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Tuesday, 25 July 2017 09:57

Creativity from chaos

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IAS 2017, July 23-26

At the opening session of the 9th IAS Conference on HIV Science in Paris, IAS Chair Prof Linda-Gail Bekker compared the global environment with that of the previous conference, commenting that since 2015 it seems that “the world has turned upside down”. Not least of which, the period has seen a decline in global funding for HIV, and important donors are proposing substantive cuts to research and treatment. This threatens to erode former gains. But, says Bekker, these setbacks can lead to new partnerships and “creativity can grow out of chaos”.

Judging from the conference programme, there has been an outbreak of creativity about pre-exposure prophylaxis |(PrEP). In this new phase, we are moving from PrEP demonstration programmes to broader implementation and scale-up. To facilitate this, the World Health Organisation (WHO) has now released a new PrEP implementation tool, with different modules for different audiences. South Africa and Kenya are the two ESA countries that have begun national implementation of PrEP, albeit on a small scale. But more about this later…

Another area of exciting and creative research concerns the next wave of prevention options – injections, infusions, vaginal rings and implants. A session on Sunday provided an update on progress towards long-acting options for the release of ARVs both as PrEP and as treatment for HIV. Presenters reminded the audience that these types of interventions are still perceived to be highly desirable by users, and cited key reasons for this including: they bring increased peace of mind about avoiding or treating HIV, they are convenient as one does not have to remember to take a daily pill, one does not have to negotiate their use, and they are perceived to have limited side effects and adequate levels of protection. Injectables, the vaginal ring and implants are considered more desirable than infusions.

Progress in ARV injectables and implants are at an exciting stage with good research findings on ideal duration (now up to 12 weeks), better absorption rates, elimination of refrigeration and light as conditions for storage and good safety, and tolerance amongst trial participants.

Many of the trials are conducted in first world settings (mostly the US) and once efficacy is approved and the drugs registered in these contexts (still 3-5 years away), it will be important to test them more widely in other settings and cultural contexts where uptake may be less attractive and where health system and supply chain weaknesses may impact their implementation at scale.

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