Friday, April 4: Summary of Day Three

  • What’s ahead

    • The final day of the Treatment as Prevention Workshop features a morning session on what works and what doesn’t.
    • The Workshop closes with a session on the underestimated benefits of TasP.
    • Two abstract-driven late-breaker sessions begin at 11:00. These sessions will not be live-streamed.
    • For details on session times and presenters, please click here.
    • Follow along with the Treatment as Prevention Workshop live stream and on Twitter @BCCfE and #TasP2014.

    Anna Zakowicz of AHF Europe and GNP+

    Prioritizing treatment impact

    The third day of the International Treatment as Prevention Workshop featured a pair of roundtable discussions on the topic of treatment access.

    The future of HIV testing and ART delivery was the theme of the first roundtable session. Anna Zakowicz of AHF Europe and GNP+ called for a human rights approach to testing and treatment of people living with HIV, including patient-centred comprehensive care that prioritizes patient rights and needs.

    Dr. David Ripin from the Clinton Health Access Initiative spoke about the need to recognize and define the largely ignored cost of inaction caused by waiting for patients' CD4 to decline. This waiting, he argued, comes at a cost to both the patient and the health system. Investment in retention and a higher quality of care now will reduce costs over time. Mario Fernandez from Coca-Cola advocated for tapping into private sector solutions to address health systems issues.

    The industry perspective was provided by Gilead's Dr. Hans Reiser and Dr. Manuel Goncalves of ViiV Healthcare. Dr. Reiser spoke about the need for making treatment available for all. Successfully reaching patients in developing countries requires a number of support activities to ensure medicines are available and used, he said. In addition, generic licensing will aid in treatment expansion by lowering costs of medicine. In order to produce enough medicines to increase the number of people on treatment, Dr. Goncalves said, we should look at the capacity of India, China, and others for local production. He also argued for facility-based provision, making ARVs available at the point of care.

    The day's second roundtable featured presentations from Drs. Mead Over, Joep Lange, and Brian Williams examining approaches for prioritizing resources for maximum impact.

    Dr. Over, from the Center for Global Development, argued for a behavioral-first approach. Individual behavior, he said, is the most important determinant of HIV infection and treatment success. The biomedical approach was argued for by Dr. Lange, who advocated for treatment as early as possible. Early treatment, he said, maximizes both individual and public health benefits.

    Dr. Williams, from the South African Centre for Epidemiological Modelling and Analysis (SACEMA), advocated for hotspotting — targeting those regions where the HIV epidemic is most concentrated. Efficiency, he said, dictates that we should test where the prevalence is highest, while equity and impact both dictate that we should test people once a year so that if they do get infected they start ART within one year.

    Analyzing Outcomes

    Day three opened with a session examining methods and best practices for capturing relevant outcomes.

    Dr. Bernard Branson from the Division of HIV/AIDS Prevention at the U.S. Centre for Disease Control presented on HPTN 065, focusing on the study's investigation of the feasibility of community-level Treatment as Prevention in the U.S. Among the questions examined was how often to test. Using relevant surveillance data, they were able to identify the necessity to promote twice annual testing among high-risk men who have sex with men. Data had revealed that 45% of this population with HIV and unaware of their status had not been tested in the previous 12 months. Relevant outcomes, Dr. Branson said, were clarified as interventions proceeded.

    The Swaziland Treatment as Prevention experience was presented by Dr. Velephi Okello from that country's Ministry of Health. With one of the highest HIV incidence rates in the world and limited resources, research is focused on the acceptability, feasibility, sustainability and affordability of Treatment as Prevention initiatives. In order to influence policy decisions, they have been using minimal additional resources and ensuring best data collection available. Their approach, she said, has been to pilot new interventions in a few selected sites before scaling up to other sites — a method she described as conducting research while establishing standard of care.

    Dr. Bohdan Nosyk from the BC Centre for Excellence in HIV/AIDS presented on the formation, composition, and use of British Columbia's “Seek and Treat for Optimal Prevention of HIV/AIDS” database. Database construction, he said, has required partnerships among several surveillance organizations, relationships that have been developed over a long period of time. The uniquely comprehensive data is then used to populate the province's HIV Cascade of Care and delivered to each Health Authority to help inform their regional treatment and outreach efforts.

    Dr. Till Bärnighausen from Harvard University's Department of Global Health and Population presented a range of impact evaluation studies of Treatment as Prevention trials being conducted in real-life conditions, including in KwaZulu-Natal (Africa Centre) based in the Hlabisa sub-district. Treatment scale-up there has been vigorous, he said, resulting in positive household-level impact, life expectancy increases, and economic benefits.

    Dr. Richard Jenkins spoke about data harmonization initiatives by the National Institute on Drug Abuse (NIDA). Harmonization, he said, maximizes scientific gain with minimal cost, risk, and time while increasing the capacity to ask new questions.

    The session was followed by two abstract-driven sessions to close out the morning program. Videos of these presentations will be available on the International HIV Treatment as Prevention Workshop website following the International AIDS Society AIDS2014 conference.