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:

Join

CROI 2024 Community Breakfast Club Webinars

Read

Watch and Listen

Use

CAB for PrEP for Advocates

Basics of Injectable Cabotegravir for HIV Prevention

This wide-ranging presentation introduces advocates to cabotegravir injectable PrEP. The slides provide a background on clinical research, what users think, regulatory status and prepares advocates for implementation.

Coalition to Accelerate Access to Long-Acting PrEP

The Coalition to Accelerate Access to Long-Acting PrEP is an initiative that brings together leading donors, agencies, and advocates to ensure an accelerated, equitable, sustainable and collaborative approach to making longer-acting PrEP options accessible as quickly and as equitably as possible. The Coalition is convened by Unitaid, WHO, UNAIDS, Global Fund and PEPFAR, with AVAC as the Secretariat.

Coalition to Accelerate Access to Long-Acting PrEP

The Coalition to Accelerate Access to Long-Acting PrEP brings together leading donors, agencies, and advocates aimed at a practical goal: jointly develop strategies and take coordinated action to identify and overcome access challenges to just-approved and future PrEP options. AVAC serves as the Secretariat.

Find more information here.

What is PrEP Access Right Now and What’s Next in 2024?

AVAC is thrilled to see the launch of injectable cabotegravir for PrEP (injectable CAB) in Zambia—the first program outside of the US to do so. And the Desmond Tutu Health Foundation in South Africa recently announced “the first jab” of injectable CAB administered in its FASTPrEP study.

Webinars to Look Out for in February!

2024 is off and running and a slew of webinars are on the calendar. This selection of topics is both broad and deep, providing updates on the pipeline from cure to vaccines, insights on critical advocacy, a conversation with the new director of NIAID, and opportunities for you to engage. Scroll down for what’s coming up and recordings of webinars from December and January that you may have missed.  

Coming up!

AVAC in Conversation with NIAID’s Jeanne Marrazzo

February 27, 11:30 am – 12:00 pm EST 

Join AVAC in conversation with the new Director of NIAID, Jeanne Marrazzo. Register here.

The New Public Health Order: How is Africa preparing for pandemics?

February 29, 9:00-10:30 am EST 

WACI Health and The Choice Agenda invite you to join us for a webinar introducing key initiatives of the Africa CDC and the African Union. It will illuminate roles for civil society and community engagement. Register here.

The Adolescent Medicine Trials Network (ATN): Research addressing HIV health inequities among US adolescents and young adults

Join The Choice Agenda for an overview of the newest cycle of the Adolescent Medicine Trials Network! This webinar includes highlights of: ATN 165: Linking Youth to PrEP Services, which tests an innovative mobile delivery and mHealth intervention for PrEP adherence and persistence among sexual minority men; ATN 167: Legal, Economic, and Affirming Peer Support (LEAP) for transgender and gender diverse youth; and how the network prioritizes and amplifies the voices of youth directly impacted by the ATN’s pivotal research. Register here.

Advocacy Navigator Program Info Session

February 13, 10:00-11:00 am EST

This webinar is intended for anyone interested in applying to participate in AVAC’s Advocacy Navigator program. The session will provide an overview of the program, expectations, eligibility, and application process, followed by Q&A with the AVAC team. 

In case you missed it!

Reporting the African Science Story: Decoding scientific research to support public health in Africa

Through the Media Science Café Program, AVAC partners with health media associations in Kenya, Tanzania, Uganda, Zambia and Zimbabwe to bring journalists together with researchers, implementers, civil society, policy makers, regulators and policy makers to build relationships that will foster accurate reporting of HIV, COVID and other science or health stories in those countries. Learn about the model! Recording, slides and resources.

PrEPVacc: An in-depth look at the trial, and what’s next

This webinar reviewed key aspects of PrEPVacc, including its innovative study design, implementation, integrated social science, and data analysis plans. An engaging conversation about what we’ve learned from PrEPVacc, what we can still learn, and what this may mean for the HIV prevention field. Recording, slides and resources.

Cervical Cancer Awareness Month Webinar Series

Check out our 4-part webinar series on cervical cancer, which featured a deep dive on: what cervical cancer is, who is impacted, and prevention and treatment options; advocacy strategies to bring more attention to cervical cancer and its impact on communities; options for screening and treating cervical cancer along with ongoing research; and the impact of cervical cancer on key populations and those vulnerable to HIV infections. Recording, slides and resources.

HIV Cure and the Environment: How location informs cure research

This webinar reviewed core concepts discussed in the previous webinar, Let’s Talk About HIV Cure Research: An Introduction to the science under investigation, and introduced how the environment may impact cure strategies. Recording, slides and resources.

Learn more about the townhall discussion on Black Gay Men and HIV in the US featuring influential figures in the Black Gay community, including Ace Robinson, Daniel D. Driffin, and Kenyon Farrow by checking out highlights on AVAC’s Twitter page and watch the full recording. 

Thanks for checking out these conversations. We hope you will join us in these rich discussions and watch this space for future webinars!  

New issue of POSITIVELY AWARE points the way towards a more equitable future

By Kenyon Farrow

In many ways the world is entering an era of HIV prevention that many of us have spent the last 40 years fighting for— there now exists multiple options for preventing HIV that are safe, highly effective and easy to use. 2012 saw the introduction of the first ARV-based prevention option—daily oral PrEP. And over the past two years, WHO recommended, and several national regulatory agencies have approved, injectable ARVs for treatment and prevention, as well as the dapvirine vaginal ring.  

While these advances are something to celebrate, this is far from the end of the road. Technological gains only go as far as people’s awareness of them, desire to use them, and access to them. And this is where we — as a public health community and as a planet of humans — struggle. Just like with the first ARV therapies in the mid 1990s, and the first PrEP pill for prevention a decade ago, we’re now four years into the FDA approval of the first long-acting ARV therapy and we are several years away from scaling up these long-acting medications and truly seeing the impact they can have on the lives of people (whether living with HIV or in need of PrEP), and on the HIV epidemic itself.  

It takes the HIV response far too long to move these innovative inventions to the point where they become medical miracles, experienced by everyone who needs and wants them, regardless of race, ethnicity, national origin, religion, sexual orientation, gender identity, sex assigned at birth, pregnancy status or income. 

There is a new special issue of the magazine POSITIVELY AWARE, co-edited by Kenyon Farrow, AVAC’s communications director, and Jim Pickett, AVAC’s senior advisor and lead of the Choice Agenda, that explores the impact of long-acting injectable treatment and PrEP. The articles, including a piece co-authored by John Meade, AVAC’s senior policy manager, and Danielle Campbell of PrEP in Black America and longtime AVAC partner, speak to the humans involved in downstream research, and what their experiences as patients, researchers, advocates and medical providers of long-acting treatment and PrEP teach us about how these products could be transformative. These stories make clear how far we still have to go to change our health systems so that they can meet their maximum potential. 

AVAC will continue our work to advocate for global equity in access to prevention and treatment in all their current and future forms. We celebrate this issue of POSITIVELY AWARE as one collection of voices helping to point the way towards a more equitable future. 

Avac Event

AVAC in Conversation with NIAID’s Jeanne Marrazzo

The new director of National Institute of Allergy and Infectious Diseases (NIAID), Dr. Jeanne Marrazzo joined AVAC Executive Director in conversation.

Remembering a Legacy and Celebrating AVAC Fellow Alumni

For over a decade, the AVAC Advocacy Fellows Program has played a role in shaping the landscape of HIV prevention by strengthening leadership skills and building a growing and evolving network of fierce and unstoppable advocates. Last year, AVAC released A Legacy of Impact: The power and reach of AVAC’s Advocacy Fellows to tell the story of the Fellows program and to share testimonies of impact from research to policy, and beyond.  

Today, on Martin Luther King Jr. Day, a day dedicated to the importance of advocacy to influence change, AVAC honors its nearly 100 Fellow alumni and applauds our most recent class which closed out their fellowship in December.  

Read on for testimonies from the AVAC 2022/2023 Fellows and explore their work in their individual pages. 

AVAC 2022/2023 Fellows in their words

Learn about Ruth’s work around the approval and rollout of the dual prevention pill (DPP) in Uganda here. 

Learn about Onward’s work with engaging religious institutions on adolescent sexual and reproductive health in Zimbabwe here.

Learn about Prince’s work ensuring access to injectable CAB for PrEP for trans people in Malawi here. 

Learn about Catherine’s work in the rollout and implementation of the dapivirine vaginal ring for adolescents and young women (AGYW) in Tanzania here. 

Learn about Natasha’s advocacy for the approval of the dapivirine vaginal ring and injectable CAB for PrEP in Zambia here. 

Learn about Peter’s work with differentiated service delivery of PrEP and expediting new PrEP tools in Lesotho here. 

Learn about Elizabeth’s work advocating for sex workers and people who use drugs (PUD) here. 

Learn about Liyema’s work on advocating and implementing the decriminalization of sex work in South Africa here.  

Get to know the full AVAC Fellows community by exploring the full alumni database and stay tuned to meet the 2024/2025 class to be announced in April! 

New Year, New PrEPWatch Resources

In 2024 we look forward to continuing to provide advocates with tools to support our collective work to ensure access to PrEP in all its forms to all who can benefit from it.  

PrEPWatch.org has grown significantly in the past year, reaching a growing number of implementers, policy makers and advocates with continually updated tools and information that are instrumental to delivering the growing range of HIV prevention options. Throughout 2023, visitors from every country in the world have used PrEPWatch.org, a one-stop online clearinghouse of data, guidelines, tracking tools and other resources to help the global community speed the delivery of every proven method of PrEP to everyone who needs it. Check out what’s new and updated on PrEPWatch.org! 

New on PrEPWatch

Modelling the Scale-Up of Injectable CAB for PrEP 

Our Biomedical Prevention Implementation Collaborative (BioPIC) teamed up with the HIV Modelling Consortium to produce this analysis of the potential impact of scaling up injectable cabotegravir (CAB) for PrEP, What can modelling tell us about the scale-up of CAB for PrEP? The findings can help implementers and policymakers understand what to expect and guide early policy decisions to maximize the impact of CAB for PrEP on the HIV epidemic. 

Country Pages 

PrEPWatch has added 35 new country pages where you can find the status of drug registration for PrEP products, data on PrEP initiations by product, country-level PEPFAR targets, and links to key policy documents and guidelines.  

The Integrated Study Dashboard  

Produced under the BioPIC project, the Integrated Study Dashboard tracks all currently known activities relating to implementation research, modelling, clinical research, and landscaping for new biomedical HIV PrEP options, including CAB for PrEP and the dapivirine vaginal ring (DVR), and has been recently expanded to include links to study results and study websites. The dashboard is updated in real time, and links to results will be added as they become available. 

More Essential Resources on PrEPWatch.org

Tracking Country Planning for Product Introduction 

The Country Planning for Product Introduction Matrix tracks key indicators for the introduction of injectable CAB and the DVR by country, including regulatory status, late-stage clinical trials and implementation research, procurement plans, and recent oral PrEP provision. 

Training PrEP Champions  

Among the most popular resources on PrEPWatch, the HIV Prevention Ambassador Training Package and Toolkit prepares potential and current PrEP users to be leaders – and “Ambassadors” – in the rollout of PrEP for HIV prevention in their communities. Developed as part of the MOSAIC project, it includes a training manual and resources for Ambassadors to use in peer outreach and community education.  

Trends in PrEP Initiations  

The Global PrEP Tracker provides quarterly updates on global trends in PrEP initiation by geography, delivery models, and more. The Global PrEP Tracker has become an indispensable resource for following the state of the field in delivering PrEP.  

We hope these tools, created through strong partnerships and joint effort, support your work to accelerate the delivery of HIV prevention options. We are always interested in collaboration to ensure needed resources are developed and up to date.  If you have information to share or resource needs, please let us know by reaching out to janki@avac.org and catherine@avac.org.