Dataset Information

Impact of early antiretroviral treatment on sexual behaviour: a randomised comparison.

ABSTRACT: BACKGROUND:Antiretroviral treatment (ART) reduces HIV infectiousness but the effect of early ART on sexual behaviour is unclear. METHODS:We assessed, within the START randomized trial that enrolled HIV-positive adults with CD4 cell count greater than 500?cells/?l, the effect of early (immediate) versus deferred ART on: condomless sex with HIV-serodifferent partners (CLS-D); all condomless sex (CLS); HIV transmission-risk sex (CLS-D-HIV risk, defined as CLS-D and: not on ART or started ART <6 months ago or viral load greater than 200 copies/ml or no viral load in past 6 months), during 2-year follow-up. Month-12 CLS-D (2010-2014) was the primary outcome. RESULTS:Among 2562 MSM, there was no difference between immediate and deferred arms in CLS-D at month 12 [12.6 versus 13.1%; difference (95% CI): -0.4% (-3.1 to 2.2%), P?=?0.75] or month 24, or in CLS. Among 2010 heterosexual men and women, CLS-D at month 12 tended to be higher in the immediate versus deferred arm [10.8 versus 8.3%; difference:2.5% (-0.1 to 5.2%), P?=?0.062]; the difference was greater at month 24 [9.3 versus 5.6%; difference: 3.7% (1.0 to 6.4%), P?=?0.007], at which time CLS was higher in the immediate arm (20.7 versus 15.7%, P?=?0.013). CLS-D-HIV risk at month 12 was substantially lower in the immediate versus deferred arm for MSM [0.2 versus 11%; difference: -10.7% (-12.5 to -8.9%), P?

SUBMITTER: Lampe FC

PROVIDER: S-EPMC6882545 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Impact of early antiretroviral treatment on sexual behaviour: a randomised comparison.

Lampe Fiona C FC Rodger Alison J AJ Burman William W Grulich Andrew A Friedland Gerald G Sadr Wafaa El WE Neaton James J Corbelli Giulio M GM Emery Sean S Molina Jean Michel JM Orkin Chloe C Gatell Jose J Gerstoft Jan J Ruxrungtham Kiat K Barbosa de Souza Monica M Phillips Andrew N AN

AIDS (London, England) 20191201 15

<h4>Background</h4>Antiretroviral treatment (ART) reduces HIV infectiousness but the effect of early ART on sexual behaviour is unclear.<h4>Methods</h4>We assessed, within the START randomized trial that enrolled HIV-positive adults with CD4 cell count greater than 500 cells/μl, the effect of early (immediate) versus deferred ART on: condomless sex with HIV-serodifferent partners (CLS-D); all condomless sex (CLS); HIV transmission-risk sex (CLS-D-HIV risk, defined as CLS-D and: not on ART or sta ...[more]

PMID: 31764099

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Project description:ObjectiveTo assess the impact of Stepping Stones, a HIV prevention programme, on incidence of HIV and herpes simplex type 2 (HSV-2) and sexual behaviour.DesignCluster randomised controlled trial.Setting70 villages (clusters) in the Eastern Cape province of South Africa.Participants1360 men and 1416 women aged 15-26 years, who were mostly attending schools.InterventionStepping Stones, a 50 hour programme, aims to improve sexual health by using participatory learning approaches to build knowledge, risk awareness, and communication skills and to stimulate critical reflection. Villages were randomised to receive either this or a three hour intervention on HIV and safer sex. Interviewers administered questionnaires at baseline and 12 and 24 months and blood was tested for HIV and HSV-2.Main outcome measuresPrimary outcome measureincidence of HIV. Other outcomes: incidence of HSV-2, unwanted pregnancy, reported sexual practices, depression, and substance misuse.ResultsThere was no evidence that Stepping Stones lowered the incidence of HIV (adjusted incidence rate ratio 0.95, 95% confidence interval 0.67 to 1.35). The programme was associated with a reduction of about 33% in the incidence of HSV-2 (0.67, 0.46 to 0.97; P=0.036)-that is, Stepping Stones reduced the number of new HSV-2 infections over a two year period by 34.9 (1.6 to 68.2) per 1000 people exposed. Stepping Stones significantly improved a number of reported risk behaviours in men, with a lower proportion of men reporting perpetration of intimate partner violence across two years of follow-up and less transactional sex and problem drinking at 12 months. In women desired behaviour changes were not reported and those in the Stepping Stones programme reported more transactional sex at 12 months.ConclusionStepping Stones did not reduce incidence of HIV but had an impact on several risk factors for HIV-notably, HSV-2 and perpetration of intimate partner violence.Trial registrationClinical Trials NCT00332878.

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Dataset Information

Impact of early antiretroviral treatment on sexual behaviour: a randomised comparison.

Publications

Impact of early antiretroviral treatment on sexual behaviour: a randomised comparison.

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