[Viva] Fwd: PrEP use linked to fewer new HIV infections in American states - Thursday 26 July 2018

Thu Jul 26 14:30:15 PDT 2018

Some interesting updates from Amsterdam (see below)
Also, did anyone else hear the news today on the study out of Saskatchewan
about a more virulent strain of HIV that progresses to AIDS quicker?
Ugh! Terrible news!
I just hope this will light a fire under some of the policy makers/
healthcare providers to do something about getting people connected to
testing and treatment.
OX
Margarite
---------- Forwarded message ----------
From: aidsmap conference news <bulletins at bulletins.aidsmap.com>
Date: Thu, Jul 26, 2018 at 7:09 AM
Subject: PrEP use linked to fewer new HIV infections in American states -
Thursday 26 July 2018
To: margaritesanchez at gmail.com

Having trouble reading this email? View it in your browser
<http://www.aidsmap.com/page/3314032>
Thursday 26 July 2018
Contents

   - PrEP use linked to fewer new HIV infections in American states
   <#m_-3595317935266717246_item3314035>
   - Donor funding for HIV programmes stalls
   <#m_-3595317935266717246_item3314036>
   - Test and treat studies show high rates of HIV diagnosis and viral
   suppression <#m_-3595317935266717246_item3314034>
   - Universal test and treat greatly improves retention in care
   <#m_-3595317935266717246_item3314037>
   - HIV treatment services need to adapt for mobile and migrant
   populations <#m_-3595317935266717246_item3314038>
   - Why are some countries slow to implement HIV treatment guidelines?
   <#m_-3595317935266717246_item3314040>
   - High uptake of HIV self-tests by outpatients
   <#m_-3595317935266717246_item3314041>
   - Consensus statement on HIV science in the context of criminal law
   <#m_-3595317935266717246_item3314042>
   - Scientific analysis from Clinical Care Options
   <#m_-3595317935266717246_item3314039>
   - Support our work <#m_-3595317935266717246_item3314033>

<http://www.aidsmap.com/page/1036964/>
PrEP use linked to fewer new HIV infections in American states

Graph from Patrick Sullivan's poster at AIDS 2018.

As pre-exposure prophylaxis (PrEP) use continues to grow in the US,
epidemiological evidence is starting to show an association between
increases in PrEP uptake and declines in new infections
<http://www.aidsmap.com/page/3313879/>.

A new analysis presented this week at the 22nd International AIDS
Conference (AIDS 2018) <http://www.aidsmap.com/page/3249960/> in Amsterdam
shows a correlation between higher PrEP use and lower HIV incidence in US
states.

The US Food and Drug Administration approved *Truvada*
(tenofovir/emtricitabine) for HIV prevention in July 2012. PrEP use has
risen steadily since then, especially among white gay and bisexual men in
major cities, but it has been difficult to determine the total number or
demographics of people using PrEP because these data are not centrally
collected.

Gilead Sciences, the maker of *Truvada*, has been reporting PrEP use
estimates based on surveys of commercial pharmacies, and with researchers
at Emory University's Rollins School of Public Health reported earlier this
year
<http://www.aidsmap.com/PrEP-use-growing-in-US-but-not-reaching-all-those-in-need/page/3222068/>
that just over 77,000 people were taking PrEP in the US in 2016.

But PrEP is still only reaching a small proportion of those who might
benefit, so is this increase in PrEP use leading to a decrease in new HIV
infections?

The new analysis shows that the overall HIV diagnosis rate decreased
significantly, from 15.7 per 100,000 persons in 2012 to 14.5 per 100,000
persons in 2016, an estimated annual decline of -1.6% per year.

Some notable differences were seen in relation to PrEP use. New HIV
diagnoses declined by -4.7% in the quintile of states with the highest PrEP
use. In contrast, diagnoses increased in the quintile with the lowest PrEP
use (+0.9%).

"PrEP uptake was significantly associated with declines in HIV diagnoses in
the USA, and this association is independent of levels of viral
suppression," the researchers concluded.
Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/3313879/>
   - View the abstract on the AIDS 2018 website
   <http://programme.aids2018.org/Abstract/Abstract/13004>
   - Visit our conference news pages for all our AIDS 2018 coverage
   <http://www.aidsmap.com/page/3249960/>

Donor funding for HIV programmes stalls

Jennifer Kates speaking at a press conference at AIDS 2018. ©International
AIDS Society/Rob Huibers

Falling levels of donor government funding for HIV programmes threaten
progress towards the 2020 global target of 90-90-90
<http://www.aidsmap.com/page/3313685/>. The 90-90-90 targets endorsed by
governments in 2014 call for 90% of people to know their HIV status, 90% of
people with diagnosed HIV infection to be on treatment, and 90% of people
on treatment to be virally suppressed.

At the AIDS 2018 conference, Jennifer Kates of the Kaiser Family Foundation
presented data from a recent joint report with UNAIDS alongside three
studies showing that overall funding by donor governments has largely
stalled, with 8 out of 14 governments reducing their global spend on HIV
efforts in 2017.

A study from the Harvard TH Chan School of Public Health showed that of the
US$48 billion spent by 188 countries on HIV in 2015, overall 62% came from
domestic spending by governments and 30% from development assistance.
However, in countries with high HIV prevalence nearly 80% of funding came
from development assistance, making these countries vulnerable to any
reductions in aid.

Deepak Mattur of UNAIDS presented an analysis of data from 112 low- and
middle-income countries. While almost all regions increased their domestic
HIV resources, the lowest increase (33%) was in Eastern Europe and Central
Asia. "We are already almost 20% short of the funding needed to reach the
2020 targets,” he said.

John Stover of Avenir Health, however, presented a paper contending that
more focused allocation of resources could improve cost-effectiveness by
about a quarter in the 55 low- and middle-income countries that account for
about 90% of all new infections.
Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/3313685/>

Test and treat studies show high rates of HIV diagnosis and viral
suppression

Moeketsi Joseph Makhema at AIDS 2018. ©International AIDS Society/Marcus
Rose.

Two large studies of community-based universal test and treat campaigns to
promote HIV diagnosis, treatment and prevention show that the campaigns
achieved very high rates of HIV diagnosis and viral suppression, as well as
reductions in HIV incidence on some measures
<http://www.aidsmap.com/Test-and-treat-studies-show-high-rates-of-HIV-diagnosis-viral-suppression/page/3313688/>
.

Large-scale community campaigns that go beyond the HIV clinic to offer
testing and link people to HIV care have been piloted in several African
countries, adopting methods such as door-to-door testing and community
health events to reach people who might not attend health facilities or
otherwise be offered an HIV test.

The SEARCH study, carried out in Uganda and Kenya, offered HIV testing and
rapid treatment initiation within a multi-disease campaign also designed to
diagnose and treat high blood pressure, diabetes and tuberculosis (TB) in
the whole community.

Overall, the study found that by the end of year three, 79% of people with
HIV in the intervention communities had a fully suppressed viral load
compared to 68% in the control communities.

The effects of the multi-disease campaign went beyond viral suppression.
People with HIV in the intervention communities were 20% less likely to die
during the study than people with HIV in the control communities, and the
mortality rate was 11% lower among all people enrolled in the intervention
communities compared with the control communities. Results across the
targeted health conditions were good, including TB incidence being almost
60% lower in the intervention communities.

The Ya Tse study, carried out in Botswana, evaluated the impact of an
intensive community testing campaign, immediate treatment initiation and
scaled-up provision of male circumcision.

In the intervention arm, 57 people acquired HIV infection compared to 90 in
the standard-of-care arm, representing a 30% reduction in incidence.

The study also found a high rate of viral suppression among people
diagnosed with HIV at baseline. The proportion of people who were virally
suppressed increased by 18% in the intervention group and 7% in the control
group. By the end of the study, 88% of all people diagnosed with HIV in the
intervention group had an undetectable viral load.
Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/3313688/>
   - View the abstract on the AIDS 2018 website
   <http://programme.aids2018.org/Abstract/Abstract/13469>

Universal test and treat greatly improves retention in care

Velephi Okello at AIDS 2018. ©International AIDS Society/Marcus Rose.

People who started HIV treatment in Swaziland under a universal test and
treat policy were seven times more likely to still be in care and to have a
fully suppressed viral load six months after starting treatment when
compared to management of patients under the existing standard of care, the
AIDS 2018 conference heard <http://www.aidsmap.com/page/3313714/>.

‘Universal test and treat' aims to provide HIV testing to everyone in a
local area and then – for those diagnosed with HIV – to link everyone to
medical care and to provide everyone with HIV treatment that lowers their
viral load to undetectable levels.

The findings presented at the conference come from the MaxART study, a
comparison of providing treatment according to a standard model or through
a universal test and treat approach. The study was designed to evaluate the
real-world performance of a universal test and treat policy in a country
with a very high prevalence of HIV and a predominantly rural population.

The study was conducted in 14 public health facilities in Swaziland,
randomised to begin offering universal test and treat in stages, with a new
group of facilities moving to test and treat every four months.

When the research group looked at outcomes six months after enrolment, they
found that universal test and treat was associated with a 94% increased
likelihood of retention in care and a sevenfold increase in the likelihood
of both being retained in care and having an undetectable viral load.
Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/3313714/>
   - View details of this session on the AIDS 2018 website
   <http://programme.aids2018.org/Abstract/Abstract/13370>

HIV treatment services need to adapt for mobile and migrant populations

Bwalya Chiti at AIDS 2018. Image credit: @HIVptn

Health facilities must be responsive to the needs of mobile individuals and
of migrants if they are to retain people in care, the conference was told
<http://www.aidsmap.com/page/3313860/>. Lifelong engagement with care is
required for good individual and public health outcomes, but the rigidity
of many health services is a barrier.

Social scientists working in the settings of universal test and treat
studies in African countries, in order to understand the social context and
impact of these interventions, have found that mobility and migration is a
key theme.

In countries where welfare and social protection systems usually do not
exist, people’s reasons for mobility are primarily to raise money for
household basic needs such as food, shelter and children’s schooling.

Bwalya Chiti of the University of Zambia highlighted that the clinic system
usually requires people living with HIV to collect their medication from
the same location. They may have to attend once a month, within normal
working hours, and a visit can take a full day. Chiti argued people living
with HIV need to be involved in decisions about service design to develop
more flexible services.

Joseph Larmarange of the Centre Population et Développement (CEPED)
commented that whereas the solutions in relation to short-term mobility
seem fairly clear, it was less obvious how to adapt services for migrants
who cross borders.

If health is seen as a human right, this must apply to mobile and migrant
populations too.
Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/3313860/>
   - View the Population Mobility edition of the *Journal of the
   International AIDS Society* (open access)
   <https://onlinelibrary.wiley.com/toc/17582652/2018/21/S4>

Why are some countries slow to implement HIV treatment guidelines?

Slide from Matthew Kavanagh's presentation.

Differences in countries’ economic prosperity and HIV prevalence do not
explain the speed with which they update their national treatment policies
and guidelines, but factors related to a country’s political structure are
relevant, the AIDS 2018 conference heard yesterday
<http://www.aidsmap.com/page/3313452/>.

Over the years, there have been a series of important changes in the expert
opinion and scientific evidence on when people should begin antiretroviral
therapy (ART). Since September 2015, the World Health Organization has
recommended treatment for all people with HIV, regardless of CD4 count.
However, there is a great deal of diversity in national policies, with many
countries lagging behind the guidelines.

A new study identified 290 published national ART guidelines from 122
countries, and interviewed 25 key people from 12 countries in order to shed
light on barriers and facilitators of policy change.

It found that several factors which could be expected to have an impact on
uptake of new guidance had only a minor impact. These included HIV
prevalence, gross domestic product (GDP), and how democratic a country was.

However, it did find that the structure of government was important, with
countries which have more centralised power structures being slower to
implement changes. It seems that in countries with more complex
bureaucratic and political structures, there are more opportunities for
professional and community groups to exert influence.

Ethnic and linguistic diversity within a country also had a strong
association with slower decision making. To influence change in such
contexts, it may be helpful to have a variety of ‘messengers’ who can reach
different ethnic, linguistic and social groups.
Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/3313452/>
   - View the abstract on the AIDS 2018 website
   <http://programme.aids2018.org/Abstract/Abstract/12213>

High uptake of HIV self-tests by outpatients

Images from Kathryn Dovel's presentation slides.

Most models of HIV self-test distribution are based on community settings
but providing self-tests to outpatients at health facilities is a promising
strategy <http://www.aidsmap.com/page/3313144/>, the conference heard.

Patients at clinics offering self-testing in Malawi were seven times more
likely to take a test than people offered provider-initiated testing and
counselling (PITC).

Fifteen healthcare facilities were randomised to provide HIV testing in one
of three ways:

   - Standard PITC: patients referred to another part of the facility for
   an HIV test.
   - Optimised PITC: HIV testing in the outpatient department, before
   receiving the service the person was attending for.
   - Facility-based self-testing: HIV self-test kits distributed in the
   waiting area.

In a six-month period, 13,077 adults attended the outpatient facilities.
Self-testing dramatically increased the proportion of outpatients tested –
from 13% with standard PITC and 14% with optimised PITC, to 51% with
self-testing. The benefit was most pronounced in young people aged 15 to
24. After adjusting for other factors that could influence the results,
being at a self-testing site was associated with a sevenfold greater odds
of testing for HIV.

Providing self-tests within health facilities may have advantages in terms
of being an approach that is feasible to scale up, which facilitates
linkage to care, and in relation to quality assurance.
Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/3313144/>
   - View the abstract on the AIDS 2018 website
   <http://programme.aids2018.org/Abstract/Abstract/7379>

Consensus statement on HIV science in the context of criminal law

To coincide with the AIDS 2018 conference, 20 of the world’s leading HIV
scientists published the *Expert consensus statement on the science of HIV
in the context of criminal law* <http://www.aidsmap.com/page/3313286/>.

The statement is based on robust evidence and counsels caution when
prosecuting people for HIV transmission, exposure and non-disclosure. It
encourages governments, law enforcement officers, and those working in the
judicial system to note carefully advances in HIV science so as to ensure
that current knowledge in this field informs the application of the law.

The statement is explicit that its purpose is to assist those providing
expert opinion evidence in individual criminal cases, and that it is “not
intended as a public health document to inform HIV prevention, treatment
and care messaging or programming”.

The statement covers the factors influencing transmission risk and the risk
associated with particular acts, the importance of proving transmission,
and the harmfulness of HIV, noting that “persistent misconceptions
exaggerating the harms of HIV infection appear to influence application of
the criminal law”.

The statement is notable not only for its engagement with the most recent
research findings, but also for its intended global reach, and in its
uncompromising recognition of the impact which the refusal to deploy, or to
misuse, science can have. It is a milestone in the history of HIV
criminalisation, and in the campaign to ensure that people living with HIV
are treated fairly in the criminal justice system.
Related links

   - Read this news story in full on aidsmap.com
   <http://www.aidsmap.com/page/3313286/>
   - View the consensus statement in the *Journal of the International AIDS
   Society* (open access)
   <https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25161>

Scientific analysis from Clinical Care Options

Clinical Care Options (CCO)
<https://www.clinicaloptions.com/hiv/conference-coverage/aids-2018> is an
official online provider of scientific analysis for the conference.

Their coverage will include capsule summaries of important clinical data,
downloadable slides and expert faculty commentary on key HIV prevention and
treatment studies.
Related links

   - Visit the Clinical Care Options AIDS 2018 pages
   <https://www.clinicaloptions.com/hiv/conference-coverage/aids-2018>

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