Exploring the population-level impact of antiretroviral treatment

Mishra, Sharmistha; Mountain, Elisa; Pickles, Michael; Vickerman, Peter; Shastri, Suresh; Gilks, Charles F.; Dhingra, Nandini K.; Washington, Reynold; Becker, Marissa; Blanchard, James; Alary, Michel; Boily, Marie‐Claude

doi:10.1097/qad.0000000000000109

Cited by 14 publications

(16 citation statements)

References 39 publications

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“…The best implementation strategies for specialized HIV-positive communities and their larger population in which they reside should also be investigated and employed to ensure the success of TasP. For instance, it was found that prioritizing access to care to female sex workers and their clients was the most efficient way to expand ART and avert remaining HIV infections within the general population in a ten year period in South India, rather than expanding ART eligibility (Mishra, Mountain, Pickles, Vickerman, Shastri, Gilks et al, 2014).…”

Section: ) Prioritized Tasp Scale-up In Key Populations At High Riskmentioning

confidence: 99%

The economics, financing and implementation of HIV treatment as prevention: What will it take to get there?

Wilson

Taaffe

Fraser‐Hurt

et al. 2014

African Journal of AIDS Research

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The 2013 Lancet Commission Report, Global Health 2035, rightly pointed out that we are at a unique place in history where a "grand convergence" of health initiatives to reduce both infectious diseases, and child and maternal mortality--diseases that still plague low income countries--would yield good returns in terms of development and health outcomes. This would also be a good economic investment. Such investments would support achieving health goals of reducing under-five (U5) mortality to 16 per 1000 live births, reducing deaths due to HIV/AIDS to 8 per 100,000 population, and reducing annual TB deaths to 4 per 100,000 population. Treatment as prevention (TasP) holds enormous potential in reducing HIV transmission, and morbidity and mortality associated with HIV/AIDS--and therefore contributing to Global Health 2035 goals. However, TasP requires large financial investments and poses significant implementation challenges. In this review, we discuss the potential effectiveness, financing and implementation of TasP. Overall, we conclude that TasP shows great promise as a cost-effective intervention to address the dual aims of reducing new HIV infections and reducing the global burden of HIV-related disease. Successful implementation will be no easy feat, though. The dramatic increases in the numbers of persons who need antiretroviral therapy (ART) under a TasP approach will pose enormous challenges at all stages of the HIV treatment cascade: HIV diagnosis, antiretroviral (ARV) initiation, ARV adherence and retention, and increased drug resistance with long-term enrolment on ART. Overcoming these implementation challenges will require targeted implementation, not focusing exclusively on TasP, most-at-risk population (MARP)-friendly services for key populations, integrating services, task shifting, more efficient programme management, balancing supply and demand, integration into universal health coverage efforts, demand creation, improved ART retention and adherence strategies, the use of incentives to improve HIV treatment outcomes and reduce unit costs, continued operational research and tapping into technological innovations.

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Section: ) Prioritized Tasp Scale-up In Key Populations At High Riskmentioning

confidence: 99%

The economics, financing and implementation of HIV treatment as prevention: What will it take to get there?

Wilson

Taaffe

Fraser‐Hurt

et al. 2014

African Journal of AIDS Research

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“…Models constructed around concentrated epidemics in Asia have found that the relative benefits of ART expansion in FSW are highly dependent on condom use and epidemic size. 24,25 Few models have been constructed around FSW in West Africa, where successful targeted interventions have been in place since the 1990s, which could influence gains of ART expansion. 26,27 Burkina Faso is one of several nations in which the incidence of HIV has declined, despite limited availability of ART until recently.…”

Section: Introductionmentioning

confidence: 99%

Potential Impact of Existing Interventions and of Antiretroviral Use in Female Sex Workers on Transmission of HIV in Burkina Faso

Low

Nagot²,

Konaté

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

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“…171 A recent modeling study in India suggests that in the presence of existing condom-based interventions, existing ART programs could avert 11-28% of the remaining HIV infections in FSW between 2014 and 2024. 172 Several studies of TasP are ongoing in India, Vietnam, Thailand, China, and Indonesia. In China, a 10-fold increase in ART could decrease the number of HIV-related deaths by 58% and the number of new infections by 25% by 2015.…”

Section: Treatment As Prevention (Tasp)mentioning

confidence: 99%

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

Phanuphak

Shao³

et al. 2015

AIDS Research and Human Retroviruses

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An overall decrease of HIV prevalence is now observed in several key Asian countries due to effective prevention programs. The decrease in HIV prevalence and incidence may further improve with the scale-up of combination prevention interventions. The implementation of future prevention trials then faces important challenges. The opportunity to identify heterosexual populations at high risk such as female sex workers may rapidly wane. With unabating HIV epidemics among men who have sex with men (MSM) and transgender (TG) populations, an effective vaccine would likely be the only option to turn the epidemic. It is more likely that efficacy trials will occur among MSM and TG because their higher HIV incidence permits smaller and less costly trials. The constantly evolving patterns of HIV-1 diversity in the region suggest close monitoring of the molecular HIV epidemic in potential target populations for HIV vaccine efficacy trials. CRF01_AE remains predominant in southeast Asian countries and MSM populations in China. This relatively steady pattern is conducive to regional efficacy trials, and as efficacy warrants, to regional licensure. While vaccines inducing nonneutralizing antibodies have promise against HIV acquisition, vaccines designed to induce broadly neutralizing antibodies and cell-mediated immune responses of greater breadth and depth in the mucosal compartments should be considered for testing in MSM and TG. The rationale and design of efficacy trials of combination prevention modalities such as HIV vaccine and preexposure prophylaxis (PrEP) remain hypothetical, require high adherence to PrEP, are more costly, and present new regulatory challenges. The prioritization of prevention interventions should be driven by the HIV epidemic and decided by the country-specific health and regulatory authorities. Modeling the impact and cost-benefit may help this decision process.

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Exploring the population-level impact of antiretroviral treatment

Cited by 14 publications

References 39 publications

The economics, financing and implementation of HIV treatment as prevention: What will it take to get there?

The economics, financing and implementation of HIV treatment as prevention: What will it take to get there?

Potential Impact of Existing Interventions and of Antiretroviral Use in Female Sex Workers on Transmission of HIV in Burkina Faso

HIV Epidemic in Asia: Implications for HIV Vaccine and Other Prevention Trials

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