Grant: Applied Public Health Chair

The expansion of access to antiretroviral therapy (ART) has led to a dramatic reduction in HIV-related death and disease and transformed HIV into a chronic manageable illness. Now, the potential of HIV Treatment as Prevention (TasP) suggests that earlier and more aggressive treatment will extend the personal benefits of ART to produce important population health benefits, particularly in decreasing the number of new HIV infections. A world where HIV is no longer a global public health emergency can be envisaged, even in sub-Saharan Africa (SSA). Since 2001, the Academic Model Providing Access to Healthcare (AMPATH) program, headquartered in Eldoret, Kenya, has enrolled >150,000 HIV-infected patients across a swathe of western Kenya. AMPATH has already conducted widespread door-to-door HIV testing and is now undertaking to test/re-test (Find) >95% of all eligible adults and children in its catchments, Link to care >80% of those found to be positive, Treat 100% of those who are eligible according to current treatment guidelines, and Retain 95% of those treated. This population-health intervention, called FLTR (Find-Link-Treat-Retain), aims to improve health and health equity across the lifespan of both the general population of these catchments as well as Most At-Risk Populations (MARP), including high-risk youth, commercial sex workers, pregnant women, and adult men (all at high risk of acquiring HIV and/or less equitably accessing HIV prevention, care, and treatment services). The primary objective of my program of research is to evaluate the impact of this population-health intervention of HIV testing, care and treatment in an HIV endemic region of East Africa. The primary outcomes are a reduction in HIV incidence, and improved equity in, access to, and outcomes from HIV care. The implications and applications of this population-health intervention are far-reaching for both low- and high-income settings, including Canada.