Integrated Strategies for Combination HIV Prevention: Principles and Examples for Men who Have Sex with Men in the Americas and Heterosexual African Populations

July 2013 - Combination Prevention

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Celum, C., Baeten, J., Hughes, J., et al. Journal of Acquired Immune Deficiencies Syndromes, (July 2013), Vol. 63 Suppl. 2, pp. S213-S220.

The authors discussed HIV risk factors and combination HIV prevention interventions for three populations - (1) men who have sex with men (MSM), including transgender women, in the Americas, (2) young women in sub-Saharan Africa, and (3) heterosexual serodiscordant couples in sub-Saharan Africa. For MSM, the authors propose combining interventions resulting in high uptake and adherence to assess potential synergies to reduce HIV in MSM. The interventions should address components of the transmission chain (e.g., reduce multiple partnerships) and target populations with marginal overlap (e.g., pre-exposure prophylaxis [PrEP]). Strategies targeting young women should include interventions that combine youth-friendly reproductive health and HIV prevention services to increase HIV testing uptake, PrEP with adherence counseling, and contraceptive options. Interventions for heterosexual couples should incorporate understanding of couples' adoption of HIV prevention behaviors and prioritize prevention activities, e.g., couples testing. The HPTN 052 trial, which aimed to determine effectiveness of early antiretroviral therapy on reducing HIV transmission in serodiscordant couples; and the Partners PrEP trial, which aimed to determine effectiveness of daily oral PrEP in preventing HIV transmission among serodiscordant couples, both resulted reduced HIV transmission. While the trials demonstrated effectiveness, implementing the strategies in real-world settings will require further assessment and integration with other strategies. The authors concluded that combination HIV prevention activities must align with epidemiologic HIV drivers, and future research should assess the feasibility, acceptability, impact, potential for synergies, and economic effectiveness of interventions.

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