One Timeline, Two Stories, One Message: Putting trials and targets together

One problem with HIV prevention agendas is that they either live in an eternal present or in a far-off future. It’s “work with what we’ve got, which is condoms and VMMC and a little bit of PrEP”, or it’s “nothing can change without an AIDS vaccine”. The future depends on using what’s available, better and more widely, without ever losing sight of what’s in the pipeline.

As the figures below show, in the very same timeframe that the world will miss its critical target for incidence reduction and scale-up of primary prevention, several trials will release results that could change the future. 2020 will be a time of hope and reckoning. But only if the two stories start to be told as one.

Towards a Demand Creation Cascade

Many countries report low initiation and continuation of PrEP. This doesn’t mean people don’t want the product. They might not want the program that’s offering it; or they might not be being reached. A “demand-creation cascade” such as the one proposed here for PrEP is one way to evaluate the program and the product. It would measure how many people received the full suite of demand-side activities the program hopes to deliver at a given stage. The precise set of steps would depend on the service-delivery design and strategy in question.

Phases of Informed-Choice PrEP Counseling

This flow chart emerged from socio-behavioral research, including surveys and in-depth interviews with Kenyan and South African women. The research team set out with the goal of adapting the informed-choice approach used in family planning programs for use in PrEP, a prime example of fields learning from each other. The result is very clinic-centered; AVAC has added the column at the far right to reflect additional elements. However, it is a step towards much-needed exploration of how to make informed choice a reality in HIV prevention today.

Putting Women at the Center: Informed choice in 2018 and beyond

We need to give women the choice to use DTG or not and to use contraception if indicated and desired. We need to support choices across options, with risk reduction—not use of a specific product—as the primary outcome. We need to give women the choice to use DMPA-IM or –SC or not, and to use HIV prevention as desired.

Map of HIV Prevention Research and PrEP Demonstration Sites in Kenya

This map demonstrates the breadth of HIV prevention research and demonstration projects in Kenya by site and type (e.g. daily oral PrEP, preventive Vaccines, etc.). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research.

Map of HIV Prevention Research and PrEP Demonstration Sites in Malawi

This map demonstrates the breadth of HIV prevention research in Malawi by site and type (e.g. ARV-based vaginal rings, long-acting injectable PrEP, preventive Vaccines, antibodies). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research.

Map of HIV Prevention Research and PrEP Demonstration Sites in Uganda

This map demonstrates the breadth of HIV prevention research and demonstration projects in Uganda by site and type (e.g. daily oral PrEP, preventive Vaccines, etc.). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research.

Map of HIV Prevention Research and PrEP Demonstration Sites in Zambia

This map demonstrates the breadth of HIV prevention research and demonstration projects in Zambia by site and type (e.g. daily oral PrEP, preventive Vaccines, etc.). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research.

Map of HIV Prevention Research and PrEP Demonstration Sites in Zimbabwe

This map demonstrates the breadth of HIV prevention research and demonstration projects in Zimbabwe by site and type (e.g. daily oral PrEP, preventive Vaccines, etc.). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research.

From Research to Roll Out: Comparing oral PrEP to the dapivirine ring

These slides provide an overview of the process that takes an HIV prevention product from the final phases of research into the real world where it’s broadly available. Also included is a comparison of findings from research on the dapivirine ring and oral PrEP at key points along the process.

A PDF version is also available.