The Promise, Progress of PrEP
This promising class of therapy is an expanding treatment option for people who are looking for HIV prevention offerings.
In 2015, World Health Organization (WHO) recommended to offer oral PrEP to anyone at substantial risk of HIV as part of combination prevention strategy.
With sub-Saharan Africa’s high rates of HIV and AIDS comes the unfortunate reality of significant numbers of orphaned children. In Kenya, for example, a new study showed parentless youth living on the streets had the highest rates of HIV and death, but extended-family living situations were not necessarily better than institutional care.
To address PrEP implementation in Kenya, a team of investigators evaluated practices and contextual modifications across public HIV clinics. They created strategies to help address potential barriers to PrEP initiation including initiating clients on PrEP without creatinine testing if otherwise healthy. While monthly refill appointments are recommended, a majority of clinics issued PrEP users 2 to 3 months of pills at a time. Clinics also implemented practices that had not been specified in the guidelines including incorporating PrEP-related topics into routine health talks, calling clients with missed PrEP appointments, discussing PrEP service delivery in regular staff meetings, ‘fast-tracking’ PrEP clients and dispensing PrEP in clinic rooms rather than at clinic-based pharmacies.
There was a 73 percent increase year over year in persons using PrEP across the US from 2012 to 2016. Although this would suggest a growing trend in the right direction, many more people could take advantage of the therapy. “In the United States, fewer than 25% of those who could benefit from PrEP are currently taking it, which points to the need for additional HIV prevention options. We believe new options like investigational cabotegravir long-acting for PrEP will help play a significant role in our collective efforts to end the HIV epidemic,” Kimberly Smith, MD, MPH, head of Research & Development at ViiV Healthcare.
Cabotegravir/rilpivirine (Cabenuva) is the first long-acting medication used for treating HIV infection. Cabotegravir, an integrase strand transfer inhibitor, and rilpivirine, a nonnucleoside reverse transcriptase inhibitor (NNRTI), were approved and co-packaged as the first injectable treatment option for adults with HIV. Cabotegravir is also being studied as an injectable form of PrEP intended for individuals at risk of sexually acquired HIV infection. The therapy might be approved by early next year.
Both here in the United States and internationally, pre-exposure prophylaxis (PrEP) is increasingly being seen as a valuable treatment option for HIV prevention.
The World Health Organization (WHO) has recommended offering oral PrEP to anyone at substantial risk of HIV as part of combination prevention strategy.
According to a study published in The Lancet HIV, there was a global increase in PrEP use, but fell short of targets. The study analyzed data on the adoption of WHO PrEP recommendation and numbers of PrEP users from 2016-2019 and forecasted numbers of PrEP users through 2023.
The study found that there were 626,000 PrEP users in 77 countries in 2019, after two-thirds of countries (120) had adopted WHO recommendations into national guidelines. This was a 69% increase from 370,000 PrEP users across 66 countries in 2018, when 30 countries had adopted the recommendations, but fell short of a goal of 3 million oral PrEP users by 2020 set by the UN General Assembly in 2016.
According to the Centers for Disease Control and Prevention, as many as 1.1 million Americans could benefit from PrEP, including 175,000 women and 780,000 people of color. Yet, statistics on usage remains low compared to the prospective benefactors. According to AIDSVu, there were only 77,120 PrEP users in the US in 2016.
The development of various forms of PrEP such as different oral therapies as well as long-acting injectables have been in development and working their way through clinical trials and also federal government approvals.
For example, ViiV Healthcare announced in late September that the Food and Drug Administration (FDA) has granted Priority Review for a New Drug Application (NDA) for cabotegravir, for an HIV prevention indication. The review is expected to be in late January 2022.
With so much going on in this area of HIV prevention, review the slideshow to understand more about where PrEP is in the treatment spectrum.