The document summarizes evidence for HIV prevention interventions that work. It discusses biomedical interventions like male circumcision, HAART, and PMTCT that have good evidence of effectiveness ranging from 60-98% based on randomized controlled trials. It also reviews behavioral interventions like HIV counseling and testing, the Stepping Stones program, and structural interventions like microfinance combined with gender training, finding some have promising evidence of effectiveness while evidence is limited or lacking for others.
Burden of HIV and Research Gaps Among Key Populations in Sub-Saharan AfricaHopkinsCFAR
Key populations including sex workers, men who have sex with men, and people who inject drugs experience disproportionately high HIV burdens in sub-Saharan Africa due to various biological, behavioral, and structural factors. HIV prevalence among female sex workers ranges from 10.9% in Eastern Europe to 36.9% in sub-Saharan Africa, where sex workers are 12 times more likely to be infected than other women. Men who have sex with men also experience high HIV prevalence, though data remains limited in sub-Saharan Africa. Combination prevention approaches including behavioral, biomedical, and structural interventions are needed to address the outsized impact of HIV on key populations.
Bending the Curve: PrEP for HIV PreventionHopkinsCFAR
This document summarizes the current state of HIV prevention using pre-exposure prophylaxis (PrEP). It outlines key populations at high risk of HIV like men who have sex with men, sex workers, people who inject drugs, and provides data on HIV rates in these groups. The document reviews evidence from PrEP efficacy trials showing significant reductions in HIV risk with daily oral PrEP use. It discusses real-world implementation studies in the US and South Africa that demonstrate high adherence to PrEP resulting in no new HIV infections. Global health organizations like WHO now recommend offering PrEP to those at substantial risk of HIV as an additional prevention method.
Achievements and Implications of HIV Prevention Programme among Female Sex wo...QUESTJOURNAL
Background: Plateau State, Nigeria with HIV prevalence rate of 7.7% as at 2010 had among the highest HIV and syphilis levels in Nigeria, earning itself a reputation of being one of the 12 + 1 states contributing the highest HIV prevalence in Nigeria and described as “hot zone” of HIV infections. Factors responsible for this were not unrelated to the high-risk activities of Female Sex Workers (FSWs). This paper therefore presents achievements and implications HIV prevention among FSWs in Plateau State, Nigeria Methods: This project was an intervention effort focused on delivering evidence-based HIV prevention activities among FSWs in 3 local government areas within the State. The estimated target population for the study was 460 and this project used the minimum prevention package intervention (MPPI). Peer educators were selected and trained among the FSWs to reach out to their peers using cohort session. Data were documented using various monitoring and evaluation tools, entered on the District Health Information Software version 2 and analyzed using Microsoft Excel. Results: A total of 68 community dialogues were held with 1,466 influencers participating in the process. In addition, 601 peers were registered, while 18 persons benefitted from 27 income generation activities aimed at capacity building for FSWs. A total of 642 persons were counseled, tested and shown their results, with 15 persons tested positive resulting in HIV prevalence of 2.3%. Although 10,560 condoms were distributed however, these numbers was below the number of condoms required during the intervention. Conclusion: This intervention was a success. However, more needs to be done with regards to condom distribution and supply among FSWs since there is a crucial role for FSWs to play in the plot of taking the HIV prevalence of Plateau State even further down
The document provides an overview of HIV/AIDS in India, focusing on what is known and what further data is needed for evidence-based decision making. It discusses HIV prevalence and risk factors in southern and northeastern states. While some data exists on high-risk groups like female sex workers, men who have sex with men, and injecting drug users, more systematic data collection is needed to better understand trends over time and inform targeted prevention programs. A rights-based, evidence-informed approach is critical to effectively address HIV in India.
1. The document summarizes Malaysia's HIV/AIDS situation and recommendations for interventions. It reports that while HIV transmission is declining overall, sexual transmission now accounts for over 50% of new cases, especially among heterosexuals and men who have sex with men. 2. Key recommendations include expanding access to antiretroviral treatment, strengthening prevention services for at-risk groups, and implementing proven interventions like condom promotion and harm reduction programs. 3. Achieving the UNAIDS 90-90-90 targets of diagnosing 90% of HIV cases, treating 90% of those diagnosed, and virally suppressing 90% of those treated is an important goal.
This document summarizes the position statement of the American College of Preventive Medicine (ACPM) regarding routine HIV screening. The ACPM supports routine HIV screening for all adolescents and adults ages 13-64, as well as pregnant women, based on evidence that risk-based screening is inadequate and leads to low testing rates, lack of HIV status awareness, and late diagnoses. The ACPM endorses opt-out consent procedures, use of rapid HIV tests, streamlined counseling separate from screening, and linking patients to treatment. The organization also recommends annual repeat testing for high-risk groups and repeat testing every 5 years for the general population.
Getting to scale: How we can achieve the reach required of prevention service...HopkinsCFAR
This document discusses disparities in HIV/STI rates among Black and White MSM in Atlanta from 2009-2014. The study found significantly higher rates of new HIV infections, prevalent HIV infections, and STIs among Black MSM compared to White MSM. Factors contributing to the disparities included higher community-level HIV prevalence among Black MSM networks, increased likelihood of Black MSM encountering an HIV-positive partner, geographic clustering of Black MSM in high-poverty/high-stigma neighborhoods, and higher rates of condom failures or incomplete use among Black MSM. The document advocates for scaling up multiple prevention interventions like PrEP to achieve sufficient coverage levels to meaningfully reduce new HIV transmissions.
Burden of HIV and Research Gaps Among Key Populations in Sub-Saharan AfricaHopkinsCFAR
Key populations including sex workers, men who have sex with men, and people who inject drugs experience disproportionately high HIV burdens in sub-Saharan Africa due to various biological, behavioral, and structural factors. HIV prevalence among female sex workers ranges from 10.9% in Eastern Europe to 36.9% in sub-Saharan Africa, where sex workers are 12 times more likely to be infected than other women. Men who have sex with men also experience high HIV prevalence, though data remains limited in sub-Saharan Africa. Combination prevention approaches including behavioral, biomedical, and structural interventions are needed to address the outsized impact of HIV on key populations.
Bending the Curve: PrEP for HIV PreventionHopkinsCFAR
This document summarizes the current state of HIV prevention using pre-exposure prophylaxis (PrEP). It outlines key populations at high risk of HIV like men who have sex with men, sex workers, people who inject drugs, and provides data on HIV rates in these groups. The document reviews evidence from PrEP efficacy trials showing significant reductions in HIV risk with daily oral PrEP use. It discusses real-world implementation studies in the US and South Africa that demonstrate high adherence to PrEP resulting in no new HIV infections. Global health organizations like WHO now recommend offering PrEP to those at substantial risk of HIV as an additional prevention method.
Achievements and Implications of HIV Prevention Programme among Female Sex wo...QUESTJOURNAL
Background: Plateau State, Nigeria with HIV prevalence rate of 7.7% as at 2010 had among the highest HIV and syphilis levels in Nigeria, earning itself a reputation of being one of the 12 + 1 states contributing the highest HIV prevalence in Nigeria and described as “hot zone” of HIV infections. Factors responsible for this were not unrelated to the high-risk activities of Female Sex Workers (FSWs). This paper therefore presents achievements and implications HIV prevention among FSWs in Plateau State, Nigeria Methods: This project was an intervention effort focused on delivering evidence-based HIV prevention activities among FSWs in 3 local government areas within the State. The estimated target population for the study was 460 and this project used the minimum prevention package intervention (MPPI). Peer educators were selected and trained among the FSWs to reach out to their peers using cohort session. Data were documented using various monitoring and evaluation tools, entered on the District Health Information Software version 2 and analyzed using Microsoft Excel. Results: A total of 68 community dialogues were held with 1,466 influencers participating in the process. In addition, 601 peers were registered, while 18 persons benefitted from 27 income generation activities aimed at capacity building for FSWs. A total of 642 persons were counseled, tested and shown their results, with 15 persons tested positive resulting in HIV prevalence of 2.3%. Although 10,560 condoms were distributed however, these numbers was below the number of condoms required during the intervention. Conclusion: This intervention was a success. However, more needs to be done with regards to condom distribution and supply among FSWs since there is a crucial role for FSWs to play in the plot of taking the HIV prevalence of Plateau State even further down
The document provides an overview of HIV/AIDS in India, focusing on what is known and what further data is needed for evidence-based decision making. It discusses HIV prevalence and risk factors in southern and northeastern states. While some data exists on high-risk groups like female sex workers, men who have sex with men, and injecting drug users, more systematic data collection is needed to better understand trends over time and inform targeted prevention programs. A rights-based, evidence-informed approach is critical to effectively address HIV in India.
1. The document summarizes Malaysia's HIV/AIDS situation and recommendations for interventions. It reports that while HIV transmission is declining overall, sexual transmission now accounts for over 50% of new cases, especially among heterosexuals and men who have sex with men. 2. Key recommendations include expanding access to antiretroviral treatment, strengthening prevention services for at-risk groups, and implementing proven interventions like condom promotion and harm reduction programs. 3. Achieving the UNAIDS 90-90-90 targets of diagnosing 90% of HIV cases, treating 90% of those diagnosed, and virally suppressing 90% of those treated is an important goal.
This document summarizes the position statement of the American College of Preventive Medicine (ACPM) regarding routine HIV screening. The ACPM supports routine HIV screening for all adolescents and adults ages 13-64, as well as pregnant women, based on evidence that risk-based screening is inadequate and leads to low testing rates, lack of HIV status awareness, and late diagnoses. The ACPM endorses opt-out consent procedures, use of rapid HIV tests, streamlined counseling separate from screening, and linking patients to treatment. The organization also recommends annual repeat testing for high-risk groups and repeat testing every 5 years for the general population.
Getting to scale: How we can achieve the reach required of prevention service...HopkinsCFAR
This document discusses disparities in HIV/STI rates among Black and White MSM in Atlanta from 2009-2014. The study found significantly higher rates of new HIV infections, prevalent HIV infections, and STIs among Black MSM compared to White MSM. Factors contributing to the disparities included higher community-level HIV prevalence among Black MSM networks, increased likelihood of Black MSM encountering an HIV-positive partner, geographic clustering of Black MSM in high-poverty/high-stigma neighborhoods, and higher rates of condom failures or incomplete use among Black MSM. The document advocates for scaling up multiple prevention interventions like PrEP to achieve sufficient coverage levels to meaningfully reduce new HIV transmissions.
This document provides an overview of the HIV/AIDS epidemic and programmatic response in Uttar Pradesh, India. It finds that key vulnerability factors driving the epidemic include a large population, gender disparities, the presence of high-risk groups like migrants, female sex workers, and injecting drug users. HIV prevalence trends show a concentrated epidemic among high-risk groups but signs of spread to the general population. The government's response under NACP III aims to prevent new infections, increase access to care and treatment, build capacity, and strengthen strategic information systems through targeted interventions for high-risk groups and the general population. Key ongoing challenges include curbing the spread from high-risk to low-risk groups and further decentralizing
At baseline, two of 986 sex workers were HIV positive in Madagascar. 77.5% of sex workers in Antananarivo and 73.5% in Tamatave had at least one curable sexually transmitted infection (STI). Two months after treatment and counseling, 64.9% of sex workers in Antananarivo and 57.4% in Tamatave had at least one STI. The researchers developed evidence-based STI treatment guidelines for sex workers in Madagascar in collaboration with sex workers and health professionals. The guidelines included speculum exams, syphilis screening and treatment, and presumptive treatment for other STIs during initial and follow-up visits.
HIv risks and vulnerabilities among Gay, Bisexuals and Others MSM, Stefan BaralMSMGF
MSMGF held the Civil Society Hearings Side Event,: Unfinished Business – Taking bolder action to address HIV among gay and bisexual men and other men who have sex with men, at the United Nations in New York City in close consultation with the Global Platform to Fast Track the HIV and Human Rights Responses Among Gay, Bisexual Men and Other Men Who Have Sex with Men (The Platform), and supported by UNAIDS, UNDP, OGAC/PEPFAR, and the Global Fund.
The document summarizes the key points from a quarterly review meeting of India's National AIDS Control Programme. It provides an overview of the program, highlights achievements in reducing HIV infections and AIDS-related deaths, and outlines the vision and targets to end AIDS by 2030. Key agenda items discussed establishing ART centers in all medical colleges, eliminating mother-to-child HIV transmission, implementing the HIV/AIDS Prevention and Control Act of 2017, and achieving the 90-90-90 fast track targets to diagnose and treat people living with HIV. Support was requested from states to help scale up HIV testing, treatment and care.
Violence against Women living with HIV A Cross Sectional Study in NepalNabaraj Mudwari
This study examined violence against women living with HIV in Nepal through interviews with 43 HIV-positive women. The study found that the vast majority (93%) of participants had experienced at least one form of violence, and prevalence of violence increased sharply after being diagnosed with HIV (93% vs 54% before diagnosis). Husbands and mothers-in-law were the most common perpetrators, and consequences included self-humiliation and health/treatment problems. This cross-sectional study suggests violence is highly prevalent among HIV-positive women in Nepal.
RESULTS ON UTILIZATION OF INSECTICIDE TREATED MOSQUITO NETS IN KISAUNI MOMBASAStanford Kapere
This document outlines a research project on the utilization of insecticide-treated nets among families with children under five years old in Kisauni, Kenya. The study aims to determine the level of knowledge, attitudes, and factors affecting the use of insecticide-treated nets. A cross-sectional study using questionnaires and observations will collect data on net ownership, use, and related knowledge from a sample of households. Preliminary results show over half of households own at least one net, but net use among young children is still low, especially in rural areas. The study recommends improving distribution to vulnerable groups and education programs to increase proper net use.
This document summarizes a study that assessed the prevalence of asymptomatic genital tract infections (GTIs) among sexually active youth in South Africa. The study found:
1) Over two-thirds of young women tested positive for at least one GTI, compared to just 10% of young men, with the majority of infections being asymptomatic.
2) Syndromic management identified a small fraction of actual GTI cases and was suboptimal for screening this population.
3) Youths' high burden of asymptomatic GTIs and other vulnerabilities increase their risk for HIV, highlighting the need for improved laboratory-based GTI screening and youth-centered HIV prevention programs.
This presentation summarizes research on cryptococcal antigen screening and treatment in resource-limited settings. It finds that screening individuals with CD4 counts <100 cells/uL and <200 cells/uL can reduce mortality, and point-of-care tests now enable screening in primary care clinics. Studies of simplified treatment regimens show promise, such as using high-dose liposomal amphotericin B for only 1-2 weeks. Field work in Mozambique demonstrated a 7.3% prevalence of cryptococcal antigenemia through screening at two clinics, and identified opportunities to improve care through expanded screening and ambulatory treatment models.
Michael Tang, MD
Infectious Disease Fellow
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
The document summarizes HIV epidemiology among men who have sex with men (MSM) globally and in Asia Pacific. Some key points:
- HIV prevalence among MSM ranges from under 1% to over 25% depending on the country/region, with most of Asia and Africa over 5%.
- HIV is increasing among MSM in many countries as prevalence declines elsewhere, with urban areas often having much higher rates.
- Condom use and HIV testing is low among MSM in most areas. Criminalization and stigma also limit data collection and access to services.
- MSM population size estimates vary widely but are often in the hundreds of thousands to millions in Asia Pacific countries.
1) The study evaluated the suitability of populations of sexually active women in two districts of South Africa, Madibeng and Mbekweni, for microbicide trials by determining HIV prevalence and incidence.
2) HIV prevalence was 24% in Madibeng and 22% in Mbekweni. Estimated HIV incidence rates were 6.0/100 person-years in Madibeng and 4.5/100 person-years in Mbekweni.
3) Pregnancy incidence rates were 4.8/100 person-years in Madibeng and 7.0/100 person-years in Mbekweni. Genital symptoms were very common.
4) The
Review from the 24th Conference on Retroviruses and Opportunistic Infections (CROI) – 2017
Charles Hicks, M.D.
April 21st, 2017
UCSD HIV & Global Health Rounds
This document provides information from the HIV and AIDS Data Hub for Asia-Pacific on data availability and population size estimates of people who inject drugs, men who have sex with men, transgender people, and male sex workers across several countries in Asia and the Pacific region. It includes tables and charts with the countries where data is available from sentinel surveillance surveys, behavioral surveys, and population size estimates. It also provides references for the estimates and surveys.
HIV prevalence and incidence remain high in peri-urban areas of KwaZulu-Natal, South Africa according to a study of three districts. Cross-sectional surveys found HIV prevalence of 42% in Ladysmith, 46% in Edendale, and 41% in Pinetown. Follow-up cohort studies in these areas measured HIV incidence rates of 14.8, 6.3, and 7.2 per 100 person-years respectively. Pregnancy incidence was also high at 5.7, 3.1, and 6.3 per 100 person-years despite high reported contraceptive use. These findings suggest ongoing high risk of HIV transmission in these communities.
This document summarizes emerging trends in HIV/AIDS in Kenya and globally. It provides key statistics on HIV prevalence rates over time in Kenya, showing a decline from 13.4% in 1999 to 5.6% in 2012. It also breaks down prevalence by age, region, and residence. The majority (57%) of new HIV infections in Sub-Saharan Africa are among women. Marginalized groups like men who have sex with men and sex workers have very high prevalence rates over 25% but face legal and social barriers to accessing health services. The document reviews strategies and terminology around HIV prevention, treatment, and awareness of HIV status.
- The study analyzed data from the 2000 Malawi Demographic and Health Survey to determine factors influencing willingness to undergo voluntary HIV counseling and testing among Malawians prior to marriage.
- Willingness for premarital HIV testing was positively associated with increased age, urban residence, and a preference for confidentiality of one's HIV status. However, it was negatively associated with knowledge of HIV/AIDS, testing locations, sexually transmitted infections, and a belief that abstinence prevents HIV.
- Not all population groups had an equal likelihood of accepting voluntary HIV counseling and testing. Public health interventions on HIV testing need to be tailored to different groups.
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"StopTb Italia
This document discusses the challenges of diagnosing HIV, AIDS, and co-infections. It notes that distinguishing between HIV infection, AIDS, and co-infections can be difficult. Point-of-care rapid tests have helped increase HIV testing, though they cannot identify acute HIV infections. The document emphasizes the importance of confirming positive rapid HIV tests with supplemental tests due to the potential for false positives in low prevalence populations.
This document describes Project B.R.I.E.F., a high-volume rapid HIV testing program using a multimedia model in an urban emergency department. The program utilized public health advocates and educational videos to efficiently offer HIV testing to over 65,000 patients from 2005-2008. Of those tested, 0.92% were HIV-positive. The program achieved a linkage to outpatient HIV care rate of 84% for those diagnosed. Project B.R.I.E.F. demonstrated the effectiveness and cost-savings of using a multimedia approach to significantly increase access to HIV testing and counseling in an emergency department setting.
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
This document discusses HIV prevention interventions that have been shown to work based on evidence. Interventions with strong evidence of effectiveness include male circumcision, HAART, PMTCT, and condoms. Treatment of STIs has moderate evidence. Microbicides, vaccines, and abstinence-only programs have weak or no evidence. Barriers to implementing effective interventions include inadequate funding, resource misallocation, capacity limitations, and socio-cultural factors. A combination of evidence-based interventions delivered at scale is needed to reverse the HIV epidemic.
Dr. Kathleen Brady's presentation on PrEP (pre-exposure prophylaxis) for HIV, as given to the Philadelphia HIV Prevention Planning Group (HPG) on March 25, 2015.
This document provides an overview of the HIV/AIDS epidemic and programmatic response in Uttar Pradesh, India. It finds that key vulnerability factors driving the epidemic include a large population, gender disparities, the presence of high-risk groups like migrants, female sex workers, and injecting drug users. HIV prevalence trends show a concentrated epidemic among high-risk groups but signs of spread to the general population. The government's response under NACP III aims to prevent new infections, increase access to care and treatment, build capacity, and strengthen strategic information systems through targeted interventions for high-risk groups and the general population. Key ongoing challenges include curbing the spread from high-risk to low-risk groups and further decentralizing
At baseline, two of 986 sex workers were HIV positive in Madagascar. 77.5% of sex workers in Antananarivo and 73.5% in Tamatave had at least one curable sexually transmitted infection (STI). Two months after treatment and counseling, 64.9% of sex workers in Antananarivo and 57.4% in Tamatave had at least one STI. The researchers developed evidence-based STI treatment guidelines for sex workers in Madagascar in collaboration with sex workers and health professionals. The guidelines included speculum exams, syphilis screening and treatment, and presumptive treatment for other STIs during initial and follow-up visits.
HIv risks and vulnerabilities among Gay, Bisexuals and Others MSM, Stefan BaralMSMGF
MSMGF held the Civil Society Hearings Side Event,: Unfinished Business – Taking bolder action to address HIV among gay and bisexual men and other men who have sex with men, at the United Nations in New York City in close consultation with the Global Platform to Fast Track the HIV and Human Rights Responses Among Gay, Bisexual Men and Other Men Who Have Sex with Men (The Platform), and supported by UNAIDS, UNDP, OGAC/PEPFAR, and the Global Fund.
The document summarizes the key points from a quarterly review meeting of India's National AIDS Control Programme. It provides an overview of the program, highlights achievements in reducing HIV infections and AIDS-related deaths, and outlines the vision and targets to end AIDS by 2030. Key agenda items discussed establishing ART centers in all medical colleges, eliminating mother-to-child HIV transmission, implementing the HIV/AIDS Prevention and Control Act of 2017, and achieving the 90-90-90 fast track targets to diagnose and treat people living with HIV. Support was requested from states to help scale up HIV testing, treatment and care.
Violence against Women living with HIV A Cross Sectional Study in NepalNabaraj Mudwari
This study examined violence against women living with HIV in Nepal through interviews with 43 HIV-positive women. The study found that the vast majority (93%) of participants had experienced at least one form of violence, and prevalence of violence increased sharply after being diagnosed with HIV (93% vs 54% before diagnosis). Husbands and mothers-in-law were the most common perpetrators, and consequences included self-humiliation and health/treatment problems. This cross-sectional study suggests violence is highly prevalent among HIV-positive women in Nepal.
RESULTS ON UTILIZATION OF INSECTICIDE TREATED MOSQUITO NETS IN KISAUNI MOMBASAStanford Kapere
This document outlines a research project on the utilization of insecticide-treated nets among families with children under five years old in Kisauni, Kenya. The study aims to determine the level of knowledge, attitudes, and factors affecting the use of insecticide-treated nets. A cross-sectional study using questionnaires and observations will collect data on net ownership, use, and related knowledge from a sample of households. Preliminary results show over half of households own at least one net, but net use among young children is still low, especially in rural areas. The study recommends improving distribution to vulnerable groups and education programs to increase proper net use.
This document summarizes a study that assessed the prevalence of asymptomatic genital tract infections (GTIs) among sexually active youth in South Africa. The study found:
1) Over two-thirds of young women tested positive for at least one GTI, compared to just 10% of young men, with the majority of infections being asymptomatic.
2) Syndromic management identified a small fraction of actual GTI cases and was suboptimal for screening this population.
3) Youths' high burden of asymptomatic GTIs and other vulnerabilities increase their risk for HIV, highlighting the need for improved laboratory-based GTI screening and youth-centered HIV prevention programs.
This presentation summarizes research on cryptococcal antigen screening and treatment in resource-limited settings. It finds that screening individuals with CD4 counts <100 cells/uL and <200 cells/uL can reduce mortality, and point-of-care tests now enable screening in primary care clinics. Studies of simplified treatment regimens show promise, such as using high-dose liposomal amphotericin B for only 1-2 weeks. Field work in Mozambique demonstrated a 7.3% prevalence of cryptococcal antigenemia through screening at two clinics, and identified opportunities to improve care through expanded screening and ambulatory treatment models.
Michael Tang, MD
Infectious Disease Fellow
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
The document summarizes HIV epidemiology among men who have sex with men (MSM) globally and in Asia Pacific. Some key points:
- HIV prevalence among MSM ranges from under 1% to over 25% depending on the country/region, with most of Asia and Africa over 5%.
- HIV is increasing among MSM in many countries as prevalence declines elsewhere, with urban areas often having much higher rates.
- Condom use and HIV testing is low among MSM in most areas. Criminalization and stigma also limit data collection and access to services.
- MSM population size estimates vary widely but are often in the hundreds of thousands to millions in Asia Pacific countries.
1) The study evaluated the suitability of populations of sexually active women in two districts of South Africa, Madibeng and Mbekweni, for microbicide trials by determining HIV prevalence and incidence.
2) HIV prevalence was 24% in Madibeng and 22% in Mbekweni. Estimated HIV incidence rates were 6.0/100 person-years in Madibeng and 4.5/100 person-years in Mbekweni.
3) Pregnancy incidence rates were 4.8/100 person-years in Madibeng and 7.0/100 person-years in Mbekweni. Genital symptoms were very common.
4) The
Review from the 24th Conference on Retroviruses and Opportunistic Infections (CROI) – 2017
Charles Hicks, M.D.
April 21st, 2017
UCSD HIV & Global Health Rounds
This document provides information from the HIV and AIDS Data Hub for Asia-Pacific on data availability and population size estimates of people who inject drugs, men who have sex with men, transgender people, and male sex workers across several countries in Asia and the Pacific region. It includes tables and charts with the countries where data is available from sentinel surveillance surveys, behavioral surveys, and population size estimates. It also provides references for the estimates and surveys.
HIV prevalence and incidence remain high in peri-urban areas of KwaZulu-Natal, South Africa according to a study of three districts. Cross-sectional surveys found HIV prevalence of 42% in Ladysmith, 46% in Edendale, and 41% in Pinetown. Follow-up cohort studies in these areas measured HIV incidence rates of 14.8, 6.3, and 7.2 per 100 person-years respectively. Pregnancy incidence was also high at 5.7, 3.1, and 6.3 per 100 person-years despite high reported contraceptive use. These findings suggest ongoing high risk of HIV transmission in these communities.
This document summarizes emerging trends in HIV/AIDS in Kenya and globally. It provides key statistics on HIV prevalence rates over time in Kenya, showing a decline from 13.4% in 1999 to 5.6% in 2012. It also breaks down prevalence by age, region, and residence. The majority (57%) of new HIV infections in Sub-Saharan Africa are among women. Marginalized groups like men who have sex with men and sex workers have very high prevalence rates over 25% but face legal and social barriers to accessing health services. The document reviews strategies and terminology around HIV prevention, treatment, and awareness of HIV status.
- The study analyzed data from the 2000 Malawi Demographic and Health Survey to determine factors influencing willingness to undergo voluntary HIV counseling and testing among Malawians prior to marriage.
- Willingness for premarital HIV testing was positively associated with increased age, urban residence, and a preference for confidentiality of one's HIV status. However, it was negatively associated with knowledge of HIV/AIDS, testing locations, sexually transmitted infections, and a belief that abstinence prevents HIV.
- Not all population groups had an equal likelihood of accepting voluntary HIV counseling and testing. Public health interventions on HIV testing need to be tailored to different groups.
PPT Castelli "Dall'HIV all'AIDS fino alla coinfezione: una diagnosi difficile?"StopTb Italia
This document discusses the challenges of diagnosing HIV, AIDS, and co-infections. It notes that distinguishing between HIV infection, AIDS, and co-infections can be difficult. Point-of-care rapid tests have helped increase HIV testing, though they cannot identify acute HIV infections. The document emphasizes the importance of confirming positive rapid HIV tests with supplemental tests due to the potential for false positives in low prevalence populations.
This document describes Project B.R.I.E.F., a high-volume rapid HIV testing program using a multimedia model in an urban emergency department. The program utilized public health advocates and educational videos to efficiently offer HIV testing to over 65,000 patients from 2005-2008. Of those tested, 0.92% were HIV-positive. The program achieved a linkage to outpatient HIV care rate of 84% for those diagnosed. Project B.R.I.E.F. demonstrated the effectiveness and cost-savings of using a multimedia approach to significantly increase access to HIV testing and counseling in an emergency department setting.
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
This document discusses HIV prevention interventions that have been shown to work based on evidence. Interventions with strong evidence of effectiveness include male circumcision, HAART, PMTCT, and condoms. Treatment of STIs has moderate evidence. Microbicides, vaccines, and abstinence-only programs have weak or no evidence. Barriers to implementing effective interventions include inadequate funding, resource misallocation, capacity limitations, and socio-cultural factors. A combination of evidence-based interventions delivered at scale is needed to reverse the HIV epidemic.
Dr. Kathleen Brady's presentation on PrEP (pre-exposure prophylaxis) for HIV, as given to the Philadelphia HIV Prevention Planning Group (HPG) on March 25, 2015.
The document discusses biomedical HIV prevention modalities currently being researched and tested, including microbicides, pre-exposure prophylaxis (PrEP), circumcision, vaccines, and others. It outlines the research processes involved and challenges, and notes that within the next two years results will be seen from several PrEP and microbicide studies that could impact availability and discussions around access and use. Key concerns discussed include understanding and communicating "partial efficacy", monitoring and preventing drug resistance, and ensuring equity in access.
This study evaluated the suitability of populations of sexually active women in two districts of South Africa, Madibeng and Mbekweni, for participation in microbicide trials by determining HIV prevalence and incidence. The study found HIV prevalence was 24% in Madibeng and 22% in Mbekweni. HIV incidence rates based on seroconversions over 12 months were 6.0/100 person-years in Madibeng and 4.5/100 person-years in Mbekweni. Genital symptoms were very common. The populations were found to be suitable for microbicide trials if HIV incidence remains sufficiently high over time.
This study evaluated the suitability of populations of sexually active women in Madibeng, North-West Province and Mbekweni, Western Cape, South Africa for microbicide trials by determining HIV prevalence and incidence.
The study found an HIV prevalence of 24% in Madibeng and 22% in Mbekweni. HIV incidence rates based on seroconversions over 12 months in the cohort studies were 6.0/100 person-years in Madibeng and 4.5/100 person-years in Mbekweni. Incidence rates estimated by cross-sectional BED testing were similar. Pregnancy incidence rates were also determined.
Nearly all participants expressed a willingness to participate
This document summarizes key information from an HIV & Global Health Rounds presentation on updates from the 2020 Conference on Retroviruses and Opportunistic Infections (CROI 2020). The presentation covered the global HIV epidemic, contraception and prevention, treatment as prevention, pre-exposure prophylaxis (PrEP), and HIV vaccines. Highlights included findings from the ECHO contraceptive study showing no increased HIV risk from various contraceptives, modest reductions in HIV incidence from universal test and treat trials, long-term efficacy and safety data from the DISCOVER PrEP trial, and the failure of the HVTN 702 vaccine trial to show efficacy.
Hiv &ictc seminar by Dr. Mousumi Sarkarmrikara185
India's national adult HIV prevalence is estimated at 0.26%. The total number of people living with HIV in India is estimated to be 21.17 lakhs. India has one of the world's largest HIV surveillance systems which helps monitor trends, levels, and burden of HIV among different populations. This system includes sentinel surveillance at antenatal clinics, Integrated Biological and Behavioural Surveillance among high-risk groups, sexually transmitted infection surveillance, AIDS case reporting, and death registration. The surveillance data is used to estimate disease distribution, identify groups for intervention, evaluate program effectiveness, and guide prevention efforts.
Socio-demographic Characteristics of Clients Visiting Integrated Counseling and Testing Centre (ICTC) at SMS Medical College, Jaipur (Rajasthan) India-Human immunodeficiency virus (HIV) infection is a global pandemic and India counts for 10% of the global HIV burden and 65% of that in the South and South-East Asia. This study of clients of ICTC was carried out to know the association of HIV positivity with socio-demographic variables. Total 2412 clients have visited at ICTC of SMS Medical College, Jaipur, either voluntarily or referred by various department of this institute in ICTC in 1st quarter of 2009. They Overall HIV positivity was found 12.35% with a significant difference in voluntary and referred clients i.e. 83.59% v/s 8.36%. It was also found that HIV positivity is more in reproductive age group than extremes of ages, more in females than males, more in person who were married but presently single because of separation of spouse, divorce form spouse or death of spouse than the unmarried or married living with their spouses.
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01 Setswe~Hiv Prevention Where Is The Evidence Of Interventions That Work
1. HIV prevention:
Where is the evidence of interventions that
work?
Geoffrey Setswe DrPH, MPH
SAHARA Conference
1 December 2009
1
2. In this presentation
1. Introduction
2. What is evidence and levels of evidence in HIV prevention?
3. HIV prevention interventions
3.1. Biomedical HIV prevention interventions
3.2. Behavioural HIV prevention interventions
3.3. Structural HIV prevention interventions
4. Summary of HIV prevention interventions that work
5. Conclusion
2
3. 1. Introduction
• Remarkable advances in the molecular biology of HIV and major
therapeutic discoveries in the past 28 years of the epidemic.
• Many interventions have been developed and implemented – some were
tested for evidence of efficacy or effectiveness and some were not.
• In 2009, we are not sure which interventions work! We need to identify and
use best and good evidence HIV prevention interventions that work.
• Policymakers, implementers, researchers, funders and the community - all
need evidence that an HIV prevention intervention works…
• We present evidence of HIV prevention interventions that work and also
present their level of effectiveness or efficacy.
3
4. 2. What is evidence?
• Evidence refers to “facts or testimony in support of a conclusion, statement
or belief” and “something serving as proof”.
• Proof that something works.
• The Law uses witnesses and other forms of evidence to prove guilt beyond
reasonable doubt.
• Epidemiology uses p-value to show level of significance e.g. p<=0.05 says
we are 95% confident that the observed difference is not due to chance.
4
6. Proposed levels of evidence
Level of evidence % Effectiveness or
efficacy (in RCT)
80% +
Good evidence
60-79%
Promising
30-59%
evidence
Weak or No 0-29%
Evidence
6
7. 3.1. Biomedical HIV prevention interventions
3.1.1. Male circumcision (MC)
3.1.2. Highly Active Antiretroviral Therapy (HAART)
3.1.3. Prevention of mother to child transmission (PMTCT)
3.1.4. Condoms (Male and Female)
3.1.5. Treatment of Sexually Transmitted Infections (STI)
3.1.6. Microbicides and cervical barriers
3.1.7. HIV vaccine 7
8. 3.1.1. Male Circumcision (MC)
• RCTs on MC in South Africa, Uganda, and Kenya[1] :
“There is compelling evidence that MC is 65%
Good evidence
effective in reducing the risk of acquiring HIV in
circumcised men…”
• A Cochrane review assessed data from trials in SA,
Uganda, and Kenya between 2002 and 2006 that
enrolled 11,054 males said that research on the
effectiveness of MC for preventing HIV in
heterosexual men is conclusive.
Reviewers concluded that no further trials are
required to establish that HIV infection rates are
reduced in heterosexual men for at least the first two
years after circumcision[2]
[1] Gray, H. et al. (2007). MC for HIV prevention in young men in Rakai: A RCT. Lancet 369:657-66.
[2] Siegfried N, Muller M, Volmink J, Deeks JJ,. MC for prevention of heterosexual acquisition of HIV in men.
8
Cochrane Database of Systematic Reviews, Issue 4, 7 October 2009
9. 3.1.2. Highly Active Antiretroviral Therapy
(HAART)
• RCTs on HAART* reported 60% to 80% reductions in new
Good evidence AIDS illnesses, hospitalizations and deaths
• A meta-analysis** of 54 antiretroviral clinical trials has
demonstrated that:
• Using one antiretroviral reduced progression to AIDS or
death by 30% against placebo.
• Using two antiretrovirals reduced progression to AIDS or
death by 40% against one antiretroviral
• Using three antiretrovirals reduced progression to AIDS
or death by 40% against two antiretrovirals
*Jordan et al. (2002) Systematic review and meta-analysis of evidence for increasing numbers of drugs in antiretroviral
combination therapy. BMJ 2002;324:757 http://www.bmj.com/cgi/content/full/324/7340/757 9
**Palella et al. (1998) Declining morbidity and mortality among patients with advanced HIV infection. NEJM, 338:853-860.
10. 3.1.3. Preventing Mother-To-Child Transmission
(PMTCT) of HIV
ARV and Perinatal Transmission in Africa, 1995-2006
25
Transmission
rates are as
20
high as 35%
Transmission Rate (%)
when there is no
15 intervention and
below 5% when
10 antiretroviral
treatment and
appropriate care
5
are available
0
none SD NVP ZDV +SDNVP HAART
SC ZDV ZDV +3TC ZDV + 3TC
+SDNVP
10
11. 3.1.4. Condoms
Weapons of mass protection!
• A meta-analysis commissioned by UNAIDS* =
male condom use is 90% effective in
preventing HIV transmission.
• “Evidence from Family Planning programs over many
years makes it abundantly clear that the condom is a
safe and relatively effective method…”
• Based on laboratory and clinical evidence, the
US FDA approved the female condom as 94-
97% effective in reducing the risk of HIV
infection, if used correctly and consistently**.
*Hearst N and Chen S, Condom promotion for AIDS prevention in the developing world: is it working?
Studies in Family Planning, 2004, 35(1):39–47. http://www.usp.br/nepaids/condom.pdf 11
**AVERT, “The Female Condom” fact sheet, available online at http://www.avert.org/femcond.htm
12. 3.5. STI treatment
• Evidence from a cluster RCT in Mwanza, Tanzania, suggests
Promising
evidence that improved STI treatment services were shown to reduce
HIV transmission by about 40%.
NO
• Two trials (Mwanza & Rakai) indicate no evidence for
evidence substantial benefit from STI treatment of all community
members.
Promising
• Cochrane Reviewers concluded that limited evidence from
evidence
RCTs indicates that STI control serves as an effective HIV
prevention strategy.
Schulze KF (2004) Population-based interventions for reducing sexually transmitted infections,
including HIV infection. The WHO Reproductive Health Library; Geneva
12
Wilkinson D, Rutherford G. Population-based interventions for reducing sexually transmitted infections,
including HIV infection. The Cochrane Library, Issue 1 2003.
13. 3.1.6. Microbicides and cervical barriers
• Studies of early-generation microbicides have failed to detect a
NO
evidence
prevention benefit, and disappointing results were reported on the HIV
prevention potential of female diaphragms.
• HPTN 035: A multi-centre clinical trial conducted at 7 sites (6 in Africa)
evaluated the safety and effectiveness of two candidate microbicides,
Promising
evidence BufferGel and PRO 2000 with 3,099 participants. PRO 2000 was 30%
effective compared with no gel but BufferGel had no detectable effect
on preventing HIV infection.
NO
• Topical microbicides have not performed well in human HIV prevention
evidence studies, with 10 trials of surfactant and polyanionic compounds yielding
negative results.
13
14. 3.1.7. HIV vaccine
• The Thai Phase III HIV vaccine clinical trial (RV 144), tested the
“prime-boost” combination of two vaccines: ALVAC® HIV
vaccine (the prime), and AIDSVAX® B/E vaccine (the boost).
Promising
evidence The vaccine combination was based on HIV strains that
commonly circulate in Thailand. The trial demonstrated that the
vaccine regimen was safe and modestly effective in
preventing HIV infection. The results show that the prime-boost
combination lowered the rate of HIV infection by 31.2%*
• HIV Vaccine Trials Network (HVTN) launched the first large-
NO
evidence
scale study to evaluate a candidate clade B HIV HIV vaccine.
The phase IIb or "test of concept" efficacy trial involved 3,000
participants at 5 sites in South Africa. Unfortunately, the trials
were halted in September 2007 owing to the vaccine’s lack of
efficacy
*Rerks-Ngarm R, Pitisuttithum P, Nitayaphan S, Kaewkungwal J, Chiu J et al.Vaccination with ALVAC and AIDSVAX
to Prevent HIV-1 Infection in Thailand. NEJM 20 October 2009 14
15. Summary: Evidence of Biomedical HIV prevention
interventions
Level of evidence Interventions % Effectiveness or efficacy
Male Condoms 80-95% [Natural experiment]
Female Condoms 94-97% [Natural experiment]
PMTCT [Dual & triple therapy] 92-98% [RCTs]
HAART 60-80% [RCTs]
Good evidence
Male Circumcision 65% [3 RCTs]
HPTN 035 (PRO 2000) 30% [1 RCT]
Promising STI treatment 40% [1 RCT]
evidence
RV 144 Thai vaccine trial 31.2% [1 RCT]
HIV Vaccine Trials Network No efficacy [RCT]
NO (HVTN)
evidence
Early-generation microbicides Failed [RCTs] and negative
& topical microbicides results [10 RCTs] 15
16. 3.2. Behavioural HIV prevention interventions
3.2.1. Abstinence-only and ABC interventions
3.2.2. Voluntary Counselling & Testing (VCT)
Global HIV Prevention Working
3.2.3. Stepping Stones counselling intervention Group (2008). Behavior Change
and HIV Prevention:
Re)considerations for the 21st
3.2.4. Concurrent sexual partnerships Century.
“Behavioral HIV prevention works. Some
have been pessimistic that it’s possible to
reduce HIV risk behaviors on a large scale,
but this concern is misplaced”
Dr. Helene Gayle, co-chair of the Working Group
16
17. 3.2.1. Abstinence-only and ABC interventions
A Cochrane review of 13 RCTs comparing abstinence-only
NO
evidence
programs to various control groups in the US concluded that
…abstinence-only programs do not appear to reduce or
exacerbate HIV risk among participants in high-income
countries, although this evidence might not apply beyond US
youth. Of the 13 trials, 7 trials reported incidence of
vaginal sex.
“It is time to scrap the ABCs and elevate the debate on HIV prevention beyond
NO the incessant controversies over individual interventions. Small scale, isolated
Evidence? HIV prevention programs, however effective, will not bring the AIDS epidemic
under control…Policy makers, donors and advocates need to demand
national prevention efforts…ABC infantalizes prevention, oversimplifying what
should be an ongoing, strategic approach to reducing incidence.”
Collins et al, AIDS, 2008
Underhill K, Operario D, Montgomery P. Abstinence-only programs for HIV infection prevention in
high-income countries. Cochrane Database of Systematic Reviews 2007, Issue 4.
17
18. 3.2.2. HIV Counseling and Testing
(HCT)
• Meta-analysis of 11 studies of the impact of counseling and
testing for PLWH/A*
Good evidence
• 68% reduction in high risk sexual behaviors with partners
not already HIV+ (95% CI: 59% - 76%)
• Very similar findings for men and women
• Examining pool of 27 studies, a meta-analysis** found no
NO
evidence
significant impact of “counseling and testing” bundle on
behavior relative to the untested
*Marks G et al. JAIDS 2005;39:446-453.
**Weinhardt LS et al. Am J Public Health. 1999;89:1397-1405. 18
19. 3.2.3. Stepping Stones counseling intervention:
Impact on HIV-1, HSV-2 & Behaviour
• Stepping Stones, a 50-hour “participatory learning”
Promising
evidence counseling program, lowered the risk of herpes simplex
virus type 2 (HSV-2) infection by 34.9 per 1000 people
exposed in a community RCT of 70 E.Cape villages.
Compared with a shorter program, Stepping Stones did not
NO
evidence lower incidence of HIV-1 infection and had variable impacts
on risk behavior in the young adults studied.
Promising • Men who completed the Stepping Stones program reported
evidence
less intimate partner violence (IPV) over 2 years, less
transactional sex over 12 months, and less problem drinking
over 12 months.
NO • But Stepping Stones women reported more transactional
evidence
sex than women in the control program.
Jewkes, Nduna, Levin, Jama, Dunkle, Puren, Duvvury. Impact of Stepping Stones on incidence of HIV and HSV-2
19
and sexual behaviour in rural South Africa: Cluster randomised controlled trial. BMJ. 2008;337:a506
20. 3.2.4. Concurrent Sexual Partnerships
• Taken together, the evidence that concurrency is driving the
Africa AIDS epidemics is limited. There is as yet no conclusive
evidence that concurrency:
(1) is associated with HIV prevalence;
NO
evidence (2) increases the size of an HIV epidemic;
(3) increases the speed of HIV transmission;
(4) increases the persistence of HIV in a population; or
(5) that this relationship has a large magnitude of effect.
• Current data on MCP comes from cross-sectional and ecological
studies only; no RCTs or observational studies.
Lurie M and Rosenthal S (2009)Concurrent Partnerships as a Driver of the HIV Epidemic in Sub-Saharan
Africa? The Evidence is Limited. AIDS and Behavior
Mah T. L. and Halperin D. T. (2008). Concurrent sexual partnerships and the HIV epidemics in Africa: 20
Evidence to move forward. AIDS and Behavior
21. 3.3. Structural HIV prevention interventions
IMAGE study on micro-finance
• Intervention with Microfinance for AIDS and Gender Equity (IMAGE)
Promising
evidence
RCT in rural Limpopo assessed a structural intervention that combined a
microfinance programme with a gender and HIV training curriculum.
They study found that experience of intimate-partner violence (IPV)
was reduced by 55%.
• The intervention did not affect the rate of unprotected sex with a non-
NO spousal partner (aRR 1—02, 0—85–1—23), and there was no effect on the
evidence
rate of unprotected sex at last occurrence with a non-spousal partner
(0—89, 0—66–1—19) or HIV incidence (1—06, 0—66–1—69) in cohort three
Pronyk P, Hargreaves J, Kim J, et al. (2006) Effect of a structural intervention for the prevention of 21
intimate-partner violence and HIV in rural South Africa: a cluster randomised trial. Lancet Vol 368: 1973-83
22. Summary: Behavioural and Structural HIV
prevention interventions that work
Level of Interventions % Effectiveness or efficacy
evidence
HCT for PLWHA 68% reduction in high risk sexual
Good evidence behaviors [1 comm RCT]
Stepping Stones Lowered the risk of HSV-2 by 34.9 per
Promising 1000 people exposed; less IPV and less
evidence
transactional sex [comm RCT]
IMAGE study IPV was reduced by 55% [comm RCT].
Abstinence-only interv’s 7/13 reported sex [SR]
NO HCT on untested no impact of C&T on behavior of untested
evidence
Stepping Stones did not lower incidence of HIV-1
IMAGE No effect on HIV incidence [comm RCT]
Concurrency No conclusive evidence 22
23. The AIDS epidemic has taught us to be innovative and to invent, test and implement
new interventions.
We now have evidence of HIV prevention strategies that work!
Picture source: Naidoo D (2007). Science, Technological and Innovation –
A Strategic Imperative for South Africa 23
24. However, despite our innovation, inventiveness and compelling evidence of effective
strategies, the “killer virus” is still chasing and killing us!
Picture source: Naidoo D (2007). Science, Technological and Innovation – 24
A Strategic Imperative for South Africa
25. 5. Conclusion
No “Magic Bullet” for HIV
“It is critical to note that there is no “magic bullet” for HIV
prevention. None of the new prevention methods currently
being tested is likely to be 100 percent effective, and all will
need to be used in combination with existing prevention
approaches if they are to reduce the global burden of
HIV/AIDS.”
Source: Global HIV Prevention Working Group (2008)
25