Biomedical HIV Prevention & TaP Treatment as Prevention 2013

Transcription

1 Biomedical HIV Prevention & TaP Treatment as Prevention 2013 Community Education Team The AIDS Institute/AIDS Alliance Be the Generation to End the AIDS Epidemic bethegeneration.nih.gov This work is supported by the BTG Bridge Project, a collaboration between FHI 360/HIV Prevention Trials Network (HPTN) and the Legacy Project at the Office of HIV/AIDS Network Coordination (HANC).

2 Today s Agenda & Ground-rules Agenda 1.Project Overview 2.Introduction to biomedical HIV prevention & research 3.Highlight on Treatment as Prevention (TaP) 4.Discussion & Questions Ground rules 1.Sign in sheet 2.Time for Discussion 3.Parking Lot 4.More information

3 Be The Generation The Be The Generation project was created to promote awareness and understanding of biomedical prevention in communities most impacted by the HIV/AIDS epidemic Biomedical HIV Prevention involves approaches to HIV prevention that include medicines or are medically based Some are still in development & require more research, such as HIV vaccines, microbicides Some are already available and recently proven by research, such as Pre-exposure prophylaxis (PrEP), Treatment as Prevention (TaP) The best prevention strategies will be a combination of biomedical and behavioral approaches such as condom use and limiting substance abuse.

4 PMTCT- Prevention of Mother to Child Transmission First Biomedical HIV Prevention Success Now regular care in U.S. and much of the world. Before 1994, HIV positive women had at least a 25% chance of passing HIV onto their babies. (1 in 4) Now, in the U.S with PMTCT treatment there is approx. 1% chance of HIV infection in babies where mom and baby treated with HIV meds (1 in 100) Result of a prevention research study known as PACTG 076

5 Why is it important to have community involvement and understanding of biomedical HIV prevention and research?

6 Value of Community Support & Involvement in Research Every year about 50,000 people become infected with HIV in the United States. Even with tremendous advances in treatment prevention is still the best strategy. The relatives, friends and neighbors of people living with HIV may benefit most from prevention advances. Opportunity to better understand the priorities, concerns, beliefs and knowledge of community members

7 Work in progress!

8 Ice Breaker Exercise QUESTION 1 What have I heard about Treatment as Prevention (TaP)? QUESTION 2 What would I like to know about TaP? Question 3 What would I like to know about other biomedical prevention efforts?

9 TaP Treatment as Prevention Overall Strategy of TaP Treatment of HIV positive individuals to achieve: Overall health maintenance STD treatment Lower or undetectable viral load = less HIV symptoms Other Gain of Undetectable Viral Load ( UDVL) Lessen the chance of transmission to uninfected persons Biomedical HIV Prevention research proved the concept & strategy worked Reality of Treatment Cascade is a challenge

10 TaP Treatment as Prevention Issues & Questions: For every 100 individuals living with HIV in the United States, it is estimated that: 80 are aware of their HIV status. 62 have been linked to HIV care. 41 stay in HIV care. 36 get antiretroviral therapy (ART). Only 28 are able to adhere to their treatment and sustain undetectable viral loads.

11 TaP Treatment as Prevention This approach to HIV prevention was proven by a biomedical HIV prevention research study. HPTN 052: Prevention of HIV Infection with Early Antiretroviral Therapy Enrolled more than 1,700 discordant heterosexual Couples were stable couples (94% married) in 9 countries SA, Zimbabwe, Kenya, Botswana, Malawi, India, Thailand, Brazil, US Equal number of male/female were HIV Positive

12 TaP Treatment as Prevention Study Design HPTN 052 The HIV positive person was treated with approved HIV medications in order to prevent infection in their partner. ½ treated early ( at study enrollment) ½ delayed treatment (until CD4 250 or AIDS) All had study visits every 3 months and received counseling, condoms and treatment of STI. Both groups had high adherence (95%) to study instructions by majority of participants Stable couples High condom use (96% in study reported 100% condom use) 89% of early treatment group had UDVL

13 How the TaP Study worked HIV (+) Participants, Randomly Assigned to early or late treatment Early HIV meds, Counseling & Condoms, STD Care Regular Visits for 2-3 Years HIV meds w/aids, Counseling & Condoms, STD Care Regular Visits for 2-3 Years Check partner HIV; side effects, all info into computer database Check partner HIV; side effects, all info into computer database All information on participants is monitored throughout the study by an external group of experts, known as the Data Safety Monitoring Board or DSMB- looking for unexpected side effects or unexpected overwhelming evidence of effect

14 TaP Treatment as Prevention HPTN 052 Study Results: The chance of the uninfected partner getting HIV was reduced by 96% in in early treatment group compared to the no/late treatment group The rate of HIV illness events in infected partner was reduced by 41% in early treatment group compared to no/late treatment group Called the 2012 Scientific Breakthrough of the Year For prevention & health reasons: Standard of care in US ( and other part of world) is now changed to offer immediate treatment of HIV (+)

15 TaP Treatment as Prevention Issues & Questions:

16 Treatment Cascade

17 Discussion & Information