23 DECEMBER 2021 VOLUME 23 ISSUE 51

The first long-acting injectable for HIV prevention has now been approved for use, the FDA announced on Monday. Long-acting injectable cabotegravir (CAB-LA, branded as Apretude) is administered as a monthly injection for the first 2 months, then every 2 months afterwards. It is the first long-acting injectable for pre-exposure prophylaxis (PrEP). The drug is approved for adults and adolescents weighing at least 77 lb.

There had been more 200,000 pre-exposure prophylaxis (PrEP) initiations in North America from 2016-2020, according to data from the AVAC earlier this year. While the US is highly contributory to the gradually increasing rate of HIV-risk persons gaining access to PrEP annually, it’s not enough to consider the work accomplished on a national scale.

On December 20, the Food and Drug Administration (FDA) approved Apretude, or extended-release cabotegravir, as the first long-acting injectable option for HIV pre-exposure prophylaxis (PrEP). Apretude, which is administered by a health care worker every other month, is indicated for adults and adolescents weighing at least 77 pounds to reduce the risk of sexually acquired HIV.

A qualitative study by Dr. Adam Bourne and colleagues published in Global Public Health highlights the stigma and discrimination experienced by men who have sex with men (MSM) and trans women when accessing sexual health services in Nairobi, Kenya. Most participants preferred community run services and did not want to be referred to another clinic or public hospital. Trans interviewees emphasised the need for trans-run clinics.

Olivia and Amy are sitting outside in the shade, trying to escape from New Zealand’s early-summer humidity. Amy, 10 months old, burbles happily in the background as her mother talks. She is healthy, happy, and oblivious to her status as a world first: one of a handful of babies born from the first sperm bank for HIV-positive donors.

In the last decade, rates of new HIV infections have nearly doubled in eastern Europe and central Asia (EECA), while decreasing globally. More than 1.6 million people are living with HIV in eastern Europe and central Asia and every day more than 380 people are newly diagnosed. The figures buck the trend elsewhere in the world and prompted the Joint United Nations Programme on HIV/AIDS (UNAIDS) – the organisation leading efforts to end AIDS by 2030 – to warn this summer that the epidemic in EECA is out of control.

The COVID-19 pandemic hit South Africa’s tuberculosis (TB) response early and hard. Between February and May last year COVID-19 lockdowns resulted in a 59 percent decline in TB tests, and a 33 percent decline in the number of TB diagnoses in South Africa, according to data released last year by the National Institute for Communicable Disease (NICD).

This paper presents results of a research priority setting process focused on trans women living with and affected by HIV across Canada. It features data from semi-structured interviews and focus groups conducted with a diverse group of 76 trans women in five urban centers across the country on how they have navigated health and social service programming within their geographic context. The results focus on the structure and types of services. Respondents offered simple, yet creative ways to address barriers to vital services based on their individual and collective experiences.

Historically, HIV policy discourses have combined—in various forms—at least three elements: a human rights perspective, a teleological approach whereby HIV strategies are designed in line with overarching objectives such as ending AIDS, and an economic perspective. Good economics informs epidemic control efforts. Advances in economics have the potential to help end the colliding HIV and COVID-19 pandemics and accelerate progress towards universal health coverage.

As some bNAbs have been shown to lose potency against cell-associated virus, we investigated the ability of bNAb scFv to neutralize this mode of transmission. We demonstrate that unlike IgG, scFv of bNAbs are able to neutralize cell-free and cell-associated virus with similar potency. These scFv, which show functional activity in the therapeutic range, may therefore be suitable for further development as passive immunity for HIV prevention.

The AMP studies (HVTN 703/HPTN 081 and HVTN 704/HPTN 085) are harmonized Phase 2b trials to assess HIV prevention efficacy and safety of intravenous infusion of anti-gp120 broadly neutralizing antibody VRC01. Antibodies for other indications can elicit infusion-related reactions (IRRs), often requiring pre-medication and limiting their application. We report on AMP study IRRs.

Findings in the study suggest promotion of male education, and suggest further investigation into the relationship between HIV non-testing among sexually active men (15 – 54 years) and being married across regions of the country. The study also proposes appreciation of regional differences in the outcome of HIV non-testing and suggests that efforts be focused on addressing regional differences in order to attain high HIV testing among sexually active men (15 – 54 years) across regions of Uganda, and thus reduce HIV related morbidity and mortality.

In Kenya, people who inject drugs (PWID) are disproportionately affected by HIV and hepatitis C (HCV) epidemics, including HIV-HCV coinfections; however, few have assessed factors affecting their access to and engagement in care through the lens of community-embedded, peer educators. This qualitative study leverages the personal and professional experiences of peer educators to help identify HIV and HCV barriers and facilitators to care among PWID in Nairobi, including resource recommendations to improve service uptake.

Use of HIV testing services among FSW in sub-Saharan Africa (SSA) is below the desired UNAIDS target of 90 percent. We estimated the prevalence and factors associated with HIV testing among FSW in Dar es Salaam, Tanzania. A respondent-driven sampling method was used to recruit FSW aged 18. Modified Poisson regression models were used to determine factors associated with recent HIV testing.

A four-month regimen containing rifapentine and moxifloxacin has non-inferior efficacy compared to the standard 6-month regimen for drug-sensitive tuberculosis. We evaluated the effect of regimens containing daily, high-dose rifapentine on efavirenz pharmacokinetics and viral suppression in patients with HIV-associated TB.

Community pharmacies play an important role in the healthcare system: they are frequently accessed and have increasing capacity to deliver HIV prevention services. In communities where the prevalence of HIV is high and access to antenatal care clinics is delayed or irregular, there is a unique opportunity to leverage pharmacies to enhance early and sustained access to HIV prevention among pregnant women.

Differentiated service delivery for HIV treatment seeks to enhance medication adherence while respecting the preferences of people living with HIV. Nevertheless, patients’ experiences of using these differentiated service delivery models or approaches have not been qualitatively compared. Underpinned by the tenets of descriptive phenomenology, we explored and compared the experiences of patients in three differentiated service delivery models using the National Health Services’ Patient Experience Framework.

Although efficient suppression of HIV replication below the limits of detection is achievable with potent combination antiretroviral therapy (cART), the risks of adverse effects and drug resistance still exist. HIV latently infected cells are in a state of non-productive infection, do not respond to cART and are not cleared by the host immune system. As a consequence, latently infected cells establish reservoirs that persist during cART and become a source of productive infection upon therapy interruption.