MONDAY, JUNE 18, 2018

Avahan AIDS initiative prevented estimated 600,000 HIV infections

Avahan, the India AIDS Initiative, may have saved approximately 600,000 people in India from becoming infected with HIV in the last decade, according to a new report published in Lancet Global Health.

Avahan was funded by the Bill & Melinda Gates Foundation and launched in 2003. The initiative was meant to prevent HIV transmission in the general population using a comprehensive HIV prevention program. The program included the promotion of condoms among the people at most risk in the six Indian states with the highest HIV rates.

The report estimated that 606,000 infections were prevented over the course of 10 years.

"These findings suggest that the approach used by Avahan, of targeting high risk groups with behavioral interventions, adequate provision of prevention commodities and support for programs to build community resilience, can be effective at controlling HIV in the population at large," Marie-Claude Boily, a researcher with the School of Public Health at Imperial College London, said. "Expanding the coverage of similar programs could have a considerable impact on HIV epidemics in many parts of the world."

The Bill & Melinda Gates Foundation contributed more than $250 million to Avahan. The program also included outreach and risk reduction education programs, in addition to measures meant to reduce the stigma attached to HIV and build community resilience.

"If replicated, it is possible that the large scale expansion of this intervention to other settings in Asia and Africa could have a demonstrable impact on the worldwide HIV epidemic over the next decade," Peter Vickerman, a senior lecturer with the London School of Hygiene & Tropical Medicine, said.

The authors used mathematical models to compare the observed trends in HIV infection with the number infections that would have occurred in the absence of the increase in condom use following the initiative. The researchers took results from 24 districts and extrapolated the results to all 69 districts in south India where Avahan operated.

"The design of the evaluation itself, which was planned as an integral part of the program, was innovative as it combined mathematical modeling with detailed data collection, which enabled us to conduct a rigorous analysis in a situation where it was not possible to conduct community-based randomized trials," Michael Pickles, a research associate with the School of Public Health at Imperial College London. "Evaluating the impact of prevention programs is crucial for determining which interventions should be prioritized."