Women and ARV‐based HIV prevention – challenges and opportunities

Abstract

ARV-based HIV prevention methods available in pill, gel or ring formulations (broadly referred to as microbicides) offer the possibility of protection against HIV for women who find it difficult because they cannot ask their partners to use condoms or even refuse sex. Partial efficacy of ARV-based medications has been demonstrated in a number of clinical trials around the world among various populations, building the evidence that ARV-based technologies will contribute to reducing the AIDS epidemic worldwide. Disappointing results, however, from two trials in sub-Saharan Africa, where poor adherence contributed to study closure due to futility, have raised questions about whether women at the centre of the epidemic are able to effectively use products that require routine use. Also, there are fears by some of risk compensation by decreased condom use because of the availability of microbicides when only partial efficacy has been demonstrated in microbicide trials to date. Of note, sub-analyses of biologic measures of adherence in trials where this was possible have shown a strong correlation between good adherence and efficacy, reinforcing the necessity of good adherence. Research conducted in conjunction with clinical trials and post-trials in advance of possible rollout of ARV-based products have examined social and cultural factors, gender-related and otherwise, influencing adherence and other aspects of women's use of products. These include HIV stigma, women's perception of risk, partner and community influences and the differing needs of women in various stages of life and in different circumstances. It is the purpose of this supplement to give voice to the needs of women who can benefit from woman-initiated methods by presenting research results and commentary to contribute to the global conversation about optimizing women's experience with ARV-based prevention.

Enema ion compositions for enhancing colorectal drug delivery

“…Risk of colorectal HIV transmission is 10 – 20 fold higher than vaginal transmission, and enema use is widespread for cleansing the bowel prior to receptive anal intercourse (RAI) [1, 21, 34-39]. In addition to an increased risk of viral transmission with RAI, adherence to prescribed drug regimens has been a significant issue in most HIV PrEP clinical trials [40, 41]. Using a microbicide-loaded enema would require minimal behavioral modification, leading to improved adherence, which may significantly improve PrEP outcomes.…”

The Vaginal Microbiome and its Potential to Impact Efficacy of HIV Pre-exposure Prophylaxis for Women

“…ring, film, and injectable products) that ease the burden of daily adherence and can effectively deliver PrEP drugs to target tissue in any vaginal microbiome environment (43,44). An additional priority is to continue developing innovative implementation strategies to improve daily oral PrEP adherence among women and frame PrEP as a tool to support women’s lives (4,45). Oral PrEP remains a critical biomedical HIV prevention strategy for women with symptomatic or asymptomatic bacterial vaginosis, who are protected from HIV acquisition when adherence to the daily pills is high, and there remains a need to improve oral PrEP access for women regardless of their bacterial vaginosis status (31 ■■ ).…”

Implementation of pre‐exposure prophylaxis for human immunodeficiency virus infection: progress and emerging issues in research and policy

“…Demonstration projects to explore PrEP implementation in those populations are a priority. Medication adherence in younger women has also been recognized as a significant challenge [39,40]. Risk assessment tools have been designed for men who have sex with men (MSM) and people who inject drugs (PWID) but have not been critically evaluated yet in terms of their usefulness in PrEP implementation.…”