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HIV Prevention Knowledge Base

A Collection of Research and Tools to Help You Find What Works in Prevention

Biomedical Interventions: Antiretroviral Therapy as an HIV Prevention Strategy

Link to important additional materials and websites

Debate Six: Treatment as Prevention

World Bank & U.S. Agency for International Development. (2012).

This report outlines the sixth in the Emerging Issues in Today’s HIV Response debate series sponsored by the World Bank and the U.S. Agency for International Development. In November 2011, a panel of four renowned public health experts—two each assigned to argue for and against—addressed the proposition: countries should spend a majority of what is likely to be a flat or even declining HIV prevention budget on treatment as prevention. The topic was inspired by the stunning findings of the recent HIV Prevention Trial Network (HPTN) 052 clinical trial of serodiscordant couples showing that early treatment reduces the risk of HIV transmission to an uninfected partner by at least 96 percent. Among other arguments, the two panelists in favor said that because of the overwhelming evidence for the effectiveness of treatment as prevention, ethical principles require that this strategy be implemented quickly as part of comprehensive HIV prevention and care programming. The two panelists in opposition countered that, despite HPTN 052’s powerful results, a blanket recommendation to launch treatment as prevention is premature, because there are still too many unanswered questions about its long-term effects in different populations. They also argued that each country’s response to HIV should not be driven by a single programming imperative but instead reflect the specific characteristics and prevention needs of the local epidemic. More than 800 people worldwide registered to attend the debate either in person in Washington, via the Internet, or by video conferencing.

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The Impact of ART on HIV and TB: South African Centre for Epidemiological Modelling and Analysis

Williams, B. (2009).

This complex, technical presentation shows the formulae and models used for assessing the impact of ART on HIV and tuberculosis (TB). It includes models and studies looking at the following various outcomes: increases in TB with declines in CD4 cell counts, decreases in disease duration as incidence increased, reduction in TB when on ART, and predicted versus observed CD4 cell counts. The presentation ends with research needs, such as models that include age, gender, and better data to inform the assumptions.

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Informal Working Group Meeting: Modelling the Impact of ART on TB and HIV

WHO. (2009).

These notes from the informal working group meeting discussing modeling simulations provide a flavor of the presentations and discussion taking place among participants. As a result of the discussions, recommendations on moving forward were made for designers of trials to provide proof of concept, for considerations for developers of models, and for the WHO as a convening body.

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The Case for Expanding Access to Highly Active Antiretroviral Therapy to Curb the Growth of the HIV Epidemic

Montaner, J. S., Hogg, R., Wood, E., et al. The Lancet (2006), Vol. 368 No. 9543, pp. 531–6.

This commentary makes the case that the HIV pandemic presents “an exceptional threat to humanity” and that “similarly exceptional interventions” are needed to reverse the pandemic. Given that prevention efforts are only partially successful and underused, a vaccine is not on the horizon, and current treatment cannot eradicate infection, the authors argue that there is potential for HAART to help stem the HIV epidemic. The authors present a brief theoretical model of their approach.

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AVAC, Global Advocacy for HIV Prevention

The website offers the latest news on the past, present, or ongoing status of biomedical HIV prevention research studies. Readers can review summary tables from various HIV prevention clinical trails, search information on prevention trails, see what is new on the site this month, and review the user’s guide for help in using the site. The site offers information about the following biomedical prevention trails: Microbicides, pre-exposure prophylaxis (PrEP), Treatment as Prevention, and Vaccines.

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View AVAC's HIV Prevention Research and Development Database (PxRD)