PrEP and Microbicides:
|CaféTitle/ Topic||PrEP and Microbicides: ARV-based prevention technologies in the wake of the CROI results and the implications for HIV prevention worldwide.
|· Toprovidea platformfor engagementbetweenkeyjournalists andbiomedical HIV preventionscientists, programimplementers, advocates,policymakersetc.inUganda
· Toprovidejournalists updatesonlatestdevelopments in researchonmicrobicidesandother newor emergingbiomedical HIVpreventionoptions
· Help journaliststogeneratestoryandfeaturesideason microbicidesandothernew oremergingbiomedicalHIV preventionoptions, critiquetheir work andengageinthought provokingdebate
· Tolay thegroundworkforongoingdialogue amongstjournalists onscientific relatedtopicsandfindings, especiallyrelatedtoHIV issues
· Toprovidenetworkingopportunities amongjournalists themselves,andbetweenjournalistandadvocates, policymakers, researchersandimplementers.
“Media ScienceCafés” present aplatformfor uniquepublic engagementonissuesthatmaybeisolated fromthe general public, includingjournalists. Thesecafésare conducted inaninformal settingoversoftdrinks, tea andsnacksthat allowsforcasual interaction. Themaximum numberof participants is usually 25toallowfor greater andmorein-depthinteractionandabsorptionof the topics discussed. Targeted keyresources –preferablyarespectedscientist and/or implementer, policymaker,[potential]clientwhoismedia savvy,keyadvocateshouldbeavailable toensurethatexpert opinions are shared.
|Like the inaugural event, the second science café, which was held on March 4, 2015 brought together journalists from the print, broadcast and online platforms.
Several journalists who attended the first café were present as well as new young journalists who are starting to get their feet into health/science reporting.
Many showed enthusiasm in learning and knowing more about the different HIV prevention technologies, especially microbicides and PrEP and the debate that will follow.
Proximity plays a key role to the enthusiasm displayed by the journalists. One of the research studies, the Partners Demonstration Study is being conducted in Uganda and Kenya.
|Partners||Partners Demonstration Project (Specifically focusing on Pre-Exposure Prophylaxis for HIV prevention and civil society advocacy to develop PrEP guidelines in Uganda) and University Johns Hopkins University Collaboration (MUJHU), focusing on the Microbicide vaginal ring.
Pre-Exposure Prophylaxis: What is it in light of the Partners Demo results that were released recently?
DrNuluBulya from the Infectious Diseases Institute/Partners Demonstration Project took the journalists though this topic, discussing the current status of the research, what has come out of it and the way forward.
DrNulu started her discussion with the definition of PrEP, explaining that it involves the use of antiretroviral medicines to reduce the risk of HIV infection in an HIV negative person, especially those in discordant relationships.
She explained that the Partners Demo Study was undertaken as a result of findings from a 2012 study that found Truvada, an antiretroviral drug was effective in reducing the risk of HIV acquisition by a negative partner.
“When the clinical trial was carried out, it demonstrated that if used consistently, Truvada was 75% against HIV infection,” said DrNulu.
It also sought to demonstrate how PrEP, away from clinical trials could be used in a real world setting.
In Uganda, the number of people getting infected with HIV continues to grow, while many are living in discordant relationships.
The study sought to establish if people in discordant relationships would accept to use the intervention of ART for the positive partner and PrEP for the negative partner in order to reduce the risk of infection for the negative partner.
“So far the results we have is that PrEP can reduce the risk of infection by 90 per cent,” said DrNulu.
The PrEP study was started in 2013, with first enrolment in November. It has enrolled 1013 people at two sites in Kasangati and Kabwohe Clinical Research Center in Uganda and . There are two other sites in Kenya– Kisumu and Thika.
Civil society perspective on PrEP
Charles Brown, also from the Partners’ PrEP demonstration study gave a civil society perspective, focusing more on advocacy for the establishment of guidelines/policies that ensures that health workers are able to administer PrEP.
“From the recent CROI 2015, we now have more than enough data that PrEP works. What we want is for the government to come up with guidelines that can be used by health workers both in the public and private facilities to prescribe PrEP,” said Mr Brown.
At the moment, many discordant couples and other key risk groups are missing out on the opportunity to access services because the country does not have these guidelines or policies in place.
He also urged the media to play a leading role in pushing the government to put in place such policies.
|The Vaginal Ring
Dr Dr. ClemensiaNakabiito, Makerere University Johns Hopkins University Collaboration (MUJHU)
DrNakabiito discussed the potential of the vaginal ring, which she said will be a life-changing HIV prevention technology for women if found to be effective at the end of the study.
The dapivirine ring was developed by the International Partnership for Microbicides (IPM) and the active ingredient in it is an antiretroviral (ARV) drug called dapivirine.
The ring is designed in a way that a woman can insert and remove it on her own without a health worker being present.
Explaining to journalists how it works, DrNakabiito said once placed inside the vagina, the ring slowly releases dapivirine during the four weeks when a woman is wearing it.
According to DrNakabiito, the vaginal ring study is targeting women who are at high risk of contracting HIV.
Uganda has been previously involved in other HIV prevention studies that specifically target women. One example is the trial involving the use of a microbicide gel. However, the trial was discontinued because the women using the gel with the active ingredient under study and those using the placebo were getting infected equally.
The Daprivirin ring study started in 2013 and the site at the Makerere University-Johns Hopkins University Research Collaboration (MUJHU) was the first to enroll women.
The study is being conducted in Uganda, South Africa, Zimbabwe and Malawi. In total, there are 15 sites across these countries where the trials are being conducted.
A similar study is being conducted at a trial site in Masaka, although the design is different.
DrNakabiito said so far the data from the study shows the ring is safe. As a result, MUJHU was stopped from enrolling more participants.
“After analyzing the available statistics, we found that the 2629 women we had enrolled were enough to give us an end point of effectiveness. So far the safety is okay,” said DrNakabiito.
Before enrolment on the study, community sensitization was carried out to inform the women of its intentions and why having an effective method to prevent women from getting HIV/Aids is important.
After the community sensitization, more information is usually given at the site, where screening is done to ensure those enrolled are from the intended high-risk group of women.
In this case, a high-risk person is defined as someone who has had sex at least once in the last three months, without a condom or a person who has multiple partners.
One of the biggest challenges involving such large scale and long-term trials is adherence and the ability to remain in the trial to its conclusive stage. “Once a person makes a commitment to take part in the study, they are encouraged to continue with the process to its completion” explained DrNakabiito.
Key questions from journalists
Can we say the vaginal ring is on track as far as protecting women against HIV is concerned?
· We are closing the follow-up of the participants. By July we will have stopped following up all the participants and then the data will be analyzed.
· We expect results in the last quarter of this year or first quarter of next year
· So far it is safe but we have to combine results of the ring study in SA and Masaka sites.
· At the moment we continue to give the women the ring to wear for one month before returning to the centre. Some get the one with the product under trial and others continue to get the placebo.
· When they return every month, we test them for HIV and pregnancy because we don’t want them to become pregnant when they are on the ring.
· When they become pregnant, we discontinue the product.
So will the ring be recommended only after we have the final results? How is this information important at this stage?
In these studies, do you offer incentives for the women to be able to participate?
Do you think the long study period also contributes to the lack of adherence?
Explain what the vaginal ring looks like and what it contains.
· The active ingredient in the ring is an antiretroviral (ARV) drug called dapivirine.
Why did you target people in discordant relationships?
How does PrEP work and when does someone start taking it?
How has been the adherence of PrEp by the participants?
Can PrEP be taken like family planning?
Does PrEP have side effects?
|Other issues arising
|To ensure that journalists do not misrepresent issues arising from the discussion, especially about the vaginal ring, DrClemensiaNakabiito wondered if would be possible for her to look at the articles before publication.
However, Esther Nakkazi assured her that the journalists would be trusted to be able to write accurate stories as they have always done so. She also encouraged all those journalists to seek any clarifications on things they did not understand with the presenters.
The contact details of the presenters were shared with the journalists
|Stories linked to café||http://www.theeastafrican.co.ke/news/HIV-study–Vaginal-ring-shows-promise-/-/2558/2711322/-/87ih9w/-/index.html