New delivery strategy reduces HIV transmission

Researchers delivered ART to reduce the infectiousness of HIV-infected persons and PrEP to reduce susceptibility of their uninfected partners. PrEP was offered prior to ART initiation and for the first six months of ART, until the HIV-infected partner would have been expected to achieve viral suppression. Then PrEP was discontinued.

“Our primary goals were to evaluate this delivery model, but partway through the span of the study, it became clear that HIV transmission rates were considerably lower than would have been anticipated,” said lead author Dr. Jared Baeten, vice chair and professor of global health and professor of epidemiology at the School.

Researchers examined the feasibility and acceptability of a program in Kenya and Uganda to offer medications to 1,013 couples in which one member was HIV-positive and the other was HIV-negative. The findings, published online August 23 in PLOS Medicine, showed that the observed rates of HIV transmission were 96 percent lower than simulated rates of transmission in historic controls.

“We learned that the approach is desirable and highly cost-effective and could be delivered affordably to people in that setting,” Dr. Baeten said. Researchers also noted that this study does not include a concurrent comparison population for HIV transmission because it would not have been ethical to enroll a control population and not offer access to PrEP and ART.

Link: http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002099