HIV Treatment as Prevention: Optimising the Impact of Expanded HIV Treatment Programmes
Wim Delva,Jeffrey W. Eaton,Fei Meng,Christophe Fraser,Richard G. White,Peter Vickerman,Marie-Claude Boily,Timothy B. Hallett +7 more
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TLDR
In re-evaluating the allocation of ART in light of the new data about ART preventing transmission, the goal should be to create policies that maximise epidemiological and clinical benefit while still being feasible, affordable, acceptable, and equitable.Abstract:
Until now, decisions about how to allocate ART have largely been based on maximising the therapeutic benefit of ART for patients. Since the results of the HPTN 052 study showed efficacy of antiretroviral therapy (ART) in preventing HIV transmission, there has been increased interest in the benefits of ART not only as treatment, but also in prevention. Resources for expanding ART in the short term may be limited, so the question is how to generate the most prevention benefit from realistic potential increases in the availability of ART. Although not a formal systematic review, here we review different ways in which access to ART could be expanded by prioritising access to particular groups based on clinical or behavioural factors. For each group we consider (i) the clinical and epidemiological benefits, (ii) the potential feasibility, acceptability, and equity, and (iii) the affordability and cost-effectiveness of prioritising ART access for that group. In re-evaluating the allocation of ART in light of the new data about ART preventing transmission, the goal should be to create policies that maximise epidemiological and clinical benefit while still being feasible, affordable, acceptable, and equitable.read more
Citations
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Antiretroviral Therapy Uptake, Attrition, Adherence and Outcomes among HIV-Infected Female Sex Workers: A Systematic Review and Meta-Analysis
Elisa Mountain,Sharmistha Mishra,Peter Vickerman,Michael Pickles,Charles F. Gilks,Marie-Claude Boily +5 more
TL;DR: It is suggested that FSWs can achieve levels of ART uptake, retention, adherence, and treatment response comparable to that seen among women in the general population, but these data are from only a few research settings.
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"You are wasting our drugs": health service barriers to HIV treatment for sex workers in Zimbabwe
TL;DR: Sensitising health workers through specialised training, refining referral systems from sex-worker friendly clinics into the national system, and providing opportunities for SW to collectively organise for improved treatment and rights might help alleviate the barriers to treatment initiation and attention currently faced by SW.
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Phylogenetic inferences on HIV-1 transmission: implications for the design of prevention and treatment interventions.
TL;DR: Migration and globalization has contributed to the spread of non-B subtypes contributing to 20–60% of new infections in Europe, Asia and America.
Journal ArticleDOI
HIV treatment as prevention: Principles of good HIV epidemiology modelling for public health decision-making in all modes of prevention and evaluation
Wim Delva,David Wilson,Laith J. Abu-Raddad,Laith J. Abu-Raddad,Marelize Gorgens,David Wilson,Timothy B. Hallett,Alex Welte +7 more
TL;DR: It is hoped that the principles described here will become a shared resource that facilitates constructive discussions about the policy implications that emerge from HIV epidemiology modelling results, and that promotes joint understanding about when modelling is useful as a tool in quantifying HIV epidemiological outcomes and improving prevention programming.
Journal ArticleDOI
Combination Prevention: New Hope for Stopping the Epidemic
Sten H. Vermund,Richard J. Hayes +1 more
TL;DR: “treatment as prevention” for adult-to-adult transmission reduction includes expanded HIV testing, linkage to care, antiretroviral coverage, retention in care, adherence to therapy, and management of key co-morbidities such as depression and substance use.
References
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TL;DR: To accurately target the most appropriate time to start HAART, the CD4 percentage could be more reliable than the absolute count in sub-Saharan African pregnant women.
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