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TRACK C RAPPORTEURS REPORT. Prepared by. Anne Buv é Belgium Sabina Bindra-Barnes India Saidi Kapiga Tanzania Jorge Sanchèz Peru David Wilson Australia. The CAPRISA 004 trial. Trial of vaginal microbicide: 1% Tenofovir gel in HIV negative women in South Africa

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Track c rapporteurs report

TRACK C RAPPORTEURS REPORT


Prepared by
Prepared by

  • Anne Buvé Belgium

  • Sabina Bindra-Barnes India

  • Saidi Kapiga Tanzania

  • Jorge Sanchèz Peru

  • David Wilson Australia


The caprisa 004 trial
The CAPRISA 004 trial

  • Trial of vaginal microbicide: 1% Tenofovir gel in HIV negative women in South Africa

  • Proof of concept trial, double-blind, placebo-controlled

  • Coital dependent insertion of gel



The caprisa 004 trial2
The CAPRISA 004 trial

  • No safety issues, no resistance detected

  • Excited, but not ready for roll out

    • One trial in one population

    • Adherence: can we do better?


Young people
Young people

  • Trends in HIV and behaviors in young people 15-24 yrs (TuAC0204)

  • 21 countries with generalised epidemics (Africa and the Caribbean)

  • 2000 – 2008:

    • significant reduction of 25% in HIV prevalence in 10 countries

    • correlation with behavior change in 8


Incentivising behavior change
Incentivising behavior change?

  • Malawi: Zomba cash transfer program (SUSA22)

    Cash transfers to schoolgirls and young women who had recently dropped out of school to stay in (or return to) school

  • After 1 year, among school girls

    Significantly lower prevalence of HIV and HSV-2 in the intervention group than the control group (but no baseline data)

  • Effect due to schooling or higher income?


Intravenous drug users
Intravenous drug users

  • RDS survey in 8 cities in Russia (2008-2010)

    • HIV: 2.6 % - 64.3% (>50% in 3 cities)

    • HCV prevalence: 49% - 90%

    • Non-IDU sexual partners: 32% - 70%

      MOAC0202

  • Zanzibar (2007): first RDS survey among IDU in Africa

    • HIV: 16% ,associated with high risk sexual behavior

      MOAC0401


Needle and syringe programmes
Needle and syringe programmes

  • NSPs in Australia (MOAC0403)

    • In the past 10 years, for every 1$ invested in NSPs

      • 0.2 days of disability adjusted life saved

      • > 4$ returned in health care cost savings


Needle and syringe programmes1
Needle and syringe programmes

  • NSPs in Estonia (MOAC0402)

    • 2003 – 2009: numbers of needles distributed from 18,000 to >770,000

    • 2005-2009: HIV incidence among new injectors (start injecting < 5 yrs ago)

      18 / 100 pyrs to 7.5 / 100 pyrs

  • Strong evidence on cost-effectiveness but policies and laws block implementation (Lancet series).


MSM

  • Survey in Kampala (Uganda) – RDS

    • HIV: 14%

    • Recruitment difficult because of police actions

      Opening session:”Human rights violations are a barrier to knowing your epidemic”

      (TUAC0305)


MSM

  • South Africa and Senegal: difficult access to prevention and care services (WEPDC101 & WEPDC102)

    Lack of understanding of risk behaviors by service providers - risky behaviors with female partners.


Commercial sex workers
Commercial sex workers

  • Avahan: program targeting sex workers in 6 states in India – worldwide largest SW program

  • Karnataka: baseline survey and follow-up survey

    • Longer duration of program exposure associated with increased condom use

    • Significant reduction in HIV: 19.6% to 16.4%


Male circumcision where are we
Male circumcision: where are we?

  • Kenya: rapid scale up was feasible and safe – task shifting

  • Kisumu (Kenya): population based survey

    • Increase in prevalence of MC

    • No evidence of sexual risk compensation.

      (THAC0103 & THAC0101)


Mother to child transmission
Mother-to-child transmission

  • Coverage of PMTCT in Eastern and Southern Africa: 58% (THSY09)

  • The Antiretroviral Pregnancy Registry:

    • Overall prevalence of birth defects for any ART exposure during pregnancy: 2.7 per 100 live births

      (session WEAX01)


Treatment as prevention
Treatment as prevention

  • Biological plausibility

  • Mathematical models

  • Empirical evidence

    • Individual level: discordant couples

      Risk of transmission very low but not 0

    • Population level: ecological analyses, e.g. British Columbia, Denmark (MOAC0103)


Treatment as prevention1
Treatment as prevention

  • Issues (WESY0705)

    • Transmission during acute infection: how much?

    • Transmission of resistant strains

    • Sustainability of viral suppression: how long?


Combination prevention
Combination prevention

  • “The strategic, simultaneous use of different classes of prevention activities (biomedical, behavioral, social/ structural) that operate on multiple levels (individual, relationship, community, societal), to respond to the specific needs of particular audiences and modes of HIV transmission, and to make efficient use of resources through prioritizing, partnership and engagement of affected communities”.


Combination prevention1
Combination prevention

  • Challenging to evaluate

    • RCTs difficult, may not be suited

    • Use of variety of methods and data sources

    • Make pathway to impact explicit


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