Universidad Peruana Cayetano Heredia

The promises and challenges of pre-exposure prophylaxis as part of the emerging paradigm of combination HIV prevention

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dc.contributor.author Caceres Palacios, Carlos Fernando
dc.contributor.author Koechlin, Florence
dc.contributor.author Goicochea, Pedro
dc.contributor.author Sow, Papa-Salif
dc.contributor.author O'Reilly, Kevin R.
dc.contributor.author Mayer, Kenneth H.
dc.contributor.author Godfrey-Faussett, Peter
dc.date.accessioned 2019-02-06T14:59:06Z
dc.date.available 2019-02-06T14:59:06Z
dc.date.issued 2015
dc.identifier.uri https://hdl.handle.net/20.500.12866/5533
dc.description.abstract INTRODUCTION: Towards the end of the twentieth century, significant success was achieved in reducing incidence in several global HIV epidemics through ongoing prevention strategies. However, further progress in risk reduction was uncertain. For one thing, it was clear that social vulnerability had to be addressed, through research on interventions addressing health systems and other structural barriers. As soon as antiretroviral treatment became available, researchers started to conceive that antiretrovirals might play a role in decreasing either susceptibility in uninfected people or infectiousness among people living with HIV. In this paper we focus on the origin, present status, and potential contribution of pre-exposure prophylaxis (PrEP) within the combination HIV prevention framework. DISCUSSION: After a phase of controversy, PrEP efficacy trials took off. By 2015, daily oral PrEP, using tenofovir alone or in combination with emtricitabine, has been proven efficacious, though efficacy seems heavily contingent upon adherence to pill uptake. Initial demonstration projects after release of efficacy results have shown that PrEP can be implemented in real settings and adherence can be high, leading to high effectiveness. Despite its substantial potential, beliefs persist about unfeasibility in real-life settings due to stigma, cost, adherence, and potential risk compensation barriers. CONCLUSIONS: The strategic synergy of behavioural change communication, biomedical strategies (including PrEP), and structural programmes is providing the basis for the combination HIV prevention framework. If PrEP is to ever become a key component of that framework, several negative beliefs must be confronted based on emerging evidence; moreover, research gaps regarding PrEP implementation must be filled, and appropriate prioritization strategies must be set up. Those challenges are significant, proportional to the impact that PrEP implementation may have in the global response to HIV. en_US
dc.language.iso eng
dc.publisher Wiley
dc.relation.ispartofseries Journal of the International AIDS Society
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Humans en_US
dc.subject Drug Therapy, Combination en_US
dc.subject HIV prevention en_US
dc.subject public health en_US
dc.subject health policy en_US
dc.subject Pre-Exposure Prophylaxis en_US
dc.subject HIV Infections/prevention & control en_US
dc.subject Anti-HIV Agents/administration & dosage en_US
dc.subject antiretrovirals en_US
dc.subject Emtricitabine/administration & dosage en_US
dc.subject pre-exposure prophylaxis en_US
dc.subject Tenofovir/administration & dosage en_US
dc.title The promises and challenges of pre-exposure prophylaxis as part of the emerging paradigm of combination HIV prevention en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.7448/IAS.18.4.19949
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.03.08
dc.relation.issn 1758-2652


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