ABSTRACT In 2007, the Guidance on Provider-Initiated Testing and Counseling in Health Facilities1... more ABSTRACT In 2007, the Guidance on Provider-Initiated Testing and Counseling in Health Facilities1 was launched by the World Health Organization and the United Nations Joint Programme on HIV/AIDS (UNAIDS) to help ensure that human immunodeficiency virus (HIV) is systematically diagnosed to improve treatment outcomes and increase access to prevention services. Since then, many HIV programs have adopted the global guidance. This has been associated with earlier diagnosis and treatment compared with other HIV testing and counseling approaches in health facilities.2 According to the 2009 Universal Access progress report, among 110 countries reporting on provider-initiated testing and counseling (PITC), 95 countries indicated their policies promoted it and 89 countries reported that their guidelines ensure confidentiality and informed consent.3
To review methods for measuring HIV self-testing (HIVST) among key populations, including both co... more To review methods for measuring HIV self-testing (HIVST) among key populations, including both conventional approaches and implementation science approaches. We reviewed the literature on evaluating HIVST among key populations. Simple HIV self-tests have already entered markets in several regions, but metrics required to demonstrate the benefits and costs of HIVST remain simplistic. Conventional measurements of sensitivity, specificity, acceptability, and behavioural preferences must be supplemented with richer implementation science measurement tools and innovative research designs in order to capture data on the following components: how self-testing affects subsequent linkage to confirmatory testing, preventive services and onward steps in the HIV continuum of care; how self-testing can be marketed to reach untested subpopulations; and how self-testing can be sustained based on overarching organisational and financial models. We outline an implementation science research agenda t...
Clinical and basic science advances have raised considerable hope for achieving an HIV cure by ac... more Clinical and basic science advances have raised considerable hope for achieving an HIV cure by accelerating research. This research is dominated primarily by issues about the nature and design of current and future clinical trials. Stakeholder engagement for HIV cure remains in its early stages. Our analysis examines timing and mechanisms of historical stakeholder engagement in other HIV research areas for HIV-uninfected individuals [vaccine development and pre-exposure prophylaxis (PrEP)], and HIV-infected individuals (treatment as prevention, prevention of mother-to-child transmission, and treatment of acute HIV infection) and articulate a plan for HIV cure stakeholder engagement. The experience from HIV vaccine development shows that early engagement of stakeholders helped manage expectations, mitigating the failure of several vaccine trials, while paving the way for subsequent trials. The relatively late engagement of HIV stakeholders in PrEP research may partly explain some of ...
The Chinese government has invested US$140 million annually on prevention of mother-to-child tran... more The Chinese government has invested US$140 million annually on prevention of mother-to-child transmission (PMTCT) of HIV. This study evaluates the programme by examining the improvements in programme coverage HIV testing and provision of antiviral drugs along the PMTCT cascade. Data for PMTCT cascade indicators were collected through a comprehensive systematic review of published peer-reviewed English and Chinese literature during 2003-2011. Meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This study included 113 publications. HIV prevalence among pregnant women in China who accessed antenatal care (ANC) remained below 0.1% during the past decade. HIV testing coverage in pregnant women attending ANC and in HIV-exposed infants at 18 months significantly increased from 62.4% (95% CI 4.7% to 98.2%) and 22.1% (16.3% to 32.3%) in 2003 to 90.3% (88.4% to 91.8%) and 82.8% (66.9% to 99.5%) in 2011 respectively, whereas a...
Mother-to-child transmission (MTCT) of HIV is the predominant mode of HIV transmission in childre... more Mother-to-child transmission (MTCT) of HIV is the predominant mode of HIV transmission in children worldwide. It is estimated that around 1.3 million children are living with HIV and that approximately 1,600 children are infected with HIV each day. Numerous clinical trials using antiretroviral drugs to reduce MTCT of HIV-1 have shown that perinatal transmission can be reduced effectively. Based on the PACTG 076 study administering a long antenatal zidovudine regimen, a signific ant reduction in vertical HIV-1 transmission has been achieved in the developed world. Trials conducted in developing countries have shown that perinatal transmission can be reduced effectively even using shorter and less costly antiretroviral regimens. Prevention of MTCT interventions have been implemented on a large scale in a number of developing countries.
HIV epidemics spread rapidly through Asian sex work networks two decades ago under conditions of ... more HIV epidemics spread rapidly through Asian sex work networks two decades ago under conditions of high vulnerability, low condom use, intact male foreskins and ulcerative STIs. Experiences implementing interventions to prevent transmission in sex work in ten Asian countries were reviewed. All report increasing condom use trends in sex work. In the seven countries where condom use exceeds 80%, surveillance and other data indicate declining HIV trends or low and stable HIV prevalence with declining STI trends. All four countries with national-level HIV declines among sex workers have also documented significant HIV declines in the general population. While all interventions in sex work included outreach, condom programing and STI services, the largest declines were found in countries that implemented structural interventions on a large scale. Thailand and Cambodia, having controlled transmission early, are closest to providing universal access to HIV care, support and treatment and are exploring HIV elimination strategies.
ABSTRACT In 2007, the Guidance on Provider-Initiated Testing and Counseling in Health Facilities1... more ABSTRACT In 2007, the Guidance on Provider-Initiated Testing and Counseling in Health Facilities1 was launched by the World Health Organization and the United Nations Joint Programme on HIV/AIDS (UNAIDS) to help ensure that human immunodeficiency virus (HIV) is systematically diagnosed to improve treatment outcomes and increase access to prevention services. Since then, many HIV programs have adopted the global guidance. This has been associated with earlier diagnosis and treatment compared with other HIV testing and counseling approaches in health facilities.2 According to the 2009 Universal Access progress report, among 110 countries reporting on provider-initiated testing and counseling (PITC), 95 countries indicated their policies promoted it and 89 countries reported that their guidelines ensure confidentiality and informed consent.3
To review methods for measuring HIV self-testing (HIVST) among key populations, including both co... more To review methods for measuring HIV self-testing (HIVST) among key populations, including both conventional approaches and implementation science approaches. We reviewed the literature on evaluating HIVST among key populations. Simple HIV self-tests have already entered markets in several regions, but metrics required to demonstrate the benefits and costs of HIVST remain simplistic. Conventional measurements of sensitivity, specificity, acceptability, and behavioural preferences must be supplemented with richer implementation science measurement tools and innovative research designs in order to capture data on the following components: how self-testing affects subsequent linkage to confirmatory testing, preventive services and onward steps in the HIV continuum of care; how self-testing can be marketed to reach untested subpopulations; and how self-testing can be sustained based on overarching organisational and financial models. We outline an implementation science research agenda t...
Clinical and basic science advances have raised considerable hope for achieving an HIV cure by ac... more Clinical and basic science advances have raised considerable hope for achieving an HIV cure by accelerating research. This research is dominated primarily by issues about the nature and design of current and future clinical trials. Stakeholder engagement for HIV cure remains in its early stages. Our analysis examines timing and mechanisms of historical stakeholder engagement in other HIV research areas for HIV-uninfected individuals [vaccine development and pre-exposure prophylaxis (PrEP)], and HIV-infected individuals (treatment as prevention, prevention of mother-to-child transmission, and treatment of acute HIV infection) and articulate a plan for HIV cure stakeholder engagement. The experience from HIV vaccine development shows that early engagement of stakeholders helped manage expectations, mitigating the failure of several vaccine trials, while paving the way for subsequent trials. The relatively late engagement of HIV stakeholders in PrEP research may partly explain some of ...
The Chinese government has invested US$140 million annually on prevention of mother-to-child tran... more The Chinese government has invested US$140 million annually on prevention of mother-to-child transmission (PMTCT) of HIV. This study evaluates the programme by examining the improvements in programme coverage HIV testing and provision of antiviral drugs along the PMTCT cascade. Data for PMTCT cascade indicators were collected through a comprehensive systematic review of published peer-reviewed English and Chinese literature during 2003-2011. Meta-analysis was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. This study included 113 publications. HIV prevalence among pregnant women in China who accessed antenatal care (ANC) remained below 0.1% during the past decade. HIV testing coverage in pregnant women attending ANC and in HIV-exposed infants at 18 months significantly increased from 62.4% (95% CI 4.7% to 98.2%) and 22.1% (16.3% to 32.3%) in 2003 to 90.3% (88.4% to 91.8%) and 82.8% (66.9% to 99.5%) in 2011 respectively, whereas a...
Mother-to-child transmission (MTCT) of HIV is the predominant mode of HIV transmission in childre... more Mother-to-child transmission (MTCT) of HIV is the predominant mode of HIV transmission in children worldwide. It is estimated that around 1.3 million children are living with HIV and that approximately 1,600 children are infected with HIV each day. Numerous clinical trials using antiretroviral drugs to reduce MTCT of HIV-1 have shown that perinatal transmission can be reduced effectively. Based on the PACTG 076 study administering a long antenatal zidovudine regimen, a signific ant reduction in vertical HIV-1 transmission has been achieved in the developed world. Trials conducted in developing countries have shown that perinatal transmission can be reduced effectively even using shorter and less costly antiretroviral regimens. Prevention of MTCT interventions have been implemented on a large scale in a number of developing countries.
HIV epidemics spread rapidly through Asian sex work networks two decades ago under conditions of ... more HIV epidemics spread rapidly through Asian sex work networks two decades ago under conditions of high vulnerability, low condom use, intact male foreskins and ulcerative STIs. Experiences implementing interventions to prevent transmission in sex work in ten Asian countries were reviewed. All report increasing condom use trends in sex work. In the seven countries where condom use exceeds 80%, surveillance and other data indicate declining HIV trends or low and stable HIV prevalence with declining STI trends. All four countries with national-level HIV declines among sex workers have also documented significant HIV declines in the general population. While all interventions in sex work included outreach, condom programing and STI services, the largest declines were found in countries that implemented structural interventions on a large scale. Thailand and Cambodia, having controlled transmission early, are closest to providing universal access to HIV care, support and treatment and are exploring HIV elimination strategies.
Uploads
Papers by Ying-ru Lo