The TREAT Asia collaboration

Currently recruiting: 
Yes
The challenge: 

An estimated 5.1 million adults and children are living with HIV infection in the Asia-Pacific region, with nearly 1,000 new infections occurring every day. While access to HIV treatment antiretroviral therapy (ART) has rapidly expanded, Asia persistently lags behind the global average. A diverse range of under-resourced health care systems, co-infections, drug resistance, and issues of long-term ART accessibility, are important considerations in the expansion and effectiveness of HIV treatment programs in the region. As regional treatment guidelines adopt recommendations for earlier ART initiation, the feasibility and outcomes of ART use, and the long-term impact of chronic HIV management in resource-limited settings, remain essential areas of investigation.

The project: 

The collaboration with TREAT Asia, a program of the Foundation for AIDS Research, evaluates the impact of HIV disease, co-infections, and ART management on clinical outcomes in both adults and children in the Asia-Pacific. Our adult and paediatric cohorts, TAHOD and TApHOD, collect detailed prospective data on ART treatment, outcomes and risk factors, including on over 8,000 adults and 5,000 children. A simplified adult study, TAHOD-LITE, collecting treatment program data at 8 sites, facilitates surveillance-level evaluations. As the Asia-Pacific region of the International Epidemiology Databases to Evaluate AIDS (IeDEA), a world-wide NIH funded collaboration, these studies also contribute to analyses that aim to understand changes in HIV treatment and outcomes globally.

The method: 

The program is managed out of the TREAT Asia office in Bangkok. Participating sites from around the region are generally referral clinics and hospitals selected based on their HIV data recording, demographic, and geographic profile. Although a wide range of access to HIV treatments and monitoring tools exist across sites, standardised collection of clinical data is a key goal. Core variables include: patient demographics, clinical stage and markers of disease progression, ART and prophylactic treatments, adverse events, routine laboratory tests, cancer diagnoses, ART adherence, drug resistance and non-communicable disease diagnoses. Clinic data are sent to the Biostatistics and Databases Program at the Kirby Institute every 6 months where it is subject to quality checks, aggregated and subsequently analysed.

The results: 

Since the inception of the TREAT Asia collaboration, network investigators have published over 60 analyses in peer-reviewed medical journals, creating a unique evidence base to support our understanding of regional HIV trends. Collaborations through IeDEA multi-regional analyses have a similar impact on global HIV epidemiology. For example, a 2013 article reported a global analysis that while the average CD4 count of patients starting HIV therapy in developing countries increased over the previous decade, it remained below 200 cells/mm3. Global analyses are an increasing focus of this work, and are having an important impact informing WHO reports and guidelines, and supporting critical assumptions in mathematical modelling projects.

The impact: 

The TREAT Asia collaboration provides unique adult and paediatric data resources that help to understand the treatment environment for HIV-positive adults and children in Asia. Data from the collaboration illustrate how changes in treatment guidelines are translated into routine clinical practice. Our data are used by National Health Departments and international organisations such as the WHO and UNAIDS to understand the current treatment status of HIV-positive patients and to inform policy and focus HIV programming towards the most effective interventions.

Project contact: 
Research Fellow
Research Fellow
Project supporters: 
Project collaborators: 

The TREAT Asia HIV Observational Database (TAHOD):

 

The TREAT Asia Paediatric HIV Network (TApHOD):

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