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PrEP works. Investment in more options must continue, and faster, smarter rollout must be a top priority.

Clinical trials have shown that different types of pre-exposure prophylaxis (PrEP) using antiretroviral (ARV) drugs dramatically reduce the risk of HIV infection for people who take it as directed. While PrEP won’t be right for every individual at risk for HIV, millions will benefit—if they can access this potentially life-saving option.

So far, PrEP’s implementation has been piecemeal. Meanwhile the landscape is changing as more options move through research, regulatory review or enter the market, intensifying the need to improve implementation.

TDF/FTC (brand name Truvada) was first approved for use as oral PrEP in 2012, now dozens of countries have approved it, but PrEP still has not reached many of the people who need it most. In 2019, F/TAF (brand name Descovy) became the 2nd oral PrEP product to be approved, but only for men who have sex with men (MSM) and transgender women. Efficacy studies of F/TAF among cisgender women are ongoing. Findings reported in 2020 show injectable cabotegravir is safe and effective and the product is undergoing regulatory review. For more information go to our dedicated pages on cabotegravir on and PrEPWatch.

For all these interventions and other ARVs still in the R&D pipeline, advocacy is crucial: There must be continued investment in the development of additional options, community engagement must be integrated from trial design to implementation, and improved programming must support those who need HIV prevention options the most.

What We're Reading

Cost cannot be allowed to derail the scale up of new PrEP modalities. The provision of CAB-LA in LMICs, particularly in sub-Saharan Africa, will add to the biomedical prevention armamentarium that includes oral PrEP and the dapivirine vaginal ring but also other prevention options, such as condoms and voluntary medical male circumcision. Agreement on the terms of licensing, necessary transfers of technology, and interim pricing should be completed urgently so that CAB-LA becomes an option for those most in need.

July 1, 2022
The Lancet HIV

A study in France that matched new HIV diagnoses in adult men who had been taking PrEP with diagnoses in men at similar risk who had not been taking it, has found that the overall effectiveness of PrEP in stopping infection in this high-risk population was 60 percent. This 60 percent effectiveness figure included some men who discontinued PrEP for at least three months during the study period and who in many cases did not resume it. PrEP effectiveness in men who did not discontinue PrEP was 86 percent, similar to that found in randomised controlled trials.

June 29, 2022
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