Study Highlights Need for Person-Centered HIV Prevention Efforts

A new analysis published by PLOS Medicine examines a new set of HIV prevention targets to be achieved by 2025 to facilitate progress toward a sustainable development target by 2030 through the United Nations General Assembly and other partners.

Although the number of new HIV infections in the world have declined, there are still regions that are geographically heterogenous that have reported an increase in infection rates. Additionally, some milestones for 2020 were missed, such as insufficient scaling up of treatment to reduce the number of new HIV infections.

Treatment options have grown over the past decades, such as oral pre-exposure prophylaxis (PrEP), 2 monthly injections of a long-acting formulation of cabotegravir, and intra-vaginal silicone rings. These plus technological developments have significantly improved the management of HIV; however, challenges still persist in areas such as services, cost, supply chain and logistics, monitoring, and evaluation.

In 2020, UNAIDS implemented the “90-90-90” method to improve the treatment of HIV, which has helped to lower onward transmission of HIV, according to the study authors. The success of the 90-90-90 goal springs from the ability to improve survival among people with HIV as well as the simple concept that all of the 37.7 million people living with the virus should be diagnosed and linked to effective treatment. Conversely, preventing the spread of the virus is significantly more complicated because the billions of people with at-risk lifestyle habits or who are born to mothers with HIV require a variety of interventions and approaches.

The target for 2025 is to decrease the gap between treatment and prevention, which led to 6 overarching targets for HIV services to hit 95% prevention.

These targets include:

Choice of HIV prevention methods

The availability of different prevention methods may enable people to have greater ability to exercise their autonomy and agency. These approaches in selecting the right prevention method include choosing the right partners, choosing PrEP or post-exposure prophylaxis, choosing condoms/lube, and using clean needles and syringes for injection.

HIV prevention appropriate to individual circumstances

Some prevention methods are developed with a specific population in mind. These include services to help prevent mother-to-child transmission, harm reduction approaches for people who inject drugs, and topical PrEP products adapted for rectal or vaginal sex.

Prioritized approaches to HIV prevention

Minor coverage of HIV services among certain populations are frequently influenced by societal and legal barriers that can create environments in which patients with HIV and people those exposed to infection may not feel safe to use health services.

Person-centered prevention

Prior research indicates that for many people at risk of HIV, current health services that seek offer HIV treatment and prevention are not welcome among these populations.

Combination HIV prevention

A combination approach addresses the need for behavioral and structural intervention to accompany biomedical therapy. These services may include an integrated service delivery that offers tailored, co-located, or well-coordinated services that are convenient.

Specific HIV prevention targets

These targets should help national planners to define appropriate targets for their own priorities and populations.

As for next steps, the investigators said that prioritizing greater use of subnational and local data sources and models help to better estimate the size of different key populations and improve the monitoring and evaluation of interventions. Further, improved surveillance systems will help to detect new localized outbreaks of HIV in real time, which allows for appropriate streamlined course corrections to be made, according to the investigators.

“The HIV service targets, including these prevention principles and targets, are an integral part of the whole package of targets within the global HIV strategy,” the study authors wrote. “Increasingly, HIV services will need to be integrated within the larger health sector and within the context of universal health coverage. These prevention efforts will not succeed unless there are strong links with human rights and clear intersections with efforts to reduce structural and societal barriers.”

REFERENCE

Godfrey-Faussett P, Frescura L, Karim QA, et al. HIV prevention for the next decade: appropriate, person-centred, prioritized, effective, combination prevention. PLOS Medicine. September 26, 2022. Accessed October 24, 2022. https://doi.org/10.1371/journal.pmed.1004102