Presentation is loading. Please wait.

Presentation is loading. Please wait.

Stefan Baral, MD MPH FRCPC

Similar presentations

Presentation on theme: "Stefan Baral, MD MPH FRCPC"— Presentation transcript:

1 Overview of HIV Epidemiology and Prevention Sciences for key populations
Stefan Baral, MD MPH FRCPC Center for Public Health and Human Rights, Johns Hopkins School of Public Health

2 Outline Background HIV among Key Populations
Female Sex Workers Men who have Sex with Men People who Inject Drugs Transgender People Levels of HIV Risk HIV among Key Populations Epidemiology Prevention Studies Community Determinants Conclusions and Moving Forward

3 Most At Risk or Key Populations
Populations that have specific acquisition and transmission risk factors for HIV Three Universal Key Populations Sex workers (SW) and their clients Gay Men and other Men who have sex with Men (MSM) People who Use Drugs (PUD) Country Specific Key Populations Migrant populations Fisherfolk, Truckers Often clients of sex workers

4 Levels of HIV Acquisition and Transmission Risks
Source: Baral, Logie, et al. Modified Social Ecological Model of HIV Risk. BMC Public Health. 2013

5 Map of HIV prevalence among female sex workers in low-income and middle-income countries, 2007-2011
Pooled OR for HIV infection among FSW compared to other reproductive age women 13.49 (95% CI )

6 Global HIV prevalence among MSM, 2007-2011
Source: Beyrer, Baral, van Griensven, Goodreau, Chariyalertsak, Wirtz, Brookmeyer, The Lancet, 2012

7 HIV Prevalence among MSM in Africa
Legend 2002 2003 2004 2005 2006 2007 2008 Senegal 21.5% (463) 21.8% (501) Ghana 25.0% (N/A) Nigeria 13.4% (1,125) Sudan 9.3% (713) 7.3% (406) Kenya 24.6% (285) Tanzania 12.3% (509) Malawi 21.4% (201) Soweto 28.9% (249) Botswana 19.7% (117) (200) Cape Town (Township) Cape Town 10.6% (538) Namibia 12.4% (218) Egypt 6.2% (267) 4.9% (1,778) 4.4% (90) Morocco Tunisia 5.7% (259) 5.9% (262) 17.2% (1,291) 13.3% (215) The Gambia 13.2% (306) 19.0% (563) Uganda 40.7% (285) 2009 2010 2011 Modified From : van Griensven, Baral, et al. The Global Epidemic of HIV Infection among Men who have Sex with Men. Curr Opinion on HIV/AIDS, 2009

8 Map of HIV prevalence among transgender women, 2000-2011
Pooled OR for HIV infection among TGW compared to other reproductive people. 48.8 (95% CI )

9 HIV prevalence among PWID in 2011
Source: Mathers, et, al, Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet, 2008

10 PrEP Many ongoing & planned Phase III/IV research & feasibility/demonstration projects ≥ 17 studies with GMT Feasibility studies in FSW in Nigeria, Kenya, RSA, Benin, Senegal supported by BMGF Trial & product Population N Country Expected Completion FTC/TDF (Intervention to Enhance PrEP Uptake and Adherence in a Community-Based Setting) GMT 445 Callen-Lorde Clinic, NYC, US 2015 TDF2 OLE TDF/FTC heterosexual men & women   1,219 Botswana Nov 2013 iPrEX OLE 1,770 Brazil, Ecuador, Peru, South Africa, Thailand & U.S. Early 2014

11 PrEP Trial Product Population N Country Expected Completion HPTN073
FTC/TDF Black MSM ≥18 years 225 U.S. June 2015 PrEP at STD Clinics GMT 600 Dec 2014 Project PrEPare Young MSM years 300 March 2016 Partners Demonstration Project Heterosexual serodiscordant couples 1000 Kenya & Uganda 2015 Sibanye MSM 200 South Africa Demo PrEP 400 Brazil Jan 2016 PROUD Immediate or deferred FTC/TDF 500 U.K. Early 2015 PATH-PrEP 375 May 2017 VicPrEP Study High risk men & women -- Australia SAPPH-Ire (C-RTC of combination prevention incl. PrEP) Female sex workers 2800 Zimbabwe Oct 2015

12 Oral PrEP – Dosing/Regimens Study
Trial Intervention Population N Country Expected Completion ADAPT Study/ HPTN067 FTC/TDF: daily, time-based, or event-based Inc. MSM & TGW 540 South Africa, Thailand & U.S. July 2014 NEXT-PrEP/ HPTN069 Daily MVC, MVC+FTC, MVC+TDF, or FTC/TDF MSM & women 600 U.S. Dec 2014 IPERGAY/ CTN 268 ANRS Intermittent FTC/TDF or placebo MSM 1900 Canada & France Dec 2016

13 Topical PrEP – Ongoing Research
Trial Intervention Population N Country Expected Completion FACTS 001 1% TDF gel Women 18-30 2900 South Africa Dec 2014 CAPRISA 008 Women 700 Feb 2015 MTN-017 TDF rectal microbicide GMT 186 Peru, South Africa, Thailand, U.S. ASPIRE/ MTN-020 Dapivirine vaginal ring Women 18-45 3476 Malawi, Uganda, South Africa & Zimbabwe Dec 2014 / early 2015 The Ring Study/ IPM 027 1650 Rwanda & South Africa Aug 2015

14 Acute Infection/Universal ART Study
Trial Intervention Population N Country/ Region Expected Completion "Test & Treat" Indonesia Immediate ART Y1, immediate ART & CB intervention package Y2 MSM, FSW, PWID -- Indonesia TBD Integrated Care Clinics (ICC) for IDUs in India IDU-oriented ICCs for improving "seek, test, treat, and retain" continuum PWID & MSM 1000 India 2016 Multi-component Intervention Packages Package of Test & Link-to-Care interventions MSM China 2015

15 Universal Coverage of ART
Trial Intervention Population N Country/ Region Expected Completion Thai MSM/TG Test & Treat Study Universal HIV testing & ART regardless of CD4 GMT 2000 Thailand Dec 2014 CDC Test & Treat Thailand 8000 TBD Test and Treat - Peru Immediate ART vs. ART after 24 weeks 150 Peru Dec 2016 ART for prevention & treatment Immediate ART Serodiscordant couples Viet Nam Early ART among PWID PWID Dec 2015 Anza Mapema Immediate ART; Comprehensive package of find, test, link & retain in care (FTLR) interventions MSM 700 Kenya

16 Studies for Transgender Women
NIH Funded Studies Feasibility study of an anti-stigma intervention among health care providers in Mumbai, India to improve access to HIV services for hijra Feasibility study of a telemedicine approach to improving engagement in care among TGW of color in Washington, DC RCT of the LifeSkills program (a six session, peer-led, group intervention for sexually active TGW ages years) in Boston and Chicago. RCT of T-Talk, a peer-led harm reduction and social support intervention for TGW in New York City Pilot RCT of Sheroes, a 5-session group intervention based on gender affirmation in the USA.

17 Map of low-income and middle-income countries reporting community level measurements for HIV risk among key populations,

18 Results Men who have Sex with Men Mitigating HIV Risks
Participating in HIV Prevention Programs in Beijing OR 2.3 (95% CI ) knowing 10 or more MSM Potentiating HIV Risks Prevalent HIV infections in Kampala, Uganda OR 4.3 (95% CI ) exposure to homophobic abuse Sources: Ma W, Raymond HF, Wilson EC, et al. Participation of HIV prevention programs among men who have sex with men in two cities of China—a mixed method study. BMC Public Health. 2012; Hladik W, Barker J, Ssenkusu JM, et al. HIV infection among men who have sex with men in Kampala, Uganda—a respondent driven sampling survey. PLoS One

19 Results Female sex workers
Studies regularly focused on measuring social participation and cohesion among FSW Consistent condom use with all partners Swaziland OR 2.3 (95% CI ) social cohesion China OR 1.2 (p<.01) peer support for condom use Sources: Fonner VA, Kerrigan D, Mnisi Z, et al. Social cohesion, social participation, and HIV related risk among female sex workers in Swaziland. PloS One. 2014; Correlates of consistent condom use among female entertainment workers in Shanghai, China: a repeated measures analysis. Int J STD AIDS

20 Results Transgender people
Limited studies in LMIC focused on this population Consistent condom use with a paying partner in India OR 1.9 (95% CI ) collective efficacy among high-risk MSM and transgender women Source: Saggurti N, Mishra RM, Proddutoor L, et al. Community collectivization and its association with consistent condom use and STI treatment seeking behaviors among female sex workers and high-risk men who have sex with men/transgenders in Andhra Pradesh, India. Aids Care. 2013.

21 Results People who inject drugs
Limited data measuring community- and social-level determinants among PWID Highly criminalized population Avoiding HIV testing in Bangkok, Thailand OR 6.7 (95% CI ) ever been refused health care services Source: Ti L, Hayashi K, Kaplan K, et al. HIV test avoidance among people who inject drugs in Thailand. AIDS Behavior

22 Conclusions Increasing amount of data characterizing the HIV epidemiology, prevention and HIV treatment needs of key populations Predominant majority of epidemiologic and surveillance studies have focused on individual-level determinants of HIV risk among key populations Burden of HIV Often sustained or increasing HIV incidence The future holds increased HIV prevention studies for key populations Necessitates effective partnerships between community and academia Contextualize HIV-related risk behaviors among key populations Affect the coverage of HIV prevention, treatment, and care services by mitigating both the provision and uptake of services

23 Acknowledgements Key Populations Program
Ashley Grosso, Erin Papworth, Andrea Wirtz, Emily Crawford, Sheree Schwartz, Charles Cange, Sosthenes Ketende Collaborators: Enda Santé (Daouda Diouf), UNAIDS Gambia (Nuha Ceesay), CEDEP (Gift Trapence), Desmond Tutu, HSRC, PAMAC, AEC, EVT, IRSS, AIDSETI, Emory University, Fenway Health, PNPEC, PLS-PHV (Dr. Marguerite Thiam), Rebecca Ezouatchi, Amara Bamba CPHHR Emily Clouse, Tara Lonergan, Michele Decker, Susan Sherman, Chris Beyrer amfAR Owen Ryan, Chris Collins, Sam Avrett, Kent Klindera JHSPH Students Claire Holland, Madeleine Schlefer, Faiza Yazin, Sarah Peitzmeier, Krystal Mason, Darrin Adams, Jennifer Wilburn, Ben Liestman, Ju Park, Antonio Lee, Katie Rischer, Michelle Silver, …

Download ppt "Stefan Baral, MD MPH FRCPC"

Similar presentations

Ads by Google