The Road Ahead: Working Towards Effective Clinical Translation of Biomedical HIV Prevention Strategies

Gita Ramjee; Sarita Naidoo

Disclosures

Future Virology. 2015;10(3):271-282. 

In This Article

Abstract and Introduction

Abstract

Emerging evidence from several randomized controlled trials show that antiretroviral-based biomedical HIV prevention interventions are efficacious in preventing HIV if they are taken as directed, and could potentially reduce the number of new HIV infections globally. Strategies such as treatment as prevention and use of oral pre-exposure prophylaxis for HIV prevention have shown great promise, yet have raised important implementation concerns around awareness and acceptance, delivery, adherence, side effects, risk compensation, cost–effectiveness and drug resistance. In order to address these issues, a number of treatment as prevention and pre-exposure prophylaxis demonstration projects have been initiated to assess the feasibility of introducing these interventions in 'real-world' settings. These projects will be instrumental in determining best practices for optimal delivery and sustainability of these HIV prevention interventions. The road to effective translation to clinical setting is promising, but comes with challenges which are not insurmountable.

Introduction

Translational research is the process of applying discoveries generated during basic science research in the laboratory through preclinical and clinical studies in humans to public health impact.[1,2] Based on the outcomes of these human trials, further research is undertaken to identify and enhance the adoption of best practice for delivery to the population through development of policies and guidelines. Examples of such studies include postefficacy demonstration and cost–effectiveness projects. Several biomedical discoveries have been translated into policy and practice, including voluntary medical male circumcision (VMMC) for HIV prevention;[3–5] prevention of mother-to-child transmission of HIV (PMTCT);[6] male and female condom promotion;[7] clean needle-exchange programs for injecting drug users;[8,9] HIV counseling and testing programs to reduce sexual behavioral risks;[10] postexposure prophylaxis for occupational and other exposures;[11] and treatment of sexually transmitted infections (STIs).[12] More recent proven biomedical prevention interventions include pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) (.[13–17] The purpose of this review is to discuss the road ahead for translation of these new scientifically proven biomedical prevention strategies into policy and practice with particular reference to TasP and oral PrEP.

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