Rapidly declining HIV infection in MSM in central London

Nwokolo, Nneka; Hill, Andrew; McOwan, Alan; Pozniak, Anton

doi:10.1016/s2352-3018(17)30181-9

Cited by 91 publications

(73 citation statements)

References 4 publications

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“…Some documented 'success stories' of PrEP having a role in the reduction of new HIV diagnoses have been described for Sydney, San Francisco, New York City and London. [71][72][73][74] Cities, as health jurisdictions, are well placed to respond to HIV, and several socalled Fast-Track cities are now including PrEP in their planning and HIV responses.…”

Section: Discussionmentioning

confidence: 99%

Going global: the adoption of the World Health Organization’s enabling recommendation on oral pre-exposure prophylaxis for HIV

et al. 2018

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In September 2015, the World Health Organization (WHO) launched evidence-based guidelines by recommending that any person at substantial HIV risk should be offered oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) as an additional prevention choice. Since 2017, PrEP medicines have also been listed in the WHO’s Essential Medicines List, including TDF/emtricitabine (FTC) and TDF in combination with lamivudine (3TC). A descriptive policy review and analysis of countries adopting WHO’s 2015 recommendation on oral PrEP was conducted. As of June 2018, we identified 35 countries that had some type of policy on oral PrEP, and an additional five countries where a specific policy on PrEP is currently pending. A total of 19 high-income countries (HICs) and 21 low- and middle-income countries (LMICs) have adopted or have a pending policy. Most countries that have adopted or pending PrEP are in the European (42.9%) or African (30.0%) region. TDF/FTC is the most commonly recommended PrEP drug in the guidelines reviewed, although seven countries, namely in sub-Saharan Africa (6/7), are also recommending the use of TDF/3TC for PrEP. In sum, by the end of 2018, at least 40 countries (20.6%) are anticipated to have adopted WHO’s oral PrEP recommendation. Nonetheless, policy uptake does not reflect broader programmatic coverage of PrEP services, which remain limited across all settings, irrespective of income status. Enhancing global partnerships is needed to support and track ongoing policy adoption and to ensure that policy is translated into meaningful implementation of PrEP services.

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Section: Discussionmentioning

confidence: 99%

Going global: the adoption of the World Health Organization’s enabling recommendation on oral pre-exposure prophylaxis for HIV

et al. 2018

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“…In particular, very large sample sizes are required to generate sufficient HIV endpoints (typically more than 100) to establish non-inferiority as currently defined. (10) In light of evidence of recent rapid declines in HIV incidence in some MSM populations(21, 22) and the very high effectiveness of TDF-FTC(23), achieving such sample sizes is becoming impracticable. Our analyses indicate that adopting the AIR would allow the use of substantially smaller sample sizes and therefore produce significant cost savings.…”

Section: Discussionmentioning

confidence: 99%

The averted infections ratio: a novel measure of effectiveness of experimental HIV pre-exposure prophylaxis agents

et al. 2018

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There is clear evidence that tenofovir disoproxil fumarate combined with emtricitabine (TDF-FTC) is a highly efficacious oral pre-exposure prophylaxis agent for preventing the acquisition of HIV. This has consequences for the design and analysis of trials evaluating experimental pre-exposure prophylaxis regimens, which now generally include an active-control TDF-FTC arm rather than a placebo arm as a comparator. We point out major problems in the interpretation of the primary measure of effectiveness proposed for these trials, namely the ratio of the HIV incidence rates in the experimental agent and TDF-FTC arms. We argue that valid interpretation requires an assumption about one of two parameters: either the incidence rate that trial participants would have experienced had they not received pre-exposure prophylaxis or the effectiveness of the TDF-FTC within the trial. However, neither parameter is directly observed due to the absence of a no-treatment arm, requiring the use of external evidence or subjective judgement. We propose an alternative measure of effectiveness based on the concept of “averted infections”, which incorporates one of these parameters. The measure is simple to interpret, has clinical and public health relevance, and is a natural “preservation of effect” criterion for assessing statistical non-inferiority. Its adoption would also allow the use of smaller sample sizes, currently a major barrier to the evaluation of experimental pre-exposure prophylaxis regimens.

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“…The rationale of test-and-treat strategies is to combine the benefit of treatment for the individual with the public health benefit of preventing onward transmission. In HIV, the rollout of antiretroviral therapy has led to reductions in incidence of new infections [10][11][12]. A similar effect can be expected from treating hepatitis B infections, whereby-comparable to HIV-test-and-treat strategies should contribute to achieving HBV elimination.…”

Section: Lessons Learned From Efforts To Control Hivmentioning

confidence: 95%