The Future of HIV Prevention

Padian, Nancy; Isbell, Michael T.; Russell, Elizabeth S.; Essex, Max

doi:10.1097/qai.0b013e31825b7100

Cited by 16 publications

(8 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Since 2010, there have been declines in HIV incidence many countries, yet young women aged 15–24 years remain at disproportionately high risk, accounting for 20% of new infections [ 2 ]. In sub-Saharan Africa, young women accounted for 25% of new adult HIV infections in 2015 [ 2 ] Implementation science research is required to identify how best to optimise delivery of these prevention interventions in different settings [ 18 , 40 ]. Optimal delivery is not straightforward, requiring the implementation of multiple interventions to increase demand, achieve acceptable and accessible supply, and overcome barriers to adherence and use, including socioeconomic barriers [ 18 , 39 ].…”

Section: Discussionmentioning

confidence: 99%

Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe

et al. 2018

View full text Add to dashboard Cite

Background“Determined, Resilient, AIDS-free, Mentored and Safe” (DREAMS) is a package of biomedical, social and economic interventions offered to adolescent girls and young women aged 10–24 years with the aim of reducing HIV incidence. In four of the six DREAMS districts in Zimbabwe, DREAMS includes an offer of oral pre-exposure prophylaxis (DREAMS+PrEP), alongside interventions to support demand and adherence, to women aged 18–24 who are at highest risk of HIV infection, including young women who sell sex (YWSS). This evaluation study addresses the question: does the delivery of DREAMS+PrEP through various providers reduce HIV incidence among YWSS Zimbabwe? We describe our approach to designing a rigorous study to assess whether DREAMS+PrEP had an impact on HIV incidence.MethodsThe study design needed to account for the fact that: 1) DREAMS+PrEP was non-randomly allocated; 2) there is no sampling frame for the target population for the evaluation; 3) there are a small number of DREAMS districts (N = 6), and 4) DREAMS+PrEP is being implemented by various providers. The study will use a cohort analysis approach to compare HIV incidence among YWSS in two DREAMS+PrEP districts to HIV incidence among YWSS in non-DREAMS comparison sites. YWSS will be referred to services and recruited into the cohort through a network-based (respondent-driven) recruitment strategy, and followed-up 12- and 24-months after enrolment. Women will be asked to complete a questionnaire and offered HIV testing. Additional complications of this study include identifying comparable populations of YWSS in the DREAMS+PrEP and non-DREAMS comparison sites, and retention of YWSS over the 24-month period. The primary outcome is HIV incidence among YWSS HIV-negative at study enrolment measured by repeat, rapid HIV testing over 24-months. Inference will be based on plausibility that DREAMS+PrEP had an impact on HIV incidence. A process evaluation will be conducted to understand intervention implementation, and document any contextual factors determining the success or failure of intervention delivery.DiscussionHIV prevention products of known efficacy are available. Innovative studies are needed to provide evidence of how to optimise product use through combination interventions to achieve population impact within different contexts. We describe the design of such a study.

show abstract

Section: Discussionmentioning

confidence: 99%

Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Voluntary medical male circumcision (VMMC) has been demonstrated to reduce risk of HIV acquisition through heterosexual vaginal sex in males by 50–73% [6] – [9] , and is an essential part of the ‘HIV prevention toolbox’ of evidence-based behavioural, biomedical and structural interventions [10] – [12] . Targeting VMMC at young males as part of such a combination prevention program in schools before entry into the high risk period could represent a directed and cost-effective means of altering current epidemic trajectories for HIV.…”

Section: Introductionmentioning

confidence: 99%

Implementation of Adolescent-Friendly Voluntary Medical Male Circumcision Using a School Based Recruitment Program in Rural KwaZulu-Natal, South Africa

et al. 2014

View full text Add to dashboard Cite

BackgroundEpidemiological data from South Africa demonstrate that risk of human immunodeficiency virus (HIV) infection in males increases dramatically after adolescence. Targeting adolescent HIV-negative males may be an efficient and cost-effective means of maximising the established HIV prevention benefits of voluntary medical male circumcision (VMMC) in high HIV prevalence–, low circumcision practice–settings. This study assessed the feasibility of recruiting male high school students for VMMC in such a setting in rural KwaZulu-Natal.Methods and FindingsFollowing community and key stakeholder consultations on the acceptability of VMMC recruitment through schools, information and awareness raising sessions were held in 42 high schools in Vulindlela. A three-phase VMMC demand-creation strategy was implemented in partnership with a local non-governmental organization, ZimnadiZonke, that involved: (i) community consultation and engagement; (ii) in-school VMMC awareness sessions and centralized HIV counselling and testing (HCT) service access; and (iii) peer recruitment and decentralized HCT service access. Transport was provided for volunteers to the Centre for the AIDS Programme of Research in South Africa (CAPRISA) clinic where the forceps-guided VMMC procedure was performed on consenting HIV-negative males. HIV infected volunteers were referred to further care either at the CAPRISA clinic or at public sector clinics. Between March 2011 and February 2013, a total of 5165 circumcisions were performed, the majority (71%) in males aged between 15 and 19 years. Demand-creation strategies were associated with an over five-fold increase in VMMC uptake from an average of 58 procedures/month in initial community engagement phases, to an average of 308 procedures/month on initiation of the peer recruitment–decentralized service phase. Post-operative adverse events were rare (1.2%), mostly minor and self-resolving.ConclusionsOptimizing a high volume, adolescent-targeted VMMC program was feasible, acceptable and safe in this setting. Adaptive demand-creation strategies are required to sustain high uptake.

show abstract

“…3, 4 These advances have ignited debate about how best to use ART in efforts to further reduce HIV incidence. 5 An approach combining multiple biomedical and behavioral interventions will be required, 6 and policy makers are currently debating the criteria used to target interventions, including TasP and PrEP.…”

Section: Introductionmentioning

confidence: 99%

Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data

et al. 2013

View full text Add to dashboard Cite

Summary Background The proportion of heterosexual HIV transmission in Sub-Saharan Africa that occurs within cohabiting partnerships, as opposed to among single people, or in extra-couple relationships, is a subject of active debate. This question is of immediate importance. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is critical to targeting intervention efforts. Methods We built a mechanistic HIV transmission model using data from Demographic and Health Surveys covering 27,201 cohabiting couples from 18 sub-Saharan African countries with information on couple duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and ART coverage. We then estimated the proportion of observed infections in surveyed cohabiting couples that occurred prior to couple formation, between couple members, and through extra-couple intercourse. Findings We estimate that extra-couple transmission accounts for between 27-61% and 21-51% of all infected males and females, respectively, in surveyed couples, with the ranges given reflecting inter-country variation. We project that over the next year extra-couple transmission will account for 30-65% and 10-47% of new incident HIV infections in males and females, respectively, in cohabiting couples. Our results also suggest that the directionality of transmission within couples is largely from males to females; however, females experience a very high-risk period prior to couple formation. Interpretation Due to the large contribution of extra-couple transmission, HIV prevention interventions should target the general sexually active population, and not just serodiscordant couples.

show abstract

The Future of HIV Prevention

Cited by 16 publications

References 36 publications

Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe

Evaluating the impact of DREAMS on HIV incidence among young women who sell sex: protocol for a non-randomised study in Zimbabwe

Implementation of Adolescent-Friendly Voluntary Medical Male Circumcision Using a School Based Recruitment Program in Rural KwaZulu-Natal, South Africa

Extra-couple HIV transmission in sub-Saharan Africa: a mathematical modelling study of survey data

Contact Info

Product

Resources

About