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Tampilkan postingan dengan label HIV Prevention Justice Alliance. Tampilkan semua postingan

PrEP: A Possible Approval Like No Other

Via Poz, by Tim Horn

The AIDS Healthcare Foundation began a paid advertisement campaign urging Gilead Sciences to refrain from seeking approval from the U.S. Food and Drug Administration for Truvada for use of the combination tablet as HIV prevention, in an approach known as pre-exposure prophylaxis, or PrEP.

The ads were met by an outcry from the community. One prominent organization, the HIV Prevention Justice Alliance, issued a sign-on letter , dated March 16, urging the FDA "to examine the study results of PrEP rather than playing to speculation and fear."

While I agree that PrEP should be considered as an option in the HIV prevention toolkit and would ultimately support an effort by Gilead to expand Truvada's labeling to include PrEP--should the company petition the FDA for approval--I am also of the mind that a green light from the FDA should not be met with the rush-to-treatment that typically follows approval of a drug.

Given how little we know about the safe application of PrEP in a real-world setting--read: outside of a clinical trial--not to mention the expense of a comprehensive prevention program that includes PrEP, I think more feasibility studies need to take place before we consider a widespread HIV prevention program involving PrEP.

Here's what we do know: PrEP is effective in one population of at-risk individuals: men who have sex with men (MSM). The iPrEx clinical trial, sponsored by the National Institute of Allergy and Infection Diseases (NIAID) of the U.S. National Institutes of Health (NIH) and co-funded by the Bill & Melinda Gates Foundation, involved a large sample size (approximately 2,500) of MSMs. The study, which had sound design and statistical analysis, proved Truvada use resulted in significantly fewer infections compared with those using a placebo.

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[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Is Africa ready for PrEP?

Via Incidence0.org, by Adebisi Ademola Alimi

One of the biggest breakthrough in HIV clinical research, since the outbreak of the epidemic 30 years ago, is the recent success in a clinical trial of a new HIV prevention approach based on the daily use of the antiretroviral drug Truvada by HIV negative person to prevent HIV transmission (Called PrEP, for Pre-Exposure Prophylaxis).

The results of the iPrEX trial raised hope but also many questions and concerns as showed by the ensuing debate about what the next step should be. Divergences culminated with the Aids Health Foundation (AHF) petitioning the FDA not to consider Gilead’s request for a licence to use Truvada for the prevention of HIV infection and a joint counter response by a number of HIV advocacy organisations.

But for me as an advocate and an African living in Europe, the most important thing on my mind is “Will Africa be able to access PrEP?” Providing ARV to HIV negative people in Africa needs to be considered in light of the challenge of accessing treatment in Africa, where more than 50% of HIV positive people in the world live (UNAIDS report).

Even if PrEP drugs become available, what are the mechanisms in place to ensure that it will not be tribalized in a continent where there are some indications that access to ARVs is based on political and ethnical loyalty and where there are evidences of bribery at the delivery point, misused of funds and a non-negligible ARVs black market leading to ARVs being dispensed to increasing numbers of patients at the periphery of the health system. One has to be skeptical about the PrEP implementation process in this context.

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[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article's content, whether in support or in opposition.]

Q and A: Moving PrEP from Promising Trial Result to Practical, Public Health Prevention Intervention?

by Julie Davids, AIDS Foundation of Chicago, HIV Prevention Justice Alliance and IRMA member

As noted in these pages and press reports worldwide, the iPrex trial found that daily use of truvada protected gay men, other MSM and trangender women from HIV infection.

Updated data presented at this week's Conference on Retroviruses and Opportunistic Infections (CROI) showed the trial results held true through 144 weeks - nearly three years - and that the key challenge seems to be adherence. Those who took the drug most or all of the time (about 1/2 of the people in the study) had high rates of protection - over 90%. But because the other half took little or no drug at all (as confirmed by blood tests), the overal efficacy rate among trial participants was 44%.

After a long day at the conference, an eager crew of conference-goers - including researchers, people with HIV, White House officials and press - joined local community members here in Boston on Tuesday night in the auditorium of Fenway Community Health for ARV-Based Prevention: A Community & Research Forum on Recent Results and What Happens Next, sponsored by AVAC and Fenway.

At the end of the formal presentations, I asked the panelists (on behalf of the HIV Prevention Justice Alliance)

"What are one to three next steps that are vital to making PrEP [pre-exposure prophylaxis] effective at the community or public health level, rather than just a boutique intervention for a few individuals?"

I captured the responses, which cover a wide range of issues and strategies, and wanted to share them with you. Panelists, in order of response, were:

- Morenike Ukpong, New HIV Vaccines and Microbicide Advocacy Society, Nigeria
- Kevin Cranston, Massachusetts Bureau of Infectious Disease
- Cate Hankins, UNAIDS
- Salim Abdool Karim, CAPRISA
- Jared Baeten, University of Washington and Partners PrEP
- Robert Grant, Gladstone Institute of Virology and Immunology
- Jim Rooney, Gilead Sciences
- Mark Hubbard, Tennessee Association of People With AIDS



Q and A: Moving PrEP from Promising Trial Result to Practical, Public Health Prevention Intervention? from HIV Prevention Justice Alliance on Vimeo.