22 APRIL 2022 VOLUME 24 ISSUE 16

Despite appearances, mRNA technology is not new. But ever since mRNA vaccines burst onto the global scene to take on COVID-19, a wealth of possibilities has opened up as research teams explore ways to harness mRNA technology to tackle other global health concerns.

The HIV prevention injection called long-acting cabotegravir (aka CAB-LA), currently costs more than R300,000 per person for a year’s supply in the United States. This prices the medicine out of range for many governments, including South Africa’s. If nothing changes, South Africa will not have access to the injection and people will have to rely on other HIV prevention measures, like the oral pill Truvada or the vaginal ring. The injection could be made for as little as R300 per person, shows research conducted by the Clinton Health Access Initiative.

Operation Warp Speed, a federal effort supporting COVID-19 vaccine development, helped get multiple vaccines authorized for use in less than a year. We asked Carlos del Rio, MD, Infectious Disease News Editorial Board Member, executive associate dean at Emory University School of Medicine, past chair of the HIV Medicine Association and president-elect of the Infectious Diseases Society of America, if a similar effort could produce a cure for HIV within a year.

NSW reported its lowest number of new HIV infections on record last year with the goal of elimination of the virus in the state now “well within reach by 2025”. The achievement would make NSW one of the first places in the world to eliminate HIV before the global target of 2030, public health experts say.

HIV and SARS-CoV-2 are completely different viruses. They spread and make people sick in completely different ways. But in 2020, when COVID-19 started to spread, Stephanie Brooks-Wiggins says, it felt familiar.

When Anthony Cantu received a $373 bill from Blue Cross Blue Shield of Texas (BCBS) for lab work related to his prescription for PrEP (i.e., HIV prevention medication), he knew it was a mistake. That’s because a rule under the Affordable Care Act stipulates that everything related to PrEP, including labs and doctor visits, should be covered at no charge. That bill plus another for more PrEP labs sent Cantu on a months-long quest to reverse the charges—starting with his doctor, who submitted an appeal to BCBS and called the payer, who wasn’t aware that PrEP services should be covered.

The WHO recommends conducting molecular diagnostic testing for tuberculosis in all HIV-positive patients in high-burden settings; these guidelines were informed by a paper published in The Lancet HIV.

Key populations are disproportionately affected by human immunodeficiency virus (HIV). Access, retention, and adherence are important barriers for the efficacy of preexposure prophylaxis (PrEP) and HIV treatment among these populations. Long-acting (LA) antiretrovirals hold the promise to solve some of these backdrops. The objective of the current review is to update the perceptions of key populations and PLWH about LA, based on their opinion, acceptability, and willingness to use it.

HIV preexposure prophylaxis (PrEP) is a key tool in ending the HIV epidemic. Long-acting cabotegravir (LA- CAB) phase II/III studies revealed promising efficacy in preventing HIV acquisition. Here, we discuss key considerations for implementing LA-CAB in low- and middle-income countries (LMIC).

Traditional healer-delivered HIV testing was considered more confidential and easily accessible compared to clinic-based testing. Offering services through traditional healers may improve uptake of HIV testing services in rural, medically pluralistic communities.

We highlight a paucity of real-world data and key unanswered questions. Existing data on injection techniques may have implications for training; monitoring of outcomes is crucial to ensure clinical trial results are replicated in real-life. Better understanding of treatment failure, and individualised therapy, is crucial, and it is important to repeat patient preference surveys as new data emerges to ensure decisions are based on the most recent evidence of benefit vs risk.

HIVST responds to some service access barriers experienced by Asian, Black and Latin American MSM. The decoupling of HIV testing and clinic attendance may be particularly valuable for MSM of minority ethnic backgrounds who are likely to experience anxiety and discomfort in clinic waiting rooms more acutely than White MSM due to concerns around implied disclosure. This suggests that HIVST may have the potential to increase testing uptake and frequency, particularly for those with complex relationships with clinical services.

Respondents placed the greatest importance on PrEP medication formulation and healthcare facility. Latent class analyses showed the group with the highest rural proportion preferred for on-line visits. Black women in the Deep South had distinct preferences regarding PrEP service delivery. These findings can inform tailored interventions to improve PrEP uptake among Black cis-gender women across diverse settings in the South.

The qualitative interviews revealed that, despite TW being aware of their risk of contracting HIV, their vulnerabilities overlapped their risk perception, making them trivialize or ignore the risk. This study will help to understand the HIV dynamics among TW and contribute to further health research, education, policymaking, and planning associated with specific health strategies to promote the sexual health of TW.

We found that greater reported PrEP barriers were associated with higher odds of using PrEP on-demand or not using PrEP compared to daily PrEP use. More past 3-month sex partners and greater comfort telling others about PrEP use were associated with lower odds of on-demand compared to daily PrEP use. In addition, compared to daily PrEP use, more past 3-month sex partners, greater comfort telling others about PrEP use, and higher anticipated PrEP stigma were associated with lower odds of no current PrEP use compared to daily PrEP use.

Self-reported PrEP adherence and persistence were high, but instances of PrEP non-adherence were observed to frequently overlap with episodes of condomless anal sex. The most prominent reasons cited for missing PrEP doses were being too busy, not having PrEP on hand, and not being sexually active. Completing short, biweekly surveys of PrEP use and sexual behavior is feasible and acceptable to MSM in the southern US. Future studies should investigate incorporating biomarker measurements to validate self-reported adherence.

MSM living with HIV, especially those sexually active, showed positive attitude towards functional cure and willingness to join related clinical trials despite low awareness. To enhance preparedness for HIV functional cure trials, community education, updated information and appropriate medical advice would be needed. Safety is a major concern for potential enrollees in HIV functional cure trials.

The WHO four-symptom screen (W4SS) and other potential screening tests to guide Xpert testing have suboptimal accuracy in HIV-positive inpatients. On the basis of these findings, WHO now strongly recommends molecular rapid diagnostic testing in all medical HIV-positive inpatients in settings where tuberculosis prevalence is higher than 10 percent.