Targeting HIV Transmission Rates

The National HIV/AIDS Strategy (NHAS) has sought to reduce HIV transmission in the United States. To complete this task, the NHAS established 3 prevention goals in 2010¹:

• A 25% reduction in new HIV infections
• A 30% reduction in HIV transmission
• Increasing the percentage of people living with HIV aware of their serostatus to 90%

Of these 3 goals, none were achieved. The United States only achieved a 15% decrease in HIV transmission rate between years 2010 and 2015,¹ and new infections fell by only a 17.7% reduction by 2015. As a result, the federal government decided to find new ways of effectively targeting the HIV transmission rate.

In a comprehensive review recently published in the Journal of Acquired Immune Deficiency Syndromes,¹ the authors record HIV transmission rates between years 2010 and 2015, including both the goals implemented and numbers achieved.

Achieving these goals would require additional measures, including a rise in the utilization of HIV treatment and an increase in both diagnostic and prevention services.¹ Health care professionals, including pharmacists and nurse practitioners, play a critical role in attaining these goals. They must raise awareness of HIV and prevention of transmission, the author suggests.

Recent work by researchers suggests that high levels of retention in care (at least 90%) and reengagement in care (at least 70%) are critical to halving HIV incidence by 2025, highlighting the importance of improving the HIV care continuum.

Health care providers should use the tracking systems built into their computer systems to monitor their patients who have HIV. By considering this additional insight, health care professionals may contribute to increased awareness and decreased transmission of HIV.

Prevention would involve encouraging the use of pre-exposure prophylaxis, post-exposure prophylaxis, condoms, and antiretroviral therapy (ART).²

The CDC refers to ART as “treatment as prevention,” because ART is effective in causing an undetectable viral load. By reducing the amount of virus, it will also lead to a decrease in transmission to others.

In supporting HIV prevention, health care professionals should routinely engage patients in conversations regarding prevention steps that can be taken and are currently being taken to reduce their risks.³

To target this issue effectively, health care professionals must address the needs of those most commonly affected. This high-risk population includes men who have sex with men, African American and Hispanic individuals, and transgender women.

Diagnostic services are also necessary in monitoring this epidemic. Researchers recommend HIV testing be completed at least annually in high risk populations, including people using injectable drugs.²

Health care professionals may also play a role in encouraging high risk individuals to get tested.

RELATED ARTICLES

• CDC Analysis Underscores Need for More HIV Testing
• Senate Bill Proposes Expansion of PrEP Access

Monique F. Miller is a 2020 PharmD Candidate he University of Connecticut in Storrs.

References

• Bonacci, RA, Bradley H, Rosenberg ES, Holtgrave DR. Evaluating the Impact of the US National HIV/AIDS Strategy, 2010-2015. JAIDS Journal of Acquired Immune Deficiency Syndromes. Published May 28, 2019 [epub ahead of print] doi: 10.1097/QAI.0000000000002113
• Bazazi AR, Vijay A, Crawford FW, et al. HIV Testing and awareness of HIV status among people who inject drugs in greater Kuala Lumpur, Malaysia. AIDS Care. 2018;30(1):59-64.
• Centers for Disease Control and Prevention (2019). HIV/AIDS. Retrieved from https://www.cdc.gov/hiv/risk/art/index.html. Accessed June 22, 2019.