IAS Policy and Advocacy priority on

Treatment as Prevention Carlos F. Cáceres

Multidisciplinary Research on ARV-based Prevention30 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

•new partnerships and alternative funding mechanisms: mining licenses, corporate social responsibility programmes, levies

•tracking investment of the government in treatment and health care

Financing

•investment in prevention

•adherence to ART

Behavioural issues

•making testing accessible and acceptable

•reduction of barriers to ART initiation

Patient centred approach

•voluntary and confidential testing

•patients’ choice when to start treatment

•decriminalization of sex work, IDU and MSM

Human rights

•adoption of TasP as a national policy

•TasP as a way to establish National Health Fund

•opportunity to consolidate policies

Country ownership

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