HIV Transmission Models: Lessons Learned for Microbicide Formulation Design

2014 ◽  
pp. 55-89
Author(s):  
Pedro Mesquita ◽  
Betsy Herold
Keyword(s):  
Hiv Transmission ◽  
Lessons Learned ◽  
Formulation Design ◽  
Transmission Models

scholarly journals Formative Assessment of ARM-U: A Modular Intervention for Decreasing Risk Behaviors Among HIV-Positive and HIV-Negative Methamphetamine-Using MSM

2010 ◽  
Vol 4 (1) ◽  
pp. 105-115 ◽  
Author(s):  
Richard S Garfein ◽  
Mitcheal Metzner ◽  
Jazmine Cuevas ◽  
Chad A Bousman ◽  
Thomas Patterson
Keyword(s):  
Focus Groups ◽  
Risk Behaviors ◽  
Hiv Transmission ◽  
Anal Intercourse ◽  
Formative Research ◽  
Lessons Learned ◽  
Transmission Risk ◽  
Individual Risk ◽  
Satisfaction Survey ◽  
Methamphetamine Use

Background: Methamphetamine is a major contributor to HIV transmission among men who have sex with men (MSM). Recent studies show that up to one-third of methamphetamine-using MSM (MUMSM) inject the drug. We developed a behavioral intervention for MUMSM to decrease unprotected anal intercourse and increase awareness of parenteral HIV transmission risk. This 6-session (3 in-person, 3 by telephone) modular intervention was designed to be tailored to participants’ HIV (+/-) and injection drug user ([IDU] yes/no) status. We present results of formative research used to evaluate the content and to assess feasibility and acceptability of this individual-level HIV risk-reduction intervention. Setting: HIV research clinic in a high MSM and methamphetamine prevalence neighborhood. Project: Avoiding Risks from Methamphetamine-Use (ARM-U) is a brief toolbox intervention that allows counselors to select modules that suit a client’s individual risk profile and intervention needs employing motivational interviewing and cognitive behavioral theory. We evaluated the format and content of the intervention through focus groups and pre-testing of the entire intervention using volunteers from the target population stratified into four groups (HIV+/IDU, HIV-/IDU, HIV+/non-IDU, HIV-/non-IDU). Four individuals in each stratum were recruited to undergo the intervention and complete a satisfaction survey at the end of each in-person session. Results: In total, 25 MUMSM attended one of five focus groups. Participants thought all proposed intervention topics were important and could aid in reducing sexual risk behaviors among MUMSM. However, the neurocognitive effects of methamphetamine were reported to be a barrier to practicing safer sex, condom use negotiation or HIV status disclosure. Fifteen (94%) of 16 participants completed all 6 sessions and the satisfaction survey. On average, participants felt the intervention was useful for MUMSM, made them contemplate and move toward behavior change, and would recommend the program to their peers. Lessons Learned: Based on our formative research, we revised the ARM-U intervention to emphasize pre-planning to avoid combining methamphetamine use and sex or develop strategies to avoid sex risk following methamphetamine use. We also increased emphasis on referrals for care and other requested services. Future efficacy trials are needed to evaluate the intervention’s ability to reduce HIV-associated risk behaviors.

scholarly journals Risk heterogeneity in compartmental HIV transmission models of ART as prevention in Sub-Saharan Africa: A scoping review

2021 ◽  
Author(s):  
Jesse Knight ◽  
Rupert Kaul ◽  
Sharmistha Mishra
Keyword(s):  
Scoping Review ◽  
Hiv Transmission ◽  
Population Level ◽  
Sub Saharan Africa ◽  
Key Populations ◽  
Hiv Diagnosis ◽  
Cascade Transitions ◽  
Sub Saharan ◽  
Modelling Assumptions ◽  
Transmission Models

AbstractObjectiveTransmission models provide complementary evidence to clinical trials about the potential population-level incidence reduction attributable to ART (ART prevention impact). Different modelling assumptions about risk heterogeneity may influence projected ART prevention impacts. We sought to review representations of risk heterogeneity in compartmental HIV transmission models applied to project ART prevention impacts in Sub-Saharan Africa.DesignScoping review to identify common modelling assumptions and applications.MethodsWe systematically reviewed studies published before January 2020 that used non-linear compartmental models of sexual HIV transmission to simulate ART prevention impacts in Sub-Saharan Africa. We summarized data on model structure/assumptions (factors) related to risk and intervention heterogeneity, and explored crude associations of ART prevention impact with modelled factors.ResultsOf 1384 search hits, 94 studies were included, which primarily modelled medium/high prevalence epidemics in East/Southern Africa. 64 studies considered sexual activity stratification and 39 modelled at least one key population. 21 studies modelled faster/slower ART cascade transitions (HIV diagnosis, ART initiation, or cessation) by risk group, including 8 with faster and 4 with slower cascade transitions among key populations versus the wider population. Models without activity stratification predicted the largest ART prevention impacts, followed by models with key populations that had faster cascade transitions versus the wider population.ConclusionsAmong compartmental transmission models applied to project ART prevention impacts, representations of risk heterogeneity and projected impacts varied considerably, where models with less heterogeneity tended to predict larger impacts. The potential influence of modelling assumptions about risk and intervention heterogeneity should be further explored.

scholarly journals Evidence for the importance of community involvement: Implications for initiatives to prevent mother-to-child transmission of HIV

2001 ◽  
Keyword(s):  
Community Involvement ◽  
Hiv Transmission ◽  
Perinatal Transmission ◽  
Companion Paper ◽  
Lessons Learned ◽  
Mother To Child Transmission ◽  
Child Transmission ◽  
Voluntary Counseling And Testing ◽  
Counseling And Testing ◽  
Mother To Child

This paper offers lessons learned from a literature review of community involvement in biomedical and other technologies that can guide appropriate and effective introduction of services for prevention of mother-to-child transmission of HIV. A companion paper discusses research in Botswana and Zambia that showed gaps in community knowledge about HIV transmission, particularly from mother to child, and yielded insights into community perspectives about barriers to using voluntary counseling and testing services; stigma and fear associated with HIV; traditional norms on breastfeeding; and the role of family and community members in women’s decisions to participate in programs to prevent mother-to-child transmission of HIV. A separate publication (“Community involvement in the prevention of mother-to-child transmission of HIV: Insights and recommendations”) offers recommendations for community involvement strategies. Placed within the framework of community involvement, an intervention that addresses mother-to-child transmission of HIV offers an enormous opportunity to improve HIV prevention and care. Successful interventions can influence how AIDS is perceived by the community, reduce stigma, and have an effect beyond the immediate prevention of perinatal transmission.

scholarly journals Using developmental evaluation to implement an oral pre-exposure prophylaxis (PrEP) project in Kenya

2020 ◽  
Vol 4 ◽  
pp. 158
Author(s):  
Linda Fogarty ◽  
Abednego Musau ◽  
Mark Kabue ◽  
Daniel Were ◽  
Jane Mutegi ◽  
...  
Keyword(s):  
Sex Workers ◽  
Hiv Transmission ◽  
Dynamic Environment ◽  
Lessons Learned ◽  
Transmission Risk ◽  
Service Access ◽  
Developmental Evaluation ◽  
Sex With Men ◽  
Hiv Transmission Risk ◽  
Exposure Prophylaxis

Oral Pre-Exposure Prophylaxis (PrEP) is highly effective in lowering HIV transmission risk. The Bill and Melinda Gates-funded Jilinde Project was designed to identify the best ways to introduce and support PrEP services in Kenya for female sex workers, men who have sex with men, and adolescent girls and young women. We chose Developmental Evaluation (DE) as a core project approach because our goal was not just to recruit 20,000 new PrEP users, but to learn how to deliver PrEP effectively to optimally benefit users in a complex, dynamic, resource-limited setting. This paper describes how we incorporated DE into the Jilinde Project, and shares experiences and lessons learned about the value of DE in PrEP service implementation in a real-world situation. With the Ministry of Health, Jilinde developed consensus about the structure and roll-out of PrEP services. The DE evaluator, embedded in Jilinde, designed and implemented the five-step DE methodology—collect, review, reflect, record and act—according to a core set of project guiding principles. The paper describes how we operationalized the five elements, citing findings reported and actions taken reflecting on the data. It summarizes challenges to DE implementation, such as uneven uptake and competing demands, and how we addressed those challenges. Used consistently, DE helped adapt and refine PrEP services, improve service access, reach target audiences and improve continuation rates. The look, feel and yield of our DE efforts evolved over time, increasingly integrated into existing systems and providing deeper and richer understandings, and we learned how to better implement DE in the future. This case study provides practical guidance for using a DE approach in program design. The DE process can be used successfully working with partners on a common complex public health challenge within a dynamic environment in a way that feeds back into and improves programs.

scholarly journals Lesotho's Minimum PMTCT Package: lessons learned for combating vertical HIV transmission using co-packaged medicines

2012 ◽  
Vol 15 (2) ◽  
Author(s):  
Lotus McDougal ◽  
Mpolai M Moteetee ◽  
Florence Mohai ◽  
Malisebo Mphale ◽  
Binod Mahanty ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Lessons Learned

scholarly journals Understanding the effects of different HIV transmission models in individual-based microsimulation of HIV epidemic dynamics in people who inject drugs

2016 ◽  
Vol 144 (8) ◽  
pp. 1683-1700 ◽  
Author(s):  
J. F. G. MONTEIRO ◽  
D. J. ESCUDERO ◽  
C. WEINREB ◽  
T. FLANIGAN ◽  
S. GALEA ◽  
...  
Keyword(s):  
New York ◽  
People Who Inject Drugs ◽  
Hiv Transmission ◽  
Unprotected Sex ◽  
Hiv Incidence ◽  
Epidemic Dynamics ◽  
Quantitative Understanding ◽  
The Individual ◽  
Modelling Process ◽  
Transmission Models

SUMMARYWe investigated how different models of HIV transmission, and assumptions regarding the distribution of unprotected sex and syringe-sharing events (‘risk acts’), affect quantitative understanding of HIV transmission process in people who inject drugs (PWID). The individual-based model simulated HIV transmission in a dynamic sexual and injecting network representing New York City. We constructed four HIV transmission models: model 1, constant probabilities; model 2, random number of sexual and parenteral acts; model 3, viral load individual assigned; and model 4, two groups of partnerships (low and high risk). Overall, models with less heterogeneity were more sensitive to changes in numbers risk acts, producing HIV incidence up to four times higher than that empirically observed. Although all models overestimated HIV incidence, micro-simulations with greater heterogeneity in the HIV transmission modelling process produced more robust results and better reproduced empirical epidemic dynamics.

Lessons Learned From Coaching Postsecondary Students With Traumatic Brain Injury

2020 ◽  
Vol 5 (1) ◽  
pp. 88-96
Author(s):  
Mary R. T. Kennedy
Keyword(s):  
College Students ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Sense Of Self ◽  
Scientific Evidence ◽  
Sudden Onset ◽  
Lessons Learned ◽  
Speech Language Pathologists ◽  
The Brain ◽  
Exhaustive List

Purpose The purpose of this clinical focus article is to provide speech-language pathologists with a brief update of the evidence that provides possible explanations for our experiences while coaching college students with traumatic brain injury (TBI). Method The narrative text provides readers with lessons we learned as speech-language pathologists functioning as cognitive coaches to college students with TBI. This is not meant to be an exhaustive list, but rather to consider the recent scientific evidence that will help our understanding of how best to coach these college students. Conclusion Four lessons are described. Lesson 1 focuses on the value of self-reported responses to surveys, questionnaires, and interviews. Lesson 2 addresses the use of immediate/proximal goals as leverage for students to update their sense of self and how their abilities and disabilities may alter their more distal goals. Lesson 3 reminds us that teamwork is necessary to address the complex issues facing these students, which include their developmental stage, the sudden onset of trauma to the brain, and having to navigate going to college with a TBI. Lesson 4 focuses on the need for college students with TBI to learn how to self-advocate with instructors, family, and peers.

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