Wednesday, April 24, 2013

  • Daily Summary

    Can TasP
    work with MSM?

    Day Three of the International Treatment as Prevention Workshop began with a debate addressing whether Treatment as Prevention can work with men who have sex with men (MSM).

    David Evans, a community educator and activist from San Francisco, argued for TasP with MSM. Addressing what he characterized as the human element in a scientific debate, Mr. Evans highlighted the need to implement TasP in combination with other interventions to remove the stigma and fear associated with HIV. While focusing on the necessity to offer treatment, he also pointed to successes in San Francisco, where a significant reduction in HIV transmissions has been observed despite an increase in STDs.

    Dr. Myron Cohen, Professor of Medicine at the University of North Carolina, presented the against side of the debate, arguing for managing expectations when making the case for TasP with MSM to policymakers. Dr. Cohen presented research that showed the challenges with treating this population, showing receptive anal intercourse as especially efficient for HIV transmission and the limitations of ART in MSM. He highlighted other challenges to HIV prevention, including acute HIV infection, sexual risk behaviours, and the complicating nature of STDs on ART.

    The debate was followed by two abstract-driven sessions to close out the morning.

    Elimination of vertical transmission

    The afternoon session began with presentations on national pilot programs aimed at eliminating new HIV transmissions in children and providing treatment for HIV positive pregnant women.

    Following the opening presentation by Dr. Meg Doherty on WHO guidelines in process, UNICEF's Dr. Chewe Luo presented findings from bottleneck analysis in the four pilot countries implementing PMTCT: the Democratic Republic of Condo, Malawi, Uganda, and Cote d'Ivoire. Objectives of the pilots include reducing new HIV infections in children and optimizing delivery of simplified triple ARV to mothers. She pointed to strengthening primary health care services as a key component to achieving this goal.

    Presentations by representatives of the national pilot studies focused on challenges with adherence and retention. Presenting on behalf of Cissy Mirembe, Dr. Godfrey Esiru gave the Uganda experience, which utilized mentor mothers to strengthen linkages to care and services.

    Paula Donovan from AIDS Free World provided the advocacy perspective, arguing for approaches that centre on women's health care across the HIV spectrum, rather than focus on pregnant women and mothers.

    TasP impact on TB

    The second session of the afternoon looked at the impact of Treatment as Prevention on Tuberculosis. Dr. Somya Gupta, UNAIDS consultant based in India, outlined the global policy for ART on a disease that is the leading cause of HIV-related deaths worldwide. Dr. Gupta presented the key interventions to decrease the impact of TB for people living with HIV, which include intensified TB case finding, isoniazid preventive therapy (IPT), and infection control for TB.

    Dr. Haileyesus Getahun, Coordinator of the TB/HIV and community engagement unit at the WHO Stop TB Department in Geneva, spoke about the magnitude of TB mortality and morbidity for people living with HIV. Pointing to the prevalence of TB in people living with HIV, Dr. Getahun presented evidence of the preventive effects of ART on TB. He argued for ART to be part of a TB prevention package and should be administered to all TB patients irrespective of CD4 count. He further emphasized the need for integrating programs and for ART and IPT to comprise the core components of HIV services.

    TasP in HCV infection

    Day Three concluded with a roundtable session looking at Treatment as Prevention in Hepatitis C (HCV). Dr. Ron Valdiserri from the U.S. Department of Health began by presenting the U.S. experience with HCV. Challenges with HCV infection begin with the significant number of HCV-infected individuals who fail to be tested and gaps in linkages to care and treatment, particularly among racial and ethnic minorities. He pointed to unstable housing and lack of insurance as obstacles to treatment adherence. Dr. Valdiserri argued for implementing best practices in Treatment as Prevention to address HCV, including linking to confirmatory testing and care, leveraging established HIV systems, utilizing electronic health records, exploring non-physician centred models, and educating and supporting patients.

    In his talk, Dr. John Ward, Head of Viral Hepatitis at CDC, presented on the need for expanding the individual and public health benefits of HCV treatment. He pointed to new HCV treatments as representing a tremendous opportunity to reduce morbidity and mortality, and advised that policies should be focused on expanding access to testing care and treatment services. Dr. Ward highlighted injection drug users and marginalized populations as particularly in need of outreach and expanded access. He closed with a call for further research to guide an HCV Treatment as Prevention framework.

    The session ended with a presentation from Dr. Mel Krajden, Director of Hepatitis Services at BCCDC. Dr. Krajden gave findings from the British Columbia experience with HCV, specifically among two highly impacted groups: ’baby boomers’ and injection drug users. He argued for Treatment as Prevention to be part of a comprehensive population-based HCV prevention, care, and treatment strategy.

    What’s ahead

    The final day of the Treatment as Prevention Workshop begins with a debate that will ask if PrEP is an essential component of Treatment as Prevention. Bob Grant and Brian Williams will participate in this debate moderated by Ann Duerr and Ken Mayer. The morning session will continue with two abstract-driven sessions featuring late breaker presentations.

    The afternoon will begin with a session entitled “Evolving HAART guidelines and TasP”. Reuben Granich of the World Health Organization will present on global guidelines, followed by a roundtable comprising Charles Holmes, Bernhard Schwartländer, and Theo Smart.

    Community peer-based efforts will be the focus of the second afternoon session. Presenters include Daniel Ochieng Ofuwo, Maria Campos, and Paul Kawata.

    The workshop will conclude with a final roundtable session, “Financing: More money or more ‘bang for the buck’?” Panelists include Joep Lange, Denis Broun, and Meredith Moore.

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