Introducing the Dapivirine Vaginal Ring in Sub-Saharan Africa: What Can We Learn from Oral PrEP?

Bhavaraju, Neeraja; Shears, Kathleen; Schwartz, Katie; Mullick, Saiqa; Jeckonia, Patriciah; Murungu, Joseph; Persaud, Udita; Vij, Ashley; Torjesen, Kristine

doi:10.1007/s11904-021-00577-8

Cited by 11 publications

(4 citation statements)

References 61 publications

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“…As with primary cost studies, activities like implementation research to inform decision‐making, target setting, awareness raising, technical assistance, and health information system strengthening—vital and catalytic investments in the early phase of introducing new products into the public health system—were not included. Our findings corroborate other reviews examining PrEP cost and cost‐effectiveness in mathematical modelling studies [23, 66–79]. Case et al.…”

Section: Discussionsupporting

confidence: 91%

“…As with primary cost studies, activities like implementation research to inform decision-making, target setting, awareness raising, technical assistance, and health information system strengthening-vital and catalytic investments in the early phase of introducing new products into the public health system-were not included. Our findings corroborate other reviews examining PrEP cost and cost-effectiveness in mathematical modelling studies [23,[66][67][68][69][70][71][72][73][74][75][76][77][78][79]. Case et al highlighted in a 2019 review the outdated assumptions in the modelling literature, the lack of "real-world costing" and the limitation of the modelling studies to include programme implementation, among other factors [23].…”

Section: Table 7 Economic Analysis Features and Analytic Approaches O...supporting

confidence: 88%

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Implementation and resource needs for long‐acting PrEP in low‐ and middle‐income countries: a scoping review

Castor,

Heck,

Quigee

et al. 2023

J Int AIDS Soc.

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Introduction Several low‐ and middle‐income countries (LMICs) are preparing to introduce long‐acting pre‐exposure prophylaxis (LAP). Amid multiple pre‐exposure prophylaxis (PrEP) options and constrained funding, decision‐makers could benefit from systematic implementation planning and aligned costs. We reviewed national costed implementation plans (CIPs) to describe relevant implementation inputs and activities (domains) for informing the costed rollout of LAP. We assessed how primary costing evidence aligned with those domains. Methods We conducted a rapid review of CIPs for oral PrEP and family planning (FP) to develop a consensus of implementation domains, and a scoping review across nine electronic databases for publications on PrEP costing in LMICs between January 2010 and June 2022. We extracted cost data and assessed alignment with the implementation domains and the Global Health Costing Consortium principles. Results We identified 15 implementation domains from four national PrEP plans and FP‐CIP template; only six were in all sources. We included 66 full‐text manuscripts, 10 reported LAP, 13 (20%) were primary cost studies‐representing seven countries, and none of the 13 included LAP. The 13 primary cost studies included PrEP commodities (n = 12), human resources (n = 11), indirect costs (n = 11), other commodities (n = 10), demand creation (n = 9) and counselling (n = 9). Few studies costed integration into non‐HIV services (n = 5), above site costs (n = 3), supply chains and logistics (n = 3) or policy and planning (n = 2), and none included the costs of target setting, health information system adaptations or implementation research. Cost units and outcomes were variable (e.g. average per person‐year). Discussion LAP planning will require updating HIV prevention policies, technical assistance for logistical and clinical support, expanding beyond HIV platforms, setting PrEP achievement targets overall and disaggregated by method, extensive supply chain and logistics planning and support, as well as updating health information systems to monitor multiple PrEP methods with different visit schedules. The 15 implementation domains were variable in reviewed studies. PrEP primary cost and budget data are necessary for new product introduction and should match implementation plans with financing. Conclusions As PrEP services expand to include LAP, decision‐makers need a framework, tools and a process to support countries in planning the systematic rollout and costing for LAP.

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Section: Discussionsupporting

confidence: 91%

Section: Table 7 Economic Analysis Features and Analytic Approaches O...supporting

confidence: 88%

Implementation and resource needs for long‐acting PrEP in low‐ and middle‐income countries: a scoping review

Castor,

Heck,

Quigee

et al. 2023

J Int AIDS Soc.

Self Cite

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“…In particular, we wish to emphasize that the fight against AIDS is a long-term campaign, so the use of PrEP agents in high-risk individuals and the popularization of related prevention knowledge are also particularly important. Another promising DAPY-type NNRTI dapivirine, which was developed in the form of a vaginal microbicide, was approved by the European Medicines Agency (EMA) in 2020 as an effective PrEP agent for HIV-1 prevention. − As prescriptions and treatments become more personalized, the application of precision medicine based on individual patient information may be promising in the future, despite being relatively advanced in the field of anti-viral therapy.…”

Section: Concluding Remarks and Future Perspectivesmentioning

confidence: 99%

Contemporary Medicinal Chemistry Strategies for the Discovery and Development of Novel HIV-1 Non-nucleoside Reverse Transcriptase Inhibitors

et al. 2022

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Currently, HIV-1 non-nucleoside reverse transcriptase inhibitors (NNRTIs) are a major component of the highly active anti-retroviral therapy (HAART) regimen. However, the occurrence of drug-resistant strains and adverse reactions after long-term usage have inevitably compromised the clinical application of NNRTIs. Therefore, the development of novel inhibitors with distinct anti-resistance profiles and better pharmacological properties is still an enormous challenge. Herein, we summarize state-of-the-art medicinal chemistry strategies for the discovery of potent NNRTIs, such as structure-based design strategies, contemporary computer-aided drug design, covalent-binding strategies, and the application of multi-target-directed ligands. The strategies described here will facilitate the identification of promising HIV-1 NNRTIs.

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“…4 for strategies and their mechanisms of action) [10 ▪▪ ,53,57–60]. Although this work is still nascent, it remind us of the ways in which contextual factors and implementation decisions can impact DVR use and effectiveness [61].…”

Section: Review Of the Literaturementioning

confidence: 99%

Advancing considerations of context in the evaluation and implementation of evidence-based biomedical HIV prevention interventions: a review of recent research

Velloza¹,

Roche²,

Concepcion³

et al. 2022

Current Opinion in HIV and AIDS

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Purpose of review A paradigm shift is needed in how we think about biomedical HIV prevention product effectiveness. Often, we expect randomized trial findings to be generalizable across populations and settings where products will be delivered, without consideration of key contextual drivers that could impact effectiveness. Moreover, researchers and policy-makers generally discount products with varied effect sizes across contexts, rather than explicating the drivers of these differences and using them to inform equitable product choice and delivery. We conducted a review of the recent HIV prevention research to advance considerations of context in choices of when, why, and how to implement biomedical HIV prevention products, with a particular focus on daily oral preexposure prophylaxis (PrEP) and the dapivirine vaginal ring (DPV). Recent findings Findings across recent studies of PrEP and DPV emphasize that products that do not work well in one context might be highly desirable in another. Key contextual drivers of PrEP and DPV effectiveness, use, and implementation include population, health system, cultural, and historical factors. We recommend conceptualization, measurement, and analysis approaches to fully understand the potential impact of context on prevention product delivery. Execution of these approaches has real-world implications for HIV prevention product choice and could prevent the field from dismissing biomedical HIV prevention products based on trial findings alone. Summary Ending the HIV epidemic will require tailored, person-centered, and equitable approaches to design, implement, and evaluate HIV prevention products which necessitates considerations of context in ongoing research and implementation.

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Introducing the Dapivirine Vaginal Ring in Sub-Saharan Africa: What Can We Learn from Oral PrEP?

Cited by 11 publications

References 61 publications

Implementation and resource needs for long‐acting PrEP in low‐ and middle‐income countries: a scoping review

Implementation and resource needs for long‐acting PrEP in low‐ and middle‐income countries: a scoping review

Contemporary Medicinal Chemistry Strategies for the Discovery and Development of Novel HIV-1 Non-nucleoside Reverse Transcriptase Inhibitors

Advancing considerations of context in the evaluation and implementation of evidence-based biomedical HIV prevention interventions: a review of recent research

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