Public Affairs & Media Relations
Study: increased community efforts can bolster HIV treatment
March 6, 2013
CHARLESTON – As clinicians the world over celebrate the announcement of a child seemingly cured of HIV immediately after birth, researchers are also celebrating the success of well-implemented community efforts to stop HIV’s worldwide spread.
Study results presented March 4 at the Conference on Retroviruses and Opportunistic Infections by the HIV Prevention Trials Network (HPTN) and the National Institutes of Health (NIH) showed that a series of community efforts can increase the number of people who get tested and know their HIV status, especially among men and young people with HIV who might otherwise transmit the virus to others. The study also demonstrated a modest (14 percent) reduction in new HIV infections in the intervention communities compared to control communities. This is the first community-randomized trial to test a combination of social, behavioral and structural interventions for HIV prevention and to assess the impact of such a strategy. MUSC was one of four institutions selected to run the study, along with UCLA, Johns Hopkins, and University of California, San Francisco. Michael Sweat, Ph.D., professor of psychiatry and behavioral sciences, served as MUSC’s principal investigator and ran the Tanzania-based portion of the study. He is also the director of the Center for Global Initiatives and the Family Services Research Center.
“The research we conducted during the past decade in rural Tanzania has taught us a lot about to how to best approach HIV prevention in the U.S. The problem of reaching rural populations with care and prevention are virtually the same in Tanzania as they are in South Carolina,” Sweat said. “We used novel strategies to provide mobile care, and we can now translate them to U.S. settings.”
Sweat and his colleagues showed that mobile HIV testing and community acceptance of prevention programs can increase HIV treatment and reduce transmission of the disease. The study also showed that mobile, large-scale testing reduces HIV risk behavior, and lowers the number of new HIV infections.
The four major interventions were designed to:
1) increase access to voluntary counseling and testing and post-test services;
2) change community attitudes around HIV, particularly the benefit of knowing one’s HIV status;
3) remove barriers to knowing one’s HIV status; and
4) increase the safety of testing and minimize potential negative consequences of testing by providing various forms of support.
NIMH Project Accept (HPTN 043) was conducted in 34 communities in Africa (South Africa, Tanzania and Zimbabwe) and 14 communities in Thailand. Intervention communities received the combined strategy and others served as control communities.
Many HIV prevention programs, especially in sub-Saharan Africa, have reported difficulty in reaching men; however, the National Institute of Mental Health’s Project Accept (NIMH, HPTN 043) study was able to achieve a 45 percent higher rate of testing of men within intervention versus control communities. In addition, HIV-infected individuals in the intervention communities reported greater reductions in risky sexual behaviors. This effect was especially strong among HIV-infected men who reported 18 percent fewer sexual partners and 29 percent fewer concurrent sexual partners as compared to the control communities.
Study participants who learned they were HIV-infected were directed to the study’s post-test services which included counseling, referrals to health care and social services assistance. Participants who tested HIV negative were also directed to post-test services for further counseling, referrals and support in staying HIV uninfected. Local health authorities were thoroughly briefed on the study findings and encouraged to continue implementation efforts.
NIMH Project Accept began in 2003. The research was funded by NIMH, the U.S. National Institute of Allergy and Infectious Diseases, and the Office of AIDS Research, all components of the NIH. It was conducted by the NIH-funded HIV Prevention Trials Network (HPTN).
Founded in 1824 in Charleston, The Medical University of South Carolina is the oldest medical school in the South. Today, MUSC continues the tradition of excellence in education, research, and patient care. MUSC educates and trains more than 3,000 students and residents, and has nearly 13,000 employees, including approximately 1,500 faculty members. As the largest non-federal employer in Charleston, the university and its affiliates have collective annual budgets in excess of $1.7 billion. MUSC operates a 750-bed medical center, which includes a nationally recognized Children's Hospital, the Ashley River Tower (cardiovascular, digestive disease, and surgical oncology), and a leading Institute of Psychiatry. For more information on academic information or clinical services, visit www.musc.edu. For more information on hospital patient services, visit www.muschealth.com.
The HIV Prevention Trials Network (HPTN) is a worldwide collaborative clinical trials network that develops and tests the safety and efficacy of interventions designed to prevent the acquisition and transmission of HIV. The HPTN research agenda is focused primarily on reduction of HIV transmission and acquisition through the use of ART for HIV-infected persons and ARVs as pre-exposure prophylaxis (PrEP) for HIV-negative persons for HIV prevention, reducing the impact of behavioral and biologic cofactors that increase risk of infection, treatment of substance use (particularly injection drug use), behavioral risk reduction interventions, and structural interventions. The highest priority of the HPTN is to develop and implement combination prevention strategies that demonstrate a significant and measurable reduction in HIV incidence in a variety of populations and epidemic settings.