ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP...
Transcript of ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP...
![Page 1: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/1.jpg)
ORAL AND SYSTEMIC PrEPPamela G. Marimbe-Nyatsambo
University of Zimbabwe College of Health Sciences-Clinical Trials Research Centre
![Page 2: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/2.jpg)
Potential Conflicts and Financial Disclosures• I have no actual or potential conflicts to declare in
relation to this programme and presentation
• Grant/Research support: US National Institutes of Health, Bill and Melinda Gates Foundation, USAID
• Consulting: US National Institutes of Health, World Health Organization, Merck
![Page 3: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/3.jpg)
INTRODUCTION
• Despite global progress in the last decade, the HIV epidemic remains uncontrolled.
• Sub‐Saharan Africa hardest hit, where young women are up to twice as likely to be infected as young men
• In this sub-population, un-protected heterosexual intercourse is the leading mode of HIV-1 transmission.
![Page 4: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/4.jpg)
intro
• “Youth bulge” in sub-Saharan Africa, therefore more young men and women than when epidemic began
• High rates of HIV in these young women remain unchecked
• If HIV prevention not effectively targeted to this population, early gains in fighting HIV will be reversed
![Page 5: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/5.jpg)
ORAL PrEP in Young Women
![Page 6: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/6.jpg)
![Page 7: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/7.jpg)
![Page 8: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/8.jpg)
IMPAACT 2009
• Study has two components: pharmacokinetic and PrEPcomparison components
• PHARMACOKINETIC (9 months): 30 participants will be enrolled who will receive DOT Truvada for 12 weeks with monitoring of their blood concentrations
• Findings will guide the opening of the PrEP Comparison Component
• PREP COMPARISON: 300 participants who are at least 32 weeks gestation, offered PrEP at enrollment
• PrEP acceptors and decliners will be compared
![Page 9: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/9.jpg)
IMPAACT 2009
Primary Objectives
– To characterize PrEP adherence among HIV-uninfected young women during pregnancy and for twenty-six weeks postpartum, when provided with enhanced adherence support through mobile technology and counseling based on observed drug levels
- To assess the safety of FTC/TDF for PrEP during pregnancy and postpartum
9
![Page 10: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/10.jpg)
Injectable PrEP
![Page 11: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/11.jpg)
![Page 12: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/12.jpg)
Injectable PrEP – Advantages and Disadvantages
Advantages
• Injection every 1-3 months could address adherence issues
• Different drug, not used heavily for treatment -> less concern for resistance/cross-resistance
Disadvantages
• Cannot be removed once given → prolonged side effects
• Long pharmacologic tail after last injection
(up to 48 weeks) → safety and resistance
![Page 13: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/13.jpg)
![Page 14: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/14.jpg)
Giving Women Control of HIV
Prevention: How Injectable
PrEP Could Change
Everything
Long-Acting Injectable Cabotegravir for PrEP Well Tolerated in HPTN 077: Results
Support Dosing Regimens in HPTN 083 and HPTN 084
Jul 25, 2017
![Page 15: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/15.jpg)
![Page 16: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/16.jpg)
![Page 17: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/17.jpg)
![Page 18: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/18.jpg)
CONCLUSION
• It is possible to get zero new infections by 2030, but the road may not be smooth
• A multidisciplinary approach to enhancing adherence in the most vulnerable populations is a must for success
• HPTN 082; HPTN 084 and IMPAACT 2009, among others, offer a window of hope
• The success of these studies could provide the much needed solutions to adherence issues in this very important population
• Adherence is the answer, but let us work together to achieve and maintain it
![Page 19: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/19.jpg)
ACKNOWLEDGEMENTS
![Page 20: ORAL AND SYSTEMIC PrEP...2018/05/09 · Giving Women Control of HIV Prevention: How Injectable PrEP Could Change Everything Long-Acting Injectable Cabotegravir for PrEP Well Tolerated](https://reader035.fdocuments.us/reader035/viewer/2022071607/614473dbb5d1170afb43e222/html5/thumbnails/20.jpg)