Background/Objectives STD/HIV field investigations and the initial findings of Interdiction Project reveal that some persons with HIV infection have unprotected sex, multiple anonymous sex partners, and don't disclose their HIV status. Consistent condom use is low; recurrent co-infection with STDs and HIV transmission to sex partners is high. The Interdiction Project is a clinic-based, individual-level HIV intervention that combines linkage for treatment adherence/risk reduction education and testing with ongoing monitoring of patient care and epidemiologic data system. This project targets HIV positive persons who present with a new STD or history of unprotected sex.
Methods This is a prospective STD intervention follow-up study of 69 patients referred by HIV/AIDS and STD clinic providers and STD/HIV investigation specialist. Project staff conducted initial HIV/AIDS and STD transmission prevention and treatment monitoring knowledge plus risk assessment, intensive practical STD and HIV/AIDS health education, condom negotiation, condom skill training, sex partner elicitation for rapid HIV testing and linkage to care. STD and STD morbidity rates 18 months prior to follow-up were compared to 18 months of follow-up after referral. We analysed follow-up data to determine the STD rates, undetectable HIV viral loads and how Interdiction Project may help reduce the spread of HIV and STD co-infections.
Results Initial findings revealed high STD morbidity since HIV diagnosis and 26 clients had 48 STDs before referral. Overall STD rate was 50.7% (35/69) at referral, 14% consistent condom use always but 96% intend to use condoms and sex partner HIV positivity rate was 30% (6/20). HIV genotype resistance was 34% (14/41). At 18 months of follow-up, significant overall STD morbidity rate reduced from 74.3% to 25.4%, RR 0.34 (95% CI 0.22 to 0.52) and RR of STD reduced from 72.5% to 23.2%, RR 0.32 (95% CI 0.20 to 0.50). Achieving higher perfect knowledge score from pre- to post-education knowledge assessment correlated with reduction in STD and STD morbidity. Significant STD rates reduction was noted for many risk categories. Clients who had undetectable viral load on HAART increased from 50% (17/34) at referral to 88.2% (30/34) at 6–9 months and 77.4% (24/31) from 13 to 18 months of follow-up.
Conclusion/Implication Interdiction Project applies concepts of clinical epidemiology similar to in-patient hospital infection control processes and may help HIV/AIDS patients to achieve undetectable HIV viral load, reduce STD co-infection and HIV transmission. The findings suggest that epidemiologic work to reduce the spread of HIV, STD co-infection and resistant HIV must be an important component of HIV/AIDS programs and will require collaborative work by medical providers and intensive practical health education by knowledgeable HIV/AIDS health educator/epidemiologist.
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