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.
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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?
Treatment as prevention (TasP) is an HIV prevention intervention where treating an HIV-positive person with antiretroviral drugs is used to reduce the risk of transmitting the virus to an HIV-negative partner.1,2,3,I main goal of antiretroviral therapy …
Is treatment the same thing as 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 prevention the best treatment?
Oct 24, 2020 · Medically reviewed by Latesha Elopre, MD, MSPH HIV Treatment as Prevention (TasP) is an evidence-based strategy by which persons with an undetectable viral load are far less likely to transmit the virus to an uninfected sexual partner.
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
What happens if you take ARVs while negative?
“When a HIV-positive person is given ARVs, it boosts their immunity, but when a HIV-negative person takes them, it just undermines their immunity and interferes with their body organs.”Jul 5, 2020
What is treatment as prevention?
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.
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 .
What is observational research?
Observational research investigates the outcome of something that is naturally occurring. The researcher does not assign a person to either treatment or no treatment -- it is something that has happened naturally.
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 a model study?
A modelling study is a hypothetical description of what could happen if a change is made in a population or community. Modelling studies have attempted to explain the relationship between the effect of HAART and viral load on HIV transmission. A model developed by researchers in B.C. suggests that, at a population level, HAART may reduce the risk of HIV transmission. The model predicted that, with increasing numbers of people receiving HAART, there will be fewer transmissions within the population. However, the model suggests that at least 75% of people who are clinically eligible for treatment would have to receive treatment for there to be a substantial reduction in HIV transmission. 6
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.
Is HIV prevention a magic bullet?
Since we are introducing another approach to prevention, one that we know is not a magic bullet, it is very important that treatment as prevention be en visioned as yet another potential component to HIV prevention.
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 antiretroviral therapy?
Antiretroviral therapy requires HIV-positive individuals to abide by strict adherence and thrives when countries have the necessary HIV services available for infected individuals to access. Management of HIV/AIDS includes services such as HIV testing and diagnosing, consistent HIV care and treatment, education lessons regarding how to use ART effectively and distribution methods to ensure individuals receive their medications. In LMICs, HIV testing has expanded, which, in turn, creates the opportunity for the initiation of treatment as a preventative method as an increasing number of infected individuals are aware of their HIV status.
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 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, ...
When will HIV/AIDS be eliminated?
The diminished rate of new HIV infections brought about by these strategies are marked progress towards UNAIDS' 90-90-90 and 95-95-95 target to eliminate HIV/AIDS as a public health crisis by 2030.
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 ...
Can HIV-1 be prevented?
The study's purpose was to reveal that HIV-1 viral transmission can be prevented through treatment, leading many regions to incorporate a treatment as prevention plan into their public health policy for responding to HIV.
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 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.
What is a tasp?
HIV Treatment as Prevention (TasP) is an evidence-based strategy by which persons with an undetectable viral load are far less likely to transmit the virus to an uninfected sexual partner. 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 ...
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.
How many people are unaware of HIV?
In the U.S., as many as one in five people with HIV are fully unaware of their status. In response, the U.S. Prevention Services Task Force is now recommending the once-off testing of all Americans ages 15 to 65 as part of a routine doctor's visit. It would require intensifying the follow-up of existing patients.
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.
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.
Who is James Myhre?
James Myhre is an American journalist and HIV educator. Latesha Elopre, MD, is a board-certified internist specializing in HIV and an assistant professor of infectious diseases at the University of Alabama at Birmingham. HIV Treatment as Prevention (TasP) is an evidence-based strategy by which persons with an undetectable viral load are far less ...
What are the national prevention activities?
National prevention activities include initiatives, regulatory programs, and policies that establish nationwide programs to reduce both the presence of and exposure to harmful agents in the environ-ment (e.g., the Clean Water Act, National Tobacco Control Program, National Asthma Control Program). Many agencies are involved in activities that either directly or indirectly reduce public exposure. The Department of Health and Human Services, which includes the CDC and the U.S. Food and Drug Administration; the Environmental Protection Agency (EPA); the Department of Housing and Urban Development (HUD); and the Department of Agriculture (USDA) all have a hand in prevention efforts.
What are some examples of successful preventive measures?
Clean air and secondhand smoke prevention are just two examples of the many successes that have occurred through the use of proactive preventive measures. Many more success stories will emerge as individuals, communities, and other stakeholders take on a more active role in environmental public health.
How has the American public improved over the last decades?
The health of the American public has improved on many fronts over the last decades—from decreasing incidence of lung cancer in men to large reductions in the number of childhood lead poisoning cases. But as previous modules highlight, many diseases and illnesses are increasing in frequency. Though the reasons for these increases are often unknown, to the extent that the causes are recognized or suspected, preventive measures are desirable. Public health focuses on prevention of disease and health promotion rather than the diagnosis andtreatment of diseases.
How to improve the environmental health system?
Build and improve long-term strategic partnerships, commitments by all stakeholders, and additional resources, as well as collaboration with environmental regulatory agencies and development of a competent and effective environmental public health workforce.16
Is second hand smoke bad for you?
Secondhand smoke, also called environmental tobacco smoke (ETS), is the mixture of gases and particles given off by burning cigarettes, pipes, and cigars as well as the smoke exhaled by smokers.22 Breathing secondhand smoke, even in small amounts, is dangerous to human health and can cause lung cancer and an increased risk of heart disease, including heart attack, in adult nonsmokers22 (see Secondhand Smoke section in Homes chapter).
How to minimize environmental impact?
Make healthy lifestyle choices, choose environmental-ly-friendly products and services, and conscientiously try to minimize the environmental impact of yourself and your family. Become informed about the issues, and be proactive in prevention initiatives promoting health and preventing illness and disease.
Is air pollution a success story?
One of the most substantial environmental pollution success stories has been the reduction in levels of air pollutants throughout the United States (see Outdoor Air Quality chapter). While national air quality has improved since the early 1990s, air quality problems still exist, presenting many challenges in protecting public health and the environment.
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 eli...
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
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 ...
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 …