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Vicks aims to raise HIV awareness through its ‘Touch of Care’ campaign

 

In Asia-Pacific region, the Philippines is one of the countries with the most number of HIV/AIDS incidence. In 2018, Philippine National AIDS Council (PNAC) cited that as many as 32 Filipinos have been diagnosed with HIV/AIDS daily. With 62,024 cases recorded from January 1984 to December 2018, Department of Health has recognized the Philippines as “the country with the fastest-growing HIV epidemic in Asia and the Pacific.”

Risky behavior and lack of knowledge are some of the major factors that contribute to the rapid spread of HIV/AIDS. In spite of tremendous efforts to stop this public health threat, there are still fear, stigma, and discrimination that impede access to testing and treatment. In an effort to raise HIV/AIDS awareness and eradicate stigma, Procter & Gamble, which owns Vicks Vaporub, released a heartwarming video as part of their “Touch of Care” campaign.

The 4-minute video tells the true story of a child with HIV and the prejudice directed at them. Country Category Leader for Vicks Philippines Vijay Pampana said that, “We are a brand believing that the ‘Touch of Care’ has the power to transform lives. Basically, what we are trying to do is showing stories or real-life stories that can really transform lives and inspire more generations.”

Country Category Leader for Vicks Philippines talks about the “Touch of Care” campaign.

The company also partnered with Project Red Ribbon, an HIV and AIDS advocacy foundation, to support the “Duyan Program.” In order to improve the life of children with HIV, the program aims to provide continuous care and support for them.

HIV advocate for the Department of Health Patrixia Santos shares about the negative connotations associated to people living with HIV.

Patrixia Santos, HIV advocate for the Department of Health and one of Project Red Ribbon volunteers shared that, “At the end of the day, it’s not the virus or the disease that kills people––it’s the hatred and discrimination against them because that’s the very reason why they don’t test and that’s the very reason why it’s being transmitted.”

Project Red Ribbon President Ico Rudolfo Johnson shares what Project Red Ribbon in order to combat stigma and help people living with HIV.

The Project Red Ribbon foundation believes that children with HIV can still live a meaningful life through awareness, treatment, care, and support.

TRR President Ico Rudolfo Johnson mentioned that, “The core of the Project Red Ribbon is all about treatment, care and support. For the longest time we have been having children and youth under our care so that they can live a productive life.”

“Our programs include awareness, we got to schools. We [collaborated] with the Department of Health as a communication partner so that we can we reach out to different local government units and educational institutions to differents NGOs and church-based organizations. We are also doing prevention, we promote condoms and lubricants so that we can reverse the epidemic,” Johnson added.

Last year, Vicks launched an online campaign spot called “Learning to Love #TouchOfCare”. A portion of the proceeds went to the Save the Children’s protection efforts for abandoned children. This time, the fund will go to the foundation that helps and cares for children who are infected by the virus.

Vicks recognizes the power of touch of care and believes that replacing prejudice with compassion is what will help transform lives of people with HIV. INQUIRER.net BrandRoom/TV

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Study finds high rate of viral suppression among people new to HIV care

Eighty-six percent of individuals who entered HIV care soon after diagnosis maintained viral suppression after 48 weeks during a clinical trial conducted at four National Institutes of Health (NIH)-funded Centers for AIDS Research (CFARs) across the United States. Participants in the clinical trial, called iENGAGE, achieved viral suppression in an average of just 63 days. The findings were presented in a poster at the Conference on Retroviruses and Opportunistic Infections (CROI 2019) in Seattle.

The findings from iENGAGE, which was funded by NIH’s National Institute of Allergy and Infectious Diseases (NIAID), underscore the benefits of linking people with HIV to treatment services soon after diagnosis and highlight the importance of efforts to engage all people with HIV in care. Provision of effective HIV treatment resulting in sustained viral suppression is a critical component of efforts to end the HIV epidemic in the United States.

Notably, many iENGAGE participants had other medical conditions and unmet basic needs that can make adherence to medical visits and daily antiretroviral therapy (ART) difficult. About half of the study participants reported needing supportive services, including assistance with housing, employment, food and transportation. Mental health issues were also prevalent, with 31 percent of participants having depression and 30 percent having anxiety. Roughly one-third of participants reported high-risk alcohol use, and 18 percent reported substance use.

“Even when facing many other challenges in their lives, the majority of people engaged in HIV care can achieve viral suppression, benefiting their health and preventing transmission of the virus to others,” said NIAID Director Anthony S. Fauci, M.D. “To end the HIV epidemic in the United States, we must ensure that effective HIV prevention and treatment strategies are accessible to all who need them, especially in the areas of the country with the highest HIV burden.”

The iENGAGE trial was conducted at clinical trial sites in Baltimore; Seattle; Birmingham, Alabama; and Chapel Hill, North Carolina, participating in the CFAR Network of Integrated Clinical Systems (CNICS). Ten years ago, these sites recorded an approximately 60 percent rate of viral suppression among people new to HIV care.

 

The iENGAGE trial was designed to evaluate a behavioral intervention aimed at educating people newly diagnosed with HIV and reinforcing the importance of adherence to care. The 371 participants were enrolled within 14 days of initiating HIV medical care and randomly assigned to receive either the behavioral intervention plus standard care or standard care alone. The intervention, which combined two established approaches to enhance HIV medical visit adherence and ART adherence, comprised four in-person counseling sessions tailored to participants’ individual needs, as well as phone support, during the first 48 weeks of treatment.

The intervention did not appear to affect viral suppression after 48 weeks. The high overall rate of viral suppression and the short average time to achieving suppression did not differ between the two study arms.

The iENGAGE investigators suggest that recent improvements in standard HIV care contributed to this overall high rate of viral suppression. These improvements include changes in HIV treatment guidelines to encourage early treatment for everyone diagnosed with HIV, an increased focus in clinical practice guidelines on retaining people in the HIV care continuum from diagnosis to viral suppression, and the inclusion of integrase inhibitors–a new potent and well-tolerated class of antiretroviral drugs–in first-line ART regimens. The researchers plan to assess viral suppression rates among iENGAGE participants at 96 weeks to evaluate whether the intervention improves long-term adherence to care.

The findings underscore the effectiveness of HIV care but also highlight the remaining challenges of closing treatment gaps by identifying strategies to engage and retain people with HIV in HIV treatment services. One potential approach could involve incorporating behavioral interventions into communities as part of rapid ART initiation programs, the iENGAGE investigators suggest.

Source: https://www.news-medical.net/news/20190309/Study-finds-high-rate-of-viral-suppression-among-people-new-to-HIV-care.aspx

Universal ‘Test and Treat’ Program Cut New HIV Infections in Africa

But largest ever HIV prevention trial produced some other surprising results

SEATTLE — A universal “test and treat” strategy in African communities was associated with a 30% reduction in HIV after 3 years compared with standard of care, a researcher said here.

When trained community health workers went door-to-door to deliver HIV services, including testing and linkage to care, as well as treatment according to in-country guidelines, there was a significant reduction in the incidence rate of HIV versus standard of care (adjusted IRR 0.70, 95% CI 0.55-0.88, P=0.006), reported Richard Hayes, DSc, of the London School of Hygiene & Tropical Medicine in England.

However, in the most intensive intervention arm of the study, which also provided immediate access to antiretroviral therapy in addition to the other interventions, there was no significant difference compared with standard of care (adjusted IRR 0.93, 95% CI 0.74-1.18, P=0.51).

The results of this late-breaking study were presented at the Conference on Retroviruses and Opportunistic Infections.

In a separate interview prior to the conference, National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci, MD, whose organization helped to fund the research, told MedPage Today that the fundamental principle of studies like this is to show “in the field that [test-and-treat] actually works when you do it,” and that this proactive strategy can potentially have an impact on HIV incidence in a community.

The Population Effects of Antiretroviral Therapy to Reduce HIV Transmission (PopART) study, also called HPTN 071, had a total study population of around one million, which Hayes described as “the largest HIV prevention trial ever carried out.”

PopART took place from 2013 to 2018 in 21 communities in Zambia and South Africa. It was a three-armed study (with two intervention arms and one control arm) and there were seven communities in each arm.

Arm A was the full PopART intervention. This included door-to-door services, such as testing, linkage to care for those who tested positive, and a suite of prevention services, such as condom promotion and sexually transmitted infection screening, along with immediate access to antiretroviral therapy. Arm B was the same intervention, except that treatment was offered according to national guidelines. Arm C was standard of care, with local HIV treatment and prevention services, and treatment according to national guidelines.

The researchers examined a random sampling of this population of around 48,000 adults ages 18-44. Participants were visited once at the start of the trial, then once a year for 3 years for data collection and HIV testing. Baseline HIV prevalence was similar across arms, at around 20% each, the team reported. Overall, there were 533 incident HIV infections in the cohort.

At the presentation, Hayes admitted that Arm A, which did not have a statistically significant difference in HIV infection rates, was where researchers “expected to see the greatest effect.” He added that “clearly we need to do more analysis to try and explain this finding.”

When asked at the press conference about why there may have been so little difference, Hayes said that by the end of the study period, “the two interventions were very similar because of the way local guidelines had evolved, and that could be why we didn’t see an effect in Arm A.” Hayes also noted that there also may have been a difference in sexual risk behavior between the two arms, which could explain some of the findings.

But overall, Hayes emphasized the positive results of the intervention itself. Indeed, the two intervention arms of this three-arm trial achieved the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets after three annual rounds, and rates of viral suppression (defined as viral load <400 copies/ml) around 70%, the researchers said.

“Overall, evidence for the effect of the intervention was strong, and that’s the important take-home message,” Hayes said. “Taken together with findings of other studies, our results provide key evidence that a universal test-and-treat strategy can bring down the incidence of new HIV infections, even in settings with severe HIV epidemics.”

Author: Molly Walker

Author: https://www.medpagetoday.com/meetingcoverage/croi/78401?xid=nl_mpt_DHE_2019-03-07&eun=g1169726d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=Daily+Headlines+Email_TestA+2019-03-07&utm_term=San+Serif+Daily+Headlines+Email_TestA&fbclid=IwAR01DetHxjTwU8figDpCpvWc2q28_SoF9zMmIxxGuoWmrBZs-Hs5CSd10O4

Exhibit in New York Unearths 1990s Activism by HIV-Positive Women in Prison

 

Joann Walker Metanoia
Part of the “Metanoia” exhibit on display at The Center in New York City from March 11 to April 29, 2019. (Credit: Judy Greenspan)

 

 

March 11 through April 29, New York City’s LGBT Community Center presents Metanoia, an extraordinary archive of letters, flyers, poems, newspaper articles, and other ephemera documenting activism both by and for women with HIV in prison in the early-to-mid 1990s, particularly in California’s Chowchillafacility, where health care was virtually nonexistent and no institutional services existed for women with HIV/AIDS.

The exhibit is culled largely from The Center’s 13 boxes of archives from Judy Greenspan, an activist who was a link between the women in prison and outside groups such as ACT UP San Francisco, and is inspired in part by [an exhibit last year in Los Angeles of 1980s to 90s AIDS prevention materials from the ONE Archives. It centers the work of HIV-positive women of color including Joann Walker, Betty Jo Ross, Twilllah Wallace, and Katrina Haslip, who have all since died of AIDS but who fought for HIV/AIDS care, prevention, and education while in prison in the 1990s.

On April 8 at 6 p.m., The Center will also present three short documentaries on the topic: I’m You, You’re Me: Women Surviving Prison, Living with AIDS (Catherine Saalfield-Gund and Debra Levine, 1992); Blind Eye to Justice (Carol Leigh, 1998); and Digital Stories (From The Center and Margaret Rhee, 2011). Guests that night will include Greenspan and all the filmmakers.

We talked with Katherine Cheairs and Alexandra Juhasz, two of the exhibit’s four curators — the other two are Theodore Kerr and Jawanza Williams — about the exhibit.

Tim Murphy: How did this exhibit come to be?

Alexandra Juhasz: There was a show last year at the ONE Archives in LA called “Lost and Found,” focusing on AIDS prevention materials from across the decades, including safe sex and safe drug use, that curator David Frantz had put together. The New York LGBT Center asked me if I was interested in moving that show to New York. I was intrigued but said I wasn’t comfortable curating it by myself and wanted to do it with a diverse group of activists. So last December I met with Kat [Katherine Cheairs], Ted [Theodore Kerr], and Jawanza [Jawanza Williams]. We know one another from the collective “What Would an HIV Doula Do?”, which is a group of clinical providers, artists, and writers pulled together by Ted.

Katherine Cheairs: So we were collaborating on this exhibit, which features archival ephemera that speaks to a historical moment and centers people we haven’t heard from a lot in the HIV narrative, including women of color and trans women. We were digging into the archives to see what voices we might find. And the LGBT Center had the archives of Judy Greenspan, who [lives in San Francisco] and was a real bridge between the activist/nonprofit sector and the federal government and the incarceration system when it came to HIV in prison. She worked with ACT UP San Francisco’s Prison Issues Committee, then went on to work with Catholic Charities. Her archive is a treasure trove of knowledge and information: letters and documentation by and about prisoners with HIV, not just from California but all over the country.

TM: Tell us about some of what you found in those boxes.

KC: There is a newsletter called The Fire Inside put out by California women prisoners that started in the 1990s. And in one of the early issues, I found a story about a woman in Chowchilla named Joann Walker, with a very small photo of her. She looks so assured in it. The article said that there had been a successful campaign for the compassionate release from Chowchilla of a woman very sick from AIDS named Betty Jo Ross. It turns out that Joann had become an activist through this campaign. Judy Greenspan was the liaison between them and the activists on the outside.

AJ: There was no care whatsoever for women with AIDS or HIV in these facilities, so a lot of the activism was about granting this compassionate release.

KC: It’s important to note that Joann is the one who contacted ACT UP San Francisco and said, “You need to know what’s going on here, because women are dying in here and we need some advocacy and support.” So there is a lot of correspondence between Joann and Judy over several months. The letters reveal how strong Joann was. I knew none of this prior to opening that box. Joann was granted compassionate release, but she died in 1995. Betty Jo died around the same time. Twillah Wallace advocated for Joann’s release. Twillah lived until 2006, and she’s featured in one of the films we’ll show.

AJ: In New York, there was a parallel story with Katrina Haslip, who was a prisoner activist in the ACE program at the Bedford Hills women’s prison. We also found evidence of chants that activists were using at various demonstrations, and we’ve hung them on the walls of the exhibit. Like, “Women die, they do nothing!” And, “Women with AIDS can’t wait till later/We’re not your fucking incubator!” And, “If you’re poor and a woman, it’s no surprise/Carceral medicine is telling you lies.”

KC: In one letter, Joann writes, “The stress level here at CCWS [Chowchilla] is so great that I had 565 T cells when I was first incarcerated and now I have under 100. I’m not the only one. T cells drop like flies around here! Upon my release, I will be asking the state for $10,000 for each T cell I lost due to their murder game.” There’s this incredible defiance on the part of women of color fighting for their lives that shows up in these archives. Women prisoners weren’t getting treatment for all kinds of preventable illnesses. So there’s this ferocious take-no-prisoners approach that [activists] were exercising both inside and out.

TM: And you have some contemporary images in the exhibit as well?

KC: Yes, we commissioned portraits from the studio Lolita Lens [Photography] of Kiara St. James, Malaya Manacop, Rusti Miller-Hill, Nathylin Flowers Adesegun, and Shirlene Cooper, all women of color working in the HIV space today in New York. The work the women did in prison in the 1990s continues to be a source of inspiration today.

AJ: The title of the show, Metanoia, means transformation through change. HIV has been something that often would bring people into activism, community, and their best selves. The lives of Joann and the other women in the show really embody that.

Tim Murphy has been living with HIV since 2000 and writing about HIV activism, science and treatment since 1994. He writes for and has been a staffer at POZ, and writes for the New York Times, New York Magazine, Out Magazine, The Advocate, Details and many other publications. He is also the author of the NYC AIDS-era novel Christodora and the forthcoming novel Correspondents (May 2019).

 

Source: http://www.thebody.com/content/81648/ny-hiv-exhibit-women-of-color-activists-prison.html

One year of preventing new HIV infections throughout B.C.

There are an estimated 7,271 British Columbians living with HIV

 

Adrian Dix
Photo by Chandra Bodalia

THOUSANDS of people at the highest risk of acquiring HIV in B.C. are benefiting after a successful year since government expanded coverage for HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).

“Since expanding access to PrEP on January 1, 2018, nearly 3,300 people have been prescribed the potentially life-saving medications. It is positive to see people are participating in government’s expansion of this program and taking charge of their health by protecting themselves from HIV / AIDS,” said Adrian Dix, Minister of Health. “For more than a year, people at high risk of HIV infection have had access to these treatments, and through this program, we will continue to work with the BC Centre for Excellence (BC-CfE) in HIV / AIDS, and health-care and community partners, to prevent more cases and support people who are living with HIV.”

The preventive treatment has been available at no cost through the BC-CfE for eligible British Columbians, including men who have sex with men, transgender women, people with ongoing relationships with HIV-positive sex partners who are not on regular HIV medication or have a low viral load, and people who share drug-use equipment with a partner known to be living with HIV.

The expansion of coverage for HIV PrEP and PEP in B.C. added a new resource to the BC-CfE’s Treatment as Prevention program.

“We are delighted with the uptake of our preventive treatment programs PrEP and PEP,” said Dr. Julio Montaner, Executive Director and Physician-in-Chief of the BC-CfE. “We anticipate that at this rate, the preventive treatment program will further reduce new HIV infections in B.C.”

Since its establishment in 1992, the BC-CfE has worked to improve the health and longevity of people living with HIV, and to prevent new HIV infections through research, innovation and treatment programs. PrEP is one component of the made-in-B.C. Treatment as Prevention strategy pioneered by the BC-CfE to expand the reach of HIV treatment in order to reduce morbidity, mortality and HIV transmission. This expansion forms the basis of the provincial Seek and Treat for Optimal Prevention of HIV  /AIDS (STOP HIV / AIDS) program, with $19.9 million in annual funding from the Ministry of Health.

 

Quick Facts:

* PrEP is a daily oral antiretroviral medication that is highly effective in reducing new cases of HIV – between 92% and 99% in some clinical trials.

* Since expanding access to PrEP on Jan 1, 2018, uptake has continued to grow. Six months following government’s coverage expansion, there were 1,944 people who had sought-out coverage.

* According to data from the BC-CfE’s drug treatment program:
* Of the individuals who have accessed PrEP, the median age is 34.

* 84% reside in Greater Vancouver and 2.3% reside in a rural location.

* Of the individuals who accessed PrEP, 98.4% are male, 0.5% are female and 1.1% identify as transgender, other gender identity or unspecified.

* PEP has been available since 1998 for people who encounter an isolated HIV exposure, predominately in the occupational setting.

* PEP uptake from Jan. 1 to Dec. 31, 2018, was 1,182 PEP five-day starter kits and of those, 642 people continued their PEP for a complete 28 days.

 

Author: Rattan Mall

Source:

One year of preventing new HIV infections throughout B.C.

The angel giving cast-out Muslim women with AIDS hope for a normal life

Matron Fadzilah offers a temporary shelter, and some tough love, to HIV/AIDS-infected women rejected by their families.

PETALING JAYA: Becoming infected with HIV/AIDS is bad enough for any woman, but to then be cast out by her own family seems like the end of the world.

Being ostracised by her community is especially tragic for the many women who are innocent victims, having been infected by promiscuous or closet bisexual husbands.

But there is one compassionate woman, Fadzilah Abdul Hamid, better known as Matron Fadzilah, who can offer a temporary home and some tough love to these rejected women and children.

Over 20 years ago, she and fellow senior officers at the health ministry started a care home under the Islamic Medical Association Malaysia.

Since it started, Solehah House has helped nearly 400 victims, 50 of whom were children as young as 20 days old.

At Rumah Solehah, women are encouraged to identify their interests and capabilities and develop their potential so they will be able to earn a living.

 

 

Matron Fadzilah’s care home gets referrals from all over Malaysia.

A veteran nurse, she said all women with HIV/AIDS face stigma from their own families and community but particularly Muslim women.

“They come to us because they have been rejected. When they arrive, their self-esteem is shattered. We rebuild their confidence, and then tend to their physical problems such as skin lesions.”

She runs the treatment and counselling programme, integrated with Islamic teachings and values, which can last from three months to two years depending on the individual.

The programme includes working with the women to identify their interests and capabilities and develop their potential so they will be able to earn a living when they return to their communities.

She also teaches them health basics, like how to stay clean in order to prevent transmission of the virus.

For the past five years, there has been a decline in the number of women actually living in the home, she said. The majority of those who come for help are now home-based.

She attributes this to an improvement in public awareness, saying most are now able to stay with their own families who are more accepting.

Rumah Solehah survives with basic funding from the government and the corporate sector.

 

 

But others with families who are not as up-to-date about how the virus is transmitted are not as lucky.

“Many families still fear HIV, even though it is just like any other infection. It cannot spread very easily.”

For the past six years, the home has been receiving funding from the Selangor Islamic Religious Council, which also funds a number of other HIV/AIDS shelters.

She believes this is a sign that the Muslim community is becoming more open.

“The Quran teaches us that God is most forgiving, especially for those who have repented,” said Matron Fadzilah.

Running a home is not easy, as staff and funds are usually lacking.

Matron Fadzilah said it is difficult to find new staff, as few are dedicated enough to undergo the strenuous tasks involved in looking after and counselling AIDS patients. Many also worry about becoming infected themselves.

“We cannot retain our staff, especially the younger ones. They are not that interested in staying with us because they have their own lives outside,” she said.

Now there are virtually no full-time staff, but regular volunteers. They also train former patients to return and work at the home.

These days, despite people becoming more aware of the disease, more people are actually contracting HIV.

Matron Fadzilah worries that now most HIV cases are due to casual and unhealthy sexual activity.

She said many people are well aware of the consequences of unprotected sex, but practise it anyway.

“It is a problem for the nation,” she said.

Luckily the angel of Solehah House is there to do what she can.

Source: https://www.freemalaysiatoday.com/category/nation/2019/03/08/the-angel-giving-cast-out-muslim-women-with-aids-hope-for-a-normal-life/

On International Women’s Day, UNAIDS calls for greater action to protect young women and adolescent girls

Every day, 460 adolescent girls become infected with HIV and every week 350 adolescent girls die of AIDS-related illnesses

GENEVA, 8 March 2019—On International Women’s Day, UNAIDS is urging countries to step up and protect young women and adolescent girls from HIV.

AIDS-related illnesses remain the leading cause of death for women aged 15–49 years globally. In 2017, 66% of new HIV infections among 10–19-year-olds were among females globally—in eastern and southern Africa, 79% of new HIV infections among 10–19-year-olds were among females.

“There is a vicious cycle of gender inequities, gender-based violence and HIV infection in many parts of the world,” said Michel Sidibé, Executive Director of UNAIDS. “Oppression and power imbalances must be reversed and harmful masculinities addressed in order to ensure that women and girls have full control over their sexual health and rights.”

Much more needs to be done to reach young people with HIV prevention, treatment and care. Young women and adolescent girls are especially being left behind. Gender-based violence, sexual exploitation and drug use are among the many factors that can increase the vulnerability of young women and adolescent girls to HIV.

Efforts to end AIDS are undermined where the human rights of young women and adolescent girls—especially their sexual and reproductive health and rights—are not supported. Countries must therefore enact laws and policies that enable access to services, including health and social protection, by young women and adolescent girls, helping them to claim their right to health.

International law gives people, including young women and adolescent girls, the right to access services to protect their sexual and reproductive health. However, 45 countries worldwide still have laws that require people under the age of 18 years to obtain the consent of their parents in order to be tested for HIV.

Social protection, education—including comprehensive sexuality education—and HIV prevention services that are integrated with sexual and reproductive health services have been shown to improve the health of, and empower, young women and adolescent girls. A South African study showed that HIV prevalence among girls who had finished high school was about half that among girls who had not (8.6% versus 16.9%). Children who access universal primary education in Botswana, Malawi and Uganda have been shown to have similar outcomes.

Investing in education. Investing in HIV and other health services. Preventing and protecting women and girls from violence. Eradicating harmful practices such as early, forced and child marriage. Promoting women’s rights. Through these actions young women and adolescent girls can be protected from HIV and the world can build towards ending AIDS by 2030.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on FacebookTwitterInstagram and YouTube.

 

Source: http://ow.ly/AspS30nYLiM

HIV infections lowered by 30% in universal testing and treatment study

Richard Hayes presenting at CROI 2019. Photo by Liz Highleyman.

Communities in southern Africa which received a door-to-door HIV testing intervention and support for linkage to care had substantially lower HIV incidence, the Conference on Retroviruses and Opportunistic Infections (CROI 2019) in Seattle was told today.

This clear-cut effect was seen in the communities randomised to receive these interventions and treatment according to national guidelines, but as those guidelines changed to treatment-for-all early on in the life of the trial, the researchers believe it still provides evidence of the efficacy of the universal test and treat approach.

“Taken together with the findings of other studies, our results provide key evidence that the universal test and treat strategy can bring down incidence of new HIV infections, even in settings with severe generalised HIV epidemics,” Professor Richard Hayes of the London School of Hygiene and Tropical Medicine told a press conference.

PopART, also known as HPTN 071, was a large community-randomised trial carried out in Zambia and KwaZulu-Natal, South Africa. The study aimed to measure the impact on HIV incidence of household-based HIV testing and linkage to care by community health workers (lay counsellors) and immediate initiation of antiretroviral treatment delivered through routine health care services.

PopART was an important test of the feasibility of offering testing and treatment at a very large scale, essential for achievement of the 90-90-90 target of 90% diagnosed, 90% of diagnosed people on treatment and 90% of those on treatment virally suppressed. It is the largest HIV prevention trial ever done: around a million people live in the 21 urban communities in Zambia and South Africa where it was conducted.

While there have been several large trials of the ‘test and treat’ approach in African countries in recent years, their results have been mixed. The ANRS 12249 Treatment as Prevention study showed that a massive scale-up of HIV testing was feasible, but linkage to care was slow and there was no benefit in terms of HIV incidence. SEARCH offered HIV testing alongside screening for non-communicable diseases and achieved very high rates of HIV diagnosis and viral suppression, but not an overall effect on HIV incidence. The Botswana Community Prevention Project led to a 30% drop in HIV infections, although this was of borderline statistical significance.

The intervention

The researchers developed a comprehensive intervention to support HIV testing and linkage to care. This involved community health workers systematically visiting all households within a geographical area and offering home-based HIV testing and counselling. Individuals found to be HIV positive were referred to government health clinics for immediate HIV treatment, regardless of CD4 cell count. Support was also offered for adherence, retention in care, HIV prevention, STI screening, TB screening, and male circumcision.

The community health workers returned to households throughout the year as necessary to follow up on referrals and linkages to care, and to offer HIV testing to household members who were absent at previous visits or who had declined testing. Hayes emphasised that this was a trial of universal testing, linkage to care and treatment – not just of universal treatment.

In this cluster randomised trial, the unit of randomisation was a geographical community. The 21 urban communities were clustered into seven groups of three with similar features and similar HIV prevalence. Within each cluster, one community was randomised to study arm A, one to study arm B and one to study arm C.

  • Arm A: the comprehensive intervention, including universal antiretroviral therapy (ART).
  • Arm B: the comprehensive intervention, with ART initiation according to national guidelines.
  • Arm C: standard of care provision through routine health services, with ART initiation according to national guidelines.

As in other ‘test and treat’ trials, this study design was made less clear-cut by shifting global recommendations concerning when people should start HIV treatment. When the study opened at the tail end of 2013, the Zambian and South African guidelines were recommending ART below CD4 cell counts of 350 copies/mm3. But within a few months, that level was raised to 500 copies/mm3. In late 2015, the World Health Organization recommended universal treatment, regardless of CD4 count, and this was implemented at the Zambian and South African trial sites in early and late 2016 respectively.

In terms of evaluating the impact of the intervention, the key data were collected between mid-2015 to mid-2018. Due to the guideline changes, for two of these three years, there was no difference at all between arms A and B. In addition, people in arm C were also receiving universal treatment, but not universal testing.

So it would seem that the results in arm B can tell us about a universal test and treat approach, even if it was not designed to do so.

To measure the impact of the intervention, the researchers recruited a random sample of 48,301 adults from the overall study population (described as the ‘population cohort’). The study’s primary outcome was changes in HIV incidence (new infections) at the population cohort’s month 12 and month 36 visits, which occurred between mid-2015 and mid-2018. A different team of research workers made annual visits to test these individuals for HIV, without offering the comprehensive package of interventions.

Those in the population cohort were predominantly young (39% were aged 18 to 24) and female (71%). Men were often away from home for work and it was hard to enrol them, despite repeated visits. At baseline, only around 55% of those living with HIV were virally suppressed.

Results

  • There were 553 new HIV infections in 39,702 person years of follow-up.
  • Annual incidence was 1.45% in arm A, 1.06% in arm B and 1.55% in arm C.
  • Compared to arm C, incidence was 7% lower in arm A, but this difference was not statistically significant (adjusted rate ratio 0.93, 95% confidence interval 0.74-1.18).
  • Compared to arm C, incidence was 30% lower in arm B, a difference that was highly statistically significant (adjusted rate ratio 0.70, 95% confidence interval 0.55-0.88).

Incidence was lower in each of the seven B communities than in its matched C community. Hayes said that such a consistent result is rarely seen in cluster randomised trials and is highly unlikely to be due to chance.

The lower incidence in arm B was most notable among women and people over the age of 25.

The researchers say it is puzzling that incidence was significantly lower in arm B (which received the comprehensive intervention and ART according to national guidelines), but not in arm A (which received the comprehensive intervention and universal ART throughout). They were expecting similar results in these two arms. If anything, a greater reduction in incidence should have been seen in arm A, which had universal treatment throughout the study, rather than for most of it.

What could explain the better results in arm B than in arm A? There is no evidence of sub-optimal implementation of the intervention in arm A. In fact, levels of viral suppression were higher (72%) in arm A than arm B (68%) and arm C (60%).

In the coming months, the researchers will explore possible causes. There is plenty of evidence in southern Africa that migration raises risks for HIV and it is possible that some of the communities randomised to arm A happened to have more mobile populations. Phylogenetic analysis of viral strains in the population may identify transmission clusters that could help explain the results. It is also possible that there were differences in sexual risk behaviour between the arms – data on STIs may shed light on this. But the result could simply be an unlikely chance occurrence.

“We found very strong evidence of an effect in the group that received treatment according to national guidelines,” said Professor Hayes. “The absence of a clear reduction in HIV incidence in the group that received the most intensive HIV prevention intervention is surprising and inconsistent with the group’s rate of viral suppression. Further analyses of qualitative and quantitative data from the study communities may help us better understand this unexpected result.”

During questions and answers, he said that the team had conducted a post-hoc analysis which combined arms A and B, in comparison with arm C. This showed a statistically significant 20% reduction in HIV incidence.

“The overall evidence for the effectiveness of the intervention is strong,” Hayes said. “Community-based services for universal HIV testing and linkage to care are a key component of combination prevention in the global effort to achieve effective HIV control.”

Author: Roger Pebody

Source: http://www.aidsmap.com/page/3464265/

AIDS success ‘unworkable’ for vast majority

Graphic representation of the AIDS virus.

Graphic representation of the AIDS virus. Copyright: Preshkova, (Image has been cropped).

Speed read

  • For the second time, a bone marrow transplant eliminates the AIDS virus from the blood of a patient
  • Given its complexity and cost, this method is not likely to be used on a large scale
  • Pending ongoing research, ARVs remain the recommended treatment

Medical experts hailed the news this week that a second HIV-positive man appears to have eliminated the virus from his body, but warned the treatment used is completely unviable for the vast majority of the 37 million people living with the disease.

AIDS, caused by infection with the human immunodeficiency virus (HIV) virus, is one of the three big diseases affecting people in the developing world along with tuberculosis and malaria. Around a million people died from AIDS-related illnesses in 2017.

Researchers from University College London (UCL) reported 5 March in the journal Nature the case of an HIV-positive man who, after receiving a bone marrow transplant, no longer showed any sign of the AIDS virus, 18 months after he had stopped taking antiretroviral therapy.

Presenting their work on the same day at the annual conference on retroviruses and opportunistic infections in Seattle, USA, the researchers said they used largely the same method which had been used in 2007 in Berlin on Timothy Ray Brown.

“Even reaching a very limited number of people to achieve ‘near-cure’ of HIV infection is a welcome achievement. It still seemed utopian a decade ago.”

Avelin Aghokeng

The so-called “Berlin patient” is considered the first person in the world to have been cured of HIV/AIDS, as the virus has not been detected in his body since then.
The method involves finding a compatible donor who additionally has a mutation in a gene called CCR5.
It is this gene that causes the AIDS virus to penetrate the immune cells and multiply. But the mutation prevents the virus from entering and taking hold.

As a stem cell, the transplanted bone marrow will produce new immune cells containing the mutated CCR5 gene which will gradually replace the old cells, blocking the virus, which can no longer replicate.

“Continuing our research, we need to understand if we could knock out this receptor in people with HIV, which may be possible with gene therapy,” said Ravindra Gupta, lead author of the study in a statement published by UCL.

There are strong reservations about this method, however, among parts of the scientific community.

Eric Delaporte, head of the laboratory for translational research on HIV and infectious diseases at the Institute of Research for Development (IRD), in France, says the rare genetic mutation is only found in one per cent of the population.

“As is often the case with AIDS, we are dealing with an overrepresentation of a result where we speak of ‘healing’, when in practice, for the millions of people living with HIV, this is not the solution,” he tells SciDev.Net.

‘False hope’

Delaporte also finds the process “complicated and dangerous”.

“You have to put the patient in aplasia, that is, destroy the cells with chemotherapy and then transplant the marrow of a compatible donor,” he says.

“During the aplasia phase when cells are destroyed, the slightest infection can kill, because the patient has no defence. It must therefore take place in a specialist unit with a sterile room, so with an advanced, sophisticated and expensive medical infrastructure.”
For Delaporte, the excitement around the story gives “false hope”.
But Michel Sidibé, executive director of UNAIDS, gives a more nuanced view.
“Although this breakthrough is complicated and much more work is needed, it gives us great hope for the future that we could potentially end AIDS with science, through a vaccine or a cure,” he wrote in a press release issued by the organisation.
“However, it also shows how far away we are from that point and of the absolute importance of continuing to focus HIV prevention and treatment efforts.

Sidibé’s optimism is shared by Avelin Aghokeng, researcher at the International Centre for Medical Research in Franceville, Gabon.

“Even reaching a very limited number of people to achieve ‘near-cure’ of HIV infection is a welcome achievement. It still seemed utopian a decade ago,” he says.
“Advances in research are enriched by such proofs of concept and open up new avenues for research and intervention.”

‘Proof of concept’

“Although it is not a viable large-scale strategy. these new findings reaffirm our belief that there exists a proof of concept that HIV is curable,” says Anton Pozniak, president of the International AIDS Society (ISA).

The British infectious disease specialist said he hoped “that this will eventually lead to a safe, cost-effective and easy strategy to achieve these results using gene technology or antibody techniques.

The authors of the work prefer to focus on the potential for the scientific community.

“If it is too early to say for sure that our patient is now cured of HIV, the apparent success of stem cells gives hope that new strategies can be developed to combat the disease,” says research team member Eduardo Olavarria.

Commenting on the findings in relation to the 2007 case, Aghokeng says the question of reproducibility of a procedure, experiment or intervention is “crucial”.
“It is difficult,” he says, “to draw important conclusions from a single case. A second success, realized by another research team and in a different patient, allows scientists to confirm the first result and consider the experiment reproducible,” he tells SciDev.Net.

“It also helps to better control the approach, its benefits and also its limitations and dangers. It should be noted that behind this success are also many failures of this approach.”
Meanwhile, everyone in the scientific community agrees that the only way to treat this disease, which affects 37 million people worldwide, according to UNAIDS, is to take antiretrovirals for life.
Source: https://www.scidev.net/global/hiv-aids/news/aids-success-unworkable-for-vast-majority.html

Factors Associated With CVD and Mortality in HIV Patients

HIV cell
Mortality in PLHIV in the Asia-Pacific region is still primarily caused by AIDS and, to a lesser extent, by noncommunicable diseases such as CVD.

Factors associated with the development of fatal or nonfatal cardiovascular disease (CVD) events in a cohort of people with HIV from multiple Asian countries were older age and treatable risk factors such as high blood pressure, triglycerides, total cholesterol, and body mass index, according to data published in HIV Medicine.

As the population of people with HIV ages, CVD is a growing cause of death and morbidity. Patient data from Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) from 2003 to 2017 were used to identify 8069 patients receiving antiretroviral therapy (ART) with >1 day of follow-up. Data from these patients were used to investigate CVD-related and other causes of death and the associated factors.

The median follow-up time of the patient cohort was 7.3 years (interquartile range, 4.4-10.7 years). Of these 8069 patients, 378 died (incidence rate, 6.2 per 1000 person years), including 22 CVD-related deaths (incidence rate, 0.36 per 1000 person years). Older age (subhazard ratio [sHR], 2.21 [95% CI, 1.36-3.58] for age 41-50 years; sHR 5.52 [95% CI, 3.43-8.91] for age ≥51 years compared with age <40 years), high blood pressure (sHR, 1.62; 95% CI, 1.04-2.52), high total cholesterol (sHR, 1.89; 95% CI, 1.27-2.82), high triglycerides (sHR, 1.55; 95% CI, 1.02-2.37), and high body mass index (sHR, 1.66; 95% CI, 1.12-2.46) were all significantly associated with any CVD event (incidence rate, 2.2 per 1000 person years). Investigators also found that CVD crude incidence rates were lower in the lower middle- and upper middle-income countries, as well as in those with a later ART initiation period.

The study was unable to discern the differences in risk factors for fatal vs nonfatal CVD because of small sample size in the cohort. Investigators also believed there may have been an underdiagnosis of CVD events, as a result of factors involved with lower resource settings, such as limited accessibility of screening tools and a tendency for marginalized groups to not seek care. In addition, the influence of specific antiretroviral drugs and inflammatory markers associated with CVD could not be evaluated. Nor was the effect of comedications or treatments received outside of the observation period accounted for. Finally, investigators noted that there was a relatively high proportion of missing data regarding CVD risk factors, meaning some of the effect was undetected.

Investigators concluded that the primary cause of mortality for those living with HIV in the Asia-Pacific regions remains HIV and, to a lesser extent, noncommunicable disease, including CVD. The fact that most risk factors were modifiable was encouraging to investigators, “[i]t is reassuring that many of the risk factors we identified are of a modifiable nature and can be targeted with interventions.” However, these results highlight the importance of regular monitoring and treatment of CVD risk profiles. These findings were similar to those found in other regions, noted investigators, revealing “lessons may be learned from efforts to improve CVD risk profiles that have proved successful in other settings.”

Author: Bradley van Paridon

Source:

 

Factors Associated With CVD and Mortality in HIV Patients