Challenges-in-HIV-infection-control-in-transgender

Comment
Challenges in HIV infection control in transgender women

sex workers
Simultaneous interventions directed at various control strategies.2 Health system capacity evaluation Published Online
January 22, 2019
segments of the infection chain is an effective approach allows for additional costs to be incorporated into the http://dx.doi.org/10.1016/
to control HIV infection. Controlling the source of analysis, such as the cost of introducing outreach mobile S2468-2667(18)30259-7
infection (ie, through antiretroviral treatment [ART]), units to increase HIV testing rates. Stakeholder analysis See Articles page e127
protecting ports of entry (through condom use), and integrates with mathematical modelling hypotheses
increasing host defenses (through prophylactic ART) that reflect the specificities of the group, examples of
can bring infection rates down, but it all comes at a which include the distribution of branded rather than
cost. Moreover, on the path to success, every extra step generic condoms or the difficulty of increasing condom
to achieve infection control requires a greater effort use between TGSW and their stable partners. Complex
and the increasing marginal costs of elimination are problems often demand multipronged strategies
particularly evident in the case of HIV. Thus, robust tackling a variety of disease transmission factors
modelling, monitoring, and evaluation—including a simultaneously. The sum of the effectiveness of
good understanding of the behavioural characteristics individual interventions does not necessarily equal the
of the population group—are essential to inform policy effectiveness of their combination.
formulation and implementation. Nevertheless, when modelling meets reality,
A few population groups are at high risk of policy implementation can differ from the expected
contracting and transmitting HIV and require packages outcomes based on a model’s parameters. Therefore,
of interventions tailored to the susceptibilities of their reliable monitoring and evaluation of the proposed
specific infection chain. Such groups include men interventions are needed to guarantee that deviations
who have sex with men, male or female sex workers, from expected results can be matched with timely policy
transgender people, drug users, prison inmates, reformulation. A good example of the complexities
migrants, or any combination of the above.1 Providing involved in the implementation of these policies
access to highly effective prevention and treatment is the assumption on the availability of low-priced
interventions for these populations is extremely generic drugs, an essential condition to deliver cost-
challenging, partly because of the criminalisation and effectiveness. Bórquez and colleagues2 suggest that Peru,
stigmatisation of the very same acts that cause their currently employing branded drugs, can achieve these
vulnerability. In The Lancet Publish Health, Annick Bórquez prices by joining the PAHO Strategic Fund. Nevertheless,
and colleagues acknowledge this fact and build the case these proposals have come up against political and
around transgender women sex workers (TGSW) in logistical implementation barriers in other country
Lima, Peru, in their mathematical modelling study.2 settings.3,4 Vested interests related to the use of branded
The evaluation framework of the cost-effectiveness of drugs might be an important obstacle in joining the
combined HIV prevention and treatment interventions, Fund, whereas countries that are already members can
aimed at averting future infections in TGSW and their struggle to come up with basic Fund requirements such
partners and clients, captures the complexities of HIV as demand analysis or procurement plans.5 Taking into
infection control and provides valuable lessons not only account the difficulties that Peru might face in its effort
for other populations group at risk of infection of HIV to become a member of the Fund is vital to achieve the
but also for other infectious diseases that present the results the study model predicts.2 Similarly, targeted
same challenges of hard-to-reach populations.2 promotion to increase condom use between TGSW and
By focusing on the triple combination of health their clients is countered by market forces, where the
system capacity evaluation, stakeholder analysis, risk incurred for sex services with and without condom
and mathematical modelling, a more balanced and commands differentiated prices.6
robust conclusion can be reached on the feasibility, The effort to close the gap between efficacy and
acceptability, and cost-effectiveness of different HIV effectiveness of policies, interventions, drugs, devices,
www.thelancet.com/public-health Vol 4 March 2019 e117

Comment
or other health inputs is further reflected in the agenda EG-P reports advisory fees from Hoffmann—La Roche, outside of the submitted
work. GP declares no competing interests.
pushed through by the US Food and Drug Administration
Copyright © 2019 The Author(s). Published by Elsevier Ltd. This is an Open
for the use of real-world evidence to support health-care Access article under the CC BY 4.0 license.
decision making.7 Collection of real-world data has been 1 WHO. Consolidated guidelines on HIV prevention, diagnosis, treatment
facilitated by the increasing availability of computers and care for key populations. Geneva: World Health Organization, 2016.
2 Bórquez A, Guanira J V, Revill P, et al. The impact and cost-effectiveness of
and other digital information technologies but can combined HIV prevention scenarios among transgender women sex workers in
Lima, Peru: a mathematical modelling study. Lancet Public Health 2019;
further be enriched through continuous monitoring published online Jan 22. http://dx.doi.org/10.1016/S24682667(18)30236-6.
and evaluation. This, in combination with innovative 3 Cruz Martínez A. Demanda de amparo contra la Cofepris. Enfermos de
VIH/sida se quejan de genéricos. Nov 6, 2018. La Jornada (Mexico).
study designs and sophisticated analytical tools, allows https://www.jornada.com.mx/2018/11/06/sociedad/038n1soc (accessed
answering of questions previously thought unfeasible Nov 22, 2018).
4 Centro Nacional para la Prevención y Control de VIH y el sida. Opinión de
and advancement in the implementation of real-world Censida sobre las nuevas sales de Tenofovir. Nov 5, 2018. https://www.gob.
policies. mx/censida/documentos/opinion-de-censida-sobre-las-nuevas-sales-de-
tenofovir?idiom=es (accessed Nov 22, 2018).
5 PAHO Strategic Fund. Access to high-quality medicines and health
technologies in the Americas. Annual report 2016. Washington, DC:
Giota Panopoulou*, Eduardo Gonzalez-Pier Pxn Health Organization, 2017.
Medica Sur Clinical Foundation, Mexico City, 14050 Mexico (GP, 6 Rao V, Gupta I, Lokshin M, Jana S. Sex workers and the cost of safe sex:
EG-P), Center for Global Development, Washington DC, USA the compensating differential for condom use among Calcutta prostitutes.
J Dev Econ 2003; 71: 585–603.
(EG-P); and Mexican Health Foundation, Mexico City,
7 Sherman RE, Anderson SA, Dal Pan GJ, et al. Real-world evidence—what is it
Mexico (EG-P) and what can it tells us? N Engl J Med 2016; 375: 2293–97.
[email protected]
e118 www.thelancet.com/public-health Vol 4 March 2019

Challenges-in-HIV-infection-control-in-transgender

Uploaded by

Copyright:

Available Formats

Challenges-in-HIV-infection-control-in-transgender

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Challenges-in-HIV-infection-control-in-transgender

Uploaded by

Copyright:

Available Formats

Comment

Challenges in HIV infection control in transgender women

www.thelancet.com/public-health Vol 4 March 2019 e117

e118 www.thelancet.com/public-health Vol 4 March 2019

You might also like