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Thursday, 03 December 2015 10:00

ICASA, Wednesday December 3

by Josee Koch, Technical Lead

Delegates of ICASA had an opportunity today to seek an answer to the big question: when will the clever scientists discover a cure for AIDS and an HIV vaccine? I found myself brave enough today to engage with the “real scientists”. Unfortunately, I quickly discovered that I am part of the so-called lay public. But with me, in the same boat, were most of the policy makers in the room, trying their best to keep up with incomprehensible jargon, graphs and randomised control trials.

Several trials are ongoing at the moment trying to bring the world closer to a massive breakthrough. These trials build on the work of the RV144 trial more popularly known as the “Thai Vaccine.” One of these trials is currently taking place in South Africa and results are expected to be released in March 2016. The South African trial is understandably called HVTN702.
Scientists were frank; developing a cure is difficult because HIV exists in reservoirs in the body, which hide the virus, making it challenging to find and destroy. Developing a vaccine is equally challenging and delegates were told not to hold their breath for an early breakthrough. A vaccine will probably be developed before a cure, but for now the biomedical world is directing us to the established evidence around Treatment as Prevention and new-kid-one-the-block, PrEP (pre-exposure prophylaxis).
PrEP for at-risk adolescents is a popular theme at this ICASA. However, despite the fast evolving body of evidence, PrEP is an emerging field and there is no real progress on implementation yet. Scientists are clear though: PrEP works, there is no question about it. Well, if that is the case, what would it take to operationalise PrEP?
It will take data, intelligence and evidence to:
1) Identify and prioritise sexually active adolescents at substantial risk of infection
2) Tackle issues around informed consent and confidentiality in the legal frameworks
3) Conduct modelling to present an economic case, taking the saving in future treatment costs and the current costs of PrEP (around US$100) into account.
Whilst excitement around biomedical progress is understandable, PrEP, like all other innovations needs to be embraced by a combination prevention approach.
Reflecting on the day, it became clear that EHPSA’s research portfolio on adolescents has a real opportunity to influence global guidance and national implementation efforts.
Now, that is something to be genuinely excited about.
Josee Koch
EHPSA’s technical lead: evidence into practice
Tweet me @joseekoch
PS: I learned today that there are condoms that glow in the dark and condoms that vibrate; the world of AIDS is not short of innovation.

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