Table 2.
Description, Effectiveness, and Scale-up Implementation Scenarios for the Evidence-Based HIV Prevention Programs and Care Interventions Included in Analysis
| Intervention | Supporting Evidence | Description and Effectivenessb | Scale-up Implementation Scenariose | |||
|---|---|---|---|---|---|---|
| Source, Evidence Levela | Study Design | Study Setting | Optimistic, % | Ideal, %c | ||
| HIV prevention programs | ||||||
| SSP | Aspinall et al 2014 [11], 2a | Meta-analysis | SSP | Clean injection equipment reduces the risk of parenteral HIV transmission by 58% | 200 syringes/PWID/yearf | 90 |
| MOUD with buprenorphine | MacArthur et al 2012 [37], 2a | Meta-analysis | Primary care and OTP | Office-based MOUD reduces the number of shared injections by 54% for PWID with OUDd | 29g | 90h |
| MOUD with methadone | MacArthur et al 2012 [37], 2a | Meta-analysis | Primary care and OTP | Opioid treatment program-based MOUD reduces the number of shared injections by 54% for PWID with OUDd | Additional scale-up of 17 | 90h |
| Full-time PrEP | Liu et al 2016 [27], 1b | RCT substudy and cohort study | Primary care | Protective level adherence to PrEP (≥4 doses/week) reduces the risk of HIV infection by 60%i | 50 | 90 |
| HIV testing | ||||||
| EMR testing offer reminder | Felsen et al 2017 [28], 2b | Pre/post | Hospital | HIV testing increases by 178% among PWID visiting the ER | 13–35 | 14–36d |
| Nurse-initiated rapid testing | Anaya et al 2008 [29], 2b | RCT | Primary care | Nurse-initiated screening and rapid testing increases HIV testing by 73% during health care visits | 34–52 | 56–87 |
| MOUD integrated rapid testing | Metsch et al 2012 [30], 1b | RCT | DTP | On-site rapid testing increases HIV testing by 352% among PWID receiving MOUD | 22 | 49 |
| ART engagement | ||||||
| Case management (ARTAS) | Gardner et al 2005 [31] 1b | RCT | HIV clinics | Contacts with a case manager increases ART initiation by 41% among PLHIV linked to care | 61 | 77 |
| Care coordination | Robertson et al 2018 [32], 2b | Pre/postj | HIV clinics | Comprehensive care coordination increases ART retention by 10% among PLHIV | 12–25 | 34–68 |
| Targeted care coordination | Robertson et al 2018 [32], 2b | Pre/postj | HIV clinics | Targeted comprehensive care coordination increases ART retention by 32% among PLHIV with CD4 < 200 cells/µL | 41–48 | 57–66 |
| EMR ART engagement reminder | Robbins et al 2012 [33], 1b | RCT | HIV clinics | Interactive EMR alerts reduces ART drop-out by 31% among PLHIV on ART | 47–84 | 60–91d |
| RAPID ART initiation | Pilcher et al 2017 [34], 3b | Cohort study | HIV clinics | Multidisciplinary care and support increases immediate ART initiation by 32% among newly diagnosed PLHIV | 38–71 | 47–90 |
| ART reengagement | ||||||
| Enhanced personal contact | Gardner et al 2014 [35], 1b | RCT | HIV clinics | Continuous contact increases ART reinitiation by 22% among PLHIV having dropped out of ART | 49 | 62 |
| Relinkage program | Bove et al 2015 [36], 2b | Cohort study | HIV clinics | Outreach using surveillance data increases ART reinitiation by 70% among PLHIV who are out of care | 10 | 22 |
Abbreviations: ARTAS, Antiretroviral Treatment Access Study; DTP, drug treatment program; EMR, electronic medical records; ER, hospital emergency room; MOUD, medication for OUD; OTP, opiate treatment program; OUD, opioid use disorder; PLHIV, people living with HIV; PrEP, preexposure prophylaxis; Pre/post, Prospective, quasi-experimental pre/post study; PWID, people who inject drugs; RAPID: rapid ART program for individuals with an HIV diagnosis; RCT, randomized control trial; SSP, syringe service program; WHO, World Health Organization.
aLevels 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.
bInterventions target the PWID adult population aged 15–64 years including men who have sex with men who inject drugs.
cIdeal implementation refers to 90% adoption unless otherwise noted by d which refers to 100% adoption of EMR.
dMOUD also reduces the risk of mortality, increases quality of life, and decreases the probability of ART discontinuation.
eWhere applicable, scale-up ranges indicate evidence stratified by sex/gender and/or race/ethnicity and/or city/region.
fAs recommended by WHO [38], except Seattle (400 syringes/PWID/year) because status quo service levels were already equivalent to this level.
gAs recommended by WHO [38], 40% coverage among the 72.7% of PWID with an OUD [23] results in 29% coverage among all PWID.
hMaximum 90% coverage of both medications combined among the 72.7% of PWID with an OUD [23].
iEffectiveness defined as efficacy for 4 doses/week (96%; 95% confidence interval, 90%–99%) × protective level adherence (62.5%; associated with taking ≥ 4 doses/week), further details in Supplementary Materials.
jStudy with contemporaneous surveillance registry-based comparison group.