Archived Events

• Please see archived presentations from Methods Core Seminars.

Drs. George Rutherford and Michael Reyes will lead the discussion

Table of Contents

1. Table of Contents ……………………………………………………………………………………………………………….. 2

1. INTRODUCTION ……………………………………………………………………………………………………………………… 6

1.1 Purpose ……………………………………………………………………………………………………………………… 6

1.2 The global HIV prevention context ………………………………………………………………………………….. 6

1.3 PEPFAR’s strategy: combination prevention …………………………………………………………………….. 7

2. KNOW YOUR EPIDEMIC, CONTEXT, RESPONSE, AND COSTS ………………………………………………………. 7

2.1 The Four “Knows” …………………………………………………………………………………………………………. 7

2.2 Using computer modeling to estimate population-level effects of HIV prevention activities … 11

3. HIV PREVENTION AS PART OF THE COUNTRY CONTINUUM OF RESPONSE ………………………………… 12

3.1 Supporting the country continuum of response………………………………………………………………. 12

3.2 Overarching principles of PEPFAR prevention programming …………………………………………….. 14

4. EVIDENCE AND IMPLEMENTATION GUIDANCE ON SPECIFIC INTERVENTIONS ……………………………. 15

4.1 Levels of evidence for elements of combination prevention …………………………………………….. 15

4.2 Biomedical interventions for prevention of sexual transmission ……………………………………….. 16

4.2.1 Male and female condoms ……………………………………………………………………………………. 16

4.2.2 Voluntary medical male circumcision (VMMC)…………………………………………………………. 19

4.2.3 HIV testing and counseling (HTC) ……………………………………………………………………………. 21

4.2.4 Diagnosis and treatment of sexually transmitted infections (STIs) ……………………………… 24

4.2.5 Antiretroviral drug (ARV)-based prevention …………………………………………………………….. 26

4.3 Behavioral interventions for prevention of sexual transmission ………………………………………… 30

4.3.1 Standalone behavioral interventions to minimize sexual risk or increase protection ………….. 30

4.3.2 Supportive behavioral interventions to optimize biomedical prevention …………………………… 35

4.4 Structural supports for sexual prevention ………………………………………………………………………. 36

4.4.1 Legal and policy reform ……………………………………………………………………………………………….. 36

4.5 Prevention packages for specific populations …………………………………………………………………. 39

4.5.1 Comprehensive package for most-at-risk populations (MARPs) ……………………………………….. 39

4.5.2 Positive Health, Dignity and Prevention (PHDP): Prevention for people living with HIV ………. 40

4.5.3 Prevention interventions for young people ……………………………………………………………………. 42

5. ASSEMBLING A PORTFOLIO OF INTERVENTIONS …………………………………………………………………….. 45

5.1 Categories of activities …………………………………………………………………………………………………. 46

5.2 Prioritizing and assembling the portfolio: defining the continuum of response by population and geography …………………………………………………………………………………………………………………….. 49

Table 1: Examples of how to apply prevention priorities across different epidemic-types.Appendix: HIV prevention and the Global Health Initiative (GHI): connecting to the broader country continuum of response …………………………………………………………………………………………………………………………………. 51

1.1 Purpose

The purpose of this guidance is to assist PEPFAR country teams in developing Country Operational Plans (COPs) that align activities to prevent sexual transmission of HIV with country-specific epidemiology and country-owned responses, and that support the continuum of response at the country level. This guidance seeks to aid teams in identifying and implementing the optimal combination of prevention activities needed to maximize reduction of new infections as part of the continuum of country HIV response, while reflecting the following key principles:

• · Identifying and addressing gaps in scope and reach of prevention activities among priority populations
• · Ensuring that interventions address populations and communities in such a way that the level of investment matches the level of risk
• · Using resources so that they have maximum impact on HIV incidence
• · Prioritizing the most effective biomedical, behavioral, and structural interventions in the country context
• · Enhancing coordination across prevention, care, and treatment activities. 

9:30 – 11:00 AM

50 Beale/13th fl/McKusick Conference Rm.

Presenter:  David G Ostrow, MD, PhD  

David Ostrow received his SB, PhD and MD from the University of Chicago and has since been a leader in issues of gay men’s health.  In 1974, Ostrow co-founded the Howard Brown Health Center, the first and one of the largest LGBT health centers in the US. At his suggestion, NIH started the Multicenter AIDS Cohort Study (MACS), the longest-running HIV/AIDS natural (now the treated) history study. Ostrow has focused on the behavioral, mental health & substance use aspects of HIV among gay/bisexual men, publishing more than 200 scientific papers and 12 books, many with Ron Stall of CAPS.

Dr. Ostrow retired from practicing addiction psychiatry in 2004 to focus on researching the links between drug use and HIV infection and national drug policy reform. In June, 2007, he founded the Medical Marijuana Policy Advocacy Project (MMPAP) to educate healthcare providers regarding the protection of medicinal cannabis (MC) patients from federal prosecution; and expanded MC research. In 2008, he joined the research staff of the Ogburn-Stouffer Center for Social Organizational Research at NORC at the U of Chicago, where he leads a multi-disciplinary longitudinal study of “Social Network Dynamics, HIV and Evolving Risk Reduction Strategies of Young Black MSM.” He is also a co-founder and V.P. for Community Based Research of the American Academy of Cannabinoid Medicine (AACM, see www.AACMsite.org)

12:00 – 1:00 PM

50 Beale Street/13^th floor/McKusick Conference Room

Presenter:  Mark L. Hatzenbuehler, PhD

In the current talk, Dr. Hatzenbuehler will present data from five recent studies examining the deleterious effect of structural stigma on the mental health of LGB populations, with a particular focus on social policies (e.g., constitutional amendments banning same-sex marriage, anti-bullying policies).  He will discuss the implications of this research for the development of social policy initiatives and evidence-based public health interventions that may reduce mental health disparities among LGB populations.

Mark L. Hatzenbuehler, PhD, is a Robert Wood Johnson Foundation Health & Society Scholar at Columbia University in New York City. He completed his doctoral degree in clinical psychology at Yale University.  Mark’s research examines how structural forms of stigma increase risk for adverse mental health outcomes among members of socially disadvantaged populations, including LGB individuals. His research has been published in several leading journals, including the American Journal of Public Health, Psychological Bulletin, and Pediatrics. Mark’s research has received multiple awards from the American Public Health Association and the American Psychological Association and has been cited in court cases on sexual orientation-related discrimination, including Perry vs. Schwarzenegger.

Wednesday, January 18th, 2012 — 12:00 – 1:00 PM

50 Beale/13th floor/McKusick Conference Room

 

Dr. Caceres will draw upon his recent work in the Aids2031 collaboration and with the UNAIDS Prevention Unit in Geneva to assess the nature and characteristics of structural approaches to HIV prevention, and discuss the role they may play in a comprehensive response to HIV based on a combination prevention framework.  Dr. Caceres will present key elements of the literature published so far on structural interventions, and discuss how they can be better integrated into present prevention approaches.

Carlos F. Cáceres, MD, PhD, is a Professor of Public Health at Cayetano Heredia University in Lima, and Director of the Institute of Studies in Health, Sexuality and Human Development. After a summer at the CAPS International Program in 1989, Dr Caceres came back to UC Berkeley where he got master and doctoral degrees in Epidemiology. He was co-PI of the Peru Site of the NIMH Collaborative Intervention Trial, which involved UCSF, and became adjunct faculty of this university in 2000. At present he is co-PI of a R34 grant led by Dr. Kegeles in Lima. Dr. Caceres is a member of the Global HIV Prevention Workgroup and of the Governing Council of the International AIDS Society. He is the Past-Chair of the International Association for the Study of Sexuality, Culture and Society. He also serves in the international advisory boards of several journals and often collaborates with various UN agencies.

50 Beale Street, 12th floor, Corner Conference Room

12:00 – 1:00 PM

Presenter: Z. Mike Chirenje, MD

 Zvavahera Mike Chirenje, MD, is a Professor in the Department of Obstetrics and Gynecology at the College of Health Sciences at the University of Zimbabwe (UZ), and is Executive Director of the UZ-UCSF Collaborative Research Program in Harare, Zimbabwe, where he also serves as Principal Investigator of the NIH-funded Clinical Trials Unit (CTU), providing leadership that promotes high quality research for the four affiliated HIV/AIDS networks of ACTG, HPTN, IMPAACT, and MTN.  He is also protocol co-chair for MTN 003 (VOICE), a phase IIB safety and effectiveness study testing oral and vaginal formulations of Tenofovir for HIV prevention in women.

Summary of presentation:

Dr. Chirenje will discuss recent Data Safety Monitoring Board recommendations, which resulted in the closure of the oral and vaginal tenofovir arms of the VOICE trial, and the potential implications this has on PrEP and microbicide research agendas.  He will also briefly discuss the current debate on HIV risk acquisition and hormonal contraceptive use.

For questions, please contact Jared Kitagawa at (415) 597-4991, or at KitagawaJ@globalhealth.ucsf.edu.

If you plan to attend, but are based outside of the Beale Street offices, please contact Jared Kitagawa (above) to have your name added to the guest list in the building lobby.

1:00 – 2:00pm

 50 Beale Street, 12^th Floor, Rodnick Conference Room

 

Presenters: Katerina Christopoulos, MD, MPH/Kim Koester, MA              

Katerina Christopoulos and Kim Koester, on behalf of a multidisciplinary CAPS study team, will discuss the findings of a qualitative evaluation of HIV testing in three local emergency departments using data from staff and patient participants.

Katerina Christopoulos, MD, MPH, is Assistant Adjunct Professor in the HIV/AIDS Division at San Francisco General Hospital and a clinician in the Ward 86 Positive Health Program. She is the recipient of a K23 Mentored Career Development Award from the National Institutes of Health. Her research uses qualitative and quantitative approaches to investigate issues in linkage and retention in HIV care. She is currently conducting a qualitative study of patients diagnosed with HIV in the emergency department and a methodological assessment of which retention measures best predict clinical outcomes.

Kimberly Koester, MA, is the Director of Qualitative Research in the AIDS Policy Research Center at the Center for AIDS Prevention Studies, UCSF. Ms. Koester is a cultural anthropologist and has worked in the field of HIV prevention for over ten years.  She is particularly interested in and has extensive experience conducting qualitative studies with vulnerable populations including people living with HIV, gay and bi-sexual men, injection drug users and sex workers. Ms. Koester serves as a co-investigator on multiple projects within the Center for AIDS Prevention Studies including HIV/AIDS policy research at the state-level and HIV-related research and evaluation at the local and national level.

 12:00 – 1:00 p.m.

50 Beale Street/13^th floor/McKusick Conference Room

 

Presenter:   Mi-Suk Kang Dufour, PhD

It is widely recognized that poverty is a driver of adverse health.  Thus, programs that address economic status as a means to improve health and wellbeing have garnered increasing attention in recent years.  These interventions, sometimes referred to as “livelihoods opportunities” interventions, encompass a range of strategies to improve economic status and earning potential.  Research has demonstrated positive impacts of economic interventions on reproductive outcomes, the health and wellbeing of children and reductions in violence.   However, not all findings from these interventions are positive.  There is also a lack of rigorous evaluation of the health outcomes for many economically based interventions.  Populations suffering social and economic disadvantage are often populations also suffering from increased mental health morbidity.  Mental health issues such as depression, anxiety and lack of hope for the future may prevent these populations from participating fully in interventions and may reduce intervention effectiveness, unless mental health care is incorporated into the interventions.  Conversely, it may be that opportunities made available through intervention programs can create a sense of hope and self efficacy and, thus, lead to improvement in mental health status overall.

This presentation uses the Shaping the Health of Adolescents in Zimbabwe (SHAZ!) project as a case study of the role mental health plays in intervention participation and the impact of economic livelihoods interventions on mental health.  These longitudinal data were explored using causal inference based methods to estimate average treatment effects for each component of the intervention on mental health status and for each measure of mental health status over time on intervention completion.

Applying novel methods to intervention evaluations allows a more nuanced understanding of multi-component interventions.  Results from this project suggest that incorporating mental health support, particularly at baseline may have important benefits in terms of intervention impacts in disadvantaged populations.

Mi-Suk Kang Dufour is a Statistician at CAPS.  She received her PhD in Epidemiology from the University of California Berkeley this spring.

12:00 – 1:00 P.M.

50 Beale/13^th fl/McKusick Conf. Rm.

David Vlahov, PhD, RN, an experienced epidemiologist who specializes in working with community partners to improve urban health, joined the UCSF leadership team as the first male dean of the School of Nursing. Vlahov comes to UCSF with a successful track record as an expert in epidemiology, infectious diseases, substance abuse, and mental health. He has served as the senior vice president of research and director of the Center for Urban Epidemiologic Studies at the New York Academy of Medicine, as a professor of clinical epidemiology at the Mailman School of Public Health, and as adjunct professor in epidemiology at the John Hopkins Bloomberg School of Public Health. Vlahov also brings a unique global perspective as founder of the International Society for Urban Health, serving as its first president, and works with the World Health Organization’s Urban Health Center in Kobe, Japan.

12:00 – 1:00 pm

50 Beale/13th floor/McKusick Conference Rm.