Track D report by Carlos F. Caceres
bridging session, entitled “Treatment as Prevention” (TasP), discussed this
topic from the science, community and policy perspectives, and offered
insights into what implementing TasP entails in the read world, including
social, cultural and economic aspects. The changing relevance of the terms “treatment
as prevention” and even “early treatment for prevention”, given quickly
evolving guidelines about the time to start treatment, was pointed out early
in the session.
Montaner, from Canada, presented a report of the TasP Workshop (Vancouver,
April 2014), including a summary of follow-up data from the research trials,
and programmatic data related to the impact of treatment in viral load in
Vancouver and other places.
Quarraisha Abdul-Karim presented the perspective of ongoing research. She showed
the latest data on TasP and reviewed and assessed how implementation is
playing out in practice and offered examples of best practices from South
Bernard (UK) and N. Ao (Thailand) presented a range of community perspectives.
They analyzed the role of the community in strengthening TasP approaches and
addressing bottlenecks, including questions of access as well as ethical
aspects. They also identified a number of issues around human rights that
become a focus of concern in TasP implementation; e.g. the fact that
implementing TasP may elicit both positive and negative consequences for
people’s human rights in the field.
Mesquita (Brazil), the Director of the Brazilian AIDS Program, presented on
Leadership. He examined the challenges of large-scale implementation and focused on the
Brazilian case to discuss the role of various factors (programmatic, community,
policy) and particularly the role of commitment and leadership. He emphasized
on specific issues related to key populations.
posed a broad number of questions, which, under the moderation of Richard
Horton (The Lancet, UK) were responded by panelists. Many of them focused on
concerns about sustainability, tensions between early treatment for prevention and
any treatment for those who presently lack access to it, and also the need for
consent and the potential human rights abuses posed by implementation of early
treatment for prevention. The session offered an opportunity to better
understand current treatment guidelines and their possible impact on various epidemic
settings, have a better comprehension of community perspectives, and be able to
identify implications, trade-offs and operational requirements of implementing
TasP on a larger scale.