title: Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region.
abstract: Evidence has emerged over the past few years on the effectiveness of antiretroviral-based prevention technologies to prevent (i) HIV transmission while decreasing morbidity and mortality in HIV-infected persons, and (ii) HIV acquisition in HIV-uninfected individuals through pre-exposure prophylaxis (PrEP). Only few of the planned studies on treatment as prevention (TasP) are conducted in Asia. TasP might be more feasible and effective in concentrated rather than in generalised epidemics, as resources for HIV testing and antiretroviral treatment could focus on confined and much smaller populations than in the generalised epidemics observed in sub-Saharan Africa. Several countries such as Cambodia, China, Thailand and Vietnam, are now paving the way to success. Similar challenges arise for both TasP and PrEP. However, the operational issues for PrEP are amplified by the need for frequent retesting and ensuring adherence. This paper describes challenges for the implementation of antiretroviral-based prevention and makes the case that TasP and PrEP implementation research in Asia is much needed to provide insights into the feasibility of these interventions in populations where firm evidence of 'real world' effectiveness is still lacking.
authors.affiliation: World Health Organization Regional Office for the Western Pacific - HIV, Hepatitis and STI, P.O. Box 2932 (United Nations Avenue), 1000 Manila, Philippines.
authors.forename: Ying-Ru
authors.initials: YR
authors.lastname: Lo
authors.affiliation: World Health Organization Vietnam Country Office - HIV, 63 Tran Hung Dao Street, Hoan Kiem District, Hanoi, Vietnam.
authors.forename: Masaya
authors.initials: M
authors.lastname: Kato
authors.affiliation: Thai Red Cross AIDS Research Centre, 104 Rajdamri Road, Pathumwan, Bangkok 10330, Thailand.
authors.forename: Nittaya
authors.initials: N
authors.lastname: Phanuphak
authors.affiliation: World Health Organization Cambodia Country Office - HIV and TB, P.O. Box 1217, 177-179 Pasteur Street, Sangkat Chak Tomouk, Khan Daun Penh, Phnom Penh, Cambodia.
authors.forename: Masami
authors.initials: M
authors.lastname: Fujita
authors.affiliation: Ministry of Health Vietnam - Viet Nam Authority of HIV/AIDS Control, Ministry of Health, 135/3 Nui truc, Hanoi, Vietnam.
authors.forename: Duong Bui
authors.initials: DB
authors.lastname: Duc
authors.affiliation: Ministry of Health - National Center for HIV/AIDS, Dermatology and STD, No. 245H, National Road 6A, Sangkat Kean Klang, Khum Prek Leap, Khan Russey Keo, Phnom Penh, Cambodia.
authors.forename: Seng
authors.initials: S
authors.lastname: Sopheap
authors.affiliation: World Health Organization Regional Office for South-East Asia - HIV/AIDS and STI, WHO House, Indraprastha Estate, Mahatma Gandhi Marg, 110002 New Delhi, India.
authors.forename: Razia
authors.initials: R
authors.lastname: Pendse
authors.affiliation: World Health Organization Regional Office for the Western Pacific - HIV, Hepatitis and STI, P.O. Box 2932 (United Nations Avenue), 1000 Manila, Philippines.
authors.forename: Dongbao
authors.initials: D
authors.lastname: Yu
authors.affiliation: Chinese Center for Diseases Control and Prevention - National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, China.
authors.forename: Zunyou
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Chiang Mai University - Research Institute for Health Sciences, Chiang Mai University, P.O. Box 80 (Chiang Mai University), Chiang Mai 50202, Thailand.
authors.forename: Suwat
authors.initials: S
authors.lastname: Chariyalertsak