Grant: Travel Awards - Institute Community Support

There is growing evidence demonstrating the promise of antiretroviral 'Treatment as Prevention' (TasP) in reducing HIV incidence by preventing disease progression among seropositive individuals (and thus decreasing the likelihood of onward disease transmission to uninfected partners). To be effective, efforts to "scale up" TasP must also be informed by information pertaining to the social and economic realities of the implementation contexts. Some have suggested that the scale-up of TasP across several country settings provides 'natural experiments' that may yield insights regarding the ways in which this large-scale intervention interacts with particular contexts to produce potentially heterogeneous implementation experiences and outcomes. Drawing on data gathered through a multi-site, four-year longitudinal study, the presentation will describe the heterogeneous experiences of TasP scale-up in: Vancouver (Canada); Paris (France); and Rio de Janeiro (Brazil). Data were gathered using techniques associated with Implementation Science and guided by theoretical frameworks from the social sciences (e.g., risk environment theory) and population health ethics (e.g., social justice). The presentation will highlight the emergent findings, including heterogeneous effects on: HIV-related stigma; non-biomedical forms of HIV prevention; and anticipated scale-up coverage. Several features of each implementation context (e.g., socio-cultural, economic and legal contexts) and TasP programming approaches are identified and discussed in terms of their capacity to facilitate or impede effective and ethical scale-up of TasP among heterogeneous populations of people living with HIV. This presentation concludes by underlining a set of policy implications, including those within and outside of the health sector that may provide more equitable experiences and outcomes related to TasP within and across heterogeneous populations and contexts.