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Treatment as prevention holtgrave

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  • 1. David Holtgrave, PhD HIV Treatment as Professor and Chair Prevention: Dept. of Health, Behavior &Is this the end of HIV? Society
  • 2. AS A NATION, DO WE AND WILL WE PROVIDE NECESSARY HIV CARE AND TREATMENT?2
  • 3. Gardner treatment cascadeFrom: Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies forprevention of HIV infection. Clin Infect Dis. 2011 Mar 15;52(6):793-800.3
  • 4. CDC MMWR, November 30, 2011From: Vital Signs: HIV Prevention Through Care and Treatment — United States. MMWR. 2011;60:47. 1618-1623.4
  • 5. ADAP Waiting Lists are the Tip of the Iceberg http://coastal.er.usgs.gov/ocean- acidification/arcticcruise2011/journal/index.php/2011/08/20/icebergs/5
  • 6. In 2004, IOM Panel calls for HIV care entitlement program…6
  • 7. “COMBINATION PREVENTION” HAS SADLY BECOME “SUBSTITUTION PREVENTION” WHEN WE NEED “SYNERGISTIC PREVENTION” TO URGENTLY IMPACT INCIDENCE7
  • 8. HIV is transmitted during an act ofunprotected risk behavior in a serostatusdiscordant partnership with virus present Unprotected transmission No unprotectedIn a serostatus discordant relevant risk behavior transmission relevant riskpartnership….. present behavior Concentration of Essentially no transmissionUnsuppressed Viral Load transmission Essentially no transmissionSuppressed Viral Load Essentially no transmission8
  • 9. Key US populations defined by HIV serostatus and relevanceof various treatment-related prevention approachesFrom: Holtgrave DR, Maulsby C, Wehrmeyer L, Hall HI. Behavioral Factors in Assessing Impact of HIV Treatment as Prevention. AIDS Behav. 2012 Apr 11. [Epubahead of print].9 © 2009, Johns Hopkins University. All rights reserved.
  • 10. Number of forward HIV transmissions fromsubgroups of persons living with HIV, and potentialpoints of prevention interventionFrom: Holtgrave DR, Maulsby C, Wehrmeyer L, Hall HI. Behavioral Factors in Assessing Impact of HIV Treatment as Prevention. AIDS Behav. 2012 Apr 11. [Epubahead of print].10
  • 11. Key services needs of the threesubpopulations of persons living with HIVFrom: Holtgrave DR, Maulsby C, Wehrmeyer L, Hall HI. Behavioral Factors in Assessing Impact of HIV Treatment as Prevention. AIDS Behav. 2012 Apr 11. [Epubahead of print].11
  • 12. Incidence of HIV under various scenarios Incidence 70000 Flat TR Comparator 60000 S694YMC Incidence 50000 S694YFSC 40000 S694NMC 30000 S694NFSC 20000 S807YMC S807YFSC 12 16 10 14 18 20 20 20 20 20 20 20 S807NMC Year S807NFSCHoltgrave et al., under review (please do not reproduce)12
  • 13. 13
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