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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Podcast: Mapping Pathways' San Francisco "Knowledge Exchange Workshop" - More Robust, Better Resourced Behavioral and Implementation Science is Needed!

Jim and Jessica from the Mapping Pathways team have podcasted again!

This new 12-minute podcast (click to listen) was produced by AIDS Foundation of Chicago (a Mapping Pathways partner) and is the fourth in a series of discussions inspired by our new report "Developing Evidence-Based, People-Centred Strategies for the Use of Antiretrovirals as Prevention."

In this new podcast,  Jim and Jessica talk about the recent Mapping Pathways "Knowledge Exchange Workshop" at the beautiful San Francisco AIDS Foundation which included researchers, public health officials, policy experts, advocates, and prevention staffers from the Bay Area. Our report provided the backdrop - and the launch pad - for rich discussion/debate and a series of future-thinking exercises focued on ARV-based prevention strategies and scenario planning. The above pic is an "action shot" from the workshop.

Big take-aways from our two days together include the need for more robust (and better resourced) behavioral science and implementation projects - and for advocacy devoted to both these areas. We have vaccine advocates, microbicide advocates, treatment advocates, PrEP advocates.... it's about time we have some concerted advocacy for behavioral science and implementation science too! Without more attention and adequate funding for these activities - it won't matter how efficacious a biomedical tool proves to be in a clinical trial. Things like PrEP, etc.  need to work in the REAL world - which a clinical trial does not accurately represent .

Here are the presentation slides used during the workshop.

Other podcasts

Click here for previous podcasts on topics like PEP and PrEP.

And please stay tuned for future podcasts on topics like microbicides, the use of treatment for prevention, and more. Feel free to leave comments or questions here, on the podcast itself, of by sending an email to mappingpathways@gmail.com. [Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

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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NEW Podcast on the Promise of PEP, and the Unfortunate Lack of PEP Implementation

Jim and Jessica (pictured above) from the Mapping Pathways team are back with a new podcast - and this time the topic is PEP - post-exposure prophylaxis for HIV prevention.

This 12-minute podcast (click to listen) was produced by AIDS Foundation of Chicago (a Mapping Pathways partner) and is the third in a series of discussions inspired by the new report "Developing Evidence-Based, People-Centred Strategies for the Use of Antiretrovirals as Prevention."

In this new podcast,  Jessica Terlikowski and Jim Pickett discuss the promise of PEP, and the unfortunate lack of strong implementation that characterizes this intervention in nearly every part of the world.

Other podcasts

Click here for a previous podcast in which Jessica and Jim  introduce the Mapping Pathways report (published by Mapping Pathways partner RAND) and explain its relevance for multiple audiences. Click here for their second podcast where they chat about PrEP - pre-exposure prophylaxis.

Please stay tuned for future podcasts on topics like microbicides, the use of treatment for prevention, and more. Feel free to leave comments or questions here, on the podcast itself, of by sending an email to mappingpathways@gmail.com.

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Podcast: A Little PrEP Talk Inspired by New Mapping Pathways Report

This 10-minute podcast (click to listen) was produced by AIDS Foundation of Chicago (AFC) and is the second in a series of discussions inspired by "Developing Evidence-Based, People-Centred Strategies for the Use of Antiretrovirals as Prevention."

This new Mapping Pathways report was published 19 June 2013 by RAND Europe and AFC.

In this new podcast, AFC staffers and Mapping Pathways team members Jessica Terlikowski and Jim Pickett chat about PrEP - pre-exposure prophylaxis.

Click here for Jessica and Jim's previous podcast - posted June 21, 2013 -  which introduces the report and talks about why it is relevant for multiple audiences.

Keep your eyes and ears open.

Jessica and Jim will be back soon to talk about the other ARV-based prevention strategies that were explored in the report: PEP (post-exposure prophylaxis), TLC+ (testing, linkage to care, plus treatment) and microbicides. And you will find out about it right here.


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PODCAST: Mapping Pathways Team Talks About Our New Report on ARV-based Prevention

Snapshot of the global epidemic, highlighting India, South Africa and the U.S. where Mapping Pathways collected data. From the new report.

This 14-minute podcast (click below to listen) was produced by AIDS Foundation of Chicago (AFC) and kicks off a series of discussions about "Developing Evidence-Based, People-Centred Strategies for the Use of Antiretrovirals as Prevention" the new Mapping Pathways report published 19 June 2013 by RAND Europe and AFC.

AFC staffers and Mapping Pathways team members Jessica Terlikowski and Jim Pickett introduce the report and talk about why it is both interesting and useful.

Jessica and Jim will be back to talk more in depth about each of the ARV-based prevention strategies that were explored: PEP (post-exposure prophylaxis), PrEP (pre-exposure prophylaxis), TLC+ (testing, linkage to care, plus treatment) and microbicides. Watch - and listen - to this space!



Mapping Pathways Partners

Mapping Pathways Podcast: Intro by AIDSChicago

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Mapping Pathways VIDEO: New Report's Lead Author Discusses ARV-based Prevention

90 Seconds: Molly Morgan Jones, a Research Leader in RAND Europe, and lead author of the new Mapping Pathways report "Developing Evidence-Based, People-Centred Strategies for the Use of Antiretrovirals as Prevention" discusses how antiretroviral (ARV)-based HIV prevention strategies need to be closely tailored to local contexts and cultures in order to make an impact on new HIV infections globally.

Watch below. Access the report here. Check out the report's Research Brief here.

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New International Report on HIV Prevention Urges Localized Consideration of Antiretroviral Strategies

First Report on Antiretroviral Drugs for HIV Prevention to Bring Science Together with the Wisdom of Communities

June 19, 2013 – To make an impact on new HIV infections globally, antiretroviral (ARV)-based HIV prevention strategies need to be closely tailored to local contexts and cultures, according to a new report released today by RAND Europe and AIDS Foundation of Chicago.

“‘Mapping Pathways: Developing Evidence-Based, People-Centred Strategies for the Use of Antiretrovirals as Prevention’ [available by open access online on the RAND Europe website, and on the Mapping Pathways blog] provides an important resource to help communities, prevention programmers, funders and policymakers decide whether, and how, an ARV-based strategy could work in their locality,” said Jim Pickett, director of prevention advocacy at AIDS Foundation of Chicago and project director.

Last year, more than 2 million people globally became infected with HIV suggesting current prevention strategies are not doing enough to halt HIV transmission. Research suggests that some of the most promising prevention strategies are based on ARV drugs, such as pre-exposure prophylaxis (PrEP) and treatment.

“However, just because we know that ARVs can prevent HIV infection does not mean that we will, in practice, successfully implement their use in communities that need them,” said lead author Molly Morgan Jones, research leader at RAND Europe in Cambridge, UK.

Mapping Pathways is a community-led research project on the strategic use of ARV drugs for HIV prevention, involving RAND Europe, AIDS Foundation of Chicago and other partners in India, South Africa and the United States.

The group engaged more than 1,000 community respondents with an online survey and interviewed several dozen key stakeholders, including policy experts, program implementers, health care professionals and advocates. Participants rated the importance of various ARV-based prevention strategies, shared their perspectives regarding barriers to implementation and suggested the kinds of information they needed to make informed decisions about whether to implement any ARV-based strategy.


Click to enlarge

Additionally, an extensive literature review was conducted during 2011 and 2012 to assess the published scientific evidence. Detailed snapshots from these activities are highlighted in the report and provide rich, localized context that reveal the opinions and concerns of a wide array of individuals and underscore important gaps in the evidence.

Community members and key stakeholders in each country consistently agreed they must address three key challenges in order to maximize the prevention potential of ARV drugs:

• First, structural issues such as community-level living conditions that affect access, such as proximity to appropriate health care and other social determinants of health, are as important as individual-level behaviors.

• Second, more information about implementation is needed by policymakers, funders and prevention programmers in order to determine what mix of ARV-based prevention strategies, if any, are appropriate.

• The third challenge is to adapt ARV-based prevention strategies for local contexts, as reflected in the book’s foreword written by Archbishop Desmond Tutu (“All science is local”).

The research found that within each country, and among varied types of people, the same sets of scientific data were interpreted and framed in different ways depending on the local context and perspectives. For instance, participants in South Africa and India tended to view the scientific data with more skepticism than individuals from the United States, so the successful adoption of ARV-based prevention strategies, such as PrEP, requires consideration of both the science and the local context.

 “It is important to marry the published evidence with the wisdom of communities to make decisions on prevention programming that make sense locally, for communities to map out their own, unique pathways,” Jones said.

Moving forward, there are many considerations for the use of ARVs as prevention in localities.

“Different countries and communities are at different places,” said Dr. Linda-Gail Bekker, deputy director of the Desmond Tutu HIV Foundation in South Africa and a Mapping Pathways partner. “We all have to ask policymakers, funders, and ourselves a host of questions. How will we implement a certain strategy? How will we pay for it? Is it for the generalized epidemic or is it only for certain key populations? What are the social factors that make certain populations vulnerable? Is this strategy ethical? Does it make sound public health sense? What won’t be afforded if we go this route? Who will benefit if we do?

“Meanwhile, we must continue to advocate and conduct implementation science so that we can show policymakers what is feasible and what the impact in the public sector could be.”


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The social drivers of HIV: In conversation with Charles Stephens Part 2

Original content from our Mapping Pathways blog team

"HIV has never been just a question of behavior. It forces us to look at science in a critical way and examine behavioral and social factors." 

In the second of this three-part series, Charles Stephens of AIDS United, a Mapping Pathways partner organisation, speaks about the social drivers of HIV and its impact on vulnerable communities. Click here for part one.

MP: According to the Centers for Disease Control and Prevention (CDC) figures, men who have sex with men (MSM) accounted for 61% of all new HIV infections in the U.S. 2009. There was also a 48% increase in HIV incidence figures among young black gay men (aged 13-29). Why has the HIV epidemic seemed to have disproportionately affected this demographic?

CS: I think there are a number of researchers right now investigating that question. I feel we are still at the stage of trying to figure out what questions we should be asking. For example, a number of researchers have done work that suggests that black gay men don’t necessarily engage in any higher sexual risks or drug-taking risks than white gay men. However, there is a higher incidence of HIV among black gay men – so why is that?

One argument is that there is a higher prevalence of HIV within existing black, gay male sexual networks, which leads to higher incidence numbers. There is also some thought about ways that poverty, stigma and other social factors can play a role in driving the HIV epidemic among black gay men.

HIV has never been just a question of behavior. It forces us to look at science in a critical way and examine behavioral and social factors. One of most exciting conversations I’ve witnessed in the research and advocacy realm is ‘What are the social drivers of HIV and how do those social drivers disproportionately impact some communities over others?’

I think researchers should be looking at lot of areas. But more importantly, considering the impact of HIV among young black gay men in particular, I think its important that researchers, policymakers and community members all come together in grappling with this really severe epidemic.

MP: Can you elaborate on some of the social drivers you talked about?

CS: Some of the questions we have to ask are: What is the role of housing or joblessness? What are the roles of social class, stigma and homophobia? These questions force us to think about HIV in a very intersectional way. By intersectional, I mean the challenge and issue of HIV is also connected to these other larger social issues.

An intersectional approach forces us not to operate in silos. It forces us to be very innovative in how we think about grappling with HIV. It’s impossible to think about HIV without some analyses of social issues because very often those social issues reinforce the impact of HIV, particularly in vulnerable communities.

Ultimately, it is important to look at communities that are most vulnerable. But what we seem to find is that communities vulnerable to HIV are also vulnerable to a number of other social issues, which means that we have to think very critically about the role that these other social drivers of HIV play – particularly in the lives of young black gay men.

MP: What are some of these challenges and issues that young black gay men seem to face in particular? What makes them so vulnerable?

CS: I think that, again, is a research question. There needs to be a research agenda around young black gay men, particularly in the context of HIV, that asks those very questions. Some of the questions to be asked are: How do we understand the vulnerability of this population? What are some of the forces that contribute to this vulnerability?

The research agenda should bring together researchers from multiple disciplines and approaches. This research agenda requires diverse methodologies, skillsets and worldviews. In effect, this would not just be a research agenda but a research and advocacy agenda, with the research helping drive the advocacy.

Current vulnerabilities include, but are not limited to, joblessness, poverty and stigma. We talk about stigma, in particular, as a barrier to someone accessing prevention or care services. Someone might be unwilling to get an HIV test because they don’t want to be seen going to an AIDS service organisation because of the stigma associated with HIV. Someone diagnosed with HIV might not tell people and thus fail to build a support system around them.

Lack of healthcare access is another vulnerability in this population. Communities that are marginalised because of race, class or gender sometimes don’t have access to the best healthcare resources, which contributes to negative health outcomes.

A number of steps have been taken to make HIV testing as accessible as possible. There are efforts to bring HIV testing to communities and one sees HIV testing events at community centers and mobile testing.

Stay tuned to the blog as we bring you part three of our conversation with Charles, where he speaks about some of the challenges faced by people living with HIV in rural areas and shares his thoughts on the good work being done in the HIV prevention landscape. 

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

The social drivers of HIV: In conversation with Charles Stephens

Original content from our Mapping Pathways blog team

"There was a charge at the conference to do more, research more and advocate more because what we are looking at is quite devastating." 

In the first of this three-part series, we speak to Charles Stephens of AIDS United, a Mapping Pathways partner organisation, and get his perspectives on the recently-concluded AIDS 2012 conference in Washington D.C. and the FDA ruling on Truvada for PrEP.

MP: Please tell us a bit about what you do.

CS:  My name is Charles Stephens and I’m the Southern Regional Organiser for AIDS United. In that role, I work with our partners and grantees in the southern region of the U.S. to help build their capacity to engage in and implement advocacy work. I am very passionate about HIV prevention research and my goal is to bridge the gap that sometimes exists between communities and academia, researchers and practitioners.

I provide workshops on advocacy and help to build and sustain coalitions that might develop around an issue or campaign. I also help create tools such as factsheets, which are used by some of our grantees and partners in their advocacy efforts.

My role with AIDS United has given me the opportunity to work with the Mapping Pathways project by helping to disseminate findings and using the project as a community education tool to raise awareness about biomedical HIV prevention in general and ARV-based HIV prevention in particular. Being on the ground with various communities gives me the opportunity to draw upon the perspectives of a wide range of stakeholders to help make the case for the significance and value of ARV-based prevention, which is one of the aims of the Mapping Pathways project.

MP: How did the AIDS 2012 conference go? What were some of the conversations taking place there?

CS: AIDS 2012 was extremely exciting! It was the first time in a long time that a conference was held in the U.S. Several conversations centered on the possibility of ending AIDS as we know it is and we feel this possibility is within our grasp.

There have been a number of scientific breakthroughs, particularly in the context of biomedical HIV prevention, that have given us a lot of hope. TLC+, PrEP and other technologies and strategies were prominently discussed and debated.

There was also a lot of discussion about the catastrophic HIV rates among young black gay men and possible strategies to combat that problem. There was a charge at the conference to do more, research more and advocate more because what we are looking at is quite devastating. There was a contrast, though, between the optimism of envisioning an AIDS-free generation and at the same time looking at the dismal HIV rates among young black gay men. Overall though, I get the sense that many of us left empowered and energised.

MP: What is your opinion on the recent FDA ruling on Truvada for PrEP?

CS: The FDA approval of Truvada for PrEP was another exciting development that lent an air of positivity to the conference. The FDA approval gives us more opportunities to engage in research and demonstration around PrEP and answer key questions.

We have to understand better how PrEP will work in real-world settings. There are a number of questions that a lot of communities and researchers have around PrEP and I think that the FDA approval will allow us to look for the answers to those questions

From an advocacy perspective we are at a unique time. However, we still have to work out accessibility issues and think about how people and communities, particularly vulnerable communities, can afford the drug. Advocates are also having conversations about the Affordable Care Act and other health-care reform.

MP: Is there anything else coming up in the near future that excites you?

CS: I’m looking forward to The National Gay Men’s HIV/AIDS Awareness Day that is coming up on September 27. The U.S. celebrates a number of National HIV/AIDS Awareness days through the year. These provide opportunities to raise awareness and also help de-stigmatise HIV by acknowledging the impact HIV has on certain communities and commemorating unsung heroes in the movement.

The impact of HIV and AIDS on my community motivates me to go out everyday and do all that I can to change the direction things are going in. I’m also thrilled at having the opportunity to work with a number of very talented, skilled and committed individuals. Watching their work inspires me and I think their stories need to be told.

Stay tuned to the blog as we bring you part two and three of our conversation with Charles, where he speaks about some of the social drivers of HIV and the disproportionate impact of HIV on some communities.

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

AIDS 2012 Poster Presentations from Mapping Pathways - Check Them Out!

Original content from the Mapping Pathways blog team

[Pictured discussing the implications of the findings from the posters  are Georgina Caswell from GNP+ and Jessica Terlikowski and Molly Morgan Jones from the Mapping Pathways team.]

The Mapping Pathways project presented two posters at the AIDS 2012 conference on Monday, July 23. One was "Developing the evidence base for biomedical prevention strategies" and the other "Synthesising the empirical evidence to map pathways for HIV prevention planning."

Check out both posters below.

Developing the evidence base for biomedical prevention strategies 

Synthesising the empirical evidence to map pathways for HIV prevention planning 

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

For Global Perspectives on ARV-based Prevention, Find Mapping Pathways at AIDS 2012

Original content from the Mapping Pathways blog team

The Mapping Pathways team will be participating in a number of sessions at the International AIDS Conference (AIDS 2012) in Washington, DC this July. Please check out our list of activities below, and join us!

We will be sharing data we collected in 2011 from India, South Africa and the United States - all related to the utilization of ARVs as HIV prevention. Community and stakeholder perspectives from the "grassroots" and the "grasstops" will be highlighted in each of our focus countries, and sharing an analysis of an extensive literature review conducted by RAND.

Mapping Pathways at AIDS 2012

Click on "View on slideshare" to download the PDF. We hope to see you in DC!

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

Six Months In…. Highlights from the dynamic world of HIV-prevention and the Mapping Pathways project

Original content from the Mapping Pathways blog team

As the year 2012 passes its halfway mark, it is time to take stock of some of the key events this year in the field of HIV treatment and prevention as well as some of the highlights of the Mapping Pathways project.

The year opened on a slippery note with the January 2012 issue of Sexually Transmitted Diseases – Journal of the American Transmitted Diseases Association publishing data from a rectal health and behavior study whose findings “suggest some lubricant products may increase vulnerability to STIs.”

The paper fueled a tremendous amount of discussion in HIV treatment and prevention communities around the world, including the membership listserv run by IRMA (International Rectal Microbicide Advocates).

“We need to be clear – there are only associations between lube use for anal intercourse and STDs. There is no proof that lube use causes increased risk. We simply don’t know that. Because we don't know, IRMA has long been advocating for a lube safety research agenda to fill in our gaps in the science and the evidence base,” says Jim Pickett, Director of Prevention Advocacy and Gay Men’s Health at the AIDS Foundation of Chicago, chair of IRMA, and a member of the Mapping Pathways team. Click here for more info on lube safety.

In March, important new data, specifically from the FEM-PrEP, iPrEX and 

Partners PrEP trials, was revealed at the 19^th Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, Washington. All the webcasts and sessions from the conference can be viewed online here.

The FEM-PrEP trial’s independent data and safety monitoring board (DSMB) recommended that the trial be halted due to “futility” in April 2011 as the study could not answer the question of whether daily Truvada worked, or not, in terms of preventing HIV among the trial population. New information presented by investigators at CROI suggested that the lack of efficacy was related to low levels of adherence to medication.

While participants in the study stated that they took their pills 95% of the time, drug levels found in the blood of women assigned to the Truvada study wing indicated that less than 50% of the women had actually taken the drug in the last 12 days.

In contrast, the Partners PrEP study indicated adherence to medication at almost 97%. Early results reported in Rome last July showed high levels of effectiveness in both men and women. These findings were reviewed at CROI, with no major changes to the estimated effectiveness of the drug.

At CROI, the Partners PrEP team presented analyses of plasma tenofovir levels in trial participants who became HIV-positive and a group of 1,000 participants who did not.

Two key findings were that individuals who remained HIV-negative had detectable blood levels of tenofovir at 82% of their study visits and that having detectable tenofovir in your blood at any given study visit was highly predictive of being HIV-negative at that visit.

The trial had a tenofovir arm, a Truvada arm and a placebo arm. According to the Partners PrEP team, “TDF (tenofovir) and FTC/TDF (Truvada) PrEP definitely provided 67% and 75% protection, respectively, against HIV-1 acquisition in African men and women at risk for HIV-1 infection, when provided in the context of other HIV-1 prevention services.” In short, women and men who took daily tenofovir-based PrEP had a significant reduction in HIV risk.

The results of the iPrEX trial indicated that gay/MSM participants who took Truvada daily had a 44% reduction in HIV incidence over the course of 1.2 years of follow-up compared with placebo. For individuals who did take the drug, and had detectable levels of drug in their bodies, the efficacy of Truvada as PrEP was approximately 90%.

At CROI, researchers presented new results of a case-control analysis on drug levels of the iPrEx trial participants that indicated that the blood-drug level observed with a dosing frequency of four doses per week was associated with a 95% reduction in HIV risk.

Mapping Pathways presented an oral abstract at the Microbicides 2012 (M2012) conference in Sydney in April. Pickett says the abstract and presentation were well received and generated a lot of interest in work Mapping Pathways has been doing and is planning to do in the coming year.

The importance of adherence was further highlighted at M2012. Says Jim “Adherence, the A-word, was a very big topic throughout the entire conference. We realized that we have to make HIV-prevention or treatment products people like and will want to adhere to. We have to figure out how tools like PrEP and microbicides fit in people’s lives, and funding should be put in place to better understand what people want, how they have sex, and the role of pleasure, love and intimacy, among many other ‘real world’ realities.” (Read our entire interview with Jim here.)

In May, an important landmark was achieved when a panel of experts at the U.S. Food and Development Administration (FDA) recommended approval of Truvada for use in PrEP in HIV-uninfected gay men and MSM, HIV-uninfected partners in serodiscordant relationships and other individuals “at risk” of acquiring HIV through sexual activity.

The webcast can be seen here and copies of all the slide presentations are here. The final FDA decision is expected by mid September.

June saw Mapping Pathways team members disseminating findings at the International Association of Physicians in AIDS care (IAPAC) evidence summit on TasP and PrEP in London. Click here to see Jim’s slides and here to read more analyses of the meeting via aidsmap. .

In light of the FDA panel’s approval of Truvada for PrEP in May, Mapping Pathways U.S. partners, AIDS United and AIDS Foundation of Chicago, presented a webinar June 19 focusing on PrEP. Key U.S.-focused findings of the Mapping Pathways online survey and stakeholder interviews were presented at the webinar helping illuminate diverse perspectives of advocates, clinicians, policy makers and people living with HIV.

In a few weeks, Mapping Pathways team members will be presenting data collected in 2011 from India, South Africa and the U.S. at the International AIDS Conference (AIDS 2012) in Washington D.C. The data presented will include findings related to community stakeholder perspective on ARV-based prevention – “grassroots” and “grasstops” – as well as an extensive literature review conducted by RAND, a Mapping Pathways partner.

Please click here to see the complete list of Mapping Pathways activities at AIDS 2012. And join us! All posters and presentations from AIDS 2012 will be made available on the blog, and archived here.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

From Revolution to Reality: How Will New Science Impact the US National HIV/AIDS Strategy?

via wiredforchange.com

AIDS 2012 Conference Satellite - Free and open to the public

RSVP requested

Sunday, July 22, 2012, 11:15 AM -1:15 PM

Mini Room 4, Walter E. Washington Convention Center, Washington, DC

Hosted by the Coalition for a National HIV/AIDS Strategy

Moderator: Gregorio Millett, Senior Scientist, CDC/HHS Liaison to White House Office of National AIDS Policy DONE

Presenters include (list still in formation):

- Carlos del Rio, MD, Hubert Professor and Chair, Hubert Department of Global Health, Emory University: Treatment Cascade
- Keith R. Green, MSW, Director of Federal Affairs, AIDS Foundation of Chicago: PrEP and the NHAS 
- David R. Holtgrave, PhD, Chair, Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health: Costs, Consequences and Feasibility of Achieving the NHAS Goals
- Molly Morgan Jones, PhD, Senior Analyst, RAND Europe: Mapping Pathways: Exploring strategies in the use of ARV-based prevention

Please register here.

The U.S. National HIV/AIDS Strategy (NHAS) has been in place for two years, and since its release, scientific breakthroughs and new research have transformed our thinking about the US HIV epidemic.  HPTN 052 and successful PrEP and microbicide trials demonstrate that biomedical interventions hold promise that were unthinkable just 2 years ago. 

At the same time, Gardner and his coauthors shine a spotlight on the human factors impacting the epidemic-half of people with HIV are not in medical care, and just 1 in 4 achieves treatment success.  Key researchers, including some who contributed to these breakthrough findings, will weigh in on the implications of new research on the US strategy.

Click here to register.

This session will be immediately followed by the satellite session, "Achieving the Goals of the United States National HIV/AIDS Strategy: Next steps", organized by the U.S. Department of Health and Human Services. 

This symposium is conducted in collaboration with and funded by Bristol-Myers Squibb with no editorial review of content. 


[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]