Discussion: Innovative HIV Interventions

Reducing HIV Infection Rates: Currently available tools that have been shown to significantly reduce the risk of HIV transmission or

acquisition

Reducing HIV Infection Rates •  HIV Testing •  Screening the blood supply •  Testing blood-derived products for human use •  Evidence based behavioral programs – DEBI – HIP

•  Prophylaxis (treatment as prevention) – PrEP – Truvada – PEP – Tenofovir + Others

•  PMTCT

Reducing HIV Infection Rates

•  Interventions to Improve Access to Prevention Tools – Syringe Services Programs – Laws Allowing Sterile Syringe Purchase – Condom Distribution Programs

•  Drug Treatment •  STD Diagnosis and Treatment •  Medical Male Circumcision

Evidence-Based Programming •  The life cycle of evidence-based programming involves

identifying effective programs. •  Four steps to choose which interventions will lead to the

greatest reduction in disease or disparities given resources:

1.  Assess program efficacy and effectiveness. This step looks at the success of an intervention both in a controlled or optimal environment (efficacy) and within an everyday situation (effectiveness). RESEARCH

2.  Establish cost and cost-effectiveness per infection averted and life-years saved. This step includes calculating the costs and outcomes of a program. Measured outcomes include cases of a disease prevented, years of life gained, or quality- adjusted life-years.

Evidence-Based Programming

3. Develop epidemic models to project impact of intervention combinations. This step uses modeling to assign priority to interventions that are practical to implement on a large scale, are cost-effective, and prevent the greatest number of new infections. 4. Implement and evaluate the programs. This step looks at which programs are working and which ones need adjustment to improve outcomes. CDC monitors and evaluates programs across the nation to identify success and areas in need of improvement.

Evidence-Based Programming

•  Behavioral Interventions – Diffusion of Effective Behavioral Interventions

•  RESPECT – client-centered prevention counseling – High Impact Prevention (HIP)

•  ARV •  Access to condoms and sterile syringes •  Behavioral counseling •  Treatment of substance abuse •  Screening for other STIs

Reducing HIV Infection Rates •  Eliminating viral reservoirs

–  The HIV genome, known as a provirus, can ride along with host chromosomal DNA for decades

–  Eliminate by forcing them out of hiding, vulnerable to body’s immune response and ARVs

•  Bone marrow transplants –  Restoration of immune function –  Host bone marrow must be completely eliminated to work (chemotherapy and radiation)

•  Gene therapy –  New genes will provide genetic codes for certain proteins not normally produced

–  One form involves attaching genes that encode HIV proteins to the DNA of mouse viruses, which are harmless to humans

Reducing HIV Infection Rates •  Vaccines –  Inactivated

•  Virus unable to multiply within the body –  Attenuated (live)

•  Contain weakened viruses, multiply very slowly –  Subunit (protein)

•  Viral protein subunits from virus injected to illicit immune response to whole virus

–  Recombinant •  DNA Vaccine: Plasmid DNAs modified to carry protein-encoding genes

–  Vector •  Uses a mild or virulent virus to humans to carry HIV genes into host cells

Reducing HIV Infection Rates

•  Vaccines – complications – HIV more complex than other viruses

•  Integration of the viral genome as a provirus (versus into DNA) •  Antibodies elicited by vaccine do not enter body cells, virus can escape neutralization (viral reservoirs). •  Ability of HIV to mutate

–  Three main groups: M, N, O + many subgroups

Reducing HIV Impact

•  Social Media Campaigns •  Efficacious in engaging key populations and tracing how

communities learn and share HIV prevention information during intervention treatment.

Reducing HIV Infection Rate

•  POST Strategy – People

•  Who are you looking to reach? Who is your primary audience?

– Objectives •  What are you trying to accomplish?

– Strategy •  Ask yourself: What will change if this effort is a success?

– Technology •  What tools make sense?

Discussion:

•  You are developing an app to help address some aspect of the HIV epidemic… – Pick a topic (related to HIV) you will target using your app

– Get creative with a unique or helpful way to approach this topic using technology

– Propose your app using the P.O.S.T. strategy