HPTN 062: A Feasibility and Acceptability Pilot Intervention to Reduce HIV Transmission Risk Behaviors Among Individuals with Acute and Early HIV Infection in Lilongwe, Malawi

Abstract

Acute HIV infection (AHI) is a relatively brief period when individuals are highly infectious and the opportunity to intervene to prevent forward transmission is extremely limited. HPTN 062 partnered with CHAVI 001 to evaluate the feasibility and acceptability of a motivational interviewing (MI)-based counseling intervention to reduce HIV-transmission risk behaviors among individuals with acute and early HIV infection in Lilongwe, Malawi. Participants were randomized to receive either (1) brief education sessions about HIV and AHI; or (2) the same brief education sessions plus an MI-based counseling intervention called Uphungu Wanga. Although Uphungu Wanga was determined to be feasible and acceptable, few major differences existed between the two arms with regard to acceptability, feasibility, and self-reported sexual behaviors. We therefore conclude that an additional MI-based counseling intervention may not be needed during the short period of AHI. Instead, we recommend that individuals with AHI receive frequent, but brief, counseling immediately after diagnosis and then transition to receiving counseling at less frequent intervals until they can initiate antiretroviral therapy. Other recommendations are provided.

HPTN 062: A Pilot Randomized Controlled Trial Exploring the Effect of a Motivational-Interviewing Intervention on Sexual Behavior among Individuals with Acute HIV Infection in Lilongwe, Malawi

“…HIV Prevention Trials Network (HPTN) 062 was a single-site, two-arm, randomized pilot intervention study conducted in Lilongwe, Malawi (clinicaltrials.gov registration number NCT01197027, the full trial protocol can be accessed at www.HPTN.org )[ 9 ]. Participants were recruited from CHAVI 001, a study to identify and follow individuals with AHI.…”

“…Participants were recruited from CHAVI 001, a study to identify and follow individuals with AHI. Individuals diagnosed with AHI who provided informed consent were block-randomized in a 1:1 ratio to either brief education about HIV and AHI, provided as part of CHAVI 001, or the same brief-education plus MI-based counseling intervention called “Uphungu Wanga” (translated as “my own counseling”)[ 9 ] (see Fig 1 ). A blocked randomization design with 11 blocks of size 4 and 1 block of size 2 without stratification was used at the study site using a central computerized system.…”

“…Participants in both arms were followed for 24 weeks at weeks 1, 2, 3, 4, 8, 12, 16, 20, and 24, which coincided with the CHAVI 001 clinic visit schedule, and received the brief education at each visit (see Corneli A et al for AHI messages provided)[ 9 ]. Participants assigned to the Uphungu Wanga arm also received four additional MI sessions plus a booster at the following times: on the day of AHI diagnosis, three days later, and at weeks 1, 2, and 8 post-diagnosis (booster).…”

“…In this manuscript, we explore whether the MI intervention resulted in a reduction in risky behavior, primarily, unprotected sex acts. This analysis was part of a larger study that included determining the feasibility and acceptability of the intervention [ 9 ].…”

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

“…AHI is often diagnosed during a period of increased sexual risk, suggesting the importance of rapid behavioural interventions [177][178][179]. Given that persons with AHI can name more recent sex partners who are respectively at greater risk of HIV, this provides an opportunity for behavioural interventions among serodiscordant couples [180] or serosorting [181].…”