Treatment as Prevention once again shown to lower incidence of illness, infection, death, in British Columbia findings consistent with Kwazulu Natal, other settings, authors say

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The idea was to document and demonstrate the effectiveness of the “Treatment as Prevention” strategy in fighting HIV and AIDS, but a population-wide study of data spanning 16 years in British Columbia’s HIV epidemic scored points for harm reduction and accessible, publically funded health care as well, it turned out.

The PLOS One article on the findings sums them up in the title: 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. While over the years between the first of January 1996 and the end of December 2012, estimated HIV prevalence in British Columbia grew from 7,900 individuals to 11, 972, the number of people on highly active antiretroviral treatment grew from 837 to 6,772. During that time, AIDS incidence and HIV-related deaths dropped by 80 percent each, and new HIV diagnoses dropped by 66 percent. For every 1 percent rise in the number of people whose virus was suppressed by antiretroviral treatment, a corresponding 1 percent drop occurred in new HIV infections and a 2 percent drop in AIDS-related illnesses and deaths.

All of this took place in an exceptionally resource-rich and supportive environment, the authors, who include Julio Montaner, Viviane Lima, P. Richard Harrigan, Lillian Lourenco, Benita Yip, et al, note. Among its advantages in monitoring and treating HIV patients, British Columbia has a publically funded health care system, and access to antiretroviral treatment with no co-payments or deductibles. In addition, harm reduction practices that include widely available needle and syringe exchange, opioid substitution, and drug treatment facilities as well as the only legal supervised injection site in North America, all appear to have helped to boost antiretroviral treatment enrollment, while reducing HIV transmission risks. While high rates of chlamydia, syphilis and gonnorhea continued during the time frame studied, hepatitis C incidence also declined.

But for all of those advantages, the findings reflect similar findings showing population-wide impacts of HIV treatment as prevention, the authors say, noting “the magnitude of the impact of the expansion of HAART coverage on HIV transmission derived from our models is entirely consistent with the effect noted from the experience in Kwazulu-Natal.” That experience, published in Science magazine last year, showed the more antiretroviral treatment coverage increased in KwaZulu Natal the more steeply rates of acquisition of HIV declined.

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