Transcript Slide 1
IAS Policy and Advocacy priority on
Treatment as Prevention
Carlos F. Cáceres
Multidisciplinary Research on ARV-based Prevention
30 June 2013
Kuala Lumpur
TasP Advisory Group, IAS
Goal
To expand access to antiretrovirals for
individual and societal benefit and to
investigate and address programmatic and
implementation challenges
Objectives
To disseminate the results of research on the individual and
community benefit of antiretrovirals and on their use for
prevention, bridging the gap between science and
implementation
To work with civil society, National AIDS programmes and other
stakeholders to deliver services and to ensure increased
access to high quality prevention, care and treatment,
including antiretrovirals
To create opportunities for dialogue and discussion at
national, regional and international levels on increasing access
of quality antiretrovirals for treatment and prevention
Key areas of TasP implementation
economic issues
policy, legal, legislative and regulatory issues
impact on health care systems and health
care providers, and additional challenges or
benefits it can bring
Individual and social issues
Zambia consultation- March 2013
Concerns:
HIV testing done when people
seek medical help for health
symptoms or pregnancy
inadequacies in staffing and
workload
low quality of care and health
worker attitudes
unacceptable waiting time
poor confidentiality
poor follow up
difficulties in reaching people
in rural areas
urban bias in services
Ways forward:
ensure efficiency and
effectiveness of health service
task shifting of community health
workers
investment in long term security
of drug supply to ensure
diversity, sufficiency, affordable
production/ acquisition
national analysis on cost
modeling based on the PopART
work across disciplines and
departments
shortening the time between HIV
diagnosis and ART initiation
mobile companies to support
adherence
Zambia consultation- March 2013
France consultation- April 2013
knowledge of TasP
reduction of the number of people not knowing they have
HIV status
responsibility of all stakeholders
risk of categorising people living with HIV
TasP must not become a new moral standard
no enthusiasm or consensus on TasP
use of condoms remaining the main part of combined prevention
incorporating the effects of preventive treatment
for the populations most exposed to HIV, TasP seems to complement
pre-exposure prophylaxis (PreP)
certain consensus on TasP to guide the next national
recommendations on care for people living with HIV
Recommendations: France
A common position on forms of treatment needs to be developed, highlighting in a more
positive way the individual benefits of taking part in an ARV programme
More research is needed on the effect of TasP on MSM
how TasP and PreP complement each other
effect of early treatment on treatment options and choices
Prevention needs to incorporate the effects of preventive treatment, promoting lifelong
individualised combined prevention and be based on the use of condoms
A major focus needs to be put on screening as a way of revealing the "hidden epidemic”
Improving access to care and getting people to remain in care
the needs of patients need to be at the centre
social determinants of health
GP- incorporation of sexual health and quality of life are further challenges in
improving care
effects of long-term treatment
Advocacy priorities, mainly focused on the issue of funding improvements in the fight
against AIDS in France (financing prevention, sexual health education and sexual health
centres, etc.). Such advocacy can be the precursor to a discussion on treatment costs,
based on the introduction of generic drugs in France.
IAS – WHO Pre-Conference- 29 June
Presented and discussed scientific evidence and
programme experience across regions on maximizing
the treatment and prevention benefits of ART for key
populations
Discuss human rights and ethical implications of
maximizing the treatment and prevention benefits of
ART for key populations
Formulated research questions in the context of
maximizing the treatment and prevention benefits of
ART for key populations