A look at four major factors relevant to primary prevention and correlated interventions to support their impact.
Excerpted from AVAC Report 2019: Now What?
Monitoring Primary Prevention: What to look at and why it matters – for oral PrEP and more
What Gets Measured Matters
There is enormous variability in country and funder/normative approaches to tracking PrEP program rollout. Assessments of progress require common, comprehensive measures against and estimates of the parameters seen here.
Excerpted from AVAC Report 2019: Now What?
Total and Additional Users of Modern Contraception, 2012-2019
In November 2019, FP2020 released Women at the Center: 2018-2019, its latest progress report from which this graphic is adapted. As its graphic below shows, coverage of modern contraception in the 69 low-income countries that partner with FP2020 in tracking progress has increased since 2012, but not at the pace needed to meet the FP2020 goal. The group has also launched a post-2020 vision, and AVAC looks forward to working together towards an integration agenda.
Excerpted from AVAC Report 2019: Now What?
Metrics for Epidemic Transition: A glossary
Following the 2016 UN High-Level Meeting on HIV/AIDS, UNAIDS undertook work to derive a better definition of what “epidemic control” might look like and how it might be measured. It turns out that out saying the era of seeking the “end of the AIDS epidemic”—a phrase from a few years back—has come to an end. It’s rhetorically powerful but tricky to pin down what this means. Countries and communities need better, more precise ways to track progress. Funders need this information too, in order to see impact and sustain confidence in the effort. With great global diversity in incidence and mortality rates, worldwide measures obscure progress and challenges.
This table summarizes the work to date on identifying metrics that make sense for tracking the epidemic. Civil society must weigh in on what matters to us, which of these terms is meaningful and how to minimize the potential for manipulation and misinterpretation.
Excerpted from AVAC Report 2019: Now What?
Universal Test and Treat (UTT) Trial Results
As this table shows, the two trials that offered community-wide testing in both arms (SEARCH, TasP) did not find a difference in incidence between the arms. One explanation may be that the expanded access to testing and linkage in both arms had an impact in both intervention and control communities. The two trials that only provided universal testing in the intervention arm identified differences in incidence between that arm and the control arm.
There were other differences between the four UTT trials. As described below, PopART was the only trial with urban and peri-urban communities.
Excerpted from AVAC Report 2019: Now What?
AVAC Report 2019: Now What?
Each year, the AVAC Report frames the most pressing advocacy issues facing the HIV response. At the threshold of 2020, it’s clear that global goals for HIV prevention will miss the mark by a long shot. Though important progress has been made, the crisis UNAIDS called out in 2016 persists today with new infections around 1.7 million annually, a far cry from the 2020 target of fewer than 500,000. So, we asked ourselves, Now What?, and answered with cross-cutting analysis and an advocacy agenda to match.
For more from the report, including a link to all its graphics, visit report.avac.org. A one-pager of AVAC’s 2020 priorities is also available.
The Dapivirine Ring: Key learnings from like-product introductions
Vaginal insertion and partial efficacy are two challenges that could affect the uptake and continued use of the dapivirine ring. Analyses of the introductions of other products that share similar characteristics provide useful lessons to inform planning for rollout of the dapivirine ring. This paper provides information for planners, implementers, funders, researchers, trainers, providers of technical assistance and others to build an agenda for introducing the dapivirine ring that addresses these two challenges.
Human-Centered Design and Prevention in the Real World
In this episode of Px Pulse, we hear from AVACer Anabel Gomez about the human-centered design project she’s leading with partners in South Africa to chart a path that will better support a journey to HIV prevention. We also hear from two members of the research team—Lesego Taule and Mpumi Mbethe—who helped lead these discussions in communities where HIV is epidemic. And a program implementer for HIV prevention in South Africa, Anthony Ambrose of NACOSA, tells us how this research can be applied to programs and how it changed the way he thinks about HIV risk.
Contraceptive Eligibility for Women at High Risk of HIV Guidance Statement
WHO released updated guidance on “Hormonal Contraceptive Eligibility for Women at High Risk of HIV”. The WHO updated guidance shifts DMPA, other progestogen-only injectables and IUDs to a MEC 1 classification, which states that the products can be used without restriction. The updated WHO recommendations follow a thorough review of the latest scientific evidence, including the recent results of the ECHO trial, which evaluated whether the risk of HIV differs with the use of three different safe and effective contraceptive methods.
AVAC Comments to Antimicrobial Drugs Advisory Committee and FDA re: TAF/FTC (Descovy) as PrEP
AVAC comments submitted to the Antimicrobial Drugs Advisory Committee and FDA re: TAF/FTC (Descovy) as PrEP, which encourage the Advisory Committee to recommend, and the FDA to approve, the supplemental indication for daily oral PrEP with F/TAF for adult men and women at risk of sexually acquired HIV-1 infection – with the appropriate requirements for labeling, post-marketing surveillance and REMS as described in the letter, and as per the FDA’s own updated guidance on REMS and access posted earlier this year.