INA-RESPOND Test and Treat Study

Slides:



Advertisements
Similar presentations
No one left behind: Increased coverage, better programmes and maximum impact for key populations WHO Consolidated Guidelines on HIV Prevention, Diagnosis,
Advertisements

Women and ARV-based Prevention: Challenges and Opportunities Tim Mastro, MD, DTM&H AIDS 2014 Melbourne, Australia 24 July 2014.
NATIONAL INSTITUTES OF HEALTH: National Institute of Allergy and Infectious Diseases National Institute of Mental Health National Institute on Drug Abuse.
The U.S. President’s Emergency Plan for AIDS Relief The Evolving HIV Prevention Strategy for IDUs in PEPFAR Amb. Eric Goosby US Global AIDS Coordinator.
Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive DR. Nicholas Muraguri OGW, MD,MPH, MBA,
From “What If” to “What Now” Perspectives on ARVs and the Future of Treatment and Prevention Mitchell Warren Executive Director, AVAC IAS 2011, Rome.
PEPFAR Emmanuel Njeuhmeli, MD, MPH, MBA Senior Biomedical Prevention Advisor and Co-Chair PEPFAR Male Circumcision Technical Working Group Office of HIV/AIDS.
HIV Prevention Programs Among Older Adult Populations
Maurice Cook ( EM Designs Group, Inc.) The End of AIDS Transmission? Robert M Grant, June 2012.
HIV in Texas: The Ways Forward Ann Robbins Manager of HIV/STD Prevention and Care Department of State Health Services.
Does Africa need a rectal microbicide? IRMA and AVAC presentation 27 September 2011 Salim S. Abdool Karim Pro Vice-Chancellor (Research), University of.
Accelerating Anti-Retroviral Treatment as a catalytic action for Ending AIDS Pride Chigwedere, MD, PhD Senior Advisor to the African Union AWA CONSULTATIVE.
How well are we doing in preventing HIV and how can we do better?
Doing the Right Thing Karen A. Stanecki XV International AIDS Conference.
Epidemiology of HIV and Access to Prevention services, Tanzania Joint Biennial HIV National Response Review Stakeholders meeting. November, 2014 Blue Pearl.
HIV Science Update: From Rome to Addis – Biomedical Prevention Elly T Katabira, FRCP Department of Medicine Makerere University College of Health Sciences.
Are people living with HIV less likely to pass HIV to others if they are on treatment? Exploring the use of treatment as prevention James Wilton Project.
Use of Antivirals in Prevention Oral and Topical Prophylaxis
The potential and challenges of ARV-based HIV prevention: An overview
Washington D.C., USA, July 2012www.aids2012.org Implementation Science: Realizing the HIV Prevention Revolution Nelly R. Mugo, MD, MBChB, MMed, Kenyatta.
Treatment as prevention: a new paradigm for HIV control? Richard Hayes.
Creating an AIDS-Free Generation The beginning of the end of AIDS Center for Strategic & International Studies Washington, DC March 22, 2012 Thomas R.
This presentation and the information contained therein is the sole property of the South African Medical Research Council TREATMENT ACCESS IN TRIALS AND.
Making it happen! In Support of the Global Plan Towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive.
ART Regimen Selection and Treatment Initiation for PMTCT Programs Lara Stabinski, MD, MPH Medical Officer Clinical Services S/GAC June 18, 2012.
Topical, Oral; Daily, Intermittent; Single, Combination agents; What do we need AND what will work? Patrick Ndase, Microbicide Trials Network & Dep’t of.
Contraception – the Best Kept Secret in HIV Prevention May 24, 2008 CCIH Annual Conference Ed Scholl Family Health International.
Cindra Feuer and Marc-André LeBlanc HRCF, 21 April 2010 ARV-based Prevention.
IMPLEMENTATION PLAN TO SCALE UP HIV/AIDS PREVENTION AND TREATMENT 1.
State of the Art: Epidemiology and Access
The Strategic Use of ARVs | IAC Satellite, July 22, |1 | Strategic Use of Antiretroviral Drugs WHO Perspective for Future Guidelines Chair of WHO.
Population-based impact of ART in high HIV prevalence settings Marie-Louise Newell Professor of Global Health Faculty of Medicine, Faculty of Social and.
Myron S. Cohen, MD Associate Vice Chancellor Director, Institute for Global Health The University of North Carolina.
Washington D.C., USA, July 2012www.aids2012.org Summary of Track C: Epidemiology and Prevention Science Audrey Pettifor, UNC Christopher Hurt, UNC.
HIV and STI Department, Health Protection Agency - Colindale HIV and AIDS Reporting System HIV in the United Kingdom: 2012 Overview.
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.
Office of Global Health and HIV (OGHH) Office of Overseas Programming & Training Support (OPATS) Session: Voluntary Medical Male Circumcision (VMMC)
What Is Currently in the Pipeline & What is Ideal for an ARV-based Prevention Candidate? Carl W. Dieffenbach, Ph.D. Director, Division of AIDS, NIAID,
HIV-infected subjects with CD4 350 to 550 cells/mm serodiscordant couples HPTN 052 Study Design Immediate ART CD Delayed ART CD4
ART: When to Start? – Case Discussion Roy M. Gulick, MD, MPH Professor of Medicine Chief, Division of Infectious Diseases Weill Medical College of Cornell.
The National HIV Counselling and Testing Campaign and Treatment Expansion in South Africa: A return on investments in combination prevention XIX International.
Global overview of the state of the epidemic and new strategies of Response Peter Godfrey-Faussett, Senior Science Adviser, UNAIDS Karl Dehne, Chief, Prevention,
High-impact interventions. Number of people living with HIV who were not receiving antiretroviral therapy, 2014 and 2015 Source: UNAIDS estimates, 2014.
IAS July 1 The Caprisa 004 result in context Sheena McCormack Clinical Scientist MRC Clinical Trials Unit.
THE 6 TH NATIONAL SCIENTIFIC CONFERENCE ON HIV/AIDS Ending the AIDS epidemic: Science, Policy and Community Peter Godfrey-Faussett UNAIDS, Geneva.
PrEP Update: The science, new tools, and next steps Dawn K. Smith MD, MS, MPH Division of HIV/AIDS Prevention, CDC “The findings and conclusions in this.
N ORTHWEST A IDS E DUCATION AND T RAINING C ENTER Pre-exposure Prophylaxis for HIV Prevention Efficacy and the importance of adherence Joanne Stekler,
25 Years of AIDS – The Global Response 16 August 2006 XVI International AIDS Conference Toronto.
Effective HIV & SRH Responses among Key Populations Module 2: The Comprehensive Package of Programmes and Services.
Dr. William P. Howlett Matthew P. Rubach, MD Dr. Neema W. Minja Department of Internal Medicine, KCMC KCMC/Duke Collaboration HIV in Tanzania: Current.
HIV and Women Collaborating Across Borders to Advance the Health of Women IAS 2012 Gina M. Brown, M.D. July 22, 2012.
STATE OF THE EPIDEMIC AND THE RESPONSE PROMISES, PROGRESS AND PROBLEMS DR. ALEX COUTINHO MD MPH Executive Director Infectious Diseases Institute.
Prevention Science Gaps and the HIV/AIDS Pandemic Quarraisha Abdool Karim, PhD Head: CAPRISA Women and AIDS Pogramme Associate Professor in Epidemiology,
What Will it Take to Reach the Fast Track Prevention Targets? July 18, 2016, International AIDS Conference Karl L. Dehne, Chief Prevention, UNAIDS.
Pre-exposure Prophylaxis (PrEP) for HIV Prevention: What’s the Future? Joanne Stekler, MD MPH Assistant Professor of Medicine University of Washington.
Session: Treatment is Prevention? 16 th International Conference on AIDS and Sexually Transmitted Infections in Africa, Addis Ababa, Ethiopia Catherine.
HPTN 071 (PopART): Have we reached the targets after two years of the PopART intervention IAS Paris July 2017 Richard Hayes.
IAS Satellite Session 25th July 2017 Daniel Were, PhD
Dr. Monica Beg, Chief, HIV/AIDS Section, UNODC
27 years of responding to AIDS
Voluntary Male Medical Circumcision Case for Accelerated Scale Up
27 years of responding to AIDS
25 years of AIDS People living with HIV Children orphaned by AIDS in
Richard hayes London school of hygiene & Tropical Medicine
Quarraisha Abdool Karim, PhD
National Department of Health: South Africa
27 years of responding to AIDS
Overview of importance and emerging innovations for testing and linkage CHERYL JOHNSON WORLD HEALTH ORGANIZATION HIV AND HEPATITIS DEPARTMENT 23 JULY.
National Department of Health: South Africa
Presentation transcript:

INA-RESPOND Test and Treat Study Dr. M. Karyana, MPH Pusat Teknologi Terapan Kesehatan dan Epidemiologi Klinik, Badan Litbang Kesehatan – Kementerian Kesehatan RI Jakarta, 28 October 2014

Global AIDS response – first 25 years First cases of unusual immune deficiency are identified among gay men in the USA June 1981 First regimen to reduce MTCT of HIV Global Fund to fight AIDS, TB and Malaria Acquired Immune Deficiency Syndrome (AIDS) defined WHO and UNAIDS launch the "3 x 5" initiative Millions HAART launched 50 45 40 35 30 25 20 15 10 5 A heterosexual AIDS epidemic is revealed in Africa Brazil becomes the first developing country to provide ART HIV identified as cause of AIDS May 1983 The first HIV antibody test becomes available Global Network of People living with HIV/AIDS (GNP+) The WHO launches the Global Programme on AIDS President Bush announces PEPFAR The first therapy for AIDS - zidovudine/ AZT - is approved for use in the USA The UN General Assembly Special Session on HIV/AIDS UNAIDS created 2010 International AIDS Conference in Durban People living with HIV 1980 ‘81 ‘82 ‘83 ‘84 ‘85 ‘86 ‘87 ‘88 ‘89 ‘90 ‘91 ‘92 ‘93 ‘94 ‘95 ‘96 ‘97 ‘98 ‘99 ‘00 ‘01 ‘02 ‘03 ‘04 ‘05 The chronology above summarizes the ‘BIG Picture’ of AIDS – from the UNAIDS website Source: UNAIDS 2008 2

Source: UNAIDS Global Report 2014 Global number of people living with HIV & HIV-related deaths: Changes post-2005 Source: UNAIDS Global Report 2014

Top 20 countries: People living with HIV Zambia South Africa Nigeria India Kenya Mozambique 14.7 million = 42% Uganda Tanzania Zimbabwe USA Zambia 21.5 million = 61% Malawi China Ethiopia Russia Brazil 25.6 million = 73% Indonesia Cameroon D.R.Congo Thailand Cote d’Ivoire 28 million = 80% Source: UNAIDS Global Report 2014

ARV prophylaxis HIV PREVENTION Male circumcision Treatment of STIs Auvert B, PloS Med 2005 Gray R, Lancet 2007 Bailey R, Lancet 2007 Treatment of STIs Grosskurth H, Lancet 2000 Microbicides for women Abdool Karim Q, Science 2010 Female Condoms Male Condoms HIV PREVENTION Grant R, NEJM 2010 (MSM) Baeten J , NEJM 2012 (Couples) Paxton L, NEJM 2012 (Heterosexuals) Choopanya K, Lancet 2013 (IDU) Oral pre-exposure prophylaxis HIV Counselling and Testing Coates T, Lancet 2000 Sweat M, Lancet 2011 Post Exposure prophylaxis (PEP) Scheckter M, 2002 Treatment for prevention Cohen M, NEJM, 2011 Donnell D, Lancet 2010 Tanser, Science 2013 Behavioural Intervention Note: PMTCT, Screening transfusions, Harm reduction, Universal precautions, etc. have not been included – this is on sexual transmission

Clinical trial evidence for preventing HIV transmission – July 2013 Effect size (95%CI) Prevention in IDUs Bangkok Tenofovir Study - Daily oral PrEP for IDUs 49% (10; 72) HPTN 052 - ART for prevention 96% (73; 99) PartnersPrEP - Daily PrEP for discordant couples 73% (49; 85) TDF2 - Daily PrEP for heterosexual men and women 62% (22; 84) Medical male circumcision 54% (38; 66) Sexual transmission prevention iPrEX - Daily PrEP for MSM 44% (15; 63) Mwanza - STD treatment 42% (21; 58) CAPRISA 004 - Coital microbicide for women 39% (6; 60) RV144 - HIV vaccine 31% (1; 51) MTN 003 - Daily microbicide for women 15% (-21; 40) FEM-PrEP - Daily oral PrEP for women 6% (-52; 41) -60 -20 20 40 60 80 100 Effectiveness (%) Source: adapted from Abdool Karim SS. Lancet 2013

Audience with the Minister of Health

Study Title Indonesia Prevention of HIV and AIDS Transmission by Increasing Testing and Prompt Treatment

Research Question “Does a strategy of combination HIV prevention including universal HIV testing and treatment reduce HIV transmission (incidence) at community level?”

Hypothesis Universal voluntary HIV testing with appropriate combination prevention offered to all those testing HIV negative - in addition to immediate ART for all those testing HIV positive - will have a substantial impact on HIV incidence at population level

Lancet 2009 373: 48-57

Why is a Study Needed? Not known whether a UTT intervention can be delivered with high acceptability Many uncertainties in model parameters Population-level impact of intervention package is not known A rigorously designed study can measure the costs and benefits of this strategy and provide reliable evidence on cost-effectiveness for health policy makers

Design Issues What should the combination prevention package contain? HCT- universal uptake Linkage to care and provision of ART Sexual risk reduction PMTCT STI TB What scenarios would be useful to policy makers? Universal test and treat Vs current Costs of each Delivery under routine programmatic conditions as far as possible

Study Design

Study Coverage

Measuring HIV Incidence HIV incidence will be estimated by assessing HIV seroconversion in a longitudinal cohort Advantages Gold standard approach for HIV incidence estimation Uses routine HIV test methods Provides interim and cumulative incidence estimates Cohort allows for measurement of other indicators Disadvantages Requires longitudinal cohort follow-up Impacted by loss-to-follow up, including differential loss to follow-up Complex sampling is needed to ensure that the cohort reflects the population as a whole

Intervention Package Health centre Universal testing: annual door-to-door HCT Follow-up on referral Support for: Retention in care Adherence to treatment CHiPs: Community HIV-care Providers PMTCT: Prevention of Mother to Child Transmission TB: Tuberculosis STI: Sexually Transmitted Infections Service promotion and referral for - HIV care for HIV +ve including PMTCT - TB - STI Universal treatment for HIV +ve irrespective of CD4 count Facilitated by CHiPs

What is the influence of process parameters? efficacy of ART in blocking transmission treatment drop-out/failure Relative reduction in 3-year HIV incidence in arms A and B Linear model uptake of testing, ART Effect of counselling on infectivity % sex acts with partners from other communities Delays in linkage to care

Conclusions This study will use a cohort measure of HIV incidence to assess the effectiveness of a package of combination HIV prevention including a “universal test and treat” approach Adoption of new consolidated WHO guidelines should only moderately affect ability to detect differences between arms in the study Primary outcome mostly depends on Community-level changes in behaviours Efficacy of ART in blocking transmission (adherence) Uptake of HIV testing and treatment

Acknowledgement Supported by: The National Institute of Allergy and Infectious Diseases (NIAID), the U.S. National Institutes of Health (NIH) National Institutes of Health Research and Development (NIHRD), the Indonesia Ministry of Health

THANK YOU TERIMA KASIH MATUR SUKSMA MATUR SUWUN HATUR NUHUN