You Get What You Measure: Why Monitoring for PrEP Choice Helps Tell Our Story
The data we collect on a program determines its path and priorities. This webinar covered the current state of PrEP M&E and efforts to improve and simplify the data we collect, allowing our data to better reflect how people are using PrEP, support PrEP choice amongst the growing array of PrEP methods, and enhance the stories we can tell about PrEP program implementation.
Accelerating the rollout of the full range of proven HIV prevention options depends on learning from what’s been done in the past and investing in coordination and innovation to put improved solutions in place. The Biomedical Prevention Implementation Collaborative (BioPIC) is doing just that. Over the last two years, BioPIC—a project led by AVAC with support from the Gates Foundation—has been gathering and sharing evidence on these critical lessons to ensure the next generation of HIV prevention products reaches everyone who needs and wants them with much greater speed and equity.
What We’re Learning—Highlights from 2024 Convenings
An ongoing series of think tanks, convened by BioPIC and WHO since 2021, are generating key insights for people-centered product delivery. Below, read the latest reports from these think tanks that are informing decision-making on priorities for accelerating access to PrEP. Go to the BioPIC’s page on PrEPWatch to find reports on all think tanks since 2021.
Early Insights from EBONI and PILLAR, February 2024: Early insights from ViiV Healthcare, the manufacturer of CAB for PrEP, from two CAB for PrEP implementation studies, EBONI and PILLAR. Conducted by ViiV in the US, these are among the first studies gathering data in real-world settings. Learn more
Taking Stock of PrEP Evidence, March 2024: An analysis of current data and priority evidence gaps. This inquiry was not focused on any one PrEP product, and its findings are informing the focus of future think tanks. Learn more
Discussing Early Results from the SEARCH Dynamic Choice Study, April 2024: Professor Moses Kamya of Makerere University shares early insights from the SEARCH Dynamic Choice Study in Kenya and Uganda, which gave participants a choice between oral PrEP, PEP, and CAB for PrEP, and analyzes the role of choice in PrEP coverage. Watch here
PrEP and the Role of HIV Self-Testing, May 23: Highlights from the WHO guidance on use of self-testing (HIVST) as an innovative way to increase PrEP access and coverage and further simplify PrEP delivery. Panelists also share experiences with procurement, costing, rollout and scale-up. Watch Here
We hope you will book mark these resources, and stay up to date on findings from future think tanks and webinars in 2024 on the BioPIC page of PrEPWatch.
PxWire Volume 14, Issue No. 2
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
New research provides reassuring evidence that oral PrEP can reliably prevent HIV infection in cisgender women even with non-perfect adherence. Prior to becoming the director of NIAID, Dr. Jeanne Marrazzo led a team in a study assessing the effectiveness of F/TDF for PrEP (brand name Truvada) among cisgender women across a wide range (11) of studies. This paper—HIV Preexposure Prophylaxis with Emtricitabine and Tenofovir Disoproxil Fumarate Among Cisgender Women, which she also presented on a recent Choice Agenda webinar—dramatically shifts the conversation away from the need for women to be “super-adherers” to oral PrEP. The data also reinforce the need to support an array of options for women.
These graphics show the very high effectiveness of oral F/TDF for women with daily adherence and also for those who had consistently high adherence. Data comes from 11 demonstration projects of 2,954 cisgender women across six countries (Botswana, India, Kenya, South Africa, Uganda, USA) over eight years (2012-2020).
The data also demonstrates comparable effectiveness of F/TDF found in cisgender men who have sex with men (MSM).
Global and Country Milestones
January-March 2024
Global cumulative PrEP initiations surpassed 6.7 million, which includes CAB initiations (12,075) and DVR initiations (1,797).
Mexico and the United Arab Emirates approved oral F/TAF (or Descovy) in April.
For more comprehensive PrEP initiation data, see our tracker, data.prepwatch.org.
PrEParing for New Products
It has taken over a decade from positive efficacy results for daily oral TDF/ FTC to reach scale globally—and six years post-efficacy just to become available, in limited quantities, in lower-and middle-income countries (LMIC). During this time, nearly 20 million people acquired HIV. How many of those infections would have been prevented with faster, more efficient rollout of PrEP?
The rollout of oral PrEP demonstrates that people don’t take PrEP simply because it’s available—there needs to be a demand for it, and it needs to be accessible, acceptable and used effectively by those who need and want it. These are the lessons the field is applying to the rollout of the dapivirine vaginal ring (DVR) and injectable cabotegravir for PrEP. To reach the UNAIDS target of 10 million PrEP users by 2025, initiations of oral PrEP alone will not be enough—and the graphic at right does show that the field is beginning to apply past lessons to accelerate introduction of injectable cabotegravir.
Having multiple options for users to choose from is critical to increasing PrEP coverage, as seen from the early results of the SEARCH dynamic choice study, where coverage among participants featured a choice of products and settings for receiving oral PrEP, PEP, or injectable cabotegravir. The study showed 70% PrEP coverage in contrast with 13% coverage among those only offered oral PrEP or PEP from standard programs.
Product Updates
So far this year, Canada, Mozambique, Tanzania, and the United Kingdom approved injectable cabotegravir, and it’s now under review in Taiwan.
Malawi, Zambia and Zimbabwe are the second, third and fourth countries now rolling out injectable CAB outside the planned and ongoing implementation science studies. This is due to initial quantities supplied via PEPFAR.
The PURPOSE efficacy trials are expected to report results later this year or in early 2025. If the six-monthly injectable lenacapavir demonstrates safety and efficacy, it will be the next long-acting injectable PrEP option to enter the market—and it is not too early to plan.
PURPOSE 1 is evaluating the safety and efficacy of both twice-yearly injectable lenacapavir and daily oral F/TAF in cisgender women in South Africa and Uganda.
PURPOSE 2 is assessing injectable lenacapavir among cisgender men who have sex with men, transgender men, transgender women and gender non-binary individuals who have sex with partners assigned male at birth in Argentina, Brazil, Mexico, Peru, South Africa, Thailand and the United States.
PURPOSE 3 is studying injectable lenacapavir for PrEP among cisgender women in the United States who are disproportionately affected by HIV, with a focus on Black women and other women of color.
PURPOSE 4 is evaluating injectable lenacapavir in adults who inject drugs in the United States.
PURPOSE 5 will evaluate injectable lenacapavir compared to F/TDF in people who may benefit from PrEP but who are not currently taking PrEP in Europe. The study has an intentional focus on recruiting participants from groups across France and the United Kingdom that are disproportionally affected by HIV and often underrepresented in clinical trials.
Prevention Playlist
AVAC develops a wide range of materials and resources to inform decision making and action. Check out the latest:
Displayed in these two graphics: researchers documented patterns of adherence for oral PrEP and we graphed HIV incidence based on weekly F/TDF adherence in cisgender women. Excerpted from PxWire.
Avac Event
Illinois PrEP Summit 2024: Disrupting Disparities and Advancing Access
The conference focuses on advancing biomedical HIV prevention to help achieve Getting to Zero by 2030. Key summit goals include improving access, addressing disparities, fostering research and promoting community engagement. Join us for in-person sessions covering strategies, policies and implementation research.
This conference is curated by AFC, MATEC, PrEP4Teens and Project VIDA.
Registration closes, June 7, 2024.
Avac Event
HIV, Viral Hepatitis and Sexually Transmitted Infections: Progress and gaps
13:00 – 14:30 CEST PM
Please join this webinar being held in the run up to the 77th World Health Assembly.
The World Health Organization (WHO) will launch a publication, which describes progress and gaps identified during the first two years of implementing the global health sector strategies on HIV, viral hepatitis and sexually transmitted infections (STIs) for 2022-2030.
Moderators will ask key leaders in the responses to HIV, viral hepatitis and STIs how we can increase visibility, political will and community activism to accelerate action.
Panelists include:
Jérôme Salomon, WHO, Switzerland
Jessica Hicks, World Hepatitis Alliance, United Kingdom
Maureen Luba, AVAC, Malawi
Meg Doherty, WHO, Switzerland
Patty Garcia, Cayetano Heredia University, Peru
Philippe Duneton, Unitaid, Switzerland
Sabin Nsanzimana, Ministry of Health, Rwanda (TBC)
The conversation will be moderated by Charles Gore from the Medicines Patent Pool (MPP) and Birgit Poniatowski from IAS – the International AIDS Society.
The webinar is organized by IAS – the International AIDS Society – and its partners, WHO, Medicines Patent Pool and Unitaid.
Cabotegravir Long-Acting Injectable for Prevention
Frequently Asked Questions
Afrocab has developed a FAQ (below) that covers the topics of PrEP and explains how CAB-LA works, is taken, and its side effects.
Biomedical HIV Prevention Summit and PrEP in Black America Summit
AVAC Highlights
1,000+ community advocates, researchers, policy experts, federal public health leadership, medical and service providers attended the NMAC annual Biomedical HIV Prevention Summit in Seattle. The discussion and debate on PrEP access, especially for racial and ethnic minorities and key populations, PrEP research, care, policy and community-based programs are ones to follow.
The Years Ahead in Biomedical HIV Prevention Research
This graphic shows the updated status of large-scale prevention trials through the end of 2024.
Allocation of Non-Commercial CAB for PrEP Supply in Low- and Middle-Income Countries, 2023-2025
Malaysia, Nigeria, Peru, Zambia, and the European Medicines Agency have approved CAB for PrEP; ViiV also made submissions in Canada, Colombia, and the United Kingdom. There are now 13 regulatory approvals and 15 additional submissions that are pending.
