The Potential Impact of Expanding Antiretroviral Therapy and Combination Prevention in Vietnam

Abstract

Supplemental Digital Content is Available in the Text.

Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

“…HPTN 052 confirmed the results of observational and epidemiological [18][19][20][21] and modelling studies [22][23][24] that earlier ART reduces the sexual transmission of HIV. 6 The findings created hope that elimination of new HIV infections was possible and had a galvanising effect on health authorities, such as the US President's Emergency Plan for AIDS Relief (PEPFAR) and WHO.…”

“…Similarly, in Vietnam, it was found that an intervention consisting of an annual offer of voluntary HTC among IDUs and immediate ART, adding to combination prevention, could potentially reduce HIV incidence from 61 per 100 000 person-years in 2010 to 6.2 per 100 000 person-years (a 90% reduction) in 10 years. 23 The study also found that prioritising IDUs would have the greatest impact and would be a highly cost-effective approach. Preliminary modelling in Thailand suggests that the most effective strategy to achieve a reduction of new HIV cases by 2016 is to increase the uptake of HIV testing among key affected populations to 90% and to treat all HIV-infected people regardless of CD4 count as part of combination prevention.…”

“…1c). 23 First, HTC uptake is very limited among key populations, with only 31% of IDU, 40% of female SWs and 39% of MSM reported that they had received HTC in the past 12 months and knew their test results in 2012 (Table 2). 69 An analysis of the new HIV diagnosis and the clinic enrolment data at national 70 and provincial levels 70 suggests that a substantial number of people diagnosed with HIV infection are lost to follow-up and are not effectively linked to care.…”

Treatment as prevention among injecting drug users; extrapolating from the Amsterdam cohort study

“…Most studies that model the spread of HIV among IDU have included treatment only of those with low CD4 þ cell counts, reflecting the current treatment guidelines which are based on health benefits of those treated rather than population benefits [8]. Few studies so far have examined a test and treat strategy among IDU; providing immediate treatment for those testing positive independent of CD4 þ cell count [9].…”

La mala calidad de sueño se asocia a una menor adherencia al tratamiento antirretroviral de gran actividad en pacientes peruanos con infección por VIH/SIDA

“…Gracias a la amplia cobertura de TARGA en pacientes con VIH/SIDA, esta condición se reconoce como una entidad de manejo crónico, a nivel mundial, así como en Perú 11,12,13,14,15 . En este contexto, la adherencia a la indicación terapéutica por parte de los pacientes constituye un factor fundamental para el éxito o fracaso del TARGA 16,17,18 .…”