TREATMENT AS PREVENTION STOP HIV/AIDS STOP HIV/AIDS In 2008, the BC-CfE developed a mathematical On February 4, 2010, then-Minister of Health “TREATMENT AS model and a cost-effectiveness evaluation Kevin Falcon announced a four-year $48 million that suggested that the expansion of HAART pilot aimed to evaluate the impact of the HIV PREVENTION” IN coverage would be highly cost-effective, as it Treatment as Prevention strategy in BC. The would prevent AIDS morbidity and mortality. strategy is a pilot project called STOP HIV/AIDS ACTION However, when the impact of the expansion of (Seek and Treat for Optimal Prevention of HIV HAART coverage on HIV transmission was taken and AIDS). Extending HAART via Treatment as into account, the strategy was found to have the The STOP HIV/AIDS pilot aims to expand access Prevention saves lives, prevents potential of becoming cost-averting, as it would to HIV/AIDS treatment and medication among HIV transmission and reduces health costs virtually eliminate vertical transmission of HIV, hard-to-reach and vulnerable populations in and dramatically reduce HIV transmission by all hile an outright cure or a preventive Vancouver’s Downtown Eastside and Prince other routes. Wvaccine for HIV/AIDS remains elusive, George. These regions had been identified as remarkable advances in HIV treatment have Most recently, HPTN 052—a randomized trial of priority sites for the pilot project because they been achieved over the past two decades. HIV sero-discordant (primarily heterosexual) were disproportionately affected by HIV/AIDS. Most significant among these advances is the couples—provided definitive proof of the The pilot project specifically serves individuals development of highly active antiretroviral efficacy of HIV Treatment as Prevention. The facing multiple barriers to care including therapy (HAART). study found an impressive 96% decrease in the addiction, mental health issues, homelessness, risk of HIV transmission with immediate HAART. and other social factors. WHAT IS HAART? Of note, immediate HAART was also associated The four-year pilot under the leadership of the HAART is a combination of antiretroviral drugs with a 30% decrease in the combined endpoint of BC-CfE operates until 2013. The pilot is being that fully suppress HIV replication and therefore disease progression and death as well as an 83% carried out in collaboration with Vancouver renders the number of viral copies present in reduction in the incidence of extra-pulmonary Coastal Health, Northern Health, the Provincial a patient’s blood undetectable, as measured by tuberculosis. Health Services Authority and Providence commercially available plasma viral load assays. The concept of HIV Treatment as Prevention Health Care. The pilot is been implemented with HAART became the standard of care in has progressively gained support from the the involvement of key community partners, developed nations around the world following international community, including the including the Aboriginal community. the International AIDS Conference in Vancouver International AIDS Society, the World Health in 1996. HAART use significantly reduced Organization (WHO), UNAIDS, PEPFAR, the PROJECT GOALS morbidity and mortality among treated patients, Clinton Initiative, Médecins Sans Frontières, the ✓ Ensure timely access to high quality allowing dramatic improvements in the quality National Institutes of Health, and international and safe HIV/AIDS care and treatment and duration of life for HIV-infected individuals. research-based pharmaceutical industries, In BC, by 1999, (within three years of deployment among other key international stakeholders. ✓ Reduce the number of new of our HAART program) the BC-CfE documented In November 2011 US Secretary of State Hillary HIV/AIDS diagnoses an 85% reduction in HIV/AIDS mortality among Clinton publicly endorsed HIV Treatment as ✓ Reduce the impact of HIV/AIDS through patients engaged in treatment. Prevention as a central piece within the PEPFAR effective screening and early detection global strategy. This was further emphasized In July 2006 at the International AIDS Conference ✓ Improve the patient experience in by US President Obama on December 1, 2011, in Toronto, the BC-CfE provided compelling every step of the HIV/AIDS journey during his International AIDS Day speech. In evidence that the viral load suppression achieved December 2011, Science, the official Journal of ✓ Demonstrate system and by HAART substantially reduced transmission the AAAS named HIV Treatment as Prevention cost optimization of HIV. In a viewpoint article published in The the #1 Scientific Breakthrough of 2011. Lancet in the summer of 2006, the BC-CfE Dr. Montaner jointly with Dr. Myron Cohen, the proposed that the expansion of HAART coverage lead investigator of HPTN 052, shared the 2011 to all those in medical need would be the most GAIA award for their work on HIV Treatment as effective strategy to dramatically reduce HIV Prevention. transmission to those at risk. NUMBERS SHOW BC IMPROVING WITH HAART

HIV DIAGNOSES BY REGION AND YEAR THE CASCADE OF CARE Public Health Agency of Canada, 1995-2011 Nosyk et al., Upcoming Publication

20

B.C.

10000 15 8000

Ontario 6000 # Patients 10 10000 Québec Ontario 4000 Prairies 8000 B.C. 2000 Québec 5 Prairies 6000

2009 HIV Diagnoses per 100,000 Population 2008

Atlantic 4000 2007 # Patients 2006 Atlantic 2005 2000 2004 2003 1995 1998 2001 2004 2007 2010 2002 2001 Year 2000 Year 1999 DiagnosedLinked 1998 1997 Retained 1996 NeedOn ARV ARV

Adherent

Suppressed

DR. JULIO MONTANER

The BC Centre for Excellence in HIV/AIDS (BC-CfE) is headed by Dr. Julio Montaner, a world-renowned researcher and a respected leader on HIV/ CONSULTING WITH HIS PATIENT WITH PREMIER CHRISTY CLARK SPEAKING AT IAS 2012 AIDS issues and advocacy.

Since 1987, Dr. Montaner has Dr. Montaner has pioneered new salvage therapy Among other international accomplishments, been making a difference in the lives strategies for patients harbouring multiple drug- Dr. Montaner was instrumental in working of people living with HIV and AIDS. resistant HIV infection. In the early 2000’s, Dr. with China to implement BC’s Treatment Born in , Dr. Montaner knew Montaner began exploring the idea of Treatment as Prevention strategy in their fight against at a very early age he wanted to be a as Prevention. The idea was to expand the use of HIV/AIDS. doctor — just like his father. He arrived HAART to decrease AIDS-related morbidity and In 2007, he was appointed Head of the newly at St. Paul’s Hospital in 1981 on a UBC mortality and to decrease HIV incidence and established Division of AIDS at the University fellowship. He completed his training prevalence. in Internal Medicine and Respiratory of British Columbia Department of Medicine, Medicine at UBC and was St. Paul’s Since 2005, as director of the BC-CfE, Dr. the first such initiative in Canada and one chief resident. In 1988, he took the Montaner leads the BC-CfE’s efforts to translate of only three in North America. His peer- position of Director of AIDS Research. research advances into clinical practice. In reviewed research papers dealing with HIV/AIDS In the mid-1990’s, working with other 2006, he introduced the pioneering Treatment have been published extensively. His current researchers at the BC-CfE, Dr. Montaner as Prevention concept to the International research interests include HAART as prevention, played a key role in the discovery of a AIDS Society conference in Toronto. He served optimal use of HAART, salvage therapy, new drug cocktail, since known as highly the IAS as President-Elect, President and Past- antiretrovirals, as well as hard-to-reach active antiretroviral therapy (HAART), President from 2006 – 2011, a fitting recognition populations and . which reduces the amount of HIV in of Dr. Montaner’s ongoing leadership and strong an infected individual’s bloodstream commitment to the international fight against to undetectable levels and restores HIV and AIDS. immune function. BACKGROUNDER CORE PROGRAMS AND INITIATIVES

LABORATORY PROGRAM ADDICTION AND URBAN The BC-CfE conducts translational HIV research HEALTH RESEARCH INITIATIVE and coordinates some of the world’s largest The BC-CfE conducts U � � � � cohort studies examining human and virus population-based H � � �� � Together we can stop HIV/AIDS R � � � � � � � variability. research on HIV/AIDS I � � � � � � � � � and related diseases The British Columbia Centre for Excellence among urban populations and those suffering in HIV/AIDS (BC-CfE) is Canada’s largest addiction. Funded cohort studies involve drug HIV/AIDS research, treatment and education users, street-involved youth and health services facility. When the BC-CfE opened in 1992, a evaluation studies. British Columbian was dying from AIDS almost INTERNATIONAL CENTRE every day. Today, advances in HIV treatment and EPIDEMIOLOGY AND POPULATION prevention­ — many of them developed by the FOR SCIENCE IN DRUG HEALTH BC-CfE — have made HIV infection preventable POLICY INITIATIVE and transformed HIV disease a chronic, This comprehensive program identifies risks The BC-CfE’s Addiction and manageable illness. for HIV infection while tracking access to Urban Health Research Initiative antiretroviral therapy and clinical outcomes However, much work remains to be done. Drug serves as the Secretariat for the ICSDP. Founded among vulnerable populations. resistance, adverse reactions to medication and by BC-CfE scientists in 2010, the ICSDP brings barriers to accessing treatment are just a few DRUG TREATMENT PROGRAM (DTP) together international experts to produce of many issues facing HIV-positive individuals. evidence-based policy statements in the field of As of December 31, 2011, the program has The BC-CfE is internationally recognized as a illicit drug policy. distributed free anti-HIV medications to leader in developing innovative, life-saving HIV approximately 10,000 eligible HIV-infected and AIDS therapies to improve the health of GENDER AND SEXUAL individuals in BC. The program distributes anti- people living with HIV and prevent infections. HEALTH INITIATIVE HIV drugs based on guidelines generated by the The inter-professional team of researchers BC-CfE’s Therapeutic Guidelines Committee. This initiative brings together conducts clinical, laboratory, epidemiological research collaborations to and behavioural research in Canada and around CLINICAL RESEARCH evaluate the intersecting interpersonal, social, the world. physical, and policy environments shaping The BC-CfE conducts research within the sexual health, HIV/STI’s and access to care The BC-CfE is based at St Paul’s Hospital, context of clinical care at the Providence Health among marginalized women and sex workers Providence Health Care and the University Care Immunodeficiency Clinic and St. Paul’s both locally and internationally. of British Columbia, and is funded by the BC Hospital’s 10C-HIV/AIDS Ward. The research Ministry of Health, donors, private partners helps set provincial HIV/AIDS therapeutic TREATMENT AS PREVENTION and the pharmaceutical industry. The BC-CfE guidelines. attracts peer-reviewed research funding from The Treatment as Prevention strategy involves numerous agencies, including BC’s Michael CLINICAL EDUCATION AND TRAINING widespread HIV testing and provision of anti- Smith Foundation for HIV drugs known as Highly Active Antiretroviral The BC-CfE provides HIV/AIDS training to Health Research, the Therapy HAART( ) to people with HIV. national and international professionals through Canadian Institutes of academic courses and events, on-site training Currently implemented through the STOP Health Research and and physician preceptorship. project, the Treatment as Prevention strategy the US NIH – National is now recognized worldwide as an effective Institute on Drug ST. PAUL’S HOSPITAL approach to combat HIV and AIDS in vulnerable Abuse. VANCOUVER, BC populations and reduce the incidence of HIV transmission in the community. 2012 2004 BC-CfE pioneers the use of the Biojector, a BC-CfE celebrates 20 years of award-winning needle-free injection device for enfuvirtide research and life-saving advancements • The Momentum Health Study launches, coordinated by the BC-CfE and funded by NIH–NIDA and CIHR, recruiting a MAJOR representative sample of Greater Vancouver 2005 Research laboratory demonstrates effects men who have sex with men HIV/AIDS of human and virus genetic variation on • BC-CfE launches an 18-month pilot project response to HAART for Non-occupational Post-Exposure ADVANCES LED • Pioneers the use of TMC114 and TMC125 Prophylaxis (NPEP), which expands BC’s as a life-saving treatment for patients Treatment as Prevention strategy by BY THE BC-CfE who have exhausted all conventional providing high-risk HIV exposures with options for HAART HAART at six local sites 2006 Over the past 20 years, the BC-CfE has BC-CfE publishes a major paper in The • BC-CfE’s GSHI publishes a study showing pioneered life-saving innovations, proposed Lancet introducing the concept of Treatment availability of indoor sex spaces is break-through strategies and campaigned as Prevention, a bold new strategy for potentially life-saving to sex workers, in for HIV and AIDS issues. As a result of the controlling the HIV/AIDS epidemic that they reduce violence, HIV risk and BC-CfE’s many achievements, HIV-positive • Dr. Julio Montaner elected President of improve relationships with police people who are appropriately treated can the International AIDS Society for the • The Washington D.C. Declaration to End now expect to live decades of healthy, term 2008–2010 the AIDS Epidemic is the official declaration productive life. 2007 Human leukocyte antigen testing predicts of the International AIDS Conference 2012, 1992 Provincial HIV/AIDS therapeutic life-threatening abacavir hypersensitivity and includes strategies that are part of guidelines introduced reactions BC’s Treatment as Prevention strategy 1994 2009 HIV/AIDS nursing course established Dr. Montaner receives $2.5 million Avant • BC-CfE’s Dr. Evan Wood at University of British Columbia Garde Award from the US National Institute is named Tier 1 Canadian School of Nursing on Drug Abuse to further develop the Research Chair in Inner

1996 City Medicine at UBC BC-CfE unveils results of the comprehensive proposed expansion of HAART, known as INCAS (Italy, Netherlands, Canada, STOP HIV/AIDS • Dr. Evan Wood appointed Australia) trial, demonstrating HAART’s • BC-CfE’s proposed expansion of HAART is to lead the Addictions remarkable suppression of HIV endorsed by Stephen Lewis, Bill Clinton, the Medicine Program at St. Paul’s Hospital • Viral load testing is introduced to monitor World Health Organization, UNAIDS and The disease progression and response to HAART Economist • Goldcorp announces funding for new • BC Premier Gordon Campbell commits to BC-CfE-led Addictions Medicine fellowship support STOP HIV/AIDS as a pilot project • Ongoing research to pioneer novel strategies to expand access to HIV/AIDS drugs to to access hard-to-reach populations, marginalized populations of Vancouver’s including the directly observed therapy Downtown Eastside and Prince George program in the Downtown Eastside and 2010 BC announces $48 million for the studies involving drug users (VIDUS) and STOP HIV/AIDS pilot project under the sex workers (AESHA) 1997 Multiple Drug Rescue Therapy is leadership of the BC-CfE • Continuing research to decrease developed for individuals failing 2011 In February 2011, China announces the drug-related harms, including conventional therapies implementation of Treatment as Prevention, needle exchange programs 1998 BC-CfE introduces Canada’s first clinical based on the BC-CfE model, as the • Bill Clinton calls for increased political drug-resistance monitoring program cornerstone in its fight againstHIV /AIDS will and investment to end the AIDS 2000 Canada’s first application of therapeutic • The Supreme Court of Canada rules that epidemic during his closing speech at drug monitoring for patients on , Vancouver’s safe injection site, can the International AIDS Conference in antiretroviral therapy remain operational Washington D.C.: 2001 BC-CfE performs scientific evaluation of “We’ll have to heed Julio Insite, North America’s first supervised Montaner’s years of pleas safe injection facility to implement Treatment

2002 as Prevention and BC is first to implement routine therapeutic implement combination drug monitoring for all patients on prevention programs, we antiretroviral therapy 2012

2003 In April 2012, Dr. Montaner reveals that can save a lot of lives if all The John Ruedy Immunodeficiency Clinic at progression to AIDS and death, as well as this is done. St. Paul’s Hospital reopens as a primary and new HIV diagnoses in BC, have significantly specialty clinic for HIV-positive individuals, decreased due to the province’s innovative introducing a new model of care based on Treatment as Prevention strategy chronic disease management