Lisa R. Metsch

Interventions for Seropositive injectors-research and evaluation: An integrated behavioral intervention with HIV-positive injection drug users to address medical care, adherence, and risk reduction

BackgroundBehavioral interventions to address the complex medical and HIV risk reduction needs of HIV-seropositive (HIV-positive) injection drug users (IDUs) are urgently needed. We describe the development of Interventions for Seropositive Injectors—Research and Evaluation (INSPIRE), a randomized controlled trial of an integrated intervention for HIV-positive IDUs, and the characteristics of the baseline sample. MethodsHIV-positive IDUs were recruited from community settings in 4 US cities. After completing a baseline assessment, participants who attended the first session were randomly assigned to (1) a 10-session peer mentoring intervention designed to improve utilization of HIV care, to improve adherence to HIV medications, and to reduce sexual and injection risk or (2) an 8-session videotape control. Periodic follow-up for 12 months is ongoing. ResultsA total of 1161 HIV-positive IDUs completed the baseline assessment, and 966 (83%) were randomized. Retention rates are greater than 80% for all follow-up periods. Approximately 79% of baseline participants reported a recent medical visit, 49% were taking highly active antiretroviral therapy, and 19% had an undetectable viral load. Use of injection and noninjection substances was prevalent, and sexual and injection risks were each reported by more than 25% of participants. ConclusionThere is a need for an integrated intervention for HIV-positive IDUs, and these data show the acceptability of such an approach.

Increases in Recent HIV Testing Among Men Who Have Sex With Men Coincide With the Centers for Disease Control and Prevention's Expanded Testing Initiative

According to National HIV Behavioral Surveillance system data, human immunodeficiency virus (HIV) testing increased among gay, bisexual, and other men who have sex with men from 2008 to 2011 in cities funded by the Centers for Disease Control and Preventions Expanded Testing Initiative, suggesting that focused HIV testing initiatives might have positive effects.

Economic evaluation of an HIV prevention intervention for seropositive injection drug users.

OBJECTIVEnTo assess the cost-effectiveness of Intervention for HIV-Seropositive injection drug users--Research and Evaluation (INSPIRE), designed to reduce risky sexual and needle-sharing behaviors in research sites in four US cities (2001-2003).nnnMETHODSnWe collected data on program and participant costs. We used a mathematical model to estimate the number of sex partners of injection drug users expected to become infected with human immunodeficiency virus (HIV) (with and without intervention), cost of treatment for sex partners who became infected, and the effect of infection on partners quality-adjusted life expectancy. We determined the minimum effect that INSPIRE must have on condom use among participants for the intervention to be cost-saving (intervention cost less than savings from averted HIV infections) or cost-effective (net cost per quality-adjusted life year saved less than

Interventions in Community Settings

50,000).nnnRESULTSnThe intervention cost was

Intimate partner violence, hiv, and crack cocaine: where and why to intervene

870 per participant. It would be cost-saving if it led to 53 percent reduction in the proportion of participants who had any unprotected sex in 1 year and cost-effective with 17 percent reduction. If behavior change lasted 3 months, the cost-effectiveness threshold was 66 percent; if 3 years, the threshold was 6 percent.nnnCONCLUSIONSnAlthough cost-saving thresholds may not be achievable by the intervention, we anticipate that cost-effectiveness thresholds will be attained.

An example of exposure heterogeneity when pooling epidemiologic studies for meta-analysis of antiretroviral medication adherence:

During the first two decades of the AIDS epidemic, HIV prevention messages typically targeted uninfected, at-risk persons with the aim of averting the acquisition of HIV. Recently, public health practitioners have recognized the importance of developing intervention strategies for persons livingwith HIV to prevent HIV transmission to uninfected persons as well as to protect infected persons from acquiring other STDs or potential reinfection with HIV (CDC, 2003b; Institute of Medicine [IOM], 2001; National Institutes of Health [NIH], 2002). One of the four key strategies outlined in CDC’s prevention initiative, “Advancing HIV Prevention: New Strategies for a Changing Epidemic,” directs efforts towards preventing new infections by working with persons diagnosed with HIV and their partners (CDC, 2003b). This additional prevention strategy is predicated on the notion that each infection begins with someone already infected and therefore, primary prevention would be strengthened by focusing some of our prevention resources on HIV-positive persons. Community-basedorganizations (CBOs),AIDSServiceOrganizations (ASOs), health departments, and other HIV prevention practitioners are now facedwith the challengeof broadening theirHIVprevention approach and strategies.Howare communities throughout theUS responding to this new challenge? Is this really a new phenomenon or have selected communities been addressing prevention with people living with HIV for some