Maximizing the impact of HIV prevention efforts: Interventions for couples

Despite efforts to increase access to HIV testing and counseling services, population coverage remains low. As a result, many people in sub-Saharan Africa do not know their own HIV status or the status of their sex partner(s). Recent evidence, however, indicates that as many as half of HIV-positive individuals in ongoing sexual relationships have an HIV-negative partner and that a significant proportion of new HIV infections in generalized epidemics occur within serodiscordant couples. Integrating couples HIV testing and counseling (CHTC) into routine clinic- and community-based services can significantly increase the number of couples where the status of both partners is known. Offering couples a set of evidence-based interventions once their HIV status has been determined can significantly reduce HIV incidence within couples and if implemented with sufficient scale and coverage, potentially reduce population-level HIV incidence as well. This article describes these interventions and their potential benefits

Family Experiences with Pediatric Antiretroviral Therapy: Responsibilities, Barriers, and Strategies for Remembering Medications

This study examines the relationship between adherence to pediatric HIV regimens and three family experience factors: (1) regimen responsibility; (2) barriers to adherence; and (3) strategies for remembering to give medications. Caregivers of 127 children ages 2–15 years in the PACTS-HOPE multisite study were interviewed. Seventy-six percent of caregivers reported that their children were adherent (taking ≥ 90% of prescribed doses within the prior 6 months). Most caregivers reported taking primary responsibility for medication-related activities (72%–95% across activities); caregivers with primary responsibility for calling to obtain refills (95%) were more likely to have adherent children. More than half of caregivers reported experiencing one or more adherence barriers (59%). Caregivers who reported more barriers were also more likely to report having non-adherent children. Individual barriers associated with nonadherence included forgetting, changes in routine, being too busy, and child refusal. Most reported using one or more memory strategies (86%). Strategy use was not associated with adherence. Using more strategies was associated with a greater likelihood of reporting that forgetting was a barrier. For some families with adherence-related organizational or motivational difficulties, using numerous memory strategies may be insufficient for mastering adherence. More intensive interventions, such as home-based nurse-administered dosing, may be necessary

Pooled relative risks of community- versus facility-based HTC sensitivity analyses.

<p>N/A, not applicable.</p

Uptake of self-testing.

<p>Uptake of self-testing.</p

Relative risks of community-based HTC versus facility-based HTC among key populations.

<p>The numerator for all RRs was the risk of an outcome in community-based testing, while the denominator was the risk of an outcome in facility-based testing.</p

Uptake of door-to-door HTC.

<p>Asterisk: data reported were exclusively from children aged 18 mo.–13 y.</p

First time testers in community-based testing approaches for key populations.

<p>First time testers in community-based testing approaches for key populations.</p

Uptake of workplace HTC.

<p>Asterisk: data reported were from the Democratic Republic of Congo, Rwanda, Burundi, Congo, and Nigeria.</p

Number needed to screen to identify a person with HIV in studies offering community- and facility-based HTC.

<p>The Henry-Reid et al. <a href="http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001496#pmed.1001496-HenryReid1" target="_blank">[87]</a> study was excluded since it did not find any people with HIV among the 20 school participants screened.</p