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What does prevention is better than cure mean?
Feb 24, 2020 · Treatment as prevention (TasP) refers to taking HIV medication to prevent the sexual transmission of HIV. It is one of the highly effective options for preventing HIV transmission. People living with HIV who take HIV medication daily as prescribed and get and keep an undetectable viral load have effectively no risk of sexually transmitting HIV to their HIV …
What are the principles of treatment and Prevention?
Another benefit of reducing the amount of virus in the body is that it helps prevent transmission to others through sex or syringe sharing, and from mother to child during pregnancy, birth, and breastfeeding. This is sometimes referred to as treatment as prevention.
Is treatment the same thing as prevention?
May 21, 2019 · HIV Undetectable=Untransmittable (U=U), or Treatment as Prevention. In recent years, an overwhelming body of clinical evidence has firmly established the HIV Undetectable=Untransmittable, or U=U, concept as scientifically sound. U=U means that people with HIV who achieve and maintain an undetectable viral load—the amount of HIV in the …
Is prevention the best treatment?
preventive treatment: [ trēt´ment ] 1. the management and care of a patient; see also care . 2. the combating of a disease or disorder; called also therapy . Schematic of the treatment planning process using occupational therapy as an example. From Pedretti and Early, 2001. active treatment treatment directed immediately to the cure of the ...
What is the difference between PrEP and treatment as prevention?
This process of taking ART, achieving undetectable status, and preventing the spread is referred to as treatment as prevention. PrEP on the other hand, is a way for people who do not have HIV to prevent infection by taking one pill every day.Jul 22, 2019
When did treatment as prevention start?
While TasP was initially seen as a means of reducing individual risk when the concept was first introduced in 2006, it was only in 2010 that evidence from the HTPN 052 study suggested that it could be implemented as a population-based prevention tool.Oct 24, 2020
Can a person on ARVs transmit the virus?
People living with HIV who take antiretroviral medications daily as prescribed and who achieve and then maintain an undetectable viral load have effectively no risk of sexually transmitting the virus to an HIV-negative partner.Jun 12, 2020
How effective is treatment as prevention?
Although some experts narrow this to only include preventing infections, treatment prevents illnesses such as tuberculosis and has been shown to prevent death. The dual impact on well being and its 100% effectiveness in reducing transmission makes TasP the most important element in the HIV prevention toolkit.
What is HIV medicine?
HIV medicine is called antiretroviral therapy, or ART. If taken as prescribed, HIV medicine reduces the amount of HIV in the body ( viral load) to a very low level, which keeps the immune system working and prevents illness.
How does HIV help you stay healthy?
Getting and keeping an undetectable viral load * is the best thing people with HIV can do to stay healthy. Another benefit of reducing the amount of virus in the body is that it helps prevent transmission to others through sex or syringe sharing, and from mother to child during pregnancy, birth, and breastfeeding.
How does HIV medicine affect the immune system?
If taken as prescribed, HIV medicine reduces the amount of HIV in the body ( viral load) to a very low level, which keeps the immune system working and prevents illness. This is called viral suppression —defined as having less than 200 copies of HIV per milliliter of blood.
What is the number to call for HIV testing?
Provides clinicians with around-the-clock advice on indications and interpretations of HIV testing in pregnancy, and consultation on antiretroviral use during pregnancy, labor and delivery, and the postpartum period. 1-888-448-8765 | 24 hours, seven days a week.
Can HIV be transmitted to a baby?
Substantially reduces, but does not eliminate risk. Current recommendation in the United States is that mothers with HIV should not breastfeed their infants. † The risk of transmitting HIV to the baby can be 1% or less if the mother takes HIV medicine daily as prescribed throughout pregnancy, labor, and delivery and gives HIV medicine ...
Can HIV be transmitted to HIV-negative partners?
A person with HIV who takes HIV medicine as prescribed and gets and stays virally suppressed or undetectable can stay healthy and has effectively no risk of sexually transmitting HIV to HIV-negative partners.
Why is community based HIV prevention important?
Therefore, the community has an important role to play in ensuring that the human rights of people at risk for or living with HIV are safeguarded independent of the potential public health benefits of this approach .
When was the statement on ART as prevention?
Statement on ART as Prevention. In October 2009, international HIV/AIDS advocacy organizations wrote a statement directed at participants of an upcoming treatment as prevention Consultation hosted by the World Health Organization that was held in November.
How can HIV be reduced in a mother?
1 Treating the expectant mother with antiretroviral therapy reduce s the mother's viral load, thus potentially reducing the risk of transmission because the fetus is exposed to less virus in utero and during birth. However, the fetus also receives antiretroviral therapy while in the womb (as antiviral drugs penetrate the placenta) and the child may also receive antiviral drugs post birth. These forms of pre- and post-exposure prophylaxis may also play a role in the reduction of vertical transmission from mother to child.
How does combination prevention work?
This approach utilizes a strategic combination of HIV prevention approaches to try to ensure that everyone in need has access to prevention messaging and programming when they need it. This means that program planners, with the knowledge of their communities, determine the best-case mix of programming to ensure that the fewest number of people fall through the holes in the safety net they have created by layering many different types of prevention programs.
How many HIV transmissions are there from a positive man to a negative woman?
425 transmissions from an HIV-positive man to an HIV-negative woman; 3,524 transmissions from an HIV-positive man to an HIV-negative man. 21. While there is some evidence that treatment as prevention may have an impact on HIV transmission at the level of the population, it will not eliminate all HIV transmissions.
How long do blips last?
First, people who are successfully treated with HAART can experience unexplained temporary increases in viral load. These are known as "blips.". Because blips only last for a short time (usually less than three weeks) 7-9 they may be missed by routine blood viral load tests (which often take place every three months).
What is the effect of reduced HIV transmission rate?
The reduced HIV transmission rate is an effect that only happens when large groups of people living with HIV are successfully treated. This is why experts only envision treatment as prevention as a population-level approach, which would be undertaken in combination with conventional prevention programs.
Why do people delay HIV treatment?
Research suggests that the fear of disclosure and the lack of HIV-specific care are among the reasons that so many delay treatment until the appearance of symptomatic disease. It would require the means by which to ensure population-based adherence, the success of which is highly variable and hard to predict.
How many people are unable to maintain adherence to HIV treatment?
According to the CDC, of HIV-positive people currently on therapy, nearly one in four are unable to maintain the necessary adherence to achieve complete viral suppression. Finally, the cost of implementation is seen to be a major obstacle particularly as global HIV funding continues to be severely reduced.
What is HTPN 052?
The HTPN 052 trial —which studied the impact of antiretroviral therapy (ART) on transmission rates in serodiscordant heterosexual couples —was stopped nearly four years early when it was shown that individuals on treatment were 96 percent less likely to infect their partners than participants who weren't.
Why is TasP considered inconceivable?
Prior to the introduction of newer-generation antiretroviral drugs, TasP was considered inconceivable due to high levels of drug toxicities and viral suppression rates that only hovered around 80 percent, even for those with perfect adherence.
How many people with HIV are suppressed?
In fact, according to the CDC, only 59.8 percent of people with HIV are virally suppressed. These not only include people who refuse testing and treatment but those who fail to take their drugs every day as prescribed. With that being said, the aims of the strategy remain strong.
What would be the hurdles to overcome if TasP were to be feasible?
From the start, it was clear that there would be a number of strategic hurdles to overcome if TasP were to be feasible: It would require high coverage of HIV testing and treatment, particularly in underserved, high-prevalence communities. In the U.S., as many as one in five people with HIV are fully unaware of their status.
How many people are linked to medical care for HIV?
It would require intensifying the follow-up of existing patients. According to the Centers for Disease Control and Prevention (CDC), only 44 percent of Americans diagnosed with HIV are linked to medical care.
How does treatment as prevention work?
Treatment as prevention has been used as a form of controlling the spread of HIV since the mid-1990s, initially in the context of preventing the transmission of the virus from mothers to their children. Research in 1994 revealed how the drug zidovudine can reduce vertical transmission. The testing and treatment of HIV-positive mothers during pregnancy, childbirth, and breastfeeding has since led to the reduction of the risk of transmission by up to 95%. A program for offering ARVs for life to any HIV-positive pregnant person called "Option B+" served as a precursor to the "test and treat" strategy that is now being rolled out in various countries. Assessments of the Option B+ program are able to aid in the improvement and further establishment of "test and treat".
What is ART therapy?
In relation to HIV, antiretroviral therapy (ART) is a three or more drug combination therapy that is used to decrease the viral load, or the measured amount of virus, in an infected individual. Such medications are used as a preventative for infected individuals to not only spread the HIV virus to their negative partners ...
What is undetectability in HIV?
Undetectability ensures that infection does not necessarily have an effect on a person's general health, and that there is no longer a risk of passing along HIV to others. Consistent adherence to an ARV regimen, monitoring, and testing are essential for continued confirmed viral suppression. Treatment as prevention rose to great prominence in 2011, ...
Why was HIV treatment so expensive in the 1990s?
For many countries, especially low- and middle-income countries, the overall cost of treatment in the 1990s and early 2000s was too expensive for infected patients to afford it. In addition, individuals with low incomes in United States struggle to pay high prices set by pharmaceutical companies for antiretroviral drugs. As a result, it was implausible for a global treatment system or policy to be put into place since no universal HIV/AIDS test and medication regimen existed and due to technology and wealth disparities worldwide. However, with the advent of rapid HIV testing (including self testing), viral load testing, and effective ART regimens at less than $100 per year treatment scale up (read widespread implementation of TasP) is now a reality in many settings.
What is the TasP recommendation?
TasP's legitimacy has influenced the World Health Organization's (WHO) 2015 shift from "test and wait" to " test and treat" recommendation, which push to alert as many people as possible of their HIV status through testing, and start people infected with HIV on ARVs, no matter their viral load or CD4 count.
What is a tasp?
Treatment as prevention (TasP) is a concept in public health that promotes treatment as a way to prevent and reduce the likelihood of HIV illness, death and transmission from an infected individual to others. Expanding access to earlier HIV diagnosis and treatment as a means to address the global epidemic by preventing illness, ...
What are the challenges of scaling access to treatment?
Challenges to scaling access to treatment include cost and drug resistance. However, modeling studies suggest that the costs of not providing access would be far greater and concerns regarding resistance have not been borne out despite tens of millions of people accessing treatment.
What does U=U mean for HIV?
U=U means that people with HIV who achieve and maintain an undetectable viral load —the amount of HIV in the blood—by taking antiretroviral therapy (ART) daily as prescribed cannot sexually transmit the virus to others. Thus, treatment for HIV is a powerful arrow in the quiver of HIV prevention tools. Read more about how a durably undetectable viral load prevents HIV transmission with NIAID's fact sheet 10 Things to Know About HIV Suppression.
When did triple drug ART start?
Following the advent of triple-drug ART in 1996 , observational studies suggested that viral loads lowered by ART were associated with reduced risk of sexual and perinatal HIV transmission.
Is viral load a determinant of HIV?
For nearly two decades, scientists have recognized that viral load is a key determinant of HIV transmission. Studies conducted before the availability of ART revealed that higher viral loads correlate with higher rates of both sexual and perinatal transmission of HIV.
Does ART suppress HIV?
No HIV transmission was observed when ART consistently, durably suppressed the virus in the partner with HIV.
Words nearby preventive treatment
The American Heritage® Stedman's Medical Dictionary Copyright © 2002, 2001, 1995 by Houghton Mifflin Company. Published by Houghton Mifflin Company.
How to use preventive treatment in a sentence
Yet here we are in 2014, still arguing over our right to have access to this important preventive care.
What Is Treatment as Prevention?
- We know that treatment for HIV can effectively reduce the amount of virus in the blood of someone living with HIV (often to levels that cannot be detected by current viral load tests). For many people this reduction in the amount of virus may reduce infectivity (their ability to transmit the virus). However, we also know that treatment does not eliminate the virus from the body whi…
How Do We Know If Treatment as Prevention Will Work?
- We don't really know for certain if treatment of a large group of people and the resulting reduction in average viral load will result in a meaningful and reliable reduction in HIV transmission. However, four types of evidence suggest that it might work at a population level: 1. studies on mother-to-child (vertical) transmission; 2. studies of serodiscordant couples; 3. ecological studi…
Why Doesn't Treatment as Prevention Work on An Individual level?
- "Viral load" is a measure of the amount of the virus in the body of someone living with HIV. When someone is successfully treated for HIV with HAART, the blood viral load test reads as "undetectable." However, this does not mean that the virus is not present; rather, the level of virus in the blood is very low -- too low for the test to find it. However, since there is still virus in the bo…
What Are The Main Components of A "Treatment as Prevention" Program?
- Increasing the Number of People Who Know They Are HIV-Positive
In Canada, it is estimated that 26% of people living with HIV don't know they have HIV.22This means that approximately 16,900 people in Canada are unaware they have HIV because they haven't been tested (or tested recently enough to know they are now HIV-positive). Increasing th… - Increasing the Number of People With HIV Receiving Treatment
In order for treatment as prevention to work we need to increase the number of people on treatment. This can be done by increasing the number of people who access care and treatment and increasing the number of people who are clinically eligible for HAART.
What Does This Approach Mean For Community-Based Agencies?
- Community-based AIDS service organizations (ASOs) in Canada have been at the forefront of HIV prevention since HIV emerged in our communities. The work that has been done has been integral to prevention efforts in Canada. With the advent of potential new approaches to HIV prevention, such as treatment as prevention, there may be exciting changes to community-based programm…
Impact on Services
- In addition to programming aimed at increasing testing and treatment, community agencies may have additional demands on them for other services. As discussed, research has found that some marginalized people are not currently accessing treatment. However, many of these people are not well positioned to start treatment due to competing priorities in their life, such as poverty, dr…
Funding
- The cost of increasing the number of people on therapy could have a large financial impact. There is some concern that this increasing cost could lead to prevention dollars being diverted to finance treatment costs (since treatment is now seen as a form of prevention). The community must fight to ensure that funding agencies do not divert dollars in this manner. It should be note…
What Is Happening on The Ground?
- In April 2009 at the Canadian Association of HIV Researchers (CAHR) conference in Vancouver, Gordon Campbell, the premier of B.C., announced that his government was committed to implementing several pilot projects in the province to test programming that will bring more people into treatment. This announcement followed more than a year of meetings between the …
to Wrap Up ...
- Treatment as prevention is a new potential approach to help curb the growth of the HIV epidemic. If we take a step back, away from the science and all the questions about whether and how much it will work -- bringing more people into care is essential regardless of any prevention benefit. Despite access to care and treatment in Canada, people are being diagnosed with HIV infection l…
References
- Volmink J, Siegfried N, van der Merwe L, Brocklehurst P. Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database of Systematic Reviews2006, Issue 4...
- Attia S, Egger M, Muller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: Systematic review and meta-analysis. AIDS. 2009. 23:1397-14…
- Volmink J, Siegfried N, van der Merwe L, Brocklehurst P. Antiretrovirals for reducing the risk of mother-to-child transmission of HIV infection. Cochrane Database of Systematic Reviews2006, Issue 4...
- Attia S, Egger M, Muller M, Zwahlen M, Low N. Sexual transmission of HIV according to viral load and antiretroviral therapy: Systematic review and meta-analysis. AIDS. 2009. 23:1397-1404.
- Fang CT, Jsu HM, Twu SJ, et al. Decreased HIV transmission after a policy of providing free access to highly active antiretroviral therapy in Taiwan. Journal of Infectious Diseases. 2004.190:879-885
Research Breakthrough
Undetectable = Untransmittable
- The HTPN 052 was only the starting point in the journey to implement TasP. Between 2010 and 2018, two studies—called PARTNER1 and PARTNER2—aimed to evaluate the risk of transmission in gay and heterosexual mixed-status couples in whom the HIV-infected partner was virally suppressed This was considered significant since only 2 percent of couples in the HTPN 052 wa…
Challenges in Implementation
- Prior to the introduction of newer-generation antiretroviral drugs, TasP was considered inconceivable due to high levels of drug toxicities and viral suppression rates that only hovered around 80 percent, even for those with perfect adherence. The picture has largely changed in recent years, with the introduction of more effective, cheaper medications. Even in heavily hit co…
Evidence in Support to Tasp
- The city of San Francisco may be the closest thing to a proof of concept for TasP. With gay and bisexual mencomprising nearly 90 percent of the city's infected population, consistent, targeted intervention has resulted in a low rate of undiagnosed cases. But most agree that San Francisco has a unique dynamic to other HIV populations. There is still insufficient evidence to support wh…
Overview
- Treatment as prevention is a concept in public health that promotes treatment as a way to prevent and reduce the likelihood of HIV illness, death and transmission from an infected individual to others. Expanding access to earlier HIV diagnosis and treatment as a means to address the global epidemic by preventing illness, death and transmission was first proposed in …
HIV Prevention Trials Network clinical trial 052
- Early work by Quinn in Uganda demonstrated that transmission was reduced by over 90% when people living with HIV were on treatment and virally suppressed. Observational evidence accumulated and the Attia metaanalysis supported the 2008 Swiss Statement that said that those suppressed on treatment had little or no chance of transmission. Many experts, citing the Bradf…
Implementation
- Treatment as prevention has been used as a form of controlling the spread of HIV since the mid-1990s, initially in the context of preventing the transmission of the virus from mothers to their children. Research in 1994 revealed how the drug zidovudine can reduce vertical transmission. The testing and treatment of HIV-positive mothers during pregnancy, childbirth, and breastfeedi…
Challenges and risks associated with Treatment as Prevention
- While TasP has a huge potential to prevent the further spread of HIV worldwide, the major barrier to implementing TasP is lack of political will. Specifically, estimates suggest that only around 60% of all resources for HIV go towards ensuring diagnosis and treatment while the rest is spent on other priorities. In some African countries multiple billions of dollars have been allocated with so…
Short-term and long-term solutions
- Global Fund
In 2002, The Global Fund to Fight AIDS, Tuberculosis and Malaria was a financial initiative developed to raise and provide funding to the developing world in an attempt to enhance their care and treatment programs for individuals who are living with HIV/AIDS, TB and malaria. For - PEPFAR
In 2003, in an attempt to promote the importance of HIV research and funding, George W. Bush enacted the President's Emergency Plan for AIDS Relief, committing the United States government to authorize $15 billion to support HIV/AIDS, tuberculosis and malaria over a five-year per
Moving forward
- Treatment as prevention has the ability to shift the paradigm of how HIV is received and treated. The effects of universal testing and treatment, and connecting people with resources for care will allow for global effects in terms of reduced rates of new HIV infections. The success of TasP is contingent upon innovation in strategies to increase the rate of HIV testing, along with exploring …