Transcript Slide 1

ARV-Based Prevention
What it means for women
Your name here
www.global-campaign.org
Presentation outline
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Prevention methods, those based on ARVs
and those not using ARVs
State of access to proven methods
State of research to develop new methods
Timelines
Questions and concerns
Advocacy messages
How to get involved
33.4 million people now
live with HIV/AIDS
2.7 million new infections annually
Among newly infected people:
50% are women (higher in some areas)
95% live in developing countries
80–90% of all HIV+ people in southern Africa
do not know they have HIV
Percentage of at-risk people with
access to HIV prevention
45% HIV+ pregnant women with access to PMTCT
<20% Sex workers with access to behaviour change programmes
10–12% Adults in Africa accessing HIV testing
9% Men who have sex with men with access to appropriate
behaviour change programmes
9% Sexually active people with access to male condoms
8% Injection drug users with access to harm reduction programmes
0
20
40
60
80
100
Global HIV Prevention Working Group 2008; WHO/UNAIDS/UNICEF 2007
Imagine a full spectrum of
interventions
Prior to exposure
• Rights-focused
behaviour change
• Voluntary counselling
& testing
• Sexually transmitted
infection screening
and treatment
• Male medical
circumcision
• Preventative
vaccines
• Pre-exposure
prophylaxis (PrEP)
Point of transmission
• Male & female
condoms and lubricant
• Treatment to prevent
vertical transmission
(PMTCT)
• Clean injecting
equipment
• Post-exposure
prophylaxis (PEP)
• Vaginal & rectal
microbicides
• Cervical barriers
After infection
• Antiretroviral
treatment
• Treatment for
opportunistic
infections
• Basic care/nutrition
• Prevention for
positives
• Education and
rights-focused
behaviour change
• Therapeutic
vaccines
ARV-based prevention options
Prior to exposure
Point of transmission
After exposure
Preventing vertical transmission (PMTCT+)
PrEP
Treatment of
HIV+ partner
Vaginal microbicides (rings)
Vaginal microbicides
(gels)
Rectal microbicides
PEP
HIV prevention
Not ARV-based
Male and female
condoms
Circumcision
Vaccines
Needle exchange
VCT
ARV-based
Vaginal
and rectal
microbicides
Preventing
vertical
transmission
PEP
PrEP
Treatment for
HIV+ partner
Comparing ARV-based prevention
methods
PEP
Drugs
used
Preventing
vertical
transmission
(PMTCT)
Treat HIV+
partners
PrEP
Microbicides
Multiple
ARVs
Nevirapine;
combination, if
possible (AZT+3tc+
nevirapine)
Multiple ARVs
Tenofovir and
Truvada
Tenofovir, TMC
120 (daviripine),
UC781, MV-150
Delivery
formats
Oral pills
Pills, dropper
Oral pills,
injection
Oral pills
Vaginal and rectal
gels with
applicators,
vaginal rings, film
Frequency
of use
Daily for
4 weeks
Varies from ongoing
treatment to doses
just before, during,
after delivery
At least daily
At least daily,
possible
dosing related
to exposure
Before and
possibly after
sex, possibly
daily dosing
PEP
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Post-Exposure Prophylaxis
(After)
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(Prevention)
PEP refers to taking antiretroviral drugs
to reduce the chance of infection in
individuals who have likely been
exposed to HIV
PEP access
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Work-related, or occupational, exposure
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Other exposure
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Most common: medical settings, needle-sticks
Unprotected sex, rape, condom breaks,
sharing needles
People have concerns about PEP that is not
work related
Access must be very fast
Preventing Vertical Transmission
(PMTCT)
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Preventing vertical transmission – also called
Prevention of Mother-to-Child Transmission (PMTCT)
Providing ARVs to pregnant women living with HIV,
particularly before and during labour
Providing ARVs to the baby during the first few weeks
after birth
If possible:
- Delivery by Caesarean section
- Avoidance of breastfeeding
Plus (+) = focus on mother and baby
Percentage of pregnant women with HIV receiving ARVs for
PMTCT in low- and middle-income countries, 2004 and 2007
2%
Western and
central Africa
11%
11%
Eastern and
southern Africa
43%
9%
East, south, and
southeast Asia
22%
26%
Latin America and
the Caribbean
36%
72%
71%
Eastern Europe
and central Asia
10%
Total
33%
0
10
20
2004
2007
30
40
50
60
70
80
Treatment as prevention
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HIV+ people taking ARVs regularly
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Does it work at individual level?
 Treatment = less virus = less transmission?
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Can it work at population level?
 Increased testing = more knowledge of status =
less risk-taking
 Increased testing = more HIV+ people on
treatment = less virus
 Less risk-taking + less virus = less transmission?
Steps needed for
“Treatment as prevention”
ARVs
for
prevention?
Access to treatment
Knowledge of status
Pre-exposure prophylaxis
(PrEP)
Taking medicine to prevent rather than to treat a
disease or condition.
For example:
Taking pills to prevent malaria when you travel.
Using hormonal contraceptives (injections or pills) to
prevent pregnancy.
Taking pills to avoid pneumonia, if you are at risk.
Status of current or planned
PrEP trials
Who
What
When
US (CDC)*
Men who have sex with
men
tenofovir
2010
Thailand (CDC)
Injection drug users
tenofovir
2010
Brazil, Ecuador,
Peru, US, Thailand,
South Africa (iPrEX)
Men who have sex with
men
Truvada
2010
Botswana (CDC)
Heterosexual men
and women
Truvada
2011
Uganda, Kenya
(Partners PrEP)
Serodiscordant couples
(men and women)
tenofovir,
Truvada
2012
Kenya, Tanzania, South
Africa (FEMPrEP)
Women
Truvada
2012
Southern Africa
(sites TBD**) (VOICE)
Women
tenofovir (pill &
gel), Truvada
2012
Where
*CDC: US Centers for Disease Control and Prevention
**TBD: To be determined
What is a microbicide?
A new type of product being developed
that people could use vaginally or rectally
to protect themselves from HIV and
possibly other sexually transmitted
infections.
How might a microbicide be delivered?
A suppository or
a gel applied with
an applicator
before sex
A vaginal ring
that stays in
place for up to
a month
A film, vaginal
tablet, soft-gel
capsule
Comparing ARV-based and
non-ARV-based microbicides
Disadvantages
Advantages
ARV
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More potent against HIV
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May be long lasting
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May work against other STIs
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Not contraceptive
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May be more toxic
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May cause resistance
Not ARV
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Could work against HIV and
other sexually transmitted
infections
Could be contraceptive
May be less potent against
HIV
Must be used at time of sex
ARV-based prevention trials:
When will we know?
2010
2011
2012+
PrEP
Men who have sex
with men
PrEP
Heterosexual
men/women
PrEP
Serodiscordant
couples
PrEP
Injection drug users
Treatment
Serodiscordant
couples
PrEP
Men who have sex
with men
PrEP
Women
Microbicides
Women*
PrEP/Microbicides
Women
*CAPRISA 004 trial found tenofovir gel safe and effective
If PrEP and ARV-based
microbicides work
1. Only take if you KNOW you are HIV negative.
– Regular testing is necessary.
2. May be available by prescription only.
– Access to a qualified health care provider is
necessary.
3. Only the dosing used in trials is known to work.
– PrEP: only daily dosing for now.
– ARV-based microbicides: for now, applied daily or
shortly before sex.
Drug resistance
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More likely if taking only one drug
(or one type of ARV)
Can still become HIV+ using
ARV-based prevention
Use by people who don’t know they
are HIV+ might lead to resistance?
Options for treatment may be more limited,
might pass on resistant virus
Unanswered questions at this point
Questions women have
about ARV-based prevention
If I think my
husband has HIV,
will I be able to get
PrEP?
Even if the doctor
gives me pills,
will I be able to
keep them for
myself?
If I use a
microbicide,
how will I make
my man use a
condom?
More questions women have
People will notice if
I have to go in for
testing and to get
my pills. What will
they say about me?
Will my husband
let me go to the
clinic?
How much
will it cost?
Where will I get it?
Will it
make me
sick?
Can I take PrEP
when I am pregnant?
Will it hurt my baby?
What about
breastfeeding?
Advocates are calling for:
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Better access to existing proven
prevention options.
Research into new prevention options, both
ARV based and not based on ARVs.
Research into drug resistance, alternate
dosing, pregnancy and breastfeeding, and a
greater variety of drugs.
Attention to access hurdles: more uptake of
HIV testing, access to prescribers.
Increased community engagement.
What you can do:
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Become better informed.
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Tell your colleagues.
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Send them a link or a fact sheet.
Host a discussion forum.
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Check out the resources on the next slide.
Use this presentation at work or in your community.
Join advocacy efforts.
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Contact other HIV prevention advocates in your region.
For more information…
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PEP: http://tinyurl.com/hivpep
PMTCT: http://tinyurl.com/pmtct
PrEP: www.prepwatch.org
Microbicides
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www.global-campaign.org
www.rectalmicrobicides.org
www.mtnstopshiv.org
www.ipm-microbicides.org
Treatment of HIV+ partner
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www.hptn.org (look under HPTN052)
“Sure, you know about [all types of existing and
new prevention options]...
We need you to unravel the secrets of the
science, to make all of that elusive and
mysterious information accessible to the
untutored rest of us…
Somehow, along with the science, we need the
activism. They are inseparable.”
Stephen Lewis, Co-Director, AIDS-Free World, and Former
United Nations Secretary-General’s Special Envoy for HIV/AIDS in
Africa (2001–2006)
July 19, 2009, International AIDS Society conference,
Cape Town, South Africa
© Nick Wiebe 2006
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