Reduced HIV Risk-Taking and Low HIV Incidence After Enrollment and Risk-Reduction Counseling in a Sexually Transmitted Disease Prevention Trial in Nairobi, Kenya

Kaul, Rupert; Kimani, Joshua; Nagelkerke, Nico; Fonck, Karoline; Keli, F.; MacDonald, Kelly S.; Ronald, Allan R.; Plummer, Francis A.; Bwayo, Job J.; Ngugi, Elizabeth; Temmerman, Marleen; Moses, Stephen

doi:10.1097/00042560-200205010-00009

Cited by 61 publications

(39 citation statements)

References 11 publications

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“…33-35 71 75 Three of these targeted high-risk men, 35 71 75 another targeted women and truckers in Tanzania, 34 and the fifth offered risk-reduction counselling, STI treatment and condoms to sex workers in Kenya. 33 Again, only pre-post comparisons are presented, except in one non-randomised controlled trial (NRCT) among high-risk men in the Philippines. 75 Casual sex Six studies reported intervention impact on condom use with casual or non-regular sexual partners, with three documenting significant increases (table 2).…”

Section: Resultsmentioning

confidence: 99%

A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia

Foss

Hossain

Vickerman

et al. 2007

Sexually Transmitted Infections

136

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Section: Resultsmentioning

confidence: 99%

A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia

Foss

Hossain

Vickerman

et al. 2007

Sexually Transmitted Infections

136

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“…Programs to reduce risk behavior, such as those used during the rollout of ARV therapy or other HIV prevention campaigns in African countries, may serve as templates for risk behavior reduction strategies. 57,71 Because of the decreased ability of women to negotiate condom use in their relationships and the higher risk behaviors found in men throughout sub-Saharan Africa, programs specifically targeting men should also be considered. More immediately, risk behavior assessment must remain an important component of HIV vaccine clinical trials because it provides one of the only means of predicting changes in risk behavior that might occur at the population level in an actual mass vaccination campaign.…”

Section: Discussionmentioning

confidence: 99%

Predicting the Impact of a Partially Effective HIV Vaccine and Subsequent Risk Behavior Change on the Heterosexual HIV Epidemic in Low- and Middle-Income Countries

Andersson

Owens²,

Vardas³

et al. 2007

JAIDS Journal of Acquired Immune Deficiency Syndromes

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SummaryWe developed a mathematical model to simulate the impact of various partially effective preventive HIV vaccination scenarios in a population at high risk for heterosexually transmitted HIV. We considered an adult population defined by gender (male/female), disease stage (HIVnegative, HIV-positive, AIDS, and death), and vaccination status (unvaccinated/vaccinated) in Soweto, South Africa. Input data included initial HIV prevalence of 20% (women) and 12% (men), vaccination coverage of 75%, and exclusive male negotiation of condom use. We explored how changes in vaccine efficacy and post-vaccination condom use would affect HIV prevalence and total HIV infections prevented over a 10-year period. In the base-case scenario, a 40% effective HIV vaccine would avert 61,000 infections and reduce future HIV prevalence from 20% to 13%. A 25% increase (or decrease) in condom use among vaccinated individuals would instead avert 75,000 (or only 46,000) infections and reduce the HIV prevalence to 12% (or only 15%). Furthermore, certain combinations of increased risk behavior and vaccines with <43% efficacy could worsen the epidemic. Even modestly effective HIV vaccines can confer enormous benefits in terms of HIV infections averted and decreased HIV prevalence. However, programs to reduce risk behavior may be important components of successful vaccination campaigns. 4 Given the urgent need for an HIV vaccine, vaccines with only partial efficacy are likely to be used initially in populations at high risk for HIV infection. 5 The potential for post-vaccination risk-taking behavior to increase poses a significant threat to the successful use of partially effective vaccines in future vaccination programs. [5][6][7][8] Individuals might increase their risk-taking behavior, assuming they are completely protected from HIV when, in reality, they might have only limited protection or none at all. [9][10][11][12][13][14] Models have shown that even a partially effective HIV vaccine with minimal efficacy could have an enormous population impact on the HIV epidemic in high-risk groups or areas with a high prevalence of HIV, such as sub-Saharan Africa, [15][16][17][18][19][20][21][22] but that the magnitude of this impact depends on a fine balance between the efficacy of the vaccine, the vaccine coverage level, and the change in risky behavior. 18,20,[23][24][25][26][27] NIH Public Access MethodsWe developed a dynamic compartmental epidemic model for heterosexual HIV transmission and disease progression to simulate the impact of various partially effective preventive HIV vaccination scenarios and subsequent changes in risk behavior in a population at high risk for heterosexually transmitted HIV in Soweto, South Africa.* For this study, a preventive vaccine is defined as a vaccine that prevents primary infection with HIV, and a partially effective vaccine (low-efficacy vaccine, imperfect vaccine) is defined as a vaccine with less than 100% efficacy, or ability to prevent transmission of HIV. Model DescriptionThe model defines 6 "c...

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“…The groups in Nairobi (Fonck et al 2000;Kaul et al 2002Kaul et al , 2004 and Benin ⁄ Ghana (Labbe et al 2003) looked at the effect of PPT while the group in Cote d'Ivoire (Ghys et al 2001) tested regular screening for STIs. Neither the Cote d'Ivoire nor the Nairobi studies found a difference in HIV incidence between the arms.…”

Section: Treatment Of Bacterial Sexually Transmitted Infections Combimentioning

confidence: 99%

“…The RCT that did show an effect of presumptive treatment on STI rates detected this sample size problem and lengthened the enrolment period accordingly (Kaul et al 2002(Kaul et al , 2004.…”

Section: What Interventions Worked?mentioning

confidence: 99%

Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review

Shahmanesh

Patel

Mabey

et al. 2008

Tropical Med Int Health

214

156

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Summaryobjective To systematically review the evidence for effectiveness of HIV and sexually transmitted infection (STI) prevention interventions in female sex workers in resource poor settings.method Published and unpublished studies were identified through electronic databases (Cochrane database, Medline, Embase, and Web of Science), hand searching and contacting experts. Randomizedcontrolled-trials and quasi-experimental studies were included if they were conducted in female sex workers from low and middle income settings; if the exposure was described; if the outcome was externally measurable, it was after the discovery of HIV, and if follow-up was longer than 6 months. A priori criteria were used to extract data. Meta-analysis was not performed due to the heterogeneity of studies.results Twenty-eight interventions were included. Despite methodological limitations, the evidence suggested that combining sexual risk reduction, condom promotion and improved access to STI treatment reduces HIV and STI acquisition in sex workers receiving the intervention. Strong evidence that regular STI screening or periodic treatment of STIs confers additional protection against HIV was lacking. It appears that structural interventions, policy change or empowerment of sex workers, reduce the prevalence of STIs and HIV.conclusion Rigorous evaluation of HIV ⁄ STI prevention interventions in sex workers is challenging. There is some evidence for the efficacy of multi-component interventions, and ⁄ or structural interventions. The effect of these interventions on the wider population has rarely been evaluated.

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Reduced HIV Risk-Taking and Low HIV Incidence After Enrollment and Risk-Reduction Counseling in a Sexually Transmitted Disease Prevention Trial in Nairobi, Kenya

Cited by 61 publications

References 11 publications

A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia

A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia

Predicting the Impact of a Partially Effective HIV Vaccine and Subsequent Risk Behavior Change on the Heterosexual HIV Epidemic in Low- and Middle-Income Countries

Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review

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