Darrell’s work serves as a model for how implementation research and service provision can be combined to change federal policy and have a concrete impact on ending the HIV pandemic.
The 2018 CAHR‐CANFAR Excellence in Research Award for Clinical Sciences recognizes Dr. Darrell Tan. He leads HIV research at St. Michael’s Hospital in Toronto where he is a Clinician Research Scientist and Associate Professor of Medicine.
Tan’s peers say he is one of the most energetic and committed researchers in the country and a scientist “who is truly making a profound difference to the HIV epidemic in Canada.” They add that he is well on his way to being an internationally recognized leader in his field.
Dr. Tan’s early research focused on the role of Herpes simplex 2 and clinical strategies to reduce HIV progression – a very common co-infection among people living with HIV.
A few years ago Tan “had the good fortune” to collaborate with Dr. David Knox, who was writing a description of the first known and reported case of someone who had acquired HIV, despite consistently taking Pre-Exposure Prophylaxis (PrEP). This was reported in the New England Journal of Medicine, based on the case of a patient that Dr. Knox was caring for in Toronto.
“That has had tremendous impact in the HIV community,” said Dr. Rupert Kaul, director of the University of Toronto’s Infectious Diseases division.
“Our duty is to try to uncover facts. Try to uncover and learn more about what ’the truth’ is and sometimes that’s not what we want to hear,” said Tan. “Unless we go forward with our eyes open to all the challenges we’re facing, we’re not likely to succeed in any complex endeavour like trying to end new infections.”
Dr. Tan’s knowledge led him to spearhead the committee that established the first Canadian guidelines on PrEP and non-occupational Post-Exposure Prophylaxis (PEP), published recently in the Canadian Medical Association Journal (CMAJ).
Tan’s work has culminated in a large grant from CIHR entitled “Scaling up PrEP for HIV Prevention: Optimizing strategies for targeting and delivering PrEP to MSM in British Columbia and Ontario.”
This collaborative project works with medical and at-risk communities across Canada and will ensure that the benefits of this clinical tool are maximized in gay, bisexual and other men.
The tools that we need to end new infections are at our disposal. We’ve had them, we’ve known what they were now for a few years and there’s been a lack of engagement, there’s been a lack of will to actually to put those tools into widespread practice.
Dr. Tan says one of the biggest challenges has to do with achieving “meaningful and large-scale change” that succeeds in getting the buy-in of people who hold purse strings – specifically, policy-makers and government.
“It’s a matter of trying to impress upon leaders that the HIV epidemic is not over, far from it. It’s not solved and to convince them that what we have to offer at this unique time is some low-hanging fruit, in a sense,” said Tan.
“Our mission is to build the case that what we’re doing and what we’re trying to achieve makes good sense – not only from a clinical perspective, but from a broader social and public perspective.”
A lot of the work that Tan and other researchers do in the field of HIV has to do with public health and aims to bring the number of new infections down to zero. He says that can be achieved with the tools we have today.
“So it’s really trying to demonstrate to people the urgency of what we’re doing and the potential to achieve really amazing outcomes,” said Dr. Tan.
Dr. Marina Klein is director of Research at the Chronic Viral Illness Service of the McGill University Health Centre and National co-director of the CIHR-Canadian HIV Trials Network. She says it was clear to her early on that Tan was a clinical investigator with great promise.
“I watched Darrell develop his independent research interests in sexually transmitted infections in men having sex with men, which he has grown into an impressive program of research focused on Pre- exposure Prophylaxis (PreP),” said Dr. Klein. “A critically important research area in Canada and globally.”
She adds Dr. Tan is rapidly becoming the national leader in this field and is heading a large CIHR team grant to evaluate scaling-up PrEP for HIV prevention in British Columbia and Ontario.
Beyond his skills as a clinician scientist Dr. Klein says Tan understands the importance of local and national collaboration to inform his research and extend its impact. That includes translating it for the wider community, whether academic or not.
I hope that we can get to a place in the next year to five where all folks who find themselves at risk for acquiring HIV infection have all the information they need about all the prevention tools that we have available, most notably, including PrEPs, and substance abuse – since that’s the new kid on the block.
Tan says having access to the prevention tools – without barriers – is what’s most important. That means ensuring medications are available, publicly funded and universally available.
“We’ve come close to that in many jurisdictions in Canada, but it’s definitely not universally available as it should be if we’re going to get to zero (new infections).”
He says working with front-line care providers and at-risk communities to help reduce stigma around certain sexual behaviours, recreational drug “and around HIV in general,” will help Canada get there.
“By talking about it more, by advancing it more, by emphasizing the science and the evidence base behind the importance of these interventions we can normalize PrEP use,” says Dr. Tan.
“We want to turn things around so it’s not the exception, it’s not a rarity, it’s not a weird thing, but it’s actually viewed as responsible and a positive thing for people to be taking existing science into their hands and applying it to their lives and preventing significant preventable health issues from happening – like HIV infections.”
To do this, Dr. Tan is already working with the future of Canadian HIV research. He mentors 4 summer students, 18 fellows and 4 Masters students, as well as two PhD students and six who are working towards their post-doctoral fellows in HIV-related projects.
Canada’s HIV research community is small and Tan says that being honoured with this Research award by people he feels are peers or “ahead of him” in many ways is really touching.
“I know that there’s a lot of really hard working and really deserving clinical scientists in this space,” he said. “I hope I can only live up to the expectations to continue delivering, which come with receiving an award like this.”
In the meantime, Dr. Kaul has great expectations – and no reservations – about the potential impact of Tan’s research findings on HIV.
“Darrell’s work serves as a model for how implementation research and service provision can be combined to change federal policy and have a concrete impact on ending the HIV pandemic.”
