Treatment as prevention

rdf:langString Treatment as prevention

rdf:langString Treatment as prevention (TasP) is a concept in public health that promotes treatment as a way to prevent and reduce the likelihood of HIV illness, death and transmission from an infected individual to others. Expanding access to earlier HIV diagnosis and treatment as a means to address the global epidemic by preventing illness, death and transmission was first proposed in 2000 by Garnett et al. The term is often used to talk about treating people that are currently living with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) to prevent illness, death and transmission. Although some experts narrow this to only include preventing infections, treatment prevents illnesses such as tuberculosis and has been shown to prevent death. The dual impact on well-being and its 100% effectiveness in reducing transmission makes TasP the most important element in the HIV prevention toolkit. In relation to HIV, antiretroviral therapy (ART) is a three or more drug combination therapy that is used to decrease the viral load, or the measured amount of virus, in an infected individual. Such medications are used as a preventative for infected individuals to not only spread the HIV virus to their negative partners but also improve their current health to increase their lifespans. Other names for ART include highly active antiretroviral therapy (HAART), combination antiretroviral therapy (cART), triple therapy and triple drug cocktail.When taken correctly, ART is able to diminish the presence of the HIV virus in the bodily fluids of an infected person to a level of undetectability. Undetectability ensures that infection does not necessarily have an effect on a person's general health, and that there is no longer a risk of passing along HIV to others. Consistent adherence to an ARV regimen, monitoring, and testing are essential for continued confirmed viral suppression. Treatment as prevention rose to great prominence in 2011, as part of the HPTN 052 study, which shed light on the benefits of early treatment for HIV positive individuals. Evidence through observational, ecological and clinical trials like HTPN 052 reveal positive results in regards to the implementation of antiretroviral drugs as preventative measures against HIV transmission and the global HIV response is not focused on delivering treatment to reach at least the UN 2030 95-95-95 targets (95% of people living wth HIV diagnosed, 95% of those on treatment, and 95% of people on treatment being virally suppressed). Progress in scaling up access to treatment is brisk and as of 2018 over 23 million people are now reported to be on it. Challenges to scaling access to treatment include cost and drug resistance. However, modeling studies suggest that the costs of not providing access would be far greater and concerns regarding resistance have not been borne out despite tens of millions of people accessing treatment. Current challenges include how to change thinking from the now obsolete "test and wait until severely ill" to one where people who are at risk access rapid HIV testing and immediate treatment. TasP's legitimacy has influenced the World Health Organization's (WHO) 2015 shift from "test and wait" to "test and treat" recommendation, which push to alert as many people as possible of their HIV status through testing, and start people infected with HIV on ARVs, no matter their viral load or CD4 count. The diminished rate of new HIV infections brought about by these strategies are marked progress towards UNAIDS' 90-90-90 and 95-95-95 target to eliminate HIV/AIDS as a public health crisis by 2030. However, key populations in countries in Africa, Asia, and the Middle East may still have lower access to treatment and the benefits it brings, as a result of the stigma that surrounds HIV. Understanding whether marginalized groups have access to testing and treatment are often hampered by harsh laws that do not allow for the accurate collection of data regarding these communities. In some countries answering a question about being gay in the affirmative could garner long jail sentences or even the death penalty. Estimates of the number of people who are men who have sex with men, female sex workers, and/or drug users are very difficult to ascertain, rendering understanding diagnosis and access to treatment levels also difficult to determine. TasP and test and treat to maximize access to early treatment is now the scientific proven policy and has been implemented in most countries providing treatment for people living with HIV.