Treatment as prevention

The intersection of HIV-related health outcomes and problem substance use has been well documented. New York City continues to be a focal point of the U.S. HIV epidemic. In 2011, the NYC Department of Health and Mental Hygiene (NYC DOHMH) issued a recommendation that all HIV infected individuals should be offered antiretroviral therapy (ART) regardless of CD4 cell count or other indicators of disease progression. This policy is based in the concept of "treatment as prevention," in which providing ART to people living with HIV (PLWH) greatly reduces the likelihood of HIV transmission, while also improving individual health. The "ART for ALL" (AFA) study was designed to inform modifications to and identify gaps in the implementation of universal ART, and specifically to help guide allocation of resources to obtain local policy goals for increasing viral suppression among PLWH who have problem substance use. The AFA Study is informed by two complementary frameworks:...

Journal of Patient-Centered Research and Reviews (JPCRR) is an open access, peer-reviewed medical journal focused on disseminating scholarly works devoted to improving patient-centered care practices, health outcomes, and the patient experience. While the annual rate of new HIV infections and diagnoses has remained stable for most groups, troubling increases are seen in transgender women and racial/ethnic-minority men who have sex with men (MSM), groups that are disproportionately affected by HIV. The primary purpose of this systematic review is to examine factors that impact attitudes and beliefs about preexposure prophylaxis (PrEP) and treatment as prevention (TasP) and to explore barriers to PrEP uptake in MSM and transgender women. Using MeSH terms and relevant keywords, we conducted a systematic review of studies published between 2010 and 2019. We searched 4 literature databases and identified studies on MSM and transgender women to elucidate perceptions of PrEP and TasP as well as barriers to access. The search yielded several prominent themes associated with beliefs about HIV prevention approaches and barriers to PrEP access in MSM and transgender women. One was a lack of awareness or insufficient knowledge of PrEP and TasP. Structural barriers and geographic isolation also prevent access to HIV prevention. Sexual minority and HIV-related stigma, internalized homonegativity, and misinterpretations of messages within HIV prevention campaigns have negatively impacted PrEP uptake and beliefs about PrEP and TasP. Quality of the relationship MSM or transgender people have with their health care provider can facilitate or hinder HIV prevention. Finally, variability in beliefs about the efficacy of TasP has negatively affected the impact of TasP messaging campaigns. Although there is evidence of increasing PrEP use in at-risk individuals, several barriers prevent wider acceptance and uptake. Misunderstanding about the meaning of "undetectable" and skepticism about the evidence behind TasP messaging campaigns are likely to delay the World Health Organization's stated goal of getting to zero transmissions. (

The development of potent drugs for the control of viraemia in people living with HIV means that infected people may live a normal, healthy life and offers the prospect of eliminating HIV transmission in the short term and HIV infection in the long term. Other interventions, including the use of condoms, pre-exposure prophylaxis, treatment of sexually transmitted infections and behaviour change programmes, may also be effective in reducing HIV transmission to varying degrees. Here we examine recommendations for when to start treatment with anti-retroviral drugs, estimate the impact that treatment may have on HIV transmission in the short and in the long term, and compare the impact and cost of treatment with that of other methods of control. We focus on generalized HIV epidemics in sub-Saharan Africa. We show that universal access to ART combined with early treatment is the most effective and, in the long term, the most cost-effective intervention. Elimination will require effective...

Background-The proportion of heterosexual HIV transmission in Sub-Saharan Africa that occurs within cohabiting partnerships, as opposed to among single people, or in extra-couple relationships, is a subject of active debate. This question is of immediate importance. As plans to use antiretroviral drugs as a strategy for population-level prevention progress, understanding the importance of different transmission routes is critical to targeting intervention efforts. Methods-We built a mechanistic HIV transmission model using data from Demographic and Health Surveys covering 27,201 cohabiting couples from 18 sub-Saharan African countries with information on couple duration, age at sexual debut, and HIV serostatus. We combined this model with estimates of HIV survival times and country-specific estimates of HIV prevalence and ART coverage. We then estimated the proportion of observed infections in surveyed cohabiting couples that occurred prior to couple formation, between couple members, and through extra-couple intercourse. Findings-We estimate that extra-couple transmission accounts for between 27-61% and 21-51% of all infected males and females, respectively, in surveyed couples, with the ranges given reflecting inter-country variation. We project that over the next year extra-couple transmission will account for 30-65% and 10-47% of new incident HIV infections in males and females, respectively, in cohabiting couples. Our results also suggest that the directionality of transmission within couples is largely from males to females; however, females experience a very high-risk period prior to couple formation.

The Joint United Nations Programme on HIV/AIDS (UNAIDS) recently updated its global targets for antiretroviral therapy (ART) coverage for HIV-positive persons under which 90 % of HIV-positive people are tested, 90 % of those are on ART, and 90 % of those achieve viral suppression. Treatment policy is moving toward treating all HIV-infected persons regardless of CD4 cell count-otherwise known as treatment as prevention-in order to realize the full therapeutic and preventive benefits of ART. Mathematical models have played an important role in guiding the development of these policies by projecting long-term health impacts and cost-effectiveness. To guide future policy, new mathematical models must consider the barriers patients face in receiving and taking ART. Here, we describe the HIV care cascade and ART delivery supply chain to examine how mathematical modeling can provide insight into cost-effective strategies for scaling-up ART coverage in sub-Saharan Africa and help achieve un...

In 2007 an estimated 33 million people were living with HIV; 67% resided in sub‐Saharan Africa, with 35% in eight countries alone. In 2007, there were about 1.4 million HIV‐positive tuberculosis cases. Globally, approximately 4 million people had been given highly active antiretroviral therapy (HAART) by the end of 2008, but in 2007, an estimated 6.7 million were still in need of HAART and 2.7 million more became infected with HIV.Although there has been unprecedented investment in confronting HIV/AIDS ‐ the Joint United Nations Programme on HIV/AIDS estimates $13.8 billion was spent in 2008 ‐ a key challenge is how to address the HIV/AIDS epidemic given limited and potentially shrinking resources. Economic disparities may further exacerbate human rights issues and widen the increasingly divergent approaches to HIV prevention, care and treatment.HIV transmission only occurs from people with HIV, and viral load is the single greatest risk factor for all modes of transmission. HAART c...

Background: Few studies have assessed the effects of antiretroviral therapy (ART) to prevent HIV transmission in Asian HIV epidemics. Vietnam has a concentrated HIV epidemic with the highest prevalence among people who inject drugs. We investigated the impact of expanded HIV testing and counseling (HTC) and early ART, combined with other prevention interventions on HIV transmission. Methods: A deterministic mathematical model was developed using HIV prevalence trends in Can Tho province, Vietnam. Scenarios included offering periodic HTC and immediate ART with and without targeting subpopulations and examining combined strategies with methadone maintenance therapy and condom use. From 2011 to 2050, maintaining current interventions will incur an estimated 18,115 new HIV infections and will cost US $22.1 million (reference scenario). Annual HTC and immediate treatment, if offered to all adults, will reduce new HIV infections by 14,513 (80%) and will cost US $76.9 million. Annual HTC and immediate treatment offered only to people who inject drugs will reduce new infections by 13,578 (75%) and will cost only US $23.6 million. Annual HTC and immediate treatment for key populations, combined with scale-up of methadone maintenance therapy and condom use, will reduce new infections by 14,723 (81%) with similar costs (US $22.7 million). This combination prevention scenario will reduce the incidence to less than 1 per 100,000 in 14 years and will result in a relative cost saving after 19 years. Conclusions: Targeted periodic HTC and immediate ART combined with other interventions is cost-effective and could lead to potential elimination of HIV in Can Tho.

An estimated 33 million people are living with HIV and universal access remains a dream for millions of people. By the end of year 2008, four million people were on treatment; however, over five million needed treatment, and in 2007, there were 2.7 million new infections. Without significant improvement in prevention, we are unlikely to meet universal access targets including the growing demand for highly active antiretroviral treatment (HAART). This review examines HAART as a potential tool for preventing HIV transmission. We discuss recent scientific evidence regarding the treatment and prevention gap, importance viral load and HIV transmission, HAART and HIV transmission, when to start, HIV counseling and testing, modeling results and next steps. Summary HAART has considerable treatment and prevention benefits and it needs to be considered as a key element of combination prevention. To explore HAART as an effective prevention strategy, we recommend further evaluation of human rights and ethical considerations, clarification of research priorities and exploration of feasibility and acceptability issues.

Background Scale-up of hepatitis C virus (HCV) treatment for HIV/HCV coinfected individuals is occurring in Spain, the vast majority (> 85%) with a reported history of injecting drug use and a smaller population of co-infected men who have sex with men (MSM). We assess impact of recent treatment scale-up to people living with HIV (PLWH) and implications for achieving the WHO HCV incidence elimination target (80% reduction 2015–2030) among PLWH and overall in Andalusia, Spain, using dynamic modeling. Methods A dynamic transmission model of HCV/HIV coinfection was developed. The model was stratified by people who inject drugs (PWID) and MSM. The PWID component included dynamic HCV transmission from the HCV-monoinfected population. The model was calibrated to Andalusia based on published data and the HERACLES cohort (prospective cohort of HIV/HCV coinfected individuals representing > 99% coinfected individuals in care in Andalusia). From HERACLES, we incorporated HCV treatment am...

Objectives-We used an individual-based model to evaluate the effects of hypothetical prevention interventions on HIV incidence trajectories in a concentrated, mixed epidemic setting from 2011 to 2021, and using Cabo Verde as an example. Methods-Simulations were conducted to evaluate the extent to which early HIV treatment and optimization of care, HIV testing, condom distribution, and substance abuse treatment could eliminate new infections (i.e., reduce incidence to less than 10 cases per 10,000 person-years) among non-drug users, female sex workers (FSW), and people who use drugs (PWUD). Results-Scaling up all four interventions resulted in the largest decreases in HIV, with estimates ranging from 1.4 (95%CI:1.36-1.44) per 10,000 person-years among non-drug users to 8.2 (95%CI:7.8-8.6) per 10,000 person-years among PWUD in 2021. Intervention scenarios targeting FWS and PWUD also resulted in HIV incidence estimates at or below 10 per 10,000 person-years by 2021 for all population sub-groups. Conclusions-Our results suggest that scaling up multiple interventions among entire population is necessary to achieve elimination. However, prioritizing key populations with this combination prevention strategy may also result in a substantial decrease in total incidence.

Pre-exposure prophylaxis (PrEP) is recommended by the World Health Organization as an effective method of HIV prevention for individuals at risk for infection. In this paper, we describe the unique role that Thailand has played in the global effort to combat the HIV epidemic, including its role in proving the efficacy of PrEP, and discuss the opportunities and challenges of implementing PrEP in a middle-income country. Thailand was one of the first countries in the world to successfully reverse a generalized HIV epidemic. Despite this early success, HIV prevalence has remained high among people who inject drugs and has surged among men who have sex with men (MSM) and transgender women (TGW). Two pivotal trials that showed that the use of oral antiretroviral medication as PrEP can reduce HIV transmission were conducted partially or entirely at Thai sites. Demonstration projects of PrEP, as well as clinical trials of alternative PrEP regimens, began or will begin in 2014-2015 in Thail...

Background: Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission, yet patients interested in learning more about PrEP or in getting a PrEP prescription may not be able to find local medical providers willing to prescribe PrEP. We sought to create a national database of PrEP-providing clinics to allow for patients to have access to a unified, vetted source of PrEP providers in an easily accessible database. To develop the protocol and operating procedures for the PrEP Locator, we conducted a series of 7 key informant interviews with experts who had organized PrEP or other HIV service directories. We convened an external advisory committee and a collaborators board to gain expert and community-situated perspectives. Results: At its public release in September 2016, the database included 1,272 PrEP-providing clinics, including clinics in all 50 states and in Puerto Rico. Web searches, referrals, and outreach to state health departments identified 58 unique lists of PrEP-providing clinics, with 33 from state health departments, 6 from government localities, 2 from professional medical organizations, and 19 from nongovernmental organizations. Out of the 2,420 clinics identified from the lists and Web searches, we removed 798 as duplicate entries, and we determined that 350 were ineligible for listing. The most common reasons for ineligibility were not having the appropriate medical licensure to prescribe PrEP (67/350) or not prescribing PrEP, based on self-report (192/350). Key informant interviews shaped important protocol decisions, such as listing clinics instead of individual clinicians as the primary data element and streamlining data collection to facilitate scalability. We developed a Web interface to provide public access to the data, with geolocated data display, search filter functionality, a webform for public suggestions of new clinics, and a publicly available directory Web tool that can be embedded in websites. In the 6 months following release, preplocator.org and hosting websites had received over 35,000 unique views and 300 clinic additions, and 5 websites had initiated hosting of the widget. Conclusions: Directories exist for many preventive and treatment services. As new medical applications become available, there will be a corresponding need to develop new directories for service provision. Geolocated directories can assist patients in accessing care and have the potential to increase demand for and access to newer, more efficacious medical interventions. Early choices in the development of service directories have long-lasting impact, because once data collection begins, it can be challenging to reverse course. The PrEP Locator protocol may inform early decisions in the development of future service directories. Additionally, the case study on developing the PrEP Locator demonstrates the importance of formative work in identifying service-specific factors that can guide decisions on directory development.

HAL is a multi-disciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires publics ou privés. Distributed under a Creative Commons Attribution 4.0 International License Évaluer les interventions de prévention des IST et du VIH auprès des homosexuels masculins au Sénégal (projet ANRS 12139) -Rapport Scientifique

Introduction: People who inject drugs (PWID) experience high HIV incidence and face significant barriers to engagement in HIV care and substance use treatment. Strategies for HIV treatment as prevention and substance use treatment present unique challenges in PWID that may vary regionally. Understanding differences in the risk structure for HIV transmission and disease progression among PWID is essential in developing and effectively targeting intervention strategies of HIV treatment as prevention. Methods: We present a baseline analysis of HIV Prevention Trials Network (HPTN) 074, a two-arm, randomized controlled trial among PWID in Indonesia (n = 258), Ukraine (n = 457) and Vietnam (n = 439). HPTN 074 was designed to determine the feasibility, barriers and uptake of an integrated intervention combining health systems navigation and psychosocial counselling for the early engagement of antiretroviral therapy (ART) and substance use treatment for PWID living with HIV. Discordant PWID networks were enrolled, consisting of an HIV-positive index and their HIV-negative network injection partner (s). Among the enrolled cohort of 1154 participants (502 index participants and 652 network partners), we examine regional differences in the baseline risk structure, including sociodemographics, HIV and substance use treatment history, and injection and sexual risk behaviours. Results: The majority of participants were male (87%), with 82% of the enrolled females coming from Ukraine. The overall mean age was 34 (IQR: 30,. Most commonly injected substances included illegally manufactured methadone in Ukraine (84.2%), and heroin in Indonesia (81.8%) and Vietnam (99.5%). Injection network sizes varied by region: median number of people with whom participants self-reported injecting drugs was 3 (IQR: 2, 5) in Indonesia, 5 (IQR: 3, 10) in Ukraine and 3 (IQR: 2, 4) in Vietnam. Hazardous alcohol use, assessed using the Alcohol Use Disorders Identification Test -Alcohol Consumption Questions (AUDIT-C), was prominent in Ukraine (54.7%) and Vietnam (26.4%). Reported sexual risk behaviours in the past month, including having two or more sex partners and giving/receiving money or drugs in exchange for sex, were uncommon among all participants and regions. Conclusions: While regional differences in risk structure exist, PWID particularly in Ukraine need immediate attention for risk reduction strategies. Substantial regional differences in risk structure will require flexible, tailored treatment as prevention interventions for distinct PWID populations.

From July 2012 to January 2014, the CTN0049 study, Project HOPE (Hospital Visit as Opportunity for Prevention and Engagement for HIV-infected Drug Users) interviewed 1227 people with HIV infection from 11 hospitals in the US to determine eligibility for participation in a randomized trial. Using these screening interviews, we conducted a cross-sectional study with multivariable analysis to examine groups that are at highest risk for having a detectable viral load (VL) and engaging in HIV transmission behaviors. Viral suppression was 42.8%. Persons with a detectable VL were more likely to have sex partners who were HIV-negative or of unknown status (OR = 1.72, 95% CI = 1.22–2.38), report not cleaning needles after injecting drugs (OR = 3.13, 95% CI = 1.33–7.14), and to engage in sex acts while high on drugs or alcohol (OR = 1.85, 95% CI = 1.28–2.7) compared to their counterparts. Many hospitalized people with HIV infection are unsuppressed and more likely to engage in HIV transmissio...

The intersection of HIV-related health outcomes and problem substance use has been well documented. New York City continues to be a focal point of the U.S. HIV epidemic. In 2011, the NYC Department of Health and Mental Hygiene (NYC DOHMH) issued a recommendation that all HIV infected individuals should be offered antiretroviral therapy (ART) regardless of CD4 cell count or other indicators of disease progression. This policy is based in the concept of "treatment as prevention," in which providing ART to people living with HIV (PLWH) greatly reduces the likelihood of HIV transmission, while also improving individual health. The "ART for ALL" (AFA) study was designed to inform modifications to and identify gaps in the implementation of universal ART, and specifically to help guide allocation of resources to obtain local policy goals for increasing viral suppression among PLWH who have problem substance use. The AFA Study is informed by two complementary frameworks:...

We aim to show the feasibility of using an integrated prevention and care continuum (PCC) model as a complete and improved tool for HIV control measurement and programming. Alignment of prevention and care continua is essential to further improve health outcomes and minimize HIV transmission risk. Cross-sectional study. Data from 977 persons who inject drugs (PWID) collected in 2011-2016 in Tallinn, Estonia, were used to construct an HIV PCC for PWID, stratified by risk for acquiring or transmitting HIV infection and by coverage of combined interventions. We also estimated the average protective effect of current levels of intervention provision. 74.4%, 20.3% and 35.2% of PWID were currently using needle and syringe programmes (NSP), drug treatment and HIV testing, respectively. 51.1% of current PWID were HIV seropositive and of those 62.5% were currently on ART and 19.0% were virally suppressed. Across the PCC, individuals moved between categories of being aware and ever using drug

Malnutrition in children is an old and important public health problem. The spread of HIV in Africa adds and additional problem by itself and by its relations with another infections, in particular malnutrition. We studied the rela- tions between HIV infection and in malnutrition children in the INSP nutritional Center in Abidjan (Ivory Coast). Sera were taken from underfed children in 1980,86,87 and 88 and tested with ELISA and Western Blot, showing an incidence of HIV seropositivity of 7.8 -12.5 and 13,1%. This seropositivity rate is higher than in samples of pregnant women tested during the same years and the proportion of HIV-1 is also higher. Nutritional Recovery Centers can be an excellent ((warning station)) for Al DS especially as the detection of these children allows the detection of their mothers who constitute the most important {(target group)) (women of re- productive age). HIV infection also considerably worsens of these cases of malnutrition raising new Public Health problem mortality over 12 months, 63,6% for seropositives children versus 10,4% for seronegative children.

Human immunodeficiency virus type 1 (HIV-1) non-B subtype infections occurred in Belgium since the 1980s, mainly amongst migrants and heterosexuals, whereas subtype B predominated in men-having-sex-with-men (MSM). In the last decade, the diagnosis of F1 sub-subtype in particular has increased substantially, which prompted us to perform a detailed reconstruction of its epidemiological history. To this purpose, the Belgian AIDS Reference Laboratories collected HIV-1 pol sequences from all subsubtype F1-infected patients for whom genotypic drug resistance testing was requested

Introduction Knowing the factors associated with HIV transmission is necessary in order to design preventive programmes tailored to the epidemiological situation in each region and population. Aim Our objective was to study the sociodemographic, clinical and behavioural characteristics of men who have sex with men (MSM) who were newly diagnosed with HIV infection. Methods We carried out an observational, descriptive, study on all MSM newly diagnosed with HIV infection in one clinic for sexually transmitted infections (STI) and HIV clinic in Madrid between 2014 and 2019. Information on sociodemographic, clinical, and behavioural characteristics of participants per year of diagnosis was collected. Results We detected a total of 1,398 people with HIV infection, 253 of whom were recent seroconverters (rSCV) with a median duration of documented seroconversion of 6 months. From the total, 97.9% infections were sexually transmitted and 2.1% involved injected drugs, i.e. slam practices. The...

Aide suisse contre le sida. Lausanne : Institut universitaire de médecine sociale et préventive (Raisons de santé, 142) Remerciements : Nous tenons à remercier vivement tous les établissements (liste en annexe) dans lesquels l'enquête s'est déroulée, ainsi que le comité d'organisation de la gay pride 08, pour leur accueil et leur collaboration active lors de l'enquête d'évaluation. Egalement pour leur collaboration, nous remercions les équipes de Dialogai-checkpoint (Genève), de Checkpoint-Zurich (notamment Benedikt Zahno), Thomas Bucher, responsable de la campagne « Mission : Possible » à l'Aide suisse contre le sida et Martin Gebhardt, épidémiologiste à l'Office fédéral de la santé publique. Nos sincères remerciements vont enfin à Urs Wittwer pour la mise en oeuvre de l'enquête à Zurich, l'Aide suisse contre le sida, Myriam et Zénaïde (secrétariat) et aux enquêteurs qui ont très efficacement oeuvré à la récolte des données.

Nos remerciements vont à toutes les personnes qui ont répondu au questionnaire, ainsi qu'aux membres du groupe de travail HSH qui ont contribué à la mise sur pied du questionnaire. Nous remercions aussi chaleureusement l'Aide Suisse contre le Sida, les associations, journaux, sites Internet et Checkpoints qui ont diffusé le questionnaire. Wir danken sämtlichen Personen, die den Fragebogen ausgefüllt haben sowie den Mitgliedern der Arbeitsgruppe MSM, die an diesem Fragebogen mitgearbeitet haben. Ausserdem möchten wir uns herzlich bei dem Aids-Hilfe Schweiz, den Vereinigungen, der Schwulenpresse, den Internetseiten und den Checkpoints bedanken, die den Fragebogen verbreitet haben. Octobre 2015  CHUV -DUMSC ISSN 1660-7104 b Le slam est une pratique qui consiste à s'injecter des drogues de type psychostimulant (comme de la méphédrone) dans le but d'améliorer ses performances sexuelles. c La pertinence et la possibilité de regrouper les données 'papier' et 'internet' ont été testées en appliquant aux données des modèles de régressions logistiques emboîtés 19 .

La Suisse n'est pas une île, mais un navire privilégié qui vogue habilement sur les mers du monde avec des cales encore bien remplies. Son taux de chômage est bas, le produit national brut élevé, l'interconnexion est bonne et la protection des minorités est garantie. Est-ce à dire que tout va pour le mieux dans le meilleur des mondes? La revue Swiss Aids News a cherché à savoir s'il était facile d'être homosexuel en 2016 et donne ici la parole à des auteurs engagés. Andreas Lehner parle de la campagne #undetectable destinée aux gays, lancée voilà plus d'une année maintenant. Le chef du programme HSH à l'Aide Suisse contre le Sida explique ce que signifie «indétectable» pour les personnes séropositives, et pour les homosexuels en particulier. De son côté, Alexander Bücheli a écrit un texte engagé sur le chemsex, expliquant pourquoi il vaut mieux aborder le phénomène de front. Quant à Andreas Ziegler, il brosse un tableau des droits des homosexuels en Europe et en Suisse, avec le constat que tout n'est pas toujours facile. Nous avons également interviewé Emmanuelle Boffi au sujet de la PrEP ou prophylaxie pré-exposition qui consiste, pour une personne séronégative, à prendre des médicaments antirétroviraux à titre préventif pour se protéger d'une éventuelle infection par le VIH. Ci-contre, Tobias Urech décrit en toute franchise ce que signifie être jeune et gay en 2016. Enfin la revue se termine, comme à l'accoutumée, par les articles toujours très riches d'enseignements signés Caroline Suter, juriste à l'ASS, consacrés en l'occurrence à la protection des données sur internet. A propos, la revue Swiss Aids News a eu droit à un léger lifting. Elle a gagné en clarté et est désormais plus agréable à lire. C'est du moins notre avis. Qu'en pensez-vous? Nous serons heureux de recueillir vos réactions. Daniel Seiler, Directeur de l'Aide Suisse contre le Sida Edité par Aide Suisse contre le Sida (ASS) Office fédéral de la santé publique (OFSP) Rédaction Brigitta Javurek (jak), journaliste RP, rédactrice en chef Dr jur. LL. M. Caroline Suter (cs) BLaw Cliff Egli (ce), MLaw Julia Hug (jh) lic. phil. Stéphane Praz (sp) Fabien Bertrand (fbe) Nathan Schocher, chef programme personnes vivant avec le VIH (nsch)

Current ideas about HIV prevention include a mixture of primarily biomedical interventions, sociomechanical interventions such as sterile syringe and condom distribution, and behavioral interventions. This article presents a framework for socially-integrated transdisciplinary HIV prevention that may improve current prevention efforts. It first describes one socially-integrated transdisciplinary intervention project, the Transmission Reduction Intervention Project. We focus on how social aspects of the intervention integrate its component parts across disciplines and processes at different levels of analysis. We then present socially-integrated perspectives about how to improve combination antiretroviral treatment (cART) processes at the population level in order to solve the problems of the treatment cascade and make "treatment as prevention" more effective. Finally, we discuss some remaining problems and issues in such a social transdisciplinary intervention in the hope that other researchers and public health agents will develop additional socially-integrated interventions for HIV and other diseases.

Introduction: Towards the end of the twentieth century, significant success was achieved in reducing incidence in several global HIV epidemics through ongoing prevention strategies. However, further progress in risk reduction was uncertain. For one thing, it was clear that social vulnerability had to be addressed, through research on interventions addressing health systems and other structural barriers. As soon as antiretroviral treatment became available, researchers started to conceive that antiretrovirals might play a role in decreasing either susceptibility in uninfected people or infectiousness among people living with HIV. In this paper we focus on the origin, present status, and potential contribution of pre-exposure prophylaxis (PrEP) within the combination HIV prevention framework. Discussion: After a phase of controversy, PrEP efficacy trials took off. By 2015, daily oral PrEP, using tenofovir alone or in combination with emtricitabine, has been proven efficacious, though efficacy seems heavily contingent upon adherence to pill uptake. Initial demonstration projects after release of efficacy results have shown that PrEP can be implemented in real settings and adherence can be high, leading to high effectiveness. Despite its substantial potential, beliefs persist about unfeasibility in reallife settings due to stigma, cost, adherence, and potential risk compensation barriers. Conclusions: The strategic synergy of behavioural change communication, biomedical strategies (including PrEP), and structural programmes is providing the basis for the combination HIV prevention framework. If PrEP is to ever become a key component of that framework, several negative beliefs must be confronted based on emerging evidence; moreover, research gaps regarding PrEP implementation must be filled, and appropriate prioritization strategies must be set up. Those challenges are significant, proportional to the impact that PrEP implementation may have in the global response to HIV.

HAL is a multidisciplinary open access archive for the deposit and dissemination of scientific research documents, whether they are published or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers. L'archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d'enseignement et de recherche français ou étrangers, des laboratoires REMERCIEMENTS Nous remercions les associations partenaires : AFSA, MAD' AIDS, AINGA AIDES et Solidarité des LGBT. Elles se sont appropriées les enquêtes et persévéraient malgré les innombrables difficultés rencontrées. Nos reconnaissances s'adresse aux enquêteurs et superviseurs car grâce à leurs efforts et subtilités, nous avons pu recruter les répondants souvent qualifiés d' être « difficiles d'accès ». Nous remercions également les participants et participantes qui ont consenti à nous livrer des informations précieuses ayant permis de sortir des données qui les représentent. Nos remerciements s'adressent aussi au ministère de la Santé publique de Madagascar et au personnel de santé et médecins référents qui ont joué un rôle prépondérant dans les études. Nous remercions chaleureusement Charlotte Dézé et Laurence Baryl pour leur soutien inconditionnel tout au long de l'observatoire. Leurs orientations scientifiques ont rehaussé indéniablement la qualité des données et de la rédaction. Finalement, nous formulons notre gratitude à l' égard d'Expertise France pour leur soutien financier et leur support.

Background Despite therapeutic progress, HIV remains a public health issue with about 6400 new HIV contaminations each year in France. HIV prevention relies on health education, early screening, treatment as prevention, post and pre-exposure prophylaxis. Patients’ visits to free sexually transmitted infections (STIs) screening centers (CeGIDD) are opportunities to spread prevention messages. This study aimed to assess level of HIV knowledge in a Parisian CeGIDD to improve prevention messages. Methods The study included patients older than 18 who came for STIs testing between August 2017 and August 2018 and who understand written French language. Data were collected by a self-administered electronic questionnaire filled in before medical consultation. It included sociodemographic data and knowledge regarding HIV transmission and prevention. Results The study included 2002 patients. The median age was 27 years and 66% were men. More than 96% of patients know that HIV transmission is p...

Chronic infections with hepatitis C virus (HCV) and HIV are highly prevalent in the USA and concentrated in people who inject drugs. Treatment as prevention with highly effective new direct-acting antivirals is a prospective HCV elimination strategy. We used network-based modelling to analyse the effect of this strategy in HCV-infected people who inject drugs in a US city. Five graph models were fit using data from 1574 people who inject drugs in Hartford, CT, USA. We used a degree-corrected stochastic block model, based on goodness-of-fit, to model networks of injection drug users. We simulated transmission of HCV and HIV through this network with varying levels of HCV treatment coverage (0%, 3%, 6%, 12%, or 24%) and varying baseline HCV prevalence in people who inject drugs (30%, 60%, 75%, or 85%). We compared the effectiveness of seven treatment-as-prevention strategies on reducing HCV prevalence over 10 years and 20 years versus no treatment. The strategies consisted of treatmen...

Background: Treatment of hepatitis C (HCV) is very effective, achieving a cure in 50-90% of patients. Besides its own good for individuals, this most likely translates in reduced transmission, but this phenomenon has yet to be fully explored. Methods and Findings: In this mathematical modeling study done in the context of Vietnam, we estimated the public health benefit that HCV therapy for injecting drug users (IDUs) may achieve. Treatment coverage of 25, 50 and 75% of chronically HCV-infected IDUs (4 years into infection) is predicted to reduce the chronic HCV viremia prevalence respectively by 21, 37 and 50%, 11 years after full scale up to the intended coverage. At a constant 50% coverage level, earlier treatment, 3, 2, and 1 year into infection is predicted to reduce the chronic HCV viremia prevalence by 46, 60 and 85%. In these later 3 scenarios, for every 100 treatment courses provided, a total of respectively 50, 61 and 94 new infections could be averted. These benefits were projected in the context of current low coverage of methadone maintenance therapy and needles/ syringes exchange programs, and these services expansion showed complementary preventive benefits to HCV therapy. The program treatment commitment associated with the various scenarios is deemed reasonable. Our model projections are robust under adjustment for uncertainty in the model parameter values. Conclusions: In this case study in Vietnam, we project that treatment of HCV for injecting drug users will have a preventative herd effect in addition to curing patients in need for therapy, achieving a substantial reduction in HCV transmission and prevalence.

Background: The criminal justice system (CJS), specifically prisons and jails, is ideally suited for uniform screening of psychiatric (PD) and substance use disorders (SUDs) among people living with HIV/AIDS (PLWHA), who are concentrated in these settings. By accurately diagnosing PDs and SUDs in these controlled settings, treatment can be initiated and contribute to improved continuity of care upon release. In the context of PLWHA, it may also improve combination antiretroviral treatment (cART) adherence, and reduce HIV transmission risk behaviors. Methods: A retrospective data analysis was conducted by creating a cohort of PLWHA transitioning to the community from prison or jail enrolled who were enrolled in a controlled trial of directly administered antiretroviral (DAART). Participants were systematically assessed for PDs and SUDs using the Mini International Neuropsychiatric Interview (MINI), a standardized psychiatric assessment tool, and compared to diagnoses documented within the correctional medical record. Results: Findings confirm a high prevalence of Axis I PDs (47.4%) and SUDs (67.1%) in PLWHA even after prolonged abstinence from alcohol and drugs. Although prevalence of PDs and SUDs were high in the medical record, there was fair to poor agreement among PDs using the MINI, making evident the potential benefit of more objective and concurrent PD assessments to guide treatment. Conclusions: Additional PD diagnoses may be detected in PLWHA in CJS using supplementary and objective screening tools. By identifying and treating PDs and SUDs in the CJS, care may be improved and may ultimately contribute to healthier outcomes after community release if patients are effectively transitioned.

Background Depression and alcohol use disorder are very common among people living with HIV infection, these disorders are not only common among HIV patients but also associated with antiretroviral therapy (ART) non adherence, morbidity and mortality. Objective The objective of our study is to study the prevalence of Depression, Alcohol use, and ART treatment adherence. Method This is a analytical cross-sectional study. Total of 221 participants were included in the study. Convenient method of sampling was used to collect the data from three district Kathmandu, Lalitpur and Kavre ART (Antiretroviral treatment) clinics. Beck Depression Inventory (BDI) was used for the assessment of depression, Alcohol use disorders identification test (AUDIT) was used for alcohol related problems and Visual analogue scale (VAS) was used for treatment adherence. Chi square test and multiple linear regression analysis were conducted for testing bivariate and multivariate relationship of sociodemographi...

As HIV/AIDS remains a significant concern, effective drug treatments are essential for managing the disease across large populations. Highly Active Antiretroviral Therapy (HAART) offers effective control over viral replication but comes with potential side effects, particularly with long-term use. Current treatments face challenges such as multidrug resistance, the spread of drug-resistant HIV strains, and the need for lifelong therapy. To enhance patient adherence and simplify treatment regimens, there is a need for effective fixed-dose combinations (FDCs). In this review, novel drug therapies for the treatment of HIV/AIDS will be here discussed. Several new drugs, delivery systems, and vaccines have undergone testing in pre-clinical and clinical trials. In terms of drug delivery, modifying the administration route for some traditional antiretrovirals has been successful, addressing various patient compliance issues. Nanotechnology has introduced innovative solutions for formulation challenges, such as drug solubility and distribution in the body. Encapsulating antiretroviral drugs in nanosystems has led to better drug release and improved pharmacokinetic profiles.

Introduction. les rapports hétérosexuels sont la principale voie de transmission du VIH au cours de l'épidémie mondiale actuelle du SIDA. Ainsi, en Afrique sub-saharienne, la plupart des femmes sont infectées par leur conjoint, dans le cadre des relations sexuelles conjugales. Objectif. Évaluer le risque conjugal d'exposition au VIH chez les patients suivis dans le service de maladies infectieuses du CHU du Point-G, Mali. Méthodologie. Il s'agit d'une étude prospective, transversale et descriptive portant sur les personnes vivant avec le VIH/SIDA (PVVIH) suivies dans le service de maladies infectieuses de janvier à juin 2014. Les données portant sur les facteurs de risque de la transmission sexuelle du VIH, sociodémographiques et les informations relatives à leur vie de couple ont été cueillies à partir d'un questionnaire lors des entrevues individuelles. Résultats. Nous avions colligé 110 patients dont 37 hommes (33.6%) et 73 femmes (66.40%), parmi lesquelles 31 (28,20%) étaient dans un régime polygamique. Les rapports sexuels extraconjugaux ont été notés chez 25 patients (22,70%). Les rapports sexuels n'étaient pas protégés chez 73 patients et parmi eux, 26 patients avaient une charge virale détectable. Parmi ces 26 patients, neuf patients avaient eu des rapports sexuels extraconjugaux non protégés. La sérologie VIH était positive chez 68,4% parmi 53 conjoints dépistés. 49 patients (44.55%) avaient un taux de lymphocytes TCD4 compris entre 351 et 500 et 35 patients (31.82%) avaient un taux de lymphocytes TCD4 supérieurs à 500. Conclusion. Deux tiers des PVVIH ont des rapports sexuels non protégés avec leurs conjoints souvent parce que le conjoint n'a pas été informé, parfois parce qu'elle refuse ou est déjà lui séropositif. Près d'un patient sur quatre a des rapports extraconjugaux. Le VIH/SIDA constitue toujours un sujet tabou dans notre société. Il est important de renforcer la communication sur le changement de comportement positif afin d'améliorer l'utilisation des mesures préventives et faciliter la prise en charge des PVVIH.

Since October 2015 up to September 2016, HIV diagnoses fell by 32% compared with October 2014-September 2015 among men who have sex with men (MSM) attending selected London sexual health clinics. This coincided with high HIV testing volumes and rapid initiation of treatment on diagnosis. The fall was most apparent in new HIV testers. Intensified testing of high-risk populations, combined with immediately received anti-retroviral therapy and a pre-exposure prophylaxis (PrEP) programme, may make elimination of HIV achievable.

Increasing access to direct-acting antiviral (DAA)-treatment for hepatitis C virus (HCV) infection and decelerating the rise in high-risk behaviour over the next decade, could curb the HCV epidemic among HIV-positive men-who-have-sex-with-men (MSM). We investigated if similar outcomes would be achieved by short-term intensive interventions like the Swiss-HCVree-trial. We used a HCV-transmission model emulating two 12-months intensive-interventions combining risk-counselling with 1) universal DAA-treatment (pangenotypic intervention) and 2) DAA-treatment for HCV-genotypes 1 and 4 (replicating the Swiss-HCVree-trial). To capture potential changes outside intensive-interventions, we varied time from HCV-infection to treatment in clinical-routine and overall high-risk behaviour among HIV-positive MSM. Simulated prevalence dropped from 5.5% in 2016 to ≤2.0% over the intervention period (June/2016-May/2017) with the pangenotypic-intervention, and to ≤3.6% with the Swiss-HCVree-trial. Assu...

The elimination of HIV and syphilis from Puerto Rico as per metrics of the World Health Organization has been achieved despite continued HIV risk and high background prevalence. Excellence in antenatal services and screening, deployment of antiretroviral and penicillin syphilis therapies, and proper follow-through with mothers and infants has yielded success even as control of infection overall remains elusive. We highlight the context of this achievement in our editorial to accompany the article: "

De plus en plus d'essais cliniques se déroulent dans les pays du Sud. Contrairement aux pays du Nord, où dans les années 1990 les associations critiquaient l'absence de femmes dans les essais, les femmes sont quatre fois plus nombreuses que les hommes parmi les participants lors du dernier d'entre eux mené à Dakar. Cela rend particulièrement aiguë la question de la survenue de grossesses dans les essais. Ce chapitre analyse cette féminisation des participants aux essais, avec la question de savoir si celle-ci résulte des modalités d'inclusion. Le mode de prise en charge des femmes enceintes dans les essais sera présenté et discuté à partir de l'expérience des femmes, des soignants et des chercheurs. Les problèmes que pose la féminisation des participants aux essais cliniques seront discutés, notamment pour ce qui concerne les limites du dispositif de prise en charge en matière de contraception, les dispositions éthiques exigées et la possibilité de critères d'inclusion basés sur le sexe.

; For the HPTN (065) TLC-Plus Study Team Background: Use of antiretroviral therapy (ART) to prevent HIV transmission has received substantial attention after a recent trial demonstrating efficacy of ART to reduce HIV transmission in HIV-discordant couples. Objective: To assess practices and attitudes of HIV clinicians regarding early initiation of ART for treatment and prevention of HIV at sites participating in the HIV Prevention Trials Network 065 study. Design: Cross-sectional internet-based survey. Methods: ART-prescribing clinicians (n = 165 physicians, nurse practitioners, physician assistants) at 38 HIV care sites in Bronx, NY, and Washington, DC, completed a brief anonymous Internet survey, before any participation in the HIV Prevention Trials Network 065 study. Analyses included associations between clinician characteristics and willingness to prescribe ART for prevention. Results: Almost all respondents (95%), of whom 59% were female, 66% white, and 77% HIV specialists, "strongly agreed/agreed" that early ART can decrease HIV transmission. Fifty-six percent currently recommend ART initiation for HIV-infected patients with CD4+ count ,500 cells per cubic millimeter, and 14% indicated that they initiate ART irrespective of CD4+ count. Most (75%) indicated that they would consider initiating ART earlier than otherwise indicated for patients in HIV-discordant sexual partnerships, and 40% would do so if a patient was having unprotected sex with a partner of unknown HIV status. There were no significant differences by age, gender, or clinician type in likelihood of initiating ART for reasons including HIV transmission prevention to sexual partners. Conclusions: This sample of US clinicians indicated support for early ART initiation to prevent HIV transmission, especially for situations where such transmission would be more likely to occur.

Background: Treatment of hepatitis C (HCV) is very effective, achieving a cure in 50-90% of patients. Besides its own good for individuals, this most likely translates in reduced transmission, but this phenomenon has yet to be fully explored. Methods and Findings: In this mathematical modeling study done in the context of Vietnam, we estimated the public health benefit that HCV therapy for injecting drug users (IDUs) may achieve. Treatment coverage of 25, 50 and 75% of chronically HCV-infected IDUs (4 years into infection) is predicted to reduce the chronic HCV viremia prevalence respectively by 21, 37 and 50%, 11 years after full scale up to the intended coverage. At a constant 50% coverage level, earlier treatment, 3, 2, and 1 year into infection is predicted to reduce the chronic HCV viremia prevalence by 46, 60 and 85%. In these later 3 scenarios, for every 100 treatment courses provided, a total of respectively 50, 61 and 94 new infections could be averted. These benefits were projected in the context of current low coverage of methadone maintenance therapy and needles/ syringes exchange programs, and these services expansion showed complementary preventive benefits to HCV therapy. The program treatment commitment associated with the various scenarios is deemed reasonable. Our model projections are robust under adjustment for uncertainty in the model parameter values. Conclusions: In this case study in Vietnam, we project that treatment of HCV for injecting drug users will have a preventative herd effect in addition to curing patients in need for therapy, achieving a substantial reduction in HCV transmission and prevalence.

Recent advances in the field of biomedical prevention have induced optimism among both the scientific community and the public in general. The discussion of the research evidence is complemented with a discussion of the implications of this evidence for the Caribbean, highlighting the issues and controversies that should be considered in order to encourage and advance the responsible consideration of biomedical strategies. Traditionally, HIV prevention strategies have been characterized as predominantly behavior, social or biomedical. In practice, however, some strategies defy classification: even when they rely on technological or pharmaceutical elements, they have to be adopted by a society and the individuals within it. Moreover, whatever the strategy used, it will have to be distributed, implemented and made available through health care systems or other means. And its cost will be absorbed by specific funders or by society in general. Given the current historical context of the HIV/ AIDS epidemic and the array of strategies required to control it, these distinctions (biomedical vs. behavior) can hinder the collaborations required to provide the needed combinations of strategies. The efficacy of the diverse strategies range from: 99% for programs to prevent MTCT, 63% for pre-exposure prophylaxis (PrEP), 96% for treatment as prevention, 39% for vaginal microbicides (54% with good adherence), post exposure prophylaxis (PEP), 31% for a vaccine and 53-60% for medical voluntary adult circumcision. To curtail and eliminate the HIV/AIDS epidemic in the future, expansion and scaled-up implementation of combinations of such strategies will be needed. [

Neuropsychiatric adverse events (NPAEs) observed with the integrase strand transfer inhibitor (INSTI) dolutegravir (DTG) are usually mild to moderate. The most prevalent symptoms are insomnia and sleep disorders, but the spectrum also includes dizziness, anxiety, depression, headache, paraesthesia, muscleskeletal pain, poor concentration, and slow thinking. In recent cohort studies involving >6400 patients in different countries, discontinuation rates due to NPAEs were observed in around 3.5% (range, 1.4-7.2%) of subjects treated with DTG. These rates have been higher than those seen in randomized clinical trials and were also higher than with other INSTIs such as elvitegravir or raltegravir. Elderly, female patients and those who initiate abacavir simultaneously appear to be more vulnerable in some cohorts. It remains unclear if NPAEs are driven by an increased DTG exposure. With heightened awareness of health-care providers and patients, reports of NPAEs will probably increase in the future.