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Biomedical prevention: state of the science
Sheena M McCormack1, Mitzy Gafos1, Monica Desai1
1Medical Research Council, Clinical Trials Unit at University College London, United Kingdom.
Summary
Antiretroviral drugs are effective for preventing HIV transmission (TasP) and reducing new infections (PrEP). However, challenges with daily adherence and provider concerns hinder their widespread use.
Area of Science:
- Infectious Diseases
- Public Health
- Pharmacology
Background:
- Preexposure prophylaxis (PrEP) and treatment as prevention (TasP) utilize antiretroviral drugs to reduce HIV acquisition and transmission.
- Clinical studies demonstrate high efficacy for TasP and variable effectiveness (0%-73% incidence reduction) for PrEP.
Purpose of the Study:
- To review the effectiveness of PrEP and TasP.
- To identify challenges hindering widespread adoption of PrEP and TasP.
- To highlight the need for addressing these challenges to maximize public health benefits.
Main Methods:
- Review of clinical trial data for PrEP effectiveness.
- Analysis of adherence data from PrEP trials and treatment programs.
- Examination of provider concerns regarding PrEP implementation.
Main Results:
- TasP shows consistently high effectiveness.
- PrEP effectiveness varies, with adherence being a significant challenge.
- Provider concerns include cost, impact on condom use, and drug resistance.
Conclusions:
- Daily adherence to antiretroviral prophylaxis is a major barrier for many individuals.
- Provider concerns about cost, condom use, and resistance impede PrEP acceptance.
- Addressing adherence and provider concerns is crucial for realizing the full public health potential of antiretrovirals in HIV prevention.
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