Transcript Powerpoint

ARV-based HIV Prevention in Practice
: Social and Behavioural Aspects
User Perspective on
ARV-Based HIV Prevention
Suwat Chariyalertsak,
MD., Dr.PH
Research Institute for Health Sciences
Chiang Mai University.
Chiang Mai, Thailand
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Outlines
• Why user perspectives are important
and crucial for the success of ARVbased HIV prevention strategy.
• What are different between HIV +ve and
HIV-ve people who will use ARV drug.
• Understand barriers and motivators.
• Summary
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Combination Antiretroviral Prevention
Interventions to Increase HIV Testing
Enroll in Care
Test
HIV Negative
HIV Positive
Linkage
To Care
Risk Assessment
PrEP, Adherence
Counseling
Positive
Prevention
Address concomitant concerns:
depression, substance use, relationship
dynamics
HPTN 065: Testing, Linkage
to. Care, Treatment
Decrease in
HIV Transmission
ART
Initiation
Treat
Adherence
to ART
Maintain Viral
Suppression
Is it so simple and easy to do
as we design ?
How can we make sure that it will
really work as we think and we plan ?
Clinical trials mostly will be very
much different from program
implementation in real health setting
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Strategies to reduce HIV transmission
Oral PrEP
Why user perspectives are crucial
in HIV Treatment & Prevention
• Safe sex practices, using condom, reducing
number of sex partners, these are easy to
say BUT not easy to behave all the times.
• Taking pill(s) everyday, may be easy for
someone, BUT mostly will not be so easy
for most people with various of reasons.
• Most important, NOBODY can do it for
them, they need to do it appropriately
and correctly by themselves.
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You can teach
them how to
use a condom
but you can’t
do it for them
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You can show
them how to take
a pill(s) but they
need to take and
swallow it by
him(her)self…
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What we (researchers, clinicians, health care
providers, policy makers, ect.) think it should
be good for them to prevent HIV infection,
BUT people may think and act differently
from what we thought ;
• We said...Wear condom when you have
sex will protect you from getting HIV.
• People think…Using condom
with my sex partner mean I
didn’t trust on them or I may
have HIV in my body !
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Partner types and condom use
Survey on sexual behaviour in Cape Town, SA
Published on November 28, 2013 by Wim Delva
http://sacemaquarterly.com/mathematical-modelling/coital-frequency-and-condom-use-in-monogamous-and-
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concurrent-sexual-relationships-in-cape-town-south-africa.html
• We said...Taking one pill a day
can reduce your chance to get
HIV infection from your sex
partners…
• People think… If my partner or
people see me taking ARV drug,
then they may think
I have HIV infection !
OR I don’t think I have a risk
during this week !
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Who are the targets for ARVbased HIV Prevention
HIV +ve person
One direction,
no return
HIV -ve person
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User perspectives between HIV +ve
people and HIV –ve people toward
ARV-based HIV Prevention:
Are there the SAME or DIFFERENCE ?
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What are benefits and harms
For HIV +ve person
• Benefits
– ARV drugs be used as TREATMENT.
– From HPTN052 and others, being successful
in viral suppression will help to reduce the
chance of HIV transmission to their
partners.. So call Treatment as
Prevention (TasP)
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What are benefits and harms
For HIV +ve person
• Harms
– Need to take for lifelong !
– May cause side effects from ARV drugs
– Poor drug adherence can induce drug
resistance and may be transmitted to others
– Taking ARV drug can be stigmatized and
discriminated by others and communities
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What are benefits and harms
For HIV -ve person
• Benefits
– ARV drugs can reduce the chance of getting
HIV infection from their risk behaviors BUT
they will need to take it daily.
– Not lifelong, taking ARV drug only when they
still engage in any HIV risk behaviors… Can
stop it when no more risks or can strictly
using other HIV prevention methods ?
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What are benefits and harms
For HIV -ve person
• Harms
– May cause side effects from ARV drug
– If taking ARV drug when they are infected
with HIV, then drug resistance can be
developed.
– Taking ARV drug can be stigmatized and
discriminated by others and communities
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How good we are doing now !
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A new ambitious target
90 / 90 / 90 toward 2030
• 90% of
people
having
HIV test
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• 90% of
people
living with
HIV on ART
treatment
and care
• 90% of people
on treatment
with
suppressed
viral loads
Awareness of Serostatus Among
People with HIV and Estimates of
Transmission
~25%
Unaware
of
Infection
~54%
New
Infections
Accounting for:
~75%
Aware
of
Infection
People Living with HIV
Marks, et al, AIDS 2006;20:1447-50
~46%
New
Infections
New Sexual Infections
Late Access to ART in Thailand
CD4 at newly HIV+ diagnosis and ART initiation, 2008-2013
98
94
101
98
97
109
84
75
88
97
97
111
Median
CD4
≥500
350-499
200-349
100-199
<100
100%
80%
60%
40%
20%
0%
2008
2009
2010
2011
2012
CD4 among newly
diagnosed HIV+(1)
2013
2008
2009
2010
2011
2012
2013
CD4 at ART initiation among
newly ART PLHA(2)
(1) The first CD4 that was tested within 3 m after the date of HIV+ diagnosis; only HIV+ reported
under NAP and registered to care with CD4 test
(2) CD4 that was tested during 6 month before ART initiation
* Data from NAP, NHSO, Thailand
Cascade Accessing and Retention to Care-ART, 2013
NAP-Plus Monitoring System, NHSO, Thailand
Children
Adults
23,510 (6%)
(82%)
(71%)
(56%)
(43%)
331,357
286,214
227,451
405,227
381,717
Reported
HIV+
Registered Need ART Prescribed Retained in VL tested
VL
for care
ART
ART
Suppressed
Data www.aids2014.org
source: NAP-Plus Database , National Health Security Office
175,813
(38%)
155,221
Cascade of HIV Services in China (2012)
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23
Reducing onward transmission: Viral suppression among key population groups living with HIV in the United Kingdom. 19th Annual
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Conference of the British HIV Association (BHIVA) April 2013, Valerie Delpech, Alison Brown, Stephano Conti, Venkata Polavarapu, Zing Yin
A new ambitious target
90 / 90 / 90
• 90% of
people
having
HIV test
• 90% of
people
living with
HIV on Rx
• 90% of people
on treatment
with
suppressed
viral loads
We need to begin by understanding ;
PHLA, Key affected population, individual
and communities how much they think
and understand and be a part of our goal !
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Barriers and Motivators
• How much users know about ARV drug
.. either for Treatment or Prevention.
• How much important their know for
drug adherence either for HIV +ve and
HIV-ve person.
• ARV drug(s) do not replace other HIV
prevention methods, it need to be
combined with other prevention tools.
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Barriers and Motivators
• What are their risk perception about HIV
infection or risk of HIV transmission
• How much they concern about stigma
and discrimination if they need to take
ARV drug(s).
• User perspectives will be different
among male, female, MSM, TG, PWID,
MSW, FSW, youth, eldery, etc.. So it will
need various intervention approach that
be fitted to each specific group.
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Summary
• If we want to end AIDS and HIV epidemic,
we can not ignore user perspectives on
ARV-based HIV prevention.
• Building strong user perspectives on
using ARV-based as a part of HIV
prevention is crucial and need to be
designed to fitted with any specific
target population.
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How we can achieve ?
•
•
•
•
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Increase Knowledge
Increase Adherence
Reduce adverse effects
How to implement
Etc
Please wait to hear from
the remain speakers
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Acknowledgement
•
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Jone de Wit, AIDS2014 Track D Co-Chair
Peter Godfrey-Fausset, AIDS2014 Track C Co-Chair
Veronica Noseda, France. Chairperson
Albert Liu, USA. Co-Chair
All speakers in this session
Dr.Auchara TUC, Thailand
Prof. Kenneth H Mayor Fenway, USA
Prof. Chris Beyrer
JHU, USA
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