HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era...
Transcript of HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era...
![Page 1: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/1.jpg)
Carl W. Dieffenbach, Ph.D. Director
Division of AIDS, NIAID October 29, 2013
HIV Prevention – The DAIDS Perspective
![Page 2: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/2.jpg)
The New Era of AIDS Research --Time of Great Opportunity and
Significant Resource Constraints
2010 2005 2015
Prevent HIV Infections Cure HIV infection Prevent and treat HIV co-morbidities Assist in taking interventions to scale
![Page 3: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/3.jpg)
DiscoveryDelivery: The Path to Combination Prevention
Basic science
Proof of concept
Efficacy Study
Proof of Activity
Scale-up to populations
Implementation
The art of combination prevention is the integration of an essential set of focused, single
approaches into an integrated combination prevention program
“Real-life” implementation
Testing combinations
![Page 4: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/4.jpg)
![Page 5: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/5.jpg)
?
![Page 6: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/6.jpg)
What Data Has Accumulated? Adult Male Circumcision—3 studies RV 144 HVTN 505 CAPRISA 004 VOICE IPrEX Partners PrEP Fem-PrEP CDC TDF2 Bangkok Tenofovir Study Project Accept HPTN 052
![Page 7: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/7.jpg)
![Page 8: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/8.jpg)
Vaccine
Circumcision
PrEP/PEP Condoms
Drug/Alcohol Interventions Education
Structural Interventions STI Treatment
Treatment as Prevention
HIV Testing and the Care Continuum
Microbicides
Combination HIV
Prevention
Adherence to Prevention and
Treatment
![Page 9: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/9.jpg)
No single prevention strategy is enough HIV testing is the entry point for individually-
focused prevention interventions HIV treatment is a critical component of
prevention Know your epidemic and select interventions
based upon effectiveness and cost Develop strategies to create interest and
demand for HIV prevention Evolve prevention strategies with changes in
the epidemic
![Page 10: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/10.jpg)
![Page 11: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/11.jpg)
Achieved Complete and Sustained Virological Suppression
![Page 12: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/12.jpg)
Treatment as Prevention—Role of Care Continuum
![Page 13: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/13.jpg)
Ongoing Challenges
Source of infections within a community arise from outside the community Abstract # 489, CROI 2013 Frequent HIV Introductions into Communities Sustain Local Epidemics in Rural Rakai, Uganda Mary Grabowski, J Lessler, A Redd, O Laeyendecker, J Kagaayi, T Lutalo, M Wawer, D Serwadda, T Quinn, R Gray, and Rakai Health Sciences Program
![Page 14: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/14.jpg)
![Page 15: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/15.jpg)
![Page 16: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/16.jpg)
![Page 17: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/17.jpg)
![Page 18: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/18.jpg)
The State of the ARV-based Prevention Field
Given the efficacy of treatment as prevention, what is the future niche for PrEP and microbicides in comprehensive prevention? Yes
Do we seek to optimize what we have shown to be effective or do we seek a better next generation? – Explore ring and additional longer acting delivery technologies
Will coitus-dependent gels be part of the armamentarium? Rectal use
Role of multipurpose prevention technologies ‒ Rings as a delivery technology
![Page 19: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/19.jpg)
Vaccine Approaches
![Page 20: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/20.jpg)
![Page 21: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/21.jpg)
Summary of Analyses
ITT mITT PP
N (# subjects) 16,402 16,395 12,542
Person years 52,985 52,985 36,720
Vaccine/Placebo (event #) 56 / 76 51 / 74 36 / 50
Vaccine efficacy 26.4% 31.2% 26.2%
2-sided p value 0.08 0.04 0.16
95% confidence interval -4.0, 47.9 1.1, 51.2 -13.3, 51.9
Includes 5 vaccine and 2
placebo recipients who
were HIV positive at baseline
Decreased event numbers, lower
precision
![Page 22: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/22.jpg)
![Page 23: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/23.jpg)
![Page 24: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/24.jpg)
![Page 25: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/25.jpg)
![Page 26: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/26.jpg)
![Page 27: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/27.jpg)
Lessons Learned From Prevention Research
The active agent must be at the site of exposure in sufficient concentration for ample duration to abrogate infection
New agents – Does it work for all routes of exposure? – How is it administered? – Is it behaviorally dependent?
![Page 28: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/28.jpg)
Essential Linkage of Social, Behavioral and Biomedical Research
Creation of interest and demand for HIV prevention requires an integrated approach, need to harness social marketing and behavioral economics
Social science research must inform product development in an iterative way
![Page 29: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/29.jpg)
Combination Prevention is More than Biomedical Interventions
Clinical interventions
Long-lasting prevention interventions
Changing the context
Socioeconomic factors
Structural interventions
Counseling &
Education
Approach Cost per infection averted
Addressing Stigma
Addressing housing, Poverty
Healthcare, Human rights, Gender equality
Circumcision, Vaccines,
Treatment, PrEP, Microbicides
Risk reduction counseling
![Page 30: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/30.jpg)
Vaccine
Circumcision
PrEP/PEP Condoms
Drug/Alcohol Interventions Education
Structural Interventions STI Treatment
Treatment as Prevention
HIV Testing and the Care Continuum
Microbicides
Combination HIV
Prevention
Adherence to Prevention and
Treatment
![Page 31: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/31.jpg)
![Page 32: HIV Prevention – The DAIDS Perspective · HIV Prevention – The DAIDS Perspective . The New Era of AIDS Research --Time of Great Opportunity and Significant Resource Constraints](https://reader034.fdocuments.in/reader034/viewer/2022042712/5f8d2697cb19094b8b1cb19d/html5/thumbnails/32.jpg)