High-Impact Prevention

Current prevention strategies are drastically reducing the number of annual HIV infections. However, continued growth in the population living with HIV—now estimated at 1.2 million1—will lead to increased opportunities for transmission of the virus if prevention efforts are not intensified. This is of particular concern in communities that already bear a disproportionate burden of HIV/AIDS.

To address these critical disparities, HRSA strongly supports the increased prevention efforts targeting geographic areas hardest hit by HIV/AIDS and populations at greatest risk of infection—an approach known as high-impact prevention. Several high-impact prevention efforts are underway in Ryan White HIV/AIDS Program communities nationwide.

“Test and Treat,” (PDF – 581 KB) for example, relies on HIV treatment as prevention. This approach calls for widespread HIV testing and for those found to be HIV positive, the swift linkage to care for immediate and lifelong antiretroviral therapy (ART). HIV-positive patients on ART are far less infectious because medication sharply suppresses the amount of HIV in the body;2 in fact, recent data has demonstrated that the use of ART in HIV-infected people can reduce the risk of HIV transmission by as much as 96 percent.3 To date, HRSA’s AIDS Education and Training Centers (AETCs) have reached more than 50,000 providers through their trainings to expand HIV testing and counseling in medical care settings, resulting in hundreds of sites implementing routine HIV testing. In addition, as new advancements are made, the AETCs work with Ryan White HIV/AIDS Program providers to ensure they are up to date on best practices and guidelines.

Linking people who test positive to care and treatment and ensuring their continued engagement in care remains a systemic challenge that can potentially undermine the effectiveness of Test and Treat. HRSA’s HIV/AIDS Bureau is tackling this challenge through the continued funding of the Special Projects of National Significance (SPNS) System Linkages and Access to Care for Populations at High Risk of HIV Infection Initiative to improve linkages to testing and treatment on a statewide scale. In addition, the HRSA-funded National Quality Center’s in+care Campaign has focused on retaining patients in care and bringing back those who have left HIV medical care.

LaPHIE (Louisiana Public Health Information Exchange) is an innovative partnership between Louisiana State University (LSU) and the Louisiana Office of Public Health. LaPHIE brings public health data to the hospital’s electronic medical records to identify and create alerts for providers when out-of-care patients present for care in the LSU hospital network. A study on the program found that 75 percent of these patients returned to HIV medical care.4,5 (To learn more about LaPHIE and other innovative programs, watch these Webinars on engaging hard-to-reach populations.)

While no single prevention method will bring an end to the HIV epidemic, new interventions like Test and Treat when combined with proven behavior-based prevention measures such as condoms and clean needle use, have tremendous promise in significantly curbing the spread of the disease. New innovations still on the horizon, like microbicides, may one day soon offer an even greater range of prevention measures. HRSA will continue its HIV prevention activities as an active partner in the 2010 National HIV/AIDS Strategy and the 2013 Executive Order on the HIV Care Continuum Initiative.6,7