Rausch, D.M., Grossman, C.I., and Erbelding, E.J. Journal of Acquired Immune Deficiency Syndromes (June 2013), Vol. 63 No. 1, pp. S6-S11.
The authors presented efficacy challenges experienced in recent antiretroviral therapy (ART) prevention trials; discussed behavioral challenges to ART and their effects on the design and implementation of prevention trials; and outlined priorities for future research within combination HIV prevention. A multidisciplinary approach that includes current behavioral science is essential to maximizing and sustaining the benefits of ART-based and integrated combination prevention. Clinical trials of both oral and topical approaches for pre-exposure prophylaxis have yielded both promising findings and failure, even when the same product and dose was tested. In several of these tests, adherence was a critical factor. The HIV Prevention Trials Network (HTPN)-052, which incorporated a counseling intervention, was highly successful in preventing HIV transmission among serodiscordant couples. The authors stated that because trials of biomedical approaches to HIV prevention yield conflicting results, sociobehavioral factors that may affect trial outcomes should be examined. Behavioral theories or models have influenced HIV prevention interventions, but cannot in themselves effectively address the HIV epidemic. Theoretical behavior models must evolve to complement and advance combination HIV prevention efforts—including in intervention design and potential behavioral impacts on the outcomes of clinical trials—and assessment of behavioral outcomes must be improved. Integrating behavioral and biomedical approaches is critical if global HIV prevention is to achieve maximum impacts.