Q and A: Moving PrEP From Promising Trial Result to Practical, Public Health Prevention Intervention?

As noted in these pages and press reports worldwide, the iPrex trial found that daily use of truvada protected gay men, other MSM and trangender women from HIV infection.

Updated data presented at this week's Conference on Retroviruses and Opportunistic Infections (CROI) showed the trial results held true through 144 weeks -- nearly three years -- and that the key challenge seems to be adherence. Those who took the drug most or all of the time (about 1/2 of the people in the study) had high rates of protection -- over 90%. But because the other half took little or no drug at all (as confirmed by blood tests), the overal efficacy rate among trial participants was 44%.

After a long day at the conference, an eager crew of conference-goers -- including researchers, people with HIV, White House officials and press -- joined local community members here in Boston last night in the auditorium of Fenway Community Health for ARV-Based Prevention: A Community & Research Forum on Recent Results and What Happens Next, sponsored by AVAC and Fenway.

At the end of the formal presentations, the HIV Prevention Justice Alliance asked panelists, "What are one to three next steps that are vital to making PrEP [pre-exposure prophylaxis] effective at the community or public health level, rather than just a boutique intervention for a few individuals?"

We captured the responses, which cover a wide range of issues and strategies, and wanted to share them with you. Panelists, in order of response, were:

  • Morenike Ukpong, New HIV Vaccines and Microbicide Advocacy Society, Nigeria
  • Kevin Cranston, Massachusetts Bureau of Infectious Disease
  • Cate Hankins, UNAIDS
  • Salim Abdool Karim, CAPRISA
  • Jared Baeten, University of Washington and Partners PrEP
  • Robert Grant, Gladstone Institute of Virology and Immunology
  • Jim Rooney, Gilead Sciences
  • Mark Hubbard, Tennessee Association of People With AIDS