March 2012

EVENT: Wafaa El-Sadr to Deliver University Lecture 

ICAP Director Wafaa El-Sadr has been selected to deliver the University Lecture, hosted by Columbia University President Lee C. Bollinger and Provost John H. Coatsworth, on Thursday, April 5, 2012 at 6:00 pm in Low Memorial Library on the Columbia Morningside Campus. During her lecture "The HIV/AIDS Epidemic: Global Tragedy, Lasting Triumphs,” Dr. El-Sadr will reflect on the considerable achievements in the battle against HIV/AIDS, as well as discuss future opportunities to end the epidemic.

Learn more about the University Lecture or attend a live screening of the lecture in Hess Commons at the Mailman School of Public Health on April 5 at 6:00 pm.

VIDEO: ICAP Director Wafaa El-Sadr presented the opening plenary lecture, "ART for Prevention: The Science and the Art" at the 19th Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle Washington from March 5-8. The three-day conference brought together the world's leading HIV/AIDS researchers. VIEW VIDEO

ICAP Webinar Grand Rounds: "Nurse Initiated and Managed ART" with Jennifer Dohrn, DrNP, CNM, project director of ICAP's Nurse Capacity Initiative/NEPI Coordinating Center and assistant professor of clinical nursing, April 19, 8:30 am ET. JOIN WEBINAR 

ICAP Webinar Grand Rounds Recap: "Averting Maternal Mortality" with Helen DePinho, MD, associate director of the Averting Maternal Death and Disability Program and assistant professor of clinical population and family health at Columbia University. View Webinar

ABOUT ICAP
ICAP was founded in 2004 at Columbia University’s Mailman School of Public Health. Now a global leader in HIV/AIDS services, ICAP has supported work at more than 1,200 sites across 21 countries. More than one million people have received HIV services through ICAP-supported programs.

For more information about ICAP, visit here. For more information about ICAP leadership, visit here.

Supported by Doris Duke Charitable Foundation, Bill and Melinda Gates Foundation, William and Flora Hewlett Foundation, Robert Wood Johnson Foundation, Henry J. Kaiser Family Foundation, Stephen Lewis Foundation, John D. and Catherine T. MacArthur Foundation, National Institutes of Health, David and Lucille Packard Foundation, Rockefeller Foundation, and Starr Foundation.


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HIV Rates for African-American Women in Parts of the U.S. Much Higher than Previously Estimated

ICAP is part of a network of research organizations that jointly released study results finding that the HIV infection rate of black women living in certain parts of the U.S. is five times higher than the overall rate of infection among black women estimated by the U.S. Centers for Disease Control and Prevention (CDC).

The HIV Prevention Trials Network’s (HPTN) 064 Women’s HIV Seroincidence Study found an HIV incidence of 0.24% in its study cohort of 2,099 women (88% black). Results are based on a study design that selected HIV ‘hot spots,’ i.e. geographic areas of the U.S. with elevated rates of HIV and poverty. Six distinct geographical areas in the northeast and southeast regions of the U.S. were selected—Atlanta, GA, Raleigh-Durham, NC, Washington, D.C., Baltimore, MD, Newark, NJ, and New York City —where women, ages 18 to 44, without a prior positive HIV test were eligible for enrollment.

Within ICAP’s consortium of clinical research sites, the HPTN 064 study was conducted at three New York-New Jersey sites: ICAP’s Harlem Prevention Center, the Bronx-Lebanon Hospital Center, and the New Jersey Medical School Adult Clinical Research Center. Investigators for the study included Drs. Wafaa El-Sadr, ICAP Director; Jessica Justman, ICAP Senior Technical Director; Sharon Mannheimer, Chief of Infectious Diseases at Harlem Hospital Center; Edward Telzak, Chief of Infectious Diseases/Director of AIDS Program at Bronx-Lebanon Hospital Center; and Sally Hodder, Vice Chair, Department of Medicine and Director, HIV/AIDS Program in the Division of Infectious Diseases at UMDNJ.

 “This study confirms that black women in these U.S. hotspots have disproportionately been affected by HIV. While we have made significant progress in HIV/AIDS prevention, care, and treatment, our way forward must include prevention efforts tailored for these communities that are severely affected,” said Dr. El-Sadr, who is also professor of Epidemiology at Columbia’s Mailman School of Public Health and professor of Medicine at the College of Physicians and Surgeons.

Women constitute roughly one-quarter of new HIV infections in the U.S. with 66% of these infections occurring among black women, despite the fact that black women constitute only 14% of the U.S. female population. In the U.S., the age-adjusted death rate of black women with HIV is roughly 15 times higher than that observed for HIV-infected white women.

Thirty-two women in the study (1.5%) were newly diagnosed with HIV infection at the time of enrollment, demonstrating the need to focus efforts on expanding HIV prevention and testing in hot spot areas of the US. “The study underscores the substantial ongoing HIV transmission within specific U.S. populations and highlights the need for increased focus on areas with higher HIV prevalence,” said Dr. Justman, who is also associate professor of clinical epidemiology at the Mailman School.

The HPTN 064 (ISIS) study is funded by the National Institute of Allergy and Infectious Diseases (NIAID) of the National Institute of Health. Study participants were enrolled between March 2008 and July 2010.


First Findings Released from Swaziland HIV Incidence Measurement Survey


The first findings from a nationally representative HIV survey were presented at the 19th Conference on Retroviruses and Opportunistic Infections (CROI 2012) in Seattle, WA. The Swaziland HIV Incidence Measurement Survey (SHIMS) found that overall HIV prevalence, or percentage of the population living with HIV infection, is 31% among adults ages 18-49. This figure matches the 2006 Demographic Health Survey findings for the same age group, indicating that the HIV epidemic in Swaziland has stabilized over the past five years.

 “The country continues to have the highest national HIV prevalence rate in the world, making this the most serious health issue in Swaziland. The Ministry of Health is using the findings from the SHIMS to tailor and improve HIV prevention, care, and treatment programs in Swaziland,” said Rejoice Nkambule, deputy director of health services – public health at the Ministry of Health.

SHIMS is led by the Swaziland Ministry of Health and supported by the U.S. Centers for Disease Control and Prevention (CDC) and ICAP at Columbia University’s Mailman School of Public Health through the U.S. Presidents Plan for AIDS Relief (PEPFAR). This research is a multi-phase study designed to evaluate the effectiveness of HIV prevention services in the country. The first phase of the SHIMS survey, now complete, included approximately 13,000 households in Swaziland, representing a cross-section of the national population and consisting of 18,105 men and women, ages 18-49.

Findings from this first phase indicate that the national prevalence of HIV is 31% among adults ages 18-49. Current prevalence peaks at 54% for women ages 30-34 and at 48% for men ages 35-39, which is higher than past estimates. The increase in prevalence among this group of adults in their thirties may be due to an increased number of people living longer with HIV as a result of expanded access to life-saving antiretroviral therapy (ART). At the same time, HIV prevalence has declined among women less than 30 years old and men less than 35 years old. Trends from the Swaziland Antenatal HIV Sentinel Surveillance Surveys also indicate declines in HIV prevalence among young women. This shift might mean that the rate of new HIV infections among young adults has declined.   

The majority of women (68%) who tested HIV-positive during the SHIMS survey were already aware of their status. However, half (48%) of the men who tested HIV-positive in SHIMS were not aware of their status. As such, improving strategies to engage more men in HIV testing and encourage their use of healthcare services is necessary.

Furthermore, half (50%) of all HIV-positive adults who were aware of their HIV infection prior to SHIMS reported current use of ART. It is important to note that these results do not reflect the proportion who are eligible for ART by CD4 count (an indicator of the stage of HIV infection). Rapid scale-up and decentralization of HIV services since 2005 have resulted in an increased number of people on ART in Swaziland. Since ART treatment is now understood to prevent the spread of new infections, the scale-up of ART may also have contributed to lower prevalence rates among younger adults.

 “This study may give us the opportunity to look at a ‘before-and-after’ picture of HIV infection rates in Swaziland. It is remarkable that in just one year, thousands of individuals have received HIV testing, learned of their HIV status, and were referred for care, treatment, and prevention services through SHIMS,” said Ms. Nkambule.

Along with Ms. Nkambule, the principal investigators on SHIMS include Dr. George Bicego, CDC country director in Swaziland; Dr. Jessica Justman, ICAP senior technical director; and Dr. Jason Reed, CDC Atlanta, medical epidemiologist in the Center for Global Health, Division of Global HIV/AIDS. Additional support for SHIMS has been provided by Swaziland’s National Reference Laboratory and Central Statistical Office, Statistical Center for HIV/AIDS Research & Prevention (SCHARP) at the Fred Hutchinson Cancer Center in the United States, and Maromi Health Research and EpiCentre in South Africa.


Retention of HIV/AIDS Patients in Nine Sub-Saharan African Countries Remains Stable

Since 2003, 3.9 million people have initiated antiretroviral treatment in sub-Saharan Africa. Despite this remarkable achievement, retaining patients in treatment remains a challenge and non-retention rates are particularly high in the first six to twelve months of treatment. One report found that 14 percent of patients were not retained in the first six months, while 20 percent of patients dropped off 12 months after treatment began.

A recent study conducted by ICAP assessed whether non-retention rates of HIV/AIDS patients in sub-Saharan Africa have changed over time with the scale-up of HIV/AIDS services supported largely by ministries of health and the U.S. President’s Emergency Plan for AIDS Relief. In addition to putting more people on treatment, this scale up has increased accessibility of services, enhanced health provider expertise, and resulted in earlier initiation of HIV treatment in sub-Saharan Africa.

Results from the study show that non-retention rates in the nine countries assessed at 6- and 12-month periods remained stable as HIV/AIDS programs and clinics became more experienced over the course of scale-up. These results were found by analyzing patient data from 656 ICAP-supported clinics in nine countries over the course of five years (2005-2010) and included 316,762 patients. The data incorporated a large number of clinics and patients from diverse contexts, however the study could not account for undocumented transfers of patients to other clinics. The results are similar to smaller studies conducted in Africa and in larger U.S. programs, but contradict reports questioning increased non-retention rates since the scale-up.

“Many would agree that these are welcome findings especially as they indicate that, when examined across multiple countries, non-retention rates have not increased over time as has been reported in smaller analyses in the scientific literature and discussed in the policy narrative around the sustainability of scale-up,” said ICAP Strategic Information Director Batya Elul.  

Improving retention rates in sub-Saharan Africa is possible, demonstrated by the fact that the nine countries that were evaluated varied by overall retention rates, and one country–Ethiopia—had decreased non-retention rates. ICAP researchers continue to analyze factors that contribute to non-retention in effort to understand the impact of scale-up initiatives and develop strategies for improving the likelihood that patients remain in care over the long term.