Getting it right

New research from British Columbia demonstrates sustained efficacy of treatment expansion in reducing HIV transmission, morbidity, and mortality

Vancouver, B.C. [February 2014] — British Columbia’s success in fighting HIV and AIDS has renewed calls for the global expansion of the province’s Treatment as Prevention strategy.

According to a new study from the BC Centre for Excellence in HIV/AIDS (BC-CfE) published in the peer-reviewed journal PLOS One, the expansion of HIV treatment in B.C. has led to a sustained and profound decrease in morbidity, mortality, and HIV transmission. The findings indicate the province’s Treatment as Prevention strategy should be applied in other settings, and to other diseases, around the world.

The Treatment as Prevention strategy, pioneered by the BC-CfE, involves widespread HIV testing and immediate provision of highly active antiretroviral therapy (HAART) to those living with HIV. Treatment can eliminate progression of HIV infection to AIDS and premature death, and significantly decrease the amount of virus in the blood and sexual fluids, thereby stopping transmission of HIV.

B.C. has taken a unique approach to addressing the HIV epidemic. B.C. provides fully supported access to HAART under Pharmacare, which has resulted in a significant increase in HAART coverage.

From 1996 to 2012, the estimated HIV prevalence in B.C. increased from 7,900 to 11,972 cases (a 52% increase), and the number of individuals actively on HAART increased from 837 to 6772 (a 709% increase). Overall, total HAART coverage increased from 11% to 57% during this period. 

As a result of expanded treatment coverage under the Treatment as Prevention approach, B.C. has experienced:

• 80% decrease in AIDS incidence (from 6.9 to 1.4 per 100,000 population)
• 80% decrease in HIV-related mortality (from 6.5 to 1.3 per 100,000)
• 66% decrease in new HIV diagnoses (from 702 to 238) 

In addition, the findings suggest for each increase of 100 individuals on HAART, the estimated HIV incidence decreased 1.2% and for every 1% increase in the number of individuals suppressed on HAART, the estimated HIV incidence also decreased by 1%.

The 2013 World Health Organization (WHO) Antiretroviral Therapy Guidelines are expected to expand HAART eligibility to a least 80% of those infected with HIV worldwide, presenting an opportunity for the global implementation of Treatment as Prevention™. To date, the strategy has been adopted internationally by China, Brazil, and France, and by cities across the United States, including San Francisco, New York City, and Washington, D.C.

The study is titled “Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission — The ‘HIV Treatment as Prevention’ experience in a Canadian setting.”

Quotes:

Dr. Julio Montaner, Director, BC-CfE:

“These findings strongly support Treatment as Prevention as a game-changer in the fight against HIV and AIDS. This strategy could dramatically curb morbidity and premature mortality globally, as well as HIV transmission, with impressive economic impact.”

Terry Lake, B.C. Minister of Health:

“Dr. Montaner and the BC Centre for Excellence in HIV/AIDS can be proud of their achievements in the fight against HIV/AIDS. In collaboration with those living with HIV, health care providers, health authorities and the broader community, we are turning the tide against a disease that was once considered a death sentence for so many. The Treatment as Prevention strategy is a made-in-B.C. approach that is ready to become a global standard.”

Michel Sidibé, UNAIDS:

“B.C.’s innovative strategy to fight HIV/AIDS has attracted international recognition, as reflected in the new WHO guidelines and UNAIDS Treatment 2015. Dr. Montaner and his team are at the forefront of the effort to fight HIV and AIDS—not just in B.C., but around the world.”

Dr. Zunyou Wu, Director, National Centre for AIDS/STD Control and Prevention/China CDC:

“This paper provides further solid evidence from real-world implementation that Treatment as Prevention works. It is the most appropriate strategy to control the epidemic and should be considered globally. We support and follow."

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What is Treatment as Prevention?

The Treatment as Prevention strategy has been pioneered by BC-CfE’s Dr. Julio Montaner. It involves widespread HIV testing and immediate provision of anti-HIV drugs known as HAART to medically eligible people with HIV. The BC-CfE has demonstrated that the benefits of early HAART treatment are twofold: it reduces the level of HIV in the blood to undetectable levels thus improving the health of people with HIV, and decreases the level of HIV in sexual fluids to undetectable levels thus reducing the likelihood of HIV transmission by more than 95 per cent.

In 2009, the BC government invested $48 million over four years in the BC-CfE-led Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) pilot project. The intent of the pilot was to expand HIV testing and treatment among hard-to-reach populations such as injection drug users in Vancouver’s inner city and Prince George. The success of the pilot led to the Ministry of Health announcing in 2012 the provincial roll out of the initiative. 

Treatment as Prevention is internationally recognized by organizations such as the World Health Organization, International AIDS Society and the Joint United Nations Programme on HIV/AIDS (UNAIDS). Treatment as Prevention has been endorsed by U.S. President Barack Obama, Secretary of State Hillary Clinton and former U.S. President Bill Clinton as an effective strategy in the fight against HIV/AIDS.