Amsterdam 2015
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| Abstract #2130 - Poster 2 | ||||
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Session: 59.20: Poster 2 (Poster) on Tuesday in Chaired by Authors: Presenting Author: Dr. Jeffrey Kelly - Medical College of Wisconsin, United States |
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| Additional Authors: | ||||
| Aim: Antiretroviral treatment carries great potential for reducing AIDS-related illnesses and deaths, as well as downstream HIV incidence. The field’s prevention priorities now emphasize the use of ART-based biomedical prevention strategies. To date, most interventions to encourage medical care linkage, retention, and adherence have been based on individual counseling or on service provision to individual HIV+ clients. Although individual-level interventions are very important, the field has neglected the role of community-level interventions even though engagement in HIV medical care is strongly influenced by social support, social norms, and peer values. | ||||
| Method / Issue: This presentation outlines examples of ways in which community-level interventions can play a critical role for reaching PLH and engaging infected persons into care. Only with a new generation of community interventions targeting medical care issues can treatment-as-prevention achieve its full population-level public health benefits. | ||||
| Results / Comments: Care linkage efforts have primarily relied upon individual navigation and case management models for persons newly-diagnosed with HIV infection. However, in many countries (including the US), large numbers of PLH in the community are not regularly in medical care, either because they never entered care after testing positive sometimes years earlier, because they ped out of care, or because they became lost to care systems. Since they were not recently diagnosed and are not in care, most of these PLH can only be reached through community interventions. Until this large pool of PLH is reached and engaged into care, treatment-as-prevention cannot achieve its full public health impact. Community-level models—including social network-level interventions, targeted social marketing campaigns, and opinion leader interventions—combined with low-threshold accessible services, have the potential to reach out-of-care PLH in the community and strengthen their motivations for entering, re-entering, and adhering to HIV medical care. Community-level interventions can correct outdated treatment misconceptions, emphasize health benefits, and counter fears that underlie reluctance to be treated. Community-level interventions are also needed at other junctures of the treatment cascade, including (1) to establish and strengthen social norms concerning the benefits of regular and frequent HIV testing (2) to support sustained ART treatment adherence and (3) to create awareness, especially in gay communities, about health symptoms indicative of acute (primary) HIV infection and actions to take if these symptoms occur. The development and implementation of community interventions in areas related to biomedical HIV prevention will require an expanded social science research agenda to better identify reasons why many PLH are out of care or do not sustain treatment adherence, as well as why many high-risk MSM do not regularly test. Intervention models and principles successfully used to develop programs for risk behavior reduction can be adapted with the new aim of scaling up biomedical strategies on a community level. | ||||
| Discussion: Most efforts to improve HIV care linkage, retention, and adherence have relied upon individual counseling interventions. These approaches are important. However, further reducing HIV incidence and the burden of AIDS will also require expanded interventions on a community level. | ||||
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