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Methodologies for evaluating HIV prevention intervention (populations and epidemiologic settings)
1Reproductive Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, E4132, 615 N Wolfe Street, Baltimore, MD 21205, USA. rgray@jhsph.edu
Current Opinion in HIV and AIDS
|June 18, 2009
Summary
Male circumcision significantly reduces HIV acquisition, but most other HIV prevention trials, including STI control, microbicides, and vaccines, have failed. Poor trial design and participant selection contribute to these negative findings.
Area of Science:
- Infectious Diseases
- Public Health
- Clinical Trials
Background:
- Over 30 human immunodeficiency virus (HIV)-prevention trials have been conducted, with limited success.
- Reasons for trial failures include ineffective interventions and inappropriate selection of study populations and settings.
Purpose of the Study:
- To review the efficacy of various human immunodeficiency virus (HIV)-prevention strategies.
- To identify factors contributing to the failure of HIV-prevention trials.
Main Methods:
- Systematic review of published HIV-prevention trial data.
- Analysis of factors influencing trial outcomes, including intervention efficacy, population selection, and trial design.
Main Results:
- Male circumcision demonstrated a 50-60% reduction in HIV acquisition in men.
- Most trials for sexually transmitted infection (STI) control, microbicides, and vaccines showed no HIV-prevention efficacy.
- Some microbicide trials indicated increased HIV risk due to vaginal irritation and microulceration.
Conclusions:
- Inadequate pretrial screening, insufficient data on HIV incidence, and poor selection of high-risk populations with low compliance compromise trial power.
- Lack of generalizability and treatment interruptions during pregnancy further impact the reliability of HIV-prevention trial results.
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