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
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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
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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