Vermund heads HIV Prevention Trials Network

The worldwide Coordination and Operations Center for the HPTN, headed by Vanderbilt’s Sten Vermund, is housed at Family Health International (FHI) in Research Triangle Park, North Carolina, and at Vanderbilt’s Institute for Global Health (VIGH). Central laboratory and data/biostatistical partners are located at Johns Hopkins University (Dr. Sue Eshleman) and the Fred Hutchinson Cancer Research Center (Dr. Deborah Donnell).

As Principal Investigator and chair of the HPTN Executive Committee, Dr. Vermund provides leadership during research protocol development, technical review, budgeting, study implementation, and publication of results. VIGH staff contribute to the work of HPTN in many ways, including Janeen Burlison, NP, MPH, who serves as a Program Manager, Toni Hill who supports HPTN meetings and communications, and Meredith Bortz, whose Editorial Assistant role includes assistance in the preparation of manuscripts and other HPTN communications.

HPTN activities are split between battling the global pandemic in sub-Saharan Africa, South America, and Asia, as well as tackling the intractable HIV/AIDS challenges in the United States. As of 2008, the Centers for Disease Control estimated that about 56,000 new HIV infections occur each year, with no evidence of a decrease in this number in the past decade. Of these cases, fully one-quarter are in black men who have sex with men (MSM), one-quarter are in white MSM, and almost one-quarter are in women of color, particularly African-American women. The HTPN has launched two new research studies, HPTN 064 (“ISIS” study) and HPTN 061 (“BROTHERS” study).

The HPTN 064 protocol (“ISIS” study) is designed to estimate the HIV-1 incidence rate in women at risk for HIV acquisition in selected high-risk venues in the U.S. and to evaluate the feasibility of enrolling and following at-risk women. The focus of the study is to identify incentives, barriers and facilitators to enrollment and retention (e.g., child care, transportation, stigma, partner attitudes) in HIV prevention research studies. Participants are offered services such as testing, counseling for risk reduction, and referrals for substance abuse, mental health, and HIV care. This study will determine whether the testing of a specific combination of interventions for efficacy is feasible in a U.S. clinical trial. 

The HPTN 061 protocol (“BROTHERS” study) is designed to assess the feasibility of a community-level, multi-component intervention for reducing HIV incidence among black MSM. Innovative community outreach will be used to recruit Black MSM into a longitudinal study within a clinic-linked community setting, enabling prompt care and treatment of recruited men and their partners, as indicated. Interventions provided to participants will include HIV risk reduction counseling, testing, and referral for HIV care, sexually transmitted infection (STI) testing and referral for care, screening for substance use, mental health issues, partner and/or homophobic violence, counseling and referral for care as indicated, and engagement with peer health care system navigators to facilitate uptake of health care and other services. This study is important because prior efforts to engage black MSM in testing and care have demonstrated gaps in the ability of current public health strategies to reach this important population.

A proposal that is currently under development by HPTN is the “Test aNd Treat” (TNT) strategy that involves expanded HIV screening and testing to identify individuals with HIV who are unaware of their status and then using antiretroviral therapy (ART) to prevent transmission from the HIV-infected individual to an uninfected one. Key elements of TNT include at least 7 integrated elements:

• Substantial expansion of HIV testing into higher risk populations,
  
• Expansion of HIV testing in jail and in high-risk communities,
  
• Bridging those identified with HIV to care using incentives or peer “health care system navigators,”
  
• Promptly evaluating ART eligibility and optimizing ART initiation,
  
• “Positive Prevention” intervention for risk reduction among infected persons in care,
  
• Enhancing medication adherence support for maintenance of viral suppression, and
  
• Providing facilitated referrals to care for those conditions that inhibit effective HIV care and ART adherence, including substance abuse and mental illness.
  

The HPTN protocol team expects to launch a protocol focused on the Bronx, New York City, and Washington, D.C., in 2010. More can be learned about the HPTN on www.htpn.org or from Dr. Vermund at globalhealth@vanderbilt.edu.