Implementation and ethical dimensions of scaling up HIV treatment as prevention (TasP)

A growing body of evidence has demonstrated the potential of utilizing HIV treatment as HIV prevention (TasP) to reduce the transmission of HIV to uninfected individuals, and recent policy commitments from the World Health Organization support the implementation of TasP internationally. However, a number of logistical and ethical challenges exist in relation to the implementation of TasP at the population level, and are particularly significant for TasP programs targeting people who inject drugs (PWID). There is a need for social science research that can inform the development of population level TasP programs, and PWID-tailored programs, to address systemic barriers to retention on HIV treatment and the accompanying ethical issues. TasP has been initiated in British Columbia (BC) within the public health system and HIV clinical trials seeking to improve treatment outcomes are currently ongoing in BC. The existence of these programs and trials provides the ideal setting to explore implementation issues and ethical considerations by examining actual experiences with roll out, HIV trials, and the perspectives of a range of stakeholders. This research will use qualitative research methods to address the study objectives: 1) investigate ethical issues related to health policies supporting the roll out of TasP; 2) examine implementation issues related to scaling up HIV treatment and engaging HIV positive PWID; 3) examine HIV trial participation among PWID; 4) explore the impact of TasP upon HIV positive PWID with regard to potential unintended consequences. This work will generate unique data with ability to inform the establishment of TasP programs in other Canadian and international settings, and the development of tailored TasP programs targeting PWID.