Treatment as Prevention: Characterization of Partner Infections in the HIV Prevention Trials Network 052 Trial

Eshleman, Susan H.; Hudelson, Sarah E.; Redd, Andrew D.; Swanstrom, Ronald; Ou, San San; Zhang, Xinyi Cindy; Li, Ping; Piwowar‐Manning, Estelle; Porcella, Stephen F.; Sievers, Matthew; Martens, Craig; Bruno, Daniel; Dukhovlinova, Elena; McCauley, Marybeth; Gamble, Theresa; Fogel, Jessica M.; Sabin, Devin; Quinn, Thomas C.; Gunde, Laurence; Maliwichi, Madalitso; Nhando, Nehemiah; Akelo, Victor; Moyo, Sikhulile; Panchia, Ravindre; Kumarasamy, Nagalingeswaran; Chotirosniramit, Nuntisa; Melo, Marineide; Pilotto, José Henrique; Grinsztejn, Beatriz; Mayer, Kenneth H.; Chen, Ying Qing; Hughes, James P.; Cohen, Myron S.

doi:10.1097/qai.0000000000001158

Cited by 58 publications

(29 citation statements)

References 17 publications

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“…Data on sex with outside partners were not included in this analysis, as the HIV status of those partners was unknown. Because previously reported data [ 21 ] indicate potential risk due to these outside partnerships and self-reported sexual behaviour and ART use could not be confirmed, all participants were considered to have some degree of HIV risk. Sufficient adherence : The level of adherence sufficient for prevention of HIV acquisition depends on numerous factors, including drug metabolism and tissue of exposure.…”

Section: Methodsmentioning

confidence: 99%

Alignment of adherence and risk for HIV acquisition in a demonstration project of pre‐exposure prophylaxis among HIV serodiscordant couples in Kenya and Uganda: a prospective analysis of prevention‐effective adherence

Haberer

Kidoguchi

Heffron

et al. 2017

Journal of the International AIDS Society

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Introduction: Adherence is essential for pre-exposure prophylaxis (PrEP) to protect against HIV acquisition, but PrEP use need not be life-long. PrEP is most efficient when its use is aligned with periods of risk – a concept termed prevention-effective adherence. The objective of this paper is to describe prevention-effective adherence and predictors of adherence within an open-label delivery project of integrated PrEP and antiretroviral therapy (ART) among HIV serodiscordant couples in Kenya and Uganda (the Partners Demonstration Project).Methods: We offered PrEP to HIV-uninfected participants until the partner living with HIV had taken ART for ≥6 months (a strategy known as “PrEP as a bridge to ART”). The level of adherence sufficient to protect against HIV was estimated in two ways: ≥4 and ≥6 doses/week (per electronic monitoring). Risk for HIV acquisition was considered high if the couple reported sex with <100% condom use before six months of ART, low if they reported sex but had 100% condom use and/or six months of ART and very low if no sex was reported. We assessed prevention-effective adherence by cross-tabulating PrEP use with HIV risk and used multivariable regression models to assess predictors of ≥4 and ≥6 doses/week.Results: A total of 985 HIV-uninfected participants initiated PrEP; 67% were male, median age was twenty-nine years, and 67% reported condomless sex in the month before enrolment. An average of ≥4 doses and ≥6 doses/week were taken in 81% and 67% of participant-visits, respectively. Adherence sufficient to protect against HIV acquisition was achieved in 75–88% of participant-visits with high HIV risk. The strongest predictor of achieving sufficient adherence was reporting sex with the study partner who was living with HIV; other statistically significant predictors included no concerns about daily PrEP, pregnancy or pregnancy intention, females aged >25 years, older male partners and desire for relationship success. Predictors of not achieving sufficient adherence were no longer being a couple, delayed PrEP initiation, >6 months of follow-up, ART use >6 months by the partner living with HIV and problem alcohol use.Conclusions: Over three-quarters of participant-visits by HIV-uninfected partners in serodiscordant couples achieved prevention-effective adherence with PrEP. Greater adherence was observed during months with HIV risk and the strongest predictor of achieving sufficient adherence was sexual activity.

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Section: Methodsmentioning

confidence: 99%

Alignment of adherence and risk for HIV acquisition in a demonstration project of pre‐exposure prophylaxis among HIV serodiscordant couples in Kenya and Uganda: a prospective analysis of prevention‐effective adherence

Haberer

Kidoguchi

Heffron

et al. 2017

Journal of the International AIDS Society

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“…Subsequent published analyses of the HTPN 052 data revealed no cases of linked HIV transmission within serodiscordant couples having condomless sex when the HIV‐positive partner had a stably suppressed plasma viral load (i.e. less than 200 copies/ml) 7. In the PARTNER study of 1,166 serodiscordant heterosexual and gay male couples, no linked HIV transmissions from the HIV‐positive to the HIV‐negative primary partner occurred 8.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with perceived accuracy of the Undetectable = Untransmittable slogan among men who have sex with men: Implications for messaging scale‐up and implementation

Rendina

Parsons

2018

J Intern AIDS Soc

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IntroductionRecent research has shown high efficacy of HIV treatment for reducing the risk of HIV transmission to sexual partners. As the efficacy of treatment as prevention (TasP) has proliferated, a new messaging campaign, Undetectable = Untransmittable, has been gaining popularity. The purpose of this paper was to assess factors associated with the perceived accuracy of this TasP messaging strategy among a large and diverse sample of gay, bisexual, and other men who have sex with men (GBMSM) in order to inform subsequent efforts at large‐scale and implementation of the HIV prevention message.MethodsWe conducted a nationwide survey of GBMSM in the U.S. recruited from an online social networking site and a mobile sexual networking app. We analysed data from 12,222 GBMSM separately by HIV status to examine sociodemographic and behavioural factors associated with ratings of the accuracy of the Undetectable = Untransmittable message, which included the option to indicate not understanding what “undetectable” meant.ResultsAmong HIV‐negative and unknown men, multivariable linear regression indicated that being on pre‐exposure prophylaxis (PrEP), identifying as gay or queer (versus bisexual or straight), recent serodiscordant condomless anal sex (CAS), testing every six months or more often, less concern about sexually transmitted infection (STI) infection, and lower perceived risk of HIV infection were the factors with the largest independent effect on rating the Undetectable = Untransmittable statement as more accurate. Fewer factors emerged as associated with accuracy ratings among HIV‐positive participants—reporting an undetectable viral load, a lifetime acquired immune deficiency syndrome (AIDS) diagnosis, and lower concern about STI infection were the factors most strongly associated with rating the statement as more accurate.ConclusionsThe findings of the current study highlight variability in the perceived accuracy of the Undetectable = Untransmittable message, suggesting potential subgroups who might benefit from targeted educational campaigns, perhaps broadcast utilizing sexual networking apps. Numerous factors, particularly among HIV‐negative and unknown GBMSM, were associated with rating the message as more accurate. In particular, being on PrEP and testing regularly were two of the variables most strongly associated with higher accuracy ratings among HIV‐negative GBMSM, suggesting HIV prevention services as potential points of intervention for increasing HIV knowledge and decreasing HIV stigma.

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“…In the HIV Prevention Trials Network (HPTN) 052 study, the multi-country randomized trial that established the high efficacy of treatment for prevention, only 67% (52/78) of incident HIV infections could be genetically linked to the primary partner. 17 The role of sexual networks in HIV transmission deserves further study in this context, from the perspectives of the pregnant or breastfeeding woman and her partner(s).…”

Section: Opportunities For Hiv Preventionmentioning

confidence: 99%

Involving both parents in HIV prevention during pregnancy and breastfeeding

Hanpin

Rosenberg

Mweemba

et al. 2017

Bull. World Health Organ.

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Treatment as Prevention: Characterization of Partner Infections in the HIV Prevention Trials Network 052 Trial

Cited by 58 publications

References 17 publications

Alignment of adherence and risk for HIV acquisition in a demonstration project of pre‐exposure prophylaxis among HIV serodiscordant couples in Kenya and Uganda: a prospective analysis of prevention‐effective adherence

Alignment of adherence and risk for HIV acquisition in a demonstration project of pre‐exposure prophylaxis among HIV serodiscordant couples in Kenya and Uganda: a prospective analysis of prevention‐effective adherence

Factors associated with perceived accuracy of the Undetectable = Untransmittable slogan among men who have sex with men: Implications for messaging scale‐up and implementation

Involving both parents in HIV prevention during pregnancy and breastfeeding

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