The PrEP ‘care continuum/cascade’: how would it look?

We take for granted the value of the care continuum (or ‘cascade’), now increasingly seen as the key measure of health system response to HIV (Cassell (STIs editorial)).   The application of this model to HIV has provided a benchmark for evaluation in contexts as diverse as Moscow (Wirtz & Beyrer (STIs)), South Africa (Schwartz & […]

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UK National Health Service (NHS) kicks PrEP into the long grass

A recent BMJ editorial condemns the NHS position that it will not consider PrEP for direct NHS funding.  The decision was first communicated in an NHS statement issued in March, then confirmed by a review on 31st May, following reconsideration in response to objections raised by interested groups.  This brought to an end an eighteen-month process […]

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Is the UK meeting its national guidelines for HIV testing of MSM?

The potential role of frequent HIV testing in curbing the HIV epidemic among the MSM population has long been recognized. The introduction of the strategy of ‘opt-out’ testing in the UK (2007), as in other countries at around the same time, brought a steep rise in testing, followed by stabilization (McDaid & Hart (STIs); Saxton […]

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Another failed sub-Saharan #PrEP study: unpicking the disappointing performance of the dapivirine ring

The potential value of PrEP as an intervention in Western MSM populations has recently been conclusively demonstrated (PROUD – 86% (PROUD study/STIs/blog)), despite results from a whole series of trials in sub-Saharan African populations that seemed to cast doubt on its likely efficacy (CAPRISA 004 – 39%; iPrEX – 44%; CDC TDF2 – 62%; Partners-PrEP – 75%; FEM-PrEP – 0%; VOICE– 0%). The difference in […]

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Modeling the potential effectiveness of PrEP as against other preventative interventions in addressing MSM HIV

  Despite the known preventative benefits of ART, the incidence of HIV among UK MSM population has remained relatively constant over the last 10 years and looks set to remain so. The UN 90:90:90 target will soon be achieved for this population, yet the goal of eliminating the infection seems no nearer.  Not surprisingly there […]

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Changes in the WHO Guidelines for treatment of HIV

The WHO has released early its revised guidelines on the treatment of those infected with HIV (WHO early release guideline; WHO press release).  There are two important changes.  First, ART is recommended to all HIV infected individuals regardless of their CD4+ count.  Second, PrEP is recommended for people at ‘substantial’ risk of HIV infection as […]

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PrEP highly effective against HIV in MSM and has limited impact on risk compensation

The year 2015 is likely to turn out a decisive one for the story of PrEP (pre-exposure prophylaxis for HIV).  After a slow and faltering beginning, with trials in sub-Saharan Africa dogged by problems of poor adherence (Haberer & Bangsburg/STI/blog; VOICE D/STI/blog; Hendrix & Bumpus/STI/blog), this intervention appears at last to have proved its worth […]

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Reported 86% effectiveness for MSM PrEP by PROUD study makes this intervention a viable option for UK health services

The Conference on Retroviruses and Opportunistic Infections has recently taken place.  At that event the UK PROUD (PRe-exposure Option for reducing HIV in the UK: immediate or Deferred) study of pre-exposure prophylaxis (PrEP) for MSM reported its results, prior to publication in the coming months.  The headline figure is an astonishing 86% for the reduction […]

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Failed PrEP trial (VOICE) participants give reasons for their poor adherence

Despite indications of the acceptability of Pre-Exposure Prophylaxis (PrEP) among certain populations (MSM in London (STI/Aghaizu & Nardone) 2013, and Australia (STI/Holt & De Wit) 2012), the extremely varied results that have emanated from large studies seeking to determine its efficacy and effectiveness as a preventative intervention remain a concern.  To name the most important […]

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iPrEx finds no evidence that PrEP use is associated with risk compensation

A great concern in respect to the deployment of Pre-Exposure Prophylaxis (PrEP) as an HIV prevention tool is risk compensation – i.e. the possibility that the protection afforded by PrEP would itself encourage sexual risk-taking (STI blogs/Sugarman & Mayer).  Recent studies of PrEP efficacy would seem an unpromising context in which to assess the likely impact […]

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