For Us by Us: PrEP in Black America – A Master Plan for HIV Prevention in Black America

In the spirit of seeking change to ameliorate the devastating impact of HIV in Black communities through biomedical HIV prevention, Black leaders convened the “PrEP in Black America (PIBA) Summit” virtually and in person on September 13, 2022, in Atlanta, Georgia. Attendees have included Black activists, researchers, scientists, providers, and policymakers from across the country representing more than 50 organizations. Following the event, PIBA generated a report summarizing the event and key recommendations entitled, “For Us by Us: PrEP in Black America – A Master Plan for HIV Prevention in Black America.”

Read the full report, “For Us by Us: PrEP in Black America – A Master Plan for HIV Prevention in Black America” here.

STIWatch Newsletter, March 2024

The first quarter of 2024 ends with new research and questions on the future directions of STI vaccines and diagnostics. The Conference on Retroviruses and Opportunistic Infections (CROI) was the setting for positive news on the potential for early use of doxycycline to prevent STIs (DoxyPEP) in real-world settings and questions about its effectiveness in cisgender women given major evidence gaps. Important discussions and debates continued around the issue of antimicrobial resistance (AMR), as the field continues to grapple with the rollout of DoxyPEP. Presentations at CROI also highlighted the need for new diagnostics for syphilis as infections continue to increase globally and the need for STI advocacy efforts to ensure these infections get the attention and funding needed to develop vaccines and diagnostics that can prevent, detect, and treat these infections!    

In January, the US Centers for Disease Control and Prevention (CDC) released the STI surveillance data from 2022, which showed an increase in chlamydia and syphilis cases from 2021. Gonorrhea cases decreased between 2021 and 2022 by 9%. Alarmingly, 2022 congenital syphilis cases increased by 30% from 2021, signaling an urgent need for novel prevention, treatment, and testing methods.  

In Australia, a group of researchers published a response to the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine’s October 2023 statement on the use of DoxyPEP in Australia. The authors point to the potential threat of increasing AMR and the urgent need to implement measures to monitor DoxyPEP use and its impact.  

Read on for upcoming webinars, must-read resources supporting advocacy for improved funding and commitments for STI vaccines and diagnostics. Afterwards, test your knowledge with AVAC’s new STI Trivia quiz.  

New Report! STIs: A Review of the 2022 Vaccine and Diagnostic R&D Pipeline and Investments 

STI Vaccine and Diagnostic R&D Funding by Pathogen

A new AVAC report tracks funding trends in vaccine and diagnostics R&D, and pipeline investments for some of the most common STIs, including chlamydia, genital herpes, gonorrhea, hepatitis B, human papillomavirus (HPV), syphilis, and trichomoniasis. The report finds that STI research remains underfunded and neglected compared to other infectious diseases. Read the report to learn more.

STI Advocacy Updates

AVAC spoke with two cervical cancer advocates, Tamika Felder and Karen Nakawala, in January as part of its cervical cancer webinar series. Felder and Nakawala are breaking taboos and saving lives by empowering people to share their stories of survivorship and senseless loss. 

Felder, founder of Cervivor, Inc., was diagnosed with cervical cancer at 25, and turned her struggle into a mission, providing resources and a platform for those affected by the disease. Her impactful work and advocacy inspired Nakawala to found the Teal Sisters Foundation in 2020, following her successful treatment for cervical cancer. To learn more about Tamika and Karen, watch AVACs cervical cancer webinar. Thank you, Tamika and Karen for all that you do!  

January 18 marked HPV Awareness Day. AVAC and TogetHER for Health released an updated call to action to improve HPV vaccination among people living with HIV. In total, 31 organizations signed on to this call, urging global leadership to increase access to lifesaving HPV vaccines for people living with HIV.

Upcoming Events

STI Awareness Week is April 14 – 20!

Join us for two webinars focused on syphilis and DoxyPEP. These webinars are intended for health care providers, civil society organizations, public health officials, and others working in the STI/HIV fields. 

September 2024 STI Conferences

REGISTRATION IS NOW OPEN FOR TWO IMPORTANT STI CONFERENCES IN SEPTEMBER – WHICH UNFORTUNATELY ARE RUNNING CONCURRENTLY IN DIFFERENT PARTS OF THE WORLD!

The  2024 STI Prevention Conference will bring 1,200 conference attendees to Atlanta, Georgia, from September 16-19, 2024. Abstracts are being accepted until March 29. 

The  25th IUSTI World Congress  will take place September 17-20, 2024, in Sydney, Australia, and provide an opportunity to meet, discuss and learn about the latest research and innovation in sexual and reproductive health.  

What We’re Reading and Resources

  • Testing, testing: the advancing diagnostics for sexually transmitted infections. Diagnostics are urgently needed to detect STIs and this article examines several that are on the horizon. A US-Based company, Qvin is developing the Q-pad, a diagnostic menstrual pad with a removable strip to identify signs of diabetes and symptoms of high-risk human papillomavirus. Daye, a UK based gynecological start-up, launched a diagnostic product that is a tampon with the ability to screen for STIs. These advancements are exciting and serve as a reminder that advocacy is needed to ensure these products get to the people who need them. 
  • CARB-X Funds Visyby Medical to Develop a portable rapid diagnostic for Gonorrhea Including Antibiotic Susceptibility Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) will award up to US$1.8 million to biotechnology company, Visby Medical, to develop a portable rapid polymerase chain reaction (PCR) diagnostic to detect gonorrhea and its susceptibility to ciprofloxacin, a former frontline oral antibiotic that can no longer treat gonorrhea infections resistant to this medication. Funding will also support development of a test for gonorrhea, chlamydia, and trichomoniasis in men based on urine samples.
  • Syphilis Complicating Pregnancy and Congenital Syphilis. This manuscript provides a review of syphilis during pregnancy and congenital syphilis. As syphilis and congenital syphilis infections continue to rise, novel approaches are needed to detect, prevent, and treat infections. Because syphilis disproportionately affects populations with limited access to healthcare, new and improved diagnostics and therapeutics will need to be embedded within a health framework that prioritizes equity to improve the diagnosis and treatment of congenital syphilis, a preventable disease.  
  • Near-to-patient-testing to inform targeted antibiotic use for sexually transmitted infections in a public sexual health clinic: the NEPTUNE cohort study. This study examines the effectiveness of a novel lateral flow assay for point-of-care detection of gonorrhea among people with symptoms. Lateral flow assays are tests that can detect the presence of proteins or antigens for specific infections, like COVID-19 and HIV. This test had excellent clinical sensitivity and specificity in detecting gonorrhea among male and female patients with symptoms. A test like this could provide an important tool to better detect infections in settings without direct access to laboratory testing and reduce overtreatment.
  • Breaking Barriers in STI Clinical Management: Addressing Resistance Challenges and Incorporating New Diagnostic Approaches. This on-demand webinar features Dr. Van Der Pol and Dr. William Geisler who share their insights on crucial aspects of STI clinical management, focusing on resistance challenges and new diagnostic approaches. 

To learn more about AVAC’s STI Program, visit STIWatch.org and avac.org/sti. Email sti@avac.org for questions or additional information. And to sign up for specific updates on STIs, click here.

Developments in the HIV Biomedical Prevention Pipeline & PrEP Implementation Issues

An Update for Community Educators and Advocates

The European AIDS Treatment Group published a report covering two online discussions on the HIV biomedical prevention research & PrEP implementation issues for community educators and advocates. The report covers developments from the PREVENIR Cohort study, on long-Acting intramuscular PrEP, DoxyPEP, vaccine, as well as STI-PEP research. It also reviews challenges in the uptake of PrEP among women and in particular migrant women from sub-Saharan Africa and trans people.

Download the report. For more information and to see the recordings of the online discussions, click here.

PxWire Volume 14, Issue No. 1

A Quarterly Update on HIV Prevention Research

PxWire is AVAC’s quarterly update covering the latest in the field of biomedical HIV prevention research and development, implementation and advocacy. Each issue includes updates, emerging issues and upcoming events. A PDF version of this report is also available.

Progress in PrEP Uptake

In 2020, the world missed the UNAIDS’ goal of reaching 3 million PrEP users. The updated target for 2025 is 10 million. Is the 2025 target achievable based on the current trends in PrEP uptake? Applying an Autoregressive Integrated Moving Averages (ARIMA) model to data from the Global PrEP Tracker since Q3 2016, we forecasted cumulative PrEP initiations through 2025. Based on this model, the world will surpass 10 million global cumulative PrEP initiations by Q1 2025, and by Q4 it will reach 12.4 million. This data reflects oral PrEP initiations, not continued use.

  • PrEP users and PrEP initiations are different. Data on initiations do not distinguish between new versus repeat PrEP users. We are unable to predict if the UNAIDS goal of achieving 10 million PrEP users by 2025 will be successful. This forecast shows the possibility and the promise of current momentum. But fulfilling this promise is not certain. It depends on overcoming key challenges around access and choice.
  • These updates from AVAC’s Global PrEP Tracker analyze trends and showcase data reflecting Q4 2023 updates.

Global Milestones from October-December 2023

  • The PrEP Tracker documented 6,220,507 cumulative initiations of some form of PrEP worldwide: 6,216,310 oral PrEP (including TDF/FTC, event-driven oral PrEP, and F/TAF), 2,695 injectable cabotegravir (injectable CAB), and 1,502 dapivirine vaginal ring (DVR).
  • Global PrEP uptake increased by about 500,000 PrEP initiations this quarter, modestly slower than in the last two quarters. Last year at this time, global PrEP initiations stood at 3.8 million, so this year’s increase demonstrates relatively high uptake compared to the previous year.

Country-level Milestones

  • South Africa surpassed 1.3 million oral PrEP initiations; Zimbabwe surpassed 250,000 initiations. In less than a year, Malawi more than doubled its oral PrEP initiations and now stands at over 100,000. Rwanda surpassed 30,000, Cote d’Ivoire surpassed 20,000, and Sierra Leone surpassed 10,000 initiations.
  • Other countries outside of Africa had modest increases in oral PrEP uptake: Brazil counted over 150,000 initiations; the Philippines surpassed 20,000 initiations.

PrEParing for New Products

Product Updates

  • In February, Zambia launched its injectable CAB program, making it the first country outside the US to include injectable CAB in its HIV prevention services. And the Desmond Tutu Health Foundation in South Africa also announced “the first jab” of injectable CAB administered in its FASTPrEP study. As these programs get underway, more country approvals and product launches are anticipated.
  • This quarter, Namibia approved the dapivirine vaginal ring (DVR), bringing the total to 11 approvals in the region.
  • Uruguay approved F/TAF (Descovy). Additionally, Descovy is under review in Mexico.
  • Peru, Nigeria, Thailand, and Uganda have approved injectable CAB.
  • Injectable CAB is under review in the United Kingdom, Cote d’Ivoire, Mozambique, Rwanda, Tanzania, and Canada. CAB was granted WHO prequalification status, finding it to be safe, effective, and supported by studies.
  • PrEPWatch added 35 new country pages detailing the status of drug registration for PrEP products, data on PrEP initiation by product, country-level PEPFAR targets, and links to key policy documents and guidelines.
  • At ICASA, the Population Council presented preliminary results from a dual prevention pill (DPP) acceptability study with adolescent girls and young women (AGYW) in Zimbabwe. The study found 2/3 of participants preferred a proxy for the DPP (which combines contraceptives and PrEP) compared to 1/3 who preferred taking oral PrEP and oral contraceptive pills separately. Results from another DPP acceptability study in South Africa are forthcoming and the HPTN 104 study is expected to kick off later this year, expanding the evidence on end-user experiences.
  • Alongside oral PrEP, introduction of the dapivirine vaginal ring (DVR) and injectable cabotegravir (CAB) will play a role in the scale of PrEP uptake. At least 1.2 million vials of CAB are now available for procurement and prevention programming in low-and middle-income countries over the next two years. At the same time, one million vaginal rings are projected to be distributed over the next two years. But even with these additional options, oral PrEP will continue to play a big role in PrEP uptake in the short term.
  • For a full global perspective on product introduction, check out the Integrated Study Tracker and Country Planning Matrix and see our graphic on the status of implementation scient studies on the next page.

The Latest R&D in the Prevention Pipeline

In 20 years of research and across 12 trials, only two positive signals have been observed in HIV vaccine and antibody studies.

  • In December 2023, the PrEPVacc team announced no efficacy from the vaccine candidates in the study. This was folowing a review by the independent data monitoring committee. PrEP interventions in the study, comparing TAF/FTC (Descovy) to TDF/FTC (Truvada) will continue. The termination of vaccine arms of the PrEPVacc study represents the most recent HIV vaccine or antibody trial to end without efficacy.
  • Ensuring equitable access to safe, effective, and affordable vaccines involves advocacy across multiple areas. AVAC covers the issues in a series of advocates’ guides, From the Lab to the Jab.

Prevention Playlist

AVAC develops a wide range of materials and resources to inform decision making and action. Check out the latest:

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CASPR Results Bulletin

In this issue — what the MERL Roadshow is all about, inspiring work from CASPR partners, the HIV Prevention Choice Manifesto, and what’s in store for 2024.

STIs: A Review of the 2022 Vaccine and Diagnostic R&D Pipeline and Investments 

This report examines disbursements by the U.S. NIH and the Bill & Melinda Gates Foundation and is one of few reports to track funding trends in vaccine and diagnostics R&D, and pipeline investments for some of the most common STIs, including chlamydia, genital herpes, gonorrhea, hepatitis B, human papillomavirus (HPV), syphilis, and trichomoniasis.

Harare Declaration by and for African Women Who Use Drugs

During the ICASA 2023 meeting in Harare, Zimbabwe, AVAC and AfricaNPUD convened community members to draft the Harare Declaration by and for African Women Who Use Drugs.

Read the full declaration addressed to the ICASA Secretariat here.

Global HIV Prevention Roadmap for Key Populations

This roadmap outlines a strategy for the equitable expression and delivery of HIV prevention services to key populations (KPs) globally and regionally. It introduces a critical, coordinated approach led by KPs to accelerate the implementation of existing and new HIV prevention interventions.

Call to Action for Voluntary Medical Male Circumcision

The Job Is Not Done Yet

In the pursuit of a future without HIV and AIDS, voluntary medical male circumcision (VMMC) remains an integral component of the arsenal in HIV prevention, offering a cost-effective and scientifically proven intervention that holds immense potential in curbing the acquisition of HIV.

A two-page summary document is also available.

PxWire Volume 13, Issue No. 4

PxWire is AVAC’s quarterly update covering the latest in the field of biomedical HIV prevention research and development, implementation and advocacy. Each issue includes updates, emerging issues and upcoming events. Also available as a PDF.

From Research to Rollout: A look at where we are in HIV prevention

As we look back on 2023, powerful crosscurrents confront HIV prevention and global health equity. More options than ever before could be available, but many forces threaten to undermine access to proven prevention options that exist today and the development of additional options that are still needed. Threats to PEPFAR and hate laws targeting LBGTQI+ people are just a sample.

Upstream research and development is dynamic, but robust stakeholder engagement and sustainable funding must still be secured and integrated into a people-centered research agenda. These commitments are the compass that will ultimately lead to impact in the real world. The highlights below provide a snapshot of key updates in Q3 of 2023 and resources to inform advocacy on these critical questions.

Progress in PrEP Uptake

These updates from AVAC’s Global PrEP Tracker explore trends in 2023 and highlight new data as of September 2023.

PEPFAR and PrEP

PEPFAR’s role has been instrumental to accelerating global uptake of PrEP to date. This year, four countries started providing PrEP for the first time, and seven countries exceeded 70,000 new PrEP initiations, most of which are attributable to PEPFAR. This lifesaving, uniquely effective, program must see continued full funding and a 5-year reauthorization to carry on this work and help to put the world on track to control the epidemic.

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Cumulative PrEP Initiation Milestones

Global Milestones

  • The world surpassed 5.6 million cumulative PrEP initiations as of September 2023. Initiations increased by 700,000+ since Q2 2023. Though comparable to previous quarterly increases, it is the highest ever recorded quarterly increase by the Global PrEP Tracker.
  • At the same time last year the world had reached 3.3 million cumulative PrEP initiations, representing a doubling of initiations since then.

Country Level Milestones

  • Early adopting African countries continue to show the most rapid increases in PrEP uptake. South Africa has shattered 1 million cumulative initiations. Nigeria, Uganda, and Zambia have all surpassed 500,000 initiations, Kenya has surpassed 400,000, and Zimbabwe has surpassed 200,000.
  • Malawi and Brazil saw jumps of approximately 20,000 initiations over this quarter, while Lesotho had more modest increases of 10,000 initiations.
  • Dozens of countries continue to grow their programs. For example, El Salvador, Honduras, and South Sudan all surpassed 1,000 cumulative initiations.
  • Cyprus and Malta recorded their first oral PrEP initiations, at 29 and 579 respectively.

Spotlight on West Africa

As of Q3 2023, the top five West and Central African countries for PrEP initiation have surpassed 10,000 initiations; Cameroon, Cote d’Ivoire, Democratic Republic of the Congo (DRC), Ghana and Nigeria. Nigeria has marked almost 550,000 cumulative initiations as of this quarter, ranking it second, behind South Africa, worldwide. These milestones can be credited to targeted PEPFAR investments. But despite these successes, West and Central Africa make up only 14 percent of PrEP initiations recorded in Africa, compared to 85 percent reported by East and Southern Africa. These same countries are home to two thirds of all people living with HIV in West Africa. There is vital work to be done to close the gap.

West and Central Africa can and must continue to leverage this recent growth in oral PrEP by making additional HIV prevention options available. In September, Nigeria’s regulators approved injectable cabotegravir (CAB for PrEP)—approving the first new biomedical HIV prevention option in a West and Central African country since oral PrEP. But at this time, only one other CAB for PrEP application has been submitted in the region, in Côte d’Ivoire, and none for the dapivirine vaginal ring (DVR). Only one CAB for PrEP implementation study is planned for the region.

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PrEParing for New Products

Current HIV prevention options aren’t reaching all who need them. Access to a range of options that meet the needs of diverse people, especially those most at risk, will be essential to meeting global targets for ending the HIV epidemic.

  • CAB for PrEP Supply: In October 2023, ViiV, the developer and sole manufacturer of CAB for PrEP for now, announced a 40 percent increase in forecasted doses that could be available for non-commercial use in low- and middle-income countries through 2025, an increase to 1.2 million potential doses. Of these, 116,000 have been allocated to post-trial access for HPTN 083 and 084 participants; 129,000 for an initial set of eight implementation studies; 326,000 to PEPFAR programs in Malawi, Ukraine, Vietnam, Zambia and Zimbabwe; leaving at least 629,000 doses available for procurement by PEPFAR, Global Fund and national governments. See more details in our Country Planning Matrix. Three generic manufacturers could begin to deliver doses in 2026 or 2027.
  • Implementation Science (IS): As DVR and CAB for PrEP supplies arrive in countries, dozens of implementation science studies are underway in 22 different countries. Check out AVAC’s Integrated Study Dashboard for more details and stay tuned for updates.
  • PrEParing for Choice: For the first time since oral PrEP was introduced in 2012, PrEP users will have a range of methods to choose from—but only if they have access to them. Policy makers, donors, governments and implementers must commit to making these methods available, accessible and affordable. The HIV Prevention Choice Manifesto, launched in September by the African Women’s HIV Prevention Community Accountability Board, outlines what needs to happen to make choice a reality.

Approval Information

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The HIV Prevention Pipeline: The latest in research, development and more

The HIV prevention pipeline has evolved: Few products are in late stage or efficacy trials, newly proven products are rolling out, and early phase clinical trials are exploring innovative strategies. R&D is focused on ARV and non-ARV based prevention products and HIV vaccines that build on new knowledge about the virus. The late-stage trials of recent years and basic science have brought deepening insights that are being applied today to a diversity of ‘upstream’ interventions.

  • MK-8527 Announced: Merck announced a new Phase 2a trial to evaluate the safety, tolerability, and pharmacokinetics of a monthly oral pill, MK-8527. The trial began in November 2023 in participants at low-risk for HIV acquisition. If successful, Phase 3 trials could start in 2025.
  • PURPOSE Program: A new Phase 2 study, PURPOSE 5, will evaluate lenacapavir as a twice-yearly prevention option in France and the United Kingdom, as part of the larger PURPOSE program. Purpose 5 is recruiting participants who are disproportionally affected and often underrepresented in HIV clinical trials. PURPOSE 1 and 2 are Phase 3 efficacy studies in Argentina, Brazil, Mexico South Africa, Thailand, Uganda and the United States. PURPOSE 3 & 4 are smaller studies focused on populations facing disproportionate risk.
  • The Dual Prevention Pill (DPP): In September, the DPP, which would protect against pregnancy and HIV, moved to the next stage in R&D. A pilot bioequivalence study has shown the pill’s combined drugs—an antiretroviral and a contraceptive—are absorbed at an equivalent rate as taking them separately. The DPP now moves to a larger bioequivalence study needed for a regulatory submission. Check out the updated DPP Market Preparation and Introduction Strategy for highlights. The Population Council and Medicines360 are also developing a second-generation DPP with F/TAF.
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Prevention Playlist

The most effective advocacy is based on smart analysis and accurate information. AVAC develops a wide range of materials and resources to inform decision making and action. Check out these essential resources to the global conversation on HIV prevention and global health equity.

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  • ICASA: The biennial International Conference on AIDS and Sexually Transmitted Infections in Africa. Dec 4-9. Register
  • How Our Environment Impacts Cure, webinar, Dec 13. Register
  • Sex, Gender & HIV Cure Research, Dec 6. Register

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