Table 1.
HIV prevention programs and care interventions selected for inclusion in our analysis.
| Intervention | Description | Source | Effectiveness (95% CI) | Study Setting | Target Population | Study Design | Study Size | Study Location | Evidence Level* |
|---|---|---|---|---|---|---|---|---|---|
| HIV prevention programs | |||||||||
| Syringe service program (SSP) | Reduced risk of HIV infection with increased access to clean injection equipment. | Aspinall et al. 2014 Int J Epi | 0.42 (0.22, 0.81) | SSP | PWID | Meta-analysis | n = 6 | USA: 3; Other: 3 | 2a |
| Expanded access to medication for opioid use disorder (MOUD) | Reduced risk of HIV infection with decreased number of injections. | MacArthur et al. 2012 BMJ | 0.46 (0.32, 0.67) | Primary Care & OTP | PWID | Meta-analysis | n = 9 | USA: 4; Other: 5 | 2a |
| Expanded access to full-time pre-exposure prophylaxis (PrEP) | Reduced risk of HIV infection associated with protective level adherence (≥4 doses/week). | Liu 2016 JAMA Intern Med | 0.60 (0.56, 0.62)⍑ | Primary Care | High-risk MSM | Cohort study (DEMO) | n = 557 | MIA; SF; DC | 1b |
| HIV Testing | |||||||||
| Opt-out testing | Conduct a routine rapid HIV test unless explicitly declined. | Montoya et al. 2016 The BMJ | 1.28 (1.24, 1.31) | Hospital | General | RCT | n = 4,800 | SF General Hospital | 1b |
| EMR testing offer reminder | Integrate the routine offering of testing to patients with no EMR record of HIV test or at high-risk. | Felsen et al. 2017 JAIDS | 2.78 (2.62, 2.96) | Hospital | General | Quasi-exp. pre/post | n = 55,553 | Bronx, NY | 2b |
| Nurse-initiated rapid testing | Increase testing with nurse-initiated screening and rapid HIV testing. | Anaya et al. 2008 J Gen Intern Med | 5.27 (3.11, 8.90) | Primary Care | General | RCT | n = 251 | V.A. Healthcare System | 2b |
| Integrated rapid testing | Increase testing with on-site rapid HIV testing in drug treatment centers. | Metsch et al. 2012 Am J Pub H | 4.52 (3.57, 5.72) | DTP | PWID | RCT (CTN 0032) | n = 1,281 | 12 US communities | 1b |
| ART engagement | |||||||||
| Individual case management for ART initiation | Increase ART initiation with up to five contacts with a case manager over a 90-day period. | Gardner et al. 2005 AIDS | 1.41 (1.10, 1.60) | HIV clinics | General | RCT (ARTAS) | n = 316 | ATL; BAL; LA; MIA | 1b |
| Individual care coordination for ART retention | Increase ART retention with comprehensive care coordination program. | Robertson et al. 2018 Am J Epi | 1.10 (1.07, 1.13) | HIV clinics | General | Pre/post^ | n = 6,812 | New York City | 2b |
| EMR alert of suboptimal ART engagement | Decrease ART drop-out with interactive alerts providing clinical information and mechanism for follow-up appointments and tests. | Robbins et al. 2012 Ann Int Med | 0.69 (0.53, 0.90) | HIV clinics | General | RCT (FastTrack) | n = 1,011 | Massachusetts General Hospital | 1b |
| RAPID ART initiation | Immediate ART initiation with multicomponent intervention for recent or late diagnoses. | Pilcher et al. 2017 JAIDS | 1.32 (1.23, 1.54)** | HIV clinics | General | Cohort study | n = 86 | SF General Hospital | 3b |
| ART re-engagement | |||||||||
| Enhanced personal contact | Increase ART re-initiation with face-to-face meeting and continuous contact over the year. | Gardner et al. 2014 Clin Infect Dis | 1.22 (1.09, 1.36) | HIV clinics | General | RCT | n = 1,838 | 6 US cities | 1b |
| Re-linkage program | Increase ART re-initiation with outreach intervention using clinical and surveillance data. | Bove et al. 2015 JAIDS | 1.70 (1.20, 2.30) | HIV clinics | General | Cohort study | n = 753 | Seattle, WA | 2b |
PWID: Pepople who inject drugs; MSM: Men who have sex with men; PrEP: Pre-exposure prophylaxis; EMR: Electronic medical records; V.A.: US Department of Veteran’s Affairs;
RAPID: Rapid ART Program for Individuals with an HIV Diagnosis; ATL: Atlanta; BAL: Baltimore; LA: Los Angeles; MIA: Miami; SF: San Francisco, WA: Washington State; DC: Washington, D.C.
Levels of evidence adapted from Oxford Centre for Evidence-based Medicine – Levels of Evidence: 1a - Systematic review of RCTs; 1b - Individual high-quality RCT; 2a - Systematic review of cohort studies; 2b - Individual cohort study or quasi-experimental study; 3a - Systematic review of case-control studies; 3b - Individual case-control study; 4 - Case series; 5-Expert opinion.
Effectiveness defined as efficacy for 4 doses/week [96% (90%, 99%); Anderson 2012 Sci Transl Med] X protective level adherence [62.5% (associated with taking ≥4 doses/week); Liu 2016 JAMA Int Med]
Study with contemporaneous surveillance registry–based comparison group
Range does not represent the 95% confidence interval (CI); derivation of range values are detailed in the supplement.