Advancing considerations of context in the evaluation and implementation of evidence-based biomedical HIV prevention interventions: a review of recent research.

IF 4.5 3区 医学 Q2 IMMUNOLOGY Current Opinion in HIV and AIDS Pub Date : 2023-01-01 Epub Date: 2022-11-07 DOI:10.1097/COH.0000000000000768
Jennifer Velloza, Stephanie Roche, Tessa Concepcion, Katrina F Ortblad
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引用次数: 1

Abstract

Purpose of review: A paradigm shift is needed in how we think about biomedical HIV prevention product effectiveness. Often, we expect randomized trial findings to be generalizable across populations and settings where products will be delivered, without consideration of key contextual drivers that could impact effectiveness. Moreover, researchers and policy-makers generally discount products with varied effect sizes across contexts, rather than explicating the drivers of these differences and using them to inform equitable product choice and delivery. We conducted a review of the recent HIV prevention research to advance considerations of context in choices of when, why, and how to implement biomedical HIV prevention products, with a particular focus on daily oral preexposure prophylaxis (PrEP) and the dapivirine vaginal ring (DPV).

Recent findings: Findings across recent studies of PrEP and DPV emphasize that products that do not work well in one context might be highly desirable in another. Key contextual drivers of PrEP and DPV effectiveness, use, and implementation include population, health system, cultural, and historical factors. We recommend conceptualization, measurement, and analysis approaches to fully understand the potential impact of context on prevention product delivery. Execution of these approaches has real-world implications for HIV prevention product choice and could prevent the field from dismissing biomedical HIV prevention products based on trial findings alone.

Summary: Ending the HIV epidemic will require tailored, person-centered, and equitable approaches to design, implement, and evaluate HIV prevention products which necessitates considerations of context in ongoing research and implementation.

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在评估和实施以证据为基础的生物医学艾滋病预防干预措施时推进对背景的考虑:近期研究综述。
审查目的:我们需要转变思考生物医学艾滋病预防产品有效性的模式。通常情况下,我们期望随机试验的结果能够在不同人群和不同环境中普遍适用,而不考虑可能影响有效性的关键环境因素。此外,研究人员和政策制定者通常对不同环境下效果大小不同的产品不予考虑,而不是解释这些差异的驱动因素,并利用它们为公平的产品选择和交付提供依据。我们对近期的艾滋病预防研究进行了回顾,以推动在选择何时、为何以及如何实施生物医学艾滋病预防产品时对环境因素的考虑,尤其关注每日口服暴露前预防药物(PrEP)和达匹韦林阴道环(DPV):最近对 PrEP 和 DPV 的研究结果表明,在某种情况下效果不佳的产品在另一种情况下可能非常受欢迎。影响 PrEP 和 DPV 的有效性、使用和实施的关键环境因素包括人口、卫生系统、文化和历史因素。我们建议采用概念化、测量和分析方法来充分了解环境对预防产品交付的潜在影响。这些方法的实施对艾滋病预防产品的选择具有现实意义,可防止该领域仅根据试验结果就否定生物医学艾滋病预防产品。
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来源期刊
Current Opinion in HIV and AIDS
Current Opinion in HIV and AIDS IMMUNOLOGY-INFECTIOUS DISEASES
CiteScore
7.40
自引率
7.30%
发文量
115
审稿时长
6-12 weeks
期刊介绍: Published bimonthly and offering a unique and wide ranging perspective on the key developments in the field, each issue of Current Opinion in HIV and AIDS features hand-picked review articles from our team of expert editors. With six disciplines published across the year – including HIV and ageing, a HIV vaccine, and epidemiology – every issue also contains annotated reference detailing the merits of the most important papers.
期刊最新文献
Recent data on the role of antiretroviral therapy in weight gain and obesity in persons living with HIV. Anticipating HIV viral escape - resistance to active and passive immunization. Accelerating HIV vaccine development through meaningful engagement of local scientists and communities. Guiding HIV-1 vaccine development with preclinical nonhuman primate research. Discovery medicine - the HVTN's iterative approach to developing an HIV-1 broadly neutralizing vaccine.
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