Mapping Pathways

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

2014-04-01T08:31:00.003-04:00

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?”

2013-08-02T08:00:00.000-04:00

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!

2013-07-30T15:48:00.000-04:00

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...

2013-07-29T19:04:00.000-04:00

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

2013-07-11T10:01:00.000-04:00

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.

[ Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

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

2013-07-01T14:45:00.001-04:00

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.

[ Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

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

2013-06-21T14:26:00.000-04:00

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

2013-06-20T09:40:00.000-04:00

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

2013-06-19T10:58:00.000-04:00

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

2013-03-13T03:07:00.000-04:00

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.]

Providing a range of prevention options: In conversation with Linda-Gail Bekker

2013-01-15T01:28:00.000-05:00

Original content from our Mapping Pathways blog team

We need options. Not everyone in the world is a good pill taker. Like so many things in life, we may realise that people need different prevention options since they have different personalities.

In the final part of this five-part series, Linda-Gail Bekker of the Desmond Tutu HIV Centre, a Mapping Pathways partner organisation, speaks about the importance of adherence, both in clinical trials and the real world, and the challenges and issues facing adolescents. Read parts one, two, three and four

MP: You have mentioned adolescents as a particular vulnerable group in South Africa. In an interview conducted earlier this year, your colleague, Dr. Melissa Wallace, also talked about adolescents as an especially at-risk group. What are some factors that make them so vulnerable?

LGB: One particular reason why adolescents are highly at risk for HIV is because many are at the stage of their lives where they may be experimenting with their sexuality. They may also find themselves in relationships where negotiating condoms may be incredibly difficult.

This maybe the case with younger women whose relationships can be with older men and young MSM outing themselves for the first time and who may then choose to go out with older men. In that situation, being able to use a PrEP tablet discreetly and under their own control could be a life-saving step.

So putting prevention into the hands of the vulnerable becomes a very important tool. But we can only do this if we are sure it’s safe in this population, which requires carefully run clinical research in order to adequately test the product in the relevant populations.

This requires resources and investment from sponsors and funding agencies even though this is often regarded as “high risk investment”. In that regard, I’m delighted that we’ll be starting an MP3 project (methods of prevention) based on a grant awarded to us by the National Institutes of Health (NIH) to look at PrEP and other biomedical prevention modalities in adolescents between 14-17 years old.

MP: Adherence is an issue that has come up quite a bit this year, from M2012 to AIDS 2012. How much are people talking about adherence and about taking lessons learned from trials into the real world?

LGB: Adherence is the Achilles heel of the HIV prevention and treatment worlds. This is where biology meets behavior. We know that the pill is efficacious – Partners PrEP showed that beautifully. In fact, every single one of the clinical trials has shown that once adherence increases there is a direct correlation with efficacy in the results. Starting with the 39% in the CAPRISA study leading on to 44% in the iPrEx study and going on to an astounding 75% in the Partners PrEP study – each one had an increased overall adherence rate and with this an increase in point efficacy, so the correlation appears to be a real phenomenon.

In addition, the sub-studies done in every trial showed that high adherers within a study had a better efficacy compared to the lower adherers. So we can quite confidently say there is a robust relationship between adherence and efficacy.

So how do we get people to adhere? Motivations play a great role. Partners PrEP which enrolled discordant couples had a great in-built motivation that one was protecting a loved one by taking the pill, which may be the reason we saw particularly high adherence for that population.

I think we also need to understand that not everybody in this world is a good pill-taker. There will be those who just cannot bring themselves to swallow pills on a daily basis. So PrEP may not be a very good idea for them. In that situation, maybe a rectal microbicide or a microbicide that’s part of a lubricant may work very well for that individual.

We need options. If we get to that stage in the future where other prevention technologies are available, like getting a shot in the arm that lasts three months, then we need that option on the table too. Like so many things in life, we may realise that people need different prevention options since they have different personalities.

MP: What are some of your final thoughts on what needs to happen to stem the HIV epidemic?

LGB: We need to have conversations on several different levels: ethical, scientific, public health, politics and priorities. Different countries and communities will be at different places. Some of the hard questions are : Who pays? How will we implement this prevention strategy? Is this strategy for the generalised epidemic or is it only for selected key populations? Who are the key populations? What are the social factors that make them vulnerable? Is this ethical? Does it make sound public health sense? What wont be afforded if we go this route? Who will benefit if we do?

Those are all very hard questions but they deserve to be asked and certainly require ongoing dialogue. This brings us back to the Mapping Pathway- we have been contributing to the dialogue through this project. We also need to do the modeling exercises and implement some feasibility type projects and then continue to raise more questions., It’s a wonderful thing that we are at a point where we can actually have these conversations. They are not hypothetical questions anymore. It is urgent to have these discussions in such a way that the next steps become clear and infections can be averted before too much more time is lost.

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 for the Mapping Pathways monograph, coming in early 2013

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

2013-01-03T07:17:00.000-05:00

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.

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

The prevention revolution is underway: In conversation with Linda-Gail Bekker

2012-12-20T02:47:00.000-05:00

Original content from our Mapping Pathways blog team

"We have to continue to advocate and do the implementation science so that we can show policymakers what is feasible."

In the third of this five-part series, Linda-Gail Bekker of the Desmond Tutu HIV Centre, a Mapping Pathways partner organisation, speaks about the AIDS 2012 conference and her thoughts on the FDA approval of Truvada for PrEP. Read parts one and two

MP: What were some of the conversations around the AIDS 2012 conference?

LGB: AIDS 2012 confirmed that the prevention revolution is currently underway. The energy around prevention was palpable. AIDS 2012 had me running around between presentations on microbicides to PrEP to treatment as prevention (TasP) and back again to microbicides. Since I am involved in both treatment and prevention, I am usually very torn in conferences on what to attend. This time, I did one talk on treatment of HIV-infected adolescents but everything else was related to prevention, PrEP and microbicides. This is great because this is where the science is at the moment.

I also participated in some very important and in-depth conversations about some of the studies where the results have looked less than ideal. There were conversations about what actually happened in the FEM-PrEP trial and the VOICE trial. Those conversations are ongoing and data is beginning to filter through and things are becoming clearer.

MP: The U.S. Food and Drug Administration (FDA) approval of Truvada for PrEP was another major event this year. What is your reaction to that and how does that change things?

LGB: I attended this FDA meeting and it was absolutely thrilling. Gilead and the key scientists did a great job presenting the science and I thought the discussions were very robust and thorough. I came away from the process very impressed with the way drugs are reviewed. I also subsequently read the statements from people on the panel about why they voted the way they did and felt their opinions were informed, valid and thoughtful.

However, we are now in an era where we need to be practical while still doing the science. In that sense, I’m not sure how much the FDA approval changes things in the South African context. I would be delighted if Gilead takes this forward locally (in terms of an application to the SA Medicines Control Council) because I think it would give us impetus to move forward with prevention, but clearly much will depend on our policymakers and their thoughts about cost and and further decisions of key population implementation versus a generalised population implementation.

We have to continue to advocate and do the implementation science so that we can show policymakers what is feasible and what the impact in the public sector may be so that they can understand what the logistics are.

Stay tuned to the blog as we bring you part four of our conversation with Linda-Gail, where she speaks about her involvement in the HPTN 067 study and about issues that make HIV the complicated problem that it is.

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

Biomedical science, behavioural interventions and a dollop of justice and rights: In conversation with Linda-Gail Bekker

2012-12-17T05:42:00.000-05:00

Original content from our Mapping Pathways blog team

"I’m a great protagonist of putting effective biomedical technology next to proven structural and behavioral interventions, including a good dollop of justice and rights and then asking: how does one actually make the prevention package focus on this particular population at hand?"

In the second of this five-part series, Linda-Gail Bekker of the Desmond Tutu HIV Centre, a Mapping Pathways partner organisation, speaks about vulnerable populations in Africa and the burden of HIV there. Read part one here

MP: We recently spoke to Charles Stephens of AIDS United who spoke about disturbing trends in vulnerable communities such as young black gay men in the U.S. What is your take on Africa, which carries the bulk of burden of HIV?

LGB: Southern Africa is the region where the HIV burden is greatest. . We have seen reductions in East Africa and West Africa is, to a certain extent, less troubled. The southern tip of Africa has really struggled with the HIV epidemic and my own country South Africa, with the greatest per capita of HIV, is particularly hard hit. While we obviously have contributions of perinatal infections, with universal PMTCT, we are hoping that eradicating pediatric HIV is an achievable goal.

But while the perinatal burden is happily on the downswing, there is an ongoing incidence in young women, starting at sexual debut and peaking at the age of 25. The incidence in young men starts later, in the 20s and peaks at the age of 35. So we see this alarming increase in incidence, particularly among young women from Africa who engage in penetrative, vaginal, heterosexual sex. So for our African context this is THE vulnerable population and we have to find prevention packages for that population in particular. People sometimes make the mistake of thinking of adolescents as small adults. This is wrong. Adolescents need and deserve their own tailor-made prevention packages.

MP: What are some of the other vulnerable populations that are at risk in Africa?

LGB: We do also have concentrated epidemics in key populations that are vulnerable and in this age of biomedical technology, they too need tailor-made packages for prevention. My group has been focused on men who have sex with men (MSM), particularly MSM of colour, since the prevalence in this community is much higher than men in general, regardless of colour. Migrant populations, incarcerated populations and people who sell sex all have higher rates of HIV.

MP: What needs to be done to address the problems facing these vulnerable populations?

LGB: I’m a great protagonist of putting effective biomedical technology next to proven structural and behavioral interventions, including a good dollop of justice and rights and then asking: how does one actually make the prevention package focus on this particular population at hand?

We have a lot of work ahead of us to specifically design, implement and test for effectiveness in each of these packages in each one of these populations.

Imperfect as it may be, we need to start trying to work out how to put these things together in very specific way. But it does require that we know our populations and understand their vulnerabilities.

But what stalls this progress is prejudice, judgmental thinking and mythical perceptions. This is where a project like Mapping Pathways is important since it tries to understand what people are thinking at the moment about these things. Too often, people’s opinions are actually what decide what happens and decisions made in the medical field are sometimes driven by emotion and not by hard fact or evidence. The Mapping Pathways project seeks to find out how people feel so that feelings can be contested by facts. Hopefully by employng this very pragmatic approach, we can move best approaches forward as soon and as urgently as we can.

Stay tuned to the blog as we bring you part three of our conversation with Linda-Gail, where she speaks about the AIDS 2012 conference and the FDA approval of Truvada for PrEP.

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

Combining behavioural science and biomedical tools: In conversation with Linda-Gail Bekker

2012-12-13T06:51:00.000-05:00

Original content from our Mapping Pathways blog team

"This project is an attempt to be representative of the HIV epidemic around the world, including Africa, which carries the bulk of the burden but is often forgotten when it comes to opinion."

In the first of this five-part series, Linda-Gail Bekker of the Desmond Tutu HIV Centre, a Mapping Pathways partner organisation, speaks about the evolution of the project and the recently-released South Africa guidelines for PrEP in MSM.

MP: Please give us some of your thoughts on the Mapping Pathways project as it has evolved over time.

LGB: A key component of the Mapping Pathways project is its concept of being multi-continent, which imparts depth and relevance. The world is a big place and this project is an attempt to be representative of the HIV epidemic around the world, including Africa, which carries the bulk of the burden but is often forgotten when it comes to opinion!.

The project is a wonderful attempt to gather and document important views from opinion leaders as well as from people in the street around the world on important topics in prevention. This is enhanced by the fact that we are at a very exciting time in HIV prevention, which is quite a volatile, polarised and changing field. Things move at such a rapid pace in this field that sometimes, things done a month ago can quickly be out of date.

We have shared some of our Mapping Pathways data and findings informally at conferences like the Microbicides 2012 (M2012) conference in Sydney and the AIDS 2012 conference in Washington D.C. We are now looking forward to all the data collected being put together in a more formal, structured way. RAND Europe, one of the project partners, is working to create a book that will cover results and analyses of the four methods of data collection used in this project; the Literature Review, online survey, the ExpertLens and stakeholder interviews. It is great that all the sites and partners are contributing to this.

On a personal note, I feel Jim Pickett, Director of Prevention Advocacy and Gay Men's Health at the AIDS Foundation of Chicago and Mapping Pathways project member, is one of the most charismatic and compelling people I have worked with. His “can-do” attitude, enthusiasm for prevention and vision has been essential for the success of this project, considering its scope and scale spanning three continents.

MP: Please tell us about the South Africa guidelines that recently came out based on a consensus group that you chaired.

LGB: The Southern African HIV Clinicians Society writes consensus guidelines for clinicians in the country on a variety of topics. I chaired one such consensus group to come up with guidelines for PrEP in MSM in South Africa. These guidelines were written and published earlier this year and are available online.

The rationale is that Truvada is currently available in country and we imagine that some men may wish to use it and clinicians would need guidance as to how to do that safely. The guidelines provide practitioners with a go-to document to enable them to use the drug in a safe and effective way should they have a client who wishes to and can afford to do so.

Stay tuned to the blog as we bring you part two of our conversation with Linda-Gail, where she speaks about vulnerable populations in Africa and the burden of HIV there.

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

The social drivers of HIV: In conversation with Charles Stephens Part 3

2012-10-05T05:41:00.000-04:00

Original content from our Mapping Pathways blog team

"I'd like to see us...reflecting on our successes. It has been proven that testing someone for HIV and, if positive, linking them to services and care as soon as possible has very positive health outcomes."

In the final part of this three-part series, Charles Stephens of AIDS United, a Mapping Pathways partner organisation, speaks about the successes in the HIV prevention landscape and some of the challenges faced by people in rural areas. Read part one here and part two here.

MP: What are the things being done well in the HIV prevention landscape?

CS: Models like the Mapping Pathways project excite me. The process of collecting data from a variety of different experts and stakeholders on the field and using that data to make a strong case is an excellent model. Other interesting models are AVAC’s HIV prevention research advocacy working group, which I’m a part of, and the community education and research advocacy work of the Black AIDS Institute. Most importantly, stakeholders and leaders within communities are trained and supported to go back to their communities with new biomedical HIV prevention information to disseminate it within their communities.

One of the things I’d like to see more of is reflecting on our successes and planning how to build on the victories we’ve seen over the last few years. It has been proven that testing someone for HIV and, if positive, linking them to services and care as soon as possible has very positive health outcomes. Also from the community perspective we have achieved certain successes like reducing stigma, mobilising communities and providing support networks and services. I’m extremely interested in finding out how we can build on these successes.

MP: What are some of the challenges individuals and communities face in rural areas?

CS: Capacity is one of the main challenges in rural areas. I find that the doctors on the ground are often very knowledgeable, passionate and committed, but the problem that is there just aren’t enough doctors and medical resources.

Transportation is another huge barrier in rural areas. People have a hard time getting to their doctors, as the transportation infrastructure isn’t always in place. Some people have to travel three or four hours to get to their physicians.

Addressing these barriers has been a challenge, but there have been some innovations like telemedicine, where doctors can remotely provide medical information and check in with their clients from a different location.

MP: Are there any trial results that came out recently that you have followed closely? Are there any upcoming trials you are interested in?

CS: The HPTN 061 study, which looked at 1553 black, American MSM, shared initial results at AIDS 2012 that reinforced what a lot of us had been seeing on the field. One of the most startling projections of the study was that unless improvements are seen, more than half of all young black gay men who are gay or bisexual will be infected by HIV within the next decade.

Other upcoming trials I will be following with interest are the HPTN 073 study which looks at ways to optimise PrEP adherence in black MSM and the HPTN 069 study, also called NEXT PrEP, which seeks to assess the efficacy of four ARV drug regimens used as PrEP to prevent transmission of HIV in a population of at-risk MSM.

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

2012-10-01T03:47:00.000-04:00

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.

The social drivers of HIV: In conversation with Charles Stephens

2012-09-25T06:05:00.000-04:00

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.

Sustainable HIV prevention possibilities present choices, challenges

2012-08-24T11:30:00.000-04:00

via Science Speaks, by Antigone Barton

When he looks at what biomedical science can do in the next decade to prevent HIV transmission, Jim Turpin of the National Institutes of Health said, he thinks of the lyrics of a Timbuk3 song: “The future’s so bright I gotta wear shades.”

By, which, actually, he means — don’t get blinded by the light; the search for answers will require focus.
“The challenge is not the lack of options,” he said, “but prioritizing the best options.”

Turpin, program officer and branch chief in the Prevention Sciences Program in the Division of AIDS at NIH”s National Institute of Allergy and Infection Disease spoke this morning in webinar titled “The HIV Prevention Pipeline: A Future of Possibilities.” The webinar was sponsored by the International Rectal Microbicide Advocates (IRMA) and AVAC Global Advocacy for HIV Prevention.

After a series of disappointments in the quest for a vaccine or microbicide to prevent HIV transmission, the last two years offered hope, in strategies using antiretroviral medicine to prevent acquiring HIV, organizers point out. But, with a diversity of prevention needs and challenges among women and men worldwide still demanding answers, is that all there is?

Or, as Turpin put it, “Do we currently have what it takes to create a sustainable prevention pipeline?”

Read the rest.

[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.]

Policy Implications of The Lancet MSM & HIV Series

2012-08-24T10:15:00.000-04:00

via Center for Strategic & International Studies

In light of the need to address key populations in the HIV epidemic, the Center for Strategic and International Studies is convening several authors to discuss a special issue of The Lancet focused on the global HIV epidemic among men who have sex with men (MSM).

Thursday, September 6th
3:00pm—5:00pm (EST)
B1 Conference Room
Center for Strategic and International Studies
1800 K Street NW, Washington, D.C.

CSIS will host a dialogue focusing on the domestic and global policy implications of the new research and modeling presented in this special issue. Articles examine the subject from a variety of perspectives, including epidemiology, biological and behavioral factors in HIV transmission, the success of various interventions, costing a comprehensive response, and HIV among black MSM in the United States and elsewhere. Authors will discuss why current programs are failing and HIV epidemics among MSM are still increasing. Sharon Stash, CSIS Global Health Policy Center Senior Advisor, will moderate the discussion with authors Chris Beyrer, Kenneth H. Mayer, Greg A. Millett, and Patrick S. Sullivan, and discussant Chris Collins. The session will open with concise presentations of the key findings and policy recommendations, with the majority of the time reserved for questions and discussion.

Please RSVP at: http://SmartGlobalHealth.org/Lancet

Thank you,

J. Stephen Morrison
Senior Vice President and Director, Global Health Policy Center
Center for Strategic and International Studies

Access the webcast 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.]

U.S. Preventive Services Task Force May Soon Make HIV Testing Routine

2012-08-21T14:00:00.000-04:00

via the Huffington Post, by Salimah Ebrahim

WASHINGTON, Aug 20 (Reuters) - A U.S. health panel may soon make HIV testing as standard a practice as checking cholesterol levels, a move that would fundamentally change how the virus is detected and treated.

The U.S. Preventive Services Task force, a government-backed group of clinicians and scientists, is expected to make a new recommendation on HIV screening available for public comment before the end of the year.

Health officials close to the panel, speaking on condition of anonymity, see it making a positive recommendation for routine screening, updating their current position, issued in 2005, which leaves the decision up to doctors.

Under President Barack Obama's healthcare law, passed in 2010, insurers are required to cover preventive services that are recommended by the task force.

"This would be one of those major sea changes ... moving away from what has been somewhat the segmentation of HIV - either by population, by geography," said Michael Kharfen, chief of community outreach for the Washington, D.C., Department of Health. Kharfen, who worked on the frontlines of the HIV epidemic in New York in the 1980s, recalls when the prognosis for the disease was "practically certain you were going to die.

"It still will take culture change for medical providers, but this will be a tremendous leap," he said

Read the rest.

[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.]

Three-quarters of clinicians in the US willing to prescribe early HIV treatment for the purpose of prevention

2012-08-21T10:28:00.001-04:00

via aidsmap.com, by Michael Carter

There is an overwhelming consensus among clinicians who prescribe HIV treatment in the US that people who are taking antiretroviral therapy are less likely to transmit HIV to their sexual partners, according to results of a study published in the online edition of the Journal of Acquired Immune Deficiency Syndromes. Results also showed that over three-quarters of care providers would be willing to prescribe early therapy to people with an HIV-negative partner for the purposes of prevention.

The study involved 165 prescribing clinicians working at HIV clinics in the Bronx, New York, and Washington DC. It was conducted in 2010 and 2011, well before the publication of the results of the HPTN 052 study in the summer of 2012, which showed that virologically suppressive HIV treatment reduced the risk of transmission by 96%. US HIV treatment guidelines were updated in 2012 to endorse early treatment to reduce the risk of transmission.

“This survey of HIV clinicians in two US cities found most clinicians believe that ART [antiretroviral therapy] can reduce HIV transmission, even before the results of HPTN 052 demonstrated ART to be effective for this purpose, and before 2012 treatment guideline changes recommending ART for patients at risk for HIV transmission,” write the authors.

Read the rest.

[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.]

Cipla launches HIV/AIDS treatment kit at Rs 158

2012-08-20T10:29:00.000-04:00

via IBN Live

New Delhi: Drug major Cipla on Tuesday said it has launched 'Qvir', a four-drug kit priced at Rs 158 per kit to be used for treating HIV/AIDS. The kit consists of two tablets packaged together in one strip which represents a single day's treatment, Cipla said in a statement.

Commenting on the introduction Cipla Chairman and Managing Director YK Hamied said: "While we are committed to making drugs affordable and accessible, we also endeavour to have more options for HIV infected patients, which are potent, effective, patient-friendly and easy to take".

As the tablets are packaged together in one strip, the patient does not have to remember which tablet he took, and cannot mistakenly take two of the same tablet, the company said.

Read the rest.

[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.]

Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial

2012-08-15T14:00:00.000-04:00

via The Lancet, by Lara Fairall et al.

Background

Robust evidence of the effectiveness of task shifting of antiretroviral therapy (ART) from doctors to other health workers is scarce. We aimed to assess the effects on mortality, viral suppression, and other health outcomes and quality indicators of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) programme, which provides educational outreach training of nurses to initiate and represcribe ART, and to decentralise care.

Read the rest.

Newly infected individuals sustaining HIV epidemic in Geneva

2012-08-15T11:03:00.000-04:00

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.

[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.]