PrEP What exists now for young women and where we go from here - PowerPoint PPT Presentation

PrEP …What exists now for young women and where we go from here Wanjiru Mukoma, PhD Dr Michael Kiragu 20 July 2016 InternaEonal AIDS Conference, Durban 1

Outline • Why PrEP for young women? • What do we know? • What don ’ t we know? • What should we do? Acknowledgement – Megan Dunbar Building Partnerships, transforming lives 2 www.lvcthealth.org

What we know: Young women need HIV PrevenEon New HIV infecEon in sub-Saharan Africa, by age and sex, 2013 Women 15-24y are 2 to 3 Emes as likely to be HIV infected compared to males Building Partnerships, transforming lives 3 www.lvcthealth.org

What do we know: poor results among young women Study PopulaEon Effect PROUD-Daily oral TDF/FTC MSM (UK) 88% IPERGAY-Event-driven TDF/FTC MSM (Canada and France) 86% Partners PrEP-Daily oral TDF/FTC Sero-discordant couples (Kenya and Uganda) 75% Partners PrEP-Daily oral TDF Sero-discordant couples (Kenya and Uganda) 67% TDF-2-Daily TDF/FTC Heterosexual men and women (Botswana) 67% IPrEX-Daily oral TDF/FTC MSM (North & South America, South Africa, Thailand) 44% FEM-PrEP-Daily oral TDF/FTC Women (Kenya, South Africa, Tanzania) 6% MTN 003/VOICE-Daily oral TDF/FTC Women (South Africa, Uganda, Zimbabwe) -4% MTN 003/VOICE-Daily oral TDF Women (South Africa, Uganda, Zimbabwe) -49% • Microbicide gel and ring results were disappoin^ng • Pharmacometric modelling suggests PrEP may be less forgiving to non-adherence for women compared with MSM Building Partnerships, transforming lives 4 www.lvcthealth.org

What do we know? There is some good news • There are circumstances in which young women effec^vely used PrEP e.g. in Partners PrEP Demo • QualitaEve data- from VOICE and FEM-PrEP: o Women did not say they did not want PrEP, they reported that there were barriers • S^gma • lack of peer, family and/or partner support o Uncertainty and ambivalence about taking a product of uncertain efficacy in a placebo-controlled clinical trial o Concerns about drug side effects Building Partnerships, transforming lives 5 www.lvcthealth.org

Early lessons from LVCT Health DemonstraEon Project • S^gma is a barrier to uptake of oral PrEP: young women do not want Packaging and access at HIV service delivery points • Young women will not take PrEP if they don ’ t have support from their communi^es • Forgeeng to take • Fear of side effects • Fear that it wont be available beyond the project • medica^on maintenance factors such as transport and financial barriers Building Partnerships, transforming lives 6 www.lvcthealth.org

Some things we don’t know Building Partnerships, transforming lives 7 www.lvcthealth.org

CriEcal quesEons remain • Who wants PrEP? • How do we reach those at highest risk, without s^gma^za^on? • What is the actual demand? How do we create/increase demand? • How do we effec^vely support adherence? • How and where do users want PrEP delivered? Building Partnerships, transforming lives 8 www.lvcthealth.org

Where to from here? ImplementaEon Science • Preven^on for young women is a priority – oral PrEP an addi^onal high impact method • Which young women? • How do we get it to them • How do we increase/ensure adherence Invest in communicaEon – increase knowledge and awareness to drive demand Increase communiEes demand for PrEP • PrEP advocates for young women • Demand the way young women want it • Demand for op^ons- long ac^ng injectable Building Partnerships, transforming lives 9 www.lvcthealth.org

How we communicate prevenEon mabers! Framing results: promo^on of non-HIV related • benefits may have a stronger effect on genera^ng interest than those focusing on HIV preven^on alone (for both young men and women) Building Partnerships, transforming lives 10 www.lvcthealth.org

Acknowledgements and Partnerships Ministry of Health, Kenya: NASCOP and NACC SWOP Clinics (PHDA) UN Family – WHO, UNAIDS, UNICEF PEPFAR CDC/USAID Bill & Melinda Gates FoundaKon CHAI O ’ Neill InsKtute, Georgetown Law London School of Hygiene and Tropical Medicine Imperial College London, Results for Development, IAVI, AVAC, FHI 360, WRHI, FSG, Avenir Health, McANN, Pangaea, Gilead Health Sciences Community serving organizaKons: LVCT Health, HOYMAS, GALCK, KESWA, BHESP, NYARWEK, ISHTAR MSM County and sub-county HMTs

THANK YOU CONTACT US: Email: wmukoma@lvcthealth.org www.lvcthealth.org Building Partnerships, transforming lives 12