Mapping Pathways Launches NEW Report - "Community-driven strategies for the use of ARVs as prevention: United States Workshop Report"

The Mapping Pathways United States Workshop Report is launched today, providing the results of three HIV prevention scenario-development workshops held in 2013 in the United States.

The "Community-driven strategies for the use of antiretrovirals as prevention: United States Workshop Report" analyses, aggregates and synthesises different factors, issues, and drivers identified by workshop participants and constructs a future scenario for HIV prevention strategies using ARV (antiretroviral) drugs in the United States. Integration - of factors and systems involved in both treatment and prevention - is the main driver of success.

We hope you will read the report and utilize it in your organizational/jurisdictional planning processes for HIV prevention and care services. Please share the report with colleagues you think will be interested.

 In 2013, a subset of the Mapping Pathways team conducted knowledge-exchange workshops in San

Atlanta workshop participants

Francisco, Atlanta, and Washington, D.C., to further share the findings of our 2013 report ("Developing evidence-based, people-centred strategies for the use of antiretrovirals as prevention") and to continue enhancing the community-driven, locally informed approach to the wider evidence base for ARV-based prevention.

The cities were selected based on geographic diversity as well as the diversity of experience and expertise that can be found in each setting.

All three workshops included a mix of approximately 20 researchers, advocates, policy experts, public health officials, and service providers; they were diverse in terms of age, race, gender identity, sexuality, sero-status, and years in the field, with a blend of local to national experiences and perspectives.

Participants collaboratively developed a range of future scenarios and potential strategies linked to prevention programming goals and objectives. They were asked to think ahead to the year 2025, and envision an array of outcomes associated with the implementation of ARV-based prevention.

Based on participant ideas and concepts synthesised across all three workshops, we developed a ‘Mapping Pathways’ scenario for the future which has a strongly integrated approach at its core. The main driver of this future scenario is one of integration across political, economic, social, educational, and technological factors, and integration across the broader scientific, healthcare, and delivery systems. This means that we integrate both treatment and prevention strategies, including how we develop them, how we fund them, and how we deliver them, into one holistic approach.

Political and economic factors considered by workshop participants

The Mapping Pathways scenario was informed by these key themes common to all the workshops:

• Participants emphasised the need for a more holistic approach to HIV services in which prevention and treatment were not seen as mutually exclusive.

• Social and behavioral research must be supported and integrated with biomedical research.

• Digital web and device-based technologies and information sharing will affect access, uptake, and adherence.

• The Affordable Care Act (ACA) offers major opportunities for expanding access to healthcare, and poses challenges in HIV prevention and care delivery as the landscape evolves.

• Community-based organizations have a leading role to play in the new healthcare paradigm being ushered in with the ACA. They can help generate political will, drive research agendas, and deliver integrated care to communities and populations in need.

• Diversified funding streams are needed, and many of the optimistic scenarios generated by participants included strategies to engage a wide range of funders.

Click here for the United States Workshop Report.

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IRIN Coverage of Mapping Pathways ARV-Based Prevention Report: “Here’s all this science - now what?”

via IRIN

 Excerpt:
According to Mapping Pathways, the ideal approach to implementing treatment as prevention should consider not only the clinical goal of efficacy (works in a lab), but also effectiveness (how to apply the solution in a community).

“I know that if you get anti-retroviral drugs into someone’s blood, they suppress the virus. We have amazing proof of that - it’s a major scientific breakthrough in the history of humankind,” said Linda-Gail Bekker, chief operating officer of the Desmond Tutu HIV Foundation, based in South Africa.

“But now we have to put this together so it works, which means engaging with a wide range of human beings who live very different lives than those of us who run these programmes might imagine,” she said.

Effectiveness requires behaviour change and, therefore, varies across cultures, governments, and communities based on “the firms that produce the drugs, the healthcare clinics that deliver the drugs, the community centres that provide education, and the partnerships developed,” according to Mapping Pathways.

“Human beings will behave like human beings. What does that mean? Well, social sciences have been trying to figure that out for centuries and don’t have one single theory, so why should our HIV programmes?” asked Bekker.

“The notion that in HIV programmes `one size fits all’ has backfired on us and it has been a humbling moment for those of us who work in this field.”

Read the whole article on IRIN.


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Archbishop Desmond Tutu: If we are to toss AIDS into the dustbin...

If we are to toss AIDS into the dustbin, we must do our best to understand the intersections of scientific discovery and community wisdom, address the truths in both, and move forward with decisions that take into consideration a full, robust interpretation of the evidence base.
- Archbishop Desmond Tutu

These are extraordinary times in which we are living. More than three decades into the global HIV pandemic, discussing ‘the end of AIDS’ is more than a rhetorical flourish, more than political grandstanding, and more than wishful thinking.

At this very moment, we have ‘the end of AIDS’ in our collective sights in a way we have never had before. Even as the epidemic continues to wreak havoc in the lives of far too many of our precious daughters, sons, sisters, brothers, mothers, fathers, friends and colleagues across the world – new and exciting scientific discoveries are pointing to a future where AIDS is a brutish artefact of history.

Science has shown us that treating HIV-positive people with a combination of antiretroviral drugs (ARVs) is not only good for the individual being treated, but also imparts a prevention benefit for the broader community as well. People on successful treatment do not get sick and die, and are much less likely to pass their infection to their partners.

Science has also shown that ARV drugs provided to HIV-negative individuals can protect them from the virus if exposed, much like anti-malarial drugs prevent malaria. And there are new, user-friendly ways to deliver ARVs being developed and tested at this very moment.

We simply must take the critical next steps to end AIDS now that science proves it can be achieved. If enough global citizens, people of faith, members of the private sector and world leaders summon the courage to accelerate and increase their investments in the global response to overcome AIDS, we have a very good chance of containing the worst viral scourge the world has ever known.

Conducting research in India, South Africa and the US, Mapping Pathways has taken such a step, one that helps make ‘real-world’ sense of the incredibly dynamic nature of the science. With new discoveries and insights coming so quickly it is hard to keep up.

Much like politics, all science is local. The understanding of what this new science means is local. Its utility is local. Yes, we have compelling results from clinical trials, and make no mistake, we will have more. But the opinions, perspectives and lived wisdom of communities, from the grassroots to the grasstops, matter just as much as the peer-reviewed scientific data that are coming at us fast and furiously. How communities absorb, understand and prioritise the science matters.

Placing a premium on a ‘people-centred’ interpretation of the science, Mapping Pathways has tapped the smarts, and the hearts, of advocates, researchers, clinicians, policymakers, pharmacists, funders, public health workers and people living with HIV. The results of their journey are illustrated in this monograph. I hope these findings will help communities across the globe grapple with the promises, and the marked complexities, of this thrilling new prevention paradigm in which we find ourselves.

I recommend Mapping Pathways – Developing evidence-based, people-centred strategies for the use of antiretrovirals as prevention. If we are to toss AIDS into the dustbin, we must do our best to understand the intersections of scientific discovery and community wisdom, address the truths in both, and move forward with decisions that take into consideration a full, robust interpretation of the evidence base.

Let us map new pathways together, for our generation and for those who follow. Let us be the generation to make the difference.

Let us be done with AIDS.

-Archbishop Desmond Tutu

[This is the foreword penned by Archbishop Desmond Tutu in the new Mapping Pathways report "Developing evidence-based, people-centred strategies for the use of antiretrovirals as prevention."  Click here for podcasts, an infographic, and a video associated with this report.]

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Newly infected individuals sustaining HIV epidemic in Geneva

via aidsmap, by Michael Carter

Individuals with recent HIV infection are sustaining the epidemic, a Swiss study published in the online edition of AIDS suggest. The investigators believe that their results further support the use of antiretroviral therapy as prevention, but also show that its impact on the epidemic will be blunted because of the high number of transmissions which can be attributed to individuals who have been recently infected with HIV and who are not yet taking treatment.

Phylogenetic analysis showed that only a handful of infections in individual diagnosed between 2008 and 2010 could be attributed to patients diagnosed before 2000. Patients with longer-term HIV infection were the group most likely to be taking antiretroviral therapy and to have an undetectable viral load.

“Recent HIV infections were a significant source of HIV spread,” comment the authors. “By contrast, HIV individuals diagnosed before 2000 were rarely the source of new infections before 2008.”

It is now widely accepted that patients who are taking HIV therapy that suppresses their viral load to undetectable levels are highly unlikely to transmit the virus to their sex partners.

Read the rest.


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The Value Of HIV Treatment In Couples

via NPR, by Richard Knox

Dr. Rochelle Walensky thinks the 19th International AIDS Conference will be remembered as the moment when the world began to mobilize to end the pandemic.

The Harvard researcher probably speaks for many of the 23,000 scientists, activists and policy mavens who came to the Washington conference. But they're going home with a big question on their minds: Can the world afford it?

Walensky and her colleagues provided the beginning of an answer with a presentation on the final day of the conference. They looked at the cost implications of expanding anti-retroviral treatment to all HIV-positive people in couples where one partner is not infected.

"Is it worth paying for? The answer is yes, it's very cost-effective," Walensky told Shots. At least that's the case in South Africa and India, which the researchers chose for their analysis, and for the limited situation of these so-called discordant couples.

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A World Without AIDS, Still Worlds Away

via the New York Times, by Lawrence K. Altman

WASHINGTON — Is the world on the verge of ending the AIDS epidemic and creating an AIDS-free generation, even though a cure and a vaccine are still distant hopes?

Yes, roared enthusiasts among the nearly 24,000 participants at the 19th International AIDS Conference here last week. Their hopes are based on the extraordinary scientific gains made since the conference was last held in the United States, 22 years ago, when an AIDS diagnosis was a sure death sentence.

Among those gains: antiretroviral drug combinations for women to prevent infection of their newborns; drugs to treat and prevent infection with H.I.V., the virus that causes AIDS, among adults; and evidence that voluntary male circumcision can reduce the risk of female-to-male transmission by 50 to 60 percent.

Today, H.I.V. has become a chronic disease that, if treated appropriately, can be held at bay in a newly infected young adult for decades — if the patient adheres to the rigid daily drug regimen.

Michel Sidibé, the executive director of the United Nations AIDS agency, said that the opportunity to end AIDS will “evaporate” if governments do not show greater political will and increase investments to make gains available to millions more people.

“All that can stop us now is indecision and lack of courage,” he said.

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PrEP debate is reminiscent of the past

via Global Post, by Emily Judem

WASHINGTON, DC—During the 1996 International AIDS Conference in Vancouver, Dr. David Ho announced that HIV could be suppressed to undetectable levels if patients took a “cocktail” of anti-retroviral drugs.

Time Magazine named him “man of the year,” and according to Rolling Stone, he became the most famous AIDS scientist in the world.

But in the years that followed, ARV distribution was also met with criticism, said Mitchell Warren, director of AVAC, a non-profit that advocates for HIV prevention programs.

“People said we can’t do treatment,” Warren said. “Too expensive. Not feasible. No one’s going to take their pill. What about drug resistance?”

For those who have attended sessions about pre-exposure prophylaxis (PrEP) this week at the 2012 International AIDS conference, this might sound familiar.

When the FDA approved Truvada as a preventative drug against HIV on July 16 this year, leaders of the AIDS fight and news outlets alike began posing questions. How will it be decided who takes the drug? How will the drug be distributed? How will we lower the price tag? Should we be concerned that those taking Truvada will stop using condoms and protecting themselves in other ways?

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'Treatment As Prevention' Rises As Cry In HIV Fight

via NPR, by Richard Knox

AIDS researchers, policymakers and advocates are increasingly convinced that treating HIV is one of the best ways of preventing its spread.

The rallying cry is "treatment as prevention," and it's the overarching theme of this month's International AIDS Conference in Washington, D.C.

The idea is that identifying people infected with HIV and getting them in effective treatment as soon as possible not only prevents them from getting sick but almost eliminates the risk they'll pass the virus on to others.

Last summer a big study showed that people with HIV are 96 percent less likely to pass the virus on if they faithfully take antiviral medicine. Momentum behind treatment-as-prevention has grown since then.

This is a big change. For a long time in the world of HIV and AIDS, the conventional wisdom has been to delay treatment until people show signs of damage to their immune system. Partly this is because the drugs have side effects (although some are now easier to take), and partly because few people thought medical treatment itself could slow the spread of HIV.

"After many years of frustration, it is a transformational moment in the course of this epidemic," says Kevin Cranston, head of infectious disease control at the Massachusetts Department of Public Health. "Universal treatment can in fact result in an epidemic that looks to be petering out."

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Investigating the Impact of Treatment on New HIV Infections

via PLoS Collections

The HIV Modelling Consortium aims to strengthen the support that mathematical modelling and related quantitative disciplines can provide to global decision-making in HIV. In November 2011 the HIV Modelling Consortium held a meeting in South Africa to focus on the cross-cutting issues of the impact of new scientific findings about HIV treatment preventing new infections. The group considered the feasibility of interventions, potential epidemiological impact, affordability, and new scientific observational studies and community trials. The nine reviews and one research article which comprise this collection arose from that meeting and provide insights into the factors which will support evidence-based decision-making in HIV prevention, with a focus on the use of antiretroviral treatment to prevent HIV transmission.

Read the rest here.


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TAC Fights for Proper Treatment

via allafrica.com, by Ayanda Mkhwanazidoms

The Treatment Action Campaign (TAC) has vowed to mobilise more communities to fight for quality health should the Gauteng Health Department not deliver on their demands. This week, the TAC marched to the office of Gauteng Health MEC demanding the restoration of health services.

"This is violation of many rights in the Constitution... the right to equality... everybody has a right to free health care service, but because we are poor and do not have medical aid, I can't access health care. They are further violating our right to life because, for the love of God, these ARVs are our life and without them we are dead", Deputy Chairperson of the Treatment Action Campaign in the Ekurhuleni district of Gauteng, Portia Serote, did not mix her words as she reminded the hundreds of TAC members of their basic rights as enshrined in the Constitution.

Angry TAC members marched to the office of the Gauteng Health MEC, Ntombi Mekgwe, this week, demanding an end to the drug shortage in health facilities. Health services in Gauteng have been dealt a severe blow due to drug stock outs which have been ongoing for months. The TAC says the last straw was the lack of vital treatment, such as the Tenofovir drug, one of the Anti-Retroviral Drugs (ARVs) for HIV-positive people. Serote says it is unacceptable that essential drugs are unavailable to patients.

"For example, Tenofovir is a good drug that we, as the TAC, fought for, so everybody can access it for free. But what is happening in health facilities is that they do not stock enough. Others (patients) are switched with Stavudine", she says.

Some of the messages written on posters by prostestors were loud and clear: 'Provide treatment and do not gamble with our lives'.

Serote says patients have been constantly turned away from clinics and told to return on another date

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Tenofovir Shortage Exposes Problems in Health Management in South Africa

via allafrica.com, by Khopotso Bodibe

The recent shortage of a crucial antiretroviral drug, Tenofovir, is but just a symptom of an underlying general problem of health management in South Africa. Part of this is the lack of oversight on drug supplies and availability by the national Health Department.

At the heart of the seven months' long shortage of Tenofovir, which started running out in October last year is nothing else, but poor planning. For the whole of last year, the Health Department had a donated stock of the drug from the United States' government and retained two pharmaceutical companies, Aspen Pharmacare and Sonke Pharmaceuticals to produce a tiny fraction of the supply.

It was only when small quantities of the donated stock of Tenofovir were left that the Health Department urgently requested the two drug manufacturers in November to increase their production and supply 100 % of the stock, with Aspen Pharmacare responsible for producing 70% and Sonke Pharmaceuticals 30% of the required Tenofovir packs for an estimated 1.2 million patients. But the two failed to meet the demand at short notice, leaving patients in dire straits. Director of Section 27 and executive member of the Treatment Action Campaign, Mark Heywood, says this demonstrates a general lack of planning by the Health Department to address drug shortages in the country.

"Planning is absolutely crucial. If I was the Minister of Health, then I would instruct that the relevant official in the Department of Health has a monthly meeting with the pharmaceutical companies, with key people in some of the provinces just to assess on an on-going basis, not necessarily because there's a crisis, but just to make sure that they are looking at what are the drugs are the drugs in the system, are the drugs in the pipeline, are we getting to people, where is the weak point in the chain? If you put that type of system in place, then we wouldn't be facing what we are facing now", according to Heywood.

The recent shortages of Tenofovir, for example, occurred as a result of the Health Department not informing the contracted drug manufacturers in good time that a shortage was looming. Thus, they were not able to produce the required amounts. In addition, Aspen Pharmacare and Sonke Pharmaceuticals neglected to inform the Health Department that producing 1.2 million packs of Tenofovir within the required time would not be possible.

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Hospital Fails to Make ARV Order for the Month of June

via allafrica.com, by Jennifer Dube

SCORES of people receiving anti-retroviral (ARV) drugs from Harare Central Hospital were early last week told to buy their own drugs as the hospital allegedly "forgot" to order the life-prolonging drugs.

A beneficiary of the government-free ARV programme showed The Standard his health card where "out of stock" had been written against the second line drug alluvia which is used together with tenolam.

"They said they do not have the drugs," the beneficiary said. "I was advised to buy the drugs but I currently do not have the money to do so. This will affect me as I may take long to get the money for the drugs."

Vice-president of Zimbabwe HIV and Aids Activists Union, Stanley Takaona said his organisation had been told the hospital did not make an order for the month of June.

"We have made a follow-up with the hospital together with the ministry and we were told the drugs are there at the national pharmacy but the hospital did not make an order for this month," Takaona said.

"Those are the most expensive ARV drugs, costing US$120 for a month's supply and most people who are on the government programme cannot afford them."

Takaona said such alleged negligence on the part of the hospital was disturbing as those on ARVs were supposed to take the tablets consistently, without skipping any days, for effectiveness.

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World Health Organization Encourages Antiretroviral Drug Use for HIV Prevention

via aidsmap.com, by Keith Alcorn

The number of people eligible for antiretroviral treatment will grow by around six million as a result of recent World Health Organization recommendations on the use of antiretroviral drugs to prevent HIV transmission, Dr Gottfried Hirnschall, head of the WHO’s HIV department told the IAPAC Controlling the HIV Pandemic with Antiretrovirals:Treatment as Prevention and Pre-Exposure Prophylaxis Evidence Summit in London.

The new recommendations almost double the number of people judged to be in need of antiretroviral therapy –  calculated at 7.4 million people with CD4 counts below 350 and therefore in need of treatment at the end of 2010. In 2010, antiretroviral coverage reached 47% of those eligible, he said.

His remarks coincided with the release by WHO of a Programmatic Update on Antiretroviral Treatment for Prevention of HIV and TB, which sets out the organisation’s plans to galvanise greater use of antiretroviral treatment in order to limit new infections.

The summit, organised by the International Association of Physicians in AIDS Care, is designed to review recent advances in the use of antiretroviral drugs as a means of preventing HIV transmission, and to discuss the practical implications of the new data for treatment and prevention programmes.

Speaking on the first day of the two-day summit, Dr Hirnschall pointed out that, for every person placed on treatment, 2.5 people are still becoming infected every year, amounting to approximately 2.7 million infections a year in 2010.

Scale-up of a combination of effective prevention interventions remains urgent, and antiretroviral treatment must play a central role in the prevention of new infections, he said, following last year’s release of the results of the HPTN 052 study, which showed that early antiretroviral therapy for the HIV-positive partner reduced the risk of HIV transmission by 96% in serodiscordant partnerships.

Similarly, evidence from the South African province of KwaZulu-Natal demonstrates that, at the population level, antiretroviral therapy is already having an impact on one of the most severe epidemics in sub-Saharan Africa. Every 1% increase in antiretroviral coverage among adults in rural communities between 2004 and 2011 was associated with a 1.7% reduction in the risk of HIV acquisition, suggesting the potential for large reductions in HIV incidence if greater progress towards universal access to antiretroviral treatment can be achieved.

However, Dr Hirnschall noted that current coverage in low- and middle-income countries – 47% in 2010 – “is not giving us the prevention gain we want to see”.

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Improving the Production of Tenofovir

via AllAfrica.com, by Khopotso Bodibe

The national health department has contracted additional pharmaceutical manufacturers to make up the critical shortage of the antiretroviral tenofovir across the country.

HIV clinicians and doctors warned last week that the continued stock out of tenofovir and the failure to advise health workers on how to deal with it was a looming disaster.

Reports of stock outs go as far back as October last year with the explanation given that the drug suppliers Aspen Pharmacare and Sonke Pharmaceuticals were not able to meet the demand once they were awarded the tender.

It emerged this week that the national health department had directed provinces to order tenofovir from two additional suppliers.

Dr Anban Pillay, Cluster Manager for Financial Planning and Health Economics in the national health department, confirmed that Adcock Ingram Pharmaceuticals as well as Cipla Medpro Pharmaceuticals were now also supplying tenofovir to provinces.

"The procurement rules allow that. Obviously, there's a good reason for it. The current suppliers are not able to keep up with the total need. So, for the balance they are allowed to go out and get it from other suppliers," Pillay explained.

Aspen Pharmacare and Sonke Pharmaceuticals were initially contracted to supply tenofovir to the public sector antiretroviral programme, but they have struggled to meet the demand.

"The split between Aspen Pharmacare and Sonke is a 70 30 split, meaning that 70% of the volume goes to Aspen and 30% to Sonke. Unfortunately, Sonke hasn't been able to ramp up its production to the level that is required to meet the demand," said Pillay.

The national health department estimates that tenofovir is dispensed to about 1.2 million patients every month.

Aspen Pharmacare was only able to increase its production to the 70 per cent tender requirement in recent weeks. With Sonke Pharmaceuticals not being able to supply its quota of the tender, the supplies from Aspen Pharmacare were not sufficient to serve all patients on tenofovir, resulting in the shortage.

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Tanzania Considers Compulsory HIV Testing for All Citizens

via AllAfrica.com, by Alvar Mwakyusa

People living with HIV/AIDS (PLHAs) and a section of lawmakers have proposed that every person living in the country be subjected to compulsory HIV testing in a bid to promote the fight against the disease.

However, not everyone supports the idea. Some of the people interviewed by the 'Daily News' are against the idea. Many point out that it is against human rights to compel someone to undergo a HIV test or any other medical tests.

Speaking in Dar es Salaam recently, the board chairperson of the National Council of People Living with HIV/AIDS (NACOPHA), Mr Vitalis Makayula, was of a view that if the fight against the disease was to be won, then all people must be aware of their HIV status.

He also said that those found to be positive must disclose their status. Mr Makayula made these remarks at a seminar organized by the Association of Journalists Against AIDS in Tanzania (AJAAT), to sensitize journalists on the HIV and AIDS Prevention and Control Act (HAPCA) of 2008.

"Tackling HIV/AIDS would be more effective if everyone tested for HIV and disclose his/her status. Otherwise it is like fighting an enemy you don't know," he stressed.

Mr Makayula was also optimistic that if everyone knew their HIV status stigma against those found to be positive would be reduced.When contacted for comment, the Deputy Minister for Health and Social Welfare, Dr Seif Suleiman Rashid, said that there are factors that must be considered before deciding if testing should be compulsory or not.

"Before deciding on the matter we should consider revising the current legislation, human rights and availability of resources, among others. It is an issue which requires discussion among experts and stakeholders," he explained in a telephone interview.

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UNAIDS: TRIPS and the potential impact of free trade agreements

via UNAIDS.org

For long-time HIV activist and Coordinator of the Asia Pacific Network of People Living with HIV (APN+) Shiba Phurailatpam, the importance of sustained access to affordable AIDS medicines is more than a trade, legal or logistical issue: “It is literally a matter of life and death for people living with HIV,” Phurailatpam says. “More than 60% of people in need of HIV treatment in Asia-Pacific still don’t have it.

Across the world, millions of people need access to HIV treatment, today, to keep them alive.

Antiretroviral drugs have changed the way in which HIV is viewed—from a death sentence to a chronic illness. That achievement was propelled by a surge in donor funding and by the drastic reduction of the cost of first-line antiretroviral regimens from around US$ 10 000 to under US$ 100 per person per year over the past decade, due in part to the increased availability of low-cost generic medicines.

Over the past decade, more than 6.6 million people have received antiretroviral therapy in developing countries across the world.  At the UN General Assembly High Level Meeting on AIDS in New York in June 2011, governments from around the world made a bold pledge to get all people eligible—an additional nine million people living with HIV—on treatment by 2015.

But at this time of opportunity, the sustainable future of HIV treatment programmes remains of serious concern. Countries are facing mounting challenges to produce or procure affordable HIV treatment, including cutbacks in AIDS funding and a proliferation of increasingly restrictive intellectual property measures in free trade agreements.

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Reuters: India Should Tax Air Tickets to Pay for AIDS Drugs - U.N.

via Reuters.com, by Nita Bhalla

Millions of the world's poorest people could have easier access to life-saving drugs if India introduces an air ticket tax to help fund purchases of cheap medicines for HIV/AIDS, malaria and tuberculosis, a senior U.N. official said.

UNITAID, a U.N. agency which negotiates for cheap medicines from pharmaceutical manufacturers to treat deadly diseases, is lobbying countries such as India to join its air ticket levy initiative which began in 2006.

Under the program, countries put a nominal amount on the cost of air tickets which funds UNITAID to buy drugs for patients in the developing world. Ten countries have imposed the levy, generating $200 million annually for cheap medicine.

"What we want in India is a similar system by which a very small contribution which is painless to the traveler can be applied to large numbers of travelers," UNITAID Executive Director Denis Broun told AlertNet in an interview.

"Since air traffic is very high in India, the small amount of levy makes a huge difference to the amount of drugs that we can purchase and the number of poor who can benefit from them."

HIV/AIDS, malaria and tuberculosis kill 4.4 million people each year, UNITAID says. Approximately 14.2 million people are in need of anti-retroviral drugs globally, yet more than half cannot afford them.

India's airlines are reeling under a debt load of $20 billion and lost $2 billion last year, as high fuel prices, a weakening rupee and competition kept fares low and costs high.

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The Lancet:PrEP for HIV prevention reaches key milestone

via the Lancet.com, by Salim S Abdool Karim and Quarraisha Abdool Karim

On May 10, 2012, a US Food and Drug Administration (FDA) advisory committee voted in support of the use of tenofovir-emtricitabine for HIV prevention.1 If the FDA, which is scheduled to make its decision by June 15, adopts the committee's recommendations, tenofovir-emtricitabine will become the first antiretroviral drug to be approved as pre-exposure prophylaxis (PrEP) for the prevention of HIV, paving the way for implementation.

PrEP has a unique advantage in young women in southern Africa, who bear a disproportionate burden of the HIV epidemic. In much of this region, young women are often unable to convince their male partners to use condoms, remain faithful, or have an HIV test. To rely on her HIV- positive discordant male partner to come forward to test, to agree to take antiretroviral therapy (ART), and to take his ART with high adherence, all for her protection, puts a woman's risk of acquiring HIV back in the hands of men, thereby disempowering women and undermining their efforts to control their risk of HIV.

However, there are several criticisms and concerns about PrEP. First, that data on the effectiveness of PrEP, especially in women, are inconsistent. This concern is based on the results of two PrEP studies—the FEM-PrEP2 and VOICE3, 4 trials—which were stopped, at least partly, earlier than planned when they did not show efficacy. To some extent, this concern has been allayed by recent data from the FEM-PrEP trial5 which show that adherence to daily tenofovir-emtricitabine in the trial was too low allow assessment of efficacy. Data to explain the VOICE trial, which still has an ongoing tenofovir-emtricitabine group, are not expected until 2013.

Second, some suggest that antiretroviral drugs should be provided to HIV-negative people only when all eligible HIV-positive patients are receiving ART. Although it is a legitimate concern that eligible HIV-positive patients should be prioritised for ART for their own health and to save their lives, it is spurious to trade off treatment and prevention as if these drugs are being taken away from sick and dying patients to be given to healthy people. Treatment and prevention strategies are a continuum in their use of antiretroviral drugs—both are needed in conjunction with each other to ensure ART provision is sustainable in the long term and to realise the quest to end the HIV epidemic.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Patients in South Africa Increase the Use of Antiretroviral Treatment

via aidsmap.com, by Carole Leach-Lemens

South Africa exceeded national targets for new patients starting antiretroviral treatment (ART) by around 50% between 2007 and 2011 – achieving treatment coverage of close to 80% of eligible adults – according to new research carried out by Dr Leigh F Johnson, actuarial scientist at the University of Cape Town, published  in the March issue of The Southern African Journal of Medicine.

From mid-2004 to mid-2011, the total numbers of people receiving ART increased from 47,500 (95% CI: 42,900 to 51,800) to 1.79 million people (95% CI: 1.65 to 1.93 million). The latter figure represents close to 80% of adult treatment coverage, according to eligibility criteria in use during this period (CD4 cell counts under 200 cells/mm3). Using current South African CD4 cell count eligibility criteria (under 350 cells/mm3), coverage achieved decreases to 52% (95% CI: 46-57%).

While the targets were still exceeded, children and men started ART at considerably lower ratios than women.

Women accounted for 61%, men 31% and children 8% of the total.
Effective HIV treatment significantly reduces illness and death resulting from HIV, as well as onward transmission of HIV. Evaluating the effectiveness of HIV treatment and prevention programmes requires monitoring access to ART.

Previous monitoring assessments have shown a dramatic increase in access to ART in South Africa. While these assessments have suggested South Africa was on track to meet the targets of its HIV & AIDS & STI National Strategic Plan 2007-2011 (the NSP), no formal assessment has been made, Dr Johnson adds.


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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

The Effectiveness of ARV's Used for HIV Prevention

via AIDSmeds, by Tim Horn

While studies exploring the effectiveness of antiretroviral (ARV) therapy for HIV prevention purposes have generally yielded encouraging results, a group of researchers at the University of North Carolina at Chapel Hill suggest that the way forward is not entirely clear and that additional research is needed, particularly in understanding the combined benefits of biomedical and behavioral interventions in specific at-risk communities.  

“Recent research developments in [pre-exposure prophylaxis, or PrEP] and [treatment of people living with HIV to curtail HIV transmission] provide a unique opportunity to highlight areas of advancement that have galvanized changes in HIV treatment and prevention, and to highlight topic areas that remain undecided and controversial,” write Myron Cohen, MD, and his colleagues in an editorial published ahead of print by the journal AIDS.

The paper reviews much of the scientific research that has contributed to our current understanding of ARV treatment as prevention, including pharmacologic and observational studies, ecological evaluations and various modeling and empirical data. And despite the completion of several sound clinical trials—also summarized by Cohen and his colleagues and reviewed here—gaps in knowledge remain.

The Limits of HPTN 052

Building on the results of cohort and mathematical modeling studies, the HIV Prevention Trials Network began a randomized clinical trial, called study 052 (HPTN 052), to confirm a prevention effect from ARV therapy. While the study is ongoing, its Data Safety and Monitoring Board recommended nearly a year ago that the interim results be made publicly available.

As previously reviewed by AIDSmeds, the trial demonstrated a 96 percent reduction in HIV transmission among monogomous heterosexual HIV-serodiscordant couples in which the HIV-positive partner was started on ARV therapy, compared with couples in which the positive partner had not started HIV treatment.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]