Bringing population mobility into focus to achieve <scp>HIV</scp> prevention goals

Camlin, Carol S.; Cassels, Susan; Seeley, Janet

doi:10.1002/jia2.25136

Cited by 55 publications

(66 citation statements)

References 57 publications

(64 reference statements)

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“…Pre-Exposure Prophylaxis (PrEP), which so far has not been taken up by this group [67,68] should also be promoted within combination prevention [34]. Mobile populations could benefit in particular from innovative biomedical prevention technologies in the pipeline such as long acting PrEP and HIV treatment, and delivery of these technologies to be easily accessible to community settings [69].…”

Section: Discussionmentioning

confidence: 99%

The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities

et al. 2020

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Background Migrants from high endemic countries accounted for 18% of newly diagnosed HIV infections in Europe in 2017. Knowledge on the link between HIV risk and post-migration travels and their impact on HIV acquisition is scarce, but critical to inform prevention. This study aims to explore risky sexual behaviour and HIV-acquisition among sub-Saharan African migrants, and to assess post-migration mobility as a determinant of sexual risk behaviour. Methods Data from two cross-sectional bio-behavioural surveys to assess HIV-prevalence conducted in Lisbon and Antwerp were analysed to explore migration-related characteristics, travel patterns, and sexual risk taking in the host country and abroad. Bi-and multivariate associations were estimated through adjusted odds ratios and 95% confidence intervals; multivariable logistic regression determined factors associated with condomless sexual intercourse. Results Among N = 1508 participants above 18 years (58% males), 68% travelled post-migration (49.2% reported intercourse abroad). The overall proportion of condomless sex at last sexual intercourse was high (68.1%). The odds of condomless sex in the host country was five times higher when the last sexual intercourse abroad was also condomless [OR:5.32; 95% CI:2.98-9.25]. About half of the travellers reported concurrency, i.e. a regular partner in the host country while having other sexual partners abroad. Almost three percent of the participants reported being HIV+, but 5% had a reactive HIV test-result, with similar proportions

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Section: Discussionmentioning

confidence: 99%

The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities

et al. 2020

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“…The collection of studies presented in this review support coordination of prevention efforts across regional and international borders. While optimal prevention interventions for HIV transmission need to account for behaviors and barriers to care, the goal of population-level reduction and eradication of HIV will only be achieved if the impact of human mobility is properly accounted for in these settings [57]. While the classification of internationally mobile populations as high-risk groups may be useful to identifying HIV earlier in these populations, it is important to be aware that mobility occurs regionally as well, and as such care needs to be taken not to stigmatize these populations.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Human Mobility on Regional and Global Efforts to Control HIV Transmission

Eshraghian

Ferdos

Mehta

2020

Viruses

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HIV prevention and control methods are implemented on different scales to reduce the spread of the virus amongst populations. However, despite such efforts, HIV continues to persist in populations with a global incidence rate of 1.8 million in 2017 alone. The introduction of new infections into susceptible regional populations promotes the spread of HIV, indicating a crucial need to study the impact of migration and mobility on regional and global efforts to prevent HIV transmission. Here we reviewed studies that assess the impact of human mobility on HIV transmission and spread. We found an important role for both travel and migration in driving the spread of HIV across regional and national borders. Combined, our results indicate that even in the presence of control and preventive efforts, if migration and travel are occurring, public health efforts will need to remain persistent to ensure that new infections do not grow into outbreaks.

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“…However, collectively, the four trials were unable to demonstrate consistent and substantial population reductions in HIV incidence. Aside from issues such as sexual mixing of populations which are clearly important [14], the more fundamental reason for lack of consistency in these findings is that many of the trials were unable induce a substantially higher ART coverage in intervention communities over the duration of the trial. Without a strong gradient in ART coverage across the trial arms, the causal effect of ART on population incidence cannot be estimated.…”

Section: Introductionmentioning

confidence: 99%

Opportunities and Challenges in HIV Treatment as Prevention Research: Results from the ANRS 12249 Cluster-Randomized Trial and Associated Population Cohort

et al. 2020

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Purpose of Review The ANRS 12249 treatment as prevention (TasP) trial investigated the impact of a universal test and treat (UTT) approach on reducing HIV incidence in one of the regions of the world most severely affected by the HIV epidemic-KwaZulu-Natal, South Africa. We summarize key findings from this trial as well as recent findings from controlled studies conducted in the linked population cohort quantifying the long-term effects of expanding ART on directly measured HIV incidence (2004-2017). Recent Findings The ANRS TasP trial did not-and could not-demonstrate a reduction in HIV incidence, because the offer of UTT in the intervention communities did not increase ART coverage and population viral suppression compared to the standard of care in the control communities. Ten controlled studies from the linked population cohort-including several quasiexperimental study designs-exploit heterogeneity in ART exposure to show a consistent and substantial impact of expanding provision of ART and population viral suppression on reduction in HIV incidence at the couple, household, community, and population levels. Summary In this setting, all of the evidence from large, population-based studies (inclusive of the ANRS TasP trial) is remarkably coherent and consistent-i.e., higher ART coverage and population viral suppression were repeatedly associated with clear, measurable decreases in HIV incidence. Thus, the expanded provision of ART has plausibly contributed in a major way toward the dramatic 43% decline in population-level HIV incidence in this typical rural African population. The outcome of the ANRS TasP trial constitutes a powerful null finding with important insights for overcoming implementation challenges in the population delivery of ART. This finding does not imply lack of ART effectiveness in blocking onward transmission of HIV nor its inability to reduce HIV incidence. Rather, it demonstrates that large increases in ART coverage over current levels will require health systems innovations to attract people living with HIV in early stages of the disease to participate in HIV treatment. Such innovations and new approaches are required for the true potential of UTT to be realized.

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Bringing population mobility into focus to achieve HIV prevention goals

Cited by 55 publications

References 57 publications

The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities

The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities

The Impact of Human Mobility on Regional and Global Efforts to Control HIV Transmission

Opportunities and Challenges in HIV Treatment as Prevention Research: Results from the ANRS 12249 Cluster-Randomized Trial and Associated Population Cohort

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