Table 2

Areas of HIV prevention research for prioritisation as identified by the matrix

Prevention Area

Research published 2006-9

Why Important?


Sero-sorting: identifying and understanding the undiagnosed population

4 secondary research

This population could have major implications as a source of new infections. We suggest research in the area of sero-sorting could help learn more about people within the undiagnosed population beyond the limits of current HPA unlinked anonymous surveillance, which may underestimate undiagnosed figures e.g. a recent community testing study in Scotland found 41.7% undiagnosed HIV[16]. Increasing testing facilities does not necessarily help someone recognise their need to test or overcome fears of testing.


International adaptation research

1 RCT 2 secondary research

More research here would be in the interests of shared learning and reduced duplication across many countries, not just USA and UK. Only One of three studies identified in this area points out that an HIV prevention intervention found to be effective in US cities might not be generalisable to different times and settings[17]. This area of research has great potential for the UK and the international community.


Law/ethics/policy

3 secondary research

The small number of studies found in this area was unexpected since a government white paper in 1998 attempted to update the Offences Against the Person Act 1861 and several prosecutions were successful in early 2000's. All the factors under this heading have potential to affect stigma and discrimination, barriers to testing and reluctance to disclose HIV status and are therefore potentially valuable areas for investigation.


Combination packages of interventions

3 RCTs 7 secondary research

If a person's reasons for being at risk are multi-faceted, interventions could be also. A recent article in the Lancet concludes: We now require an urgent and revitalised global movement for HIV prevention that supports a combination of behavioural, structural, and biomedical approaches and is based on scientifically derived evidence[3]. Potential to maximise impact through combining interventions was a reiterated message at the 2009 International Society for STD Research Conference; a sparsely researched area so far.


Social/population level factors

5 RCTs 5 other primary 11 secondary research

Recognition that social, economic, political, and environmental factors directly affect HIV risk and vulnerability has stimulated interest in structural approaches to HIV prevention[3,30]. Further investigation of factors such as stigma, discrimination and poverty could add valuable new knowledge and aid design of effective prevention strategies.


Education

18 RCTs 10 secondary research

Education can be employed in many different ways and settings, as a starting point for raising awareness, understanding transmission, how to protect against infection and reducing fear. It was sometimes difficult to separate education from behavioural interventions as one seeks to affect the other; we were guided by how studies described their interventions and what outcomes were used. More research in educational intervention could be valuable.


Akers[29] suggests that a nationally standardized HIV prevention intervention classification taxonomy would aid consistency and scientific validation across HIV intervention studies. A small number of external experts and our study team have developed a novel taxonomy; further development may improve this, but it is our opinion that we have contributed a promising start to providing a classification system.

Anstee et al. BMC Public Health 2011 11:381   doi:10.1186/1471-2458-11-381

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