Target and Tailor Interventions for HIV

HIV has been an epidemic for 30 years. Initially, the health system relied on behavioral interventions to slow the spread of the virus. As researchers developed effective treatments, the interventions relied increasingly on biomedical HIV control approaches. Regardless, we have been unable to meet the significant challenges associated with complete control of HIV for a number of reasons.

A review article published in the Journal of AIDS & Clinical Research walks readers through history, identifies barriers to successful HIV epidemic control, and looks into the future.

The few early behavioral approaches to control HIV were evidence-based interventions, but health care providers often applied them somewhat randomly and indiscriminately. Methods used included encouraging abstinence, advising patients to limit their sexual partners, promoting use of effective barrier contraception, repeating HIV counseling and testing, stressing total adherence to HIV prevention strategies, decreasing needle sharing, and reducing substance use.

With the advent of better biomedical strategies (eg, male medical circumcision, antiretroviral therapy, pre-exposure prophylaxis [PrEP]), HIV control has improved.

Some barriers have impeded total success:

• Early intervention, while recommended, is not always practical, and some patients aren't ready to start antiretroviral treatment (ART) when initially diagnosed.
• HIV testing is still usually done in high-risk patients; widespread, routine testing is needed to catch infections as early as possible.
• Adherence is poor, and some studies indicate that people who start ART at higher CD4 counts are less likely to remain adherent than those who start after CD4 counts drop.
• Adherence to PrEP is also lower than optimal.
• Some evidence indicates that many individuals are less concerned about HIV transmission, which has led to an increase in sexual risk-taking.
• No effective vaccine exists.

Today, health care providers understand that they need to tailor and target combination prevention strategies in certain high-transmission geographies and people.

For pharmacists, it's imperative to know local and national HIV infection trends. It's also important to know that starting ART as soon as a patient tests positive for the virus is life-saving, but that these patients are at highest risk of nonadherence. Targeting counseling to high-risk patients, early ART starters, and people using PrEP is logical.