Time for Govt to give guidelines to HIV prevention drugs (PrEP)

Another Ugandan study of ARVs given to protect the negative partner from HIV infection by the positive partner showed 80% protection. The results, which were presented during the Conference of Retroviruses and Opportunistic Infections (CROI) in Seattle last week, was a follow up on the 2011 study that showed a 67% and 72% fewer infections among couples who used the ARVs Travuda and Tenofovoir respectively.
 

The practice of giving the negative partner ARVs to protect them from infection is known as Pre Exposure Prophylaxis (PREP).
 

According to Sylvia Nakasi, the coordinator of Civil Society Organisations (CSOs) in HIV Prevention Research Coalition, the news is overwhelmingly positive.
 

“The time has come for Ministry of Health to provide guidelines on use of PrEP in our health facilities. The new NSP of 2015 also recommends that Government adopts PrEP as one of the HIV prevention option,” she said.

To date, four trials have showed evidence that PrEP has protective benefit against HIV acquisition. In Uganda’s case, PrEP was only studied in among discordant couples (where one has HIV and another doesn’t).
 

The World Health Organisation (WHO) estimates that up to 50% of people living with HIV are in discordant relationships. 60% of new HIV infections in Uganda occur in discordant couples.

“Because of these factors, the HIV negative partner in a sero discordant couple and the young women would likely be a target population, also for daily oral tenofovir-based PrEP in Uganda,” Nakasi says.
 

Experts advise that PrEP is not life-long: It is for ‘seasons’ of vulnerability. For HIV discordant couples, PrEP use would be limited to during periods of conception, when there is condom fatigue – a reality among many couples in long-term relationships and as a bridge to the start of medication by the infected partner. PrEP would also help in bridging that gap when the HIV-infected partner has not yet achieved enough viral suppression to reduce the risk of transmitting infection and in preference for PrEP to ART for some couples. For others they prefer that the HIV uninfected partner takes PrEP as the HIV infected partner prepares him/herself to initiate and continue with ART.
 

“Partners Demonstration studies have shown us that tenofovir-based PrEP should be made available more widely to those who are able to use this approach,” the advocate said.
 

With dwindling funding to HIV programming in Uganda there is need to refocus our HIV prevention efforts and add proven strategies like PrEP for specific groups like sero discordant couples so as to reduce new HIV infections in these populations.

Like all existing HIV prevention strategies, PrEP will only work if used correctly and consistently. Provision of guidelines for Health workers will increase access to of PrEP and also minimize potential drug abuse.
 

PrEP has the potential to impact on the HIV epidemic in Uganda if implemented strategically as an additional tool to other existing and emerging prevention strategies especially for populations most at risk of HIV infection.