Behavioral Factors in Assessing Impact of HIV Treatment as Prevention
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The recent NIH HPTN 052 study of using HIV treatment to prevent HIV transmission in serostatus discordant heterosexual partnerships has garnered much attention. In subsequent discussions, however, the topic of HIV-related risk behavior has been nearly absent. Here, we identify the critical roles that HIV-related risk behavior plays in determining the unmet needs, optimal targeting, and ultimate impact of treatment as prevention. We describe the size of the population at risk of HIV and three subgroups of persons living with HIV (PLWH) based on awareness of serostatus and risk behavior, and the corresponding HIV transmission rates to seronegative partners. For each of the subgroups of PLWH, we identify which approach is most relevant (“testing and linkage to care,” “treatment as prevention,” and/or “treatment as clinical care”). We observe that the impact of “treatment as prevention” on HIV incidence will depend heavily on which subgroup of PLWH is targeted for services.
KeywordsHIV Behavior Treatment Prevention Unmet needs
This manuscript was prepared as part of Government work (HIH) and there are no other funding sources to declare (DRH, CM, LW)
The findings and conclusions in this study are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Conflict of interest
No conflicts of interest to declare
- 1.The White House Office of National AIDS Policy. National HIV/AIDS Strategy for the United States. Washington D.C.: White House; 2010.Google Scholar
- 3.Cohen J. Breakthrough of the year: HIV treatment as prevention. Science. 2011;334(6063):1628.Google Scholar
- 4.Clinton HR. Address on global HIV/AIDS. National Institutes of Health, Bethesda. 2011. http://videocast.nih.gov/summary.asp?live=10787. Accessed 5 Mar 2012.
- 5.Obama B. Keynote address for world AIDS day. George Washington University, Washington, DC. 2011. http://www.whitehouse.gov/photos-and-video/video/2011/12/01/president-obama-world-aids-day. Accessed 5 Mar 2012.
- 6.Kawata P. NMAC’s big audacious goal: world AIDS day 2011. National Minority AIDS Council. 2011. http://www.nmac.org/component/content/article/52-headlines/1278-nmacs-big-audacious-goal-world-aids-day-2011.pdf. Accessed 5 Mar 2012.
- 7.Strub S. Prevention vs. prosecution: creating a viral underclass. POZ blogs. 2011. http://blogs.poz.com/sean/archives/2011/10/prevention_vs_prosec.html. Accessed 5 Mar 2012.
- 8.Kawata P. Opening plenary speech for national HIV prevention conference. Centers for Disease Control and Prevention, Atlanta. 2011. http://drcnet.org/pipermail/harmred/2011-August/000532.html. Accessed 5 Mar 2012.
- 11.Pence BW, Mugavero MJ, Carter TJ, et al. Childhood trauma and health outcomes in HIV-infected patients: an exploration of causal pathways. J Acquir Immune Defic Syndr. 2011 (Epub ahead of print).Google Scholar
- 14.Heijman T, Geskus RB, Davidovich U, Coutinho RA, Prins M, Stolte IG. Less decrease in risk behaviour from pre-HIV to post-HIV seroconversion among MSM in the combination antiretroviral therapy era compared with the pre-combination antiretroviral therapy era. AIDS. 2012;26(4):489–95.PubMedCrossRefGoogle Scholar
- 23.Nattrass N. Expanding an AIDS intervention to include HAART for all who need it. In: Nattrass N, editor. The moral economy of AIDS in South Africa. Cambridge: Cambridge University Press; 2004. p. 99–131.Google Scholar
- 24.Presidential Advisory Council on HIV/AIDS. Letter to Secretary of the Department of Health and Human Services Kathleen Sebelius. 2011. http://aids.gov/federal-resources/policies/pacha/policy-pacha/. Accessed 5 Mar 2012.
- 25.Presidential Advisory Council on HIV/AIDS. Letter to President Barack Obama. 2011. http://aids.gov/federal-resources/policies/pacha/policy-pacha/. Accessed 5 Mar 2012.
- 26.National Alliance of State & Territorial AIDS Directors (NASTAD). ADAP Watch. 2012. http://www.nastad.org/Docs/011223_ADAP%20Watch%20update%20-%204.6.12.pdf. Accessed 6 Apr 2012.
- 28.CDC. Vital signs: HIV prevention through care and treatment––United States. MMWR. 2011;60:1618–1623.Google Scholar
- 29.Hall HI, Gray KM, Tang T, Li J, Shouse L, Mermin J. Retention in care of adults and adolescents living with HIV in 13 U.S. Areas. J Acquir Immune Defic Syndr. 2012 (Epub ahead of print).Google Scholar
- 35.Institute of Medicine of the National Academies. Public financing and delivery of HIV/AIDS care: securing the legacy of Ryan White. The National Academies Press, Washington, DC; 2004.Google Scholar
- 36.CDC. Questions and answers: HIV transmission. 2010. http://www.cdc.gov/hiv/resources/qa/transmission.htm. Accessed 6 Apr 2012.
- 37.CDC. HIV surveillance report, 2009, vol 21. 2011. http://www.cdc.gov/hiv/surveillance/resources/reports/2009report/index.htm. Accessed 5 Mar 2012.
- 38.Prejean J, Song R, Hernandez A, Ziebell R, Green T, Walker F, Lin LS, An Q, Mermin J, Lansky A, Hall HI. HIV Incidence Surveillance Group. Estimated HIV incidence in the United States, 2006–2009. PLoS ONE. 2011;6(8):e17502.Google Scholar
- 42.CDC. HIV surveillance—United States, 1981–2008. MMWR. 2011;60:689–693.Google Scholar
- 44.Hall HI, Holtgrave DR, Maulsby C. HIV transmission rates from persons living with HIV who are aware and unaware of their infection, United States. AIDS. 2012 (Epub ahead of print).Google Scholar
- 49.Freedman M, Mattson C, Johnson C, et al. Medical monitoring project, 2009–2010. National representative estimates of sexual risk behaviors among HIV+ adults receiving medical care: US 19th conference on retroviruses and opportunistic infections. Seattle, Washington. 2012.Google Scholar
- 51.Van Gorder, D. Can HIV testing plus linking HIV+ people to care and treatment reduce HIV transmission? Project Inform fact sheet. University of California, Center for AIDS Prevention Studies, San Francisco. 2010. http://www.projectinform.org/pdf/tlc_caps.pdf. Accessed 5 Mar 2012.
- 53.CDC. High-impact HIV prevention CDC’s approach to reducing HIV infections in the United States. 2011. http://www.cdc.gov/hiv/strategy/dhap/pdf/nhas_booklet.pdf. Accessed 5 Mar 2012.
- 55.Farnham PG, Sansom SL, Hutchinson AB. How much should we pay for a new HIV diagnosis? A mathematical model of HIV screening in US clinical settings. Med Decis Making. 2012 (Epub ahead of print).Google Scholar
- 73.UNAIDS. Combination HIV prevention: tailoring and coordinating biomedical, behavioural and structural strategies to reduce new HIV infections. 2010. http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/20111110_JC2007_Combination_Prevention_paper_en.pdf. Accessed 5 Mar 2012.
- 75.American Psychological Association. Resolution on combination and behavioral approaches to optimize HIV prevention, Washington D.C. 2011. http://www.apa.org/pi/aids/resources/resolutions.aspx?item=2. Accessed 5 Mar 2012.
- 76.U.S. Census Bureau, population estimates. 2009. http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?pid=PEP_2009_T01&prodType=table. Accessed 5 Mar 2012.
- 77.Chandra A, Billioux V, Copen C. National Center for Health Statistics; Sionean, Catlainn, National Center for HIV/AIDS, Viral Hepititis, STD, and TB prevention. HIV risk-related behaviors in the united states household population aged 15–44 years: data from the national survey of family growth, 2002 and 2006–2010. National Health Statistics Report 2012;46. Accessed Mar 5 2012.Google Scholar