7th IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2013)


MOAC02 Treatment as Prevention: A Work in Progress
  Oral Abstract Session : Track C Prevention Science
Venue: Session Room 1
Time: 01.07.2013, 14:30 - 16:00
Co-Chairs: Suwat Chariyalertsak, Thailand
Nagalingeswaran Kumarasamy, India

14:30
MOAC0201
Abstract
Powerpoint
Webcast
Early antiretroviral therapy, sexual behaviours and HIV-1 transmission risk: estimates from the Temprano-ANRS 12136 Randomized Controlled Trial, Abidjan, Côte d´Ivoire
K. Jean1,2, D. Gabillard3,4, R. Moh3, C. Danel3, R. Fassassi5, A. Desgrées-du-Loû6, S. Eholié3,7, F. Lert1,2, X. Anglaret3,4, R. Dray-Spira1,2
1INSERM, Center for Research in Epidemiology and Population Health (CESP-U1018), Villejuif, France, 2Université Versaille Saint-Quentin, UMRS 1018, Villejuif, France, 3PAC-CI Program, CHU de Treichville, Abidjan, Cote D'Ivoire, 4Université Bordeaux Segalen, INSERM U897, Bordeaux, France, 5National Institute of Statistics and Applied Economy, Department of Population Research and Development, Abidjan, Cote D'Ivoire, 6IRD (Institut de Recherche pour le Développement), CEPED (Population and Development Research Center -UMR 196- Paris Descartes/INED/IRD), Paris, France, 7Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Cote D'Ivoire

14:45
MOAC0202
Abstract
Powerpoint
Webcast
Delay in antiretroviral therapy initiation is common among east African HIV-1-infected individuals in serodiscordant partnerships
A. Mujugira1, C. Celum1, K. Thomas1, C. Farquhar1, N. Mugo1, E. Katabira2, E. Bukusi3, E. Tumwesigye4, J. Baeten1, Partners PrEP Study Team
1University of Washington, Seattle, United States, 2Makerere University, Kampala, Uganda, 3Kenya Medical Research Institute, Nairobi, Kenya, 4Kabwohe Clinical Research Centre, Kabwohe, Uganda

15:00
MOAC0203
Abstract
Powerpoint
Webcast
The epidemiological impact and cost-effectiveness of expanded eligibility for and access to adult antiretroviral therapy in South Africa, Zambia, India and Vietnam: a twelve model analysis
J.W. Eaton1, N.A. Menzies2, J. Stover3, V. Cambiano4, L. Chindelevitch5, A. Cori6, J.A.C. Hontelez7,8,9, S. Humair10,11, C.C. Kerr12, D.J. Klein13, S. Mishra1,14, K.M. Mitchell15, B.E. Nichols16, P. Vickerman17, T. Bärnighausen8,10, A. Bershteyn13, D.E. Bloom10, M.-C. Boily1, S.T. Chang13, T. Cohen18,19, P.J. Dodd20, C. Fraser6, C. Gopalappa3, J. Lundgren21,22, N.K. Martin17,23, E. Mountain1, Q.D. Pham12, M. Pickles1, A. Phillips4, L. Platt17, C. Pretorius3, H.J. Prudden17, J.A. Salomon2,5, D.A.M.C. van de Vijver16, B.G. Wagner13, R.G. White20, D.P. Wilson12, L. Zhang12, J. Blandford24, G. Meyer-Rath25,26, M. Remme17, F. Terris-Prestholt17, P. Revill27, N. Sangrujee24, M. Doherty28, P. Easterbrook28, G. Hirnschall28, T.B. Hallett1, HIV Modelling Consortium ART Eligibility Guidelines Working Group
1Imperial College London, Department of Infectious Disease Epidemiology, London, United Kingdom, 2Harvard School of Public Health, Center for Health Decision Sciences, Boston, United States, 3Futures Institute, Glastonbury, United States, 4University College London, Research Department of Infection and Population Health, London, United Kingdom, 5Harvard School of Public Health, Department of Global Health and Population, Boston, United States, 6Imperial College London, MRC Centre for Outbreak Analysis and Modelling, London, United Kingdom, 7Erasmus Medical Center, Department of Public Health, Rotterdam, Netherlands, 8University of KwaZulu-Natal, Africa Centre for Health and Population Studies, Mtubatuba, South Africa, 9Radboud University Nijmegen Medical Centre, Nijmegen International Center for Health System Analysis and Education (NICHE), Department of Primary and Community Care, Nijmegen, Netherlands, 10Harvard School of Public Health, Boston, United States, 11Lahore University of Management Sciences, School of Science and Engineering, Lahore, Pakistan, 12University of New South Wales, Kirby Institute, Sydney, Australia, 13Intellectual Ventures Laboratory, Epidemiological Modeling Group, Bellevue, United States, 14University of Toronto, Division of Infectious Diseases, St. Michael's Hospital, Toronto, Canada, 15London School of Hygiene and Tropical Medicine, Department of Global Health and Development, London, United Kingdom, 16Erasmus Medical Center, Department of Virology, Rotterdam, Netherlands, 17London School of Hygiene and Tropical Medicine, Social and Mathematical Epidemiology Group, London, United Kingdom, 18Brigham and Women's Hospital, Division of Global Health Equity, Boston, United States, 19Harvard School of Public Health, Department of Epidemiology, Boston, United States, 20London School of Hygiene and Tropical Medicine, Department of Infectious Disease Epidemiology, London, United Kingdom, 21Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark, 22University of Copenhagen, Copenhagen, Denmark, 23University of Bristol, School of Social and Community Medicine, Bristol, United Kingdom, 24U.S. Centers for Disease Control and Prevention, Atlanta, United States, 25Boston University, Center for Global Health and Development, Boston, United States, 26University of Witwatersrand, Health Economics and Epidemiology Research Office, Department of Medicine, Johannesburg, South Africa, 27University of York, Centre for Health Economics, York, United Kingdom, 28World Health Organization, Department of HIV/AIDS, Geneva, Switzerland

15:15
MOAC0204
Abstract
Powerpoint
Webcast
Acceptability of early initiation of antiretrovirals for treatment as prevention among HIV-infected persons in Mochudi, Botswana
A. Logan1, R. Plank1,2,3, L. Bogart4, K. Moloi1, K. Maotonyane1, H. Bussmann1, L. Okui1, F. Earls5, M. Essex1,3, S. Lockman1,2,3
1Botswana-Harvard AIDS Institute Partnership, Gaborone, Botswana, 2Brigham and Women's Hospital, Division of Infectious Diseases, Boston, United States, 3Harvard School of Public Health, Immunology and Infectious Diseases, Boston, United States, 4Boston Children's Hospital, Division of General Pediatrics, Boston, United States, 5Harvard University School of Public Health, Social and Behavioral Sciences, Boston, United States

15:30
MOAC0205
Abstract
Modelling the expected impact of a treatment as prevention (TasP) implementation study on HIV incidence in Swaziland
G. Botha1, V. Okello2, C. Azih2, A. Welte3, A. End4, F. Walsh4, Y. Fleming5, W. Delva1
1SACEMA, Stellenbosch, South Africa, 2Swaziland MoH, Mbabane, Swaziland, 3Stellenbosch University, SACEMA, Stellenbosch, South Africa, 4Clinton Health Access Initiative, Mbabane, Swaziland, 5Stop AIDS Now!, Amsterdam, Netherlands

15:45
MOAC0206
Webcast
Moderated discussion

Powerpoints presentations
Early antiretroviral therapy, sexual behaviours and HIV-1 transmission risk: estimates from the Temprano-ANRS 12136 Randomized Controlled Trial, Abidjan, Côte d´Ivoire - Kévin Jean

Delay in antiretroviral therapy initiation is common among east African HIV-1-infected individuals in serodiscordant partnerships - Andrew Mujugira

The epidemiological impact and cost-effectiveness of expanded eligibility for and access to adult antiretroviral therapy in South Africa, Zambia, India and Vietnam: a twelve model analysis - Jeffrey W Eaton

Acceptability of early initiation of antiretrovirals for treatment as prevention among HIV-infected persons in Mochudi, Botswana - Andrew Logan



Rapporteur reports

Track C report by Sten Vermund


The Treatment as Prevention (TasP) scientific agenda was represented with 3 original data presentations and two mathematical models. 

Early ART, sexual behaviours and HIV-1 transmission risk: estimates from the Temprano-ANRS 12136 RCT, Abidjan, Côte d´Ivoire.” In 957 volunteers, the association of ART status with sexual behaviors was assessed.  About  70% were sexually active, and there was 21% last unprotected intercourse in the delayed ART group and 15% in early group (p=0.08).  This is good news, as it indicates strongly that earlier ART was not an incentive to throw away condoms (though both groups had fairly low condom use). In the early therapy group, only 2.4% were with high viral load and no condom use vs. 10.7% in the later therapy group (p<0.01), so early therapy seemed to be the best option.

Delay in ART initiation is common among east African HIV-1-infected individuals in serodiscordant partnerships.”   Among  4747 discordant partners, those with CD4>250 or with WHO stage 3/4 were offered ART.  Some accepted (immediate ART group), but other deferred to  >6 months later to initiate ART; 1998 of 2184 eligible for ART completed at least one visit.  By 6 months, 61% commenced ART, 79% by 12 mos. and about 90% after 18 months.  Higher initiation of ART occurred at lower CD4, higher WHO stage, and among non-alcohol consumers.  That alcohol use was a significant associated factor with delayed uptake of ART was important.  Lengthy pre-treatment processing and repeating CD4 counts inhibited ART start.

Acceptability of early initiation of antiretrovirals for treatment as prevention among HIV-infected persons in Mochudi, Botswana.” Botswana’s adult HIV prevalence is 23.4% with an estimated 9000 new infections/year (28 times higher than the US).  The qualitative work nested within the Mochudi study was “Will HIV+ persons want ART if they have >350 CD4 and feel healthy?”  Barriers to ART/TasP included stigma,disclosure/shame, side effects, that ART cannot be stopped, and that they cannot take ART with alcohol or traditional medicines. ART facilitators included the desire to improved health and knowing an adherent person who got better.

The epidemiological impact and cost-effectiveness of expanded eligibility for and access to adult antiretroviral therapy in South Africa, Zambia, India and Vietnam: a twelve model analysis.”  12 modeling groups participated and presented 15 models.  Costs per DALY saved were highly favorable in all settings under all assumptions, so early ART cost less than one GDP, the  benchmark for being very cost-effective.  Earlier commencement of ART was better than trying to find all the lower CD4 persons who had not yet gotten into the program, but this was not consistent across all assumptions and countries.  Higher risk persons being highlighted for ART access in concentrated epidemics had the greatest impact

Modelling the expected impact of atreatment as prevention (TasP) implementation study on HIV incidence in Swaziland”.  The highlights of the deterministic model included its utility to project data to out-years that are derived from current intervention data, since the model tracks closely with current realities and presumably will therefore have predictive value as well, as Swaziland rolls out ART for treatment as well as for prevention.  




Community Advisory Group report by Kevin Nicholas Baker


There is a difference in the meaning of treatment as prevention depending on the population concerned and the structural factors in the local environment – developed versus developing country for example.  Treatment as prevention needs to be a choice for the people involved.  While models are useful they don’t always reflect real life scenarios and must be used with care.  Attitudes can be barriers to accessing treatment as prevention – fear of stigma and disclosure/shame.  They can also be facilitators e.g. ART is easy to take.  Community agreed that more work needs to be done to ensure that effective treatment as prevention programming can be developed for specific settings and populations.




   

    The organizers reserve the right to amend the programme.