Pre-Exposure 5 8 Prophylaxis (PrEP) by the Numbers $3 Efficacy, regulatory 7 1 approval and more

AUGUST 2016 %6 avac.org PrEP is the use of ARVs to reduce HIV risk in people who are HIV-negative. Daily oral PrEP, the one form of PrEP proven to work today, is recommended by the World Health Pre-Exposure Prophylaxis Organization as an additional option for all people at substantial risk of HIV. In spite of this endorsement and the need for new tools, different countries are moving at different speeds. Many are looking to demonstration projects—small-scale pilots (PrEP) by the Numbers that provide information on how to deliver oral PrEP in real-world settings. Advocates will look to countries to develop policies and plans to expand PrEP access. Now is the time to take regulatory action, learn from demonstration projects and fast-track Eicacy regulatory status a more plans for scale-up. Other formulations of ARV-based prevention are also being evaluated and could provide additional options in the future.

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100 P (teoovir Trials of oral and topical gel - osig) 80 tenofovir-based PrEP show E-PrEP that these strategies reduce 60 PE () risk of HIV infection if they 40 iPrEx are used correctly and Parters PrEP () 20 consistently. Higher adherence Parters PrEP () is directly linked to greater ect iv ee ss ( ) 0 P () levels of protection. E -20 E () -40 Calculations based on E () analyses involving a subset -60 E (teoovir gel of total trial participants. 10 20 30 40 50 60 70 80 90 aily osig) Percetage o participats samples that ha etectable rug levels

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The numbers in the large circles represent global totals, many of which took years to achieve, while the smaller circles represent changes in just under a year egulatory approvals (since Oct '15). In sub- mplemetatio stuies Saharan Africa, many of plae ogoig the implementation studies complete globally are in female sex workers— mplemetatio leaving gaps in research on stuies i rica men who have sex with men, adolescent girls and young Natioal women, and other groups lobal strategies in need. recommeatios evelopmet

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The pipeline of ARV-based P Pop P P aie N PN P ilea oucil N prevention products includes oral pills, vaginal rings, E vaginal and rectal gels, Tenofovir PP P P Pop P P N ii asse vaginal films, long-acting N oucil Tenofovir P Dapivirine injectable ARVs. Not pictured prodrug are a range of multipurpose fumarate

lbert P Tenofovir/ DS003 N muest muest N technologies in development Eistei EE E (BMS793) that aim to reduce women’s Tenofovir disoproxil Oral pills Vaginal fumarate/emtricitabine P IQP -0528 tablet risk of HIV and STIs, and MIV 150 P 5P12-RANTES Vaginal gel Rectal gel provide effective contraception. P Pop Pop P P GSK 744 oucil oucil Long-acting Ripilvirine Vaginal ring injectable Monoclonal b antibody Vaginal film Thin film For up-to-date information on the polymer - MK-2048 ARV-based prevention pipeline, visit the itaa Pop oucil Phosphate HIV Prevention Research Database at Nano-fiber No drug tested buffered saline - Vicriviroc www.avac.org/pxrd. currently

PrEP PrEP atch PrEP acts y PrEP Experiece PrEP lie esources www.prepwatch.org www.prepfacts.org www.myexperience.blogspot.com www.avac.org/prep AUGUST 2016 Founded in 1995, AVAC is an international, non-profit organization that uses education, policy analysis, advocacy and community mobilization to accelerate the ethical development and global delivery of biomedical HIV prevention options as part of a comprehensive response to the pandemic. AVAC is based in the US, and focuses on issues and priorities in countries where prevention research and www.avac.org implementation are ongoing. Specifically, we seek to deliver proven HIV prevention tools for immediate impact; demonstrate and roll out new HIV prevention options; and develop long-term solutions needed to end the epidemic.