HIV Prevention 2020: a framework for delivery and a call for action

Dehne, Karl L.; Dallabetta, Gina; Wilson, David J.; Garnett, Geoff P.; Laga, Marie; Benomar, Elizabeth; Fakoya, Ade; Baggaley, Rachel; Nelson, Lisa; Kasedde, Susan; Bermejo, Alvaro; Warren, Mitchell; Benedikt, Clemens

doi:10.1016/s2352-3018(16)30035-2

Cited by 58 publications

(51 citation statements)

References 52 publications

(51 reference statements)

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“…Across programme outputs, there were high levels of coverage of FSWs by peer education and condom distribution (>80%) but there were also consistent gaps between the estimated need for condoms and the actual number of condoms distributed. In terms of programme outcomes, condom use at last sex act was high at 92%, (although slightly lower than the global target of 95% ) but, levels of consistent condom use needed improvement. Evidence shows that only when need is substantially met and the supplies are adequate, then programmes can try to understand other reasons for inconsistent condom use .…”

Section: Discussionmentioning

confidence: 80%

HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya

et al. 2019

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Introduction HIV prevention cascades have emerged as a programme management and monitoring tool that outlines the sequential steps of an HIV prevention programme. We describe the application of an HIV combination prevention programme cascade framework to monitor and improve HIV prevention interventions for female sex workers (FSWs) in Kenya. Methods Two data sources were analysed: (1) annual programme outcome surveys conducted using a polling booth survey methodology in 2017 among 4393 FSWs, and (2) routine programme monitoring data collected by (a) 92 implementing partners between July 2017 and June 2018, and (b) Learning Site in Mombasa (2014 to 2015) and Nairobi (2013). We present national, sub‐national and implementing partner level cascades. Results At the national level, the population size estimates for FSW were 133,675 while the programme coverage targets were 174,073. Programme targets as denominator, during the period 2017 to 2018, 156,220 (90%) FSWs received peer education and contact, 148,713 (85%) received condoms and 83,053 (48%) received condoms as per their estimated need. At the outcome level, 92% of FSWs used condoms at the last sex with their client but 73% reported consistent condom use. Although 96% of FSWs had ever tested for HIV, 85% had tested in the last three months. Seventy‐nine per cent of the HIV‐positive FSWs were enrolled in HIV care, 73% were currently enrolled on antiretroviral therapy (ART) and 52% had attended an ART clinic in the last month. In the last six months, 48% of the FSWs had experienced police violence but 24% received violence support. National and sub‐national level cascades showed proportions of FSWs lost at each step of programme implementation and variability in programme achievement. Hotspot and sub‐population level cascades, presented as examples, demonstrate development and use of these cascades at the implementation level. Conclusions HIV prevention programme cascades, drawing on multiple data sources to provide an understanding of gaps in programme outputs and outcomes, can provide powerful information for monitoring and improving HIV prevention programmes for FSWs at all levels of implementation and decision‐making. Complexity of prevention programmes and the paucity of consistent data can pose a challenge to development of these cascades.

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Section: Discussionmentioning

confidence: 80%

HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya

et al. 2019

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“…If the 90-90-90 targets are to be achieved, access to HIV prevention and care to all key populations, including transwomen, is needed. 35 Notwithstanding, in order to succeed, these efforts must be built on interventions aiming to reduce discrimination that create vulnerabilities within transwomen communities.…”

Section: Discussionmentioning

confidence: 99%

Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil

et al. 2017

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Background The burden of HIV in transgender women (transwomen) in Brazil remains unknown. We aimed to estimate HIV prevalence among transwomen, and identify the factors associated with newly diagnosed HIV infections. Methods “Transcender” was a respondent driven sampling study of transwomen in Rio de Janeiro, Brazil, conducted from August 2015 to January 2016. Twelve seeds were recruited from social movements and formative phase. Eligibility criteria were: self-identification as transwomen, being 18 years of age or older, living in Rio de Janeiro or metropolitan area, and having a valid peer recruitment coupon. Participants were categorized as HIV-negative, known HIV infected, or newly diagnosed as HIV infected. Predictors of newly diagnosed HIV infections were assessed by comparing the newly diagnosed with the HIV-negative. Population estimates were adjusted using the RDSII estimator. Findings In total, 345 eligible transwomen were enrolled. The study sample was young and diverse on gender identity. Population estimates of no prior HIV testing, HIV-infection and newly diagnosed as HIV-infected were 29·1%, 32·1% and 7·0%, respectively (based on n=60 with no prior testing, n=141 HIV-infected, n=40 newly diagnosed). Syphilis, rectal chlamydia and gonorrhea infection were diagnosed in 28·9%, 14·6%, and 13·5%, respectively. Newly diagnosed HIV infections were associated with black race (22·8; 95%CI 2·9–178·9), travesti (34·1; 95%CI 5·8–200·2) or transsexual woman (41·3; 95%CI 6·3–271·2) gender identity, history of sex work (30·7; 95%CI 3·5–267·3), and history of sniffing cocaine (4·4; 95%CI 1·4–14·1). Interpretation Our results suggest that transwomen bear the largest burden of HIV among any population at risk in Brazil. The high proportion of HIV diagnosis among young participants points to the need for tailored long-term health care and prevention services in order to curb the HIV epidemic and improve the quality-of-life of transwomen in Brazil. Funding This work was supported by Brazilian Research Council (470056/2014-2) and NIAID-NIH (UM1AI069496).

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“…Failure of existing prevention initiatives, in which many persons with HIV are not on ART nor virally suppressed, may explain some of the ongoing transmission events. However, the largely unchanged HIV incidence must in part be the result of current programmes failing to detect and treat acute HIV infection [2]. According to the original Fiebig classification [3], acute infection is defined as the period between viral acquisition and emergence of HIV-specific antibodies, generally accompanied by a burst of viremia [4].…”

Section: Introductionmentioning

confidence: 99%

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

Rutstein

Ananworanich

Fidler

et al. 2017

Journal of the International AIDS Society

113

140

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Introduction: The unchanged global HIV incidence may be related to ignoring acute HIV infection (AHI). This scoping review examines diagnostic, clinical, and public health implications of identifying and treating persons with AHI.Methods: We searched PubMed, in addition to hand-review of key journals identifying research pertaining to AHI detection and treatment. We focused on the relative contribution of AHI to transmission and the diagnostic, clinical, and public health implications. We prioritized research from low- and middle-income countries (LMICs) published in the last fifteen years.Results and Discussion: Extensive AHI research and limited routine AHI detection and treatment have begun in LMIC. Diagnostic challenges include ease-of-use, suitability for application and distribution in LMIC, and throughput for high-volume testing. Risk score algorithms have been used in LMIC to screen for AHI among individuals with behavioural and clinical characteristics more often associated with AHI. However, algorithms have not been implemented outside research settings. From a clinical perspective, there are substantial immunological and virological benefits to identifying and treating persons with AHI – evading the irreversible damage to host immune systems and seeding of viral reservoirs that occurs during untreated acute infection. The therapeutic benefits require rapid initiation of antiretrovirals, a logistical challenge in the absence of point-of-care testing. From a public health perspective, AHI diagnosis and treatment is critical to: decrease transmission via viral load reduction and behavioural interventions; improve pre-exposure prophylaxis outcomes by avoiding treatment initiation for HIV-seronegative persons with AHI; and, enhance partner services via notification for persons recently exposed or likely transmitting.Conclusions: There are undeniable clinical and public health benefits to AHI detection and treatment, but also substantial diagnostic and logistical barriers to implementation and scale-up. Effective early ART initiation may be critical for HIV eradication efforts, but widespread use in LMIC requires simple and accurate diagnostic tools. Implementation research is critical to facilitate sustainable integration of AHI detection and treatment into existing health systems and will be essential for prospective evaluation of testing algorithms, point-of-care diagnostics, and efficacious and effective first-line regimens.

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HIV Prevention 2020: a framework for delivery and a call for action

Cited by 58 publications

References 52 publications

HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya

HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya

Unveiling of HIV dynamics among transgender women: a respondent-driven sampling study in Rio de Janeiro, Brazil

Clinical and public health implications of acute and early HIV detection and treatment: a scoping review

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