Project Inform strongly applauds the announcement by the California HIV/AIDS Research Program (CHRP) of $11.8 million in funds to study two exceedingly promising new HIV prevention and care strategies: pre-exposure prophylaxis (PrEP) and testing and linkage to care plus treatment (TLC+).
CHRP announced April 17 that it will fund two projects to study PrEP and TLC+ rollout to populations of men who have sex with men (MSM) and transgender women at particularly high risk of HIV infection in Southern California, and a third smaller project to assess strategies for PrEP provision in the San Francisco Bay Area.
“It makes perfect sense to do what CHRP is proposing,” said David Evans, Director of Research Advocacy for Project Inform. “Test people aggressively and then offer PrEP to those who test HIV-negative if they aren’t able to pick up other prevention tools at this time. For those who test HIV-positive, doctors would discuss how starting HIV medication could simultaneously reduce transmitting the virus to others while protecting the patient from developing health problems.”
PrEP—where HIV-negative people take HIV drugs and receive HIV risk reduction counseling and condoms to prevent acquiring HIV—has been found in studies of men who have sex with men (MSM) and in heterosexual men and women to be as high as 90 percent effective in blocking infection in those who take it properly. PrEP efficacy studies began to report positive results approximately two years ago.
During that time another study called HPTN 052 confirmed that giving antiretroviral therapy to HIV-positive people could reduce the risk of passing HIV on to their HIV-negative partner by 96 percent. Project Inform was pleased to see that federal HIV treatment guidelines recently changed to encourage clinicians to discuss the HIV-prevention potential of early HIV treatment to their HIV-positive patients.
What remains unknown is how to support adherence to PrEP and guard against ill effects in real-world settings and how best to link people to care and treatment: demonstration projects, such as those being funded by CHRP, are the best way to learn that.
“Adding PrEP and TLC+ to existing prevention efforts could dramatically reverse the epidemic if these strategies live up to their potential,” adds Project Inform’s Executive Director, Dana Van Gorder. “Demonstration projects such as those being funded by CHRP are exactly what we need to learn how best to translate research findings into real-world effectiveness.”
“The federal government has thus far committed to conducting only two other PrEP demonstration projects, but we need additional studies to ensure that PrEP and TLC+ are done well and safely and in the right populations. CHRP is filling this important knowledge gap,” Van Gorder added.
Recent data from the Centers for Disease Control and Prevention (CDC) revealed that HIV infection rates have risen by nearly 50 percent in black MSM and may be rising in general among all younger MSM. Thus, it is clear that current strategies including only condoms and risk-reduction counseling are not sufficient. New tools must be rolled out as they become available.
It isn’t clear whether young black MSM, who are at among the highest risk of acquiring HIV—higher than rates found in some sub-Saharan African nations—will desire PrEP or use it correctly, but “we are morally obligated to understanding whether this new tool should be added to our arsenal of effective prevention strategies,” said Evans.
“Some are touting PrEP as a tool that is too risky or too expensive to even be considered,” Evans added. “Those of us on the front lines, however, know that we must put every cost effective tool—and researchers have confirmed PrEP’s cost-effectiveness among those at particularly high risk of acquiring HIV—at people’s disposal.”
Project Inform lauds the critical contribution to PrEP research that CHRP is proposing to fund in the coming years.
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Project Inform is a non-profit HIV and hepatitis advocacy, policy and education organization. Based in San Francisco, Project Inform fights the HIV and hepatitis C epidemics by assuring the development of effective treatments and a cure; supporting individuals to make informed choices about their health; advocating for quality, affordable health care; and promoting medical strategies that prevent new infections.