Grant: Operating Grant - PA: HIV/AIDS Res Initiative - Hlth Svs/Population Hlth Stream

For people living with HIV and AIDS, antiretroviral therapy (ART) provides life-saving clinical benefits. Immediate ART initiation after HIV diagnosis has also been shown to be highly effective at reducing HIV transmission risk within heterosexual HIV-serodiscordant couples; however, equivalent evidence for men who have sex with men (MSM) has been limited to a few observational studies in high-income settings. Although immediate treatment after HIV diagnosis (i.e., treatment as prevention), regardless of CD4 count, is now considered best practice for key populations including MSM, the evidence in support of this policy in most real-world settings is inadequate. In China, where HIV incidence is increasing among the general population and especially among MSM, immediate ART following diagnosis is being considered by public health authorities as a possible strategy to reduce transmission. Evaluating this strategy will require data on the cascade of HIV care including linkage to care, ART initiation, retention in care, adherence, viral suppression, and HIV transmission risk to HIV-negative partners. We are therefore proposing a strategic international collaboration between the University of Toronto and the Shanghai Centres for Disease Control and Prevention (Shanghai CDC) to conduct a three-phase observational study that will investigate: (1) background HIV care indicators drawing on surveillance data (n=9,284); (2) HIV care outcomes among HIV-positive MSM who select immediate ART (CD4>=500 cells/µL) or the current standard of care (CD4<500 cells/µL) (n=236); and (3) transmission risk among the HIV-negative partners (n=360). Methods will include a retrospective study of the Shanghai CDC database and a prospective cohort study among HIV-positive MSM and their HIV-negative partners. This study is poised to make significant scientific contributions to the global evidence-base for HIV prevention and to strengthen HIV care outcomes in China and globally.