{"id":1359,"date":"2017-11-09T15:37:46","date_gmt":"2017-11-09T15:37:46","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1359"},"modified":"2017-11-09T15:37:46","modified_gmt":"2017-11-09T15:37:46","slug":"what-is-the-potential-of-treatment-for-prevention-in-fighting-hivaids","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2017\/11\/09\/what-is-the-potential-of-treatment-for-prevention-in-fighting-hivaids\/","title":{"rendered":"What is the potential of \u2018Treatment for Prevention\u2019 in fighting HIV\/AIDS?"},"content":{"rendered":"

UNAIDS 90:90:90<\/a> appears to have set the course for a global \u2018treatment as prevention\u2019 strategy. In 2015 the US revised its National HIV\/AIDS Strategy (NHAS) to harmonize its goals with UNAIDS 90% targets for testing, engagement in care, and virological suppression. Though the HIV\/AIDS community have been nervous about the impact of the recent change of administration, the expenditure underpinning the NHAS has been retained despite 18% cuts to the Department of Health and Human Services budget (Trump and HIV\/AIDS spending<\/a>).<\/p>\n

It is no doubt with a view to maintaining this political course that Borre & Walensky<\/a> have recently sought to quantify the benefits of the revised goals as against \u2018current pace\u2019 by using mathematical simulation to project five- and twenty-year outcomes. Given the disproportionate implication of black MSM in these effects (they face a 50% lifetime risk of infection), outcomes are given for this group as well as for the US at large.<\/p>\n

These outcomes are impressive. Achieving NHAS targets, as against current pace, will cause rates of transmission over twenty years to decline: across the general population, from 2.8 to 1.7 per 100 person years (PY); among blacks MSM from 4.3 to 2.7. This will result in a decrease in deaths from 750,000 to 551,000. Cost-effectiveness, as against current pace, is estimated at $68,000 per Quality Adjusted Life Year (QALY) over the whole population, and at $38,300 per QALY for black MSM \u2013 though the authors point to the high proportion of costs represented by the ART drugs, and the potential for improvement in cost-effectiveness, if there were a significant reduction in ART cost. As for affordability, NHAS revised targets would require only a 3% per year increase in budgetary allocation.<\/p>\n

UNAIDS\u00a090:90:90\u00a0<\/a>represents an altogether more ambitious \u2013 and, arguably, less realistic \u2013 target in medium- or limited-resource settings. Some have cautioned against the advocacy of \u2018treatment for prevention\u2019 (TfP) as a global single plank intervention strategy \u2013 and on two counts. First, Kielmann & Cataldo\/STI<\/a> and Wringe & Renju\/STI<\/a> warn that the evaluation of success in terms of TfP targets can result in the adoption of short term or culturally inappropriate measures that could have long-term implications for public attitudes towards care providers. For example, the greater status often accorded to patient-experts in inadequately resourced contexts can result in the promotion of culturally regressive attitudes that may be counter-productive in the long-term business of establishing proper engagement in care (see ‘More haste less speed’\/STI\/blogs<\/a>).<\/p>\n

Griensven & Lo\/STI<\/a> oppose TfP on altogether more radical grounds. With the MSM populations of the cities of the Asia-Pacific region, they argue, infection is so acute and transmission so rapid that any TfP-based intervention is doomed to be ineffective: HIV will have been widely disseminated before linkage-to-care can take place. Needless to say, this critique of TfP goes along with advocacy in the case of these populations of an approach that \u2018widens the cascade with a preventive extention\u2019 \u2013 that is to say, PrEP.<\/p>\n","protected":false},"excerpt":{"rendered":"

UNAIDS 90:90:90 appears to have set the course for a global \u2018treatment as prevention\u2019 strategy. In 2015 the US revised its National HIV\/AIDS Strategy (NHAS) to harmonize its goals with UNAIDS 90% targets for testing, engagement in care, and virological suppression. Though the HIV\/AIDS community have been nervous about the impact of the recent change […]<\/p>\n

Read More…<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[16516,13992,4367,16524],"tags":[],"class_list":["post-1359","post","type-post","status-publish","format-standard","hentry","category-hiv-engagement-in-care","category-hiv-prevention","category-hiv-treatment-cascade","category-treatment-for-prevention"],"yoast_head":"\nWhat is the potential of \u2018Treatment for Prevention\u2019 in fighting HIV\/AIDS? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2017\/11\/09\/what-is-the-potential-of-treatment-for-prevention-in-fighting-hivaids\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"What is the potential of \u2018Treatment for Prevention\u2019 in fighting HIV\/AIDS? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"UNAIDS 90:90:90 appears to have set the course for a global \u2018treatment as prevention\u2019 strategy. 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