumstantial determinants were associated with being in the priority population (aOR [&ge;] 1.30; p [&le;] 0.01). Reach and efficiency of CDs (and combinations) were calculated; ROC curve algorithms evaluated their ability to identify priority population membership; and HIV prevention condom cascades were compared between CD-defined priority population subgroups. Example findings include that targeting men at bars and beerhalls could reach 48.5% of the priority population and 25.1% of lower-risk men. These percentages increase to 77.1% and 53.7% if men with poor mental health, no religious affiliation, negative social capital, or living on agricultural estates are also targeted. Targeting women with poor mental health could reach 32.0% of the priority population and 21.3% of lower-risk women. Targeting additional circumstantial determinants increases these percentages to 54.1% and 37.5%, respectively. Cascade barriers to condom use differed between CD-defined subgroups. The Circumstantial Determinants approach demonstrates proof-of-concept potential to strengthen HIV prevention services.