In the words of Professor Wafaa M. El-Sadir of the Columbia University, USA and the lead for the ICAP project, HIV management has passed through Trials, Travails and Triumphs with HIV epidemic evolving from an untreatable deadly disease to a chronic manageable condition.
As she discussed HIV prevention at the 25th anniversary of CROI held in Boston, USA from the 4th to the 7th of March 2018, she noted that despite the seeming success, new HIV infection continues and it is highly unlikely that the world would be able to reach the goal of less than half a million new infections per year by 2020. “This should compel us to think about how we can do better in terms of preventing new HIV infections,” she said.
Access to antiretroviral treatment should help expedite HIV prevention. In this case, treatment is used as prevention (TasP). Once antiretroviral therapy is adhered to, viral suppression occurs, and individuals living with the virus cannot transmit the virus. Similarly, adherence is required for antiretroviral used as pre-exposure prophylaxis (PrEP) to work.
Adherence to therapy can only be enhanced when supported with other intervention measures such as harm-reduction strategies for people who inject drugs, mental health service support for people who require this, access to regular HIV testing services, and empowerment programmes for adolescents and female sex workers.
Without these support, a population level effectiveness of treatment as prevention and pre-exposure prophylaxis would be limited in high HIV prevalence countries says Prof. Roel Coutinho from the University Medical centre Utrecht, Netherlands.
Meanwhile, mental health management of persons taking antiretroviral therapy for HIV infection management is also critical.
To control the epidemic, mental health care needs to be instituted as part of comprehensive HIV management, noted Dr. Robert H. Remien, a Professor of Clinical Psychology at the Columbia University, USA.
Poor mental health itself increases the risk of acquiring HIV infections for persons who are HIV negative as it negatively affects adherence to use of antiretroviral therapy as PrEP. It also doubles the risk of mortality for persons taking antiretroviral therapy for HIV infection management.
HIV prevention and treatment is best achieved through combination and integrated service delivery. All HIV management interventions proven effective need to be integrated into a combination of health-strengthening strategies to achieve effectiveness noted El-Sadir.
She also discussed the need for precision intervention by learning about WHERE to focus (geographic area), WHO to focus on (specific population), HOW to focus (models of prevention) and also WHAT type of tools we would use for the identified population(s).
The ability to learn how to conduct such precision interventions in Africa is limited by the capacity of local researchers to effectively oversee all aspects of the grant management cycle. Researchers in Africa have therefore had to depend on foreign partners for research administration, noted Dr. Elizabeth Bukusi of the Kenya Medical Research Institute, Nairobi, Kenya, during one of the breakfast sessions held at the conference.
“We don’t have strong management systems. Although we talk about issues of corruption, the systems are not robust enough to be able to manage research funds as we would want them; hence funds are being managed largely from the West,” Bukusi said.
“It is imperative to strengthen research administration through infrastructural, organizational, and human resource development to match the dynamic research environment and funding requirements.
“If we don’t address that capacity gap, it makes it difficult to grow the research to fit into our specific needs.”
“It was also identified that another issue we face is in infrastructural development. Facilities, resources and related services that are used by the scientific community are critical to conduct top-level research, without which, we will not be able to do the quality science that we desire,” she said.
Lots of changes have happened with the HIV prevention and treatment field over the last 35 years of the HIV epidemic. There have been indeed trials, travails and successes. The gain we have jointly made will require the sustained engagement and unique inputs from various communities, inclusive of small informal groups at the grass-roots and those of global coalitions. The struggle continues.
By Alaka Oluwatosin Bamidele
Oluwatosin, of New HIV Vaccine and Microbicide Advocacy Society (NHVMAS), writes in from Lagos.