NIDA funds proposed 'seek and treat' strategy in the fight against HIV/AIDS

For its commitment to evaluate made-in-BC strategy for control of HIV/AIDS

Dr. Julio Montaner - Director, British Columbia Centre for Excellence in HIV/AIDS (BC-CfE), and President, International AIDS Society - congratulated Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health (NIH), for taking a leadership role in the evaluation of the "Seek and Treat" strategy originally developed at the BC-CfE.

NIH has issued a Request for Applications (RFA) that will invest up to $50 million over five years to evaluate "seek and treat" in the criminal justice setting. NIDA's funding, along with the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Mental Health (NIMH), will foster the development, implementation and testing of strategies to seek, test, and treat HIV-infected people within the criminal justice system. The RFA is open to applicants from outside the U.S. "Several mathematical models suggest that increasing access to HIV testing and treatment, particularly among high risk groups, could have a substantial beneficial impact - not only on individuals' health, but also on population infection rates," says NIDA Director Dr. Nora Volkow. "That's why we're investing substantial resources to determine the real-world impact of a 'seek, test, and treat' approach, because so many HIV-infected people pass through the criminal justice system every year."

The research will be closely focused on the continuity of highly active antiretroviral therapy (HAART) during and after community re-entry following periods of incarceration. This strategy is expected to decrease HIV/AIDS related morbidity and mortality among inmates and decrease HIV transmission among their network members. "Research conducted in BC over the last five years shows that we must seek out and offer treatment to all medically eligible HIV-infected individuals to stop the progression to AIDS and death among those infected and prevent HIV infection among those at risk. Lessons learned from this research will be essential to guide further roll out of the treatment globally," said Montaner.

The "seek and treat" strategy is particularly intended to dramatically increase access to the life-saving HAART treatment among vulnerable people such as injection-drug users, sex-trade workers, prisoners, First Nations individuals, and those with other underlying conditions such as mental illness. All of these populations are overrepresented in the correctional system. "Reaching out to these populations to provide rapid HIV testing and access to appropriate therapy will save lives and avert infections, making this a cost-averting proposition," said Montaner.

On September 5, 2008, NIDA announced that Dr. Montaner was a recipient of the inaugural Avant-Garde Award of US $2.5 million over five years to support the BC-CfE's project, Seek and Treat to Optimize Prevention of HIV & AIDS (STOP HIV/AIDS).

"NIDA's leadership in funding our proposed 'seek and treat' strategy is extremely exciting news in the fight against HIV/AIDS, both in the United States and around the world," said Montaner.

Since then, the BC-CfE has published new evidence that shows that decreasing plasma HIV-viral load in the community with expanded HAART coverage among injection drug users dramatically decreases AIDS-related morbidity and mortality (Wood et al, JAMA 2008;300:550) and new HIV infections (Wood et al, BMJ 2009;338:b1649).

"It's a significant achievement that 'seek and treat' is now accepted by the global medical community as a key pillar to fight HIV/AIDS," said Dianne Doyle, President and CEO, Providence Health Care. "Providence is greatly encouraged that NIDA, a leading international health research organization, is providing significant funding to further study ways to optimally integrate the strategy of our BC Centre for Excellence in HIV/AIDS in specific settings. This clearly demonstrates the importance of working collaboratively to advance the best possible strategies to control the spread of HIV/AIDS globally."

"The research undertaken by NIDA and the BC-CfE is critical to understanding where we should best put our resources to prevent unnecessary AIDS mortality and HIV infections," said Professor Stephen Toope, President, University of British Columbia (UBC). "As the host of the G8/G20 meeting in 2010, Canada has an opportunity and a responsibility to build on these results for the benefit of the international community. We are proud of the progress that UBC-based investigators have made as we strive to eliminate HIV and other emerging diseases."