The Vancouver Consensus: antiretroviral medicines, medical evidence, and political will

Beyrer, Chris; Birx, Deborah L.; Bekker, Linda‐Gail; Barré‐Sinoussi, Françoise; Cahn, Pedro; Dybul, Mark; Eholié, Serge; Kavanagh, Matthew M.; Katabira, Elly; Lundgren, Jens D.; Mworeko, Lilian; Palà, M; Puttanakit, Thanyawee; Ryan, Owen; Sidibé, Michel; Montaner, Julio S. G.

doi:10.1016/s0140-6736(15)61458-1

Cited by 26 publications

(17 citation statements)

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“…Recent studies focused on the timing of antiretroviral therapy (ART) initiation have found that early diagnosis and treatment improves outcomes for people living with HIV (PLWH) [2••, 3••] and prevents HIV transmission to their sexual partners [4]. Based upon these results, the World Health Organization (WHO) has now stated it supports a “test and treat” model of care for all PLWH [5], supported by the Vancouver Statement [6]. If this strategy is ultimately adopted across nations in sub-Saharan Africa, it will lead to an expansive effort to include early-stage individuals in care, many of whom will be asymptomatic.…”

Section: Introductionmentioning

confidence: 99%

Cascade of Refusal—What Does It Mean for the Future of Treatment as Prevention in Sub-Saharan Africa?

Katz

Bangsberg

2016

Curr HIV/AIDS Rep

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Recent recommendations by the World Health Organization support treatment for all people living with HIV (PLWH) globally to be initiated at the point of testing. While there has been marked success in efforts to identify and expand treatment for PLWH throughout sub-Saharan Africa, the goal of universal treatment may prove challenging to achieve. The pre-ART phase of the care cascade from HIV testing to HIV treatment initiation includes several social and structural barriers. One such barrier is antiretroviral therapy (ART) treatment refusal, a phenomenon in which HIV-infected individuals choose not to start treatment upon learning their ART eligibility. Our goal is to provide further understanding of why treatment-eligible adults may choose to present for HIV testing but not initiate ART when indicated. In this article, we will discuss factors driving pre-ART loss and present a framework for understanding the impact of decision-making on early losses in the care cascade, with a focus on ART refusal.

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Section: Introductionmentioning

confidence: 99%

Cascade of Refusal—What Does It Mean for the Future of Treatment as Prevention in Sub-Saharan Africa?

Katz

Bangsberg

2016

Curr HIV/AIDS Rep

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“…After many years of frustrating trials of HIV preventive interventions which failed, measurably, to reduce new infections the field of HIV prevention, research has had some remarkable recent successes, most notably with the findings from multiple trials of the use of antiretroviral drugs for primary prevention and for treatment as prevention . Both oral pre‐exposure prophylaxis (PrEP) and the use of treatment in HIV‐infected people to reduce infectiousness as a preventive intervention (treat as prevention: TasP) have shown efficacy in multiple randomized controlled trials, and have increasingly demonstrated impressive effectiveness in real‐world settings . Translating the findings of these advances into implementable programs, and achieving meaningful coverage of those at risk and in need, poses enormous operational and human challenges.…”

Section: What Then Is the Way Forward?mentioning

confidence: 99%

Pre‐exposure prophylaxis for people who inject drugs and their sex partners

Beyrer

2016

Addiction

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“…11,14 For country-level efforts to make considerable impact on HIV-related outcomes, it is critical to identify and address the factors or determinants that influence desired behaviors at each stage of the continuum. Furthermore, as test and treat (a model promoting targeted testing and initiation of all PLHIV on ART irrespective of the CD4 level) rolls out, the ability to positively influence behavior to test early and engage in care when one still feels well will become even more pressing.…”

Section: Introductionmentioning

confidence: 99%