On Friday, October 11th, Dr. Connie Celum, professor at the University of Washington Schools of Public Health and Medicine, will deliver the keynote presentation at the 21st Annual STI & HIV Research Symposium, co-hosted by the UW/Fred Hutch Center for AIDS Research (CFAR) and the UW Center for AIDS & STD (CFAS).
Please join us for her talk, “Evidence to Implementation to Impact in HIV and STI Prevention,” from 3:35pm – 4:35pm PDT (RSVP Today).
We connected with Dr. Celum ahead of the symposium to learn more about current challenges in HIV/STI prevention, and gain insight into the inspiration behind her doxycycline postexposure prophylaxis (doxy-PEP) research and thoughts on offering it to cis-gender women in the US at higher risk of STI acquisition.
What are the most important current challenges to HIV/STI prevention?
One overarching challenge is celebrating progress and successes while maintaining momentum and addressing remaining gaps in HIV and STI prevention.
We have to acknowledge progress while motivating the funding to make prevention and treatment programs sustainable and scalable. If pre-exposure prophylaxis (PrEP) is going to have an impact, we have to increase coverage and persistence among those who need it the most. We have not done very well with implementing injectable antiretroviral therapy (ART) in part because of the cost and complexity of our medical and pharmacy systems. Can we address systematic barriers and bring down the cost of injectable ART and PrEP for those who cannot adhere to and persist with daily pills? Can we find effective long-acting oral HIV PrEP and treatment options which will likely be more cost-effective than injectable and easier for health care systems to implement? For STI prevention how can we ensure that doxy-PEP reaches those who have the highest likelihood of acquiring bacterial STIs in the near future? We will need to find ways for doxy-PEP to be understood and adopted by primary care physicians as well as infectious disease and HIV providers and Sexual Health clinics. We also need to assess antimicrobial resistance (AMR) in the context of longer-term doxycycline exposure and ‘real world’ use and build and fund better AMR surveillance systems.
We need to continue efforts towards cost-effective STI diagnostics so that STI diagnosis, treatment, partner treatment, and new interventions like doxy-PEP can be implemented in settings which have a high STI burden and no or very limited availability of STI diagnostic testing due to cost. Lastly, we also need to keep working towards identifying effective STI and HIV vaccines. It will not be easy, but there is progress in terms of the evidence for the efficacy of the single dose nonavalent HPV vaccine which makes it more scalable. There is renewed effort to develop a gonococcal vaccine building off potential cross-protection with the Bexsero 4CMenB vaccine. And we should continue to pursue to develop a vaccine against HIV, in spite of the many challenges and disappointments that the HIV vaccine field has faced.
What inspired you to investigate the research question about Doxy PEP?
I felt compelled to test whether doxy-PEP would be effective and offer a new intervention in response to the ongoing high bacterial STI rates among men who have sex with men (MSM) and transwomen. I was not sure whether event-driven dosing of doxycycline after sex would be feasible and acceptable and was delighted when our DoxyPEP trial and the DoxyVAC trial found very high effectiveness, safety, and acceptability. This provides both MSM and transwomen living with HIV or on PrEP with an STI prevention intervention under their control.
Given that Doxy PEP did not work in women in Africa, what are your thoughts about giving it to cis-gender women at risk for STI’s in the US?
I think that there is strong biologic plausibility that doxy-PEP should be effective among cisgender women based on the PK data that shows very similar blood plasma and genital levels of doxycycline in cisgender women and men. I am eager to see the results of the FoXXy Doxy trial among young cisgender women in the US which will start in late 2024, and will test fixed once weekly as well as event-driven dosing of doxy-PEP. While waiting for those data, I am supportive of offering doxy-PEP to cisgender women at higher risk of STIs (e.g., based on a history of early syphilis, CT or GC in the past year). I think we should use it selectively and explain to cisgender women that doxy-PEP works well in MSM and transwomen and we only have one study from Kenya where the results were flat and that was likely due to low use of doxy-PEP. If a woman perceives herself to potentially benefit from doxy-PEP, understands available data about effectiveness, and is motivated to use it, I think we should support her decision.
Event Details
Date: Friday, October 11, 2024
Time: 9:00am – 4:40pm PDT (Dr. Celum’s keynote presentation from 3:35pm – 4:35pm)
Location: Harborview Research & Training (R&T) Building, 300 9th Ave, Seattle, WA (Google Maps) or via Zoom
An infectious diseases physician, epidemiologist, and clinical investigator, Dr. Celum’s research focuses on HIV prevention strategies including pre-exposure prophylaxis (PrEP) and the prevention and treatment of sexually transmitted infections. In addition to her roles as professor of global health, medicine, and epidemiology (adjunct) at the UW, Dr. Celum serves are Director of the UW/Fred Hutch CFAR and the International Clinical Research Center (ICRC). She is also the recipient of the Association of Schools and Programs of Public Health’s (ASPPH) 2024 Research Excellence Award.