TREAT Asia: A Cooperative Approach to HIV/AIDS

March 2003—"South Asia stands at what epidemiologists call the 'tipping point' in the trajectory of disease," said UNICEF Executive Director Carol Bellamy at a meeting of South Asian governments on HIV/AIDS in February.

A host of indicators point to the very real possibility of a catastrophic HIV/AIDS epidemic in Asia and the Pacific. An estimated one million people in Asia and the Pacific were newly infected with HIV in 2002, an increase of 10 percent over 2001, bringing the total number living with HIV/AIDS in the region to 7.2 million (UNAIDS). Half a million died of AIDS in the region last year. India is set to surpass South Africa as the country with the most HIV/AIDS cases in the world. A study in the 12 March issue of the Journal of the American Medical Association depicts a "hidden epidemic" of sexually transmitted diseases in China, and an accompanying editorial says that "the crucial question for China remains its vulnerability to a widespread heterosexual HIV epidemic."

We have witnessed the dreadful consequences of inaction on AIDS in sub-Saharan Africa. While some governments in Asia are stepping up their HIV prevention efforts, the response to HIV/AIDS in the region must be commensurate with the scale of the threat. A comprehensive response should include treatment and prevention, care, research, education, and training, and

must involve cooperation and partnership between the public and private sectors. As an important component of this response, amfAR has launched an innovative initiative called Therapeutics Research, Education, and AIDS Training in Asia—TREAT Asia. This cooperative initiative is designed to help prepare Asia and the Pacific for the safe and effective delivery of HIV/AIDS treatments as they become more widely available across the region.

Fewer than 50,000 people are currently on antiretroviral treatment in Asia and the Pacific—less than one percent of those living with HIV/AIDS. Reductions in the price of HIV/AIDS treatments and the increasing availability of generic versions of some drugs have paved the way for expanded access to antiretroviral therapy. But as has been made clear in Africa, access to treatment is just one of the many challenges to be faced in trying to extend the benefits of HIV/AIDS therapeutics to people in the developing world. Misuse of antiretrovirals could accelerate the development of drug-resistant strains of HIV, and as treatment access broadens, the complexities of medical management will only increase, underscoring the need for specialized education and training.

What is TREAT Asia?
TREAT Asia is a network of clinics, hospitals, and research sites working together to ensure the safe and effective delivery of AIDS treatments throughout Asia and the Pacific. It will achieve its purpose by conducting research on appropriate treatment regimens, training health care workers, educating affected communities, and building regional collaboration and policy capacity.

TREAT Asia seeks to:

• Develop the skills of the health care workforce in the safe and effective administration of drug treatments for HIV/AIDS;
• Enhance existing infrastructure and formulate strategies for capacity building to prepare for expanded access to, and the safe and effective administration of, HIV/AIDS drug treatments;
• Develop a framework for regional collaboration on a therapeutics research agenda that is responsive to the needs of patient populations in the region;
• Define and address the policy issues that impede expanded access to drug treatments for AIDS.
  

What are the expected benefits of TREAT Asia?
TREAT Asia will help to increase access to high-quality HIV/AIDS treatment and care through an expanded pool of physicians and health care professionals who are qualified in the treatment and management of HIV infection and AIDS. It will spur the development of treatment standards that are responsive to the needs of the different epidemics in the region and will help to expand access to experimental therapeutics. The program will also enhance prevention efforts, improve health care infrastructure, and increase government, industry, and community engagement in HIV/AIDS.

Why amfAR?
In the mid-1980s, the Foundation funded some of the first meetings to address the global implications of the epidemic. Since then, amfAR has supported prevention education and training programs in countries as diverse as Argentina, Ethiopia, Gambia, India, Indonesia, Nepal, Nigeria, Pakistan, and Tanzania. It has also supported a series of conferences and workshops on strategies for preventing mother-to-infant HIV transmission.

Early in the AIDS epidemic, amfAR championed the need for community-based clinical research—for the "real world" testing of the efficacy, safety, and acceptability of new drugs and drug regimens among a large and diverse patient population. Although the goal at the time was to broaden access to experimental HIV drugs and help accelerate the approval of new therapeutics, the most important outcome of the program was the education and training of community physicians and health care workers across the U.S. in the proper administration of antiretroviral drugs and the medical management of patients with HIV/AIDS.

For the past three years, amfAR has worked to raise awareness of the threat of HIV/AIDS in Asia and the Pacific, primarily through high-profile events at the United Nations, the International AIDS Conference, and, most recently, at a World AIDS Day 2002 symposium at New York's Columbia University.

Who is involved in the initiative?
In developing TREAT Asia, amfAR has worked with over 13 countries in the region, and has consulted with the International AIDS Society, the HIV-Netherlands-Australia-Thailand Research Collaboration (HIV-NAT), the Fogarty Institute, the U.S. National Institutes of Health, the pharmaceutical industry, private foundations, and international community organizations in the region. TREAT Asia's steering committee is comprised of medical and clinical research experts and representatives from the HIV/AIDS community.