The Bill and Melinda Gates Foundation-funded Avahan programme may have prevented over 6 lakh HIV infections in India over 10 years, according to a report in Lancet Global Health .
It may be recalled that a 2011 study, by other institutes, also showed that the project prevented one lakh fresh HIV cases in five years in the general population by launching intervention programmes among targeted groups.
The Avahan India AIDS Initiative was launched in 2003, as a large scale, targeted intervention prevention programme and was implemented in Andhra Pradesh, Maharashtra, Tamil Nadu, Manipur and Nagaland. The study looked at 69 districts in Andhra Pradesh, Maharashtra, Karnataka and Tamil Nadu.
Govt., NGOs involved
Avahan worked with State government agencies and local non-governmental agencies to work with high-risk groups, including female sex workers and men who have sex with men. There were other components that included reaching out to truck drivers and injecting drug users, but they were in districts outside the scope of the evaluation, authors Michael Pickles et al explained.
The results of the assessment indicated that over the first four years of the programme, 42 per cent of the HIV infections were averted, and over 10 years, it rose to 57 per cent. The study examined current HIV trends, observed with epidemiological studies; compared it to what the number of infections might have been if condom use had not been promoted by the programme. The difference was estimated to be the number of HIV infections prevented.
High-risk groups
The authors say they created a mathematical model of HIV transmission in high-risk groups and the general population using data from cross sectional surveys. “This is the first assessment of Avahan to account for the causal pathway of the intervention — that of changing risk behaviour in female sex workers and high risk men who have sex with men — to avert HIV infections in these groups and the general population,” they said.
Receiving funding from the Bill and Melinda Gates Foundation, the latest study was done by the School of Public Health, Imperial College, London, in association with a number of organisations, including the London School of Hygiene and Tropical Medicine, National AIDS Research Institute, Pune, and St. John’s Medical College and Hospital, Bangalore.
The researchers found that in 24 districts, 62,800 infections were prevented in the first four years of the programme. By extrapolating the results to all 69 districts they estimate that 2,02,000 infections were prevented in those four years, with 37 per cent of infections averted in Andhra Pradesh, 30 per cent Karnataka, 8 per cent in Maharashtra and 25 per cent in Tamil Nadu. Over 10 years, this number rose to 6,06,000 across all districts.
“Our results provide evidence for a large-scale increase in consistent condom use in high risk groups since the start of the Avahan programme,” the authors have recorded. The strength of evidence for effectiveness of public health interventions in handling HIV prevention has just been bolstered with this study.
Better condom use
The beneficial effect occurred through increased condom use, which was brought about by removing barriers to use. This was achieved with distribution of condoms, social marketing of condoms, peer out reach, treatment of sexually transmitted infections, and community mobilisation.
“In an era focused on antiretroviral therapy as prevention, these results show that behaviour-focused, core group targeted HIV preventive interventions can be rapidly and successfully implemented at scale,” the authors have argued. “With high coverage, these programmes have the potential to substantially reduce concentrated HIV epidemics.”
