Interventions to Increase HIV Testing Uptake in Global Settings

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Abstract

Purpose of Review

HIV testing is the critical first step to direct people living with HIV (PLWH) to treatment. However, progress is still being made towards the UNAIDS benchmark of 95% of PLWH knowing their status by 2030. Here, we discuss recent interventions to improve HIV testing uptake in global settings.

Recent Findings

Successful facility-based HIV testing interventions involve couples and index testing, partner notification, and offering of incentives. Community-based interventions such as home-based self-testing, mobile outreach, and hybrid approaches have improved HIV testing in low-resource settings and among priority populations. Partnerships with trusted community leaders have also increased testing among populations disproportionally impacted by HIV.

Summary

Recent HIV testing interventions span a breadth of facility- and community-based approaches. Continued research is needed to engage men in sub-Saharan Africa, people who inject drugs, and people who avoid biomedical care. Interventions should consider supporting linkage to care for newly diagnosed PLWH.

Related collections

Most cited references 96

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Antiretroviral Therapy for the Prevention of HIV-1 Transmission.

Myron S Cohen, Ying Q Chen, Marybeth McCauley … (2016)

An interim analysis of data from the HIV Prevention Trials Network (HPTN) 052 trial showed that antiretroviral therapy (ART) prevented more than 96% of genetically linked infections caused by human immunodeficiency virus type 1 (HIV-1) in serodiscordant couples. ART was then offered to all patients with HIV-1 infection (index participants). The study included more than 5 years of follow-up to assess the durability of such therapy for the prevention of HIV-1 transmission.

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Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial

Sheena McCormack, David T. Dunn, Monica Desai … (2016)

Summary Background Randomised placebo-controlled trials have shown that daily oral pre-exposure prophylaxis (PrEP) with tenofovir–emtricitabine reduces the risk of HIV infection. However, this benefit could be counteracted by risk compensation in users of PrEP. We did the PROUD study to assess this effect. Methods PROUD is an open-label randomised trial done at 13 sexual health clinics in England. We enrolled HIV-negative gay and other men who have sex with men who had had anal intercourse without a condom in the previous 90 days. Participants were randomly assigned (1:1) to receive daily combined tenofovir disoproxil fumarate (245 mg) and emtricitabine (200 mg) either immediately or after a deferral period of 1 year. Randomisation was done via web-based access to a central computer-generated list with variable block sizes (stratified by clinical site). Follow-up was quarterly. The primary outcomes for the pilot phase were time to accrue 500 participants and retention; secondary outcomes included incident HIV infection during the deferral period, safety, adherence, and risk compensation. The trial is registered with ISRCTN (number ISRCTN94465371) and ClinicalTrials.gov (NCT02065986). Findings We enrolled 544 participants (275 in the immediate group, 269 in the deferred group) between Nov 29, 2012, and April 30, 2014. Based on early evidence of effectiveness, the trial steering committee recommended on Oct 13, 2014, that all deferred participants be offered PrEP. Follow-up for HIV incidence was complete for 243 (94%) of 259 patient-years in the immediate group versus 222 (90%) of 245 patient-years in the deferred group. Three HIV infections occurred in the immediate group (1·2/100 person-years) versus 20 in the deferred group (9·0/100 person-years) despite 174 prescriptions of post-exposure prophylaxis in the deferred group (relative reduction 86%, 90% CI 64–96, p=0·0001; absolute difference 7·8/100 person-years, 90% CI 4·3–11·3). 13 men (90% CI 9–23) in a similar population would need access to 1 year of PrEP to avert one HIV infection. We recorded no serious adverse drug reactions; 28 adverse events, most commonly nausea, headache, and arthralgia, resulted in interruption of PrEp. We detected no difference in the occurrence of sexually transmitted infections, including rectal gonorrhoea and chlamydia, between groups, despite a suggestion of risk compensation among some PrEP recipients. Interpretation In this high incidence population, daily tenofovir–emtricitabine conferred even higher protection against HIV than in placebo-controlled trials, refuting concerns that effectiveness would be less in a real-world setting. There was no evidence of an increase in other sexually transmitted infections. Our findings strongly support the addition of PrEP to the standard of prevention for men who have sex with men at risk of HIV infection. Funding MRC Clinical Trials Unit at UCL, Public Health England, and Gilead Sciences.

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Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

Collins C Iwuji, Joanna Orne-Gliemann, Joseph Larmarange … (2018)

Universal antiretroviral therapy (ART), as per the 2015 WHO recommendations, might reduce population HIV incidence. We investigated the effect of universal test and treat on HIV acquisition at population level in a high prevalence rural region of South Africa.

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Author and article information

Contributors

Radhika Sundararajan:

ORCID: http://orcid.org/0000-0002-8451-2243

ras9199@med.cornell.edu

Journal

Journal ID (nlm-ta): Curr HIV/AIDS Rep

Journal ID (iso-abbrev): Curr HIV/AIDS Rep

Title: Current HIV/AIDS Reports

Publisher: Springer US (New York )

ISSN (Print): 1548-3568

ISSN (Electronic): 1548-3576

Publication date (Electronic): 20 April 2022

Publication date PMC-release: 20 April 2022

Publication date (Print): 2022

Volume: 19

Issue: 3

Pages: 184-193

Affiliations

[1 ]GRID grid.5386.8, ISNI 000000041936877X, Department of Emergency Medicine, , Weill Cornell Medicine, ; 525 East 68th Street, M-130, New York, NY 10065 USA

[2 ]Weill Cornell Center for Global Health, New York, NY USA

[3 ]GRID grid.459749.2, ISNI 0000 0000 9352 6415, Mbarara Regional Referral Hospital, ; Mbarara, Uganda

[4 ]GRID grid.33440.30, ISNI 0000 0001 0232 6272, Mbarara University of Science and Technology, ; Mbarara, Uganda

[5 ]GRID grid.416716.3, ISNI 0000 0004 0367 5636, National Institute for Medical Research, ; Mwanza, Tanzania

Author information

Radhika Sundararajan http://orcid.org/0000-0002-8451-2243

Article

Publisher ID: 602

DOI: 10.1007/s11904-022-00602-4

PMC ID: 9110462

PubMed ID: 35441985

SO-VID: ac8b169a-5b99-4518-a956-f1e0a026ae58

License:

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