Treatment as Prevention: THE KEY TO AN AIDS FREE GENERATION - Irene Day and Dr. Robert Hogg

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Treatment as Prevention: THE KEY TO AN AIDS FREE GENERATION - Irene Day and Dr. Robert Hogg

  1. 1. Page 1Data Effect: April 17, 2013Irene Day, Director of OperationsBC Centre for Excellence in HIV/AIDSDr Robert Hogg, Director Epidemiology & Population HealthBC Centre for Excellence in HIV/AIDSTreatment as Prevention:THE KEY TO AN AIDS FREE GENERATION1
  2. 2. Page 2Vancouver 1996“One World One Hope”2
  3. 3. Page 3Impact of HAART in BC-CfE0204060801001201401993-94 1995-96 1997-98 1999-00 2001-02 2003-04Death Rate per 1000051015202530351993-94 1995-96 1997-98 1999-00 2001-02 2003-04Life Expectancy at age 20Modified from Hogg et al, Lancet. 20093
  4. 4. Page 4New HIV and Syphilis in BCBC-CDC, 20054
  5. 5. Page 5HAART stops HIV replicationHIV load falls to undetectable levels in plasmaas well as in sexual fluidsSharp reduction in HIV transmission5
  6. 6. Page 6The BC Experience6
  7. 7. Page 7January 2004Summer of 1996Summer of 2000Phase I Phase II Phase IIIMontaner et al, Lancet, 2010Increasing HAART Coverage withinEvolving Guidelines in BCN = 7492 by theend of 20117
  8. 8. BC: AIDS cases DiagnosedRate per 100K> 80% Decrease in AIDScase report rate in BCsince the pre cART era8
  9. 9. Page 9BC: All Cause Mortality (#)All Cause Mortality in BC0501001502002503003504001996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011YearsFrequencyMontaner et al, TasP Workshop, April 20129
  10. 10. Increasing HAART Coverage within EvolvingGuidelines in BC - Impact on New Diagnoses51 48301 289Down to 248in 2012Updated from Montaner et al, Lancet, 2010, & TasP-Workshop, Vancouver 201210
  11. 11. Page 11Hepatitis C, 1999-2008 Syphilis, 1999-2008Chlamydia, 1999-2008 Gonorrhea, 1999-2008• BCx Canada• BCx Canada• BCx Canada• BCx Canada20042004 2004200411
  12. 12. Page 12Let’s talk about $$$12
  13. 13. Granich et alExpanding ART for Treatment & Prevention of HIVEstimated Cost and Cost-EffectivenessSouth Africa, 2011-205013
  14. 14. Page 14HIV Testing14
  15. 15. Page 15Cascade of Care
  16. 16. HIV Diagnoses by Region and YearPublic Health Agency of Canada16
  17. 17. Page 17New HIV Diagnoses among First Nations in BCBC CDC, 1995–2011
  18. 18. Page 18
  19. 19. Page 19The Honourable Minister of Health, Kevin Falconannounces the launch of the STOP HIV & AIDS in BC Pilots
  20. 20. Page 20Treatment 2.0:A new prevention-treatment paradigm inthe global response toHIV/AIDSUNGASSNew York, 9 June 2010The role of antiretroviral treatment instopping new infections and how it can beeffectively used as part of combinationHIV prevention approaches must befurther explored, as shown by Dr. JulioMontaner, President of the InternationalAIDS Society.Michel SidibéExecutive Director, UNAIDS20
  21. 21. PS: By the end of 2013, PEPFARwill directly support more than 6 Mpeople on HAART– 2M more thanpreviously targeted.21
  22. 22. Page 22"To cut new infections inhalf, well have to heed JulioMontaners years of pleas toimplement Treatment asPrevention and implementcombination preventionprograms. We can save a lotof lives if all this is done..."President ClintonWashington AIDS ConferenceJuly 201222
  23. 23. Page 23
  24. 24. Page 24What’s Next?HIV/AIDSViral Hepatitis Addiction
  25. 25. Supported by $48M (+ARV Drugs) 4 year award from the MoH, Gov of British Columbia, $2.5M 5 yearAvant-Garde Award (No 1DP1DA026182-01) from the National Institute for Drug Abuse (NIDA) at the NIH,$110K Knowledge Translation Award from CIHR, and grants from Merck, Gilead, ViiV and BMSIn collaboration with PHC,VCHA, NHA, PHSA,Community, and MoH25

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