The following interventions are currently being developed or evaluated:
-
Microbicides. Most microbicide products are currently in preclinical development; however, 18 products are being evaluated in clinical research studies, most in small phase 1 safety and acceptability trials. Three phase 3 effectiveness trials are currently under way.
-
Diaphragms. The safety and effectiveness of the diaphragm and Replens gel in preventing HIV and STIs among women are being tested in an ongoing phase 3 randomized controlled trial in South Africa and Zimbabwe. Two trials, in the Dominican Republic and Madagascar, are planned to test the diaphragm's effectiveness against bacterial STIs. Several other trials in Sub-Saharan Africa are planned to test the acceptability and safety of the diaphragms plus microbicides.
-
Circumcision. Two randomized controlled trials are under way in Kenya and Uganda to examine whether circumcision confers protection among adult men.
-
Community-based VCT. Project Accept is a community-based VCT trial in 32 communities in South Africa, Tanzania, and Zimbabwe and 14 communities in Thailand. Communities are randomized to receive either a community-based VCT intervention or a standard clinic-based VCT. The community-based VCT intervention has three major strategies: to make VCT more available in community settings, to engage the community through outreach, and to provide posttest support.
-
HSV-2 treatment. One study in six countries will determine the efficacy of twice-daily acyclovir in reducing susceptibility to HIV infection among high-risk, HIV-negative, HSV-2 seropositive women and men who have sex with men. A companion study will also be conducted to assess whether acyclovir reduces HIV infectiousness in individuals infected with both HSV-2 and HIV.
-
Tenofovir for preexposure use. Studies are now enrolling participants at three West African sites and will soon begin in Botswana, Malawi, Thailand, and the United States.
-
Antiretroviral therapy to prevent sexual transmission. A phase 3, randomized, controlled, multisite trial to assess whether antiretroviral therapy can prevent sexual transmission of HIV in serodiscordant couples will begin in Brazil, India, Malawi, Thailand, and Zimbabwe.
-
Vaccines. Although preliminary results from a phase 3 clinical trial in Thailand found that AIDSVAX failed to protect against infection, several other vaccines are being developed. Merck and GlaxoSmithKline have unveiled sizable vaccine programs and moved products into human testing. An International AIDS Vaccine Initiative U.K.-Kenya team is in the midst of intermediate human trials of DNA/MVA (modified vaccinia virus Ankara), and Aventis Pasteur is taking ALVAC-AIDSVAX into the final phase of trials. The South African AIDS Vaccine Initiative is preparing for the country's first trials, India's prime minister has pledged national resources for vaccines, and the European Union is broadening its vaccine research for HIV.
-
Behavior change programs for people with HIV. In recent years, a growing number of public health experts have proposed implementing prevention interventions that target people with HIV (De Cock, Marum, and Mbori-Ngacha 2003; Janssen and others 2001), although evidence on the most effective strategies to encourage safer behavior among people with HIV is lacking.
Source: Authors.
