Maximizing the treatment and prevention benefits of antiretroviral
therapy for key populations:
What additional evidence is required?
Co-Conveners: WHO and IAS
29 June 2013
Dorsett Regency
Kuala Lumpur, Malaysia
Concept Paper
Introduction
The HPTN 052 trial demonstrated that antiretroviral drugs are important for preventing the
transmission of HIV and for treatment of the individual. Recent cohort studies further suggest that
increasing antiretroviral treatment coverage is important to decrease the risk of HIV acquisition at
the population level. Following these results, the global HIV/AIDS community has aggressively
mobilized to accelerate scale-up of antiretroviral therapy (ART) as both a treatment and a prevention
strategy.
Maximizing the treatment and prevention benefits of ART requires that clinical guidelines reflect
earlier treatment, less toxic regimens, and service delivery approaches that improve engagement of
people with HIV across the continuum of care. Implementation science (IS) plays a fundamental
role in building the evidence-base for such policy and programme decision-making by systematically
examining the challenges to treatment for prevention scale-up, developing and accessing different
strategies, and evaluating the impact of antiretroviral treatment programmes.
Dialogue on implementation science has been on-going since the results of the HPTN 052 trial were
released. A stakeholders consultation in 2011 reviewed ongoing and planned research on prevention
of ART in men who have sex with men and other populations who practice penile anal intercourse.
In 2012, the WHO, the United States National Institutes of Health (NIH) and the network on
Therapeutics Research, Education, and AIDS Training in Asia (TREAT Asia) hosted consultations in
Asia to discuss current and future efforts in implementation science to inform treatment for
prevention strategies in the region. WHO has also conducted regional consultations on the Strategic
Use of Antiretrovirals with HIV programmes in Asia and Africa. The 2013 WHO Consolidated ARV
Guidelines for HIV treatment and prevention raise questions around the strength of evidence on
offering ART to key populations with CD4 counts above 500 cells/mm3.
In 2013, the International AIDS Society (IAS) has co-organized two country level consultations in
Zambia and France, lifting up economic, legal, regulatory, systemic and social and individual issues
regarding treatment for prevention implementation. The impact on health care systems, health care
providers, health care systems delivery and additional challenges or benefits from the
implementation of maximizing the treatment and prevention benefits of ART were also analyzed.
The experiences, opportunities, challenges and complexities of potential treatment for prevention
implementation strategies were brought to the fore. The voices and experiences from communities
and national stakeholders are also being channelled to the international forums and policy makers.
We now have an opportunity to continue and further expand the dialogue on the role of
implementation science to accelerate treatment for prevention research in key populations,
addressing health systems, human rights, as well as, ethical issues.
This concept paper proposes a global consultation titled “Maximizing the treatment and
prevention benefits of ARVs for Key Populations: What Additional Evidence is Required?” on 29
June 2013. This will be held before the 7th IAS Conference on HIV Pathogenesis, Treatment and
Prevention in Kuala Lumpur, Malaysia from 30 June - 3 July 2013. This one day pre-conference
meeting will be co-convened by IAS and WHO and will bring together leading experts in HIV/AIDS
and implementation research, public health and programme specialists, policymakers, and civil
society groups to share information on current efforts and continuing challenges in using
implementation science to inform treatment for prevention and key populations. Building on the
advances outlined in the 2013 WHO Consolidated ARV Guidelines for Treatment and Prevention,
the main outcome of this meeting will be to identify research domains and questions for
maximizing the treatment and prevention benefits of ART in key populations. The audience for
this meeting will be researchers and funders of research, policy makers and civil society.
Objectives
The purpose of the meeting is to begin developing a research agenda on maximizing the treatment
and prevention benefits of ART for key populations.
The objectives are:
 To present and discuss scientific evidence and programme experience across countries on
maximizing the treatment and prevention benefits of ART for key populations
 To discuss human rights and ethical implications of maximizing the treatment and
prevention benefits of ART for key populations
 Review Child Health and Nutrition Research Initiative methodology for developing research
agenda
 To formulate research questions in the context of maximizing the treatment and prevention
benefits of ART for key populations
* Key populations are MSM, TG, PWID and SW (including adolescents in these populations)
Time
presenter
CHAIRS
08:00-08:30
08:30-08:35
Potential Topics
STEN VERMUND AND ANDREW HUNTER
Registration
Chris Lee, Malaysia MoH
Welcoming remarks
Time
08:35-08:50
presenter
Meg Doherty, WHO
Potential Topics
Meeting objectives and rationale
-Key population ART recommendations in 2013
guidelines
-Role of implementation sciences to monitor and
evaluate guidelines
-Description of CHNRI process for creating HIV
treatment research agenda
08:50-09:00
Chris Beyrer, JHU
ART scientific landscape for key populations
09:00-09:10
Anna Zakowicz, IAS
Outcomes of IAS country consultations
09:10-09:20
Emily Erbelding, NIH
NIH scientific updates, funding opportunities and
on-going collaboration
09:20-09:30
Cameron Wolf, USAID
PEPFAR scientific updates, funding opportunities
and on-going collaboration
09:30-09:45
Jerome Singh, Univ KZN
Ethical and human rights issues related to
offering ART to key populations irrespective of
their CD4 count
09:45-09:55
Panusart (Midnight)
Poonkasetwatana, APCOM
Community perspectives on accessing ART
irrespective of CD4 count in key populations
09:55-10:05
Nzansimana Sabin, Rwanda Implementation questions for maximizing the
MoH
treatment and prevention benefits of ART in KP in
Rwanda
10:05-10:15
Beatriz Grinsztejn, FIOCRUZ
Research on maximizing the treatment and
prevention benefits of ART in MSM/TG in Brasil
10:15-10:30
ALL
Tea Break
CHAIRS
SHIBA PHURAILATPAM AND MEG DOHERTY
10:30-10:40
Ying Ru-Lo, WHO Western Research on maximizing the treatment and
Pacific Regional Office
prevention benefits of ART in PWID in Asia
10:40-12:00
Kenneth
Health
Mayer,
12:00-13:00
Andrew
Institute
Grulich,
Fenway Interventions to improve engagement of key
populations as part of the ART cascade. 15
minute presentation followed by group
discussion on research questions.
Kirby Transmission dynamics in key populations
(including acute infection, on-going research). 15
minute presentation followed by group
Time
presenter
Potential Topics
discussion on research questions.
13:00-14:00
ALL
Lunch
14:00-15:20
Jens Lundgren, Copenhagen
HIV Programme (Against)
Julio Montaner, UBC (For)
TBC
ART should be offered to key populations
irrespective of their CD4 count. 10 minute
presentations followed by group discussion on
research questions
15:20-16:30
Tim Mastro, FHI 360
Programmatic monitoring and evaluation of ART
impact (incidence assays, community viral load,
mortality, morbidity, and other key metrics). 15
minute presentation followed by group
discussion on research questions
16:30-16:45
ALL
Tea Break
16:45-16:55
Annette Sohn, AMFAR
AMFAR scientific updates, funding opportunities
and on-going collaboration
16:55-17:05
Chris
Duncombe,
Foundation TBC
17:05-17:15
Mohamed Osman, Elton John Elton John Foundation scientific updates, funding
Foundation TBC
opportunities and on-going collaboration
17:15-17:45
Sten Vermund, Vanderbilt Summary of discussions and the way forward
University
and
Rachel
Baggaley, WHO
Gates Gates Foundation scientific updates, funding
opportunities and on-going collaboration
Meeting Participants
Diverse Roles, Countries, and Organizations
The meeting will have attendees representing a diverse group of researchers, technical experts,
policymakers, civil society representatives.