HIV 2016: HIV and Non-Communicable Diseases
Posted October 18, 2016
Presented By
Overview
In 1983 researchers isolated a novel T lymphotropic retrovirus with no idea of what it was, nor the danger that was to be unleashed on the world. In the 3 decades since, dramatic progress in understanding and treating this retrovirus—now called HIV—has taken place. Today, HIV is no longer a death sentence. In fact, the advent of antiretroviral therapy (ART) has extended lifespans to such an extent that HIV+ individuals are increasingly susceptible to non-communicable diseases (NCDs) associated with aging. Concerningly, incidence amongst HIV+ populations appears to surpass that seen in otherwise healthy people.
On May 26, 2016, participants gathered at the New York Academy of Sciences for HIV 2016: HIV and Non-Communicable Diseases — Opportunities and Challenges to discuss one of the next frontiers in the HIV field: how NCDs and HIV interact, how they should be treated, and how policy needs to adapt to facilitate effective treatment for people living with NCDs.
Peter Godfrey Faussett, UNAIDS, introduced the symposium, reflecting upon the progress that has been made to date. The United Nations millennium development goals (MDGs), outlined in 2000, aimed to halt the spread and reverse the incidence of HIV/AIDS, and provide universal access to treatment. By enacting efforts to properly understand the epidemic, maintaining focus, scaling actions appropriately, ensuring sustainability, and building upon national strategies already in place in almost all countries, the HIV epidemic was turned around.
As we now move on to the Sustainable Development Goals (SDGs) the focus has shifted to integration of services across the spectrum of disease. Today's symposium aims to (1) map our understanding of the epidemiology and biology of the interactions between HIV and NCDs, (2) provide examples of programmatic interventions to improve lives of people living with HIV globally, (3) promote ideas for integrating services and programs, (4) delineate the implications of these intersections for different stakeholders, and finally (5) think about the next steps for research and policy.
Global Action Plan for Combatting HIV and NCDs (image courtesy of Peter Godfrey Faussett)
Session I explored the biology of HIV and NCDs. Andrew Phillips, University College London, introduced complex epidemiological evidence for an association between HIV and NCDs. He illustrated that there is evidence for excess risk of serious disease due to HIV even in people with viral suppression and that contributing factors include ongoing CD4 cell immunodeficency, inflammation and coagulation, and adverse effects of ART. He then focussed on studies comparing people with HIV who have viral suppression and high CD4 count with people without HIV—these do not generally show large differences in risk. However, there is high potential for selection and confounding biases in these comparisons. For example, there is confounding due to differences between people with HIV and people without, with smoking, drug use, socio–economic status and mental health being examples of possible confounders. Another key issue when considering people with viral load suppression and high CD4 count is the fact that we are selecting within HIV positive people for those with better adherence and health seeking behaviour generally. He noted also that even small increased relative risks of CVD or cancer associated with HIV should not be ignored because they will become much more significant in absolute terms as people age. He also noted that re-normalisation of CD4 count level may not be achievable and, where it is, can take several years. Finally, we should remain vigilant over potentially unidentified adverse effects of antiretroviral drugs.
Screening for CD4 count can bias comparisons between HIV+ and HIV− populations (image courtesy of Andrew Phillips)
Synthesizing the available evidence, there appears to be a 1.5–2 fold increased risk of comorbid NCDs, among people with treated HIV infection. While on the face of it the relative risk ratio is small, this needs to be extrapolated to an absolute scale, and may still be very consequential in older ages. It remains to be determined whether a person who enters care early, and remains adherent, retains this risk increase.
Steven Deeks, University of California, San Francisco, explored the biological underpinnings of increased NCD incidence, and accelerated aging, observed in HIV+ populations. HIV+ status leads to stem cell exhaustion, telomerase inhibition (via ARTs), dysregulated nutrient sensing, mitochondrial toxicity, T cell senescence, and chronic inflammation all of which have been convincingly associated with poor prognosis in the general population.
Inflammation is increasingly being implicated in a broad spectrum of illness. Once activated, inflammation damages blood vessels, causing vascular and atherosclerotic disease, which impairs cardiovascular, pulmonary, kidney, and liver function . Moreover the impact of elevated inflammatory markers (IL-6, D-dimer, hsCRP), is prolonged in the context of HIV infection, exacerbating the sequelae. Moving forward, a better understanding of the biological processes driving inflammation could lead to effective interventions targeted towards the underlying causes. Because inflammation is a target in many diseases, we can learn from progress in adjacent fields to accelerate advances. In the shorter term, it is much easier to prevent aging and inflammation, than to reverse it, so early diagnosis, and treatment interventions may improve outcomes.
Inflammation, triggered by HIV, drives a cascade of adverse biological events (image courtesy of Steven Deeks)
In addition to an increased risk for NCDs and heightened susceptibility to the effects of inflammation, the possibility of negative interactions between ART and treatment for NCDs needs to be considered. Saye Khoo, University of Liverpool, spoke about how the aging HIV+ population is leading to increased prevalence of multiple morbidities, and rising polypharmacy. Multiple morbidities significantly increases the risk of harm from drug-drug interactions. Clinical guidelines are not tailored to multiple morbidities and drug interaction studies tend to inadequately explore the impact of co-treatment on relevant populations. Careful re-consideration of clinical guidelines, and improving medical history recording and access is required.
To this end, tools for crosschecking drug–drug interactions are evolving. Liverpool has produced a website and app www.hiv-druginteractions.org to serve this purpose. Additionally, STOPP—START (screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START)) is a recently revised tool that acknowledges adverse events as well as opportunities for synergy, in older patients. Concluding with some practical examples of how to manage drug–drug interactions clinically, Khoo re-iterated the importance of incorporating multiple morbidity and polypharmacy into medical training, drug development, treatment strategies, medical record administration, and policy, in order to best tailor health care approaches to the individual patients.
Session II shifted towards an exploration of policy. Tim Mastro, FHI360, introduced the session, with a message of building on HIV/AIDS Investments for NCD Prevention and Control. Unprecedented levels of investment have been committed to preventing and treating HIV, and further investments are currently being funneled towards NCD care in HIV clinics, but the need to broaden efforts to be inclusive of all people with NCDs is clear. In order to maximize the reach of NCD programs the most parsimonious path forward is to leverage existing HIV investments to advance NCD prevention and control, but scaling up NCD support is not a trivial task and given the current funding climate, cost effectiveness is critical. How can we build on HIV investments for ongoing HIV and NCD control efforts, globally?
Programs relating to NCD care can be subcategorized under the banners of prevention, diagnosis, enrollment into care, disease management, and palliative care. Linking the programs for testing, diagnosis, and care has been a very useful strategy for addressing needs in the HIV field, and given that the infrastructure is already in place, it makes sense to consider further integrating NCD programs. However, it can be difficult to convince funders to move away from vertical programs (with narrow foci) to a broader view. Moreover, just as treatment should aim to be personalized to the individual, intervention models should also be tailored to the environment: what works for retention in Thailand may not be the same as what works in Botswana.
Intersections between HIV and NCDs provide a strong rationale for integrating efforts (image courtesy of Tim Mastro)
Rebecca Dirks, FHI360, expanded on the benefits and challenges of program integration, outlining considerations that should be taken into account in order to maximize chances of success. Integrated health screening can reduce stigma associated with illness, increasing use of services, and improving self-management and empowerment. It is also of logistical benefit saving time for the individual and the workforce. Perhaps most importantly, it allows for treating individuals as a whole, rather than focusing on a single disease.
The potential benefits of integrating HIV and NCD services are numerous (image courtesy Rebecca Dirks)
However, integration models require additional resources and there is a lack of methodological evidence for their effectiveness. Thus, as we map out the path forward a clear understanding of the challenges and goals will be critical. The lack of adequate health insurance coverage poses a considerable barrier to NCD services. Moreover there is limited awareness of NCD prevalence among both the general population and health care providers, necessitating improved educational training. Finally, misperceptions with regards to the impact of NCDs are also common, and the need for long term management of the illness is underestimated. These barriers all have parallels in the HIV field and we can look to progress made there, to inform strategies for addressing these concerns.
There are many opportunities for synergism however in order to be effective, integration needs to be as extensive as possible, reflected in policy, management, resource allocation, training and supervision, and service delivery in hospitals and health centers, and funding further implementation research to develop an evidence base for optimizing NCD approaches, is crucial.
Kwasi Torpey, FHI360, illustrated the need for a more integrated approach to HIV and NCD treatment, with a case study from Zambia of a 43 year old woman had been regularly monitored in the clinic, following her HIV diagnosis in 2001. She was an adherent patient who appeared to be in good health, with low viral load and CD4 counts above 450 cells/µL. In April 2008, she was rushed to ER in serious condition and died within 2 hours of admission. Postmortem analysis showed intracranial hemorrhage. How did the system fail this patient and what lessons can be learned? An integrated approach to health care may be the answer.
Pilot programs integrating cardiovascular and diabetes services into existing HIV infrastructure have been deployed at 3 African sites in Kenya, Zambia, and Nigeria. Thousands of people have been screened for NCDs at these sites, and the local communities overwhelmingly support provision of services beyond HIV treatment. Beyond screening, these pilot programs are contributing data towards the evidence base for an interaction between HIV and NCDs. Torpey discussed some of the emerging findings, concentrating on the relationships between HIV, ART, and NCDs.
Pilot programs at 3 African sites have integrated cardiovascular services into HIV health centers, providing important epidemiological data for the link between HIV and NCDs (image courtesy of Kwasi Torpey)
Thus, the chronic care model appears to be a feasible strategy, when paired with user friendly collection and monitoring tools that facilitate data collection. Moreover, these resources appear to promote positive health seeking behavior. As countries move towards universal access, integration offers a platform for reaching clients regardless of HIV status and will help with de-stigmatization.
The Panel Discussion provided an opportunity for broader reflection on the intersections between HIV and the range of NCDs. The panel comprised David Hoos, Mailman School of Public Health, Columbia University, who has worked in programmatic delivery of HIV care with PEPFAR, Maureen Goodenow, University of Florida Health, whose experience covers research and policy, and Roy Small, UNDP, who brought a UN perspective with a focus on development.
Panelists and audience members discussed the great strides made towards achieving the MDGs, and discussed how to leverage existing infrastructure and programs to achieve the SDGs. The vertical approach has provided a lot of return on investment, including facilities and capabilities that can be leveraged for multiple illnesses and needs. Furthermore, HIV programs have transformed medical practice, expanding beyond medication to incorporate counseling, outreach, community engagement, and attention to stigma and discrimination. This legacy, in combination with emerging technological tools (mobile phones and web based applications) is very useful for NCDs where further destigmatization and demedicalization is required. There is also an opportunity to capitalize on the biological advances made in the HIV field, to explore the biology of macrophages, monocytes, and other inflammatory pathways, ultimately benefitting the broader research community.
The benefits of a shift towards integrated services are numerous and may neutralize some resentment currently felt towards appropriated funds for HIV research, however it requires an updated strategy, taking into consideration the variability in national programs for HIV care. Well-reasoned leadership is a very important factor in dealing with these issues. How can we change the funding behaviors, and convince stakeholders of the long-term benefits of this approach? The HIV field has successfully framed its argument for funding as an investment—it isn't money spent on the issue, it is money saved in the future. This strategy needs to be coopted for the SDGs, and a solid foundation of evidence will allow us to take that route. In closing, Hoos brought home an important reminder, that this is not just a high level discussion about government processes and policy. This concerns individuals, and we need to think about how all of these decisions will impact practitioner / patient interactions. We are all getting older, and facing these issues; so the conversation should adopt an inclusive tone.
The final plenary lecture was delivered by Linda Kupfer, Fogerty International Center, NIH. Inspired by discussion throughout the day, Kupfer began with a demonstration of the Council of Foreign Relations Report on NCDs website; an interactive report that includes economic information and graphical representations of compelling statistics that address rising NCD incidence across the developing world.
Kupfer went on to cover the current PEPFAR NCD project, which aims to engage existing HIV/AIDS platforms to address the rising burden of NCDs in low resource settings. Partnering with key organizations including government agencies, implementers, NGOs, and academics, the project has defined a landscape analysis, developed research questions, and identified activities for exploring these questions. Key barriers that need to be overcome include (1) shortage of healthcare workers, (2) a weak health system, (3) lack of reliable/integrated medical commodities, (4) limited funding, and (5) monitoring and evaluation facilitating demonstration of impact resulting from the programs. While some of these barriers are clearly surmountable, others require a more solid evidence base, in order to provide recommendations to the ministries of health, policy makers, and funders. In this way, the path forward relies upon an energized and engaged research community.
Presented by
Note: The HIV 2016: HIV and Non-Communicable Diseases — Opportunities and Challenges symposium was cosponsored by the Joint United Nations Programme on HIV/AIDS (UNAIDS). The views expressed in symposium materials or publications, by speakers and moderators, or by any symposium cosponsors do not necessarily reflect the official views or policies of UNAIDS; nor does mention of trade names, commercial practices, or organizations imply endorsement by UNAIDS.
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Grant Support
This program is supported by an educational grant from Gilead Sciences, Inc.
How to cite this eBriefing
The New York Academy of Sciences. HIV 2016: HIV and Non-Communicable Diseases. Academy eBriefings. 2016. Available at: www.nyas.org/HIVNCD-eB
Resources
Journal Articles
Wallet MA, Buford TW, Joseph AM, Sankuratri M, Leeuwenburgh C, Pahor M, Manini T, Sleasman JW, Goodenow MM., Increased inflammation but similar physical composition and function in older-aged, HIV-1 infected subjects. BMC Immunol. 2015 Jul 24;16:43. doi: 10.1186/s12865-015-0106-z.
Piot P, Caldwell A, Lamptey P, Nyrirenda M, Mehra S, Cahill K, Aerts A., Addressing the growing burden of non-communicable disease by leveraging lessons from infectious disease management. J Glob Health. 2016 Jun;6(1):010304. doi: 10.7189/jogh.06.010304.
Pearce N, Ebrahim S, McKee M, Lamptey P, Barreto ML, Matheson D, Walls H, Foliaki S, Miranda JJ, Chimeddamba O, Garcia-Marcos L, Haines A, Vineis P., Global prevention and control of NCDs: Limitations of the standard approach. J Public Health Policy. 2015 Nov;36(4):408-25. doi: 10.1057/jphp.2015.29. Epub 2015 Sep 17.
van Dam CJ, Baumgartner JN, Mastro TD., Managing depression in countries with low and middle incomes: an imperative for human immunodeficiency virus/acquired immune deficiency syndrome care and treatment and general public health. Psychosom Med. 2012 Nov-Dec;74(9):880-1. doi: 10.1097/PSY.0b013e318278eeef. Epub 2012 Nov 1.
Oni T, Unwin N., Why the communicable/non-communicable disease dichotomy is problematic for public health control strategies: implications of multimorbidity for health systems in an era of health transition. Int Health. 2015 Nov;7(6):390-9. doi: 10.1093/inthealth/ihv040. Epub 2015 Jun 23.
Ananworanich J, Avihingsanon A., HIV and noncommunicable diseases: the Asian perspective. J Acquir Immune Defic Syndr. 2014 Sep 1;67 Suppl 1:S99-103. doi: 10.1097/QAI.0000000000000262.
Grund B, Baker JV, Deeks SG, Wolfson J, Wentworth D, Cozzi-Lepri A, Cohen CJ, Phillips A, Lundgren JD, Neaton JD; INSIGHT SMART/ESPRIT/SILCAAT Study Group., Relevance of Interleukin-6 and D-Dimer for Serious Non-AIDS Morbidity and Death among HIV-Positive Adults on Suppressive Antiretroviral Therapy. PLoS One. 2016 May 12;11(5):e0155100. doi: 10.1371/journal.pone.0155100.
Lamptey P, Dirks R., Building on the AIDS response to tackle noncommunicable disease. Glob Heart. 2012 Mar;7(1):67-71. doi: 10.1016/j.gheart.2012.01.010. Epub 2012 Mar 10.
Websites
The Emerging Crisis: Noncommunicable Diseases
From the Council of Foreign Relations
HIV Drug Interaction Checker
From the University of Liverpool
Noncommunicable Diseases
From the World Health Organization
UN Interagency Task Force on NCDs (UNIATF)
From the World Health Organization
Organizers
Peter Godfrey-Faussett, BA, MBBS, DTM&H, FRCP (UK)
UNAIDS
website | publications
Peter Godfrey-Faussett is a professor at the LSHTM and consultant physician at the Hospital for Tropical Diseases. After training in clinical infectious diseases and molecular genetics, he spent five years leading the Zambian AIDS-related TB (ZAMBART) project, an interdisciplinary collaborative research programme between the LSHTM, Lusaka Urban District Health Management Team and the University of Zambia. Thereafter he spent a year working with the Global Tuberculosis Programme of the World Health Organization, where he was responsible for developing strategies to address the combined epidemic of TB and HIV. Following his return to London he has maintained an interest in global policies around TB and HIV and served as chairman for the Technical Review Panel of the Global Fund against AIDS, Tuberculosis and Malaria. A regular member of WHO expert groups, his research interests remain focused on the impact that the HIV epidemic is having on TB control and on interventions to reduce both diseases. He is currently seconded full-time to UNAIDS, where he is the Senior Science Adviser with a wide ranging portfolio including HIV cure, ARV-based HIV prevention, HIV vaccines and synergies between the HIV and the non-communicable disease response.
Maureen Goodenow, PhD
University of Florida Health
website | publications
Dr. Goode now is a Professor of Pathology, Immunology, and Laboratory Medicine, holds the Stephany W. Holloway University Endowed Chair for AIDS Research at the University of Florida, and is the Director of the Florida Center for AIDS Research. She received her PhD in molecular genetics from Sue Golding Graduate School at the Albert Einstein College of Medicine in New York. Following a postdoctoral fellowship in molecular oncology at the Sloan Kettering Institute in New York, she was a visiting scientist at the Pasteur Institute in Paris, where she initiated her studies of HIV. Dr. Goodenow has a research program in molecular epidemiology, pathogenesis, and vaccines for HIV and related viruses, including viruses that cause cancer.
Jill A. Kanaley, PhD
University of Missouri
website | publications
Areas of interest and expertise include: Exercise endocrinology and metabolism, issues related to obesity and type 2 diabetes and weight loss with diet and exercise, effects of meal frequency and composition on the hormonal responses (e.g., insulin, incretin hormones, etc.) in obese individuals, and if exercise training will alter this response and GH responses to exercise and how they change with diet and exercise.
Linda Kupfer, PhD
NIH Fogarty International Center
publications
Dr. Kupfer has spent over a decade at the Fogarty International Center (FIC) at the National Institutes of Health. She is currently a senior scientist at the Center for Global Health Studies, FIC. Dr. Kupfer recently spent two years (2011–2013) on detail at the US State Department, Office of the Global AIDS Coordinator, as a Senior Policy Advisor. In 2006, she served as the NIH Acting Director for Evaluation in the NIH Office of the Director. Dr. Kupfer's global research interests include the integration of non-communicable and communicable diseases in health delivery systems in low and middle income countries, implementation science and program evaluation, and she is particularly interested in the role of capacity building in international research. Dr. Kupfer received her bachelor's degree in Psychology from Cornell University and her MSc and PhD in Pharmacology from Columbia University before commencing a AAAS Science Diplomacy Fellowship at the State Department. Since receiving her doctorate Dr. Kupfer has held a number of posts focused on Science and Science Policy, including Program Officer for Bilateral Science Programs at the State Department and Director of Marine Biotechnology at the National Sea Grant College Program, NOAA.
Peter Lamptey, MD, DrPH, MPH
London School of Hygiene and Tropical Medicine, Centre for Global Non-Communicable Diseases
website | publications
Dr. Peter R. Lamptey is a public health physician and expert on health and development in developing countries, with particular expertise in communicable and non-communicable diseases. Throughout his more than 30 year career at FHI 360, he has played a pivotal role in establishing the organization as a leader in implementing HIV/AIDS prevention, care, treatment and support programs. From 1987 to 2007, Lamptey directed several key projects funded by the U.S. Agency for International Development (USAID), encompassing HIV/AIDS programs in more than 65 countries in Africa, Asia, Eastern Europe, Latin America and the Caribbean, and the Middle East. Lamptey serves on the CSIS Commission on Smart Global Health Policy and is a member of the Lancet Commission on Future Health of Sub-Saharan Africa. He is also a member of the Network of African Science Academies Committee on the Negative Effects of Tobacco on Africa's Health, Economy, and Development and was formerly a member of the Institute of Medicine's Committee on Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health.
Timothy Mastro, MD, FACP, DTM&H
FHI 360
website | publications
Dr. Timothy Mastro is Director of Global Health, Population & Nutrition at FHI 360, Durham, North Carolina, USA. He trained in primary care internal medicine in New York City. He is also Adjunct Professor of Epidemiology in the Gillings School of Global Public Health, University of North Carolina at Chapel Hill. Dr. Mastro oversees FHI 360's health, population and nutrition research and program science conducted in the United States and through FHI 360's offices in 50 countries around the world. Dr. Mastro joined FHI in 2008 following 20 years in scientific leadership positions at the US Centers for Disease Control and Prevention (CDC) in Atlanta. He joined CDC in 1988 as an Epidemic Intelligence Service Officer. At CDC his work addressed HIV, TB and STI prevention research and programs in the United States and in 25 countries in Asia, Africa and Latin America. During 1993–2000, he served in Bangkok as Director of the CDC HIV/AIDS collaboration with the Thai Ministry of Public Health. Dr. Mastro began his international public health career on the Thai-Cambodian border, where he served as a physician and medical coordinator of the United Nations Border Relief Operation. Dr. Mastro is author or co-author of more than 160 published articles and book chapters and has served on several committees for the World Health Organization, UNAIDS, PEPFAR and the US National Institutes of Health. Dr. Mastro trained in internal medicine in New York City at Metropolitan Hospital and Mount Sinai School of Medicine. He studied at the London School of Hygiene and Tropical Medicine and received a DTM&H from the Royal College of Physicians of London. He is board certified in internal medicine, a fellow of the American College of Physicians, and a member of the American Epidemiological Society.
Celeste Sandoval, BSN, RN, MHSS
UNAIDS
website
Celeste Maria Sandoval is Science Adviser at UNAIDS in Geneva. She manages the "UNAIDS Science now" web platform that hosts "HIV this month", which provides monthly updates on what's new in HIV science from scientific journals. She is also one of two people from UNAIDS who sits as part of the UN Interagency Task Force on the prevention and control of noncommunicable diseases. Previously, she has served as technical officer in HIV prevention. Before joining UNAIDS, she was a research associate at the Social Development Research Centre at De La Salle University in Manila, Philippines and was involved in research on gender, violence against women, and in developing education materials for malaria. She was also part of the secretariat of the Asia-Pacific Regional Network of International Forum for Social Sciences in Health. Prior to that, she was working as a hospital nurse in Cebu City. She holds a Bachelor of Science in Nursing and a Master of Health Social Science. She has certificates in gender, sexuality, fertility and reproductive health from the University of Melbourne and the Universitiet van Amsterdam.
Sonya Dougal, PhD
The New York Academy of Sciences
publications
Dr. Sonya Dougal serves as the Director of Life Sciences Discussion Groups at the New York Academy of Sciences. In this role, she provides strategic development and oversight of an annual portfolio of 30 scientific workshops on pressing topics across the life sciences and biomedical research. The mission of this program is to build and convene communities of academic, industry, and government scientists, clinicians, and others with similar scientific interests for the open exchange of ideas on the frontiers of science. Dr. Dougal has over 14 years of experience in scientific research and program management in academia, industry, and the non-profit sector. She was most recently Director of the Steven and Alexandra Cohen Veterans Center at NYU Langone where she oversaw the administration of a $30 million program dedicated to discovering biomarkers for Post-Traumatic Stress and Traumatic Brain Injury and providing mental health care for veterans and their families. Previously, she worked at the Academy as a member of the Conferences Department and was the founding Director of the Academy's Alzheimer's Disease and Dementia Initiative. Dr. Dougal was a Project Manager at Eric Marder Associates, a market research company, and served as a scientific consultant for R. G. Niederhoffer Capital Management.
Caitlin McOmish, PhD
The New York Academy of Sciences
publications
Caitlin McOmish began her scientific career at the University of Melbourne where she completed a BSc (Hons) and PhD in Neuroscience. She was recruited to a postdoc in New York for which received a CJ Martin Overseas Biomedical Fellowship from the NH&MRC. This fellowship allowed her to split her time between the labs of Prof Jay Gingrich at Columbia University, NY, USA, and Prof Brian Dean at the Florey Neuroscience Institute of Mental Health, Melbourne, Australia. During this period she engaged in freelance editing and science writing, as a way of exploring non-academic careers. Caitlin transitioned out of academic work, joining the New York Academy of Sciences as a Program Manager for the Life Sciences Discussion Groups, in 2015.
Speakers
Anchalee Avihingsanon, MD
The HIV Netherlands Australia Thailand Research Collaboration
website | publications
Anchalee Avihingsanon is a specialist in infectious diseases. She joined HIV–NAT in 2003 as a research physician, and since then she has led and coordinated over 40 clinical trials investigating various aspects of HIV. She is Thailand country coordinator for START and other INSIGHT Network studies, and is member of the INSIGHT Network Steering Committee. She obtained both Thai government and international funding to investigate research questions of relevance to Thailand and the region, including the pharmacokinetics of low dose antiretrovirals, and studies of tuberculosis, hepatitis B and C, and HIV renal disease. Dr. Avihingsanon has been Chief of the HIV–NAT Medical Department since 2009. She is on the writing committee for Thai HIV Treatment Guidelines, and a member of Track B planning the 2013 International Congress on AIDS in Asia and the Pacific. She advises the TRC-ARC's Community Advisory Board (CAB).
Steven G. Deeks, MD
University of California, San Francisco
website | publications
Steven G. Deeks is a Professor of Medicine in Residence at the University of California, San Francisco (UCSF) and a faculty member in the Positive Health Program (AIDS Program) at San Francisco General Hospital. Dr. Deeks has been engaged in HIV research and clinical care since 1993. He is a recognized expert on HIV-associated immune dysfunction and its impact on HIV persistence (the "reservoir") and health during antiretroviral therapy. Dr. Deeks has published over 350 peer-review articles, editorials and invited reviews on these and related topics. He has been the recipient of several NIH grants, and one of the principal investigators of DARE (the Delaney AIDS Research Enterprise), which is a U19-funded international collaboratory aimed at developing therapeutic interventions to cure HIV infection. He is the co-chair of the "Towards an HIV Cure" International Working Group and a co-chair of the NIH Office of AIDS Research Toward a Cure Planning Group. He is also a member of the Office of AIDS Research Advisory Council (ORAC). He was elected to the American Society for Clinical Investigation (ASCI), and serves on the advisory board for Science Translational Medicine and eBioMedicine. In addition to his clinical and translational investigation, Dr. Deeks maintains a primary care clinic for HIV infected patients, and was recently a member of the Department on Health and Human Services Panel on Antiretroviral Guidelines for Adults and Adolescents.
Rebecca Dirks, MA
FHI360
website
Rebecca Dirks is a public health expert with over a decade of professional experience in program implementation, technical assistance, public health project management, and assessments of public health programs. Her expertise is in public health approaches to addressing non-communicable disease, health service integration, HIV counseling and testing, and HIV prevention. At present Ms. Dirks serves as a Senior Technical Officer at FHI 360 in Washington, DC, where she provides technical assistance and project management for the organization's non-communicable disease initiative. She is the Project Director of Abundant Health, a community-based hypertension and diabetes project in Vietnam and serves as a Technical Advisor for the Community-based Hypertension Improvement Project (ComHIP) in Ghana. She has contributed to a number of integrated NCD/HIV projects in African countries. Ms. Dirks has authored numerous publications on non-communicable disease and HIV/AIDS in peer reviewed journals and presentations in international conferences. She has worked in over ten countries and is adept at working with community members and decision makers from across cultures.
Peter Godfrey-Faussett, BA, MBBS, DTM&H, FRCP (UK)
UNAIDS
website | publications
Maureen M. Goodenow, PhD
University of Florida Health
website | publications
Mark Harrington
Treatment Action Group
website | publications
Mark Harrington was born and raised in San Francisco, CA. He studied film, photography, history and literature at Harvard, where he graduated in 1983. In 1988 he joined the AIDS Coalition to Unleash Power (ACT UP)/New York, where he was a key member of its Treatment + Data (T+D) Committee, and with whom he helped lead the 1988 "Seize Control of the FDA" and 1990 "Storm the NIH" demonstrations. In 1992 along with other members of T+D he cofounded Treatment Action Group (TAG), where he has been executive directo since 2002. He cowrote AIDS Research at the NIH: A Critical Review with Gregg Gonsalves; its recommendations were included in the NIH Revitalization Act of 1993. He cowrote Problems with Protease Inhibitor Development Plans (1995) and wrote Viral Load in Vancouver (1996). He served as a member of the U.S. panel on Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents (1997–2010) and the World Health Organization (WHO) writing groups on Scaling Up Antiretroviral Therapy in Resource-Limited Settings: Treatment Guidelines for a Public Health Approach (2003, 2006), the WHO Interim policy on collaborative TB/HIV activities (2004), and recommendations to improve the diagnosis of smear negative pulmonary and extrapulmonary TB among adults in HIV prevalent and resource constrained settings (2007). He was a member of the Global TB/HIV Working Group in the Stop TB Partnership (20032014) and served on New York Governor Andrew Cuomo's Ending the Epidemic Task Force (October 2014 – January 2015) that developed New York's plan to end AIDS as an epidemic by 2020. Currently he is a member of the AIDS Clinical Trials Group Tuberculosis Transformative Sciences Group (ACTG TB TSG), the International AIDS Society (IAS) Stakeholders' Advisory Board for a Global Scientific Strategy Towards a Cure, and the Ending the Epidemic Subcommittee of the New York State AIDS Advisory Council. He is a member of the PEPFAR Scientific Advisory Board (SAB) and co-chairs it's TB/HIV Expert Working Group. In 1997 he was awarded a MacArthur Foundation fellowship and in 2012 the HealthGAP Evan Ruderman Global Health Justice Award.
David Hoos, MD, MPH
Mailman School of Public Health, Columbia University
website | publications
Dr. David Hoos is the project director for ICAP's PHIA Project, which is conducting population-based HIV impact assessments to measure HIV incidence and viral suppression in 20 PEPFAR-supported countries. He was senior implementation director at ICAP from 2004 to 2013 and was the director of the Multicountry Columbia Antiretroviral Program (MCAP), an eight-year cooperative agreement funded by the CDC, which supported the scale-up of HIV prevention, care and treatment in Cote d'Ivoire, Ethiopia, Kenya, Mozambique, Nigeria, Rwanda, South Africa, and Tanzania. Dr. Hoos was an initial member of the MTCT Plus Secretariat at Columbia's Mailman School of Public Health and was responsible for establishing the procurement system for antiretroviral and other HIV-associated medications and diagnostics for the program sites. Dr. Hoos has been recognized as a technical expert in a number of areas related to HIV policy and programming. He served as a member of the Technical Review Panel for the Global Fund for AIDS, TB and Malaria (GFATM), as well as a co-chair for the Procurement and Supply Management Advisory Panel to the GFATM on procurement-related policy and country guidance. He has been a member of several WHO technical panels and was seconded to UNAIDS in Geneva as a treatment advocacy advisor for eight months in 2011. Dr. Hoos is a board-certified internist and holds a Master of Public Health degree.
Saye Khoo, MB, BS, MRCP, DTM&H, FRCP, MD, GDipEpi
University of Liverpool
website | publications
Professor Saye Khoo is Honorary Consultant Physician in Infectious Diseases at the Royal Liverpool University Hospital, and Professor in the School of Biomedical Sciences at the university of Liverpool. His research focuses on the pharmacology of HIV treatment failure and how therapy may be improved through individualized care through understanding of why drug exposure varies markedly between individuals (and the role of individual characteristics such as weight, gender, host genetics and drug interactions), and identify vulnerable groups who are at particular risk of failure, or toxicity. These studies span bench science, through translational research and into the clinic, and onwards to population based modelling approaches.
Linda Kupfer, PhD
Fogarty International Center, NIH
publications
Andrew Phillips, PhD
University College London
website | publications
Andrew Phillips is Professor of Epidemiology in the HIV Epidemiology and Biostatistics Group at UCL working on HIV observational cohorts (including EuroSIDA, D:A:D, CASCADE, COHERE), randomized trials (including INSIGHT SMART and START trials) and simulation modelling (HIV Synthesis model). Particular areas of interest have included HIV natural progression, virologic failure, drug resistance, adverse effects of ART, and the link between HIV and risk of non-AIDS diseases. He uses an individual-based simulation model of HIV transmission, progression and the effect of ART in an attempt to address public health questions not addressable in trials or analyses of observational studies, both in developed and developing country contexts. Much of his work involves close collaboration with Copenhagen HIV Programme (CHIP).
Timothy Mastro, MD, FACP, DTM&H
FHI 360
publications
Wafaa El Sadr, MD, MPH
Mailman School of Public Health, Columbia University
website | publications
Wafaa El-Sadr is University Professor of Epidemiology and Medicine and Mathilde Krim-amfAR Professor of Global Health at Columbia's Mailman School of Public Health and College of Physicians and Surgeons. Through ICAP at Columbia University, the Center she established more than a decade ago, large scale programs have been established in sub Saharan Africa and Asia that integrate research, education, training and practice. ICAP works closely with US government agencies, international organizations, academic institutions, private sector, community-based organizations and civil society groups in the pursuit of responsive, inclusive, sustainable and innovative approaches to addressing global health threats and achieving public health impact. Dr. El-Sadr's research interests are diverse and include research on the prevention and treatment of HIV, tuberculosis, non-communicable diseases, maternal–child health among others. She is focused on implementation science research as a means to taking discoveries to action, ensuring that the benefits of scientific discoveries are garnered by populations around the world. She received her medical degree from Cairo University, a masters in public health from Columbia's Mailman School of Public Health and a masters in public administration from Harvard University's Kennedy School of Government. She was named as McArthur fellow and is a member of the National Academy of Medicine.
Roy Small
United Nations Development Programme
Kwasi Torpey, MD, PhD, MPH, FGCP
FHI360
website | publications
Kwasi Torpey is a physician, public health program manager, researcher and an Associate Professor of Population, Family and Reproductive Health with 19 years of experience in public health programming in HIV, malaria, TB, reproductive health and non-communicable disease programs in several African countries Professor Torpey served as Deputy Chief of Party, Technical for FHI360's USAID-funded Strengthening Integrated Delivery of HIV/AIDS (SIDHAS) project in Nigeria. Before this position, he was the Regional Senior Technical Advisor and Director, Technical Support for FHI/Zambia where he provided support to country programs in Africa. He has extensive experience in public health programming and implementation in HIV, malaria, TB and reproductive at different levels of the health care system as well as the community level in a number of African countries. Professor Torpey has been a global thought leader in the integration of non-communicable diseases and reproductive health into HIV programming. He has published several scientific articles in international peer reviewed journals Professor Torpey received his medical training from the University of Ghana Medical School. He received his PhD from the Institute of Tropical Medicine / University of Antwerp in Belgium. He is a fellow of the Ghana College of Physicians and Surgeons.
Sponsors
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Note: The HIV 2016: HIV and Non-Communicable Diseases — Opportunities and Challenges symposium was cosponsored by the Joint United Nations Programme on HIV/AIDS (UNAIDS). The views expressed in symposium materials or publications, by speakers and moderators, or by any symposium cosponsors do not necessarily reflect the official views or policies of UNAIDS; nor does mention of trade names, commercial practices, or organizations imply endorsement by UNAIDS.
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Grant Support
This program is supported by an educational grant from Gilead Sciences, Inc.