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Effective HIV prevention requires a combination of interventions that address the biomedical, social and structural factors contributing to a person’s risk of infection. Professionals discuss the plethora of related issues, describe their first-hand experience, and exchange resources and lessons learned.

Discussion Briefs

Promises and Pitfalls of Putting PrEP into Practice

Pre-exposure prophylaxis (PrEP) is a novel biomedical strategy being investigated for HIV prevention among diverse high-risk populations worldwide. Two completed clinical trials have demonstrated partial efficacy of PrEP in decreasing HIV acquisition risk by 39% and 44% respectively in heterosexual women and men who have sex with men (Abdool Karim et al 2010, Grant et al 2010). If safe and efficacious in ongoing trials, PrEP will likely be targeted to high-risk subpopulations. However, several questions remain regarding the most effective dosages; length and time of use; topical versus oral; patient adherence, and whether inadvertent PrEP use by HIV-infected individuals could lead to drug resistance. Additionally, the global health community will have to figure out how PrEP can fit within the larger package of sexual health promotion and HIV prevention strategies.

This discussion emanated from a GHDonline Expert Panel Discussion organized in collaboration with the HOPE Conference at Massachusetts General Hospital. Members discussed issues related to adherence and tactics being tested to promote good adherence; risks and benefits of implementing PrEP depending on patients’ risk profiles; acceptability among clinicians and patients; and topic areas for future research, including cost effectiveness, long-term safety and efficacy, different formulations and varying delivery strategies.
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