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AU EDITED FINAL: 03-18-13

Treatment as Prevention: Evaluating the Impact of HAART Expansion The British Columbia (BC) Experience. Julio Montaner, MD Professor of Medicine, and Head, Div. of AIDS, University of British Columbia Director, BC-Centre for Excellence in HIV/AIDS at Providence Health Care

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AU EDITED FINAL: 03-18-13

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  1. Treatment as Prevention:Evaluating the Impact of HAART ExpansionThe British Columbia (BC) Experience Julio Montaner, MDProfessor of Medicine, and Head, Div. of AIDS, University of British Columbia Director, BC-Centre for Excellence in HIV/AIDS at Providence Health Care Past President, International AIDS Society (2008-2010) AU EDITED FINAL: 03-18-13

  2. Increasing HAART Coverage within Evolving Guidelines in BC N = 7492 by the end of 2011 January 2004 Summer of 2000 Summer of 1996 Phase I Phase II Phase III Year Montaner et al, Lancet, 2010

  3. BC: All Cause Mortality (#) > 90% Decrease in All Cause Mortality among HIV Infected Individuals in BC since 1996 Montaner et al, TasP Workshop, April 2012

  4. AIDS New Cases for BC by year, 1996-2011 Lima et al, in preparation, 2013

  5. HAART Use & New HIV Diagnoses for BC by year, 1996-2012 Active on HAART HIV Incidence New HIV Diagnoses (All) New HIV Diagnoses (Ever IDU) Lima et al, in preparation, 2013

  6. Engagement in the Cascade of Care in BC Nosyk et al, TasP Workshop, 2013 Engagement in the Cascade of Care in BC Nosyk et al, in preparation, 2012 Estimate of HIV+ unknown went from 50% [38-59%] in 1996 to 14% [0 – 28%] in 2009 Estimate of HIV+ unknown went from 50% [38-59%] in 1996 to 14% [0 – 28%] in 2009 We used pVL ≤40c/mL x2, thus overall supp rate is: 35% [30% - 40%]. This becomes 51% & 60% if a single pVL<50 or <500c/mL are used. Supp rate: 35% [30% - 40%] for pVL ≤40c/mL x2. Supp rate: 51 & 60% for a single pVL<50 or <500c/mL, respectively.

  7. Cascade of Care by HA Lima V, Lourenco L, et al, in preparation, 2013

  8. Cascade of Care by Gender Lima et al, in preparation, 2013

  9. Cascade of Care by Age Lima et al, in preparation, 2013

  10. Programmatic Compliance Score • Assesses the impact of non-compliance with HIV treatment guidelines on all-cause mortality • PCS components include: • Baseline CD4 > 200/mm3 • Three CD4 in 1st year • Three VL in 1st year • Baseline resistance • Recommended HAART • Undetectable pVL at 9 months • Failure to meet a given component add one to the score • PCS predicts mortality Lima et al. PLoSONE 7(11): e47859. 2012

  11. PCS in BC 2000 to 2011 Lima et al, in preparation, 2013

  12. TasP Monitoring in the Real World • In a perfect world, all HIV infected individuals would follow the same pathway in the spectrum of engagement into care: • In the real world, there is attrition between each of these steps and individuals are often lost-to-follow-up. • Understanding the attrition points (leakage), and their causes are essential to optimize the effectiveness of TasP. • This can only be achieved by comprehensively monitoring standardized metrics, on a longitudinal basis and accounting for multiple sources of bias and heterogeneity (i.e.: geographic, socio-demographic, risk factors, etc).

  13. 4th Intl HIV TREATMANT AS PREVENTION Workshop April 1st to 4th 2014 - Vancouver, BC, Canada. Link

  14. In Collaboration with PHC, VCHA, NHA, PHSA, Community, and MoH

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