This World AIDS Day we at AVAC are reflecting on remarkable gains and increasing threats to progress against AIDS. Our latest issue of PxWire, tracking trends in research, development and delivery of HIV prevention options, speaks to this important progress:
Five countries have reached the UNAIDS 95-95-95 targets with more than 29 million people accessing treatment, and global incidence continuing to decline – in some places, among some populations.
However, as we look to 2024, all these gains could be imperiled by political and financial choices facing leaders today.
Will the US Congress recognize the unparalleled success of PEPFAR and safeguard its funding through a clean 5-year reauthorization?
Will health officials and policy makers embrace the Choice Manifesto, created by HIV advocates and adopted by UNAIDS Executive Director Winnie Byanyima, calling for the essential investments that will bring these diverse options to the communities that need them most?
The answers to these questions will require donors and political leaders to do the right thing, and it will depend on us, a global movement of advocates with a track record of world-changing achievements, to stay the course and build the road to reach everyone one of these goals. Below are a few key resources to support your work.
From the Lab to the Jab
A series of advocates guides on key issues to ensure equitable access to safe, effective, and affordable vaccines.
POZ Magazine’s interview with Mitchell Warren, with a comprehensive look at the status of the fight against HIV/AIDS and the scientific breakthroughs to date and still needed to end the epidemic.
A Call to Action: Scale Up HPV Vaccination in People Living with HIV
In a new call to action, Mitchell Warren and Heather White, executive director of TogetHER for Health, argue that the time is now to invest in efforts to ensure that people living with HIV can live their lives without the threat of cervical cancer.
At AVAC, we believe it’s up to all of us to make sure the world does not squander another decade in slow, fragmented rollout of life-saving innovation in HIV prevention or risk underfunding research and development. If we work together to build equity into the rollout of options that exist already and support the promise of expanding choices in the near future, the world will at long last bend the curve of HIV.
ICASA 2023 Prevention Roadmap
View the ICASA roadmap for details on sessions that help to:
Accelerate and expand access to proven prevention options that people want and need.
Dismantle the structural barriers to health faced by key populations.
Intensify demands for robust domestic and global funding for health.
Integrate HIV services with sexual and reproductive health.
Join AVAC and partners for the biennial International Conference on AIDS and Sexually Transmitted Infections (ICASA), in Harare, Zimbabwe December 4-9. More than 30 of our partners will convene at the meeting to champion community leadership and amplify their role in shaping local, national and global responses and delivering impactful advocacy. Community leadership on a range of issues are instrumental to:
Accelerate and expand access to proven prevention options that people want and need.
Dismantle the structural barriers to health faced by key populations.
Intensify demands for robust domestic and global funding for health.
Integrate HIV services with sexual and reproductive health.
And much more.
Scroll down for a roadmap to ICASA’s prevention program, and details on sessions and events that you won’t want to miss.
Biomedical Prevention Forum 9:00-15:00 GMT The Biomedical Prevention Forum will be held as a hybrid event bringing together advocates, civil society representatives, researchers, government officials and front-line providers to explore and discuss the latest advancements, challenges, and opportunities in biomedical HIV prevention, while emphasizing the importance of choice and its transformative impact on HIV prevention efforts. This is an open event. Register here.
Key Populations Preconference 9:00-15:00 GMT The Africa Key Populations Experts Group (AKPEG), African Sex Workers Alliance (ASWA), the African Network of People Using Drugs (AfricanPUD) and African Queer Youth Initiative (AQYI) Advocates for Prevention of HIV and AIDS in Africa (APHA), Global Black Gay Men Connect (GBGMC) and partners will host a safe platform to deliberate on the state of the HIV epidemic among Key Populations and to determine the stumbling blocks for progress on the path that ends AIDS for Key Populations.
Shaping the future of choice in prevention: Gearing up for the rollout of the Dual Prevention Pill, the newest MPT in the toolbox 12:25-13:10 GMT The Dual Prevention Pill (DPP), a daily pill combining oral PrEP and combined hormonal oral contraception for dual pregnancy and HIV prevention, could be introduced in the next two years and would be the only other MPT available in addition to male and female condoms – and the first MPT containing PrEP. This session will discuss the latest learnings from the DPP Consortium, a coalition of organizations preparing for the introduction of the DPP in Zimbabwe, South Africa and Kenya.
Tuesday, December 5
Advancing Integrated Biomedical Prevention: Best Practices from Zimbabwe (Session 2) 8:45-09:30 GMT This satellite session will discuss best practices and lessons learned from the delivery of biomedical HIV prevention and Voluntary Medical Male Circumcision services as we work to further universal health coverage and robust health systems. Partners will launch a global call to action to unite, mobilize, and advocate for continued prioritized funding, sustained commitment, and strategic integration of VMMC into national and global prevention strategies.
Catalyzing a sustainable HIV prevention agenda: Approaches to expand local action on global commitments 10:45-11:30 GMT Leveraging new strategic plans for HIV prevention, including the PEPFAR’s 5-year Strategy and UNAIDS’ Prevention Road Map, this satellite session will discuss combination prevention in the context of a sustainable HIV response and highlight a variety of approaches and models that leverage country and stakeholder-led innovations to meet the challenge.
Policy, Politics and HIV Management 13:05-13:50 GMT In this oral abstract session, Princess Mharire from Pangaea Zimbabwe AIDS Trust (PZAT) will present, Beyond Metrics: How the Simple Participatory Assessment of Real Change (SPARC) Tool Provides a Holistic Approach to Advocacy Measurement, and Joseph Njowa of PZAT will share the COMPASS MERL model in a presentation, Innovative tools for planning, monitoring, and evaluation of advocacy campaigns.
Strengthen integration for better SRHR outcomes 10:45-11:30 GMT This concurrent session will feature Advocates for Prevention of HIV and AIDS in Africa’s (APHA) Yvette Raphael and will explore linkages between unintended pregnancies, unsafe abortion, and HIV.
HIV Prevention-Right Place, Right time 13:05-13:50 GMT This concurrent session will feature Maureen Luba of AVAC, Definate Nhamo of PZAT and Yvette Raphael of APHA.
AVAC and Partner Poster Presentations
Tuesday, December 5
Maximizing private pharmacies for PrEP delivery to increase uptake: Lessons learnt from the Community Retail Pharmacy Distribution Point, Ruth Akulu
Wednesday, December 6
Journalist Training: A Key Advocacy Strategy, Catherine Madebe
Perceptions on the new biomedical HIV prevention methods among adolescent girls and young women in tertiary institutions in Zimbabwe, Cleo Makura
Lessons from Crisis Response from TaNPUD in Enhancing Harm Reduction from 2015 to 2018, Marineus Mutongore
Implementing Community led Monitoring for improved quality of HIV services in Tanzania, Mathew Kawogo
Impact of social media exposure on HIV services uptake among Tanzanian Young people: Implications for enhancing the HIV response, Marineus Mutongore
Effective Strategies for Operating COWLHA support groups of Adolescents Living with HIV: Case of Mangochi and Chikwawa Districts of Malawi, Harry Madukani
Thursday, December 7
Understanding Choice of HIV Prevention Options among Adolescent Girls and Young Women (AGYW) in Zambia, Natasha Mwila
Leveraging HIV to Build a Global Health Research and Development (R&D) Equity Advocacy Agenda, John Meade
Championing advocacy for domestic resource mobilization for health research and development in Africa, Ethel Makila
Friday, December 8
Rural Youth: Underserved and Unsafe When Seeking Care, Liyema Somnono
Redefining Coalition Governance and Leadership in Support of Decolonizing Global Health: The Evolution of the COMPASS Coalition, Roberta Sutton
Collaborative Monitoring & Evaluation to Support Learning and Strengthen Advocacy Coalitions: The MERL Hub, Grace Tetteh
Realities faced by street children predisposing them to HIV and STIs in Dodoma and Dar es Salaam Cities in Tanzania, Simon Shilagwa
PxWire Volume 13, Issue No. 4
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. Also available as a PDF.
From Research to Rollout: A look at where we are in HIV prevention
As we look back on 2023, powerful crosscurrents confront HIV prevention and global health equity. More options than ever before could be available, but many forces threaten to undermine access to proven prevention options that exist today and the development of additional options that are still needed. Threats to PEPFAR and hate laws targeting LBGTQI+ people are just a sample.
Upstream research and development is dynamic, but robust stakeholder engagement and sustainable funding must still be secured and integrated into a people-centered research agenda. These commitments are the compass that will ultimately lead to impact in the real world. The highlights below provide a snapshot of key updates in Q3 of 2023 and resources to inform advocacy on these critical questions.
Progress in PrEP Uptake
These updates from AVAC’s Global PrEP Tracker explore trends in 2023 and highlight new data as of September 2023.
PEPFAR and PrEP
PEPFAR’s role has been instrumental to accelerating global uptake of PrEP to date. This year, four countries started providing PrEP for the first time, and seven countries exceeded 70,000 new PrEP initiations, most of which are attributable to PEPFAR. This lifesaving, uniquely effective, program must see continued full funding and a 5-year reauthorization to carry on this work and help to put the world on track to control the epidemic.
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Cumulative PrEP Initiation Milestones
Global Milestones
The world surpassed 5.6 million cumulative PrEP initiations as of September 2023. Initiations increased by 700,000+ since Q2 2023. Though comparable to previous quarterly increases, it is the highest ever recorded quarterly increase by the Global PrEP Tracker.
At the same time last year the world had reached 3.3 million cumulative PrEP initiations, representing a doubling of initiations since then.
Country Level Milestones
Early adopting African countries continue to show the most rapid increases in PrEP uptake. South Africa has shattered 1 million cumulative initiations. Nigeria, Uganda, and Zambia have all surpassed 500,000 initiations, Kenya has surpassed 400,000, and Zimbabwe has surpassed 200,000.
Malawi and Brazil saw jumps of approximately 20,000 initiations over this quarter, while Lesotho had more modest increases of 10,000 initiations.
Dozens of countries continue to grow their programs. For example, El Salvador, Honduras, and South Sudan all surpassed 1,000 cumulative initiations.
Cyprus and Malta recorded their first oral PrEP initiations, at 29 and 579 respectively.
Spotlight on West Africa
As of Q3 2023, the top five West and Central African countries for PrEP initiation have surpassed 10,000 initiations; Cameroon, Cote d’Ivoire, Democratic Republic of the Congo (DRC), Ghana and Nigeria. Nigeria has marked almost 550,000 cumulative initiations as of this quarter, ranking it second, behind South Africa, worldwide. These milestones can be credited to targeted PEPFAR investments. But despite these successes, West and Central Africa make up only 14 percent of PrEP initiations recorded in Africa, compared to 85 percent reported by East and Southern Africa. These same countries are home to two thirds of all people living with HIV in West Africa. There is vital work to be done to close the gap.
West and Central Africa can and must continue to leverage this recent growth in oral PrEP by making additional HIV prevention options available. In September, Nigeria’s regulators approved injectable cabotegravir (CAB for PrEP)—approving the first new biomedical HIV prevention option in a West and Central African country since oral PrEP. But at this time, only one other CAB for PrEP application has been submitted in the region, in Côte d’Ivoire, and none for the dapivirine vaginal ring (DVR). Only one CAB for PrEP implementation study is planned for the region.
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PrEParing for New Products
Current HIV prevention options aren’t reaching all who need them. Access to a range of options that meet the needs of diverse people, especially those most at risk, will be essential to meeting global targets for ending the HIV epidemic.
CAB for PrEP Supply: In October 2023, ViiV, the developer and sole manufacturer of CAB for PrEP for now, announced a 40 percent increase in forecasted doses that could be available for non-commercial use in low- and middle-income countries through 2025, an increase to 1.2 million potential doses. Of these, 116,000 have been allocated to post-trial access for HPTN 083 and 084 participants; 129,000 for an initial set of eight implementation studies; 326,000 to PEPFAR programs in Malawi, Ukraine, Vietnam, Zambia and Zimbabwe; leaving at least 629,000 doses available for procurement by PEPFAR, Global Fund and national governments. See more details in our Country Planning Matrix. Three generic manufacturers could begin to deliver doses in 2026 or 2027.
Implementation Science (IS): As DVR and CAB for PrEP supplies arrive in countries, dozens of implementation science studies are underway in 22 different countries. Check out AVAC’s Integrated Study Dashboard for more details and stay tuned for updates.
PrEParing for Choice: For the first time since oral PrEP was introduced in 2012, PrEP users will have a range of methods to choose from—but only if they have access to them. Policy makers, donors, governments and implementers must commit to making these methods available, accessible and affordable. The HIV Prevention Choice Manifesto, launched in September by the African Women’s HIV Prevention Community Accountability Board, outlines what needs to happen to make choice a reality.
Approval Information
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.
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The HIV Prevention Pipeline: The latest in research, development and more
The HIV prevention pipeline has evolved: Few products are in late stage or efficacy trials, newly proven products are rolling out, and early phase clinical trials are exploring innovative strategies. R&D is focused on ARV and non-ARV based prevention products and HIV vaccines that build on new knowledge about the virus. The late-stage trials of recent years and basic science have brought deepening insights that are being applied today to a diversity of ‘upstream’ interventions.
MK-8527 Announced: Merck announced a new Phase 2a trial to evaluate the safety, tolerability, and pharmacokinetics of a monthly oral pill, MK-8527. The trial began in November 2023 in participants at low-risk for HIV acquisition. If successful, Phase 3 trials could start in 2025.
PURPOSE Program: A new Phase 2 study, PURPOSE 5, will evaluate lenacapavir as a twice-yearly prevention option in France and the United Kingdom, as part of the larger PURPOSE program. Purpose 5 is recruiting participants who are disproportionally affected and often underrepresented in HIV clinical trials. PURPOSE 1 and 2 are Phase 3 efficacy studies in Argentina, Brazil, Mexico South Africa, Thailand, Uganda and the United States. PURPOSE 3 & 4 are smaller studies focused on populations facing disproportionate risk.
The Dual Prevention Pill (DPP): In September, the DPP, which would protect against pregnancy and HIV, moved to the next stage in R&D. A pilot bioequivalence study has shown the pill’s combined drugs—an antiretroviral and a contraceptive—are absorbed at an equivalent rate as taking them separately. The DPP now moves to a larger bioequivalence study needed for a regulatory submission. Check out the updated DPP Market Preparation and Introduction Strategy for highlights. The Population Council and Medicines360 are also developing a second-generation DPP with F/TAF.
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Prevention Playlist
The most effective advocacy is based on smart analysis and accurate information. AVAC develops a wide range of materials and resources to inform decision making and action. Check out these essential resources to the global conversation on HIV prevention and global health equity.
JOIN
ICASA: The biennial International Conference on AIDS and Sexually Transmitted Infections in Africa. Dec 4-9. Register
How Our Environment Impacts Cure, webinar, Dec 13. Register
STI Watch Newsletter, a curated resource on the latest STI vaccines, diagnostics and other prevention strategies.
The STI Clinical Trials Dashboard, tracking trials on vaccines, doxycycline as post-exposure prophylaxis (DoxyPEP) and diagnostics against chlamydia, gonorrhea, hepatitis B, herpes simplex virus(HSV), human papillomavirus, syphilis and trichomoniasis infections.
African Civil Society Mobilization for PEPFAR Reauthorization
Tuesday, November 28 at 7:00 AM ET
Moderator: Richard Muko,Regional Implementation Advocacy Manager, AVAC
Panelists: Joan Chamungu, Tanzanian Network of Women Living with HIV, Lawrence Khonyongwa, Malawi Network of People of Living with HIV, TBC, African Network of Youth Living with HIV, Annette Gaudino, Advocacy Coalition Manager, GAPP
Hosted by African Network of Youth Living with HIV (AY+), East African Network of AIDS Serving Organizations (EANNASO), Key Populations Trans-National Collaboration (KPTNC) and Coalition to build Momentum, Power, Activism, Strategy & Solidarity (COMPASS)
Join civil society organizations in PEPFAR recipient countries to discuss the status and political context of the current reauthorization and mobilize to call on the US Congress to recommit this life sustaining program. Bring your questions and please share this invitation widely in your relevant networks.
Pandemic Accord Briefing for Civil Society & Community Partners
The Pandemic Accord negotiations are ongoing, and should come to fruition next year. What do they mean for your work, your country, and the future of global health?
On Tuesday, November 21, 8:00 to 9:30 AM EST / 2:00 to 3:30 PM CEST, advocates came together to discuss two years of talks and what’s next to progress global health equity.
Spotlight on New PrEP Tools and Data: From R&D to access
Tuesday, November 28
Between the recent accelerated growth in global PrEP initiations, and the introduction of new PrEP products like cabotegravir and the dapivirine vaginal ring, the field of PrEP data has never been more exciting or more complex. Staying on top of the latest advances is key for advocates, researchers, funders, and others working in HIV prevention to do their job effectively—but how can you navigate the vast amount of PrEP data online? AVAC, the Medicines Patent Pool (MPP), and Unitaid presented information on three important online PrEP resources and understand how they can support and enhance your work:
PrEPWatch.org: the one stop shop for PrEP resources to support introduction and scale-up, including the PrEPTracker, the only place to find information on global PrEP initiations online
Access to Medicines Tracker: the go-to place for quarterly-updated insights on regulatory filings, regulatory approvals, and product supplies of MPP-licensed generic medicines at the country level.
mRNA technology is currently being studied for many different uses. Excerpted From the Lab to Jab series.
How Do mRNA-Based COVID-19 Vaccines Work?
A detailed graphic showing the biological mechanisms by which mRNA vaccines work. Excerpted From the Lab to Jab series.
Getting the COVID-19 Vaccines We Need
As of March 2023, the World Health Organization reported that there are 199 COVID-19 vaccines in pre-clinical development, and 183 in clinical trials. Most are injectable; but 16 candidates are intranasal, 5 are oral, 2 are inhalable, and 1 is an aerosol.
