Avac Event

We Can’t End HIV in the United States Without Equitable PrEP Access: Strategies for success

A collaboration between HIVMA, PrEP4All and The Choice Agenda, this webinar assessed some of the key challenges to delivering PrEP in the United States equitably, including cost, the complexities of our health care system, and other factors that inhibit uptake amongst the most vulnerable communities. Strategies to address these challenges were offered included a Q&A, discussion and much-needed debate.

Speakers:
• Dr. Lorraine Dean, Johns Hopkins University, Department of Epidemiology 
• Dr. Rupa Patel, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention
• Dr. Patrick Sullivan, Rollins School of Public Health, Emory University 

Moderator:
Dr. Greg Millet, amfAR

Recording / Slides / Resources

Pamela Fuzile

Pamela has over a decade of experience working in HIV prevention and implementation programs. She is currently a research administrator for FAST PrEP, an implementation science project providing differentiated PrEP (oral, vaginal, and injectable) delivery to adolescent and young people in South Africa. She played a significant role in the design of a Youth Reference Group (YRG) in the FAST Prep project in 2020.  And, notably, Pamela was involved in the development of youth centered delivery of STI partner notification. As an AVAC 2024 Advocacy Fellow, she aims to create a youth prevention advocacy platform.

Press Release

Funding for HIV Survives Extreme Cuts Proposed By House Republicans

Final FY24 Bill Includes Calls for HHS/CDC to Increase PrEP Access

21 March 2024 – PrEP4All, AVAC, HIVMA, and the PrEP in Black America coalition celebrate Congress’ decision to both fund domestic HIV programs at the same level as last year and to lift up calls for a National PrEP Program. The final 2024 Health and Human Services bill rejects extreme cuts to HIV funding proposed by House Republicans in July of last year. The organizations have led the charge on the #SaveHIVFunding campaign following efforts to eliminate $767M in critical funds to end HIV as an epidemic. We additionally thank House and Senate LHHS Appropriations Subcommittee leaders Senators Tammy Baldwin (D-WI) and Shelley Moore Capito (R-WV) and Representatives Robert Aderholt (R-AL) and Rosa DeLauro (D-CT) for working to ensure an effective and ultimately bipartisan outcome.

“Our movement for a National PrEP Program and to end HIV as an epidemic remains strong,” says PrEP4All Executive Director Jeremiah Johnson. “The final bill ultimately shows strong bipartisan support for HIV funding, including PrEP, and rejects the flawed effort by some House Republicans to zero out the Ending the HIV Epidemic Program. We created the #SaveHIVFunding campaign in collaboration with AVAC, HIVMA, and PrEP in Black America knowing that everyone in Congress needed to hear from community advocates in order to be successful in fighting these unnecessary deep cuts. Without this work and the concerted and brilliant efforts of so many HIV organizations within the Federal AIDS Policy Partnership, this win would not have been possible.”

The outcome means that a previous $25M increase going toward CDC’s efforts to improve equitable PrEP access will be preserved, which is critical as advocates continue to engage with CDC on ways to establish a foundation for a National PrEP Program using existing funds. Congress also included final report language directing CDC to increase access to PrEP and cited previous calls from the Senate to establish the “building blocks of a national program to increase awareness of PrEP, increase access to PrEP medication, [and] laboratory services…”

“This outcome is a win for Black communities across the nation who are disproportionately impacted by HIV. Making life-saving treatment and prevention a reality for Black Americans is a possibility because of our relentless advocacy work to #SaveHIVFunding,” says Raniyah Copeland, Founding member of the PrEP in Black America Coalition and Founder of Equity Impact Solutions. 

“This has been a long process, and we are grateful to have an outcome that leaves us on firm footing to realize the vision of a National PrEP Program,” says Andrea Weddle of HIVMA. “However, the fight for FY25 is already upon us following this prolonged budget process; meaning that advocates will have to remain vigilant, fight to protect our existing funding, and continue to ensure a clear, immediate, and fully funded pathway toward equitable PrEP access.”

“This is very encouraging news for PrEP advocates, especially following the President’s reintroduction of his proposal for a National PrEP Program last week.” Explains John Meade, Senior Program Manager for Policy at AVAC . “Combined with HIV/AIDS housing advocates’ victory in achieving an FY24 funding increase, I am so proud of our movement and our ability to rally in the face of these threats.”

A National PrEP Program would be a cost effective means to achieve our national goal of Ending the HIV Epidemic by 2030. Pre-Exposure Prophylaxis (PrEP) is a 99% effective use of medication to prevent HIV. Unfortunately 64% of people who could benefit from PrEP do not have access to it. A new study shows that states with the highest PrEP coverage showed an annual percentage decrease in HIV diagnoses of 8% from 2012 – 2021. In contrast, states with low PrEP coverage increased 2% annually. A National PrEP Program will increase access among people who could benefit and address major disparities in access related to race, gender and geographic location.  “In the current political environment, this Congressional action is especially noteworthy. But we must never confuse this progress with success; our fights for funding, equity and impact in treating and preventing this epidemic must continue, and funding and implementing a national PrEP program at scale and with urgency remains a huge priority,” said Mitchell Warren, Executive Director of AVAC.

Read the full press release 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.

Avac Event

The More We Know: Evolving our understanding of PrEP for cisgender women

Science and real-world experience continue to demand a re-assessment of our collective understanding of the safety and effectiveness of PrEP options for women, including oral, vaginal ring, and injectable options. For instance, a new paper in the Journal of the American Medical Association by Dr. Jeanne Marrazzo (HIV Pre-Exposure Prophylaxis with Emtricitabine and Tenofovir Disoproxil Fumarate Among Cisgender Women) challenges the notion, baked into policies, programs and “conventional wisdom”, that cisgender women need to be “super-adherers” to achieve protection utilizing oral PrEP. In this webinar, we discussed this important paper and more.

Speakers:
• Dr. Jeanne Marrazzo, National Institute of Allergy and Infectious Diseases
• Joyce Ng’ang’a, WACI Health

Moderator:
Raniyah Copeland, Equity & Impact Solutions

Materials:
Recording / Ukrainian Audio / Slides / Resources / Audio Transcript (English/Ukrainian)

Avac Event

MOSAIC Global PrEP Learning Network – Building a Brand for PrEP: Positioning PrEP in the Hearts and Minds of Young People


With choice of PrEP products on the horizon – including oral PrEP, the PrEP ring, and injectable cabotegravir for PrEP (CAB PrEP) – PrEP marketing and demand generation must evolve with the availability of new PrEP products. Young people, in particular, need PrEP demand generation campaigns tailored to their needs and aspirations. In this webinar, we will hear from teams working to change the landscape of PrEP marketing by applying private sector approaches to brand the PrEP category. We will also hear how they are developing fresh, dynamic, and evidence-informed campaigns to increase PrEP awareness and encourage PrEP use among young people in Africa.

This webinar is being hosted by PEPFAR, USAID, and MOSAIC.

Cumulative PrEP Initiations

2016-2025

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? Excerpted from an issue of PxWire.

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

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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.