Developing Safe And Effective Hiv Treatments
One of NIAIDâs greatest success stories is that its research led to the development of numerous antiretroviral drugs to treat HIV/AIDS, turning what was once a uniformly fatal disease into a manageable chronic condition for many. NIAID is working to find new and more effective therapeutic products, drug classes, and combinations as well as safe and effective treatments for related co-infections and complications.
Careful Choice Of Study Populations And Epidemic Phase
It is well known that study populations for Phase III trials must be carefully selected to ensure internal validity. The goals are usually to select a population that is at high risk of HIV infection and able and willing to comply with trial procedures, to ensure high adherence to the intervention, and to minimise selection bias due to losses to follow-up.
In addition, it is increasingly recognised that some interventions have differential effects in different populations or at different phases of an epidemic. We have seen, for example, that STI treatment interventions are likely to be most effective in populations with high rates of curable STIs, which are likely to play a more important role in concentrated or early-phase HIV epidemics and in communities with limited treatment services than in more generalised or mature epidemics and in populations with widespread access to high quality STI care. Yet some trials have been carried out in populations with low rates of curable STIs and with highly generalised and mature HIV epidemics. Similarly, one of the possible reasons for the limited effect seen in some trials of behavioural interventions is that they were carried out in populations in which substantial reductions in risk behaviour had already occurred as a result of prior HIV prevention activities.
What Is Hptn 071
HPTN 071 – Population Effects of Antiretroviral Therapy to Reduce HIV Transmission examined the impact of a package of HIV prevention interventions on community-level HIV incidence. The prevention interventions included universal voluntary HIV counseling and testing provided at the household level, linkage of HIV infected individuals to care and early initiation of antiretroviral therapy for all those testing HIV-positive. The study was conducted in 21 communities in the Western Cape of South Africa, and in Zambia.
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Advancing The National Hiv Priorities Through Research
The National HIV/AIDS Strategy: Updated to 2020 calls for numerous ongoing research efforts, including the prioritization and promotion of research to fill in gaps in prevention science among the highest risk populations and communities the promotion and prioritization of research to fill in gaps in knowledge along the HIV care continuum the scaling up of effective, evidence-based programs that address social determinants of health support for research to better understand the scope of the intersection of HIV and violence against women and girls, as well as the development of effective interventions and the strengthening of the timely availability and use of data. Across the Federal government, agencies and programs are engaged in these efforts.
Scroll down to read about the HIV research activities of individual Federal agencies and offices.
Research To Prevent Hiv Infection And Transmission
NIAID also conducts and supports research to develop and improve cutting-edge tools and techniques that can work to prevent HIV in diverse populations around the world.
The Centers for Disease Control and Prevention also provides national leadership for HIV prevention research, including the development of biomedical and behavioral interventions to prevent HIV transmission and reduce disease progression in the United States and internationally. CDCâs research efforts include identifying scientifically proven, cost-effective, and scalable interventions and prevention strategies to be implemented as part of a high-impact prevention approach for maximal impact on the HIV epidemic.
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Who Participated In The Study
Twenty-one urban and peri-urban communities in Zambia and South Africa, with a total population of around 1 million, participated in this study. To measure the impact of the intervention, a research cohort called the Population Cohort, consisting of a sample of approximately 2,300 adults aged 1844 years, were recruited from the general population in each of the 21 communities and was followed up once a year for three years to measure HIV incidence and other outcomes.
Pilot Projects In Hiv/aids Prevention Research
Thanks to everyone who submitted Letters of Intent for the 2021 Pilot Projects in HIV/AIDS Prevention Research. Other key dates are listed below. the Call for Letters of Interest for further details.
– April 30, 2021: Application deadline- May 2021: Pilot Project Review Panel meets- May 2021: Awards announcement expected- June 1, 2021 : Earliest start date
CIRA seeks letters of intent for the 2021 Pilot Projects in HIV/AIDS Prevention Research. The pilot program is a key part of CIRA’s mission to develop new science and scientists.
Pilot awards offer resources for preliminary and/or feasibility studies in HIV-related research that will ultimately lead to larger intervention or implementation science projects. Pilots are designed to support junior investigators, and/or community-university research partnerships. CIRA provides scientific support to facilitate the development of rigorous and impactful domestic and international research with a vision towards long-term implementation, scale-up, and sustainability.
The goal of the program is to provide pilot funding to junior investigators, and/or support community-university research partnerships that will result in additional externally funded research projects. We will consider letters of intent for feasibility studies that address CIRA’s mission to support innovative, interdisciplinary research that focuses on the implementation of HIV prevention and treatment and the elimination of HIV disparities.
Characteristics Of Programs Selected By Happas Scientist Expert Panel As Ebis
Since HAPPAs inception, 88 programs have been submitted to the Scientist Expert Panel as candidates for inclusion in the collection. Of these, 55 have been selected by the Panel as EBIs for inclusion in HAPPA, based on the strength of their evidence for effectiveness per the objective criteria previously described. Sample sizes for the outcome studies documenting the efficaciousness of these 55 programs ranged from 43 to 38,635 participants. The outcome studies were done in all parts of the U.S., often in multiple locations, on diverse samples of young, middle-age, and older adults.
The 55 EBIs approved for inclusion in HAPPA target many different populations such as gay, bisexual, and non-gay identified MSM , women , substance users , sexually transmitted infection clinic patients , and PLH , among others . Additional information portraying the diversity of the EBIs is shown in Table 1. The majority are primary prevention programs intended to be conducted with small groups addressing sexual risk behaviors and originally implemented in clinics, hospitals, or treatment facilities .
Illustrative HAPPA Search Input and Results.
Putting Women At The Center Of Hiv Prevention Researchand Beyond
Although health-progress continues for many, women and girls continue to be left behind
Forty years ago this spring,the Centers for Disease Control and Prevention reported the first cases in the United States of what would later be known as HIV/AIDS. Over that time, more than 32.7 million people around the world have died from AIDS-related illnesses. But, thanks to the unrelenting efforts of a global community of advocates, policymakers and research volunteers and scientists, we now have medicines that not only allow those living with HIV to lead long lives but also to prevent the spread of the virus.
While progress marches on for many, however, some women and girls continue to be left behind.
In the early days of the epidemic, we knew that HIV was devastating communities of men who have sex with men, but it quickly became clear that the virus would also be a major threat to women’s health. Indeed, by 1988, the number of women living with HIV/AIDS in sub-Saharan Africa exceeded that of men
More than 32.7 million people around the world have died from AIDS-related illnesses
Much of this is due to gender inequities, which limit women’s ability to negotiate safe sex or select when or with whom they have sex. Women are also biologically more susceptible to HIV infection through heterosexual sex than are men. And existing prevention methods although essential to the HIV fight are not enough to control the epidemic among women.
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How Did The Study Design Evolve Over Time
HIV care and ART were provided at the local government clinic serving that community. In Arm A, all clients living with HIV were offered ART irrespective of CD4 count or clinical stage. In Arm B, ART was initiated according to in-country guidelines. Initially, this was at a CD4 count of 350, then later this changed to 500, and in 2016, following a change in World Health Organization recommendations, ART was offered to all clients living with HIV, as in Arm A.
The dates shown for the start of universal ART refer to when this was implemented in study clinics in the respective countries. In Zambia, the first study clinic transitioned April 19, 2016, and the last May 9, 2016. This transition is represented by the dark purple band in the figure. In South Africa, the first study clinics transitioned October 10, 2016, and the last on November 21, 2016, a period represented by the dark purple band in the figure. Study personnel, clinic staff and implementing partners worked to ensure study clinics implemented the new policy as soon as in-country guidelines and logistics such as staff training would allow. Transition to universal ART in study clinics, therefore, often preceded transition in neighboring communities.
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What Were The Study Objectives
The primary study outcome was HIV incidence between month 12 and month 36 among members of the Population Cohort who were HIV-negative at baseline, comparing HIV incidence between the intervention and standard of care arms, . This allowed the effectiveness of the PopART intervention at population level to be measured. Data to investigate secondary objectives were drawn from Population Cohort data as well as data from Community HIV-care Providers , health centers and social science research. These objectives assess the effect of the intervention on several additional variables, including:
Discussion: New Opportunities And Next Steps
The scope of CDCs efforts to address HIV stigma in the United States has been wide-ranging. However, there is a need for additional efforts. These could include strategies that incorporate stigma reduction activities into HIV prevention and care work and incentivize their implementation. Future research could seek to quantify the impact of antistigma efforts on reductions in sexual transmission risk behavior, nonengagement in care, and nonadherence to ART. Further, CDC-led communication campaigns and monitoring efforts could collaborate to evaluate the effects of antistigma campaigns on decreasing stigma nationwide. Monitoring gaps include a need to measure stigma in non-HIV-focused medical settings, and to assess medical mistrust among PWH and cultural competency among providers and medical staff.
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Improving And Measuring Adherence
We have already discussed the need to ensure adequate intensity of intervention. For many intervention approaches, this involves assuring participant adherence with the intervention. In some cases, adherence is not an important issue after the initial intervention. For example, the effect of male circumcision is permanent, although it is important that men adhere to advice not to resume sexual activity until the surgical incision has healed, and there is also concern about the potential for behavioural risk compensation if men think they are completely protected. Depending on the number of doses required, adherence may also be of limited relevance for vaccine trials. However, for interventions such as PrEP or microbicides that require continuous and consistent use of study product, adherence is clearly of central importance.
In prevention trials, careful attention should therefore be given to procedures both to maximise and to measure adherence. Some approaches to improve adherence include frequent visits at which adherence is assessed and adherence counselling is provided random spot checks to remind participants about adherence the use of text messaging or mobile phone calls to provide reminders and the use of electronic devices that record the opening of pill containers.
Hiv/aids Prevention Research Includes The Research
How social issues affect the spread of the disease
In the era when we have advanced to such a great extent in the field of health and medical sciences, HIV or AIDS is still considered to be one of the diseases with no known cure except to prevent it.
The reports of WHO state that 16.3 million women, men and children died due to AIDS since early 1980s when the epidemic started to spread.
One of the greatest research area that revolves around the prevention of HIV and AIDS is the research that focus on Behavioral and social science.
The main focus of this research involves on the acts that prevent the spread of HIV infection by changing behaviors. For example: It focus that unprotected sex and use of injections contaminated with HIV viruses should be strongly prohibited.
Moreover, it emphasize that the factors that lead to spread of HIV infection like poverty,complacency and low self-esteem should be treated and paid serious attention to.
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there are men and women, some choose to be both or change their gender. often times those people go by “other”. those who change their gender are known as “transgender”
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Hiv Stigma Among The General Us Population
Beginning in 2018, CDC will fund monitoring of stigmatizing attitudes toward PWH among the US adult population through the General Social Survey, which collects nationally representative trend data to monitor attitudes, behaviors, and attributes. Centers for Disease Control and Prevention proposed questions for the 2018 survey period that will capture stigmatizing attitudes toward PWH and their opinions about the morality of PWH.
How Did Hptn 071 Differ From The Other Utt Trials
HPTN071 differed from the other trials in the following ways:
1. The PopART communities were large urban or peri-urban communities whereas the other trials were in smaller rural communities.
2. HIV incidence was measured in a separately recruited population cohort in PopART and Ya Tsie/BCPP, while in TasP and SEARCH incidence was measured through the intervention.
3. In PopART and Ya Tsie/BCPP, the control communities did not receive any additional intervention outside of current standard of care, while SEARCH and TasP control communities received enhanced community-wide HIV services, particularly for HIV testing and linkage to care, probably explaining the lack of observed difference between the intervention and control arms.
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Difficulties In Measuring Behaviours
While the focus of this review has been on trials in which HIV incidence is the primary endpoint, behavioural measurements also play an important role in many of these trials and have proved to be problematic. In trials of behavioural interventions, self-reported sexual behaviour is an important secondary endpoint, but is known to be subject to reporting bias which may be differential between study arms. It is notable that several RCTs of such interventions have found significant effects on self-reported behaviours but no effect on HIV incidence and this is likely to be due, at least partly, to reporting bias. This suggests that the many other trials which have only reported behavioural endpoints should be interpreted with great caution.
Imagine A World Without Aids
Even though new HIV diagnoses in NYC declined from 2001 to 2014 in all transmission groups, certain groups like men who have sex with men and young adults remain disproportionately affected. Black and Latino MSM comprised 70% of new diagnoses among MSM in 2015. Factors contributing to high rates of HIV include poverty, stigma, substance use, and mental health issues.
Our goal is to help find a vaccine that prevents HIV infection or delays progression to AIDS after HIV infection. Developing a vaccine will save millions of lives worldwide.
Together with Project ACHIEVE of the New York Blood Center, we conduct clinical research studies in preventive HIV vaccines. We are part of the HIV Vaccine Trials Network . HVTN is an international collaboration of over 30 research sites on four continents funded by the National Institutes of Health .
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Preponderance Of Flat Trials
As recently summarised in a systematic review of late-phase RCTs of interventions to prevent sexual transmission of HIV , of 39 trials in which effects on HIV incidence have been measured, only five have shown a statistically significant positive effect, while one has shown a negative effect and the remaining 33 have shown no effect . Discrepancies between numbers of trials shown in Table 2 and the individual reviews in this supplement result from differences in eligibility criteria and classification of multi-component interventions.