HIV treatment optimization and The Bill & Melinda Gates Foundation

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Stephen Becker from The Bill & Melinda Gates Foundation updated the participants of the International Treatment as Prevention conference in Vancouver about the Foundation’s treatment optimization activities on Tuesday.  This initiative was conceived within the context of combination prevention and treatment and a constrained funding environment that does not permit treatment for all who need it.

According to Becker, the Foundation acknowledges that treatment will be at the center of HIV prevention efforts, but “no amount of treatment will obviate the need for primary prevention modalities.”

The Foundation’s treatment optimization initiative is an effort to identify additional efficiencies to permit expansion of care without compromising quality of care. The aim is to generate evidence to inform normative, regulatory and country-level policy. Becker noted that the Foundation has no policy agenda of its own.

Becker referred to the previous presentation from the Clinton HIV/AIDS Initiative (CHAI) about the costs of care and indicated that work in that area is ongoing. In addition to supporting CHAI, the Foundation has offered grant support to the World Health Organization (WHO), Pangaea Global AIDS Foundation and others to do this work.

He then spoke about their work in drug optimization, which addresses both dose optimization and potential efficiencies in manufacturing processes.  In the area of dose optimization, they are looking at a series of drugs that might be effective in lower doses.  They are currently funding a trial to test a lower dose of D4T in South Africa, India, and Uganda and are also looking at a reduced dose of efaveranz.

The Foundation is also looking at diagnostics, including HIV tests, viral load and CD4 tests.  In the second phase of this treatment optimization work, the Foundation will continue to focus on the cost of care and treatment, the potential of long acting combination antiretrovirals, manufacturing processes, and strategies to integrate HIV within broader health systems.

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