Current HIV/AIDS Reports

, Volume 10, Issue 2, pp 169–186 | Cite as

Combination Prevention: New Hope for Stopping the Epidemic

  • Sten H. VermundEmail author
  • Richard J. Hayes
Open Access
The Global Epidemic (Q Abdool Karim, Section Editor)


HIV research has identified approaches that can be combined to be more effective in transmission reduction than any 1 modality alone: delayed adolescent sexual debut, mutual monogamy or sexual partner reduction, correct and consistent condom use, pre-exposure prophylaxis with oral antiretroviral drugs or vaginal microbicides, voluntary medical male circumcision, antiretroviral therapy (ART) for prevention (including prevention of mother to child HIV transmission [PMTCT]), treatment of sexually transmitted infections, use of clean needles for all injections, blood screening prior to donation, a future HIV prime/boost vaccine, and the female condom. The extent to which evidence-based modalities can be combined to prevent substantial HIV transmission is largely unknown, but combination approaches that are truly implementable in field conditions are likely to be far more effective than single interventions alone. Analogous to PMTCT, “treatment as prevention” for adult-to-adult transmission reduction includes expanded HIV testing, linkage to care, antiretroviral coverage, retention in care, adherence to therapy, and management of key co-morbidities such as depression and substance use. With successful viral suppression, persons with HIV are far less infectious to others, as we see in the fields of sexually transmitted infection control and mycobacterial disease control (tuberculosis and leprosy). Combination approaches are complex, may involve high program costs, and require substantial global commitments. We present a rationale for such investments and cite an ongoing research agenda that seeks to determine how feasible and cost-effective a combination prevention approach would be in a variety of epidemic contexts, notably that in a sub-Saharan Africa.


HIV Prevention Combination approaches Treatment as prevention Africa Circumcision Behavior change Global epidemic HIV transmission Antiretroviral therapy (ART) Prevention of mother to child HIV transmission (PMTCT) Combination prevention 


Many infectious diseases have required a combination of approaches to reduce transmission [1]. Tuberculosis control relies on case detection, treatment, and contact tracing to find yet more cases for prophylaxis or treatment (Table 1). Malaria control may incorporate bed nets, vector control, intermittent presumptive treatment, case finding and treatment, and we hope in the not-too-distant future, a malaria vaccine. Nosocomial infections may use rigorous multi-component protocols to ensure the full array of preventive strategies in health care settings. Helminth infections may be controlled with combinations of sanitation, vector control, mass chemotherapy, and surveillance to assess where the major impact may be seen (Table 1). HIV is a sexually transmitted infection (STI), propagated by human sexual behavior. Other STIs have required combinations of case finding and treatment, behavior change (eg, fewer sexual partners), risk reduction (eg, condoms), and even structural changes (eg, 100 % condom use policies in brothels) to achieve successful control. The inability to cure HIV with current therapies renders its effective control much more challenging.
Table 1

Examples of infectious diseases for which combination prevention approaches are essential for reducing transmission: Tuberculosis, Malaria, Nosocomial infections, Helminths [325, 326, 327, 328]

Infection and key strategy

Key elements for control strategies using tools available in 2013 (note that many elements listed under 1 disease might well apply to other diseases)

Tuberculosis: Directly Observed Treatment, Short Course

• Political commitment and adequate financing

• Case detection with high quality diagnostics, including drug sensitivities

• Standardized treatment with patient support to maximize adherence

• Effective drug supply and management system

• Monitoring and evaluation to measure impact

Malaria: Reducing the basic reproduction rate

• Reduction of human infectivity with early diagnosis and effective treatment

• Reduction in vectorial capacity with effective, sustained mosquito control

• Avoidance of mosquito bites through consistent use of bed-nets

• Intermittent presumptive treatment

• Measures to reduce global warming

• Partially protective vaccine

Nosocomial infections: Reducing patient exposures

• Enhanced real-time surveillance and immediate feedback

• Implementation of clinical protocols based on evidence-based interventions, eg,

 ○ Hand hygiene, vaccines, clean environment, prudent prescribing

• Training, audit, and performance management focus

(targets, legislation)

 ○ Management commitment to rigorous protocols, eg, flu vaccine

Helminths: Control of poly-worm infections

• Vector control, eg, specific species of snails, mosquitoes, black flies

• Reduce exposures, eg, laundries away from streams, dispose fecal waste

• Case finding and treatment; mass drug administrations

• Disease surveillance with concentrated effort on highest intensity infections

A feature of many STIs is the replenishment of an at-risk pool of persons as children age into adolescence and adulthood. About half of the world’s global population is under age 25 and it is estimated that nearly half of all HIV infections are also among persons under age 25, most ages 15-24 [2]. The intensity of risk for adolescents and youth is especially high in sub-Saharan Africa once they become sexually active, given the likelihood of a sexual partner being HIV-infected [3, 4, 5, 6, 7]. Over a third of infected persons globally live in just 10 nations of southern Africa where the epidemic is driven by heterosexual contact [8, 9]. Injection drug use and male-to-male sexual contact seem to be increasing in this region, and are the major drivers of the epidemic in other parts of the world [10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31]. Iatrogenic spread is also prevalent [32, 33].

While individual approaches to HIV prevention have had some success, most interventions are of limited, partial, or unproven effectiveness. Any single intervention is unlikely to be sufficient to achieve the steep reductions in incidence that is needed to bring the epidemic under control, especially in sub-Saharan Africa where high rates of transmission in the general population are the norm.

Elements of Combination Prevention

Evidence for efficacy of elements of combination prevention can come from observational data (as with male condoms or reduction in partner numbers) or from randomized clinical trials (RCTs; as with male circumcision or early treatment as prevention). What elements might be considered essential for successful combination prevention are a matter of debate, but can be elucidated with decision-analysis and HIV transmission models (Table 2). A consensus is emerging that combination prevention should be anchored on the use of combination antiretroviral therapy (cART) given that infected persons who receive and are adherent to cART regimens can suppress HIV replication and reduce their infectiousness [34, 35, 36•, 37]. As of this writing (late 2012), Ministries of Heath of low and middle income countries (LMIC) typically limit their start of cART at the World Health Organization (WHO) recommended threshold of CD4+ cell counts <350/μL or WHO clinical status 3 or 4 [37]. Some of the most resource-limited nations continue to authorize the start of cART at a lower threshold like <250 cells/μL, despite overwhelming evidence that this is too late for optimal clinical response [38]. A large proportion of transmissions occur before patients reach the usual thresholds for ART initiation, however, a rationale for treating at earlier CD4+ cell counts (or even universal ART for all HIV-infected persons).
Table 2

Elements of combination prevention likely to synergize to improve the effectiveness of prevention programs for HIV infection [184•, 329•, 330, 331•, 332, 333, 334, 335]


Goal(s) to be achieved

Personal elements

  Treatment as prevention

Increased HIV testing, linkage to care, coverage with cART, retention and adherence; lower viral load and infectiousness

  Voluntary medical male circumcision

In high prevalence areas driven by heterosexual transmission dynamics, increase circumcision among men


Encourage delayed sexual debut among adolescents

  Partner reduction

Encourage mutual monogamy and reduced sexual partners

  Physical barriers

Market male condoms widely, and where appropriate, female condoms

  Chemical barriers

Pre-exposure prophylaxis with antiretroviral drugs, both oral and topical (ie, microbicides)

  STI control

Reduce both ulcerative and non-ulcerative STIs via diagnosis, treatment, and partner notification (contact tracing)

  Prevention of mother to child transmission

Universal testing of pregnant women and protocol-driven ART for mother and newborn child

  Nosocomial and iatrogenic transmission

Clean needle use for all medical encounters; use of infection-screened blood products with modern blood-banking techniques

Societal elements

  School attendance

Maximal school attendance by children and youth

  Workplace policies

Enable workers to live with their families

  Human rights and legal protections

Protect the rights of HIV-infected persons, widows, minority populations such as men who have sex with men, women/girls, vulnerable populations

  Structural changes

100 % condom policies in brothels and universal availability in public places, hotels, and key venues where high risk sex occurs

  Community mobilization

Engage communities in HIV control; reduce stigma, increase disclosure of status, increase coverage and adherence

Program elements

  Health workforce development

Increase substantially the numbers of health care providers for both rural and urban settings; Efficient allocation of tasks

  Integration of services

Nest HIV/AIDS care and treatment within sustainable primary care and reproductive care services, including family planning

  Physical infrastructures

Provide basic electricity, water, medical waste disposal, and space for health centers

  Pharmacy logistics systems

Ensure that inventory management, shipping, and storage systems avoid supply (eg, test kits) and drug stock-outs

  Laboratory development

Decentralize laboratory work, as much as possible and affordable, with point-of-care diagnostic tests

  Quality of care and iterative evaluation

Build sustainable quality improvement research and systems improvement efforts into HIV care programs

  Hub-and-spoke models of care

Bring primary and HIV/AIDS care closer to people who are remote from major clinical services; home-based HIV testing

  Data management systems

Build sustainable, affordable electronic medical record systems to harmonize the myriad of systems now extant

  Community engagement to support programs

Implement innovative community models of outreach, retention, and adherence support, including patient-to-patient and family-to-patient

  Cultural changes in the health sector

Train staff and reform procedures to protect patient confidentiality/privacy, provide more respectful, client-friendly services in familiar local languages

  Management and administration

Train and capacitate health systems to use modern business practices for financial and logistical management

The HIV Prevention Trials Network 052 protocol (HPTN 052) was an RCT that assessed early initiation of cART at CD4+ cell counts of up to 550/μL, demonstrating both reduced transmission of HIV to sexual partners as well as clinical benefits to their infected partners on cART [40••]. Hence it is disappointing that only 19 %–28 % (range of estimates) of Americans infected with HIV were on cART with successful suppression of HIV viral load [40••, 41••, 42•, 43•]. Even if these are overly pessimistic estimates due to some “lost-to-follow-up” patients possibly being in therapy elsewhere, the true rates of ART coverage and viral suppression are disappointing, in both high and low income nations [44, 45, 46, 47, 48•, 49•, 50, 51, 52, 53, 54•, 55•]. In selected venues, ecological evidence of prevention benefits from cART is emerging [56•, 57••, 58]. Ecological analyses in San Francisco, Vancouver, China, Taiwan, and KwaZulu-Natal have suggested that higher cART coverage may correlate with lower seroincidence rates [56, 57, 58, 59, 60, 61]. However, it is unknown whether these correlations represent success of TasP or whether other factors are contributing [62, 63].

Vancouver is a case in point. Investigators and public health officials have addressed prevention of HIV with needle/syringe exchange and opiate substitution therapy among Vancouver IDUs at the same time that cART was being made available [64]. Hence, it is hard to disaggregate the prevention impact of needle/syringe exchange and expanded heroin addiction therapy from cART expansion or other factors. Western Europe is also a region of interest [65]. It is easy to speculate that easy access to HIV testing and widespread cART use within national health systems may have resulted in lowering HIV incidence rates in Western Europe, but it is hard to know whether other sociocultural factors or prevention efforts also made impacts. However, in the United Kingdom where access to testing and treatment is facilitated by the National Health System (NHS) with free services available to all, no reduction in the incidence of new infections in MSM has been noted to date, so interpreting European experiences is not always clear-cut.

The option of moving to immediate offering of ART— irrespective of CD4+ cell count-is being supported by public health policy in San Francisco, Vancouver, New York City, and elsewhere. If HIV testing were expanded markedly and all persons were treated shortly after diagnosis and successful virally suppressed, then fewer infectious persons would be transmitting to others and the epidemic might decline. Whether this is possible is the topic of intense current investigation.

Suboptimal cART Coverage and Viral Suppression

Patient management issues are complex for HIV disease (Table 2). Rather than the lethal diagnosis for so many in the pre-treatment era, HIV disease is now a chronic, manageable disease. It requires HIV testing, linkage to care, cART availability, national guidelines permitting cART administration, and adherence to lifelong therapeutic regimens. In the US, current systems fail to meet the full need of HIV-infected patients, many of whom have co-morbidities that inhibit full viral suppression [41••, 42•, 43•]. These may include substance use (eg, drugs and/or alcohol), mental health problems, financial and health care insurance challenges, transportation issues, and stigma/disclosure challenges [66, 67, 68, 69, 70, 71, 72, 73, 74, 75, 76, 77, 78, 79, 80, 81, 82, 83, 84, 85, 86, 87]. In LMICs, it is plausible that less than 10 % of all infected persons are successfully virally suppressed. Stigmatized persons who do not “come out” may not reach medical care or be retained in care, as is the case with Black men who have sex with men (MSM) in the US [88, 89, 90, 91, 92, 93, 94, 95, 96, 97, 98, 99]. Adolescents with HIV infection have demonstrated abysmal adherence rates in some studies [100, 101, 102, 103, 104, 105, 106, 107, 108]. Children with HIV are dependent on their parents or guardians; many children have not had their HIV status disclosed to them and may not be participating actively in their ongoing care [109, 110, 111, 112, 113, 114, 115].

The gulf between current guidelines for high income countries where all HIV-infected persons are typically offered cART vs WHO and LMIC Ministries of Health guidelines that offer a smaller proportion of HIV-infected persons cART (typically persons under 350 CD4+ cells/μL) is worth highlighting. By definition, the latter policies have a larger pool of infected persons who remain virally unsuppressed. If resources were obtained to treat all HIV-infected individuals (ie, universal, immediate cART), the proportion of infectious persons would decline. If a large enough pool of infectious persons were made non-infectious, mathematical models suggest a decline in new infections. It is not certain that a test-and-treat prevention strategy is feasible, acceptable, sustainable, and affordable. The most resource-limited LMICs depend on the programmatic resources available from the President’s Emergency Program for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria; local Ministries of Health rarely have the resources to find, link, and retain HIV-infected persons in cART-based care, with optimized adherence [116, 117, 118, 119, 120]. The long-term management of chronic diseases in LMICs is challenging; HIV investments may serve as a backbone for also addressing a wide variety of diseases requiring chronic management [39, 47, 52, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132•, 133, 134, 135, 136, 137, 138].

We also do not know whether a test-and-treat approach will have the postulated benefits in a real world circumstance. Whether we can further enhance its benefits with other prevention modalities without overwhelming the public health and clinical systems is also unknown. While behavior change is a component of all approaches, some combined interventions only make sense in certain epidemic circumstances, as with male circumcision in generalized epidemics and needle exchange where IDU drives transmissions.

Adapting for Local Epidemics

HIV is a disease based on patterns of human behavior; hence, it is affected and modulated by stigma, discrimination, prejudice, fear, stress, depression, denial, and ignorance [80, 139]. Many have compared AIDS to the leprosy of the Bible when infected persons were shunned and even banished. Since HIV is transmitted similarly to patterns for other sexual and blood-borne agents, it is subjected to the same societal distress surrounding other STIs. HIV transmission is more likely in the face of multiple sexual partners (ie, high mixing rates) and failure to use condoms, so persons acquiring infection are typically judged by others [8]. However, we must put stigma into its modern perspective. While a major problem in most areas, especially perhaps in concentrated epidemics in marginalized risk-groups, there are also signs of “normalization” of HIV as a public health problem in both higher income and LMICs, including in southern Africa. We speculate that wider access to cART has contributed to an improving social environment for many persons living with HIV.

Much progress has been made in the avoidance of iatrogenic and occupational parenteral transmission unclean syringes and needles through single use technologies, serological screening of blood or blood products, and policies to reduce inadvertent needle sticks in an occupational health care setting. Progress, too, has been made in offering universal screening of pregnant women and the offering, uptake, and adherence to 1 of a variety of antiretroviral therapy options, pre-partum, intra-partum, or post-partum, to avoid mother-to-child transmission that can take place in utero, during delivery, or from breastfeeding, respectively [140, 141, 142, 143, 144]. Yet too often, successful programs are not integrated and potential synergies for combination prevention are lost. If testing/treatment successes in PMTCT, say, could be expanded into the analogous treatment as prevention cascade for adults, we might well combine components of prevention into an integrated whole, with the kind of impact on incidence not often seen in the global pandemic.

Hepatitis B virus (HBV) is spread in ways reminiscent of HIV, though HBV is typically more communicable [145, 146]. Our tools for HBV control include active and passive immunization, tools that are not yet available for HIV control. In addition, HIV infection is not yet curable, such that persons whose viral loads are not suppressed can transmit the infection for many years. Other STIs can also be spread via blood-borne routes (eg, syphilis, hepatitis C virus [HCV], and human T-lymphotropic virus type 1 [HTLV-1]), but sexual routes are the dominant mode of transmission for most STIs, as with HIV. The CD4+ T-lymphocyte tropism of HIV makes it unique among the STIs and its penchant for deep lymphoid tissue invasion and quiescence are the roots of it incurability.

Stigma, Discrimination, Poverty, and Human Rights

HIV spread is steeped in gender inequality, poverty, discrimination based on sexual preference and identity, and perverse public policies that exacerbate the epidemic, rather than control it. One’s perspective on the role of stigma in fueling the epidemic must recognize both the fear that an HIV diagnosis still engenders among many, and the fact that increased HIV testing and adherence to cART-based care represent signs of “normalization” of HIV as a public health challenge in many countries, including some in southern Africa, where wider access to cART has probably contributed to HIV being seen to be more like other diseases.

Russia’s failure to legalize and promulgate clear needle distribution and opiate substitution therapy, the continued demonization of MSM in many African countries, and the insistence on ineffective “abstinence only” educational investments in the US are all examples of policy gone awry [4, 26, 147, 148, 149, 150, 151, 152, 153, 154, 155]. In the face of the politicization of HIV/AIDS, policymakers failing to use existing tools to prevent HIV transmission are responsible for much preventable infection [156]. Failure to protect the blood supply early in the epidemic led to the infection of tens of thousands of blood and blood product recipients worldwide, especially persons with hemophilia. The taboo of politicians, religious leaders, teachers, or even health care providers discussing sexual risk reduction frankly and clearly keeps issues of HIV prevention from being fully integrated into political, religious, and social discussions. This is unfortunate since some themes — delaying adolescent coital debut and reducing numbers of sexual partners, for example — are widely supported goals in nearly all circles and political philosophies. While condoms are opposed by some due to a conviction that they may lead to higher risk sexual activities and/or that they may violate certain religious proscriptions against contraception, there is no strong evidence for the former view and support for the latter may be waning. For example, a major global religious leader who previously opposed condom use stated in a 2010 book that "there may be a basis in the case of some individuals, as perhaps when a male prostitute uses a condom, where this can be a first step in the direction of a moralization, a first assumption of responsibility." [157]. The religious leader later indicted that he also was referring to female prostitutes when he suggested that condom use may actually be a morally superior choice to prevent transmission to others. Such changes in attitude can be influential in empowering at-risk persons to protect themselves without going counter to religious views to which they may subscribe.

Failures in public policy have consequences. Modelers have quantified public policy failures, particularly the failure to provide clean needles and syringes for IDUs in the US from 1987–1995, estimating that an excess of between 4394 and 9666 infections, representing a third of incident IDU cases, was the result [158]. The attendant excess costs to the US were US$244 to $538 million. It will be a major stride in the HIV field if public health advocacy for evidence-based prevention could be the basis for HIV control policy and investment [26].

Behavior Change

Even in the face of biomedical interventions such as TasP or voluntary medical male circumcision, behavior change is an essential component of prevention interventions; for example, persons must agree to and adhere to the given intervention. All by itself, however, behavior change to reduce HIV incidence has not proven robust [159]. In studies designed to enhance adherence to ART, for example, the impact of behavioral interventions has often be very contextual or transient [160]. The HIVNET 015 Project EXPLORE protocol in MSM in the US sought to lower HIV incidence with an intensive 10-visit educational program that included reinforcement sessions [161, 162, 163]. Investigators were disappointed with the 18.2 % reduction (95 % CI: -4.7 %, 36.0 %) in HIV incidence in the intervention group compared with a control group receiving a short intervention [163]. However, given that the benefits were even lower in substance users and persons with mental health problems, this underscored the importance of attending to these co-morbidities in order to reduce HIV transmission [164, 165, 166].

For TasP, willingness to test for HIV, be linked to care, and adherence to cART to reduce infectiousness all require behavioral support. Pre-exposure prophylaxis (PrEP) using cART in seronegative persons to prevent infection, and increased testing and linkage to cART require high levels of adherence to be successful. “Serosorting” is when HIV seropositive persons have sex only with other infected persons, and HIV-seronegatives seek other uninfected persons for sex; this obviously requires a great deal of self-efficacy and motivation. Substance abuse treatment, including needle exchange, alcohol treatment, and opiate substitution therapy, as needed, depend on motivated and able clients. Contingency cash transfers are rewards for lowering risk behaviors, and depend on behavior change and political support.

Classic “ABC” approaches of Abstinence/Be faithful/Condom advocacy are fully dependent upon behavioral change [42•, 167, 168, 169, 170, 171, 172, 173, 174, 175, 176]. The US Centers for Disease Control and Prevention (CDC) has published its evidence-based interventions for risk reduction in the US; they are heavily behaviorally-based [177, 178, 179, 180, 181]. Abstinence-only education has been unsuccessful in reducing risk and was paradoxically associated with higher pregnancy rates than more comprehensive educational approaches that included STI prevention advocacy based on abstinence, partner reduction, and condom use [150, 153, 182]. It is the consensus in the HIV scientific community that “ABC” principles are vital guides for public health intervention, but are better bundled with biomedical prevention approaches; lone behavioral change approaches are not likely to stop the global pandemic [42•, 89, 183, 184•].

Linked to behavior change, but worthy of separate consideration are the so-called “structural interventions”. This involves changing laws, policies, or other societal norms to reduce risk behavior. Raising cigarette taxes to reduce tobacco use among youth or banning cigarette smoking in indoor spaces where the public has access are examples of structural interventions. If schools were improved, school fees eliminated as obstacles to full attendance, and after-school opportunities for youth were promulgated, this might be considered a structural change to seek to reduce substance abuse in higher income nations and the exchange of sexual services for money to attend school as happens in many LMICs. A law requiring all commercial transient lodgings (hotels, etc.) to provide in-room condoms would be another example of a structural intervention. Large scale programs to offer universal testing in saturation volumes, incentives to link persons with HIV to care, near-universal use of cART for all HIV-infected persons, and community partnerships to maximize clinic attendance and cART adherence are the backbone of TasP programs that, while still depending on behavioral adherence, would be enhanced considerably if a structural context could be promulgated by policymakers of routine, widespread, opt-out testing.

Packages of Tools for Combination Prevention

“Magic bullets” have not worked to control the epidemic on their own, with the possible exceptions of needle exchange for IDUs and blood screening for blood banks. Even if we had a proven, effective vaccine for HIV, vaccination would still require multiple voluntary visits to optimize immunization along with large-scale population mobilization and program expansion for children, adolescents, and/or adults, depending on vaccine characteristics (durability of protection, for example). Combination prevention packages must vary to target those at-risk persons who are at highest risk in a given epidemiologic context [185]. If the local epidemic is being driven by IDU, then needle exchange and addiction treatment will be the best strategies, along with primary prevention of drug abuse. If sex work is a principal driver of a local epidemic, community and political mobilization of sex workers and their employers (eg, brothel owners, pimps, madams) will be needed to ensure effective STI screening and treatment, to promote universal condom use, and perhaps to provide PrEP. Other efforts to offer sex workers a way out of the profession through protection and job retraining and job placement, as well as to control sexual trafficking, can help protect the women who are aided, and may or may not reduce prostitution or HIV incidence overall.

Some interventions have far stronger levels of evidence of efficacy to reduce HIV transmission (infectiousness) or acquisition (susceptibility) than others. Among these are voluntary medical male circumcision (VMMC) with compelling observational data supported by 3 definitive and remarkably consistent RCTs [186, 187, 188, 189]. ART for prevention was begun as a concept with the definitive demonstration of prevention of maternal-to-child transmission (PMTCT) with ART dating from 1994 [190]. Observational data from 2000–2001 and an incidental finding in a clinical trial in 2010 suggested that cART would reduce sexual transmission [191, 192, 193•]. Finally, the HPTN 052 RCT, over a decade in the making, demonstrated early use of cART as a major tool to reduce infectiousness and sexual transmission to partners, while clinically benefiting the infected persons as well [40••].

Other strategies are logical as adjunctive tools for HIV prevention, but are less consistently beneficial in RCTs. STI control based on syndromic management worked very well in one Tanzanian epidemic context to reduce HIV transmission, but has failed in other epidemic contexts and other treatment [194]. PrEP has had a mixed success: Tenofovir-containing PrEP (cART among HIV-seronegative at-risk persons) was successful in CAPRISA 004 (topical microbicide for women), iPrEx (MSM) and Partners PrEP, and TDF-2 studies (heterosexual men and women), but not in the large VOICE trial (heterosexual women), or the FemPrEP studies (heterosexual women) [195•, 196•, 197, 198]. The Thai vaccine prime-boost strategy published in 2009 was partially effective; however, the vaccine companies did not seek licensure for marketing of either the prime or boost products, given their very modest effects [199•, 200]. Nonetheless, as better oral and vaginal PrEP/microbicide and vaccine products are developed, they may be added as future components to the therapeutic armamentarium. Given that PrEP is a tool for use in seronegative persons and TasP a tool for use in seropositive persons, work is needed to assess how these might be combined to maximize potential HIV impact at the community level.

When RCT data are not available, observational data are used to make judgments as to likely efficacy. Evidence of male condom efficacy is confirmed by effectiveness studies [184•]. Evidence for efficacy and effectiveness of female condoms is inconsistent, but they have been reported helpful in selected contexts [201, 202, 203, 204]. Of certain utility, but not backed up by RCT evidence are needle exchange for drug users and opioid substitution therapy for IDUs [64, 205, 206, 207, 208, 209, 210, 211, 212, 213, 214, 215, 216, 217, 218, 219, 220, 221, 222, 223]. Also convincing are the use of contraception for HIV-infected women to reduce unintended pregnancies and HIV infection in infants [224, 225, 226, 227, 228, 229, 230, 231, 232, 233, 234, 235, 236, 237, 238, 239, 240, 241, 242, 243, 244, 245, 246, 247, 248, 249, 250, 251, 252, 253]. A variety of behavioral and structural interventions that reduce HIV-related risk behaviors are of possible, but uncertain utility, due to conflicting trial and study evidence [175, 254, 255, 256, 257, 258, 259, 260, 261, 262, 263, 264, 265, 266, 267].

Testing and Linkage to Care as a Core Strategy

The person who knows his or her own HIV serostatus is in a position to access HIV prevention or care services as they are provided in a given community; thus, testing is a first gateway [266, 267, 268, 269, 270, 271, 272, 273, 274, 275, 276, 277, 278, 279, 280, 281, 282, 283, 284, 285, 286, 287, 288]. While persons testing HIV seronegative may not change their risky behaviors, persons testing HIV seropositive tend to reduce their sexual transmission risk behaviors significantly [289, 290, 291]. Persons who do not know their own or their partners’ serostatus are far less likely (range of 50 %–66 %) to use condoms [292, 293]. It is estimated that <20 % of adults in sub-Saharan Africa have been tested for HIV, yet the HPTN 043 NIMH Project ACCESS study demonstrated in a community RCT how community mobilization can increase testing rates up to 10-fold [294, 295]. The best HIV testing access includes provider-initiated, routine or opt-out testing, and voluntary home-based HIV counseling and testing (HBCT) [194, 290]. HBCT may be cost-effective for population-level scale-up in generalized epidemics, despite its higher programmatic costs [296].

Once a person is tested for HIV, those testing positive must be linked to cART-based care. In the HPTN 052 trial, excellence in cART care and adherence reduced viral replication and reduced HIV transmission to sexual partners by 96 %, termed a “game-changer” by the director of UNAIDS [40••]. HIV-infected persons with 350–550 CD4+ cells/μL were assigned randomly to receive ART either immediately (early therapy) or after a decline in the CD4 count to 250–350 cells/ μL or the onset of HIV-1-related symptoms (delayed therapy). Given the success of TasP in HPTN 052 when persons with high CD4+ cell counts were the target, the option of immediate treatment for all HIV-diagnosed persons, regardless of immunological status is ideal, if resources are available. Still, a combination of interventions is inherently needed to make TasP a reality in public health terms: HIV testing has to be brought to scale, effective linkage to care must be a key priority for primary care programs, and high coverage and adherence to cART must be nurtured. WHO’s estimate of a 23 % yearly ART attrition rate in Africa illustrates the tremendous challenge faced by the public health community in this regard [297]. It is plausible that a universal testing and treatment approach (regardless of CD4+ cell count) could reduce stigma in communities where testing is common and infection is simply treated in everyone, as with other infectious diseases or chronic disease conditions.

Given this need for expanded HIV testing, accessing the service, and willingness to adhere to the prevention modality (eg, VMMC, future HIV vaccine or microbicide, cART regimen, consistent and correct condom use), behavioral co-interventions are essential. Prevention for positives to reduce risky behaviors with counseling focused on building motivation and developing skills is promising [298]. Interventions based on sound behavioral theory, such as the Health Belief model, can help address mental health and substance use issues, with a focus on adherence [67]. Condom use will continue to be emphasized as an adjunctive tool for HIV/STI risk reduction [292, 299, 300]. The biomathematics of combining methods for prevention are compelling, but intimidating at the same time; substantial coverage will be needed to succeed in bringing the basic reproductive rate to <1 thereby offering the potential prospect of eventual elimination of HIV as a public health problem [34, 301, 302, 303, 304, 305, 306, 307, 308, 309, 310•, 311, 312, 313].

The PopART Intervention

Led by one of us (RJH), our protocol team is launching a trial, HPTN 071/PopART, designed to measure the impact on HIV incidence of an intervention package that combines TasP, VMMC, STI control, PMTCT, and key behavioral approaches to reduce infection at the community level (Table 3). There are other small and large clinical and community research efforts to access the impact of various TasP and combination prevention approaches [36•, 313, 314, 315, 316, 317, 318].
Table 3

Key elements of the combination prevention community randomized clinical trial, HPTN 071: population effects of antiretroviral therapy to reduce HIV transmission (PopART): a cluster-randomized trial of the impact of a combination prevention package on population-level HIV incidence in Zambia and South Africa (to begin in 2013), Conceptual reference [331•]

Study Purpose and Design: To determine the impact of two community-level combination prevention packages on population-level HIV incidence. Both interventions are based on universal HIV testing and intensified provision of combination antiretroviral therapy (cART) and care, one with cART for all HIV infected persons and one only for persons meeting national treatment guidelines (CD4+ cells ≤350/μL and/or WHO clinical groups 3 or 4. PopART is a three-arm, cluster-randomized, longitudinal study to be implemented in 21 clusters (communities).

Study Population and Size: The prevention packages will be implemented throughout the communities randomized to the intervention arms. Main study outcomes will be measured in a randomly-selected group drawn from the adult population of the communities: a Population Cohort. The combined population of all 21 clusters is approximately 1.2 million individuals. The interventions will be implemented in 14 of the 21 clusters with a combined population of approximately 800,000 individuals (adults and children) in the intervention arms. The approximate sizes of the randomly-selected groups for main study outcome assessments are:

   • Population Cohort: 52,500 individuals

   • Case–control Studies: 2400 individuals

   • Qualitative Studies: ≈2000 individuals

Study Sites: The study communities in Zambia are spread across 4 provinces and 5 districts. Each community is the catchment population of a government health facility. The study communities in South Africa are located in the Cape Metro District and Cape Winelands District of the Western Cape Province. The communities are defined by the catchment population of a government health facility. For a list of all sites, see:

Study Duration: The planned duration of the entire study will be approximately 6 years, with enrollment and follow-up of communities and delivery of the intervention occurring over 4 years.

Intervention Packages:

  Arm A - Universal testing with immediate cART.

    •House-to-house deployment of:

      •Universal HIV counseling and testing;

      •Active linkage to care for persons diagnosed as HIV-infected, with immediate cART eligibility

      •Promotion of male circumcision and prevention of mother to child transmission (PMTCT); and

      •Provision of condoms.

    •Strengthening of HIV testing and services at health facilities and other venues.

    •Strengthening of male circumcision and prevention of mother-to-child transmission of HIV services available in the community.

    •Treatment of sexually transmitted infections (STIs) and provision of condoms at health units.

  Arm B - Universal Testing with cART Eligibility According to National Guidelines Package includes all of the Arm A interventions, except cART eligibility according to national guidelines.

  Arm C - Standard of Care (Control Arm).

    •Strengthening of HIV testing and cART services according to national guidelines at health facilities and other venues.

    •Strengthening of male circumcision and PMTCT available at health facilities and other venues in the community.

    •Treatment of STIs and provision of condoms at health facilities and other venues in the community.

Primary Objectives: To measure the impact of the 2 intervention packages on HIV incidence by enrolling and following a random sample of adults (Population Cohort) in the trial communities.

Secondary Objectives:

  •Measure the impact of the 2 intervention packages on the following:

    •HIV incidence over the first, second, and third years of follow-up;

    •Community viral load, cART drug resistance, and cART adherence and viral suppression (if funding is identified);

    •HSV-2 incidence; Sexual risk behavior; HIV-related stigma;

    •Uptake of HIV testing and retesting over the entire study period;

    •cART screening and uptake; cART toxicity based on clinic records;

    •Time between HIV diagnosis and initiation of care; Uptake of PMTCT;

    •Retention in care; HIV disease progression and death;

    •Case notification rate of tuberculosis;

    •Uptake of male circumcision.

  • Carry out case–control studies to examine factors related to:

    •Uptake of HIV testing during the first round of home-based testing in Arms A and B;

    •Uptake of immediate treatment in Arm A;

    •Uptake of HIV testing during the second round of home-based testing in Arms A and B.

  •Use qualitative methods to:

    •Assess popular understanding of testing/treatment at study initiation and during implementation;

    •Evaluate the acceptability/functioning of the Community HIV-care Providers in Arms A and B;

    •Evaluate the acceptability of interventions and barriers to access in Arms A and B;

    •Document the effect of the interventions on social networks, stigma, sexual behavior, alcohol use, gender-based violence, HIV identity, other HIV prevention options and community morale;

    •Evaluate the process and challenges of community consultation and applying ethical principles.

  •Measure burden experienced by local health centers from implementation of the community intervention.

  •Systematically record costs in all communities to measure incremental costs of intervention packages.

  •Estimate the effectiveness and cost-effectiveness of interventions by fitting mathematical models based on the empirical data from the trial, including data related to cost.


There is substantial heterogeneity in the global HIV epidemic, with the drivers of the epidemic differing substantially by mode of transmission (eg, heterosexual, homosexual, IDU) [319]. Regardless of the mode of transmission, the HIV pandemic can be confronted with a combination of approaches, anchored by the deployment of cART that can reduce infectiousness as well as the clinical boon of turning a previously fatal disease into a chronic, manageable one. Complementary preventive approaches must differ. For example, needle/syringe exchange is important for IDU-related prevention, voluntary medical male circumcision addresses heterosexual transmission in high prevalence areas like sub-Saharan Africa, and PrEP has potential to help prevent male-to-male transmission. The promise of combination prevention depends on the long-term resolution of huge health services gaps in LMICs. Yet as we have more tools for HIV prevention, “HIV-fatigue” in donor nations combined with concern from economic downturns from 2008 onwards may result in cuts in HIV programs. Past experience suggests, however, that failures in HIV prevention or early treatment will simply cost society more in the long run, given the high direct costs of illness and indirect costs of disability, suffering, and death [320, 321, 322, 323, 324]. Prevention, including testing and early cART treatment, is a good societal and economic investment.



The authors thank Megan Pask, M.S. for her considerable assistance.

Conflict of Interest

Sten H. Vermund declares that he has no conflict of interest.

Richard J. Hayes declares that he has no conflict of interest.


Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. 1.
    Fong IW. Challenges in infectious diseases. New York, NY: Springer Science Business Media; 2013.CrossRefGoogle Scholar
  2. 2.
    (UNAIDS) JUNPoHA. UNAIDS: World AIDS Day Report 2011: Core Epidemiology Slides. UNAIDS: World AIDS Day Report. 2011. Available at: Accessed January, 2012.
  3. 3.
    Kourtis AP, Kraft JM, Gavin L, Kissin D, McMichen-Wright P, Jamieson DJ. Prevention of sexually transmitted human immunodeficiency virus (HIV) infection in adolescents. Curr HIV Res. 2006;4:209–19.PubMedCrossRefGoogle Scholar
  4. 4.
    Underhill K, Operario D, Montgomery P. Systematic review of abstinence-plus HIV prevention programs in high-income countries. PLoS Med. 2007;4:e275.PubMedCrossRefGoogle Scholar
  5. 5.
    Gavin L, MacKay AP, Brown K, et al. Sexual and reproductive health of persons aged 10–24 years - United States, 2002–2007. Morb Mortal Wkly Rep Surveil Summ. 2009;58:1–58.Google Scholar
  6. 6.
    DiClemente RJ, Crittenden CP, Rose E, et al. Psychosocial predictors of HIV-associated sexual behaviors and the efficacy of prevention interventions in adolescents at-risk for HIV infection: what works and what doesn't work? Psychosom Med. 2008;70:598–605.PubMedCrossRefGoogle Scholar
  7. 7.
    Spiegel HM, Futterman DC. Adolescents and HIV: prevention and clinical care. Curr HIV/AIDS Rep. 2009;6:100–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Vermund SH, Allen KL, Karim QA. HIV-prevention science at a crossroads: advances in reducing sexual risk. Curr Opin HIV AIDS. 2009;4:266–73.PubMedCrossRefGoogle Scholar
  9. 9.
    Eyawo O, de Walque D, Ford N, Gakii G, Lester RT, Mills EJ. HIV status in discordant couples in sub-Saharan Africa: a systematic review and meta-analysis. Lancet Infect Dis. 2010;10:770–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Vlahov D, Robertson AM, Strathdee SA. Prevention of HIV infection among injection drug users in resource-limited settings. Clin Infect Dis. 2010;50 Suppl 3:S114–21.PubMedCrossRefGoogle Scholar
  11. 11.
    McCurdy SA, Ross MW, Williams ML, Kilonzo GP, Leshabari MT. Flashblood: blood sharing among female injecting drug users in Tanzania. Addiction. 2010;105:1062–70.PubMedCrossRefGoogle Scholar
  12. 12.
    Smith AD, Tapsoba P, Peshu N, Sanders EJ, Jaffe HW. Men who have sex with men and HIV/AIDS in sub-Saharan Africa. Lancet. 2009;374:416–22.PubMedCrossRefGoogle Scholar
  13. 13.
    Baral S, Adams D, Lebona J, et al. A cross-sectional assessment of population demographics. HIV risks and human rights contexts among men who have sex with men in Lesotho Journal of the International AIDS Society. 2011;14:36.Google Scholar
  14. 14.
    Rispel LC, Metcalf CA, Cloete A, Reddy V, Lombard C. HIV prevalence and risk practices among men who have sex with men in 2 South African cities. J Acquir Immune Defic Syndr. 2011;57:69–76.PubMedCrossRefGoogle Scholar
  15. 15.
    Merrigan M, Azeez A, Afolabi B, et al. HIV prevalence and risk behaviors among men having sex with men in Nigeria. Sex Transm Dis. 2011;87:65–70.CrossRefGoogle Scholar
  16. 16.
    Johnston LG, Holman A, Dahoma M, et al. HIV risk and the overlap of injecting drug use and high-risk sexual behaviors among men who have sex with men in Zanzibar (Unguja). Tanzania Int J Drug Policy. 2010;21:485–92.CrossRefGoogle Scholar
  17. 17.
    Siddiqui AU, Qian HZ, Altaf A, Cassell H, Shah SA, Vermund SH. Condom use during commercial sex among clients of Hijra sex workers in Karachi, Pakistan (cross-sectional study). BMJ. 2011;1:e000154.Google Scholar
  18. 18.
    Sahastrabuddhe S, Gupta A, Stuart E, et al. Sexually transmitted infections and risk behaviors among transgender persons (Hijras) of Pune. India J Acquir Immune Defic Syndr. 2012;59:72–8.CrossRefGoogle Scholar
  19. 19.
    Shaw SY, Emmanuel F, Adrien A, et al. The descriptive epidemiology of male sex workers in Pakistan: a biological and behavioral examination. Sex Transm Dis. 2011;87:73–80.CrossRefGoogle Scholar
  20. 20.
    Phillips AE, Lowndes CM, Boily MC, et al. Men who have sex with men and women in Bangalore, South India, and potential impact on the HIV epidemic. Sex Transm Dis. 2010;86:187–92.CrossRefGoogle Scholar
  21. 21.
    Solomon SS, Srikrishnan AK, Sifakis F, et al. The emerging HIV epidemic among men who have sex with men in Tamil Nadu, India: geographic diffusion and bisexual concurrency. AIDS Behav. 2010;14:1001–10.PubMedCrossRefGoogle Scholar
  22. 22.
    Verma R, Shekhar A, Khobragade S, et al. Scale-up and coverage of Avahan: a large-scale HIV-prevention program among female sex workers and men who have sex with men in 4 Indian states. Sex Transm Dis. 2010;86 Suppl 1:i76–82.CrossRefGoogle Scholar
  23. 23.
    Altaf A, Saleem N, Abbas S, Muzaffar R. High prevalence of HIV infection among injection drug users (IDUs) in Hyderabad and Sukkur. Pakistan JPMA. 2009;59:136–40.Google Scholar
  24. 24.
    Vermund SH, White H, Shah SA, et al. HIV/AIDS in Pakistan: has the explosion begun? JPMA. 2006;56(1 Suppl 1):S1–2.Google Scholar
  25. 25.
    Kazi AM, Shah SA, Jenkins CA, Shepherd BE, Vermund SH. Risk factors and prevalence of tuberculosis, human immunodeficiency virus, syphilis, hepatitis B virus, and hepatitis C virus among prisoners in Pakistan. Int J Infect Dis. 2010;14 Suppl 3:e60–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Mathers BM, Degenhardt L, Ali H, et al. HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet. 2010;375:1014–28.PubMedCrossRefGoogle Scholar
  27. 27.
    Bridge J, Lazarus JV, Atun R. HIV epidemics and prevention responses in Asia and Eastern Europe: lessons to be learned? AIDS. 2010;24 Suppl 3:S86–94.PubMedCrossRefGoogle Scholar
  28. 28.
    Rechel B. HIV/AIDS in the countries of the former Soviet Union: societal and attitudinal challenges. Central Eur J Public Health. 2010;18:110–5.Google Scholar
  29. 29.
    Elovich R, Drucker E. On drug treatment and social control: Russian narcology's great leap backwards. Harm Reduction J. 2008;5:23.CrossRefGoogle Scholar
  30. 30.
    Tkatchenko-Schmidt E, Renton A, Gevorgyan R, Davydenko L, Atun R. Prevention of HIV/AIDS among injecting drug users in Russia: opportunities and barriers to scaling-up of harm reduction programs. Health Policy. 2008;85:162–71.PubMedCrossRefGoogle Scholar
  31. 31.
    Kalichman SC, Kelly JA, Sikkema KJ, Koslov AP, Shaboltas A, Granskaya J. The emerging AIDS crisis in Russia: review of enabling factors and prevention needs. Int J STD AIDS. 2000;11:71–5.PubMedCrossRefGoogle Scholar
  32. 32.
    Simonsen L, Kane A, Lloyd J, Zaffran M, Kane M. Unsafe injections in the developing world and transmission of bloodborne pathogens: a review. Bull WHO. 1999;77:789–800.PubMedGoogle Scholar
  33. 33.
    Centers for Disease Control & Prevention. Progress toward strengthening national blood transfusion services–14 countries, 2008–2010. Morb Mortal Wkly Rep. 2011;60:1577–82.Google Scholar
  34. 34.
    Group HIVMCTaPEW. HIV treatment as prevention: models, data, and questions--towards evidence-based decision-making. PLoS Med. 2012;9:e1001259.CrossRefGoogle Scholar
  35. 35.
    Cohen MS, McCauley M, Gamble TR. HIV treatment as prevention and HPTN 052. Curr Opin HIV AIDS. 2012;7:99–105.PubMedCrossRefGoogle Scholar
  36. 36.
    • Padian NS, McCoy SI, Karim SS, et al. HIV prevention transformed: the new prevention research agenda. Lancet. 2011;378:269–78. A summary of randomized clinical trial evidence for HIV prevention strategies that compares the relative efficacies of different approaches.PubMedCrossRefGoogle Scholar
  37. 37.
    Smith K, Powers KA, Kashuba AD, Cohen MS. HIV-1 treatment as prevention: the good, the bad, and the challenges. Curr Opin HIV AIDS. 2011;6:315–25.PubMedGoogle Scholar
  38. 38.
    Stanecki K, Daher J, Stover J, Beusenberg M, Souteyrand Y, Garcia Calleja JM. Antiretroviral therapy needs: the effect of changing global guidelines. Sex Transm Dis. 2010;86 Suppl 2:ii62–6.CrossRefGoogle Scholar
  39. 39.
    Moon TD, Burlison JR, Blevins M, et al. Enrolment and programmatic trends and predictors of antiretroviral therapy initiation from president's emergency plan for AIDS Relief (PEPFAR)-supported public HIV care and treatment sites in rural Mozambique. Int J STD AIDS. 2011;22:621–7.PubMedCrossRefGoogle Scholar
  40. 40.
    •• Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505. The historic clincial trial that has defined a principal goal for future HIV prevention research. The multinational study determined that persons with higher CD4+ cell counts who were placed on cART were 96 % less likely to transmit HIV to their sexual partners than were persons treated at a later point in time.PubMedCrossRefGoogle Scholar
  41. 41.
    •• Centers for Disease Control, Prevention. Vital signs. HIV prevention through care and treatment-United States. Morb Mortal Wkly Rep. 2011;60:1618–23. A presentation of the "treatment cascade" in the USA suggests just how very low our success rate is for viral suppression for HIV-infected Americans.Google Scholar
  42. 42.
    • Burns DN, Dieffenbach CW, Vermund SH. Rethinking prevention of HIV type 1 infection. Clin Infect Dis. 2010;51:725–31. A first estimate of the "treatment casecade" estimates in the USA PubMedCrossRefGoogle Scholar
  43. 43.
    • Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis. 2011;52:793–800. A first CDC estimate of the "treatment cascade" estimates in the USA..PubMedCrossRefGoogle Scholar
  44. 44.
    Geng EH, Glidden DV, Bangsberg DR, et al. A causal framework for understanding the effect of losses to follow-up on epidemiologic analyses in clinic-based cohorts: the case of HIV-infected patients on antiretroviral therapy in Africa. Am J Epidemiol. 2012;175:1080–7.PubMedCrossRefGoogle Scholar
  45. 45.
    Geng EH, Glidden DV, Emenyonu N, et al. Tracking a sample of patients lost to follow-up has a major impact on understanding determinants of survival in HIV-infected patients on antiretroviral therapy in Africa. TM IH. 2010;15 Suppl 1:63–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Geng EH, Bangsberg DR, Musinguzi N, et al. Understanding reasons for and outcomes of patients lost to follow-up in antiretroviral therapy programs in Africa through a sampling-based approach. J Acquir Immune Defic Syndr. 2010;53:405–11.PubMedCrossRefGoogle Scholar
  47. 47.
    Schoni-Affolter F, Keiser O, Mwango A, et al. Estimating loss to follow-up in HIV-infected patients on antiretroviral therapy: the effect of the competing risk of death in Zambia and Switzerland. PLoS One. 2011;6:e27919.PubMedCrossRefGoogle Scholar
  48. 48.
    • Egger M, Spycher BD, Sidle J, et al. Correcting mortality for loss to follow-up: a nomogram applied to antiretroviral treatment programs in sub-Saharan Africa. PLoS Med. 2011;8:e1000390. A useful methodological tool for program evaluation of PEPFAR and other HIV treatment programs in Africa.PubMedCrossRefGoogle Scholar
  49. 49.
    • Geng EH, Glidden DV, Bwana MB, et al. Retention in care and connection to care among HIV-infected patients on antiretroviral therapy in Africa: estimation via a sampling-based approach. PLoS One. 2011;6:e21797. Retention in care and connection to care among HIV-infected patients on antiretroviral therapy in Africa: estimation via a sampling-based approach.PubMedCrossRefGoogle Scholar
  50. 50.
    Amuron B, Namara G, Birungi J, et al. Mortality and loss-to-follow-up during the pre-treatment period in an antiretroviral therapy program under normal health service conditions in Uganda. BMC Publ Health. 2009;9:290.CrossRefGoogle Scholar
  51. 51.
    Van Cutsem G, Ford N, Hildebrand K, et al. Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis. PLoS One. 2011;6:e14684.PubMedCrossRefGoogle Scholar
  52. 52.
    Yiannoutsos CT, An MW, Frangakis CE, et al. Sampling-based approaches to improve estimation of mortality among patient dropouts: experience from a large PEPFAR-funded program in Western Kenya. PLoS One. 2008;3:e3843.PubMedCrossRefGoogle Scholar
  53. 53.
    Greig J, O'Brien DP, Ford N, Spelman T, Sabapathy K, Shanks L. Similar mortality and reduced loss to follow-up in integrated compared with vertical programs providing antiretroviral treatment in sub-saharan Africa. J Acquir Immune Defic Syndr. 2012;59:e92–8.PubMedCrossRefGoogle Scholar
  54. 54.
    • Chi BH, Yiannoutsos CT, Westfall AO, et al. Universal definition of loss to follow-up in HIV treatment programs: a statistical analysis of 111 facilities in Africa, Asia, and Latin America. PLoS Med. 2011;8:e1001111. Universal definition of loss to follow-up in HIV treatment programs: a statistical analysis of 111 facilities in Africa, Asia, and Latin America.PubMedCrossRefGoogle Scholar
  55. 55.
    • Shepherd BE, Blevins M, Vaz LM, et al. Impact of definitions of loss to follow-up on estimates of retention, mortality, and disease progression: application to and HIV program in Mozambique. Am J Epidemiol. 2013;(in press). A study of the immense variation of loss to follow-up rates in the literature and the need to consider different definitions for different evaluation purposes. Google Scholar
  56. 56.
    • Montaner JS, Lima VD, Barrios R, et al. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study. Lancet. 2010;376:532–9. Association of highly active antiretroviral therapy coverage, population viral load, and yearly new HIV diagnoses in British Columbia, Canada: a population-based study.PubMedCrossRefGoogle Scholar
  57. 57.
    •• Das M, Chu PL, Santos GM, et al. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco. PLoS One. 2010;5:e11068. Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco.PubMedCrossRefGoogle Scholar
  58. 58.
    Caceres CF, Stall R. Commentary: the human immunodeficiency virus/AIDS epidemic among men who have sex with men in Latin America and the Caribbean: it is time to bridge the gap. Int J Epidemiol. 2003;32:740–3.PubMedCrossRefGoogle Scholar
  59. 59.
    Fang CT, Hsu HM, Twu SJ, et al. Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan. J Infect Dis. 2004;190:879–85.PubMedCrossRefGoogle Scholar
  60. 60.
    Tanser F, Barnighausen T, Grapsa E, Newell ML. Effect of ART coverage on rate of new HIV infections in a hyper-endemic, rural population: South Africa (Abstract #136LB). 19th Conference on Retroviruses and Opportunistic Infections (CROI) 2012, Seattle, Washington, USA. 2012.Google Scholar
  61. 61.
    • Jia Z, Ruan Y, Li Q, et al. Antiretroviral therapy to prevent HIV transmission in serodiscordant couples in China (2003–11): a national observational cohort study. Lancet. 2012;S0140-2736(12):61898–4. doi: 10.1016/S0140–6736(12)61898–4. PMID: 23206835. A large natural experiment in China that provides some evidence for both how promising treatment as prevention is, as well as how challenging it will be to gain an impact even remotely close to the optimized HPTN 052 clinical trial finding.Google Scholar
  62. 62.
    Smith MK, Powers KA, Muessig KE, Miller WC, Cohen MS. HIV treatment as prevention: the utility and limitations of ecological observation. PLoS Med. 2012;9:e1001260.PubMedCrossRefGoogle Scholar
  63. 63.
    Vermund SH. Treatment as prevention for HIV in China. Lancet. 2012. doi: 10.1016/S0140-6736(12)62005-4.
  64. 64.
    Kerr T, Small W, Buchner C, et al. Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. Am J Public Health. 2010;100:1449–53.PubMedCrossRefGoogle Scholar
  65. 65.
    Vermund SH, Leigh-Brown AJ. The HIV Epidemic: high-income countries. Cold Spring Harbor Perspect Med. 2012;2:a007195.Google Scholar
  66. 66.
    Nel A, Kagee A. Common mental health problems and antiretroviral therapy adherence. AIDS Care. 2011;23:1360–5.PubMedCrossRefGoogle Scholar
  67. 67.
    Gonzalez A, Barinas J, O'Cleirigh C. Substance use: impact on adherence and HIV medical treatment. Curr HIV/AIDS Rep. 2011;8:223–34.PubMedCrossRefGoogle Scholar
  68. 68.
    Blashill AJ, Perry N, Safren SA. Mental health: a focus on stress, coping, and mental illness as it relates to treatment retention, adherence, and other health outcomes. Curr HIV/AIDS Rep. 2011;8:215–22.PubMedCrossRefGoogle Scholar
  69. 69.
    Meyer JP, Springer SA, Altice FL. Substance abuse, violence, and HIV in women: a literature review of the syndemic. J Women Health. 2011;20:991–1006.CrossRefGoogle Scholar
  70. 70.
    Altice FL, Kamarulzaman A, Soriano VV, Schechter M, Friedland GH. Treatment of medical, psychiatric, and substance-use comorbidities in people infected with HIV who use drugs. Lancet. 2010;376:367–87.PubMedCrossRefGoogle Scholar
  71. 71.
    Bravo P, Edwards A, Rollnick S, Elwyn G. Tough decisions faced by people living with HIV: a literature review of psychosocial problems. AIDS Rev. 2010;12:76–88.PubMedGoogle Scholar
  72. 72.
    Shuper PA, Neuman M, Kanteres F, Baliunas D, Joharchi N, Rehm J. Causal considerations on alcohol and HIV/AIDS–a systematic review. Alcohol Alcoholism. 2010;45:159–66.CrossRefGoogle Scholar
  73. 73.
    Kresina TF, Bruce RD, McCance-Katz EF. Medication assisted treatment in the treatment of drug abuse and dependence in HIV/AIDS infected drug users. Curr HIV Res. 2009;7:354–64.PubMedCrossRefGoogle Scholar
  74. 74.
    Fuller BE, Loftis JM, Rodriguez VL, McQuesten MJ, Hauser P. Psychiatric and substance use disorders comorbidities in veterans with hepatitis C virus and HIV coinfection. Curr Opin Psychiatry. 2009;22:401–8.PubMedCrossRefGoogle Scholar
  75. 75.
    Pence BW. The impact of mental health and traumatic life experiences on antiretroviral treatment outcomes for people living with HIV/AIDS. J Antimicrob Chemother. 2009;63:636–40.PubMedCrossRefGoogle Scholar
  76. 76.
    Stirratt MJ, Gordon CM. Adherence to biomedical HIV prevention methods: considerations drawn from HIV treatment adherence research. Curr HIV/AIDS Rep. 2008;5:186–92.PubMedCrossRefGoogle Scholar
  77. 77.
    Whetten K, Reif S, Whetten R, Murphy-McMillan LK. Trauma, mental health, distrust, and stigma among HIV-positive persons: implications for effective care. Psychosom Med. 2008;70:531–8.PubMedCrossRefGoogle Scholar
  78. 78.
    Hartzell JD, Janke IE, Weintrob AC. Impact of depression on HIV outcomes in the HAART era. J Antimicrob Chemother. 2008;62:246–55.PubMedCrossRefGoogle Scholar
  79. 79.
    Ingersoll KS, Cohen J. The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008;31:213–24.PubMedCrossRefGoogle Scholar
  80. 80.
    Remien RH, Mellins CA. Long-term psychosocial challenges for people living with HIV: let's not forget the individual in our global response to the pandemic. AIDS. 2007;21 Suppl 5:S55–63.PubMedCrossRefGoogle Scholar
  81. 81.
    Patel V, Araya R, Chatterjee S, et al. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet. 2007;370:991–1005.PubMedCrossRefGoogle Scholar
  82. 82.
    Conway B. The role of adherence to antiretroviral therapy in the management of HIV infection. J Acquir Immune Defic Syndr. 2007;45 Suppl 1:S14–8.PubMedCrossRefGoogle Scholar
  83. 83.
    Olatunji BO, Mimiaga MJ, O'Cleirigh C, Safren SA. Review of treatment studies of depression in HIV. Topics in HIV Medicine. 2006;14:112–24.PubMedGoogle Scholar
  84. 84.
    Springer SA, Altice FL. Managing HIV/AIDS in correctional settings. Curr HIV/AIDS Rep. 2005;2:165–70.PubMedCrossRefGoogle Scholar
  85. 85.
    Chander G, Himelhoch S, Moore RD. Substance abuse and psychiatric disorders in HIV-positive patients: epidemiology and impact on antiretroviral therapy. Drugs. 2006;66:769–89.PubMedCrossRefGoogle Scholar
  86. 86.
    Ruiz MS, Gable AR, Kaplan EH, Stoto MA, Fineberg HV, Trussell J. Committee on HIV Prevention Strategies in the United States, Division of Health Promotion and Disease Prevention, Institute of Medicine. No time to lose: getting more from HIV Prevention. Washington, D.C. 2000.Google Scholar
  87. 87.
    Ford MA, Spicer CM. Committee to review data systems for monitoring HIV Care Board on Population Health and Public Health Practice, Institute of Medicine. Monitoring HIV Care in the U. S.: Washington, D.C.; Indicators and Data Systems. 2012.Google Scholar
  88. 88.
    El-Sadr WM, Mayer KH, Hodder SL. AIDS in America—forgotten but not gone. N Engl J Med. 2010;362:967–70.PubMedCrossRefGoogle Scholar
  89. 89.
    Vermund SH, Hodder SL, Justman JE, et al. Addressing research priorities for prevention of HIV infection in the United States. Clinical Infect Dis. 2010;50 Suppl 3:S149–55.CrossRefGoogle Scholar
  90. 90.
    Lauby JL, Marks G, Bingham T, et al. Having supportive social relationships is associated with reduced risk of unrecognized HIV infection among Black and Latino Men who have sex with men. AIDS Behav. 2012;16:508–15.PubMedCrossRefGoogle Scholar
  91. 91.
    Millett GA, Ding H, Marks G, et al. Mistaken assumptions and missed opportunities: correlates of undiagnosed HIV infection among Black and Latino men who have sex with men. J Acquir Immune Defic Syndr. 2011;58:64–71.PubMedCrossRefGoogle Scholar
  92. 92.
    Oster AM, Wiegand RE, Sionean C, et al. Understanding disparities in HIV infection between black and white MSM in the United States. AIDS. 2011;25:1103–12.PubMedCrossRefGoogle Scholar
  93. 93.
    Reisner SL, Mimiaga MJ, Bland S, et al. Problematic alcohol use and HIV risk among Black men who have sex with men in Massachusetts. AIDS Care. 2010;22:577–87.PubMedCrossRefGoogle Scholar
  94. 94.
    Mimiaga MJ, Reisner SL, Fontaine YM, et al. Walking the line: stimulant use during sex and HIV risk behavior among Black urban MSM. Drug Alcohol Depend. 2010;110:30–7.PubMedCrossRefGoogle Scholar
  95. 95.
    Mimiaga MJ, Reisner SL, Bland S, et al. Health system and personal barriers resulting in decreased utilization of HIV and STD testing services among at-risk Black men who have sex with men in Massachusetts. AIDS Patient Care STDs. 2009;23:825–35.PubMedCrossRefGoogle Scholar
  96. 96.
    Reisner SL, Mimiaga MJ, Skeer M, et al. Clinically significant depressive symptoms as a risk factor for HIV infection among black MSM in Massachusetts. AIDS Behav. 2009;13:798–810.PubMedCrossRefGoogle Scholar
  97. 97.
    Bond L, Wheeler DP, Millett GA, LaPollo AB, Carson LF, Liau A. Black men who have sex with men and the association of down-low identity with HIV risk behavior. Am J Public Health. 2009;99 Suppl 1:S92–5.PubMedCrossRefGoogle Scholar
  98. 98.
    Lauby JL, Millett GA, LaPollo AB, Bond L, Murrill CS, Marks G. Sexual risk behaviors of HIV-positive, HIV-negative, and serostatus-unknown Black men who have sex with men and women. Arch Sex Behav. 2008;37:708–19.PubMedCrossRefGoogle Scholar
  99. 99.
    Millett GA, Peterson JL, Wolitski RJ, Stall R. Greater risk for HIV infection of Black men who have sex with men: a critical literature review. Am J Public Health. 2006;96:1007–19.PubMedCrossRefGoogle Scholar
  100. 100.
    DeLaMora P, Aledort N, Stavola J. Caring for adolescents with HIV. Curr HIV/AIDS Rep. 2006;3:74–8.PubMedCrossRefGoogle Scholar
  101. 101.
    Reisner SL, Mimiaga MJ, Skeer M, Perkovich B, Johnson CV, Safren SA. A review of HIV antiretroviral adherence and intervention studies among HIV-infected youth. Topics HIV Med. 2009;17:14–25.Google Scholar
  102. 102.
    Dowshen N, D'Angelo L. Health care transition for youth living with HIV/AIDS. Pediatr. 2011;128:762–71.CrossRefGoogle Scholar
  103. 103.
    Koenig LJ, Nesheim S, Abramowitz S. Adolescents with perinatally acquired HIV: emerging behavioral and health needs for long-term survivors. Curr Opin Obstet Gynecol. 2011;23:321–7.PubMedCrossRefGoogle Scholar
  104. 104.
    Murphy DA, Moscicki AB, Vermund SH, Muenz LR. Psychological distress among HIV(+) adolescents in the REACH study: effects of life stress, social support, and coping. The Adolescent Medicine HIV/AIDS Res Network. J Adolesc Health. 2000;27:391–8.PubMedCrossRefGoogle Scholar
  105. 105.
    Murphy DA, Durako SJ, Moscicki AB, et al. No change in health risk behaviors over time among HIV infected adolescents in care: role of psychological distress. J Adolesc Health. 2001;29(3 Suppl):57–63.PubMedCrossRefGoogle Scholar
  106. 106.
    Vermund SH, Wilson CM, Rogers AS, Partlow C, Moscicki AB. Sexually transmitted infections among HIV infected and HIV uninfected high-risk youth in the REACH study. Reaching for Excellence in Adolescent Care and Health J Adolesc Health. 2001;29(3 Suppl):49–56.Google Scholar
  107. 107.
    Murphy DA, Mitchell R, Vermund SH, Futterman D. Adolescent Medicine HIVARN. Factors associated with HIV testing among HIV-positive and HIV-negative high-risk adolescents: the REACH Study Reaching for excellence in adolescent care and health Pediatrics. 2002;110:e36.Google Scholar
  108. 108.
    Ding H, Wilson CM, Modjarrad K, McGwin Jr G, Tang J, Vermund SH. Predictors of suboptimal virologic response to highly active antiretroviral therapy among human immunodeficiency virus-infected adolescents: analyses of the reaching for excellence in adolescent care and health (REACH) project. Arch Pediatr Adolesc Med. 2009;163:1100–5.PubMedCrossRefGoogle Scholar
  109. 109.
    Yanagisawa S, Poudel KC, Jimba M. Sibling caregiving among children orphaned by AIDS: synthesis of recent studies for policy implications. Health Policy. 2010;98:121–30.PubMedCrossRefGoogle Scholar
  110. 110.
    Zhao G, Li X, Fang X, Zhao J, Yang H, Stanton B. Care arrangements, grief and psychological problems among children orphaned by AIDS in China. AIDS Care. 2007;19:1075–82.PubMedCrossRefGoogle Scholar
  111. 111.
    Bhargava A, Bigombe B. Public policies and the orphans of AIDS in Africa. BMJ. 2003;326:1387–9.PubMedCrossRefGoogle Scholar
  112. 112.
    Vaz LM, Maman S, Eng E, Barbarin OA, Tshikandu T, Behets F. Patterns of disclosure of HIV status to infected children in a sub-Saharan African setting. J Dev Behav Pediatr. 2011; 32(4):307–315.Google Scholar
  113. 113.
    Vaz LM, Eng E, Maman S, Tshikandu T, Behets F. Telling children they have HIV: lessons learned from findings of a qualitative study in sub-Saharan Africa. AIDS Patient Care STDs. 2010;24:247–56.PubMedCrossRefGoogle Scholar
  114. 114.
    Corneli A, Vaz L, Dulyx J, Omba S, Rennie S, Behets F. The role of disclosure in relation to assent to participate in HIV-related research among HIV-infected youth: a formative study. J Int AIDS Soc. 2009;12:17.PubMedCrossRefGoogle Scholar
  115. 115.
    Vaz L, Corneli A, Dulyx J, et al. The process of HIV status disclosure to HIV-positive youth in Kinshasa, Democratic Republic of the Congo. AIDS Care. 2008;20:842–52.PubMedCrossRefGoogle Scholar
  116. 116.
    McCoy D, Chopra M, Loewenson R, et al. Expanding access to antiretroviral therapy in sub-saharan Africa: avoiding the pitfalls and dangers, capitalizing on the opportunities. Am J Public Health. 2005;95:18–22.PubMedCrossRefGoogle Scholar
  117. 117.
    Schwartlander B, Grubb I, Perriens J. The 10-year struggle to provide antiretroviral treatment to people with HIV in the developing world. Lancet. 2006;368:541–6.PubMedCrossRefGoogle Scholar
  118. 118.
    Ojikutu B. Introduction: the realities of antiretroviral therapy rollout: overcoming challenges to successful programmatic implementation. J Infect Dis. 2007;196 Suppl 3:S445–8.PubMedCrossRefGoogle Scholar
  119. 119.
    Rosen S, Sanne I, Collier A, Simon JL. Rationing antiretroviral therapy for HIV/AIDS in Africa: choices and consequences. PLoS Med. 2005;2:e303.PubMedCrossRefGoogle Scholar
  120. 120.
    Lamptey P, Wilson D. Scaling up AIDS treatment: what is the potential impact and what are the risks? PLoS Med. 2005;2:e39.PubMedCrossRefGoogle Scholar
  121. 121.
    Moon TD, Burlison JR, Sidat M, et al. Lessons learned while implementing an HIV/AIDs care and treatment program in rural Mozambique. Retrovirology. 2010;3:1–14.Google Scholar
  122. 122.
    Menzies NA, Berruti AA, Berzon R, et al. The cost of providing comprehensive HIV treatment in PEPFAR-supported programs. AIDS. 2011;25:1753–60.PubMedCrossRefGoogle Scholar
  123. 123.
    Filler SJ, Berruti AA, Menzies N, et al. Characteristics of HIV care and treatment in PEPFAR-supported sites. J Acquir Immune Defic Syndr. 2011;57:e1–6.PubMedCrossRefGoogle Scholar
  124. 124.
    Stringer JS, Zulu I, Levy J, et al. Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: feasibility and early outcomes. JAMA. 2006;296:782–93.PubMedCrossRefGoogle Scholar
  125. 125.
    Banda Y, Chapman V, Goldenberg RL, et al. Use of traditional medicine among pregnant women in Lusaka. Zambia J Alternative Complement Med. 2007;13:123–7.CrossRefGoogle Scholar
  126. 126.
    Vergara AE, Assan A, Vermund SH. Principles and experiences in national antiretroviral therapy roll-out. In: Marlink RG, Teitelman SJ, editors. From the ground up: building comprehensive HIV/AIDS care programs in resource-limited settings, vol. 3. Washington, DC: Elizabeth Glaser Pediatric AIDS Foundation; 2009. p. 1–14.Google Scholar
  127. 127.
    Klausner JD, Serenata C, O'Bra H, et al. Scale-up and continuation of antiretroviral therapy in South African treatment programs, 2005–2009. J Acquir Immune Defic Syndr. 2011;56:292–5.PubMedCrossRefGoogle Scholar
  128. 128.
    Biesma RG, Brugha R, Harmer A, Walsh A, Spicer N, Walt G. The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control. Health Policy Planning. 2009;24:239–52.CrossRefGoogle Scholar
  129. 129.
    Abimiku AG. Institute of Human Virology UoMSoMPP. Building laboratory infrastructure to support scale-up of HIV/AIDS treatment, care, and prevention: in-country experience. Am J Clin Path. 2009;131:875–86.PubMedCrossRefGoogle Scholar
  130. 130.
    Groh K, Audet CM, Baptista A, et al. Barriers to antiretroviral therapy adherence in rural Mozambique. BMC Publ Health. 2011;11:650.CrossRefGoogle Scholar
  131. 131.
    Cook RE, Ciampa PJ, Sidat M, et al. Predictors of successful early infant diagnosis of HIV in a rural district hospital in Zambezia. Mozambique J Acquir Immune Defic Syndr. 2011;56:e104–9.CrossRefGoogle Scholar
  132. 132.
    • Ciampa PJ, Burlison JR, Blevins M, et al. Improving retention in the early infant diagnosis of HIV program in rural Mozambique by better service integration. J Acquir Immune Defic Syndr. 2011;58:115–9. Improving retention in the early infant diagnosis of HIV program in rural Mozambique by better service integration..PubMedCrossRefGoogle Scholar
  133. 133.
    Koethe JR, Limbada MI, Giganti MJ, et al. Early immunologic response and subsequent survival among malnourished adults receiving antiretroviral therapy in Urban Zambia. AIDS. 2010;24:2117–21.PubMedCrossRefGoogle Scholar
  134. 134.
    Giganti MJ, Levy JW, Banda Y, et al. Methods and baseline results of a repeated cross-sectional survey to assess the public health impact of antiretroviral therapy in Lusaka. Zambia Am J Trop Med Hyg. 2010;82:971–7.CrossRefGoogle Scholar
  135. 135.
    Chi BH, Cantrell RA, Mwango A, et al. An empirical approach to defining loss to follow-up among patients enrolled in antiretroviral treatment programs. Am J Epidemiol. 2010;171:924–31.PubMedCrossRefGoogle Scholar
  136. 136.
    Morris MB, Chapula BT, Chi BH, et al. Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka. Zambia BMC Health Serv Res. 2009;9:5.CrossRefGoogle Scholar
  137. 137.
    Krebs DW, Chi BH, Mulenga Y, et al. Community-based follow-up for late patients enrolled in a district-wide program for antiretroviral therapy in Lusaka. Zambia AIDS Care. 2008;20:311–7.CrossRefGoogle Scholar
  138. 138.
    Bolton-Moore C, Mubiana-Mbewe M, Cantrell RA, et al. Clinical outcomes and CD4 cell response in children receiving antiretroviral therapy at primary health care facilities in Zambia. JAMA. 2007;298:1888–99.PubMedCrossRefGoogle Scholar
  139. 139.
    Mahajan AP, Sayles JN, Patel VA, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS. 2008;22 Suppl 2:S67–79.PubMedCrossRefGoogle Scholar
  140. 140.
    Fowler MG, Gable AR, Lampe MA, Etima M, Owor M. Perinatal HIV and its prevention: progress toward an HIV-free generation. Clin Perinatol. 2010;37:699–719. vii.PubMedCrossRefGoogle Scholar
  141. 141.
    Whitmore SK, Zhang X, Taylor AW, Blair JM. Estimated number of infants born to HIV-infected women in the United States and five dependent areas, 2006. J Acquir Immune Defic Syndr. 2011;57(3):218–22. doi: 10.1097/QAI.0b013e3182167dec.
  142. 142.
    Whitmore SK, Patel-Larson A, Espinoza L, Ruffo NM, Rao S. Missed opportunities to prevent perinatal human immunodeficiency virus transmission in 15 jurisdictions in the United States during 2005–2008. Women Health. 2010;50:414–25.PubMedCrossRefGoogle Scholar
  143. 143.
    Birkhead GS, Pulver WP, Warren BL, Hackel S, Rodriguez D, Smith L. Acquiring human immunodeficiency virus during pregnancy and mother-to-child transmission in New York: 2002–2006. Obstet Gynecol. 2010;115:1247–55.PubMedCrossRefGoogle Scholar
  144. 144.
    Racial/ethnic disparities among children with diagnoses of perinatal HIV infection - 34 states, 2004–2007. Morb Mortal Wkly Rep. 2010;59:97–101.Google Scholar
  145. 145.
    Dwyre DM, Fernando LP, Holland PV. Hepatitis B, hepatitis C and HIV transfusion-transmitted infections in the 21st century. Vox Sang. 2011;100:92–8.PubMedCrossRefGoogle Scholar
  146. 146.
    Barth RE, Huijgen Q, Taljaard J, Hoepelman AI. Hepatitis B/C and HIV in sub-Saharan Africa: an association between highly prevalent infectious diseases. A systematic review and meta-analysis Int J Infect Dis. 2010;14:e1024–31.CrossRefGoogle Scholar
  147. 147.
    Sarang A, Stuikyte R, Bykov R. Implementation of harm reduction in Central and Eastern Europe and Central Asia. Int J Drug Policy. 2007;18:129–35.PubMedCrossRefGoogle Scholar
  148. 148.
    Burki T. Russia's drug policy fuels infectious disease epidemics. Lancet Infect Dis. 2012;12:275–6.PubMedCrossRefGoogle Scholar
  149. 149.
    Muraguri N, Temmerman M, Geibel S. A decade of research involving men who have sex with men in sub-Saharan Africa: current knowledge and future directions. SAHARA J/SAHARA; Human Sciences Research Council. 2012;9:137–47.CrossRefGoogle Scholar
  150. 150.
    Ott MA, Santelli JS. Abstinence and abstinence-only education. Curr Opin Obstet Gynecol. 2007;19:446–52.PubMedCrossRefGoogle Scholar
  151. 151.
    Santelli J, Ott MA, Lyon M, Rogers J, Summers D, Schleifer R. Abstinence and abstinence-only education: a review of U.S. policies and programs. J Adolesc Health. 2006;38:72–81.PubMedCrossRefGoogle Scholar
  152. 152.
    Chin HB, Sipe TA, Elder R, et al. The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: 2 systematic reviews for the Guide to Community Preventive Services. Am J Prev Med. 2012;42:272–94.PubMedCrossRefGoogle Scholar
  153. 153.
    Trenholm C, Devaney B, Fortson K, Clark M, Bridgespan LQ, Wheeler J. Impacts of abstinence education on teen sexual activity, risk of pregnancy, and risk of sexually transmitted diseases. J Policy Anal Manage. 2008;27:255–76.PubMedCrossRefGoogle Scholar
  154. 154.
    Jemmott 3rd JB, Jemmott LS, Fong GT. Abstinence and safer sex HIV risk-reduction interventions for African American adolescents: a randomized controlled trial. JAMA. 1998;279:1529–36.PubMedCrossRefGoogle Scholar
  155. 155.
    Underhill K, Operario D, Montgomery P. Abstinence-only programs for HIV infection prevention in high-income countries. Cochrane. 2007;4:CD005421.Google Scholar
  156. 156.
    Mahy M, Warner-Smith M, Stanecki KA, Ghys PD. Measuring the impact of the global response to the AIDS epidemic: challenges and future directions. J Acquir Immune Defic Syndr. 2009;52 Suppl 2:S152–9.PubMedCrossRefGoogle Scholar
  157. 157.
    XVI PB, Seewald P. Light of the world: the pope, the church, and the signs of the times. Vol 1. 1st ed. San Francisco: Ignatius Press; 2010.Google Scholar
  158. 158.
    Lurie P, Drucker E. An opportunity lost: HIV infections associated with lack of a national needle-exchange program in the USA. Lancet. 1997;349:604–8.PubMedCrossRefGoogle Scholar
  159. 159.
    Wetmore CM, Manhart LE, Wasserheit JN. Randomized controlled trials of interventions to prevent sexually transmitted infections: learning from the past to plan for the future. Epidemiol Rev. 2010;32:121–36.PubMedCrossRefGoogle Scholar
  160. 160.
    Barnighausen T, Chaiyachati K, Chimbindi N, Peoples A, Haberer J, Newell ML. Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies. Lancet Infect Dis. 2011;11:942–51.PubMedCrossRefGoogle Scholar
  161. 161.
    Koblin BA, Chesney MA, Husnik MJ, et al. High-risk behaviors among men who have sex with men in 6 US cities: baseline data from the EXPLORE Study. Am J Public Health. 2003;93:926–32.PubMedCrossRefGoogle Scholar
  162. 162.
    Chesney MA, Koblin BA, Barresi PJ, et al. An individually tailored intervention for HIV prevention: baseline data from the EXPLORE Study. Am J Public Health. 2003;93:933–8.PubMedCrossRefGoogle Scholar
  163. 163.
    Koblin B, Chesney M, Coates T. Effects of a behavioral intervention to reduce acquisition of HIV infection among men who have sex with men: the EXPLORE randomized controlled study. Lancet. 2004;364:41–50.PubMedCrossRefGoogle Scholar
  164. 164.
    Colfax G, Vittinghoff E, Husnik MJ, et al. Substance use and sexual risk: a participant- and episode-level analysis among a cohort of men who have sex with men. Am J Epidemiol. 2004;159:1002–12.PubMedCrossRefGoogle Scholar
  165. 165.
    Colfax G, Coates TJ, Husnik MJ, et al. Longitudinal patterns of methamphetamine, popper (amyl nitrite), and cocaine use and high-risk sexual behavior among a cohort of san francisco men who have sex with men. J Urban Health. 2005;82(1 Suppl 1):i62–70.PubMedCrossRefGoogle Scholar
  166. 166.
    Salomon EA, Mimiaga MJ, Husnik MJ, et al. Depressive symptoms, utilization of mental health care, substance use and sexual risk among young men who have sex with men in EXPLORE: implications for age-specific interventions. AIDS Behav. 2009;13:811–21.PubMedCrossRefGoogle Scholar
  167. 167.
    El-Bassel N, Gilbert L, Witte S, Wu E, Hunt T, Remien RH. Couple-based HIV prevention in the United States: advantages, gaps, and future directions. J Acquir Immune Defic Syndr. 2010;55 Suppl 2:S98–101.PubMedCrossRefGoogle Scholar
  168. 168.
    Crawford ND, Vlahov D. Progress in HIV reduction and prevention among injection and noninjection drug users. J Acquir Immune Defic Syndr. 2010;55 Suppl 2:S84–7.PubMedCrossRefGoogle Scholar
  169. 169.
    Read JS. Prevention of mother-to-child transmission of HIV: antiretroviral strategies. Clin Perinatol. 2010;37:765–76. vii.PubMedCrossRefGoogle Scholar
  170. 170.
    Cohen MS, Gay CL, Busch MP, Hecht FM. The detection of acute HIV infection. J Infect Dis. 2010;202 Suppl 2:S270–7.PubMedCrossRefGoogle Scholar
  171. 171.
    Reynolds SJ, Quinn TC. Setting the stage: current state of affairs and major challenges. Clin Infect Dis. 2010;50 Suppl 3:S71–6.PubMedCrossRefGoogle Scholar
  172. 172.
    DeGruttola V, Smith DM, Little SJ, Miller V. Developing and evaluating comprehensive HIV infection control strategies: issues and challenges. Clin Infect Dis. 2010;50 Suppl 3:S102–7.PubMedCrossRefGoogle Scholar
  173. 173.
    Corsi KF, Booth RE. HIV sex risk behaviors among heterosexual methamphetamine users: literature review from 2000 to present. Curr Drug Abuse Rev. 2008;1:292–6.PubMedCrossRefGoogle Scholar
  174. 174.
    Buchbinder S. The epidemiology of new HIV infections and interventions to limit HIV transmission. Top HIV Med. 2009;17:37–43.PubMedGoogle Scholar
  175. 175.
    Rotheram-Borus MJ, Swendeman D, Chovnick G. The past, present, and future of HIV prevention: integrating behavioral, biomedical, and structural intervention strategies for the next generation of HIV prevention. Annu Rev Clin Psychol. 2009;5:143–67.PubMedCrossRefGoogle Scholar
  176. 176.
    Barrow RY, Berkel C, Brooks LC, Groseclose SL, Johnson DB, Valentine JA. Traditional sexually transmitted disease prevention and control strategies: tailoring for African American communities. Sex Transm Dis. 2008;35(12 Suppl):S30–9.PubMedGoogle Scholar
  177. 177.
    Margaret Dolcini M, Gandelman AA, Vogan SA, et al. Translating HIV interventions into practice: community-based organizations' experiences with the diffusion of effective behavioral interventions (DEBIs). Soc Sci Med. 2010;71:1839–46.PubMedCrossRefGoogle Scholar
  178. 178.
    Harshbarger C, Simmons G, Coelho H, Sloop K, Collins C. An empirical assessment of implementation, adaptation, and tailoring: the evaluation of CDC's National Diffusion of VOICES/VOCES. AIDS Educ Prev. 2006;18(4 Suppl A):184–97.PubMedCrossRefGoogle Scholar
  179. 179.
    Wingood GM, DiClemente RJ. Enhancing adoption of evidence-based HIV interventions: promotion of a suite of HIV prevention interventions for African American women. AIDS Educ Prev. 2006;18((4 Suppl A)):161–70.PubMedCrossRefGoogle Scholar
  180. 180.
    Collins C, Harshbarger C, Sawyer R, Hamdallah M. The diffusion of effective behavioral interventions project: development, implementation, and lessons learned. AIDS Educ Prev. 2006;18(4 Suppl A):5–20.PubMedCrossRefGoogle Scholar
  181. 181.
    Lyles CM, Crepaz N, Herbst JH, Kay LS. Evidence-based HIV behavioral prevention from the perspective of the CDC's HIV/AIDS Prevention Research Synthesis Team. AIDS Educ Prev. 2006;18(4 Suppl A):21–31.PubMedCrossRefGoogle Scholar
  182. 182.
    Kohler PK, Manhart LE, Lafferty WE. Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. J Adolesc Health. 2008;42:344–51.PubMedCrossRefGoogle Scholar
  183. 183.
    Dworkin SL, Ehrhardt AA. Going beyond "ABC" to include "GEM": critical reflections on progress in the HIV/AIDS epidemic. Am J Public Health. 2007;97:13–8.PubMedCrossRefGoogle Scholar
  184. 184.
    • Kurth AE, Celum C, Baeten JM, Vermund SH, Wasserheit JN. Combination HIV prevention: significance, challenges, and opportunities. Curr HIV/AIDS Rep. 2011;8:62–72. Presentation of the rationale for combination HIV prevention in lieu of single method approaches..PubMedCrossRefGoogle Scholar
  185. 185.
    Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–7.PubMedCrossRefGoogle Scholar
  186. 186.
    Auvert B, Taljaard D, Lagarde E, Sobngwi-Tambekou J, Sitta R, Puren A. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial. PLoS Med. 2005;2:e298.PubMedCrossRefGoogle Scholar
  187. 187.
    Auvert B, Ballard R, Campbell C, et al. HIV infection among youth in a South African mining town is associated with herpes simplex virus-2 seropositivity and sexual behavior. AIDS. 2001;15:885–98.PubMedCrossRefGoogle Scholar
  188. 188.
    Bailey RC, Moses S, Parker CB, et al. Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomized controlled trial. Lancet. 2007;369:643–56.PubMedCrossRefGoogle Scholar
  189. 189.
    Gray RH, Kigozi G, Serwadda D, et al. Male circumcision for HIV prevention in men in Rakai, Uganda: a randomized trial. Lancet. 2007;369:657–66.PubMedCrossRefGoogle Scholar
  190. 190.
    Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS Clinical Trials Group Protocol 076 Study Group. N Engl J Med. 1994;331:1173–80.PubMedCrossRefGoogle Scholar
  191. 191.
    Fideli US, Allen SA, Musonda R, et al. Virologic and immunologic determinants of heterosexual transmission of human immunodeficiency virus type 1 in Africa. AIDS Res Human Retroviruses. 2001;17:901–10.CrossRefGoogle Scholar
  192. 192.
    Quinn TC, Wawer MJ, Sewankambo N, et al. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group N Engl J Med. 2000;342:921–9.CrossRefGoogle Scholar
  193. 193.
    • Donnell D, Baeten JM, Kiarie J, et al. Heterosexual HIV-1 transmission after initiation of antiretroviral therapy: a prospective cohort analysis. Lancet. 2010;375:2092–8. Strong observational evidence of treatment as prevention..PubMedCrossRefGoogle Scholar
  194. 194.
    Korenromp EL, White RG, Orroth KK, et al. Determinants of the impact of sexually transmitted infection treatment on prevention of HIV infection: a synthesis of evidence from the Mwanza, Rakai, and Masaka intervention trials. J Infect Dis. 2005;191 Suppl 1:S168–78.PubMedCrossRefGoogle Scholar
  195. 195.
    • Abdool Karim Q, Abdool Karim SS, Frohlich JA, et al. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329:1168–74. The promise of microbicides is documented in this first clinical trial suggesting that tenofovir gel can be effective in exposure-dependent pre-exposure topical prophylaxis..PubMedCrossRefGoogle Scholar
  196. 196.
    • Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587–99. The promise of oral PrEP is documented in this first clinical trial of oral tenofovir/emtricitabine among MSM.PubMedCrossRefGoogle Scholar
  197. 197.
    Celum C, Baeten JM. Tenofovir-based pre-exposure prophylaxis for HIV prevention: evolving evidence. Curr Opin in InfectDis. 2012;25:51–7.CrossRefGoogle Scholar
  198. 198.
    Krakower D, Mayer KH. Promising prevention approaches: tenofovir gel and prophylactic use of antiretroviral medications. Curr HIV/AIDS Rep. 2011;8:241–8.PubMedCrossRefGoogle Scholar
  199. 199.
    • Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, et al. Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand. N Engl J Med. 2009;361:2209–20. The first ever HIV vaccine approach (prime-boost) to demonstrate some efficacy in HIV prevention..PubMedCrossRefGoogle Scholar
  200. 200.
    Johnston MI, Fauci AS. HIV vaccine development—improving on natural immunity. N Engl J Med. 2011;365:873–5.PubMedCrossRefGoogle Scholar
  201. 201.
    Gallo MF, Kilbourne-Brook M, Coffey PS. A review of the effectiveness and acceptability of the female condom for dual protection. Sex Heal. 2012;9:18–26.CrossRefGoogle Scholar
  202. 202.
    Batar I. Sivin I. State-of-the-art of non-hormonal methods of contraception: I Mechanical barrier contraception Eur J Contraception Reproductive Health Care. 2010;15:67–88.CrossRefGoogle Scholar
  203. 203.
    Vijayakumar G, Mabude Z, Smit J, Beksinska M, Lurie M. A review of female-condom effectiveness: patterns of use and impact on protected sex acts and STI incidence. Int J STD AIDS. 2006;17:652–9.PubMedCrossRefGoogle Scholar
  204. 204.
    Minnis AM, Padian NS. Effectiveness of female controlled barrier methods in preventing sexually transmitted infections and HIV: current evidence and future research directions. Sex Transm Dis. 2005;81:193–200.CrossRefGoogle Scholar
  205. 205.
    Valente TW, Foreman RK, Junge B, Vlahov D. Needle-exchange participation, effectiveness, and policy: syringe relay, gender, and the paradox of public health. J Urban Health. 2001;78:340–9.PubMedCrossRefGoogle Scholar
  206. 206.
    Hyshka E, Strathdee S, Wood E, Kerr T. Needle exchange and the HIV epidemic in Vancouver: lessons learned from 15 years of research. Int J Drug Policy. 2012;23:261–70.PubMedCrossRefGoogle Scholar
  207. 207.
    Bruneau J, Daniel M, Kestens Y, Zang G, Genereux M. Associations between HIV-related injection behavior and distance to and patterns of utilisation of syringe-supply programs. J Epidemiol Commun Health. 2008;62:804–10.CrossRefGoogle Scholar
  208. 208.
    Raboud JM, Boily MC, Rajeswaran J, O'Shaughnessy MV, Schechter MT. The impact of needle-exchange programs on the spread of HIV among injection drug users: a simulation study. J Urban Health. 2003;80:302–20.PubMedCrossRefGoogle Scholar
  209. 209.
    Marmor M, Shore RE, Titus S, Chen X, Des Jarlais DC. Drug injection rates and needle-exchange use in New York City, 1991–1996. J Urban Health. 2000;77:359–68.PubMedCrossRefGoogle Scholar
  210. 210.
    Moatti JP, Vlahov D, Feroni I, Perrin V, Obadia Y. Multiple access to sterile syringes for injection drug users: vending machines, needle exchange programs and legal pharmacy sales in Marseille. France Eur Addict Res. 2001;7:40–5.CrossRefGoogle Scholar
  211. 211.
    Neaigus A, Zhao M, Gyarmathy VA, Cisek L, Friedman SR, Baxter RC. Greater drug injecting risk for HIV, HBV, and HCV infection in a city where syringe exchange and pharmacy syringe distribution are illegal. J Urban Health. 2008;85:309–22.PubMedCrossRefGoogle Scholar
  212. 212.
    Bluthenthal RN, Kral AH, Gee L, Erringer EA, Edlin BR. The effect of syringe exchange use on high-risk injection drug users: a cohort study. AIDS. 2000;14:605–11.PubMedCrossRefGoogle Scholar
  213. 213.
    Huo D, Ouellet LJ. Needle exchange and sexual risk behaviors among a cohort of injection drug users in Chicago. Illinois Sex Transmit Dis. 2009;36:35–40.CrossRefGoogle Scholar
  214. 214.
    Henderson LA, Vlahov D, Celentano DD, Strathdee SA. Readiness for cessation of drug use among recent attenders and nonattenders of a needle exchange program. J Acquir Immune Defic Syndr. 2003;32:229–37.PubMedCrossRefGoogle Scholar
  215. 215.
    Des Jarlais DC, Marmor M, Paone D, et al. HIV incidence among injecting drug users in New York City syringe-exchange programs. Lancet. 1996;348:987–91.PubMedCrossRefGoogle Scholar
  216. 216.
    Heimer R. Community coverage and HIV prevention: assessing metrics for estimating HIV incidence through syringe exchange. Int J Drug Policy. 2008;19 Suppl 1:S65–73.PubMedCrossRefGoogle Scholar
  217. 217.
    Des Jarlais DC, Sloboda Z, Friedman SR, Tempalski B, McKnight C, Braine N. Diffusion of the D.A.R.E and syringe exchange programs. Am J Public Health. 2006;96:1354–8.PubMedCrossRefGoogle Scholar
  218. 218.
    Latkin CA, Davey MA, Hua W. Needle exchange program utilization and entry into drug user treatment: is there a long-term connection in Baltimore, Maryland? Substance Use Misuse. 2006;41:1991–2001.PubMedCrossRefGoogle Scholar
  219. 219.
    Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange programs for prevention of HIV infection. Lancet. 1997;349:1797–800.PubMedCrossRefGoogle Scholar
  220. 220.
    Schechter MT, Strathdee SA, Cornelisse PG, et al. Do needle exchange programs increase the spread of HIV among injection drug users?: an investigation of the Vancouver outbreak. AIDS. 1999;13:F45–51.PubMedCrossRefGoogle Scholar
  221. 221.
    Peak A, Rana S, Maharjan SH, Jolley D, Crofts N. Declining risk for HIV among injecting drug users in Kathmandu, Nepal: the impact of a harm-reduction program. AIDS. 1995;9:1067–70.PubMedCrossRefGoogle Scholar
  222. 222.
    Fuller CM, Galea S, Caceres W, Blaney S, Sisco S, Vlahov D. Multilevel community-based intervention to increase access to sterile syringes among injection drug users through pharmacy sales in New York City. Am J Public Health. 2007;97:117–24.PubMedCrossRefGoogle Scholar
  223. 223.
    Strathdee SA, Celentano DD, Shah N, et al. Needle-exchange attendance and health care utilization promote entry into detoxification. J Urban Health. 1999;76:448–60.PubMedCrossRefGoogle Scholar
  224. 224.
    Wall KM, Vwalika B, Haddad L, et al. Impact of long-term contraceptive promotion on incident pregnancy: a randomized controlled trial among HIV positive couples in Lusaka, Zambia. J Acquir Immune Defic Syndr. 2012. doi: 10.1097/QAI.0b013e31827ee19c.
  225. 225.
    Khu NH, Vwalika B, Karita E. et al. Contraception: Fertility goal-based counseling increases contraceptive implant and IUD use in HIV-discordant couples in Rwanda and Zambia; 2012. doi: 10.1016/j.contraception.2012.10.004.
  226. 226.
    Ngure K, Heffron R, Mugo NR, et al. Contraceptive method and pregnancy incidence among women in HIV-1-serodiscordant partnerships. AIDS. 2012;26:513–8.PubMedCrossRefGoogle Scholar
  227. 227.
    Stephenson R, Vwalika B, Greenberg L, et al. A randomized controlled trial to promote long-term contraceptive use among HIV-serodiscordant and concordant positive couples in Zambia. J Women Health. 2011;20:567–74.CrossRefGoogle Scholar
  228. 228.
    Heffron R, Were E, Celum C, et al. A prospective study of contraceptive use among African women in HIV-1 serodiscordant partnerships. Sex Transmit Dis. 2010;37:621–8.Google Scholar
  229. 229.
    Grabbe K, Stephenson R, Vwalika B, et al. Knowledge, use, and concerns about contraceptive methods among sero-discordant couples in Rwanda and Zambia. J Women Health. 2009;18:1449–56.CrossRefGoogle Scholar
  230. 230.
    Stephenson R, Mendenhall E, Muzizi L, et al. The influence of motivational messages on future planning behaviors among HIV concordant positive and discordant couples in Lusaka. Zambia AIDS Care. 2008;20:150–60.CrossRefGoogle Scholar
  231. 231.
    King R, Estey J, Allen S, et al. A family planning intervention to reduce vertical transmission of HIV in Rwanda. AIDS. 1995;9 Suppl 1:S45–51.PubMedGoogle Scholar
  232. 232.
    Allen S, Serufilira A, Gruber V, et al. Pregnancy and contraception use among urban Rwandan women after HIV testing and counseling. Am J Public Health. 1993;83:705–10.PubMedCrossRefGoogle Scholar
  233. 233.
    Crankshaw TL, Matthews LT, Giddy J, et al. A conceptual framework for understanding HIV risk behavior in the context of supporting fertility goals among HIV-serodiscordant couples. Reproduct Health Matter. 2012;20(39 Suppl):50–60.CrossRefGoogle Scholar
  234. 234.
    Muyindike W, Fatch R, Steinfield R, et al. Contraceptive use and associated factors among women enrolling into HIV care in southwestern Uganda. Infect Dis Obstet Gynecol. 2012;2012:340782.PubMedCrossRefGoogle Scholar
  235. 235.
    Busza J, Walker D, Hairston A, et al. Community-based approaches for prevention of mother to child transmission in resource-poor settings: a social ecological review. J Int AIDS Soc. 2012;15 Suppl 2:17373.PubMedGoogle Scholar
  236. 236.
    Nutman S, McKee D, Khoshnood K. Externalities of prevention of mother-to-child transmission programs: a systematic review. AIDS Behav. 2012;17(2):445–460. doi: 10.1007/s10461-012-0228-8.Google Scholar
  237. 237.
    Leslie JA, Munyambanza E, Adamchak SE, Janowitz B, Grey TW, Kirota K. Without strong integration of family planning into PMTCT services in Rwanda, clients remain with a high unmet need for effective family planning. Afr J Reproduct Health. 2010;14(4 Spec No.):144–6.Google Scholar
  238. 238.
    Wanyenze RK, Tumwesigye NM, Kindyomunda R, et al. Uptake of family planning methods and unplanned pregnancies among HIV-infected individuals: a cross-sectional survey among clients at HIV clinics in Uganda. J Int AIDS Soc. 2011;14:35.PubMedCrossRefGoogle Scholar
  239. 239.
    Mahy M, Stover J, Kiragu K, et al. What will it take to achieve virtual elimination of mother-to-child transmission of HIV? An assessment of current progress and future needs. Sex Transm Dis. 2010;86((Suppl 2):ii48–55.Google Scholar
  240. 240.
    Both JM, van Roosmalen J. The impact of Prevention of Mother to Child Transmission (PMTCT) programs on maternal health care in resource-poor settings: looking beyond the PMTCT program—a systematic review. BJOG. 2010;117:1444–50.PubMedCrossRefGoogle Scholar
  241. 241.
    Petruney T, Harlan SV, Lanham M, Robinson ET. Increasing support for contraception as HIV prevention: stakeholder mapping to identify influential individuals and their perceptions. PLoS One. 2010;5:e10781.PubMedCrossRefGoogle Scholar
  242. 242.
    Baek C, Rutenberg N. Implementing programs for the prevention of mother-to-child HIV transmission in resource-constrained settings: Horizons Studies, 1999–2007. Public Health Rep. 2010;125:293–304.PubMedGoogle Scholar
  243. 243.
    Chabikuli NO, Awi DD, Chukwujekwu O, et al. The use of routine monitoring and evaluation systems to assess a referral model of family planning and HIV service integration in Nigeria. AIDS. 2009;23 Suppl 1:S97–103.PubMedCrossRefGoogle Scholar
  244. 244.
    Elul B, Delvaux T, Munyana E, et al. Pregnancy desires, and contraceptive knowledge and use among prevention of mother-to-child transmission clients in Rwanda. AIDS. 2009;23 Suppl 1:S19–26.PubMedCrossRefGoogle Scholar
  245. 245.
    Hladik W, Stover J, Esiru G, Harper M, Tappero J. The contribution of family planning towards the prevention of vertical HIV transmission in Uganda. PLoS One. 2009;4:e7691.PubMedCrossRefGoogle Scholar
  246. 246.
    Agadjanian V, Hayford SR. PMTCT, HAART, and childbearing in Mozambique: an institutional perspective. AIDS Behav. 2009;13 Suppl 1:103–12.PubMedCrossRefGoogle Scholar
  247. 247.
    Reynolds HW, Janowitz B, Wilcher R, Cates W. Contraception to prevent HIV-positive births: current contribution and potential cost savings in PEPFAR countries. Sex Transm Dis. 2008;84 Suppl 2:ii49–53.CrossRefGoogle Scholar
  248. 248.
    Bii SC, Otieno-Nyunya B, Siika A, Rotich JK. Family planning and safer sex practices among HIV infected women receiving prevention of mother-to-child transmission services at Kitale District Hospital. East Afr Med J. 2008;85:46–50.PubMedGoogle Scholar
  249. 249.
    Peltzer K, Chao LW, Dana P. Family planning among HIV positive and negative prevention of mother to child transmission (PMTCT) clients in a resource poor setting in South Africa. AIDS Behav. 2009;13:973–9.PubMedCrossRefGoogle Scholar
  250. 250.
    Behets FM, Matendo R, Vaz LM, et al. Preventing vertical transmission of HIV in Kinshasa, Democratic Republic of the Congo: a baseline survey of 18 antenatal clinics. Bull WHO. 2006;84:969–75.PubMedGoogle Scholar
  251. 251.
    Rutenberg N, Baek C. Field experiences integrating family planning into programs to prevent mother-to-child transmission of HIV. Studies Fam Planning. 2005;36:235–45.CrossRefGoogle Scholar
  252. 252.
    Nakayiwa S, Abang B, Packel L, et al. Desire for children and pregnancy risk behavior among HIV-infected men and women in Uganda. AIDS Behav. 2006;10(4 Suppl):S95–104.PubMedCrossRefGoogle Scholar
  253. 253.
    Stringer EM, Kaseba C, Levy J, et al. A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus. Am J Obstet Gynecol. 2007;197(144):e141–8.Google Scholar
  254. 254.
    Wariki WM, Ota E, Mori R, Koyanagi A, Hori N, Shibuya K. Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in low- and middle-income countries. Cochrane. 2012;2:CD005272.Google Scholar
  255. 255.
    Tan JY, Huedo-Medina TB, Warren MR, Carey MP, Johnson BT. A meta-analysis of the efficacy of HIV/AIDS prevention interventions in Asia, 1995–2009. Soc Sci Med. 2012;75:676–87.PubMedCrossRefGoogle Scholar
  256. 256.
    Ota E, Wariki WM, Mori R, Hori N, Shibuya K. Behavioral interventions to reduce the transmission of HIV infection among sex workers and their clients in high-income countries. Cochrane. 2011:CD006045.Google Scholar
  257. 257.
    Carvalho FT, Goncalves TR, Faria ER, et al. Behavioral interventions to promote condom use among women living with HIV. Cochrane. 2011:CD007844.Google Scholar
  258. 258.
    Johnson BT, Scott-Sheldon LA, Huedo-Medina TB, Carey MP. Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: a meta-analysis of trials, 1985–2008. Arch Pediatr Adolesc Med. 2011;165:77–84.PubMedCrossRefGoogle Scholar
  259. 259.
    Kennedy CE, Medley AM, Sweat MD, O'Reilly KR. Behavioral interventions for HIV positive prevention in developing countries: a systematic review and meta-analysis. Bull WHO. 2010;88:615–23.PubMedGoogle Scholar
  260. 260.
    Kennedy CE, Spaulding AB, Brickley DB, et al. Linking sexual and reproductive health and HIV interventions: a systematic review. J Int AIDS Soc. 2010;13:26.PubMedCrossRefGoogle Scholar
  261. 261.
    Michielsen K, Chersich MF, Luchters S, De Koker P, Van Rossem R, Temmerman M. Effectiveness of HIV prevention for youth in sub-Saharan Africa: systematic review and meta-analysis of randomized and nonrandomized trials. AIDS. 2010;24:1193–202.PubMedCrossRefGoogle Scholar
  262. 262.
    Shepherd J, Kavanagh J, Picot J, et al. 2010. Health Technol Assessment. 2010;4:1–206. iii–iv.Google Scholar
  263. 263.
    Free C, Roberts IG, Abramsky T, Fitzgerald M, Wensley F. A systematic review of randomized controlled trials of interventions promoting effective condom use. J Epidemiol Commun Health. 2011;65:100–10.CrossRefGoogle Scholar
  264. 264.
    Medley A, Kennedy C, O'Reilly K, Sweat M. Effectiveness of peer education interventions for HIV prevention in developing countries: a systematic review and meta-analysis. AIDS Educ Prev. 2009;21:181–206.PubMedCrossRefGoogle Scholar
  265. 265.
    Gupta GR, Parkhurst JO, Ogden JA, Aggleton P, Mahal A. Structural approaches to HIV prevention. Lancet. 2008;372:764–75.PubMedCrossRefGoogle Scholar
  266. 266.
    Shahmanesh M, Patel V, Mabey D, Cowan F. Effectiveness of interventions for the prevention of HIV and other sexually transmitted infections in female sex workers in resource poor setting: a systematic review. TM & IH. 2008;13:659–79.CrossRefGoogle Scholar
  267. 267.
    Noar SM. Behavioral interventions to reduce HIV-related sexual risk behavior: review and synthesis of meta-analytic evidence. AIDS Behav. 2008;12:335–53.PubMedCrossRefGoogle Scholar
  268. 268.
    Vermund SH, Wilson CM. Barriers to HIV testing—where next? Lancet. 2002;360:1186–7.PubMedCrossRefGoogle Scholar
  269. 269.
    Adams AL, Becker TM, Lapidus JA, Modesitt SK, Lehman JS, Loveless MO. HIV infection risk, behaviors, and attitudes about testing: are perceptions changing? Sex Transmit Dis. 2003;30:764–8.CrossRefGoogle Scholar
  270. 270.
    Walensky RP, Weinstein MC, Smith HE, Freedberg KA, Paltiel AD. Optimal allocation of testing dollars: the example of HIV counseling, testing, and referral. Med Dec Making. 2005;25:321–9.CrossRefGoogle Scholar
  271. 271.
    Wallrauch C, Heller T, Lessells R, Kekana M, Barnighausen T, Newell ML. High uptake of HIV testing for tuberculosis patients in an integrated primary health care HIV/TB program in rural KwaZulu-Natal. S Afr Med J (Suid-Afrikaanse tydskrif vir geneeskunde). 2010;100:146–7.Google Scholar
  272. 272.
    Burke RC, Sepkowitz KA, Bernstein KT, et al. Why don't physicians test for HIV? A review of the US literature. AIDS. 2007;21:1617–24.PubMedCrossRefGoogle Scholar
  273. 273.
    Boxall EH, Smith N. Antenatal screening for HIV; are those who refuse testing at higher risk than those who accept testing? J Public Health. 2004;26:285–7.CrossRefGoogle Scholar
  274. 274.
    Ebrahim SH, Anderson JE, Weidle P, Purcell DW. Race/ethnic disparities in HIV testing and knowledge about treatment for HIV/AIDS: United States, 2001. AIDS Patient Care STDs. 2004;18:27–33.PubMedCrossRefGoogle Scholar
  275. 275.
    Tolou-Shams M, Payne N, Houck C, et al. HIV testing among at-risk adolescents and young adults: a prospective analysis of a community sample. J Adolesc Health. 2007;41:586–93.PubMedCrossRefGoogle Scholar
  276. 276.
    Massari V, Dorleans Y, Flahault A. Trends in voluntary HIV testing in general practices in France between 1987 and 2002. Eur J Epidemiol. 2005;20:543–7.PubMedCrossRefGoogle Scholar
  277. 277.
    Wu Z, Rou K, Xu C, Lou W, Detels R. Acceptability of HIV/AIDS counseling and testing among premarital couples in China. AIDS Educ Prev. 2005;17:12–21.PubMedCrossRefGoogle Scholar
  278. 278.
    Reis C, Heisler M, Amowitz LL, et al. Discriminatory attitudes and practices by health workers toward patients with HIV/AIDS in Nigeria. PLoS Med. 2005;2:e246.PubMedCrossRefGoogle Scholar
  279. 279.
    Holtgrave DR. Costs and consequences of the US Centers for Disease Control and Prevention's recommendations for opt-out HIV testing. PLoS Med. 2007;4:e194.PubMedCrossRefGoogle Scholar
  280. 280.
    Weiser SD, Heisler M, Leiter K, et al. Routine HIV testing in Botswana: a population-based study on attitudes, practices, and human rights concerns. PLoS Med. 2006;3:e261.PubMedCrossRefGoogle Scholar
  281. 281.
    Minniear TD, Gilmore B, Arnold SR, Flynn PM, Knapp KM, Gaur AH. Implementation of and barriers to routine HIV screening for adolescents. Pediatrics. 2009;124:1076–84.PubMedCrossRefGoogle Scholar
  282. 282.
    Nichols SA, Bhatta MP, Lewis J, Vermund SH. Prenatal HIV counseling, testing, and antiretroviral prophylaxis by obstetric and family medicine providers in Alabama. Am J Med Scil. 2002;324:305–9.CrossRefGoogle Scholar
  283. 283.
    Heijman RL, Stolte IG, Thiesbrummel HF, et al. Opting out increases HIV testing in a large sexually transmitted infections outpatient clinic. Sex Transmit Dis. 2009;85:249–55.Google Scholar
  284. 284.
    Lau C, Muula AS, Kalanda R, Horwitz G, Misiri H. Test offering, not additional information, may increase HIV testing uptake in a knowledgeable population. Central Afr J Med. 2004;50:85–90.Google Scholar
  285. 285.
    Veloso VG, Portela MC, Vasconcellos MT, et al. HIV testing among pregnant women in Brazil: rates and predictors. Revista de Saude Publica. 2008;42:859–67.PubMedCrossRefGoogle Scholar
  286. 286.
    Sullivan SG, Wu Z, Detels R. Missed opportunities for HIV testing and counselling in Asia. AIDS. 2010;24 Suppl 3:S49–53.PubMedCrossRefGoogle Scholar
  287. 287.
    Sanchez TH, Sullivan PS. Expanding the horizons: new approaches to providing HIV testing services in the United States. Public Health Rep. 2008;123 Suppl 3:1–4.PubMedGoogle Scholar
  288. 288.
    Zetola NM, Klausner JD, Katz MH. Simplifying consent increases HIV testing and new case detection: the San Francisco experience. Am J Public Health. 2009;99. author reply 1924–5.Google Scholar
  289. 289.
    Denison JA, O'Reilly KR, Schmid GP, Kennedy CE, Sweat MD. HIV voluntary counseling and testing and behavioral risk reduction in developing countries: a meta-analysis, 1990–2005. AIDS Behav. 2008;12:363–73.PubMedCrossRefGoogle Scholar
  290. 290.
    Allen S, Tice J, Van de Perre P, et al. Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa. BMJ. 1992;304:1605–9.PubMedCrossRefGoogle Scholar
  291. 291.
    Wilson D, Halperin DT. "Know your epidemic, know your response": a useful approach, if we get it right. Lancet. 2008;372:423–6.PubMedCrossRefGoogle Scholar
  292. 292.
    Stoneburner RL, Low-Beer D. Population-level HIV declines and behavioral risk avoidance in Uganda. Science. 2004;304:714–8.PubMedCrossRefGoogle Scholar
  293. 293.
    Stoneburner RL, Low-Beer D. Sexual partner reductions explain human immunodeficiency virus declines in Uganda: comparative analyses of HIV and behavioral data in Uganda, Kenya, Malawi, and Zambia. Int J Epidemiol. 2004;33:624.PubMedCrossRefGoogle Scholar
  294. 294.
    Khumalo-Sakutukwa G, Morin SF, Fritz K, et al. Project Accept (HPTN 043): a community-based intervention to reduce HIV incidence in populations at risk for HIV in sub-Saharan Africa and Thailand. J Acquir Immune Defic Syndr. 2008;49:422–31.PubMedCrossRefGoogle Scholar
  295. 295.
    Sweat M, Morin S, Celentano D, et al. Community-based intervention to increase HIV testing and case detection in people aged 16–32 years in Tanzania, Zimbabwe, and Thailand (NIMH Project Accept, HPTN 043): a randomized study. Lancet Infect Dis. 2011;11:525–32.PubMedCrossRefGoogle Scholar
  296. 296.
    Bunnell R, Cherutich P. Universal HIV testing and counselling in Africa. Lancet. 2008;371:2148–50.PubMedCrossRefGoogle Scholar
  297. 297.
    Renaud-Thery F DC, Ken S, Thierry S, Perriens J. Adult antiretroviral therapy in resource limited settings: a systematic review of first-line treatment failure and attrition rates. 17th Conference on Retroviruses and Opportunistic Infections. 2010.Google Scholar
  298. 298.
    Bunnell R, Ekwaru JP, Solberg P, et al. Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda. AIDS. 2006;20:85–92.PubMedCrossRefGoogle Scholar
  299. 299.
    Hanenberg RS, Rojanapithayakorn W, Kunasol P, Sokal DC. Impact of Thailand's HIV-control program as indicated by the decline of sexually transmitted diseases. Lancet. 1994;344:243–5.PubMedCrossRefGoogle Scholar
  300. 300.
    Interview VM. King Kennard Holmes—chair of the Department of Global Health of the University of Washington. Lancet Infect Dis. 2007;7:516–20.CrossRefGoogle Scholar
  301. 301.
    El-Sadr WM, Coburn BJ, Blower S. Modeling the impact on the HIV epidemic of treating discordant couples with antiretrovirals to prevent transmission. AIDS. 2011;25:2295–9.PubMedCrossRefGoogle Scholar
  302. 302.
    Hallett TB, Baeten JM, Heffron R, et al. Optimal uses of antiretrovirals for prevention in HIV-1 serodiscordant heterosexual couples in South Africa: a modelling study. PLoS Med. 2011;8:e1001123.PubMedCrossRefGoogle Scholar
  303. 303.
    Maleta K, Bowie C. Selecting HIV infection prevention interventions in the mature HIV epidemic in Malawi using the mode of transmission model. BMC Health Service Res. 2010;10:243.CrossRefGoogle Scholar
  304. 304.
    Delva W, Eaton JW, Meng F, et al. HIV treatment as prevention: optimizing the impact of expanded HIV treatment programs. PLoS Med. 2012;9:e1001258.PubMedCrossRefGoogle Scholar
  305. 305.
    Eaton JW, Johnson LF, Salomon JA, et al. HIV treatment as prevention: systematic comparison of mathematical models of the potential impact of antiretroviral therapy on HIV incidence in South Africa. PLoS Med. 2012;9:e1001245.PubMedCrossRefGoogle Scholar
  306. 306.
    Granich R, Kahn JG, Bennett R, et al. Expanding ART for treatment and prevention of HIV in South Africa: estimated cost and cost-effectiveness 2011–2050. PLoS One. 2012;7:e30216.PubMedCrossRefGoogle Scholar
  307. 307.
    Baggaley RF, Garnett GP, Ferguson NM. Modelling the impact of antiretroviral use in resource-poor settings. PLoS Med. 2006;3:e124.PubMedCrossRefGoogle Scholar
  308. 308.
    Andrews JR, Wood R, Bekker LG, Middelkoop K, Walensky RP. Projecting the benefits of antiretroviral therapy for HIV prevention: the impact of population mobility and linkage to care. J Infect Dis. 2012;206:543–51.PubMedCrossRefGoogle Scholar
  309. 309.
    Hallett TB, Gregson S, Dube S, Mapfeka ES, Mugurungi O, Garnett GP. Estimating the resources required in the roll-out of universal access to antiretroviral treatment in Zimbabwe. Sex Transmit Dis. 2011;87:621–8.Google Scholar
  310. 310.
    • Wagner BG, Blower S. Universal access to HIV treatment vs universal 'test and treat': transmission, drug resistance & treatment costs. PLoS One. 2012;7:e41212. A hard look at the challenges of high coverage of testing and treatment to interrupt HIV transmission in Africa, using mathematical models..PubMedCrossRefGoogle Scholar
  311. 311.
    Dodd PJ, Garnett GP, Hallett TB. Examining the promise of HIV elimination by 'test and treat' in hyperendemic settings. AIDS. 2010;24:729–35.PubMedCrossRefGoogle Scholar
  312. 312.
    Granich R, Lo YR, Suthar AB, et al. Harnessing the prevention benefits of antiretroviral therapy to address HIV and tuberculosis. Curr HIV Res. 2011;9:355–66.PubMedCrossRefGoogle Scholar
  313. 313.
    Granich R, Crowley S, Vitoria M, et al. Highly active antiretroviral treatment as prevention of HIV transmission: review of scientific evidence and update. Curr Opin HIV AIDS. 2010;5:298–304.PubMedCrossRefGoogle Scholar
  314. 314.
    Boily MC, Masse B, Alsallaq R, et al. HIV treatment as prevention: considerations in the design, conduct, and analysis of cluster randomized controlled trials of combination HIV prevention. PLoS Med. 2012;9:e1001250.PubMedCrossRefGoogle Scholar
  315. 315.
    Padian NS, Isbell MT, Russell ES, Essex M. The future of HIV prevention. J Acquir Immune Defic Syndr. 2012;60 Suppl 2:S22–6.PubMedCrossRefGoogle Scholar
  316. 316.
    Padian NS, McCoy SI, Manian S, Wilson D, Schwartlander B, Bertozzi SM. Evaluation of large-scale combination HIV prevention programs: essential issues. J Acquir Immune Defic Syndr. 2011;58:e23–8.PubMedCrossRefGoogle Scholar
  317. 317.
    Bertozzi S, Padian NS, Wegbreit J, et al. HIV/AIDS prevention and treatment. In: Jamison DT, Breman JG, Measham AR, et al., editors. Disease control priorities in developing countries. 2nd ed. Washington, DC: 2006.Google Scholar
  318. 318.
    Merson M, Padian N, Coates TJ, et al. Combination HIV prevention. Lancet. 2008;372:1805–6.PubMedCrossRefGoogle Scholar
  319. 319.
    Beyrer C, Wirtz AL, Walker D, Johns B, Sifakis F, Baral SD. The Global HIV epidemics among men who have sex with men, vol. 1. Washington, DC: World Bank; 2011.Google Scholar
  320. 320.
    Wagner B, Blower S. Costs of eliminating HIV in South Africa have been underestimated. Lancet. 2010;376:953–4.PubMedCrossRefGoogle Scholar
  321. 321.
    Wilson DP, Blower SM. Designing equitable antiretroviral allocation strategies in resource-constrained countries. PLoS Med. 2005;2:e50.PubMedCrossRefGoogle Scholar
  322. 322.
    Wagner BG, Kahn JS, Blower S. Should we try to eliminate HIV epidemics by using a 'Test and Treat' strategy? AIDS. 2010;24:775–6.PubMedCrossRefGoogle Scholar
  323. 323.
    Schwartlander B, Stover J, Hallett T, et al. Towards an improved investment approach for an effective response to HIV/AIDS. Lancet. 2011;377:2031–41.PubMedCrossRefGoogle Scholar
  324. 324.
    Walensky RP, Paltiel AD, Losina E, et al. The survival benefits of AIDS treatment in the United States. J Infect Dis. 2006;194:11–9.PubMedCrossRefGoogle Scholar
  325. 325.
    Reid SE, Reid CA, Vermund SH. Antiretroviral therapy in sub-Saharan Africa: adherence lessons from tuberculosis and leprosy. Int J STD AIDS. 2004;15:713–6.PubMedCrossRefGoogle Scholar
  326. 326.
    Mendis K, Rietveld A, Warsame M, Bosman A, Greenwood B, Wernsdorfer WH. From malaria control to eradication: The WHO perspective. TM IH. 2009;14:802–9.PubMedCrossRefGoogle Scholar
  327. 327.
    Duerden BI. Responsibility for managing healthcare-associated infections: where does the buck stop? J Hosp Infect. 2009;73:414–7.PubMedCrossRefGoogle Scholar
  328. 328.
    Gazzinelli A, Correa-Oliveira R, Yang GJ, Boatin BA, Kloos H. A research agenda for helminth diseases of humans: social ecology, environmental determinants, and health systems. PLoS Neglected Tropical Dis. 2012;6:e1603.CrossRefGoogle Scholar
  329. 329.
    • Vermund SH, Sidat M, Weil LF, Tique JA, Moon TD, Ciampa PJ. Transitioning HIV care and treatment programs in southern Africa to full local management. AIDS. 2012;26:1303–10. Presents an argument for “staying the course” in global support for HIV control programs in poorly resourced nations, given the lack of capacity or resources to take over programs that PEPFAR or the Global Fund are now supporting. PubMedCrossRefGoogle Scholar
  330. 330.
    Sabapathy K, Van den Bergh R, Fidler S, Hayes R, Ford N. Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med. 2012;9:e1001351.PubMedCrossRefGoogle Scholar
  331. 331.
    • Hayes R, Sabapathy K, Fidler S. Universal testing and treatment as an HIV prevention strategy: research questions and methods. Curr HIV Res. 2011;9:429–45. A rationale for multicomponent interventions strategies for HIV transmission control. PubMedCrossRefGoogle Scholar
  332. 332.
    Heise LL, Watts C, Foss A, et al. Apples and oranges? Interpreting success in HIV prevention trials. Contraception. 2011;83:10–5.PubMedCrossRefGoogle Scholar
  333. 333.
    Hayes R, Watson-Jones D, Celum C, van de Wijgert J, Wasserheit J. Treatment of sexually transmitted infections for HIV prevention: end of the road or new beginning? AIDS. 2010;24 Suppl 4:S15–26.PubMedCrossRefGoogle Scholar
  334. 334.
    Hayes R, Kapiga S, Padian N, McCormack S, Wasserheit J. HIV prevention research: taking stock and the way forward. AIDS. 2010;24 Suppl 4:S81–92.PubMedCrossRefGoogle Scholar
  335. 335.
    Kapiga S, Hayes R, Buve A. HIV prevention–where now? Background and introduction. AIDS. 2010;24 Suppl 4:S1–3.PubMedCrossRefGoogle Scholar

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© The Author(s) 2013

Open Access This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Authors and Affiliations

  1. 1.Vanderbilt Institute for Global Health and Department of PediatricsVanderbilt School of MedicineNashvilleUSA
  2. 2.MRC Tropical Epidemiology GroupLondon School of Hygiene and Tropical MedicineLondonUK

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