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March 13, 2013

Study Identifies Ways to Increase HIV Testing, Reduce HIV Infection and Detect Previously Undiagnosed HIV Infections

Community efforts such as community mobilization and mobile testing can increase the number of people who get tested for HIV and know their status—especially among men and young people with HIV who are at an increased risk of transmitting the virus to others. This is according to a new study by the National Institutes of Health and the HIV Prevention Trials Network which includes a team of researchers from the Johns Hopkins Bloomberg School of Public Health. They tested a combination of social, behavioral and structural interventions for HIV prevention in South Africa, Zimbabwe, Tanzania and Thailand and found a 14 percent reduction in new HIV infections in the intervention communities compared to the control communities. The results were presented at the Conference on Retroviruses and Opportunistic Infections on March 4 in Atlanta.

"Our data clearly demonstrate that men and younger people can be convinced to get HIV tests in low- and middle-income countries,” said David Celentano, ScD, MHS, principal investigator for the Thailand site and the Charles Armstrong Chair of the Bloomberg School’s Department of Epidemiology. “This can lead to better identification of those at risk without undue stigma and discrimination, and we found no instances of social harms associated with community-based testing."

The NIMH Project Accept (HPTN 043) study is the first community-randomized trial to test a combination of interventions for HIV prevention and to assess the impact of an integrated strategy at the community level. Conducted in 34 communities in Africa and 14 communities in Thailand, the interventions were designed to: increase access to voluntary counseling and testing and post-test services; change community attitudes around HIV awareness, particularly the benefit of knowing one’s HIV status; remove barriers to knowing one’s HIV status; and increase the safety of testing as well as minimize the potential negative consequences of testing by providing various forms of support.

The authors reported, “Despite the challenges of many HIV-prevention programs in reaching men, this study achieved 45 percent higher testing rates of men in intervention versus control communities. In addition, HIV-infected individuals in the intervention communities reported greater reductions in risky sexual behaviors. This effect was especially strong among HIV-infected men, who reported 18 percent fewer sexual partners and 29 percent fewer concurrent sexual partners as compared to the control communities.”

Study participants who learned they were HIV-infected were directed to the study’s post-test services which included counseling, referrals to health care and social services assistance. Participants who tested HIV negative were also directed to post-test services for further counseling, referrals and support in staying HIV negative. Local health authorities were thoroughly briefed on the study findings and encouraged to continue implementation efforts.

"What our study clearly shows is that it is possible to have an effect on entire communities, not just those who we reach in research studies. We also were able to reach populations that are most likely to spread HIV to others, by enhanced testing among men, who are often missed in testing campaigns, and younger people," notes Celentano.

The research was funded by the U.S. National Institute of Mental Health, the U.S. National Institute of Allergy and Infectious Diseases, and the Office of AIDS Research, all components of the U.S. National Institutes of Health. It was conducted by the NIH-funded HIV Prevention Trials Network (HPTN).

Media contact for Johns Hopkins Bloomberg School of Public Health: Natalie Wood-Wright at 410-614-6029 or nwoodwri@jhsph.edu.