Oral pre-exposure HIV prophylaxis (PrEP) has been shown to be up to 90% effective in preventing HIV infection among people who take it consistently. However, the United States of America is the only country in which PrEP is licensed and recommended for use within HIV prevention programmes.
In order to find ways to bridge the gaps between evidence and policy-making processes, UNAIDS, AVAC and WHO organized a meeting during the 2014 HIV Research for Prevention (HIV R4P) conference, which is taking place from 28 to 31 October in Cape Town, South Africa. HIV R4P is the world’s first scientific meeting dedicated exclusively to biomedical HIV prevention research.
Participants
The meeting brought together representatives of ministries of health and national AIDS councils from Kenya, Mozambique, South Africa, Uganda and Zimbabwe, PrEP researchers and participants from research and demonstration sites where PrEP is currently being delivered, funders and drug manufacturers, and HIV activists.
Key messages
- PrEP is being used in several demonstration projects across eastern and southern Africa, covering a wide range of populations, including serodiscordant couples in Kenya and Uganda, sex workers in Zimbabwe and men who have sex with men in Kenya and South Africa.
- In order to be used more widely, PrEP must be part of a comprehensive prevention strategy with associated milestones and success indicators that have been defined with policy-makers. The Kenyan Prevention Roadmap already includes the possibility of PrEP.
- Costs and cost-effectiveness models remain key, as are the selection of populations for which PrEP should be offered and the choice of an appropriate delivery model. The Sisters clinics, which provide a dedicated service for sex workers in Zimbabwe, are acceptable to many sex workers and fit within a government strategy.
- The early stopping of the PROUD PrEP study demonstrates that within the sexual health services of the United Kingdom of Great Britain and Northern Ireland there is a strong demand for PrEP and that it is feasible to identify people at greatest risk.
- Demand is now beginning to grow in African communities and needs to be stimulated among those who would most benefit and would be most likely to use PrEP.
- Policy-makers in health and other government departments need more information on PrEP presented in a way that they can use, as well as opportunities to discuss their specific concerns, for example on PrEP safety studies or measures to improve adherence.
- More needs to be understood about the costing of PrEP. This demands greater understanding of who would use PrEP, how they would use it and where they would access it.
“As a woman living with HIV, how I wish that we had known about PrEP then. We knew how to judge our risk and we knew that our risks of getting HIV were high; we would have taken PrEP.”
Teresia Njoki Otieno, member of the African Gender and Media Initiative and of the International Community of Women Living with HIV
“The opportunity costs of scaling up PrEP provision are high but can bring wider benefits beyond HIV infections and lifelong treatment averted. We need a coherent strategy, to be sure that the investment pays off.”
Chrisitne Ondoa, Director General, Ugandan AIDS Commission
“The voluntary medical male circumcision experience can inform the advancement of PrEP.”
Helen Rees, Executive Director, University of Witwatersrand Reproductive Health and HIV Institute
