Krishnaratne, S., Hensen, B., Cordes, J., et al., The Lancet HIV (2016), 3: e307–17, doi: 10.1016/S2352-3018(16)30038-8.
This systematic review of 292 studies (1995–2015) mapped the current evidence for HIV prevention, using the HIV prevention cascade to classify interventions. Studies were categorized into four intervention areas:
- Demand-side interventions (n=194) included information, education, and communication to increase knowledge of risk and change attitudes towards prevention practices. These interventions consisted of multimedia, text messages, posters, and peer-to-peer approaches. Demand-side interventions generally did not influence HIV outcomes; the exact mix of interventions to influence population level HIV acquisition requires further analysis.
- Supply-side interventions (n=35) included HIV integration, and policy changes to influence needle/syringe and condom distribution program access. Supply-side interventions generally proved efficacious. The authors called for further studies, including randomized controlled trials (RCTs), to understand how supply-side interventions influence HIV outcomes.
- Adherence interventions (n=51) included individual and couples HIV testing and counseling, prevention for positives, and cash transfer and microfinance interventions. These interventions comprised counseling in health facilities and community settings, cash transfers for school attendance and school performance, and small loans for income-generation activities, at times combined with life skills training. There remain significant evidence gaps for adherence interventions.
- Direct mechanism interventions for HIV prevention (n=98) included voluntary medical male circumcision, condoms, pre-exposure prophylaxis, microbicides, treatment of sexually transmitted infections, and vaccines. Multiple RCTs provided evidence for direct mechanism interventions, although vaccine trials have provided mixed results.