'Getting to zero' in Asia and the Pacific through more strategic use of antiretrovirals for HIV prevention

Abstract

Encouraged by experimental trials demonstrating the efficacy of antiretrovirals (ARVs) in preventing HIV infection, countries across the Asia-Pacific region have committed to the achievement of ambitious targets tantamount to ending AIDS. The available data suggest that some countries still can make progress through targeted condom promotion and the expansion of harm-reduction interventions, but that none may realise its vision of 'zero new HIV infections' without more strategic use of ARVs as part of a combination of HIV prevention efforts targeting key populations. Low rates of HIV testing among men who have sex with men, people who inject drugs, sex workers and other key populations evidence low treatment coverage where treatment could have the greatest impact on curbing local epidemics. Studies have demonstrated the promise of adding ARV treatment and pre-exposure prophylaxis to the existing HIV prevention toolkit, but achieving population-level impact will require service-delivery approaches that overcome traditional prevention, care and treatment program distinctions. Priorities include: (1) innovative strategies to reach, test, treat and retain in services the individuals most likely to acquire or transmit HIV; (2) task shifting and enhanced partnerships between the public sector and civil society; (3) improved 'cascade' data systems to assess and promote service uptake and retention; and (4) policy and financing reform to enhance HIV testing and treatment access among key populations.

Bringing new HIV infections to zero – opportunities and challenges offered by antiretroviral-based prevention in Asia, the Pacific and beyond: An overview of this special issue

“…Cassell and colleagues describe how countries in our region also differ with respect to HIV epidemiology, including the intensity and trajectory of the epidemics, the population groups and HIV transmission factors involved. 8 Although the epidemic is stabilising in the region as a whole, the regional indicators may mask important epidemic transmission dynamics across countries. Overall, HIV infections seem to be concentrated in the key population groups, but the relative burden of new infections in specific key populations differs by country, sometimes even within contiguous counties in a limited geographic area (as illustrated among counties in the Mekong subregion).…”