Tuesday, April 23, 2013

  • Daily Summary

    International perspectives

    Day Two of the 3rd International HIV Treatment as Prevention Workshop began with presentations by representatives from organizations conducting and supporting international research initiatives.

    Dr. Carl Dieffenbach, Director of NIAID’s Division of AIDS, outlined how his organization’s work in Treatment as Prevention is focused on achieving universal testing, as well as engaging and retaining people into care. Acknowledging that molecular biology will help researchers better understand HIV, Dr. Dieffenbach cautioned that biomedical interventions must begin with behavioural interventions.

    Dr. Jacques Normand, Director of the AIDS Research Program at NIDA, provided an overview of NIDA’s seek, treat, test, and retain portfolio, which predominantly focuses on highly impacted groups such as men who have sex with men, injection drug users, and specific ethnicities, including African American and Hispanic populations. Further, he discussed the work that NIDA supports looking at the interaction with illegal substance use as well as alcohol abuse. A further area of special interest relates to the optimal management of individuals within the criminal justice system.

    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, including ongoing trials Ipergay and Start ART. “Our focus is on the acceptability and feasibility of intervention at individual and community levels,” he said.

    Strategies to enhance TasP implementation

    Dr. Zunyou Wu presented the China experience implementing Treatment as Prevention. Referencing the unique challenges associated with scaling up testing and treatment in a large population, Dr. Wu spoke to the commitment from the Chinese government to fighting HIV/AIDS. To date, HIV risk in the country has been reduced by 38 per cent.

    Along with further regional updates from New York City, Washington, D.C., Rwanda, and Zambia, presentations during the day’s second session turned to HIV Treatment as Prevention among drug users and the criminal justice system.

    Dr. Evan Wood presented on Treatment as Prevention in injection drug users in Vancouver, during which he called for structural changes to address drug addiction issues and harm reduction in incarceration. Dr. Shoshana Kahana of NIDA pointed out the need for improving testing, treatment, and services in the prison population. Brown University’s Dr. Curt Beckwith then spoke to the opportunities for engagement throughout the criminal justice setting. “If Treatment as Prevention is to succeed, we really need to bring in the criminal justice system,” he said.

    Study updates

    The first session of the afternoon offered a series of ongoing study updates, including presentations on HPTN 043 by Dr. Hedi van Rooyen, HPTN 052 by Dr. Myron Cohen, Combination Trials in South Africa and Uganda by Dr. Ruanne Barnabas, PopART by Dr. Sarah Fidler, Botswana Trial by Dr. Max Essex, and SEARCH Trial by Dr. Diane Havlir.

    Dr. Velephi Okello presented on MaxART, a trial studying the impacts of Treatment as Prevention in Swaziland as they move to implement the strategy as their national approach. In a country that has experienced the highest HIV prevalence and highest TB incidences in the world, early results from the trial have demonstrated dramatic improvements — national ART coverage stands at 80 per cent and researchers witnessed a plateau in HIV prevalence. National protocols have taken a human rights approach, with an emphasis on community and organization. “In the end it’s about the people, not only the science,” said Dr. Okello.

    Cascade of care

    The HIV cascade of care represents a focused approach for implementing Treatment as Prevention, illustrating the steps in care and support for those living with HIV/AIDS. The second afternoon session featured presentations that examined the various stages in the cascade of care.

    Dr. Viviane Lima of the BC Centre for Excellence in HIV/AIDS presented research that examined the cascade of care across different subgroups and geographical regions. Her research identified previously unrecognized heterogeneities and gaps in the cascade of care, which can help identify vulnerable subgroups and best interventions to maximize the effect of Treatment as Prevention.

    Dr. Lisa Metsch of Columbia University presented on the implications of and factors associated with poor retention in care. She argued for implementing a holistic approach with proven interventions that include systematic monitoring, linkage case management, intensive outreach, and patient navigation.

    What’s ahead

    Day Three of the Treatment as Prevention Workshop opens with a debate on Treatment as Prevention among men who have sex with men (MSM). David Evans and Myron Cohen will participate in this debate moderated by Pedro Cahn and Nikos Dedes. The morning will also feature two abstract-driven sessions.

    The day’s afternoon begins with a session entitled “Elimination of vertical transmission: Catalyzing use of FDC triple ARV drug regimen for all pregnant women living with HIV”. Presenters include Meg Doherty of the World Health Organization and Chewe Luo of UNICEF. Presentations will be followed by a panel discussion Michael Eliya Godfrey Esiru, Konan Kouadio, and Irma Ahoba Bobo. Paula Donovan will provide the advocacy perspective.

    Two roundtable sessions will end the day’s sessions. The first will discuss the impact of Treatment as Prevention on Tuberculosis. Panelists include Somya Gupta, Thembi Nkambule, and Haileyesus Getahun. The second roundtable will focus on Treatment as Prevention in hepatitis C infection. Ron Valdisseri, John Ward, and Mel Krajden will participate in this panel session.

    For further details on session times and presenters, please click here.