IAS Policy and Advocacy priority on Treatment as Prevention Carlos F. Cáceres Multidisciplinary Research on ARV-based Prevention 30 June 2013 Kuala Lumpur

TasP Advisory Group, IAS  Goal To expand access to antiretrovirals for individual and societal benefit and to investigate and address programmatic and implementation challenges

Objectives  To disseminate the results of research on the individual and community benefit of antiretrovirals and on their use for prevention, bridging the gap between science and implementation  To work with civil society, National AIDS programmes and other stakeholders to deliver services and to ensure increased access to high quality prevention, care and treatment, including antiretrovirals  To create opportunities for dialogue and discussion at national, regional and international levels on increasing access of quality antiretrovirals for treatment and prevention

Key areas of TasP implementation  economic issues  policy, legal, legislative and regulatory issues  impact on health care systems and health care providers, and additional challenges or benefits it can bring  Individual and social issues

Zambia consultation- March 2013  Concerns:  HIV testing done when people seek medical help for health symptoms or pregnancy  inadequacies in staffing and workload  low quality of care and health worker attitudes  unacceptable waiting time  poor confidentiality  poor follow up  difficulties in reaching people in rural areas  urban bias in services  Ways forward:  ensure efficiency and effectiveness of health service  task shifting of community health workers  investment in long term security of drug supply to ensure diversity, sufficiency, affordable production/ acquisition  national analysis on cost modeling based on the PopART  work across disciplines and departments  shortening the time between HIV diagnosis and ART initiation  mobile companies to support adherence

Zambia consultation- March 2013

France consultation- April 2013  knowledge of TasP  reduction of the number of people not knowing they have HIV status  responsibility of all stakeholders  risk of categorising people living with HIV  TasP must not become a new moral standard  no enthusiasm or consensus on TasP  use of condoms remaining the main part of combined prevention incorporating the effects of preventive treatment  for the populations most exposed to HIV, TasP seems to complement pre-exposure prophylaxis (PreP)  certain consensus on TasP to guide the next national recommendations on care for people living with HIV

Recommendations: France  A common position on forms of treatment needs to be developed, highlighting in a more positive way the individual benefits of taking part in an ARV programme  More research is needed on the effect of TasP on MSM  how TasP and PreP complement each other  effect of early treatment on treatment options and choices  Prevention needs to incorporate the effects of preventive treatment, promoting lifelong individualised combined prevention and be based on the use of condoms  A major focus needs to be put on screening as a way of revealing the "hidden epidemic”  Improving access to care and getting people to remain in care  the needs of patients need to be at the centre  social determinants of health  GP- incorporation of sexual health and quality of life are further challenges in improving care  effects of long-term treatment  Advocacy priorities, mainly focused on the issue of funding improvements in the fight against AIDS in France (financing prevention, sexual health education and sexual health centres, etc.). Such advocacy can be the precursor to a discussion on treatment costs, based on the introduction of generic drugs in France.

IAS – WHO Pre-Conference- 29 June  Presented and discussed scientific evidence and programme experience across regions on maximizing the treatment and prevention benefits of ART for key populations  Discuss human rights and ethical implications of maximizing the treatment and prevention benefits of ART for key populations  Formulated research questions in the context of maximizing the treatment and prevention benefits of ART for key populations