naa a22 4500 510735584 CHVBK 20180411083008.0 cr unu---uuuuu 180411e20130601xx s 000 0 eng 10.1007/s11904-013-0155-y doi (NATIONALLICENCE)springer-10.1007/s11904-013-0155-y Combination Prevention: New Hope for Stopping the Epidemic [Elektronische Daten] [Sten Vermund, Richard Hayes] HIV research has identified approaches that can be combined to be more effective in transmission reduction than any 1 modality alone: delayed adolescent sexual debut, mutual monogamy or sexual partner reduction, correct and consistent condom use, pre-exposure prophylaxis with oral antiretroviral drugs or vaginal microbicides, voluntary medical male circumcision, antiretroviral therapy (ART) for prevention (including prevention of mother to child HIV transmission [PMTCT]), treatment of sexually transmitted infections, use of clean needles for all injections, blood screening prior to donation, a future HIV prime/boost vaccine, and the female condom. The extent to which evidence-based modalities can be combined to prevent substantial HIV transmission is largely unknown, but combination approaches that are truly implementable in field conditions are likely to be far more effective than single interventions alone. Analogous to PMTCT, "treatment as prevention” for adult-to-adult transmission reduction includes expanded HIV testing, linkage to care, antiretroviral coverage, retention in care, adherence to therapy, and management of key co-morbidities such as depression and substance use. With successful viral suppression, persons with HIV are far less infectious to others, as we see in the fields of sexually transmitted infection control and mycobacterial disease control (tuberculosis and leprosy). Combination approaches are complex, may involve high program costs, and require substantial global commitments. We present a rationale for such investments and cite an ongoing research agenda that seeks to determine how feasible and cost-effective a combination prevention approach would be in a variety of epidemic contexts, notably that in a sub-Saharan Africa. The Author(s), 2013 HIV nationallicence Prevention nationallicence Combination approaches nationallicence Treatment as prevention nationallicence Africa nationallicence Circumcision nationallicence Behavior change nationallicence Global epidemic nationallicence HIV transmission nationallicence Antiretroviral therapy (ART) nationallicence Prevention of mother to child HIV transmission (PMTCT) nationallicence Combination prevention nationallicence Vermund Sten Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt School of Medicine, 2525 West End Ave, Suite 750, 37203, Nashville, TN, USA aut Hayes Richard MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK aut Current HIV/AIDS Reports Current Science Inc. 10/2(2013-06-01), 169-186 1548-3568 10:2<169 2013 10 11904 https://doi.org/10.1007/s11904-013-0155-y text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11904-013-0155-y text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Vermund Sten Vanderbilt Institute for Global Health and Department of Pediatrics, Vanderbilt School of Medicine, 2525 West End Ave, Suite 750, 37203, Nashville, TN, USA aut NATIONALLICENCE 700 1- Hayes Richard MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, Keppel Street, WC1E 7HT, London, UK aut NATIONALLICENCE 773 0- Current HIV/AIDS Reports Current Science Inc 10/2(2013-06-01), 169-186 1548-3568 10:2<169 2013 10 11904 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer