Posted: Jul 30, 2019
Maximizing the impact of HIV prevention technologies in sub-Saharan Africa
There have been substantial gains in the range and efficacy of technologies available for HIV prevention, with voluntary medical male circumcision (VMMC), treatment as prevention, and pre-exposure prophylaxis (PrEP) being added to the existing toolbox of condoms, lubricant, behaviour change, harm reduction, structural interventions and advocacy programmes. These advances led to the optimism of calls to end the AIDS epidemic by 2030 with a target of fewer than 500,000 new cases a year by 2020 and 200,000 by 2030 . However, progress towards these goals is slow with an estimated 1.9 million new infections in 2017 globally, including over a million in sub-Saharan Africa. Although these numbers represent a substantial reduction from the height of the epidemic in the late 1990s, they are well off target despite intensive efforts to promote HIV combination prevention encompassing structural, behavioural and biomedical interventions. The targets were based on modelling which estimated the coverage needed to achieve these reductions, namely meeting 90-90-90 treatment targets, 90% coverage of key populations with combination prevention programmes, 90% reported condom use rates with non-regular partners and 90% male circumcision. However, investment in prevention has been lower than required to achieve this coverage , and results from trials of intensive population “test and treat” approaches show a lower impact than hoped for, with up to 30% reduction in incidence, but with lower engagement and coverage of younger people.
© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society. Helen Ward1, Geoffrey P Garnett2, Kenneth H Mayer3, Gina A Dallabetta2
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Posted: Dec 12, 2017
Helping our patients take HIV pre-exposure prophylaxis (PrEP): a systematic review of adherence interventions
Adherence is critical for maximizing the effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV infection. Strategies for promoting adherence to HIV treatment, and their potential application to PrEP adherence, have received considerable attention. However, adherence promotion strategies for prevention medications have not been well characterized and may be more applicable to PrEP. We aimed to identify adherence support interventions that have been effective in other prevention ﬁelds and could be applied in the HIV prevention context to support pill taking among PrEP users.
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JL Marcus,1,2 T Buisker,2 T Horvath,3 KR Amico,4 JD Fuchs,5 SP Buchbinder,6,7 RM Grant1,7 and AY Liu6
1Gladstone Institute of Virology and Immunology, San Francisco, CA, USA, 2Department of Epidemiology, University of California, Berkeley, CA, USA, 3Global Health Sciences, University of California, San Francisco, CA, USA, 4Center for Health, Intervention and Prevention, University of Connecticut, Storrs, CT, USA, 5Center for Learning and Innovation, San Francisco Department of Public Health, San Francisco, CA, USA, 6Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA and 7Department of Medicine, University of California, San Francisco, CA, USA
Posted: Jan 27, 2017
When and why women might suspend PrEP use according to perceived seasons of risk: implications for PrEP-specific risk-reduction counselling
Oral pre-exposure prophylaxis (PrEP) using the antiretroviral drug emtricitabine/tenofovir disoproxil fumarate (Truvada) has been shown to dramatically reduce the risk of HIV acquisition for women at higher risk of infection if taken daily. Understanding when and why women would intentionally stop using an efficacious oral PrEP drug within the context of their ‘normal’ daily lives is essential for delivering effective PrEP risk-reduction counselling. As part of a larger study, we conducted 60 qualitative interviews with women at higher risk of HIV in Bondo, Kenya, and Pretoria, South Africa. Participants charted their sexual contacts over the previous six months, indicated whether they would have taken PrEP if available and discussed whether and why they would have suspended PrEP use. Nearly all participants said they would have used PrEP in the previous six months; half indicated they would have suspended PrEP use at some point. Participants’ reasons for an extended break from PrEP were related to partnership dynamics (e.g., perceived low risk of a stable partner) and phases of life (e.g., trying to conceive). Life events (e.g., holidays and travel) could prompt shorter breaks in PrEP use. These circumstances may or may not correspond to actual contexts of lower risk, highlighting the importance of tailored PrEP risk-reduction counselling.
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Emily Namey, Kawango Agot, Khatija Ahmed, Jacob Odhiambo, Joseph Skhosana, Greg Guest & Amy Corneli (2016): When and why women might suspend PrEP use according to perceived seasons of risk: implications for PrEP-specific risk-reduction counselling, Culture, Health & Sexuality, DOI: 10.1080/13691058.2016.1164899
Posted: Jan 27, 2017
Pre-exposure prophylaxis in Southern Africa: feasible or not?
Introduction: Southern and Eastern Africa bear the brunt of the AIDS epidemic, and current prevention interventions remain inadequate. Antiretroviral-based pre-exposure prophylaxis (PrEP) is gaining momentum as an effective prevention intervention. Discussion: Discussions have been started on how this strategy could be employed in Africa such that the populations most in need can be reached urgently for the greatest impact.This requires the selection of specific risk groups and service environments in which PrEP can be distributed safely and cost effectively while being mindful of any ethical issues.
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Conclusions: Given the need for an integrated public health approach to this, a number of potential populations and opportunities for PrEP distribution exist and are discussed in this commentary.
Venter, W. D. F., Cowan, F., Black, V., Rebe, K., & Bekker, L.-G. (2015). Pre-exposure prophylaxis in Southern Africa: feasible or not? Journal of the International AIDS Society, 18(4Suppl 3), 19979. http://doi.org/10.7448/IAS.18.4.19979
Posted: Jan 17, 2017
Tenofovir Pre-exposure Prophylaxis for Pregnant and Breastfeeding Women at Risk of HIV Infection: The Time is Now
Pre-exposure prophylaxis (PrEP) using either daily oral tenofovir disoproxil fumarate (TDF) or co-formulated TDF/emtricitabine (TDF/FTC) has been shown in clinical trials to be effective for prevention of HIV acquisition in men who have sex with men, heterosexual men and women, and persons who inject drugs . However, unfortunately, the relevant clinical trials excluded pregnant or breastfeeding women; the trials included frequent pregnancy testing, and PrEP was discontinued if pregnancy was recognized (generally at gestation months 1–2).
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Mofenson, L. M. (2016). Tenofovir Pre-exposure Prophylaxis for Pregnant and Breastfeeding Women at Risk of HIV Infection: The Time is Now. PLoS Medicine, 13(9), e1002133. http://doi.org/10.1371/journal.pmed.1002133 Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5038968/pdf/pmed.1002133.pdf