How do your define ‘household’ in a culture where extended families split time between town, the farm, and a cattle post? Who else has had trouble enrolling men? What happens if several large, expensive clinical trials deliver completely different results several years from now?
These were some of the important questions asked at the Treatment as Prevention in Africa (TasP Africa) workshop held this May in Gaborone, Botswana.Worldwide, 35 million people are living with HIV. About 25 million of those people live in sub-Saharan Africa. About 1.5 million people were newly infected with HIV in sub-Saharan Africa last year.
In 2011, the HPTN 052 study found that early antiretroviral therapy could reduce HIV transmission by 96% in serodiscordant couples, that is couples in which one partner has HIV and the other is uninfected. Since then, Treatment as Prevention (TasP) has become a major focus for attention in the global fight against AIDS. In June 2012, the World Health Organization (WHO) wrote a comprehensive guideline to recognize the role of Treatment as Prevention.
Though the concept of Treatment as Prevention has been clearly validated in a controlled trial in discordant couples, it is not known how to use TasP most effectively in populations, especially in sub-Saharan Africa, where the need is greatest.
Several large clinical trials, funded mainly by the Office of the U.S. Global AIDS Coordinator (OGAC), are currently being conducted in Africa. Each trial uses a different approach.
“The use of Treatment as Prevention represents one of the most important advances in HIV control over the past 20 years, but we do not know enough about how to implement this to achieve high coverage or what the impact will be at the population level,” said Dr. Richard Hayes, a Professor of Epidemiology & International Health at the London School of Hygiene & Tropical Medicine, and one of the Principal Investigators (PI) of a large trial taking place in South Africa and Zambia.
The TasP Africa workshop, conceived and chaired by Dr. Max Essex, Chair of the Harvard AIDS Initiative, brought together PIs from the large trials, other noted HIV/AIDS researchers, policy makers, and drug industry representatives to share plans and compare notes.
“Until now, most of the discussion on the use of Treatment as Prevention has been based on populations and cohorts from the U.S. or Europe, with little emphasis on countries that have high prevalence, like those in southern Africa,” said Essex, who is also the PI of a large HIV prevention trial in Botswana. “This was the first international conference devoted to TasP in Africa to be held in Africa,” he added.
“It was important to bring together the various groups working on these issues in Africa to share information on their methods and findings so that we can move the field forward as quickly as possible,” said Hayes. “Holding the workshop in Africa ensured that there was a strong focus on issues relevant to the implementation and evaluation of TasP in this region and that there was strong representation of African research groups and scientists.”
“The workshop created an atmosphere of trust and collaboration so that, for the first time, investigators could focus on the larger collaborative effort and the potential collective impact of their entire suite of studies,” said Dr. Nancy Padian, a leader in the epidemiology of HIV and a senior technical advisor at OGAC.
“We had open and constructive discussion about common goals and problems,” said Essex. “Those conversations should enable the various projects on Treatment as Prevention in Africa to move ahead more expeditiously.”
“There is much to share regarding lessons learned and logistical issues related to providing early treatment,” said Padian.
TasP Africa was organized by HAI and generously funded by contributions from the MAC AIDS Fund, Johnson & Johnson, ViiV Healthcare, Abbvie, and Mylan.
Click here to watch videos or PowerPoint presentations from the workshop.