REPORT BACK: 10th International Conference on HIV Treatment and Prevention Adherence
july 13, 2015
Presented by: Barbara Santosuosso, CTAC Policy Researcher
July 9, 2015
On June 28th to the 30th of this year, CTAC joined almost 500 delegates from over 25 countries in Miami, Florida to attend the 10th International Conference on HIV Treatment and Prevention Adherence. This year’s conference, entitled ‘A Decade of Success, A World of Opportunities’, focused on applying and translating evidence-based strategies to enhance ART adherence, biomedical prevention, and the continuum of care. Below are some of the highlights of the session events.
At the pre-conference symposia, Dr. Julio Montaner from the BC Centre for Excellence in HIV/AIDS introduced the preliminary International Association of Providers of AIDS Care (IAPAC) Guidelines for the Optimization of the HIV Care Continuum. The guidelines, which have just been recently submitted for publication, offer over 60 recommendations, including: removing laws that criminalize MSM, transgender, substance users, sex workers and HIV exposure; and increasing access to PrEP, HIV testing, gender-sensitive programming, harm reduction approaches, and culturally competent care. The guidelines are set to be based on principles of equity and will offer recommendations that could be implemented in different steps of the care continuum to address barriers and enhance the quality of care.
In the opening session later that afternoon, Dr. Quaraisha Abdool Karim, the Associate Scientific Director of the Centre for the AIDS Program of Research in South Africa (CAPRISA), provided an overview of the gaps, challenges, and strategies to optimize implementation of the HIV care continuum. Dr. Karim highlighted that although significant progress has been made on increasing ART coverage globally, many people living with HIV are still not being linked and retained to care. In order to improve models of care, Dr. Karim remarked that simplified treatment protocols, decision-making tools and approaches, and implementation science (the integration of research findings and evidence into healthcare policies and practices) are required. Some of her proposed real-world strategies to enhance engagement in the care continuum include HIV self testing; peer support; call centre approaches, point-of-care testing; quality improvement interventions; and adherence support groups.
The day ended with a poster and exhibit session, where CTAC presented a poster on the Treatment Access Map, a new and exciting initiative that will be available later this fall on the CTAC website. CTAC was thrilled to have the opportunity to share our work on this interactive, online tool that will map out the current HIV and hepatitis C treatment access landscape in Canada with conference delegates on an international scale.
Day two of the conference commenced with a keynote address from Ambassador Deborah L. Birx, U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health Diplomacy. In her address, Ambassador Birx pointed out that despite the dramatic reductions in HIV incidence rates globally, several challenges, including unequal progress in different jurisdictions and the pervasiveness of layered stigma and discrimination, still remain. In order to enhance any achievements made to date, Dr. Birx noted that focusing on areas of the greatest need and providing the right service delivery models requires the use of site-level data and evidence-based interventions. These initiatives cannot be done without collective will, efforts, and accountability of all stakeholders involved.
Senior Policy and Strategy Adviser from the UNAIS U.S Liaison Office in Washington, Jason Sigurdson, followed Ambassador Birx’s address with a presentation on addressing the role of stigma, discrimination, and punitive laws and outlining how all three undermine the HIV response. His presentation brought into light the concerning state of the HIV-related legal environment.: 76 countries criminalize same-sex relations; 61 countries have laws criminalizing HIV transmission; 36 countries have HIV-related entry and stay restrictions; and 29% of countries provide no legal protection against HIV-related discrimination. While UNAIDS published a document in 2012, Key Programmes to Reduce Stigma and discrimination and Increase Access to Justice in National HIV Responses, with 7 key programmes to improve the legal and social environment, Sigurdson also discussed ways that care providers could contribute to ending HIV criminalization. These approaches include advocating for criminal law provisions that are informed by advanced medical and scientific evidence, as well as sensitizing the media, public, and elected officials on the current HIV context and more effective approaches to address HIV, such as expanded services.
PrEP dissemination and implementation received a lot of attention at the conference. Dr. Sarit Golub from the Hunter AIDS Research Team suggested, in fact, that “PrEP is a gateway drug to primary care”. Dr. Golub discussed the SPARK project, where PreP is provided and supported as a regular part of care at the largest LGBT-focused Community Health Center in New York, Callen-Lorde Community Health Center, and then evaluated. 273 patients have been enrolled in SPARK since February 2014, 88% of which have begun PrEP. Of these patients, 29% who had no previous primary care became newly paneled; 68% of the 45% uninsured patients at time of enrolled were connected to Medicaid or the Affordable Care Act (ACA) Plans; and several reported lower levels of depression and anxiety. Despite the noted benefits, Dr. Golub reminded delegates that implementation is not access and that HIV prevention must be placed within a larger social and structural context that emphasizes control and empowerment.
Another noteworthy topic of conversation throughout the conference was linking data to care and the impact of high-impact technology on the HIV care continuum. Harnessing technology to partner with communities has been identified as a way to not only increase cross organizational collaboration, but to also enhance global connectivity and increase care engagement. Some of these initiatives include the Fast-Track Cities, a strategy where cities around the globe are collaborating to achieve 90-90-90 targets by 2020 through open data principles and a real-time monitoring; HIVContinuum, an interactive map that reveals steps in the continuum of care by zip code in several U.S cities; and AIDSVu, an interactive map that displays demographic-specific information on HIV prevalence and new diagnosis.
The morning plenary began with a presentation from Dr. Steve Morin from the University of California. In his presentation, Dr. Morin discussed the importance of state policy environments in addressing the gaps along the continuum of care. Some of the policy facilitators to address these critical gaps include: dedicated HIV funding from legislature; timely plans with monitoring and evaluation; surveillance to increase linkage and retention; and timely feedback to care providers and clinics. Dr. Morin also reminded delegates that adherence is a part of a “cascade within a cascade”, warranting greater attention and research.
To further explore the gaps along the cascade of care, Dr. Rivet Amico from the University of Michigan explored the limitations of the cascade-specifically that it fails to identify reasons for and strategies to address existing gaps and does not include people who are HIV-negative. Dr. Amico discussed the potential for a prevention cascade and its opportunity to demonstrate treatment and prevention as interrelated components, as well as an infection cascade that identifies some of the events that lead to infection and approaches that disrupt it, such as poverty, stigma, and gender dynamics.
The conference ended with a rapporteur session from Dr. Michael J. Stirratt from the NIMH Division of AIDS Research, summarizing some of the highlights from the conference. His presentation could be found at: http://iapac.org/AdherenceConference/presentations/ADH10_Rapporteur.pdf
CTAC was delighted to have the opportunity to attend the 10th International Conference on HIV Treatment and Prevention Adherence and engage with a remarkable community of delegates from around the world. Readers are encouraged to view conference presentations available on the IAPAC website at:
Throughout the conference, CTAC was also actively present on Twitter, providing real-time updates on the conference events and highlights. To view the tweets, check us out @CTAC_CAN or by using the hash tag #Adherence2015.
 Sigurdson, J. Addressing the Role of Stigma, Discrimination, and Punitive Laws in Disrupting the HIV Care Continuum. 10th International Conference on HIV Treatment and Prevention Adherence, June 28-30, 2015, Miami
 Golub.A.G. PrEP Can “Do More”: Synergistic effects on primary care, insurance and mental health.. 10th International Conference on HIV Treatment and Prevention Adherence, June 28-30, 2015, Miami
RECAP OF CONFERENCE TWEETS