WHO ‘Treatment as Prevention’ guidelines are unlikely to decrease HIV transmission in the UK unless undiagnosed HIV infections are reduced

The goal to effectively prevent new HIV infections among gay, bisexual, and other men who have sex with men (MSM) is more challenging now than ever before. Despite declines in the late 1990s and early 2000s, HIV incidence among MSM is now increasing in many low- and high-income settings including the US, with young, adolescent, and racial/ethnic minority MSM being among those at highest risk. Potentiating HIV risks across all settings are individual-, network-, and structural-level factors such as stigma and lack of access to pre-exposure prophylaxis (PrEP) and antiretroviral treatment as prevention. To make a sustained impact on the epidemic, a concerted effort must integrate all evidence-based interventions that will most proximally decrease HIV acquisition and transmission risks, together with structural interventions that will support improved coverage and retention in care. Universal HIV treatment, increased access to HIV testing, and daily oral PrEP have emerged as integral to the prevention of HIV transmission, and such efforts should be immediately expanded for MSM and other populations disproportionately affected by HIV. Respect for human rights and efforts to combat stigma and improve access to prevention services are needed to change the trajectory of the HIV pandemic among MSM.

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HIV Treatment as Prevention: Contradictory Perspectives from Dynamic Mathematical Models

The Scientific World JOURNAL ◽

10.1155/2014/760734 ◽

2014 ◽

Vol 2014 ◽

pp. 1-9

Author(s):

Jing Wu ◽

Jessie L. Norris ◽

Yujiang Jia ◽

Ning Wang

Keyword(s):

Mathematical Models ◽

Hiv Transmission ◽

Dynamic Models ◽

Hiv Infections ◽

Hiv Treatment ◽

Treatment As Prevention ◽

Poor Countries ◽

Input Variables ◽

Hiv Treatment As Prevention ◽

Preventive Effects

The preventative effects of antiretroviral therapy for people with HIV have been debated since they were first raised. Models commenced studying the preventive effects of treatment in the 1990s, prior to initial public reports. However, the outcomes of the preventive effects of antiretroviral use were not consistent. Some outcomes of dynamic models were based on unfeasible assumptions, such as no consideration of drug resistance, behavior disinhibition, or economic inputs in poor countries, and unrealistic input variables, for example, overstated initiation time, adherence, coverage, and efficacy of treatment. This paper reviewed dynamic mathematical models to ascertain the complex effects of ART on HIV transmission. This review discusses more conservative inputs and outcomes relative to antiretroviral use in HIV infections in dynamic mathematical models. ART alone cannot eliminate HIV transmission.

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The impact in the UK of the Central and Eastern European HIV epidemics

Epidemiology and Infection ◽

10.1017/s0950268809002155 ◽

2009 ◽

Vol 137 (9) ◽

pp. 1266-1271 ◽

Cited By ~ 4

Author(s):

V. C. DELPECH ◽

Z. YIN ◽

J. ABERNETHY ◽

C. HILL ◽

L. LOGAN ◽

...

Keyword(s):

Drug Users ◽

Hiv Transmission ◽

Hiv Prevalence ◽

Health Clinic ◽

Eastern European ◽

Hiv Epidemic ◽

Undiagnosed Hiv ◽

Sex With Men ◽

The Uk ◽

The Impact

SUMMARYDespite increasing migration, the impact of HIV epidemics from Central and Eastern Europe (C&EE) on the UK HIV epidemic remains small. C&EE-born adults comprised 1·2% of adults newly diagnosed with HIV in the UK between 2000 and 2007. Most C&EE-born women probably acquired their infection heterosexually in C&EE. In contrast, 59% of C&EE-born men reported sex with men, half of whom probably acquired their infection in the UK. Previously undiagnosed HIV prevalence in C&EE-born sexual-health-clinic attendees was low (2007, 0·5%) as was overall HIV prevalence in C&EE-born women giving birth in England (2007, <0·1%). The high proportion of men who have sex with men (MSM) suggests under-reporting of this group in C&EE HIV statistics and/or migration of MSM to the UK. In addition to reducing HIV transmission in injecting drug users, preventative efforts aimed at C&EE-born MSM both within their country of origin and the UK are required.

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The Bio/Necropolitics of ACTG 076: Lessons from Pregnant Women of Colour Living with HIV for Treatment for Prevention in the Twenty-first Century

Somatechnics ◽

10.3366/soma.2020.0315 ◽

2020 ◽

Vol 10 (2) ◽

pp. 233-253

Author(s):

Eli Manning

Keyword(s):

Hiv Transmission ◽

Ethical Dilemmas ◽

Hiv Treatment ◽

First Century ◽

Hiv Positive ◽

Treatment As Prevention ◽

People Living With Hiv ◽

Hiv Positive Women ◽

Aids Clinical Trials ◽

Living With Hiv

Since the pharmaceutical turn, using HIV treatment to prevent transmission is increasingly common. Treatment as Prevention®, or TasP, has relied on HIV treatment to prevent HIV transmission, targeting people living with HIV. However, TasP is predicated on troublesome heterosexist, classist, and racist medical practices borrowed from various times and spaces that enact biopolitical and necropolitical relations. This paper discusses the debate surrounding the first clinical trial that used HIV treatment to prevent transmission from woman-to-foetus. The 1994 landmark AIDS Clinical Trials Group 076 study laid the groundwork for using HIV treatment to prevent HIV transmission, the essential precursor to TasP. By examining the concerns of HIV positive women of colour and other AIDS activists, we are able to understand the ethical dilemmas and practical consequences that still haunt today's game-changing uses of HIV treatment for prevention and to see how biopolitics and necropolitics persist in TasP.

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High percentage of undiagnosed HIV cases within a hyperendemic South African community: a population-based study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2017-209713 ◽

2017 ◽

Vol 72 (2) ◽

pp. 168-172 ◽

Cited By ~ 12

Author(s):

Alain Vandormael ◽

Tulio de Oliveira ◽

Frank Tanser ◽

Till Bärnighausen ◽

Joshua T Herbeck

Keyword(s):

Hiv Testing ◽

South African ◽

Hiv Infections ◽

Population Based ◽

Hiv Positive ◽

Aids Epidemic ◽

Undiagnosed Hiv ◽

African Community ◽

Repeat Hiv Testing ◽

High Level

BackgroundUndiagnosed HIV infections could undermine efforts to reverse the global AIDS epidemic by 2030. In this study, we estimated the percentage of HIV-positive persons who remain undiagnosed within a hyperendemic South African community.MethodsThe data come from a population-based surveillance system located in the Umkhanyakude district of the northern KwaZulu-Natal province, South Africa. We annually tested 38 661 adults for HIV between 2005 and 2016. Using the HIV-positive test results of 12 039 (31%) participants, we then back-calculated the incidence of infection and derived the number of undiagnosed cases from this result.ResultsThe percentage of undiagnosed HIV cases decreased from 29.3% in 2005 to 15.8% in 2011. During this period, however, approximately 50% of the participants refused to test for HIV, which lengthened the average time from infection to diagnosis. Consequently, the percentage of undiagnosed HIV cases reversed direction and steadily increased from 16.1% to 18.9% over the 2012–2016 period.ConclusionsResults from this hyperendemic South African setting show that the HIV testing rate is low, with long infection times, and an unsatisfactorily high percentage of undiagnosed cases. A high level of repeat HIV testing is needed to minimise the time from infection to diagnosis if the global AIDS epidemic is to be reversed within the next two decades.

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Prevention of HIV transmission in the UK: what is the role of male circumcision?

Sexually Transmitted Infections ◽

10.1136/sti.2008.029934 ◽

2008 ◽

Vol 84 (3) ◽

pp. 158-160 ◽

Cited By ~ 7

Author(s):

A. MacDonald ◽

J. Humphreys ◽

H. W Jaffe

Keyword(s):

Male Circumcision ◽

Hiv Transmission ◽

The Uk ◽

Prevention Of Hiv

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Sexually acquired HIV infections in the United States due to acute-phase HIV transmission: an update

AIDS ◽

10.1097/qad.0b013e32832e7d04 ◽

2009 ◽

Vol 23 (13) ◽

pp. 1792-1794 ◽

Cited By ~ 31

Author(s):

Vimalanand S Prabhu ◽

Angela B Hutchinson ◽

Paul G Farnham ◽

Stephanie L Sansom

Keyword(s):

United States ◽

Acute Phase ◽

Hiv Transmission ◽

Hiv Infections ◽

The United States

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Deep–sequence phylogenetics to quantify patterns of HIV transmission in the context of a universal testing and treatment trial — BCPP/ Ya Tsie trial

10.1101/2021.06.19.21259186 ◽

2021 ◽

Author(s):

Lerato E Magosi ◽

Yinfeng Zhang ◽

Tanya Golubchick ◽

Victor De Gruttola ◽

Eric J Tchetgen Tchetgen ◽

...

Keyword(s):

Hiv Transmission ◽

Population Level ◽

Treatment As Prevention ◽

Population Mobility ◽

Mobility Patterns ◽

Test And Treat ◽

Hiv Intervention ◽

Universal Test ◽

Universal Test And Treat ◽

The Impact

Mathematical models predict that community–wide access to HIV testing–and–treatment can rapidly and substantially reduce new HIV infections. Yet several large universal test–and–treat HIV prevention trials in high–prevalence epidemics demonstrated variable reduction in population–level incidence. To elucidate patterns of HIV spread in universal test–and–treat trials we quantified the contribution of geographic–location, gender, age and randomized–HIV–intervention to HIV transmissions in the 30–community Ya Tsie trial in Botswana (estimated trial population: 175,664). Deep–sequence phylogenetic analysis revealed that most inferred HIV transmissions within the trial occurred within the same or between neighboring communities, and between similarly–aged partners. Transmissions into intervention communities from control communities were more common than the reverse post–baseline (30% [12.2 – 56.7] versus 3% [0.1 – 27.3]) than at baseline (7% [1.5 – 25.3] versus 5% [0.9 – 22.9]) compatible with a benefit from treatment–as–prevention. Our findings suggest that population mobility patterns are fundamental to HIV transmission dynamics and to the impact of HIV control strategies.

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Call To action - Prevention of mother To child transmission of HIV

Southern African Journal of HIV Medicine ◽

10.4102/sajhivmed.v10i4.256 ◽

2009 ◽

Vol 10 (4) ◽

pp. 12

Author(s):

Ashraf Hassen Coovadia ◽

Ameena Ebrahim Goga ◽

Laurie Schowalter

Keyword(s):

Hiv Transmission ◽

Hiv Infections ◽

Mother To Child Transmission ◽

Child Transmission ◽

Pmtct Programme ◽

Is Implementation ◽

Main Challenge ◽

Drug Regimens ◽

Development Goals ◽

Mother To Child

The Prevention of Mother to Child Transmission of HIV (PMTCT)programme is a critical intervention to reduce the incidence of paediatric HIV infections . It is also a key intervention to decrease infant, child and maternal mortality. The optimal implementation of a sound, evidence-based PMTCT programme is essential to meet both the HIV reduction targets in the National Strategic Plan1 and to achieve Millennium Development Goals(MDGs) 4 (reducing infant and child mortality) and 5 (reducing maternal mortalty).2 Since 2001, South Africa has been implementing a programme to prevent mother-to-child transmission of HIV. Since 2007, national PMTCT policy has evolved into a strong, enabling framework that should reduce vertical transmission significantly. This paper reviews the milestone studies that have contributed to our knowledge about drug regimens to reduce MTCT (mother-to-child transmission of HIV), reviews the latest South African PMTCT guidelines and the possible future changes. Strengthened / revised drug regimens for PMTCT are, essential but insufficient for measureable decreases in HIV transmission and improvements in maternal and childl health. The main challenge is implementation. Until the enhanced PMTCT policy is effectively operationalised, measureable achievements will remain elusive.

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