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Evidence for PrEP efficacy grows, but implementation presents challenges
Liz Highleyman, 2015-12-18 09:40:00

Pre-exposure prophylaxis (PrEP) was a major topic at the 2015 National HIV Prevention Conference (NHPC) last week in Atlanta. A growing body of evidence continues to confirm that Truvada PrEP is highly effective at preventing HIV infection if taken regularly, both in clinical trials and in real-world clinical use. Yet uptake has been uneven, and researchers and front-line health workers are learning about barriers to PrEP implementation and scale-up for diverse population groups.

"The argument is over about PrEP," US National Institute of Allergy and Infectious Diseases (NIAID) director Anthony Fauci said during his opening lecture. "If you take the drug, it works, not only in a clinical trial but in the field."

That message appears to finally be getting out to people at risk for HIV and their providers.

"We're now reaching a tipping point where clinicians are hearing that their colleagues are prescribing PrEP and maybe they could too," said Dawn Smith of the US Centers for Disease Control and Prevention (CDC).

A plenary lecture by NIAID Division of AIDS director Carl Dieffenbach and dozens of abstract presentations were devoted to different aspects of PrEP, ranging from knowledge and attitudes of users and providers, to implementation of PrEP in various settings

"PrEP works, but only if you take it," Dieffenbach emphasised, underlining the importance of offering PrEP as part of a comprehensive prevention package that is attractive to the people most at risk for HIV.

New PrEP methods are "not on the horizon, but just over the horizon," Dieffenbach continued, potentially including broadly neutralising antibodies, microbicides in rings or other sustained-release delivery systems and long acting injectable agents. "We may one day have PrEP that can be administered once a year," he predicted.

Some of the most promising findings on Truvada (tenofovir/emtricitabine) PrEP in real-world use have come from cities with large populations of gay men, progressive political attitudes and generous public health funding.

But as New York City assistant health commissioner Demetre Daskalakis stressed, PrEP is "not just a big old gay good time," and access needs to expand "beyond our gay choir."