Interventions to strengthen the HIV prevention cascade: a systematic review of reviews

Shari Krishnaratne,Bernadette Hensen,Jillian Cordes,Joanne Enstone,James R Hargreaves

doi:10.1016/s2352-3018(16)30038-8

Shari Krishnaratne, Bernadette Hensen + Show 3 more

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https://doi.org/10.1016/s2352-3018(16)30038-8

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Abstract

Much progress has been made in interventions to prevent HIV infection. However, development of evidence-informed prevention programmes that translate the efficacy of these strategies into population effect remain a challenge. In this systematic review, we map current evidence for HIV prevention against a new classification system, the HIV prevention cascade. We searched for systematic reviews on the effectiveness of HIV prevention interventions published in English from Jan 1, 1995, to July, 2015. From eligible reviews, we identified primary studies that assessed at least one of: HIV incidence, HIV prevalence, condom use, and uptake of HIV testing. We categorised interventions as those seeking to increase demand for HIV prevention, improve supply of HIV prevention methods, support adherence to prevention behaviours, or directly prevent HIV. For each specific intervention, we assigned a rating based on the number of randomised trials and the strength of evidence. From 88 eligible reviews, we identified 1964 primary studies, of which 292 were eligible for inclusion. Primary studies of direct prevention mechanisms showed strong evidence for the efficacy of pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision. Evidence suggests that interventions to increase supply of prevention methods such as condoms or clean needles can be effective. Evidence arising from demand-side interventions and interventions to promote use of or adherence to prevention tools was less clear, with some strategies likely to be effective and others showing no effect. The quality of the evidence varied across categories. There is growing evidence to support a number of efficacious HIV prevention behaviours, products, and procedures. Translating this evidence into population impact will require interventions that strengthen demand for HIV prevention, supply of HIV prevention technologies, and use of and adherence to HIV prevention methods. Bill & Melinda Gates Foundation.

Highlights

Despite progress in development and delivery of efficacious HIV prevention interventions, more than 1 million people are newly infected with HIV every year.[1]
UNAIDS have called for a reinvigoration of HIV prevention methods and suggest that 25% of global HIV spending should be allocated to prevention activities.[2]
We review the available evidence for HIV prevention as reflected in systematic reviews of HIV prevention interventions published during the past 20 years

Summary

Introduction

Despite progress in development and delivery of efficacious HIV prevention interventions, more than 1 million people are newly infected with HIV every year.[1] UNAIDS have called for a reinvigoration of HIV prevention methods and suggest that 25% of global HIV spending should be allocated to prevention activities.[2] There is growing interest in the use of HIV prevention cascades to support the development and implementation of interventions and to facilitate resource allocation In this issue, Hargreaves and colleagues[3] suggest a reframing of HIV prevention interventions organised around an HIV prevention cascade that can both integrate evidence from different disciplines and be more helpful for programmers. We map the evidence base in line with the HIV prevention cascade, describe characteristics of interventions relevant to each area of the cascade, assess the type of evidence available on these interventions, and identify gaps and areas for future research

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