Implementing Federal Recommendations for HIV Prevention Will Reduce New HIV Infections and HIV-Related Illness

Kathleen Irwin, MD, MPH, a medical epidemiologist at the Division of HIV/AIDS Prevention at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, provided an overview of the latest federal recommendations by the CDC on the prevention of HIV at IDWeek 2015, a joint meeting of the Infectious Diseases Society of America (IDSA), the Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS).

“As the first significant update of the federal guidelines since 2003, the latest evidence-based guidelines expand recommendations to clinical and nonclinical providers and health department staff members who provide population-level prevention and care services and stress the use of multidisciplinary teams and collaboration of clinical, nonclinical, and public health sectors to improve the quality and prevention and care services,” explained Irwin.

These new federal guidelines, titled Recommendations for HIV Prevention with Adults and Adolescents with HIV in the United States and published in December 2014, were prepared by the CDC and its partners, including the Health Resources and Services Administration, the National Institutes of Health, and five nongovernmental organizations, including the American Academy of HIV Medicine, the Association of Nurses in AIDS Care, the International Association of Providers of AIDS Care, the National Minority AIDS Council, and the Urban Coalition for HIV/AIDS Prevention Services.

Compared with the 2003 recommendations, the updated guidelines provide important updates in four key areas, including behavioral screening for possible HIV transmission, sexually transmitted disease screening and treatment, HIV partner services, and referral for medical and social services.

New guidelines were also provided on 7 topics, including the individual, social, structural, ethical, legal, and programmatic factors influencing HIV transmission and use of services; medical care linkage and retention; antiretroviral therapy (ART); reproductive healthcare for men and women; pregnancy-related services; and methods to monitor, evaluate, and improve quality of HIV prevention and care and programs for HIV-infected individuals.

For clinicians, key recommendations were updated on the importance of informing all persons with HIV about the benefits of early ART to improve health and to reduce transmission and the importance of offering ART to all patients, regardless of CD4 count. Irwin also discussed the need to provide patients with appointment scheduling, insurance enrollment, and other proactive linkage assistance and explained how the guidelines provide ways of providing support care retention and increasing long-term ART adherence through patient monitoring, simplified treatment regimens, and advice on managing ART dosing, side effects, and costs.

Finally, she discussed how the updated guidelines can help clinicians by offering evidence-based risk-reduction interventions, reducing HIV transmission through routinely screening genital and extra-genital sites (including rectal and oropharyngeal) sites for sexually transmitted diseases (STDs); offering reproductive health counseling, family planning, special conception methods, and pregnancy services that reduce sexual and perinatal HIV transmission; and screening partners for HIV, STDs, and viral hepatitis.

“These expanded guidelines, based on the latest scientific evidence on biomedical, behavioral, and structural interventions, may help providers, health departments, and HIV planning groups to more effectively coordinate, consolidate, and align interventions and enhance the health of people with HIV, their families, and their communities,” she concluded.