The LGBT Health & Development Program

Research Blog—Improving HIV Prevention: Comparing the Impact of Different Approaches


Posted on April 21st, 2016 by Patrick in Featured, Research Blog. No Comments

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Image credit: National Institute of Allergy and Infectious Disease (NIAID)

HIV Treatment as Prevention

Successful antiretroviral therapy (ART) for people living with HIV helps them stay healthy and decreases the chance of transmitting the virus to others [1-2]. The potential for ART to prevent the spread of HIV has led to a four-part approach to finding and treating individuals with HIV [3]. This approach is commonly referred to as Seek, Test, Treat, and Retain (STTR). These steps include:

  • Seek: Identifying individuals at high risk for HIV
  • Test: Connecting high-risk individuals to HIV testing services
  • Treat: Linking HIV-positive individuals with comprehensive HIV care
  • Retain: Maintaining HIV treatment to achieve viral suppression

Maximizing the Impact of HIV Prevention

Despite the success of STTR, it’s unclear which aspect should be targeted to achieve the greatest reduction in HIV. A recent study [4] attempted to examine the relative impact of each component among men who have sex with men (MSM). The authors compared how four potential improvements in STTR would affect HIV transmission rates. These improvements included:

  1. Increased frequency of testing
  2. Increased proportion who ever get tested
  3. More accurate HIV tests (i.e., allowing shorter time from infection to detect the virus)
  4. Increased number of diagnosed HIV-positive MSM successfully retained in care

Findings

The authors found that increasing the percent of HIV-positive MSM with viral suppression was the only individual approach that decreased HIV transmission. Yet, the greatest reduction in transmission occurred when the frequency of HIV testing was increased to every 90 days and all HIV-positive MSM achieved viral suppression. These findings highlight the importance of linking and retaining individuals who test positive in HIV care. They also suggest that increasing HIV testing alone may have limited impact on HIV transmission. However, increased frequency of testing may be beneficial when it occurs with other improvements in HIV care.

Implications

While preliminary, this study raises import questions about the relative impact of HIV prevention approaches. Like all studies, there were several limitations such as simplification of complicated situations. For example, all MSM were assumed to have equal access to HIV care regardless of age or race. Nonetheless, these results should be considered when considering future improvements in HIV prevention and need to be further explored in future studies.

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References:

[1] Maartens, G., Celum, C., & Lewin, S. R. (2014). HIV infection: epidemiology, pathogenesis, treatment, and prevention. The Lancet, 384(9939), 258-271. doi: 10.1016/S0140-6736(14)60164-1.

[2] CDC. HIV Treatment as Prevention. http://www.cdc.gov/hiv/risk/art/.

[3] Chandler, R. K., Kahana, S. Y., Fletcher, B., Jones, D., Finger, M. S., Aklin, W. M., … & Webb, C. (2015). Data Collection and Harmonization in HIV Research: The Seek, Test, Treat, and Retain Initiative at the National Institute on Drug Abuse. American Journal of Public Health, 105(12), 2416-2422.

[4] Delaney, K. P., Rosenberg, E. S., Kramer, M. R., Waller, L. A., & Sullivan, P. S. (2015, December). Optimizing Human Immunodeficiency Virus Testing Interventions for Men Who Have Sex With Men in the United States: A Modeling Study. In Open forum infectious diseases (Vol. 2, No. 4, p. ofv153). Oxford University Press.





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