Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

18 April 2012

PRESENTATION: Expanding the Evidence Base for ARV Prevention Strategies: Community Perspectives from India, South Africa, and the United States

Mapping Pathways presented this oral abstract - see below for PowerPoint and abstract - at Microbicides 2012 in Sydney, Australia on 17 April, 2012.

Background: Several clinical trials have reported efficacy of three different ARV-based prevention strategies including vaginal microbicides (CAPRISA 004), PrEP (iPrEx, Partners PrEP, TDF 2), and HIV treatment (HPTN 052). Statistically significant P-values and strong confidence intervals are not sufficient for countries to make decisions on the potential deployment of any ARV-based prevention strategy. Stakeholder inputs from community, research, policy and governmental spheres are critical for mapping pathways to sound, evidence-based decision making.

Methods: Community organizations in India, South Africa and the United States collaborated with RAND to solicit community opinions and concerns regarding ARV-based prevention strategies through an online survey and individual interviews. The online survey ran for six months and was open to anyone interested in ARV-based prevention from the three countries. Interviews were conducted concurrently with specially selected stakeholders in the three target countries.

Results: Among the three countries, 1,069 individuals answered the survey, and 572 completed all questions. Most respondents were from urban settings and identified as advocates, AIDS service organization personnel, doctors, and/or people living with HIV. Survey respondents were most in favour of expanded treatment and microbicides, but all had concerns about accessibility, economics, health systems impacts, and stakeholder resistance to these strategies. Forty semi-structured stakeholder interviews were conducted concurrently (India = 9, South Africa = 13, United States = 18) revealing some convergent opinions across geographies and disciplines about the strength of the science for treatment as prevention, but also strongly divergent opinions on issues such as readiness and feasibility. PrEP was the most polarizing strategy with concerns including prohibitive resource costs, behavioural disinhibition and drug resistance. There were also concerns about the individuals who needed treatment in all three countries who were unable to access ARV drugs.

Conclusions: Scientific results proving the efficacy of vaginal microbicides, PrEP, and TLC+ are not sufficient to successfully implement these strategies in India, South Africa, and the United States. Funders and policy makers must understand and address stakeholder support as well as stakeholder resistance when deciding whether or not to implement any ARV-based prevention strategy.

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