Stefan Baral, FRCPC CCFP

Slides:

Advertisements

Similar presentations

Stefan Baral, MD MPH FRCPC

Advertisements

STIGMA AND DISCRIMINATION REDUCTION AS AN ESSENTIAL PART OF COMBINATION PREVENTION Stefan Baral, MD MPH FRCPC Center for Public Health and Human Rights,

Africa at a glance: Penetration of ICTs The reach of popular ICTs The most connected countries.

Brazzaville, Congo 5-7 March 2014

Ecological Model for HIV Risk in MSM Stage of Epidemic Individual Community Public Policy Network Level of Risks Source: Baral and Beyrer, 2006.

Successes and challenges of HIV prevention in men who have sex with men Patrick Sullivan, Alex Carballo-Dieguez, Thomas Coates, Steven M Goodreau, Ian.

UNAIDS, Regional Support Team, Eastern and Southern Africa

July 2014 Regional Data Slides. Source: UNAIDS.

Moving to the final chapter of the AIDS epidemic.

Introduction to Africa. Create a chart like the one below – 6 Columns, 7 Rows Subregions Countries GDP Per Capita Life Expectancy Infant Mortality Economic.

ANAL INTERCOURSE AND HIV AMONG MSM EPIDEMIOLOGICAL REALITIES AND WAYS FORWARD Stefan Baral MD MPH CCFP FRCPC Johns Hopkins School of Public Health, USA.

November 8th, 2013 A Business Plan for Africa Breakaway Sessions 4: Execution plan by regional clusters Session 3: Central Africa.

Disclaimer Median Real Income, Sub- Saharan Africa.

AFRICAN ECONOMIC DEVELOPMENT: AN OVERVIEW By Prof. Augustin K. Fosu Visiting Professor of Economics, Aalto University, Helsinki, FINLAND African Economic.

Brian Kanyemba, Research Assistant/AVAC Fellow/IRMA Advocate

ENHANCING BENEFITS OR INCREASING HARMS COMMUNITY RESPONSES FOR HIV AMONG KEY POPULATIONS Stefan Baral, MD MPH FRCPC Center for Public Health and Human.

AIDS impact Wim Van Damme Department of Public Health ITM, November 2006.

Bell Ringer What conditions could lead to an atmosphere susceptible to genocide?

OVERVIEW OF THE HIV/AIDS EPIDEMIC Marie Laga

Looking back, looking forward: what we know and don’t know about oral PrEP and tenofovir gel for preventing HIV in women Jared Baeten MD PhD Departments.

Looking back, looking forward: what we know and don’t know about oral PrEP and tenofovir gel for preventing HIV in women Jared Baeten MD PhD Departments.

Splash Screen Contents Africa South of the Sahara Physical Political Gems and Minerals Fast Facts Country Profiles Click on a hyperlink to view the corresponding.

Entrance Ticket Name all the continents

AIDS Epidemic Update December /06 e. AIDS Epidemic Update December /06 e TOTAL North America Eastern Europe & Central Asia Latin America.

PEPFAR Investment Strategy (8 years of PEPFAR) Data source : OGAC Budget Total PEPFAR Investment: $21,285,918,291 Saving Lives : Changing the.

African Countries Report Objective: To demonstrate an understanding of the history and culture of an African nation. Activity: Student will choose an African.

HIV/AIDS epidemics among men who have sex with men (MSM) in Africa, Asia, Latin America and the Caribbean, and the CIS Full Enjoyment of Human Rights by.

AFRICA HIV/AIDS AIDS DATA SOURCE: UNAIDS 2007 REPORT WORLD HEALTH ORGANIZATION.

High-impact interventions. Number of people living with HIV who were not receiving antiretroviral therapy, 2014 and 2015 Source: UNAIDS estimates, 2014.

Computer Class – Summer 20091/8/ :32 PM African Countries Algeria Angola Benin Botswana Burkina Faso Burundi Cameroon Cape Verde Central African.

GeoCurrents Customizable

Where services are needed The number of women and girls who were newly infected with HIV in Note: For Botswana and Zimbabwe, the number of women.

Annex Questions on economic characteristics included in the census questionnaires, 18 African countries.

Global and Regional Perspective on Maternal, Infant & Young Child Nutrition: Overview of Progress and way forward for Sustainable Development Goals Ms.

HIV RISKS AND VULNERABILITIES AMONG GAY, BISEXUAL, AND OTHER MEN WHO HAVE SEX WITH MEN Stefan Baral, MD MPH FRCPC Key Populations Program, Center for Public.

COMPARATIVE POVERTY PROGRESS IN AFRICA, AND CHANGES IN (P.C.) GDP, INCOME, AND INEQUALITY BY COUNTRY African Economic Development, Lecture 2 10 th May.

1 06/06 e Global HIV epidemic, 1990 ‒ 2005*HIV epidemic in sub-Saharan Africa, 1985 ‒ 2005* Number of people living with HIV % HIV prevalence, adult (15-49)

Prevention Science Gaps and the HIV/AIDS Pandemic Quarraisha Abdool Karim, PhD Head: CAPRISA Women and AIDS Pogramme Associate Professor in Epidemiology,

Government Control ++ Lawful ActorsUnlawful Actors Government Sanctioned Role Potentials (i.e. Unions, Lobbyists, Privatization)

Physical and Sexual Violence Affecting Female Sex Workers in Côte d’Ivoire Carrie Lyons, MPH Center for Public Health and Human Rights Johns Hopkins Bloomberg.

COMBINATION HIV PREVENTION AND TREATMENT FOR MEN WHO HAVE SEX WITH MEN Stefan Baral, MD MPH FRCPC Key Populations Program, Center for Public Health and.

An overview of PrEP trials Bea Vuylsteke Institute of tropical Medicine, Antwerp, Belgium Marrakech, IUSTI 2016.

Jennifer Sherwood amfAR, The Foundation for AIDS Research

Canadian International Development Platform

Africa HIV/AIDS Infection Rates

Trading sex and building capital: Sexual identity and the programmatic challenge of reaching young African MSM Copyright Colin Purrington (

Urbanization, Wealth and Overweight in Sub-Saharan Africa

Ambassador Deborah L. Birx, MD

HIV/AIDS in sub-Saharan Africa July 2002

African Academy of Neurology (AFAN)

Africa Map Review Directions: Use the cursor or mouse button to advance the review. A country will be highlighted. Try to identify the country. The.

Frances M Cowan PrEP in Practice Symposium International AIDS Society

Getting PrEP to where it is needed most: Opinions in Africa

Tiffany G. Harris, PhD, MS Director of Strategic Information

Jepkoech Kottutt1, Emilia D. Rivadeneira2, Susan Hrapcak2

. Strategically supporting PrEP implementation for adolescents & young adults Shona Dalal, PhD 24 July

Time for a quality revolution in global health

Forecasting the Cost of Financing ART in Sub-Saharan Africa under Differential Funding Scenarios Tahvi Frank and Austin Carter July 25, 2018.

Reported measles cases, measles coverage for 1st and 2nd doses and supplementary measles activities for the African Continent For 1990 – 2007 Data as of.

Heterogeneity of Demographic and Risk Strata Across the UNAIDS Targets in Sub-Saharan Africa – A Systematic Review July 23rd, 2018.

THE FIRST GROUP OF COUNTRIES:

Name: _____________________________________________________ Period: ________ Date: _____________ Africa Study Tool.

Fifty Years of Economic Growth in Sub-Saharan Africa

Stigma, Human Rights, and HIV Measurement and Interventions

Africa Map Review Game.

survey prevalence (%) (year)

Disclaimer This document contains data provided to WHO by member states. Note that some member states only provide aggregate data to WHO, and for these,

Managing TB in the era of HIV

Countries of Africa.

Presentation transcript:

The Potential Utility of PREP for Gay men and other MSM across Sub-Saharan Africa Stefan Baral, FRCPC CCFP Key Populations Program, Department of Epidemiology, Johns Hopkins School of Public Health

Outline Moving Forward Global Epidemiology of HIV among Gay men and other MSM Epidemiology of HIV among MSM in Sub Saharan Africa Ongoing PrEP Demonstration Projects for MSM in South Africa PrEP in other Places? Moving Forward

Global HIV Prevalence among MSM, 2007-2012 Modified From: Beyrer, Baral, van Griensven, Goodreau, Chariyalertsak, Wirtz, Brookmeyer, The Lancet, 2012

HIV Prevalence among MSM in Africa 4.9% (1,778) 4.4% (90) Morocco Tunisia 6.2% (267) 5.7% (259) 5.9% (262) Egypt 21.5% (463) 21.8% (501) 19.0% (n/a) 9.3% (713) 7.3% (406) 0.98% (n/a) 17.2% (1,291) 50.0% (96) 13.4% (1,125) 21.1% (712) Senegal Sudan 9.8% (205) Burkina Faso 17.0% (n/a) 13.3% (215) Nigeria 24.6% (285) 14.3% (449) Cote d’Ivoire Togo CAR 13.2% (306) The Gambia 19.0% (563) Ghana 20.3% (N/A) 37.0% (511) Uganda 25.0% (N/A) Cameroon Kenya 19.8% (253) Legend Tanzania 2005 12.3% (509) 33.0% (641) 2006 Zambia 21.4% (201) 2007 Malawi 3.1% (353) 12.4% (218) 9.1% (583) Nampula 2008 19.7% (117) 2009 Beira Namibia 8.1% (358) Botswana 31.1% (318) 2010 Maputo 8.1% (358) 40.7% (285) Maseru 2011 Swaziland 25.5% (200) 35.4% (211) 2012 28.9% (249) 10.6% (538) Soweto Maputsoe 2013 Cape Town (Township) Cape Town 2014 Modified From : van Griensven, Baral, et al. The Global Epidemic of HIV Infection among Men who have Sex with Men. Curr Opinion on HIV/AIDS, 2009

HIV Incidence among MSM, 1995-2014 High Income Countries Low and Middle Income Countries

HIV Incidence among MSM in Sub-Saharan Africa 16.0% Senegal 14.0% Nigeria 3.6% Uganda 7.2-20% Kenya 7.1% Malawi 5-6% South Africa Modified From : van Griensven, Baral, et al. The Global Epidemic of HIV Infection among Men who have Sex with Men. Curr Opinion on HIV/AIDS, 2009

HIV Incidence among MSM in Kilifi, Kenya Source: Sanders, Mugo, van der Elst, Smith, Graham. High HIV-1 incidence, correlates of HIV-1acquisition, and high viral loads following seroconversion among MSM JAIDS ,2013

Modified: Abdool Karim et al, AVAC Report, 2014 Oral/Topical PrEP Efficacy/Effectiveness Modified: Abdool Karim et al, AVAC Report, 2014

“Forgiveness” TFV Concentration: Rectal>Cervical>Vaginal Days post single-dose Patterson KB et al. Sci Transl Med. 2011.

HIV prevalence and awareness of HIV positivity by age, Cape Town and Port Elizabeth, South Africa

Modeling Utility of PrEP For MSM in South Africa Source: Brookmeyer et al, PLoS ONE 2014

PrEP Continuum for MSM in Cape Town and Port Elizabeth, South Africa, 2014-2016

Person Days on and off PrEP among 80 MSM in Cape Town and Port Elizabeth, South Africa, 2014-2016

SA PrEP Demo Project Assess feasibility of delivering PrEP in standard PHC facilities In line with International and SA Guidelines 300 MSM across 2 sites (Woodstock, CPT & Yeoville, JNB) Minimal additional research components (i.e no active recruitment)

SA PrEP Demo: Retention Outcomes Source: Brown, Rebe, Bekker, McIntyre

SA PrEP Demo: Adherence Outcomes 81% 19% 85% 15% 87% 13% Source: Brown, Rebe, Bekker, McIntyre

Ever Used any PrEP among MSM

Key Themes The world is more similar than it is different Wherever HIV is studied around the world, risk is not evenly distributed Highest incidence appears to be among young gay men and other MSM Similar Risk factors for HIV Infections among MSM Sustained HIV incidence supports the need for addition of PrEP Demonstration data from South Africa suggests feasibility in the context of primary health care facilities

Acknowledgements CPHHR Desmond Tutu HIV Foundation Key Populations Program Carrie Lyons, Sosthenes Ketende, Ben Liestman, Amrita Rao, Sheree Schwartz, Gnilane Turpin Nunez, Karleen Coly, Shauna Stahlman Emory Travis Sanchez, Patrick Sullivan, Rachel Kearns, Ryan Zahn Human Sciences Research Council Refilwe Phaswana-Mafuya, Ebrahim Hossein, Batlile Maseko Desmond Tutu HIV Foundation Linda Gail-Bekker, Karen Dominguez, Ben Brown, Andrew Scheibe CPHHR Chris Beyrer, Emily Clouse, Andrea Wirtz, Kristin Hunt, Michele Decker, Len Rubinstein