Px Wire Vol 12 No 2

PrEP and Beyond: HIV prevention from 2022 onwards

Vol 12 No 2

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 features upcoming events.

PrEP Tracker Data / Oral PrEP Progress

• The world has surpassed 3,000,000 PrEP initiations over the past decade. This milestone represents the 2020 target for PrEP uptake around the world, but reached two years late. This is progress, but definitely not success—and PrEP uptake must continue to accelerate to reach the 2025 targets.
• In Q3, South Africa reached 570,000 PrEP initiations and replaced the US as the country with the highest total number. The majority of this uptake followed scale-up of a national PrEP program.
• Nigeria, Uganda, and Zambia have each exceeded 300,000 cumulative initiations. All three countries have seen rapid growth since 2020, largely attributable to PEPFAR support.
• Mozambique and Zimbabwe broke 100,000 cumulative initiations this quarter. Rapid growth in these countries is also attributable to PEPFAR support.
• Liberia and Panama recorded their first initiations, with PEPFAR here also providing primary and essential support.

PrEParing for New Products

HIV Prevention Pipeline

A serious disappointment in September was Merck’s announcement that they are ending two efficacy trials (IMPOWER-22 and IMPOWER-24) testing a once-a-month oral pill of islatravir (ISL) for HIV prevention. The decision stems from a treatment trial with ISL in combination showing a drop in participants’ CD4+ cell counts. The end of these prevention trials comes at a time when the larger HIV prevention research pipeline has few products moving into Phase III clinical trials. The implications of this news for the research pipeline deserves careful thinking and action.

At the same time, early phase research remains dynamic across ARVs, vaccines, antibodies and multipurpose prevention technologies (MPTs). Following are a few items that caught our eye this quarter.

• An ongoing Phase I HIV vaccine study designed for infants 0-5 days, HVTN 135, is scheduled to report findings in 2023.
• The 90-day dapivirine vaginal ring for PrEP is being tested for bioequivalence compared to the 30-day formulation in a new Phase I trial, IPM 054.
• Results from a Phase I trial of a 90-day tenofovir plus levonorgestrel vaginal ring for HIV, unintended pregnancy and HSV-2 prevention, CONRAD A15-138/ENRICH show that this multipurpose prevention technology (MPT) is capable of releasing in a controlled manner two very different drugs in differing amounts, and warrants continued study.
• Multiple mRNA HIV vaccine candidates are now in Phase I trials.
• The USAID-funded MATRIX project held stakeholder consultations in Kenya, South Africa and Zimbabwe to introduce their evolving pipeline of new HIV prevention products for women.

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. Be sure to read, join or listen in on what AVAC sees as essential to the current HIV prevention and global health equity conversations of the quarter.

Join This: 

• AVAC’s Advocates’ Network offers timely updates on developments in biomedical HIV prevention and the field that supports it to a network for organizations, advocates and activists. Sign up today.
• The Choice Agenda (TCA) has a full program from its webinar series to check out. Coming up: More than Vessels: Pregnant people deserve inclusion in HIV prevention clinical and implementation research. Register here. Join the The Choice Agenda listserv with nearly 900 members by emailing jimberlypickett@gmail.com.

Read This:

• There is growing consensus for the greater inclusion of pregnant and lactating populations in HIV prevention research as an ethical imperative in public health. Find a host of resources on the issue, including AVAC’s Advocacy Guide, at avac.org/including-PLP.
• As HIV vaccine research and developments faces a period of innovation and transition, AVAC’s blog, An HIV Vaccine: The challenges ahead, frames the issues and draws highlights from a webinar series on the topic that AVAC convened earlier this year.
• AVAC’s blog, Global Fund and PEPFAR’s Essential Collaboration provides context on the 7th replenishment of the Global Fund and explores how this effort can and should complement the work of a fully-funded PEPFAR.
• The New York Times September article by Stephanie Nolen, "A New Shot Guards Against HIV, but Access for Africans Is Uncertain", explores the complexity of cost and other factors affecting the delivery of injectable CAB for PrEP to the places where it’s needed most.
• AVAC is serving as the secretariat for a new coalition aimed at transforming the approach to delivering proven products. See the announcement for The Coalition to Accelerate Access to Long-Acting PrEP and see AVAC’s Plan for Accelerating Access and Introduction of Injectable CAB for PrEP.
• Read AVAC’s full summary of the advocacy, scientific advances, discussions on policy, populations and more from AIDS2022 in our blog, A Look Back at Montreal.
• To better understand potential users of the DPP and MPTs, AVAC worked with M&C Saatchi World Services and partners to conduct qualitative human-centered design research in Kenya, South Africa and Zimbabwe. See their detailed findings here, which can also inform how we engage HIV prevention and contraceptive users writ large.

Listen to This:

• AVAC and partners showcased the new PrEPWatch website, the one-stop online repository for all things PrEP. Find the recorded webinar here.
• Doxycycline post-exposure prophylaxis (dPEP) is being studied as an STI prevention strategy to reduce chlamydia, syphilis, and possibly gonorrhea. To learn more, watch the recording of this October 7th webinar from the TCA, Doxycycline for STI Prevention: Evidence and Current Research.
• Hear the latest updates from African voices leading the advocacy for access to the dapivirine ring for PrEP in this recording of the September 7th webinar from the TCA, RINGing the Bell for Choice: Actions and Solutions on Dapivirine Ring Access.
• AVAC and FP2030 co-hosted a webinar, Private sector delivery opportunities for the DPP: Lessons from family planning for the introduction of MPTs, which highlighted findings from the report on private sector opportunities for the DPP and explored lessons from the family planning field to identify how FP/SRH stakeholders can help pave the way for smooth introduction of MPTs in private sector channels. In case you missed it, see the recording and slides here.
• PEP, post-exposure-prophylaxis, works. But far too few people know about it, or when and how to obtain this valuable intervention. Check out this recorded webinar from The Choice Agenda: PEP Needs Some Pep! Addressing PEP Neglect in HIV Prevention Research, Programming and Uptake.

About AVAC

Founded in 1995, AVAC is a non-profit organization that uses education, policy analysis, advocacy and a network of global collaborations to accelerate the ethical development and global delivery of HIV prevention options as part of a comprehensive response to the pandemic. Follow AVAC on Twitter @HIVpxresearch and find more at www.avac.org and www.prepwatch.org.