Slide 1 of 42 IAS–USA AU EDITED FINAL: Julio Montaner, MD Professor of Medicine, and Head, Div. of AIDS, University of British Columbia Director, BC-Centre for Excellence in HIV/AIDS at Providence Health Care Past President, International AIDS Society ( ) Treatment as Prevention: The Key to an AIDS-Free Generation

Slide 2 of 44 January 2004 Summer of 1996 Year Summer of 2000 Phase I Phase II Phase III Montaner et al, Lancet, 2010 Increasing HAART Coverage within Evolving Guidelines in BC N = 7492 by the end of 2011

Slide 3 of 44 Pre-HAART CD4 counts in BC by year, Lima et al, in preparation, 2013

Slide 4 of 44 Adherence to HAART in BC by year, Lima et al, in preparation, 2013

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Slide 6 of 44 HIV Drug Resistance in BC by year, Lima et al, in preparation, 2013

Slide 7 of 44 BC: All Cause Mortality (#) Montaner et al, TasP Workshop, April 2012

Slide 8 of 44 AIDS New Cases for BC by year, Lima et al, in preparation, 2013

Slide 9 of 44 BC: HIV Prevalence and TB Incidence James Johnston, WIP, May 2013

Slide 10 of 44 HAART Use & New HIV Diagnoses for BC by year, Lima et al, in preparation, 2013 HIV Incidence Active on HAART New HIV Diagnoses (All) New HIV Diagnoses (Ever IDU)

Slide 11 of 44 Annual rates (per 100,000 population) for new cases of genital chlamydia, genital gonorrhea, infectious syphilis and hepatitis C, Lima et al, in preparation, 2013 Hepatitis C Syphilis GonorrheaChlamydia

Slide 12 of 44 Programmatic Compliance Score Assesses the impact of non- compliance with HIV treatment guidelines on all-cause mortality PCS components include: Baseline CD4 > 200/mm3 Three CD4 in 1 st year Three VL in 1 st year Baseline resistance Recommended HAART Undetectable pVL at 9 months Failure to meet a given component add one to the score PCS predicts mortality Lima et al. PLoS ONE 7(11): e

Slide 13 of 44 PCS in BC 2000 to 2011 Lima et al, in preparation, 2013

Slide 14 of 44 R Lester, M Morshed, and M Gilbert, BCMJ, May 4 th 2013

Slide 15 of 44 red = drug resistance at baseline node size = date of baseline sample

Slide 16 of 44 HIV Diagnoses by Region and Year Public Health Agency of Canada

Slide 17 of 44 TasP Monitoring in the Real World In a perfect world, all HIV infected individuals would follow the same pathway in the spectrum of engagement into care: In the real world, there is attrition between each of these steps and individuals are often lost-to-follow-up. Understanding the attrition points (leakage), and their causes are essential to optimize the effectiveness of TasP. This can only be achieved by comprehensively monitoring standardized metrics, on a longitudinal basis and accounting for multiple sources of bias and heterogeneity (i.e.: geographic, socio-demographic, risk factors, etc).

Link 4th Intl HIV TREATMANT AS PREVENTION Workshop April 1 st to 4 th Vancouver, BC, Canada.

Slide 19 of 44 In Collaboration with PHC, VCHA, NHA, PHSA, Community, and MoH