Behavioral and Biomedical Combination Strategies for HIV Prevention

Bekker, Linda‐Gail; Beyrer, Chris; Quinn, Thomas C.

doi:10.1101/cshperspect.a007435

Cited by 66 publications

(54 citation statements)

References 124 publications

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“…STI infection has been shown to be a risk factor for HIV infection,6 7 and management of STIs has been identified as an element of integrated global HIV prevention strategies 8 9. Despite implementation of syndromic management and partner notification guidelines, structural barriers to service delivery remain 10–12.…”

Section: Introductionmentioning

confidence: 99%

A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa

et al. 2017

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This evaluation of STI services across South Africa found gaps in the availability of medications, adherence to STI guidelines, condom provision and prevention messaging. Limited integration with HIV services for this high-risk population was a missed opportunity. Quality of STI care should continue to be monitored, and interventions to improve quality should be prioritised as part of national strategic HIV and primary healthcare agendas.

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Section: Introductionmentioning

confidence: 99%

A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa

et al. 2017

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“…Such prevention strategies with heterosexual, drug-using couples in low-income urban neighborhoods with concentrated epidemics are essential to lowering transmission of the co-occurring epidemics of HIV, HCV, and STIs and can be incorporated into harm reduction programs, drug treatment, criminal justice systems, and other settings. In the past few years, there have been a number of calls for combination prevention (biomedical and behavioral) for people who inject drugs (PWID) [4,5,32,33]. Additional research is necessary to determine how long term gains in sexual risk reduction and HIV incidence can be achieved, and to identify how such behavioral approaches can be combined with early ART and other biomedical treatments (PREP, circumcision, microbicides) to improve maintenance of PWID in the test, treat, and retain continuum of HIV, HCV, and STI care.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Couple-Based Intervention to Reduce Risks for HIV, HCV, and STIs Among Drug-Involved Heterosexual Couples in Kazakhstan

El‐Bassel

Gilbert

Terlikbayeva

et al. 2014

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Objective Project Renaissance is a randomized controlled trial of an HIV/HCV/STI prevention intervention conducted in Almaty, Kazakhstan. We hypothesized that couples assigned to the intervention of interest will have lower incidence of HIV, HCV, sexually transmitted infections (STI), rates of unprotected sex, and unsafe injection over the 12-month follow up period compared to those assigned to an attention control arm. Design A total of 300 couples (600 participants) where one or both partners reported injecting drugs in the past 90 days were randomized to one of two arms: (1) a five-session HIV/HCV/STI prevention intervention (Risk Reduction: RR), or (2) a five-session Wellness Promotion (WP) intervention. Results Over the 12-month follow up period, assignment to RR compared to WP significantly lowered the incidence of HCV infection by 69% (IRR=0.31, 95% CI=0.10 – 0.90, p=0.031). Although differences were not statistically significant, RR participants had a lower incidence of HIV infection by 51% (IRR=0.49, 95% CI=0.16 – 1.48, p=0.204) and any STI by 37% (IRR=0.63, 95%=0.21 – 1.93, p=0.418) than WP participants. RR participants reported significantly fewer numbers of unprotected vaginal sex acts with their study partners (IRR=0.58, 95% CI=0.36 – 0.93, p=0.024) and more consistent condom use (OR=2.30, 95% CI=1.33 – 4.00, p=0.003) over the entire follow-up period compared to WP participants. Conclusion Project Renaissance demonstrated a significant effect for biological and behavioral endpoints. Findings draw attention to an HIV/HCV/STI prevention intervention strategy that can be scaled up for drug-involved couples in harm reduction programs, drug treatment, and criminal justice settings.

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“…PrEP programs are most valuable in populations with a high incidence of HIV infection (18,19). To evaluate these populations, we need to correctly diagnose HIV at PoC locations with testing algorithms that can be performed rapidly and effectively (20,21), without expensive equipment or specialized laboratory technicians. Guidelines for PrEP (22) propose that people undergo HIV testing every 3 months while taking antiretrovirals.…”

Section: Discussionmentioning

confidence: 99%

Streamlining HIV Testing for HIV Preexposure Prophylaxis

Guanira¹,

Leigler²,

Kallas³

et al. 2015

J Clin Microbiol

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f HIV-testing algorithms for preexposure prophylaxis (PrEP) should be optimized to minimize the risk of drug resistance, the time off PrEP required to evaluate false-positive screening results, and costs and to expedite the start of therapy for those confirmed to be infected. HIV rapid tests (RTs) for anti-HIV antibodies provide results in less than 1 h and can be conducted by nonlicensed staff at the point of care. In many regions, Western blot (WB) testing is required to confirm reactive RT results. WB testing, however, causes delays in diagnosis and adds expense. The iPrEx study evaluated the safety and efficacy of daily oral emtricitabine-tenofovir disoproxil fumarate among HIV-seronegative men and transgender women who have sex with men: HIV infection was assessed with two RTs plus WB confirmation, followed by HIV-1 plasma viral load testing. During the iPrEx study, there were 51,260 HIV status evaluations among 2,499 volunteers using RTs: 142 (0.28%) had concordant positive results (100% were eventually confirmed) and 19 (0.04%) had discordant results among 14 participants; 11 were eventually determined to be HIV infected. A streamlined approach using only one RT to screen and a second RT to confirm (without WB) would have had nearly the same accuracy. Discrepant RT results are best evaluated with nucleic acid testing, which would also increase sensitivity.

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Behavioral and Biomedical Combination Strategies for HIV Prevention

Cited by 66 publications

References 124 publications

A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa

A national evaluation using standardised patient actors to assess STI services in public sector clinical sentinel surveillance facilities in South Africa

Effects of a Couple-Based Intervention to Reduce Risks for HIV, HCV, and STIs Among Drug-Involved Heterosexual Couples in Kazakhstan

Streamlining HIV Testing for HIV Preexposure Prophylaxis

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