A new approach to prevent HIV transmission: Project Protect intervention for recently infected individuals

Abstract

Past research suggests that as many as 50% of onward human immunodeficiency virus (HIV) transmissions occur during acute and recent HIV infection. It is clearly important to develop interventions which focus on this highly infectious stage of HIV infection to prevent further transmission in the risk networks of acutely and recently infected individuals. Project Protect tries to find recently and acutely infected individuals and prevents HIV transmission in their risk networks. Participants are recruited by community health outreach workers at community-based HIV testing sites and drug users’ community venues, by coupon referrals and through referrals from AIDS clinics. When a network with acute/recent infection is identified, network members are interviewed about their risky behaviors, network information is collected, and blood is drawn for HIV testing. Participants are also educated and given prevention materials (condoms, syringes, educational materials); HIV-infected participants are referred to AIDS clinics and are assisted with access to care. Community alerts about elevated risk of HIV transmission are distributed within the risk networks of recently infected. Overall, 342 people were recruited to the project and screened for acute/recent HIV infection. Only six index cases of recent infection (2.3% of all people screened) were found through primary screening at voluntary counseling and testing (VCT) sites, but six cases of recent infection were found through contact tracing of these recently infected participants (7% of network members who came to the interview). Combining screening at VCT sites and contact tracing the number of recently infected people we located as compared to VCT screening alone. No adverse events were encountered. These first results provide evidence for the theory behind the intervention, i.e., in the risk networks of recently infected people there are other people with recent HIV infection and they can be successfully located without increasing stigma for project participants.

Social network approaches to locating people recently infected with HIV in Odessa, Ukraine

“…Project staff educated affected participants and communities about recent/acute HIV infection, and about the importance of avoiding stigma. As discussed in other articles , neither project staff nor participants in our project and a precursor pilot study in Ukraine reported any increases in stigma‐related problems, but participants did report significantly higher levels of experienced social support at follow‐up than at baseline. Participants were provided with standard counselling and were actively linked to care if appropriate.…”

Reducing HIV infection in people who inject drugs is impossible without targeting recently-infected subjects

“…Thus, a combination of the expansion of existing harm reduction interventions and the development of new approaches to identify and treat recently infected people should be applied to settings with PWID-driven HIV epidemics [32]. Unfortunately, reaching those recently infected is extremely challenging, especially in settings in which preventive responses have been limited due to the sociopolitical context in which the outbreak arises.…”

A network intervention that locates and intervenes with recently HIV-infected persons: The Transmission Reduction Intervention Project (TRIP)

“…On the other two measures, the proportion of recents in the networks and the incidence of recent infection in the networks, the comparison ratios ranged from 1.6 to 4.2 but the confidence intervals overlapped. Nonetheless, the overall pattern of results provides a proof of concept for the underlying hypothesis that the networks of recents will contain more recents than the networks of longer-term HIV-positives2331.…”