More than 5,900 HIV professionals from nearly 130 countries participated in the recent International AIDS Society Conference on HIV Science (IAS), including a strong UW showing that included Department of Global Health students, faculty and alumni who presented groundbreaking new research impacting HIV/AIDS treatment and prevention.
The conference, where participants presented critical advances in basic, clinical and operational research that move science into policy and practice, took place in Mexico City, Mexico, on 21-24 July 2019.
Dr. Jared Baeten, UW/Fred Hutch Center for AIDS Research (CFAR)/International Clinical Research Center (ICRC)/DGH, presented findings from the HIV Open Label Extension (HOPE) study. The findings revealed high levels of adherence and effectiveness for a new kind of HIV prevention for women – the Dapivirine vaginal ring. The silicone vaginal ring containing the antiretroviral drug dapivirine continued to demonstrate moderate effectiveness and remained well tolerated and acceptable to African women over a year-long period, according to the report presented at IAS 2019.
"Having both PrEP and the dapivirine ring would be a significant milestone for HIV prevention, because the more options the better," Baeten said. "No one method is going to be right for all women, and no method will be nor can be effective if it’s not used or not available in the first place."
In the session "New prevention products in the pipeline," Baeten affirmed that the PrEP pipeline is diverse but prevention technologies must integrate into life cycles and meet the varying contraception and prevention needs through mutipurpose prevention technologies (MPTs) that address multiple sexual and reproductive health issues with one product, or PrEP on demand. "Choice = Use but robust science on choice is needed," said Baeten.
Baeten also took part in a panel on understanding vaccine partial efficacy. Vaccine partial efficacy means that a vaccine does not fully prevent infection by a pathogen in every person upon every exposure, but helps reduce the overall risk of becoming infected and the social and economic burden of a disease. Therefore, it may be beneficial for global public health.
In the session “Start stop restart: Supporting effective PrEP use,” Dr. Connie Celum, ICRC/DGH, discussed new research findings demonstrating that although 95% of young women initiated PrEP in the HPTN 082 trial, adherence did not increase following drug level feedback. This session clearly demonstrated the need for more research to determine effective adherence support strategies to sustain PrEP use among adolescent and key populations.
“We need to develop effective ways to support young African women who still desire PrEP after this initial period to maintain their adherence and optimize their protection,” said Celum.
Dr. Nelly Mugo of the Kenya Medical Research Institute and ICRC presented findings from ECHO (Evidence for Contraceptive Options and HIV Outcomes), the landmark trial demonstrating that injectable hormonal contraceptives do not raise women’s risk of acquiring HIV. While providing reassuring news about contraception, the study also revealed an unacceptably high incidence of HIV among trial participants, despite the prevention services that had been provided.
Mugo discussed the trial’s lessons and how to better serve young women in sub-Saharan Africa, including whether integrating HIV prevention into contraceptive services reduce infections among African women.
Dr. Adrienne Shapiro, DGH, presented findings from a self-testing study in South Africa targeting men. Dr. Connie Celum co-chaired and Dr. Ruanne Barnabas, CFAR/ICRC/DGH, served as the study's principal investigator. In the study, 4355 tests were distributed, 62% reported results, and 9% were positive, demonstrating that the distribution and use of HIVST are feasible. The session provided real examples of implementation, allowing an understanding of the benefits and potential risks and unintended consequences, such as coercion and risk of partner violence. The secondary distribution of tests through clients reached more positive cases, expanding the opportunities of identifying HIV-positive individuals and contributing to the 90-90-90 goal.
Katrina Ortblad, UW postdoctoral research fellow, co-chaired a session on innovative HIV testing together with John Kinuthia, Global Center for Integrated Health of Women, Adolescents and Children (Global WACh)/DGH. The session tried to find an answer to the question ‘how to reach the hard-to-reach’, i.e. the ones that are still left behind when it comes to HIV testing. Specifically, two topics were addressed: the option of self-testing and how to reach men, who are often underscreened.
Dr. Kenneth Sherr, CFAR/Health Alliance International (HAI)/DGH, presented on implementation science. The session addressed opportunities and challenges facing implementation science to advance the HIV pandemic response. Participants discussed how can research be most useful to policy makers, and aimed to help bridge the gap between interventions and real-world practice in HIV.
Dr. Kristin Beima-Sofie, CFAR/DGH, shared focus group results about healthcare workers' implementation challenges and strategies to offer PrEP to adolescents and young women through maternal and child health and family planning clinics, as part of the PrEP Implementation for Young Women and Adolescents (PrIYA) program in Kenya.
Carey Farquhar, DGH, and Keletso Makofane, Harvard University, co-chaired a symposium on “The power of partners! Positively engaging networks of people with HIV in testing, treatment and prevention.” HIV partner notification services (PNS) are an effective means of newly diagnosing people with HIV, linking people to HIV care, and identifying people in need of HIV prevention services, including PrEP.
Elizabeth Irungu, ICRC, presented an oral abstract on the Partners Scale-Up Project.
Irene Njuguna, Brandon Guthrie, and Carey Farquhar also gave poster presentations. Global WACh's Jill Neary, Anjuli Wagner, Cyrus Mugo, and Irene Njuguna presented results from the ongoing FIT trial that showed increased testing uptake and faster time to testing with increasing incentive values to HIV-positive caregivers. Kristin Beima-Sofie and Anjuli Wagner presented on implementation challenges and strategies to integrate PrEP into family planning and maternal child health clinics in Kisumu County, Kenya.