There is an old saying in healthcare, prevention is always better than the cure. Why spend time treating an infection or a contracted disease when you can prevent it from developing? This is the fundamental principle behind TasP methods in HIV transmission prevention.
Treatment as Prevention (TasP) means treating HIV-positive individuals with antiretroviral treatment – ART to reduce the risks of HIV transmission.
They receive drugs to reduce the viral loads and limit the chance of infection. There are many studies for the approach. Communities across the world witnessed a fall in transmission rates with effective ART use. However, there are also obstacles limiting its effect.
The main focus of TasP for HIV prevention is ART.
Many healthcare agencies across the world now provide ART (antiretroviral treatment) to reduce the risk of HIV transmission in HIV prevention.
These drugs work by decreasing the viral load in bodily fluids, such as blood, semen, and vaginal fluid, to “undetectable” levels. This, therefore, reduces the chance of patients passing on the virus through blood contact, sexual intercourse or other risk factors.
The popularity of ART as an HIV prevention measure is mainly due to its rate of effectiveness. A 2011 study of people with a CD4 count between 350 and 550 saw significant improvements when ART was in use.
Here, transmission to HIV-negative partners reduced by as much 96%. This effectiveness rating means that there is great potential for the use of ART in “test and treat” measures and other key programs.
“Test and treat” is a simple process of testing a population to diagnose HIV and providing ART to all those that are positive. One of the key factors here is that ART is widely rolled out regardless of the CD4 count. There are problems regarding availability and cost, but many believe that this universal system is vital for the success of ART in HIV prevention.
Another important area of interest with this ART approach is in the prevention of mother-to-child transmission (PMTCT). This treatment in prevention in mother-to-child transmission is in use since the 1990s. There is a big risk in pregnancy and birth as mother and baby share fluids and contact with the blood system, amniotic fluid, and delivery process.
There is also a risk when breastfeeding after birth. Here the use of zidovudine reduced the direct transmission of HIV from positive mothers to their babies from 25% to 8%. Some state that just 14 days worth of treatment can reduce the risk of transmission to 1%.
The problem with the TasP system and ART drugs is that complacency and poor use can cause problems.
ART programs for HIV prevention through treatment are clearly beneficial regarding the results that we see. However, patients cannot rely on ART alone, as it needs to be consistently used alongside other prevention measures. There is the risk that those that have access to ART may assume that it is all they need and forgo other methods like condoms.
Safe sex measure, safe needle use, and other preventative measures should be in use with ART for the best results. An excellent example of this is with products such as microbicides.
Microbicides are ART drugs in creams or gels that women can apply to the vagina to reduce the risk. The problem here comes with correct use and consistency in the application for HIV prevention.
There are also some concerns over the effectiveness due to mixed results in studies. One study saw a drop by 39%, but this result is not yet fully qualified.
The next step with these microbicides is the education into proper use and the development of an anal version for men. In fact, education is a crucial part of HIV prevention measure, and we cannot overlook it.
Greater education, understanding, and access to HIV prevention methods are all essential in the fight against HIV.
The problem with ART in preventative methods does not lie in the effectiveness of the drug, but in the actions of the user. Those that do not take the right doses or fail to understand the conditions put themselves at greater risk.
The best approach here is a mixture of ART medication, behavioral changes and improved education at a community level. With the right approach, reduction rates in HIV transmission can decrease, and HIV prevention can improve.