Plenary Session III: Integrated HIV/AIDS Prevention: Policy, Practice, and Research Perspectives

The New Era of HIV Treatment as Prevention: Will Behavior Trump Biology?

HIV prevention relies on integrating biomedical technologies with behavior change strategies. The most established biomedical technologies to avert HIV infection are sterile syringes, antibody tests, and condoms. It is well known that these tools are most effective when delivered through effective behavioral interventions. At the forefront of HIV prevention is the use of antiretroviral therapies (ART) for reducing HIV infectiousness. Following the path of previous biomedical technologies, the scale-up of ART as prevention faces the humbling realities of human behavior. Treatment for prevention requires strict adherence. Furthermore, treatments for prevention may result in individuals compensating for perceived lower-risk by increasing risk behaviors. Finally, contracting co-occurring sexually transmitted infections undermine treatment as prevention by increasing infectiousness as well as susceptibility to HIV. The future of HIV prevention therefore depends on the successful integration of ART with behavioral interventions to maximize adherence, reduce risk compensation, and prevent sexually transmitted co-infections.

Integrating public health and clinical care to improve outcomes for persons living with HIV infection: An update on National HIV/AIDS Strategy implementation

The Affordable Care Act of 2010 seeks to expand access to medical care, improve health outcomes, and lower health care costs, particularly for persons at risk for or living with HIV infection. Also in 2010, the White House released the National HIV/AIDS Strategy for the United States that sought to reduce new HIV infections, improve access to quality HIV treatment and care, reduce HIV-associated health disparities and inequities, and coordinate the national response to the HIV epidemic. In late 2013, the White House issued by Executive Order the HIV Care Continuum Initiative (HCCI), which seeks to accelerate progress in addressing gaps in the HIV care continuum through, for example, the provision of “information, resources, and technical assistance to strengthen the delivery of services along the care continuum, particularly at the state and local levels.” This presentation will examine the opportunities raised by these landmark federal initiatives to deploy seamless behavioral and biomedical strategies that effectively integrate HIV prevention and treatment. It will highlight progress within the Department of Health and Human Services toward this important goal and describe future directions.

High Impact Prevention: CDC’s Approach to Reducing New HIV Infections

With a stable rate of new HIV infections and decreased mortality associated with effective treatment, the number of people living with HIV in the United States has increased markedly, creating increased opportunities for transmission. Recent scientific breakthroughs (e.g., Pre-Exposure Prophylaxis, Treatment as Prevention, and advanced diagnostics to rapidly identify acute infection) provide us with a wealth of new prevention tools as well as cause for optimism. However, budgets cuts and other fiscal constraints are requiring that we do more with fewer resources. High Impact Prevention -- CDC’s approach for reducing new infections -- promises to increase the impact of our federal HIV prevention efforts and dollars. Similar to combination prevention, High Impact Prevention involves the use of multiple prevention modalities. It also involves the science of implementation by directing how to choose, mix and maximize interventions, selecting interventions that are not only scientifically proven but also cost-effective and scalable, and targeting these interventions to the right populations in the right geographic areas. This presentation will describe ways in which the High Impact Prevention framework is guiding CDC’s HIV prevention activities, including research, surveillance and program. Examples will include the use of modeling to guide intervention prioritization, expanded focus of behavioral science to address health outcomes along the continuum of care, and the use of data and feedback processes to improve program performance and health care practices. The role of HHS demonstration projects, such as ECHPP and CAPUS, in which selected Health Departments are funded to implement strategies and identify best practices, will be discussed.