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PrEP: Roadmap to the Real World

Establishing the Real-World Effectiveness of PrEP Through Demonstration Projects

August 2011

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Conclusion

The past year has been a remarkable turning point in HIV prevention and treatment. Until recently, our only tools to guard people against HIV infection have been behavioral interventions, condoms for those who choose to be sexually active, and aggressive HIV testing campaigns. Now, we are on the threshold of a potential revolution. While optimistic, it is certainly no longer impossible to dream that HIV transmission could be all but eliminated in certain communities if we are able to marshal the resources and the knowledge to use every available tool, both old and new, including PrEP, TLC+, and hopefully -- one day -- vaginal and rectal microbicides and a vaccine.

To get there, however, we must be smart, especially in a time of limited resources. One of the best ways to ensure that we apply PrEP in the safest, most effective, and most cost efficient manner is to study its real-world implementation carefully. That's why the demonstration projects described here are so critical. What a squandered opportunity it would be if we failed to determine how best to use this promising tool and how best to combine it with other available prevention efforts.

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Ensuring that these demonstration projects are designed, funded, and implemented as they ought to be will require the support and engagement of every stakeholder. We hope that this report will stand as a call to action and spur productive dialogue to bring us one step closer to a world without HIV.


References

  1. Prejan et al. "Estimated HIV Incidence in the United States, 2006-2009." PLoS ONE 2011; 6(8):e17502.
  2. Grant et al. "Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men." New England Journal of Medicine 2010; 363:2587.2599.
  3. http://depts.washington.edu/astda/resources/PrEP_PressRelease-UW_13Jul2011.pdf. Accessed August 10, 2011.
  4. www.cdc.gov/nchhstp/newsroom/PrEPHeterosexuals.html. Accessed August 10, 2011.
  5. http://www.fhi.org/NR/rdonlyres/erj6hevouwvddigjldvcca6tvtybfolh4nedyfeo4yz2i7la53jknim6ex42bme2rvyq6zf zovyrkb/FEMPrEPFactSheetJune2011.pdf. Accessed August 10, 2011.
  6. www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf. Accessed August 10, 2011.
  7. Herbst et al. "Estimating HIV Prevalence and Risk Behaviors of Transgender Persons in the United States: a Systemic Review." AIDS and Behavior 2008; 12(1):1.17.
  8. UNAIDS/AVAC. "Good Participatory Practice: Guidelines for Biomedical HIV Prevention Trials," 2011. www.avac.org/ht/d/sp/i/309/pid/309. Accessed August 15, 2011.
  9. www.mtnstopshiv.org/sites/default/files/attachments/2011%20Celum%20MTN%20adherence%20lessons %20from%20caprisa%20&%20iPrEX%20sans%20iPrEx%20data.pdf. Accessed August 10, 2011.
  10. MacKellar et al. "Perceptions of Lifetime Risk and Actual Risk for Acquiring HIV Among Young Men Who Have Sex With Men." AIDS and Behavior 2006; 11(2):263.70.
  11. Malat et al. "Blacks' and Whites' Attitudes toward Race and Nativity Concordance with Doctors'", Journal of the National Medical Association 2009; 101(8):800.7.
  12. Oh et al. "Evaluation of Adherence and Factors Affecting Adherence to Combination Antiretroviral Therapy Among White, Hispanic, and Black Men in the MACS Cohort." JAIDS 2009; 52(2):290.3.
  13. Anderson, et al. "Expanded Case-Control Analysis of Drug Detection in the Global iPrEx Trial." 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention. 2011; abstract MOLBPE034.
  14. Liu, et al. "Hair as a Biological Marker of Daily Oral Pre-Exposure Prophylaxis (PrEP) Adherence and Tenofovir/Emtricitabine (TFV/FTC) Exposure in the Global iPrEx Study." 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, 2011; abstract MOLBPE037.
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This article was provided by Project Inform. Visit Project Inform's website to find out more about their activities, publications and services.
 
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