Thursday, April 3: Summary of Day Two

  • What’s ahead

    • Day Three of the Treatment as Prevention Workshop will feature two roundtable sessions: the first on HIV testing and ART delivery in 2020, the second on prioritizing resources for greatest impact.
    • The day will also include two abstract-driven sessions and a session on optimizing capture of relevant outcomes.
    • 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.

    Dr. François Dabis of the French Agency for Research on HIV/AIDS and Viral Hepatitis (ANRS)

    International investments

    Presentations from organizations that are developing guidelines and supporting international research initiatives began the second day of the 4th International HIV Treatment as Prevention Workshop.

    Dr. Meg Doherty, Coordinator of Treatment and Care in the Department of HIV/AIDS at the World Health Organization (WHO), presented on the evolution of the consolidated HIV treatment guidelines. She spoke to the status of guideline implementation globally as WHO moves toward their vision of treatment for all those eligible. Specific WHO goals she highlighted included treatment for all pregnant and breastfeeding women; treatment for all children under the age of 5; and routine viral load testing. She acknowledged CD4 continues to play an important role as a reliable tool for monitoring.

    Dr. Emily Erbelding is Deputy Director of the Division of AIDS at the National Institute of Allergy and Infectious Diseases (NIAID). She presented updates on key trials being conducted both domestically and in international settings. HPTN 065 is evaluating the feasibility of enhanced community-level HIV testing and link-to-care plus treat strategy in the U.S.; HPTN 071 — or PopART — is examining if test-and-treat at a community level can reduce HIV transmission. Critically, this study is investigating whether Treatment as Prevention can be delivered with high acceptability, uptake, and adherence to have a positive impact across the entire community.

    Dr. Richard Jenkins, Health Scientist Administrator at the National Institute on Drug Abuse (NIDA), presented on Treatment as Prevention among drug using populations. He emphasized NIDA is moving from supporting research on efficacy and effectiveness of treatment strategies to implementation research. Specifically, focus is on systematic strategies for promoting adoption of evidence-based practices and interventions.

    Dr. François Dabis of the French Agency for Research on HIV/AIDS and Viral Hepatitis (ANRS) gave a summary of ANRS activities and contributions to Treatment as Prevention research. Key research being supported is examining the impact of male circumcision and pre-exposure prophylaxis (PrEP) on HIV transmission. Arguing treatment initiation is context-driven, he presented on research being conducted in Côte d'Ivoire assessing the benefits of starting treatment immediately.

    The first session was closed by a presentation on the UNAIDS Treatment 2015 Situation Room. Dr. Badara Samb, Chief of Special Initiatives at UNAIDS, highlighted the real-time monitoring features of the web-based application, which can serve as an impactful tool for engaging policymakers. The Situation Room provides a countdown to the 2015 target of 15 million people accessing treatment, as well as the capability to access country and county assessments, targets, and projections.

    Delegates can visit the UNAIDS Treatment 2015 Situation Room throughout the Workshop in the Junior Ballroom at the Sheraton Wall Centre.

    Country-based Initiatives

    The day's second session featured updates on country-based initiatives. Dr. Zunyou Wu, Director, National Centre for AIDS/STD Control & Prevention, Chinese Center for Disease Control & Prevention, opened the session with a presentation on China's progress implementing Treatment as Prevention, which was adopted as the national strategy in 2011. He noted remarkable progress has been made since 2007, particularly in identifying people living with HIV and treatment coverage. However, he acknowledged this progress is moving slowly for controlling the epidemic.

    The Vietnamese HIV epidemic and response was presented by Dr. Bui Duc Duong from Vietnam's Ministry of Health. The country has focused efforts on harm reduction and condom promotion in coordination with rapid antiretroviral scale-up. Limited testing coverage, late diagnosis and ART initiation, and loss across the cascade of care remain challenges.

    In 2013, France adopted the Treatment as Prevention strategy. Dr. Christine Katlama, Head of AIDS Clinical Research Unit at Hôpital Pitié-Salpêtrière, presented on France's treatment initiatives. The French health system offers treatment, monitoring, and care free of charge. As a result, they have been successful in reducing HIV replication. However, identifying those undiagnosed remains a challenge. Dr. Katlama explained the country's focus is on defining alternative strategies for life-long control of viral replication.

    Brazil adopted Treatment as Prevention as their policy to fight HIV and AIDS in 2013. Dr. Fábio Mesquita, Director of the Department of STDs, AIDS and Viral Hepatitis, presented the first steps the country has taken towards implementation. Brazil's focus has been on key affected populations, rather than the generalized approach previously taken. Testing and treatment engagement efforts emphasize outreach to men who have sex with men, transgendered people, sex workers, and drug users, with the goal of eliminating discrimination and reducing the burden on these groups and the health care system overall.

    Challenges and Opportunities

    The final session of the day examined the challenges with and opportunities for increasing access and availability of HIV treatment.

    Dr. Christine Nabiryo from The AIDS Support Organization in Uganda began the session arguing for the necessity of community mobilization for successful treatment expansion. She pointed to weak health and community systems, adherence programs, and mobilizing people presenting no symptoms as on-going challenges to treatment scale-up.

    Dr. Joep Lange, Head of the Department of Global Health at the University of Amsterdam's Academic Medical Centre, spoke about innovative financing approaches. These innovations are necessary, he argued, because of changing global demographics. As an example of innovation, he pointed to UNITAID, which had raised more than $1 billion, 70% of which was derived from a small levy imposed in six countries on airline tickets. These innovative approaches to fundraising, he said, are key to expanding and sustaining treatment. In fact, Dr. Lange argued, they should be models for all health systems, not just HIV.

    Anil Soni began his presentation by inviting questions from the audience. As Vice President of Mylan, a pharmaceutical company developing generic HIV medicine, the audience questions focused on whether the community can be assured the best medicine will be available at the lowest price and at the necessary quantities? Mr. Soni assured the audience Mylan is committed to that goal, but unable to do it without support. The mission, he said, is to try to develop to scale and at an affordable price.

    The day closed with a presentation from Dr. Kiran Jobanputra about Treatment as Prevention efforts by Médecins Sans Frontières, providing the Swaziland model. Implementation research, he said, provides guidance for how to integrate Treatment as Prevention into routine HIV programming. The focus, he said, must be on quality and cascade optimization — improving linkage to care, adherence, retention, and earlier access to treatment.