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Pre-Exposure Prophylaxis for HIV Prevention in Women: Current Status and Future Directions

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Abstract

Pre-exposure prophylaxis (PrEP) is a promising intervention to prevent HIV acquisition, with benefits both to the individual and to population-level health. PrEP is an opportunity to complement ongoing public health efforts to eliminate HIV. For women, PrEP can also serve as a gateway to access sexual and reproductive health (SRH) services. Clinical efficacy of PrEP was initially reported in women using a 1% tenofovir vaginal gel in 2010, followed by an efficacy trial of oral PrEP using TDF/FTC in men who have sex with men (MSM). Since then, further trials have reported efficacy in oral PrEP containing tenofovir in women and heterosexual men, while the subsequent trials for women using tenofovir gel reported no efficacy, stemming from difficulties in achieving adequate adherence. In an effort to offer women additional choices to oral PrEP, alternative modalities are being tested in clinical research, including long-acting injectable formulations and intra-vaginal rings. In 2015, a meta-analysis of clinic trials and open-label extension studies led to the World Health Organization (WHO) strongly recommending the provision of oral PrEP containing tenofovir for any person at substantial risk of HIV infection, irrespective of gender or population group. Currently, PrEP services for women around the world, including those who are either pregnant or breastfeeding, remain limited. Outside sub-Saharan Africa, most PrEP programmes are focused on MSM. South Africa, Kenya, and the USA have the greatest utilization of oral PrEP by women. Yet, since 2012, of the estimated > 300,000 people globally who have initiated PrEP, a minority are women. In this narrative review, we examine the most recent literature on clinical and implementation PrEP research among women. We highlight the high burden of disease related to common sexually transmitted infections (STIs) in women, and the opportunity to integrate PrEP and other HIV prevention services, STI case management, and family planning services, as part of a more robust package of SRH services. Raising awareness on PrEP amongst women and their healthcare providers, minimizing gaps in access, and ensuring adherence and persistence of PrEP during periods of risk are critical issues if PrEP can have a meaningful impact on reducing HIV incidence in women globally.

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Notes

  1. WHO defines “substantial risk” at an HIV incidence threshold above three per 100 person-years at which offering PrEP is likely to be cost-effective and potentially cost-saving.

References

  1. UNAIDS. Data 2018 Report, Joint United Nations Programme on HIV/AIDS (UNAIDS), 2018.

  2. UNAIDS. Miles to go: closing gaps, breaking barriers, righting injustices, UNAIDS, 2018.

  3. World Health Organization. PMTCT strategic vision 2010–2015, World Health Organization, 2010.

  4. Dellar RC, Dlamini S, Karim QA. Adolescent girls and young women: key populations for HIV epidemic control. J Int AIDS Soc. 2015;18(2 Suppl 1):19408.

    PubMed  PubMed Central  Google Scholar 

  5. de Oliveira T, Kharsany AB, Gräf T, Cawood C, Khanyile D, Grobler A, Puren A, Madurai S, Baxter C, Karim QA, Karim SS. Transmission networks and risk of HIV infection in KwaZulu-Natal, South Africa: a community-wide phylogenetic study. Lancet HIV. 2017;4(1):e41–50.

    PubMed  Google Scholar 

  6. United States Food and Drug Administration, Truvada PrEP indication approval. 2012. https://www.fda.gov/downloads/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/UCM312290.pdf. Accessed 1 June 2019.

  7. World Health Organization. Guidance on pre-exposure prophylaxis (PrEP) for serodiscordant couples, men, and transgender women who have sex with men at high risk for hiv: recommendations for use in the context of demonstration projects. Geneva: World Health Organization; 2012.

  8. World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: World Health Organization; 2015.

  9. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva: World Health Organization; 2016.

  10. Hodges-Mameletzis I, Dalal S, Msimanga-Radebe B, Rodolph M, Baggaley R. Going global: the adoption of the World Health Organization'senabling recommendation on oral pre-exposure prophylaxis for HIV. Sex Health. 2018;15(6):489–500.

    PubMed  Google Scholar 

  11. World Health Organization. WHO handbook for guideline development. 2nd ed. Geneva: WHO; 2014.

    Google Scholar 

  12. World Health Organization. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva: World Health Organization; 2014.

  13. Van Damme L, Corneli A, Ahmed K, Agot K, Lombaard J, Kapiga S, et al. Preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2012;367:411–22.

    PubMed  PubMed Central  Google Scholar 

  14. Marrazzo JM, Ramjee G, Richardson BA, Gomez K, Mgodi N, Nair G, et al. Tenofovir-based preexposure prophylaxis for HIV infection among African women. N Engl J Med. 2015;372:509–18.

    PubMed  PubMed Central  Google Scholar 

  15. Fonner VA, Dalglish SL, Kennedy CE, Baggaley R, O’Reilly KR, Koechlin FM, Rodolph M, Hodges-Mameletzis I, Gran RM. Effectiveness and safety of oral HIV pre-exposure prophylaxis (PrEP) for all populations: a systematic review and meta-analysis. AIDS. 2016;30:1973–83.

    PubMed  Google Scholar 

  16. Baeten JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, et al. Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. N Engl J Med. 2012;367:399–410.

    CAS  PubMed  PubMed Central  Google Scholar 

  17. Baeten JM, Donnell D, Mugo NR, Ndase P, Thomas KK, Campbell JD, et al. Single-agent tenofovir versus combination emtricitabine plus tenofovir for pre-exposure prophylaxis for HIV-1 acquisition: an update of data from a randomised, double-blind, phase 3 trial. Lancet Infect Dis. 2014;14:1055–64.

    CAS  PubMed  PubMed Central  Google Scholar 

  18. Bekker L-G et al. HPTN 067/ADAPT Cape Town: A comparison of daily and nondaily PrEP dosing in African women. CROI 2015, 23–26 February, Seattle. Late breaker poster abstract 978LB.

  19. Henderson F, Taylor A, Chirwa L, Williams T, Borkowf C, Kasonde M, et al. Characteristics and oral PrEP adherence in the TDF2 open-label extension in Botswana. Vancouver: IAS; 2015.

    Google Scholar 

  20. Bekker LG, Roux S, Sebastien E, et al. Daily and non-daily pre-exposure prophylaxis in African women (HPTN 067/ADAPT Cape Town Trial): a randomised, open-label, phase 2 trial. Lancet HIV. 2018;5(2):e68–78.

    PubMed  Google Scholar 

  21. Sivay MV, Li M, Piwowar-Manning E, et al. Characterization of HIV seroconverters in a TDF/FTC PrEP study: HPTN 067/ADAPT. J Acquir Immune Defic Syndr (1999). 2017;75(3):271–9.

    Google Scholar 

  22. Baeten JM, Heffron R, Kidoguchi L, et al. Integrated delivery of antiretroviral treatment and pre-exposure prophylaxis to HIV-1-serodiscordant couples: a prospective implementation study in Kenya and Uganda. PLoS Med. 2016;13(8):1–17.

    Google Scholar 

  23. Heffron R, Ngure K, Odoyo J, et al. Pre-exposure prophylaxis for HIV-negative persons with partners living with HIV: uptake, use, and effectiveness in an open-label demonstration project in East Africa. Gates Open Res. 2017;1:3.

    PubMed  Google Scholar 

  24. Pyra M, Haberer JE, Heffron R, et al. Brief report: PrEP use during periods of HIV risk among east african women in serodiscordant relationships. J Acquir Immune Defic Syndr (1999). 2018;77(1):41–5.

    Google Scholar 

  25. Anderson PL, Liu AY, Castillo-Mancilla JR, et al. Intracellular tenofovir-diphosphate and emtricitabine-triphosphate in dried blood spots following directly observed therapy. Antimicrob Agents Chemother. 2018;62(1):e01710–7.

    PubMed  Google Scholar 

  26. Hendrix CW, Andrade A, Bumpus NN, et al. Dose frequency ranging pharmacokinetic study of tenofovir-emtricitabine after directly observed dosing in healthy volunteers to establish adherence benchmarks (HPTN 066). AIDS Res Hum Retroviruses. 2016;32(1):32–43.

    CAS  PubMed  PubMed Central  Google Scholar 

  27. Roberts ST, Haberer J, Celum C, et al. Intimate partner violence and adherence to HIV pre-exposure prophylaxis (PrEP) in African women in HIV serodiscordant relationships: a prospective cohort study. J Acquir Immune Defic Syndr (1999). 2016;73(3):313–22.

    Google Scholar 

  28. Heffron R, McClelland RS, Balkus JE, et al. Efficacy of oral pre-exposure prophylaxis (PrEP) for HIV among women with abnormal vaginal microbiota: a post-hoc analysis of the randomised, placebo-controlled Partners PrEP Study. Lancet HIV. 2017;4(10):e449–56.

    PubMed  PubMed Central  Google Scholar 

  29. Martin M, Vanichseni S, Suntharasamai P, Sangkum U, Mock PA, Gvetadze RJ, et al. Renal function of participants in the Bangkok tenofovir study—Thailand, 2005–2012. Clin Infect Dis. 2014;59:716–24.

    CAS  PubMed  Google Scholar 

  30. Mugwanya KK, Baeten JM, Wyatt C, et al. Brief report: frequency of monitoring kidney function in HIV-uninfected persons using daily oral tenofovir disoproxil fumarate pre-exposure prophylaxis. J Acquir Immune Defic Syndr (1999). 2018;77(2):206–11.

    CAS  Google Scholar 

  31. Mirembe BG, Kelly CW, Mgodi N, Greenspan S, Dai JY, Mayo A, et al. Bone mineral density changes among young, healthy African women receiving oral tenofovir for HIV preexposure prophylaxis. J Acquir Immune Defic Syndr. 2016;71:287–94.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Mulligan K, Glidden DV, Anderson PL, Liu A, McMahan V, Gonzales P, et al. Effects of emtricitabine/tenofovir on bone mineral density in HIV-negative persons in a randomized, double-blind, placebo-controlled trial. Clin Infect Dis. 2015;61:572–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Glesby MJ. Bone disorders in human immunodeficiency virus infection. Clin Infect Dis. 2003;37(Suppl 2):S91–5.

    CAS  PubMed  Google Scholar 

  34. Della Negra M, De Carvalho AP, De Aquino MZ, Pinto JA, Da Silva MT, Andreatta KN, et al. Long-term efficacy and safety of tenofovir disoproxil fumarate in HIV-1-infected adolescents failing antiretroviral therapy: the final results of study GS-US-104-0321. Pediatr Infect Dis J. 2015;34(4):398–405.

    PubMed  Google Scholar 

  35. World Health Organization. Preventing HIV during pregnancy and breastfeeding in the context of PrEP. Technical Brief. Geneva. World Health Organization; 2017.

  36. Mofenson LM, Baggaley RC, Mameletzis I. Tenofovir disoproxil fumarate safety for women and their infants during pregnancy and breastfeeding. AIDS. 2017;31(2):213–32.

    CAS  PubMed  Google Scholar 

  37. WHO AMS database. http://www.who.int/hiv/amds/gprm/en/. Accessed 1 June 2019.

  38. Ehrhardt S, Xie C, Guo N, Nelson K, Thio CL. Breastfeeding while taking lamivudine or tenofovir disoproxil fumarate: a review of the evidence. Clin Infect Dis. 2015;60(2):275–8.

    CAS  PubMed  Google Scholar 

  39. Nachega JB, Uthman OA, Mofenson LM, Anderson JR, Kanters S, Renaud F, Ford N, Essajee S, Doherty MC, Mills EJ. Safety of tenofovir disoproxil fumarate-based antiretroviral therapy regimens in pregnancy for HIV-infected women and their infants: a systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2017;76(1):1–12.

    CAS  PubMed  PubMed Central  Google Scholar 

  40. Mugo NR, Hong T, Celum C, Donnell D, Bukusi EA, John-Stewart G, Partners PrEP Study Team, et al. Pregnancy incidence and outcomes among women receiving preexposure prophylaxis for HIV prevention: a randomized clinical trial. JAMA. 2014;312:362–71.

    PubMed  PubMed Central  Google Scholar 

  41. Bunge K, Balkus J, Noguchi L, et al. Pregnancy incidence and outcomes in women receiving tenofovir-based PrEP in the VOICE trial. In: International AIDS conference, July 2015, Vancouver, Canada. Abs. MOPEC480.

  42. Mugwanya KK, Hendrix CW, Mugo NR, et al. Pre-exposure prophylaxis use by breastfeeding HIV-uninfected women: a prospective short-term study of antiretroviral excretion in breast milk and infant absorption. PLoS Med. 2016;13(9):e1002132.

    PubMed  PubMed Central  Google Scholar 

  43. Kharsany AB, Frohlich JA, Yende-Zuma N, Mahlase G, Samsunder N, Dellar RC, Zuma-Mkhonza M, Abdool Karim SS, Abdool Karim Q. Trends in HIV prevalence in pregnant women in rural South Africa. J Acquir Immune Defic Syndr. 2015;70(3):289–95.

    PubMed  PubMed Central  Google Scholar 

  44. Hosek SG, et al. Safety and feasibility of antiretroviral preexposure prophylaxis for adolescent men who have sex with men aged 15 to 17 years in the United States. JAMA Pediatr. 2017. https://doi.org/10.1001/jamapediatrics.2017.2007.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Hosek SG, Rudy B, Landovitz R, Kapogiannis B, Siberry G, Rutledge B, Liu N, Brothers J, Mulligan K, Zimet G, Lally M, Mayer KH, Anderson P, Kiser J, Rooney JF, Wilson CM, Adolescent Trials Network (ATN) for HIVAIDS Interventions. An HIV preexposure prophylaxis demonstration project and safety study for young MSM. J Acquir Immune Defic Syndr. 2017;74(1):21–9.

    PubMed  PubMed Central  Google Scholar 

  46. Gill, K. Pluspills: an open label, safety and feasibility study of oral preexposure prophylaxis (PrEP) in 15-19 year old adolescents in two sites in South Africa. In: 9th international AIDS Society conference on HIV science, Paris oral abstract session track C: TUAC0207LB, July 2017.

  47. World Health Organization. WHO PrEP implementation module in adolescents and young adults. World Health Organization; 2018. http://apps.who.int/iris/bitstream/handle/10665/273172/WHO-CDS-HIV-18.13-eng.pdf?ua=1.

  48. Unitaid website. https://unitaid.org/investment-area/hiv-prevention/. Accessed 1 June 2019.

  49. European Medicines Agency, summary of opinion on Truvada. http://www.ema.europa.eu/docs/en_GB/document_library/Summary_of_opinion/human/000594/WC500240366.pdf. Accessed 1 June 2019.

  50. United States Food and Drug Administration, approval letter for adolescent indication. https://www.accessdata.fda.gov/drugsatfda_docs/appletter/2018/021752Orig1s055ltr.pdf. Accessed 1 June 2019.

  51. World Health Organization. Technical update on appropriate medicines options for pre-exposure prophylaxis (PrEP). A review of the evidence from animal studies, human pharmacology, and human clinical trials. World Health Organization, 2018.

  52. Choopanya K, Martin M, Suntharasamai P, Sangkum U, Mock PA, Leethochawalit M, et al. Antiretroviral prophylaxis for HIV infection in injecting drug users in Bangkok, Thailand (the Bangkok Tenofovir Study): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2013;381(9883):2083–90.

    PubMed  Google Scholar 

  53. Grohskopf LA, Chillag KL, Gvetadze R, Liu AY, Thompson M, Mayer KH, Collins BM, Pathak SR, Oʼhara B, Ackers ML, Rose CE, Grant RM, Paxton LA, Buchbinder SP. Randomized trial of clinical safety of daily oral tenofovir disoproxil fumarate among HIV-uninfected men who have sex with men in the United States. J Acquir Immune Defic Syndr. 2013;64(1):79–86.

    CAS  PubMed  Google Scholar 

  54. Ensaio clínico de fase II comparando a utilização de Lamivudina/Tenofovir (3TC/TDF) Emtricitabina/Tenofovir (FTC/TDF)¿ como estratégias de Profilaxia Pré Exposição (PrEP) ao HIV entre gays, outros homens que fazem sexo com homens e pessoas trans. Faculdade de Medicina da Universidade Federal de Minas Gerais.

  55. Abdool Karim Q, Abdool Karim SS, Frohlich JA, Grobler AC, Baxter C, Mansoor LE, Kharsany AB, Sibeko S, Mlisana KP, Omar Z, Gengiah TN, Maarschalk S, Arulappan N, Mlotshwa M, Morris L, Taylor D, CAPRISA 004 Trial Group. Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women. Science. 2010;329(5996):1168–74.

    CAS  PubMed  PubMed Central  Google Scholar 

  56. Klatt NR, Cheu R, Birse K, Zevin AS, Perner M, Noël-Romas L, Grobler A, Westmacott G, Xie IY, Butler J, Mansoor L, McKinnon LR, Passmore JS, Abdool Karim Q, Abdool Karim SS, Burgener AD. Vaginal bacteria modify HIV tenofovir microbicide efficacy in African women. Science. 2017;356(6341):938–45.

    CAS  PubMed  Google Scholar 

  57. Baeten JM, Palanee-Phillips T, Brown ER, Schwartz K, Soto-Torres LE, Govender V, et al. Use of a vaginal ring containing dapivirine for HIV-1 prevention in women. N Engl J Med. 2016;375(22):2121–32.

    CAS  PubMed  PubMed Central  Google Scholar 

  58. Nel A, van Niekerk N, Kapiga S, Bekker LG, Gama C, Gill K, et al. Safety and efficacy of a dapivirine vaginal ring for HIV prevention in women. N Engl J Med. 2016;375(22):2133–43.

    CAS  PubMed  Google Scholar 

  59. Brown E, Palanee-Philips T, Marzinke M, Hendrix C, Dezutti C, Soto-Torre L, Baeten J. Residual dapivirine ring levels indicate higher adherence to vaginal ring is associated with HIV-1 protection. In: Abstract TUAC0105LB. 21st international AIDS conference (AIDS 2016). Durban, South Africa, July 18–22, 2016.

  60. Baeten J et al. High uptake and reduced HIV-1 incidence in an open-label trial of the dapivirine ring. In: 25th conference on retroviruses and opportunistic infections (CROI 2018), Boston, abstract 143LB, 2018.

  61. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier NCT02858037, Trial to Assess the Continued Safety of and Adherence to a Vaginal Ring Containing Dapivirine in Women. Available from: https://clinicaltrials.gov/ct2/show/NCT02858037.

  62. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier NCT02862171, To Assess Continued Safety of and Adherence to the Dapivirine (25 mg) Vaginal Ring-004 in Healthy, HIV-negative Women. Available from: https://clinicaltrials.gov/ct2/show/NCT02862171.

  63. Multi-purpose technologies information, World Health Organization; 2018. http://www.who.int/reproductivehealth/topics/linkages/mpts/en/.

  64. Smith SB, Ravel J. The vaginal microbiota, host defence and reproductive physiology. J Physiol. 2017;595(2):451–63.

    CAS  PubMed  Google Scholar 

  65. das Neves J, Sarmento B. Antiretroviral drug-loaded nanoparticles-in-films: a new option for developing vaginal microbicides? Expert Opin Drug Deliv. 2017;14(4):449–52.

    PubMed  Google Scholar 

  66. Nelson A, Zhang X, Ganapathi U, Szekely Z, Flexner CW, Owen A, Sinko PJ. Drug delivery strategies and systems for HIV/AIDS pre-exposure prophylaxis (PrEP) and treatment. J Control Release. 2015;219:669–80.

    CAS  PubMed  PubMed Central  Google Scholar 

  67. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier NCT02720094, Safety and Efficacy Study of Injectable Cabotegravir Compared to Daily Oral Tenofovir Disoproxil Fumarate/Emtricitabine (TDF/FTC), For Pre-Exposure Prophylaxis in HIV-Uninfected Cisgender Men and Transgender Women Who Have Sex With Men. Available from: https://clinicaltrials.gov/ct2/show/NCT02720094.

  68. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier NCT03164564, Evaluating the Safety and Efficacy of Long-Acting Injectable Cabotegravir Compared to Daily Oral TDF/FTC for Pre-Exposure Prophylaxis in HIV-Uninfected Women. Available from: https://clinicaltrials.gov/ct2/show/NCT03164564.

  69. World Health Organization. Global health sector strategy on sexually transmitted infections, 2016–2021. Geneva: World Health Organization; 2016.

  70. World Health Organization. cervical cancer control: a guide to essential practice, 2nd edn. World Health Organization; 2014. http://apps.who.int/iris/bitstream/handle/10665/144785/9789241548953_eng.pdf;jsessionid=50992AF8EFBA400059A5C619FF0D2F97?sequence=1.

  71. Cohen MS, Hoffman IF, Royce RA, Kazembe P, Dyer JR, Daly CC, AIDSCAP Malawi Research Group, et al. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet. 1997;349(9069):1868–73.

    CAS  PubMed  Google Scholar 

  72. Wi T, Lahra MM, Ndowa F, Bala M, Dillon JR, Ramon-Pardo P, Eremin SR, Bolan G, Unemo M. Antimicrobial resistance in Neisseria gonorrhoeae: global surveillance and a call for international collaborative action. PLoS Med. 2017;14(7):e1002344.

    PubMed  PubMed Central  Google Scholar 

  73. Torrone EA, Morrison CS, Chen PL, Kwok C, Francis SC, Hayes RJ, Looker KJ, McCormack S, McGrath N, van de Wijgert JHHM, Watson-Jones D, Low N, Gottlieb SL, STIMA Working Group. Prevalence of sexually transmitted infections and bacterial vaginosis among women in sub-Saharan Africa: an individual participant data meta-analysis of 18 HIV prevention studies. PLoS Med. 2018;15(2):e1002511.

    PubMed  PubMed Central  Google Scholar 

  74. Garrett NJ, Osman F, Maharaj B, Naicker N, Gibbs A, Norman E, et al. Beyond syndromic management: opportunities for diagnosis-based treatment of sexually transmitted infections in low- and middle-income countries. PLoS One. 2018;13(4):e0196209.

    PubMed  PubMed Central  Google Scholar 

  75. Hoffman CM, Mbambazela N, Sithole P, Morré SA, Dubbink JH, Railton J, McIntyre JA, Kock MM, Peters RPH. Provision of sexually transmitted infection services in a mobile clinic reveals high unmet need in remote areas of South Africa: a cross-sectional study. Sex Transm Dis. 2019;46(3):206–12.

    PubMed  Google Scholar 

  76. Celum C. Oral pre-exposure prophylaxis for prevention, MOSA3401. In: 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  77. Korenromp E, Wi T, Resch S, Stover J, Broutet N. Costing of national STI program implementation for the global STI control strategy for the health sector, 2016–2021. PLoS One. 2017;12(1):e0170773.

    PubMed  PubMed Central  Google Scholar 

  78. World Health Organization. WHO unmet need for family planning, WHO website. http://www.who.int/reproductivehealth/topics/family_planning/unmet_need_fp/en/.

  79. United Nations, Department of Economic and Social Affairs, Population Division (2017). World Family Planning 2017—Highlights (ST/ESA/SER.A/414).

  80. Wilcher R, Petruney T, Cates W. The role of family planning in elimination of new pediatric HIV infection. Curr Opin HIV AIDS. 2013;8(5):490–7.

    PubMed  PubMed Central  Google Scholar 

  81. Seidman D, Weber S, Carlson K, Witt J. Family planning providers’ role in offering PrEP to women. Contraception. 2018;97(6):467–70.

    PubMed  PubMed Central  Google Scholar 

  82. Bien CH, Patel VV, Blackstock OJ, Felsen UR. Reaching key populations: PrEP uptake in an urban health care system in the Bronx, New York. AIDS Behav. 2017;21(5):1309–14.

    PubMed  Google Scholar 

  83. Blackstock OJ, Patel VV, Felsen U, Park C, Jain S. Pre-exposure prophylaxis prescribing and retention in care among heterosexual women at a community-based comprehensive sexual health clinic. AIDS Care. 2017;29(7):866–9.

    PubMed  PubMed Central  Google Scholar 

  84. Flash CA, Adegboyega OO, Yu X, et al. Correlates of linkage to HIV preexposure prophylaxis among HIV-testing clients. J Acquir Immune Defic Syndr (1999). 2018;77(4):365–72.

    Google Scholar 

  85. Kwakwa HA, Bessias S, Sturgis D, et al. Engaging United States black communities in HIV pre-exposure prophylaxis: analysis of a PrEP engagement cascade. J Natl Med Assoc. 2018;110:480–5.

    PubMed  Google Scholar 

  86. Marcus JL, Hurley LB, Hare CB, et al. Preexposure prophylaxis for HIV prevention in a large integrated health care system: adherence, renal safety, and discontinuation. J Acquir Immune Defic Syndr (1999). 2016;73(5):540–6.

    Google Scholar 

  87. Rajchgot J, Siemieniuk RA, Sivachandran N, et al. Feasibility of HIV pre-exposure prophylaxis as part of routine care in Toronto. Canada. J Acquir Immune Defic Syndr (1999). 2016;72(3):e80–1.

    Google Scholar 

  88. Rusie LK, Orengo C, Burrell D, et al. PrEP Initiation and retention in care over five years, 2012–2017: are quarterly visits too much? Clin Infect Dis. 2018;67:283–7.

    PubMed  PubMed Central  Google Scholar 

  89. Seidman DL, Weber S, Timoney MT, et al. Use of HIV pre-exposure prophylaxis during the preconception, antepartum and postpartum periods at two United States medical centers. Am J Obstet Gynecol. 2016;215(5):632.e631–7.

    Google Scholar 

  90. van Epps P, Maier M, Lund B, et al. Medication adherence in a nationwide cohort of veterans initiating pre-exposure prophylaxis (PrEP) to prevent HIV infection. J Acquir Immune Defic Syndr (1999). 2018;77(3):272–8.

    Google Scholar 

  91. Mera Giler, Magnuson RD, Trevor H, Bush S, Rawlings R, McCallister S. Changes in Truvada (TVD) for HIV pre-exposure prophylaxis (PrEP) utilization in the United States: (2012–2016). In: 9th international AIDS Society conference on HIV Science, Paris, abstract 1614, July 2017.

  92. Siegler AJ, Mouhanna F, Giler RM, Weiss K, Pembleton E, Guest J, Jones PhDJ, Castel A, Yeung H, Kramer M, McCallister S, Sullivan PS. The prevalence of pre-exposure prophylaxis use and the pre-exposure prophylaxis-to-need ratio in the fourth quarter of 2017, United States. Ann Epidemiol. 2018;28:841–9.

    PubMed  PubMed Central  Google Scholar 

  93. Bailey JL, Molino ST, Vega AD, Badowski M. A review of HIV pre-exposure prophylaxis: the female perspective. Infect Dis Ther. 2017;6(3):363–82.

    PubMed  PubMed Central  Google Scholar 

  94. National Department of Health, Republic of South Africa. National policy on HIV pre-exposure prophylaxis (PrEP) and test and treat (T&T) (2016).

  95. Pillay D. Factors influencing initiation, continuation and discontinuation of oral PrEP at selected facilities in South Africa. In: Oral abstract presentation WEAE0401. 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  96. DREAMS Partnership. 2019. [Internet] Available at: https://www.pepfar.gov/partnerships/ppp/dreams. Accessed 1 June 2019.

  97. World Health Organization. Models of implementation of PrEP: lessons learnt from Kenya. “From demonstration to national adoption”. Non-commercial satellite. FRSA05. In: 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  98. Erungu EM, Mugwanya KM, Bukusi EA, Mugo NR, Odoyo J, Wamoni E, Ngure K, Morton J, O’Malley G, Masyuko S, Mukui I, Haberer JE, Anderson PL, Baeten J. High PrEP use in African men and women continuing PrEP in public-health HIV clinics. In: CROI, March 4–7, 2019. Seattle, Washington. Abstract number 992.

  99. Pillay Y. Challenges of South Africa’s sex worker PrEP programme: lessons learned, moving towards to other key populations. Satellite presentation TUSA1703. In: 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  100. Cowan F. PrEP in populations at high risk: prioritizing populations and positioning PrEP. WESA1303. In: 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  101. Matse S. Reaching those most at-risk through a general population approach: PrEP in the context of a generalized HIV epidemic. WESA1304. In: 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  102. PrEP Watch. 2019. [Internet] Available at: https://www.prepwatch.org/. Accessed 1 June 2019.

  103. PrEP Watch, Nigeria Demonstration Project. 2019. [Internet] Available at: https://www.prepwatch.org/nigeria/. Accessed 1 June 2019.

  104. WHO country profile, India. 2019 [Internet] Available at: http://www.who.int/gho/countries/ind/country_profiles/en/. Accessed 1 June 2019.

  105. Reza-Paul S. Community-led PrEP delivery: getting it right, WESA1305. In: 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  106. Koechlin K, Fonner V, Dalglish S, O’Reilly K, Baggaley R, Grant R, Rodolph M, Hodges-Mameletzis I, Kennedy C. Values and preferences on the use of oral pre-exposure prophylaxis (PrEP) for HIV prevention among multiple populations: a systematic review of the literature. AIDS Behav. 2017;21(5):1325–35.

    PubMed  Google Scholar 

  107. Hirschhorn L, Brown Rayna, Friedman EE, Christeller C, Greene G, Bender A, Bouris A, Modali L, Johnson AK, Pickett J, Ridgway J. Women’s PrEP knowledge, attitudes, preferences, and experience in Chicago. In: March 4–7, 2019, Seattle, Washington. Abstract Number: 978.

  108. COMPASS initiative. 2019. [Internet] Available at: https://www.gilead.com/purpose/partnerships-and-community/compass. Accessed 1 June 2019.

  109. Sophia Forum. 2019. [Internet] Available at: http://womenandprep.org.uk. Accessed 1 June 2019.

  110. OPTIONS Consortium. 2019. [Internet] Available at: https://www.fhi360.org/projects/optimizing-prevention-technology-introduction-schedule-options-consortium. Accessed 1 June 2019.

  111. Saul J, Bachman G, Allen S, Toiv NF, Cooney C, Beamon T. The DREAMS core package of interventions: a comprehensive approach to preventing HIV among adolescent girls and young women. PLoS One. 2018;13(12):e0208167.

    PubMed  PubMed Central  Google Scholar 

  112. She Conquers. 2019 [Internet] Available at: http://sheconquerssa.co.za. Accessed 1 June 2019.

  113. UNAIDS 90-90-90 strategy. [Internet] Available at: http://www.unaids.org/en/90-90-90. Accessed 1 June 2019.

  114. World Health Organization. Global health sector strategy on HIV 2016–2021. Geneva: World Health Organization; 2016.

  115. FP 2020 website. [Internet] Available at: http://www.familyplanning2020.org/. Accessed 1 June 2019.

  116. García-Moreno C, Zimmerman C, Morris-Gehring A, et al. Addressing violence against women: a call to action. Lancet. 2015;385:1685–95.

    PubMed  Google Scholar 

  117. Janes H, Corey L, Ramjee G, Carpp LN, Lombard C, Cohen MS, Gilbert PB, Gray GE. Weighing the evidence of efficacy of oral PrEP for HIV prevention in women in Southern Africa. AIDS Res Hum Retroviruses. 2018;34(8):645–56.

    PubMed Central  PubMed  Google Scholar 

  118. World Health Organization. Progress report on HIV, viral hepatitis and sexually transmitted infections 2019. Available at: https://apps.who.int/iris/bitstream/handle/10665/324797/WHO-CDS-HIV-19.7-eng.pdf?ua=1. Accessed 1 June 2019.

  119. Conniff J, Evensen AJ. Preexposure prophylaxis (PrEP) for HIV prevention: the primary care perspective. Am Board Fam Med. 2016;29(1):143–51.

    Google Scholar 

  120. Gandhi M, Spinelli MA, Mayer KH. Addressing the sexually transmitted infection and HIV syndemic. JAMA. 2019;321(14):1356–8.

    PubMed Central  PubMed  Google Scholar 

  121. National AIDS and STI Control Programme (NASCOP), Ministry of Health. Framework for the implementation of pre-exposure prophylaxis of HIV in Kenya. Nairobi: NASCOP; 2017.

    Google Scholar 

  122. Corneli A, Perry B, Agot K, Ahmed K, Malamatsho F, Van Damme L. Facilitators of adherence to the study pill in the FEM-PrEP clinical trial. PLoS One. 2015;10(4):e0125458.

    PubMed Central  PubMed  Google Scholar 

  123. van der Straten A, Montgomery ET, Musara P, Etima J, Naidoo S, Laborde N, Hartmann M, Levy L, Bennie T, Cheng H, Piper J, Grossman CI, Marrazzo J, Mensch B, Microbicide Trials Network-003D Study Team. Disclosure of pharmacokinetic drug results to understand nonadherence. AIDS. 2015;29(16):2161–71.

    PubMed  Google Scholar 

  124. Eakle R, Bourne A, Mbogua J, Mutanha N, Rees H. Exploring acceptability of oral PrEP prior to implementation among female sex workers in South Africa. J Int AIDS Soc. 2018;21(2):e25081.

    PubMed Central  Google Scholar 

  125. Davey J, Farley E, Towriss C, Gomba Y, Bekker LG, Gorbach P, Shoptaw S, Coates T, Myer L. Risk perception and sex behaviour in pregnancy and breastfeeding in high HIV prevalence settings: programmatic implications for PrEP delivery. PLoS One. 2018;13(5):e0197143.

    Google Scholar 

  126. Mera R et al. Changes in Truvada for HIV pre-exposure prophylaxis utilization in the USA: 2012–2016. In: 9th international AIDS Society conference on HIV science, Paris, abstract WEPEC0919, July 2017.

  127. Annual HIV epidemiological report. San Francisco City Health Department. 2017. Available at: https://www.sfdph.org/dph/files/reports/RptsHIVAIDS/AnnualReport2017-Green-20180904-Web.pdf. Accessed 1 June 2019.

  128. Grulich A, Guy RJ, Amin J, et al. Rapid reduction in HIV diagnoses after targeted PrEP implementation in NSW, Australia. In: 25th conference on retroviruses and opportunistic infections 2018, abstract 88.

  129. Nwokolo N, Hill A, McOwan A, Pozniak A. Rapidly declining HIV infection in MSM in central London. Lancet HIV. 2017;4(11):e482–3.

    PubMed  Google Scholar 

  130. Sullivan P et al. The impact of pre-exposure prophylaxis with TDF/FTC on HIV diagnoses, 2012–2016, United States. In: 22nd international AIDS conference (AIDS 2018), Amsterdam, abstract LBPEC036, 2018.

  131. Ogaz D, Miltz A, Desai S, Saunders J, Charlett A, Gill N, Mohammed H. Preparing for PrEP in England: prevalence and incidence of HIV and bacterial STIs. March 4–7, 2019; Seattle, Washington. Abstract Number 48.

  132. Paparini S, Nutland W, Rhodes T, Nguyen VK, Anderson J. DIY HIV prevention: formative qualitative research with men who have sex with men who source PrEP outside of clinical trials. PLoS One. 2018;13(8):e0202830.

    PubMed  PubMed Central  Google Scholar 

  133. Digolo L. Reaching adolescents and young persons with PrEP. In: FRSA0503, 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  134. Reza-Paul S. Community led PrEP delivery: getting it right. Satellite presentation WESA1305. In: 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  135. Mugwanya K et al. Uptake of PrEP within clinics providing integrated family planning and PrEP services: results from a large implementation program in Kenya. In: Oral abstract presentation TUAC0304. 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  136. Sarr M. Retention in care for HIV pre-exposure prophylaxis (PrEP) among sex workers of four public health centers in Senegal. In: Oral abstract TUAC0301. 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  137. Gombe M et al. Integrating oral HIV pre-exposure prophylaxis (PrEP) in a public family planning facility and youth center to inform national roll out in Zimbabwe. In: Oral abstract presentation TUAC0307LB. 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  138. Cowan F. PrEP in populations at high risk: prioritizing populations and positioning PrEP, WESA1303. In : 22nd international AIDS conference (AIDS 2018), Amsterdam, July 2018.

  139. World Health Organization. WHO PrEP implementation tool, module for monitoring and evaluation, World Health Organization, 2018. http://apps.who.int/iris/bitstream/handle/10665/273172/WHO-CDS-HIV-18.13-eng.pdf?ua=1.

  140. Davey DJ, Bekker LG, Gomba Y, Myer L, Coates TJ, Johnson LF. Modeling the impact of PrEP for pregnant and breastfeeding women in South Africa. In: Conference dates and location: March 4–7, 2019, Seattle, Washington. Abstract number 776.

  141. Global PrEP coalition, World Health Organization, 2019. [Internet] Available at: http://www.who.int/hiv/prep/global-prep-coalition/en. Accessed 1 June 2019.

  142. World Health Organization. 20th Essential Medicines List. (2017). https://www.who.int/medicines/news/2017/20th_essential_med-list/en/. Accessed 1 June 2019.

  143. Gulick RM, Wilkin TJ, Chen YQ, et al. Phase 2 study of the safety and tolerability of maraviroc-containing regimens to prevent HIV infection in men who have sex with men (HPTN 069/ACTG A5305). J Infect Dis. 2017;215(2):238–46.

    CAS  PubMed  Google Scholar 

  144. Bunge KE et al. Phase I trial to assess safety, PK, and PD of film and gel formulations of tenofovir. In: CROI 2016, Boston. Poster abstract 871.

  145. Ham AS, Buckheit RW. Current and emerging formulation strategies for the effective transdermal delivery of HIV inhibitors. Ther Deliv. 2015;6(2):217–29.

    CAS  PubMed  Google Scholar 

  146. Aidsmap. 2019. [Internet]. http://www.aidsmap.com/Implants-and-injectables-PrEP-in-the-future/page/3110737. Accessed 1 June 2019.

  147. Derby N et al. Griffithsin/carrageenan inserts prevent SHIV, HSV-2, and HPV infections in vivo. In: CROI 2018, Boston. Oral abstract 84.

  148. ClinicalTrials.gov [Internet]. Bethesda (MD): National Library of Medicine (US). Identifier NCT03467347, PK Study of 90-Day Use of Vaginal Rings Containing Dapivirine and Levonorgestrel. Available from: https://clinicaltrials.gov/ct2/show/NCT034673412047.

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Authors and Affiliations

  1. World Health Organization, Geneva, Switzerland

    Ioannis Hodges-Mameletzis, Shona Dalal & Rachel Baggaley

  2. Medical University of South Carolina, Charleston, SC, USA

    Virginia A. Fonner

  3. University of Washington/Kenya Medical Research Institute, Nairobi, Kenya

    Nelly Mugo

  4. World Health Organization, Pretoria, South Africa

    Busi Msimanga-Radebe

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  1. Ioannis Hodges-Mameletzis
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Ioannis Hodges-Mameletzis, Virginia Fonner, Shona Dalal, Nelly Mugo, Busi Msimnga-Radebe, and Rachel Baggaley declare that they have no conflicts of interest relevant to the content of this article.

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Hodges-Mameletzis, I., Fonner, V.A., Dalal, S. et al. Pre-Exposure Prophylaxis for HIV Prevention in Women: Current Status and Future Directions. Drugs 79, 1263–1276 (2019). https://doi.org/10.1007/s40265-019-01143-8

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