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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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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Risk perception, ARV-based prevention strategies and grassroot conversations – a preview of the upcoming Mapping Pathways monograph

Original content from our Mapping Pathways blog team

Risk perception and the consequent behavioral responses has been a theme that has fascinated Philip Smith throughout his professional career.

Smith, a Ph.D. candidate at the Desmond Tutu HIV Foundation (DTHF), a Mapping Pathways partner organisation, first encountered the subject of risk perception as he was completing his masters degree in social science and psychology at the University of Cape Town. Smith realised that scaring people with death as part of a prevention strategy may actually end up leading people to deny their own vulnerability.

“Smoking is an example where a key prevention strategy involves subjecting people to images of death. My research indicates that this kind of messaging actually leads to a psychological tension that can lead to risk-denial or even an increase in self-esteem boosting risky behavior to relieve that tension,” says Smith.

Smith’s interest in risk and the HIV field led him to DTHF and subsequently to a key role in the Mapping Pathways project; writing up the results of the 2011 Online Survey as part of a monograph to be published this spring by project partner, RAND.. The online survey is one of four data collection mechanisms of the Mapping Pathways project: the other three being the ExpertLens, the Literature Review and the Stakeholder Interviews.

“The Online Survey, which happened in India, South Africa, and the U.S. in 2011, seeks to understand what people at the grassroots were thinking about implementation and what the specific challenges are on successfully implementing ARV-based prevention strategies, such as PrEP and TLC+, also known as treatment as prevention, in their communities,” says Smith

The methodology involved first creating a questionnaire with two different sections: a multiple choice section and a qualitative section where respondents were asked about information they wanted and concerns they may have about ARV-based prevention strategies.

Over 1,000 individuals participated in the survey across the three countries. Among other questions, participants were asked how important they thought ARV-based prevention strategies were and what would they find useful in their work. In addition to asking participants to quantify how important they believed the different strategies are in preventing HIV infection in their communities, they were also given the opportunity to share their perspectives of the barriers to implementing successful ARV-based prevention strategies.

Lastly, participants were asked to suggest what kinds of information they would find helpful in implementing community friendly, impactful, ARV-based prevention strategies.

“Most participants felt positively about ARV-based prevention strategies and their implementation. TLC+ was the most favoured strategy and some valid concerns were raised about cost and the lack of access to healthcare, especially in South Africa and India but also in the U.S.,” says Smith.

Smith says that a key conversation that developed revolved around how healthcare systems around the world, currently tailored towards treatment, would have to adapt with a twin focus on prevention to successfully implement ARV-based prevention strategies.

Consequently, participants wanted to know how best to raise awareness about the different prevention strategies, with some participants requesting that information be made available comparing the different strategies to maximise informed choices in communities. Participants also expressed interest in understanding what policy-makers thought about ARV-based prevention methods because this would act as a useful guide for implementation.

Besides data collection and gathering an evidence base, the key mission of the Mapping Pathways project is to disseminate findings and liaise with the global HIV-treatment and prevention community at large around the use of ARVs for prevention. The upcoming monograph, “Developing evidence-based, people-centered strategies for the use of antiretrovirals as prevention” will touch on all these themes and more, including the theme of risk that has so intrigued Smith throughout his professional career.

Stay tuned for the Mapping Pathways monograph, coming soon

[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.]

Searching for comprehensive solutions: In conversation with Linda-Gail Bekker

Original content from our Mapping Pathways blog team

"The days of behaviourists, clinicians, scientists and legal policymakers being in separate rooms are over. We have to get into one room and work this problem out together."

In the fourth of this five-part series, Linda-Gail Bekker of the Desmond Tutu HIV Centre, a Mapping Pathways partner organisation, speaks about her involvement in the HPTN 067 study and about issues that make HIV the complicated problem it is. Read parts one, two and three

MP: What are some of the other issues that make HIV the complicated problem that it is?

LGB: For 30 years, many people thought HIV was a behavioural issue only - that using condoms, abstaining and being faithful would sort the whole problem out. On the other hand, the biomedically thinking people scrambled around trying to find something that worked, without a whole lot of success. Now the biomedical protagonists  have tools that work, such as PrEP and microbicides. The obvious mistake to be avoided at all cost would be to throw the behavioural science out and go entirely with the biomedical tools.  

This is a trap that medical people often fall into: (and I am one of them!!) they love to fix things with pills and find it easier to offer something tangible to a patient rather than wait for them to change their behaviour.  But pills and microbicides will not work unless they get to the people that need them and those people have the ability to take them. For example, if there’s a structural component in ones life that is a barrier, such as a violent partner, ones ability to reduce one’s risk may be compromised.

The days of behaviourists, clinicians, scientists and legal policymakers being in separate rooms are over. We have to get into one room and work this problem out together otherwise we may again end up with failure because we’re not coming up with comprehensive solutions. After 30 years thinking about a multi-sectoral approach seems the only way to go about it.

MP: Please tell us a little about the ADAPT study that you are involved in.

LGB: The HIV Prevention Trials Network (HPTN) is funding the ADAPT study, also known as HPTN 067, in three sites. Cape Town, which I am PI of, is looking at women who have sex with men, while Bangkok and Harlem are enrolling  MSM. My site has enrolled 180 at-risk women who have sex with men and we are in the process of follow-ups with them.

The women are randomised to daily PrEP, intermittent PrEP and event-driven PrEP using Truvada. The pills are put into a ‘wise pill carrier’ and when it is opened to take a dose, a signal goes to the server.  Our staff call up the young women weekly to discuss what happened over the week. It is an intense study for the participants since they have to share intimate data with site staff on a regular basis but the idea is to look at feasibility and suitability to people of these various dosing modalities to see what works, what doesn’t work, and what people can actually adhere to. It has really needed committed participants and caring site staff with a great deal of trust between them!

The primary goal is to discover if people can use the pills the way they are meant to be used. There obviously are other issues like looking at side effects, safety and other data but the primary end point is feasibility and acceptability of a dosing strategy.

Linda-Gail Bekker is deputy director of the Desmond Tutu HIV Centre at the Institute of Infectious Disease and Molecular Medicine, University of Cape Town. She also serves as the chief operating officer of the Desmond Tutu HIV Foundation, a Mapping Pathways partner organisation. 

Stay tuned to the blog as we bring you the final part of our conversation with Linda-Gail, where she speaks about her the importance of adherence, both in clinical trials and the real world, and the challenges and issues facing adolescents. 

Stay tuned for the Mapping Pathways monograph, coming in early 2013

[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.]