Combination approach reduces spread of drug-related HIV

March 4, 2014

A computer model has created the most effective formula for reducing the spread of HIV among drug users in New York City over the next 25 years. Developed by scientists at Columbia University's Mailman School of Public Health and Brown University, the model recommends a combination of interventions, including increased HIV testing, improved access to substance abuse treatment, increased use of needle and syringe exchange programs, and broad implementation of antiretroviral treatment as prevention. The result would lower new infections by more than 60% by 2040.

Results are published online in the March issue of the journal Health Affairs, which includes a cluster of articles on HIV/AIDS in America.

To estimate the effectiveness of various prevention settings, the researchers modeled HIV transmission in a group of sexually active adults age 15 to 64 in the New York metropolitan area, including those who inject drugs, who are non–injection , and people who do not use drugs. They compared the projected HIV incidence in 2020 and 2040 using current approaches to the incidence if one or more of the four interventions were applied.

The combination of all four approaches led to the largest proportion of news cases averted. Scaling-up all four interventions simultaneously resulted in a 62.4% decrease in new infections by 2040.

"A combination intervention of scaling up - as-prevention strategies by increasing access to HIV treatment for people who inject drugs, improving their adherence to therapy, and ensuring that they remained in care was the most effective approach that we analyzed," said Sandro Galea, MD, DrPH, Gelman Professor and chair of the Department of Epidemiology at the Mailman School of Public Health.

Every hypothetical strategy on its own resulted in a greater reduction in HIV compared to the strategies that are in place now. Increased HIV testing resulted in a 12% percent reduction; with expanded access to there was a 26% reduction. The other reductions were 34% for increased and syringe program usage, and 45% percent for scaling up treatment as prevention.

When two of the four interventions were combined—improving needle exchange programs and scaling up HIV treatment and care—the gains produced almost as much reduction in new HIV cases as all four interventions together. No strategy completely eliminated HIV transmission.

"This modeling demonstrates that there is an important role to play for the whole spectrum of prevention efforts we have at our disposal," said Brandon Marshall, PhD, assistant professor of at Brown and a former postdoctoral scholar at the Mailman School. "Importantly, this research supports the goals of New York's Enhanced Comprehensive Prevention Plan that calls for increased HIV testing, programs to improve retention in HIV care, syringe exchange funding, and better linkage to substance for people who use drugs. We really have to redouble our efforts scaling up these programs if we are to achieve the objectives of this ambitious plan, and ultimately, get incidence down to zero."

Recent surveillance data from the Centers for Disease Control and Prevention indicate that approximately one in ten new HIV infections annually—or 4,000 cases—are attributable to the injection of drugs. Drs. Galea and Marshall suggest that their latest results might also have important implications for international settings especially those that restrict or prohibit access to harm reduction programs.

Also of note, according to Dr. Marshall: "While this particular study did not focus on the cost effectiveness aspect, other research has showed that the interventions we modeled turn out to be cost-saving—on an average of $350,000 in lifetime treatment costs—because they prevent new infections."

Explore further: The importance of treating pediatric AIDS in the elimination agenda

Related Stories

How ACA affects vulnerable Americans living with HIV/AIDS

March 3, 2014

A series of papers in the March issue of Health Affairs examines how the Affordable Care Act could affect two sectors of the most vulnerable Americans—those living with HIV/AIDS and people who have recently cycled through ...

Predicting success of HIV interventions in NYC

March 4, 2014

New York City continues to battle an HIV epidemic, including among drug users. There are many possible interventions. Researchers have developed a sophisticated predictive computer model to help policymakers figure out which ...

Recommended for you

Videos reveal how HIV spreads in real time

October 2, 2015

How retroviruses like HIV spread in their hosts had been unknown—until a Yale team devised a way to watch it actually happen in a living organism. The elaborate and sometimes surprising steps the virus takes to reach and ...

Researchers find proteins that shut down HIV-1

September 30, 2015

A pair of studies by researchers at the University of Massachusetts Medical School, the University of Trento in Italy, and the University of Geneva in Switzerland, point to a promising new anti-retroviral strategy for combating ...

An antibody that can attack HIV in new ways

September 11, 2015

Proteins called broadly neutralizing antibodies (bNAbs) are a promising key to the prevention of infection by HIV, the virus that causes AIDS. bNAbs have been found in blood samples from some HIV patients whose immune systems ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.