Research priorities for advanced HIV disease in Latin America and the Caribbean region: a modified Delphi study.

INTRODUCTION: Advanced HIV disease (AHD) remains a leading cause of mortality in Latin America and the Caribbean (LAC), driven by late diagnosis, treatment gaps and structural barriers, particularly among key populations and children. Persistent disparities in healthcare access, stigma, and limited health system capacity highlight the need for targeted research to improve AHD outcomes in the region.

METHODS: The modified Delphi process to prioritize AHD research questions in LAC was conducted between August and November 2024. Systematic reviews, expert consultations and two Delphi rounds involving 74 and 69 participants from 17 LAC countries assessed questions based on public health relevance, feasibility and equity. A subsequent in-person workshop with 24 experts refined and validated the results, organizing the prioritized questions into short-, medium- and long-term priorities.

RESULTS: Seventy-seven high-priority research questions were identified, 60 focused on adults and 17 on children. These questions centred on opportunistic infections (OIs), HIV-related cancers and health system interventions. Tuberculosis was the most frequently addressed OI (44% of OI-related questions), followed by cryptococcosis, histoplasmosis and HIV-related malignancies. Short-term priorities included interventions to reduce late diagnosis, improve retention in care and strengthen health systems, particularly for vulnerable populations such as children, pregnant women and incarcerated individuals.

CONCLUSIONS: This study presents a comprehensive research agenda for AHD in LAC, emphasizing interventions to address OIs, strengthen the health system and support at-risk populations. The prioritized questions provide a roadmap for researchers, policymakers and funders to allocate resources effectively, ultimately improving AHD outcomes and reducing HIV-related mortality. Strengthening regional collaboration and political commitment will be critical to translating research into actionable policies and interventions.