Funding Source and Period: NIAID, 2009-2013

Key HIV Center Personnel:

Principal Investigator: Wafaa El-Sadr, M.D., M.P.H. (ICAP Director and HIV Center Associate Director)

Co-Investigators: Robert Remien, Ph.D., and Joanne Mantell, Ph.D.

Project Overview

(from abstract)

HIV prevention scientists have long recognized that it is imperative to integrate behavioral and biomedical approaches to HIV prevention and care, but have often been impeded by disciplinary boundaries, disparate funding streams, and institutional barriers. Yet behavioral interventions are incomplete if they fail to incorporate the expanding array of biomedical advances, and without a focus on the behavioral, even the most advanced biomedical approaches are unlikely to reach their full potential.

With such concerns in mind, preparations are underway for a major new study to evaluate an intervention package for preventing HIV transmission within heterosexual couples using both behavioral and biomedical approaches. Led by the International Center for AIDS Care and Treatment Program (ICAP) at the Columbia University Mailman School of Public Health, this study brings together researchers from ICAP and the HIV Center.

With funding from the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Mental Health (NIMH), the Enhanced Prevention in Couples (EPIC) Study is being conducted in Lesotho. An estimated one-quarter of adults in this small southern African country are HIV infected, and the country has the third highest HIV seroprevalence rate in the world. Transmission within heterosexual couples is a major contributor to the spread of the disease.

The EPIC Study will be conducting a series of feasibility studies to inform the development of an “Enhanced Prevention Package” among HIV-serodiscordant couples, i.e., those in which one partner is HIV-infected and the other is not. The Enhanced Prevention Package breaks new ground by including three major components that integrate biomedical and behavioral approaches.

The first component of the intervention package will be the offering of antiretroviral therapy (ART) to HIV-positive partners with CD4 cell counts below 500, which is at a higher CD4 count than is currently the standard of care in Lesotho. This part of the intervention will offer health benefits to the HIV-positive partners while also potentially lowering their infectiousness to the uninfected partners.

Second, the study will include couple-focused counseling for decreasing sexual risk behavior and enhancing adherence to HIV treatment and care.

The third core component of the intervention package will be the offering of male circumcision to HIV-negative men who have an HIV-positive partner. There are known benefits of male circumcision in preventing HIV acquisition. The couple would need to be counseled about how circumcision may affect their sexual life, including the timing of resuming sexual behavior post-circumcision.

The research team will determine the feasibility and acceptability of these intervention components while also modeling the potential effects of the enhanced package to prevent HIV transmission in Lesotho and similar settings.

 

To read more about this study in the HIV Center E-newsletter, click here.