AVAC: HIV vaccine, microbicides, PrEP trial results say reality must guide research

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AVACRandRFor all the graphics illustrating results of HIV prevention trials in recent years, the Venn diagram on the cover of Research & Reality, the report released by AVAC today, may be the one that depicts the sum of their findings. Which is really saying something, when one considers the up-and-down nature of prevention research results and their aftermaths in recent years.

Among them:

  • Great news! The CAPRISA trial showed that an antiretroviral medicine in a gel, applied in the vagina could lower women’s risks of acquiring HIV.
  • Bad news: Two more studies — FEM PrEP and VOICE showed that many of the women enrolled in trials to test the effectiveness of vaginal and oral antiretroviral doses didn’t adhere to a daily regimen.
  • Great news — the Thai RV144 HIV vaccine trial showed the first proof of concept that a vaccine could lower risks of acquiring HIV.
  • But followup to develop a potential vaccine with greater effectiveness has been slow, in part because the positive results of the first trial were unanticipated.

The list goes on, with the proven prevention value of medical circumcision to lower men’s risks of acquiring HIV not being fully realized because the intervention is not universally accessible. And while the proven double value of HIV treatment to reduce odds of HIV transmission depends on antiretroviral drugs being taken continually enough to suppress the virus, obstacles remain in many settings between consistent access to drugs and the people who need them.

With research beginning to yield promising findings, and realities on the ground providing lessons of their own, the means to prevent HIV will be found where the two, research and reality overlap, the report says. While that might sound obvious, it is not simple, and the report suggests investment in implementation science to find ways to ensure that solutions in theory are solutions on the ground. The report also suggests qualitative research, to ensure that realities are listened to, recognized and noted. For the report and all of its recommendations, its graphics, and its executive summary, go here.

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