From Lima to Vancouver: getting ahead of HIV

By Dr. Robinson Cabello

Dr Robinson Cabello, the Executive Director of Via Libre, our linking organisation in Peru, outlines why civil society organisations need to re-claim their space in the HIV treatment cascade.

I have been to countless international AIDS conferences. They provided important moments for civil society to convene, advocate and contribute to the debates on key scientific advances.

The world’s two largest HIV conferences are convened biennially in alternating years by the International AIDS Society (IAS). In one year, the focus is on science, community, leadership, and strengthening evidence-based programming.  This conference also has the world’s largest scholarship programme on HIV, facilitating greater civil society attendance. The next year, the focus is on the biomedical aspects of HIV. These events brings together researchers and clinicians, as well as HIV and health professionals to share progress around new diagnostics, treatments and the potential development of a HIV vaccine. Due to a lack of scholarships for this conference, civil society participation has traditionally been low.

Two years ago I realised we also needed to attend the biomedical conferences if we wanted to be closer to the new solutions and trends that were being discussed. At this year’s IAS Conference on HIV Pathogenisis, Treatment and Prevention in Vancouver (19-22 July) we anticipate the unveiling of new scientific data related to when people should be started on treatment, with which drugs, and how they can be retained in care.

© International HIV/AIDS Alliance

Long before UNAIDS launched their aspirational 90:90:90 targets, the Lima-based NGO which I have led for the last 12 years - Via Libre - was making the shift towards improving our  HIV care continuum. Or in other words, ensuring that clients were not lost between the multiple interventions of outreach, testing, linkage to treatment and prevention, all the way to ART initiation and long term retention in care.

For example, in 2007, as part of a Hivos and European Union funded project which aimed to integrate testing and treatment services, we increased the number of MSM in our clinic that progressed from diagnosis into treatment and care services from 30% to 83%.

Here in Peru we are working within a concentrated HIV epidemic, mainly among men who have sex with men (MSM) and transgender women.  We provide HIV tests and other STI diagnosis through our own laboratory and provide treatment through our HIV clinic. We have made tremendous progress.

Currently, our clinic and pharmacy provides HIV treatment to almost 1400 people living with HIV. In 2014 we surveyed 170 users to find out why they preferred to access treatment via our clinic - as opposed to the public health system or other private facilities. We found that they valued our service for three reasons. Firstly, we offered better confidentiality. Secondly, they appreciated the quality of our services - particularly the person-centred approach we offered as they were consistently attended to by the same clinicians, allowing them to build a personal relationship. And finally, it was the flexibility of our clinic. We offer varied opening hours, including evenings and weekends, and a sliding scale of fees based on ability to pay.

As a result of these service developments, we are now a credible research partner for academic and scientific institutions, communities, private sector sponsors and others. To date, we have been involved in ten clinical trials for new HIV treatment regimes. And recently, with the support of the Alliance's innovation fund which aims to stimulate new programming solutions, we are piloting new ways to link treatment and care services for people living with HIV. One of these is the use of internet and SMS messaging to help people living with HIV adhere to treatment. It is this work that we will be sharing at this year’s IAS biomedical conference.

This is particularly relevant given that in December 2015 the World Health Organisation is expected to revise its consolidated guidance on the use of ART drugs for treating and preventing HIV. Via Libre has been involved in the community consultations commissioned by WHO to inform this revision. Personally, there are four things I would hope to see when the guidance is re-issued:

  • A greater emphasis on the importance of prevention and in particular the need to ensure that implementation for combination prevention is strengthened through new evidence, for example relating to PrEP.
  • A push for more evidence on how to achieve an earlier diagnosis of HIV. The 90:90:90 targets will not be achieved unless HIV testing, which is the gateway to prevention and care, is expanded to vulnerable and hard to reach populations. I believe this is key to combating the epidemic as most new infections occur within the first months (even weeks) of transmission.
  • Then there is the ongoing conversation around CD4 count. In my view, a CD4 count should not be the criteria for starting treatment. Recent evidence from the START trial shows the benefits of people living with HIV starting treatment earlier (when their CD4 count is over 500cells/mm3). The new guidance should reflect this.
  • Finally, and this is where I return to my perspective as a civil society leader, the role of communities in delivering the above should be articulated in a more concrete way, not just as a principle.

So at the conference in Vancouver in a few days, you will find me networking and advocating for decentralised and sustainably financed community-based, peer-led interventions. I will also be catching up with like-minded civil society leaders from other regions of the world - including my Alliance colleagues from Alliance India, MAMTA, KHANA in Cambodia, Alliance Ukraine and the international secretariat to share our experiences and learn from each other.

Whilst there is huge progress in the drive to end AIDS, we still have a lot of work ahead of us.  That’s why Via Libre will continue to work hard to increase the awareness, access, equity and quality of HIV treatment in Peru. 

Earlier this year, Via Libre marked 25 years at the front of the HIV response in Peru.

Alliance linking organisations are presenting several abstracts at the IAS Conference in Vancouver, 19-22 July.