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Treatment as prevention holtgrave
1. David Holtgrave, PhD
HIV Treatment as
Professor and Chair
Prevention:
Dept. of Health, Behavior &
Is this the end of HIV? Society
2. AS A NATION, DO WE
AND WILL WE PROVIDE
NECESSARY HIV CARE
AND TREATMENT?
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3. Gardner treatment cascade
From: Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ. The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for
prevention of HIV infection. Clin Infect Dis. 2011 Mar 15;52(6):793-800.
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4. CDC MMWR, November 30, 2011
From: Vital Signs: HIV Prevention Through Care and Treatment — United States. MMWR. 2011;60:47. 1618-1623.
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5. ADAP Waiting Lists are the
Tip of the Iceberg
http://coastal.er.usgs.gov/ocean-
acidification/arcticcruise2011/journal/index.php/2011/08/20/icebergs/
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6. In 2004, IOM Panel calls for HIV care entitlement program…
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7. “COMBINATION PREVENTION”
HAS SADLY BECOME
“SUBSTITUTION PREVENTION”
WHEN WE NEED
“SYNERGISTIC PREVENTION”
TO URGENTLY IMPACT INCIDENCE
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8. HIV is transmitted during an act of
unprotected risk behavior in a serostatus
discordant partnership with virus present
Unprotected transmission No unprotected
In a serostatus discordant
relevant risk behavior transmission relevant risk
partnership…..
present behavior
Concentration of Essentially no transmission
Unsuppressed Viral Load
transmission
Essentially no transmission
Suppressed Viral Load Essentially no transmission
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10. Number of forward HIV transmissions from
subgroups of persons living with HIV, and potential
points of prevention intervention
From: Holtgrave DR, Maulsby C, Wehrmeyer L, Hall HI. Behavioral Factors in Assessing Impact of HIV Treatment as Prevention. AIDS Behav. 2012 Apr 11. [Epub
ahead of print].
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11. Key services needs of the three
subpopulations of persons living with HIV
From: Holtgrave DR, Maulsby C, Wehrmeyer L, Hall HI. Behavioral Factors in Assessing Impact of HIV Treatment as Prevention. AIDS Behav. 2012 Apr 11. [Epub
ahead of print].
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12. Incidence of HIV under various scenarios
Incidence
70000 Flat TR Comparator
60000 S694YMC
Incidence
50000 S694YFSC
40000 S694NMC
30000
S694NFSC
20000
S807YMC
S807YFSC
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16
10
14
18
20
20
20
20
20
20
20
S807NMC
Year
S807NFSC
Holtgrave et al., under review (please do not reproduce)
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