Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

Ying-Ru Lo; Masaya Kato; Nittaya Phanuphak; Masami Fujita; Duong Bui Duc; Seng Sopheap; Razia Pendse; Dongbao Yu; Zunyou Wu; Suwat Chariyalertsak

doi:10.1071/SH13094

REVIEW (Open Access)

Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

Ying-Ru Lo ^A ^J , Masaya Kato ^B , Nittaya Phanuphak ^C , Masami Fujita ^D , Duong Bui Duc ^E , Seng Sopheap ^F , Razia Pendse ^G , Dongbao Yu ^A , Zunyou Wu ^H and Suwat Chariyalertsak ^I

+ Author Affiliations

- Author Affiliations

^A World Health Organization Regional Office for the Western Pacific – HIV, Hepatitis and STI, P.O. Box 2932 (United Nations Avenue), 1000 Manila, Philippines.

^B World Health Organization Vietnam Country Office – HIV, 63 Tran Hung Dao Street, Hoan Kiem District, Hanoi, Vietnam.

^C Thai Red Cross AIDS Research Centre, 104 Rajdamri Road, Pathumwan, Bangkok 10330, Thailand.

^D World Health Organization Cambodia Country Office – HIV and TB, P.O. Box 1217, 177–179 Pasteur Street, Sangkat Chak Tomouk, Khan Daun Penh, Phnom Penh, Cambodia.

^E Ministry of Health Vietnam – Viet Nam Authority of HIV/AIDS Control, Ministry of Health, 135/3 Nui truc, Hanoi, Vietnam.

^F Ministry of Health – National Center for HIV/AIDS, Dermatology and STD, No. 245H, National Road 6A, Sangkat Kean Klang, Khum Prek Leap, Khan Russey Keo, Phnom Penh, Cambodia.

^G World Health Organization Regional Office for South-East Asia – HIV/AIDS and STI, WHO House, Indraprastha Estate, Mahatma Gandhi Marg, 110002 New Delhi, India.

^H Chinese Center for Diseases Control and Prevention – National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China.

^I Chiang Mai University – Research Institute for Health Sciences, Chiang Mai University, P.O. Box 80 (Chiang Mai University), Chiang Mai 50202, Thailand.

^J Corresponding author. Email: loy@wpro.who.int

Sexual Health 11(2) 126-136 https://doi.org/10.1071/SH13094
Submitted: 15 June 2013 Accepted: 11 March 2014 Published: 10 July 2014

Journal Compilation © © World Health Organization All rights reserved.
The World Health Organization has granted the Publisher permission for the reproduction of this article. 2014

Abstract

Evidence has emerged over the past few years on the effectiveness of antiretroviral-based prevention technologies to prevent (i) HIV transmission while decreasing morbidity and mortality in HIV-infected persons, and (ii) HIV acquisition in HIV-uninfected individuals through pre-exposure prophylaxis (PrEP). Only few of the planned studies on treatment as prevention (TasP) are conducted in Asia. TasP might be more feasible and effective in concentrated rather than in generalised epidemics, as resources for HIV testing and antiretroviral treatment could focus on confined and much smaller populations than in the generalised epidemics observed in sub-Saharan Africa. Several countries such as Cambodia, China, Thailand and Vietnam, are now paving the way to success. Similar challenges arise for both TasP and PrEP. However, the operational issues for PrEP are amplified by the need for frequent retesting and ensuring adherence. This paper describes challenges for the implementation of antiretroviral-based prevention and makes the case that TasP and PrEP implementation research in Asia is much needed to provide insights into the feasibility of these interventions in populations where firm evidence of ‘real world’ effectiveness is still lacking.

Additional keywords: Cambodia, China, pre-exposure prophylaxis, Thailand, treatment as prevention, Vietnam.

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