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HIVR4P in the Asia-Pacific Region
New Options and Choice: Key Studies From HIVR4P in the Asia-Pacific Region

Released: November 21, 2024

Expiration: November 20, 2025

Nittaya Phanuphak
Nittaya Phanuphak, MD, PhD
Activity Information

Activity

Progress
1
Course Completed
Key Takeaways
  • Countries in the Asia-Pacific region have contributed substantially to the data proving that lenacapavir is another effective pre-exposure prophylaxis (PrEP) option.
  • Continued work on PrEP implementation within the Asia-Pacific region requires synergy between policymakers, governments, and healthcare professionals to make PrEP options—including lenacapavir—available, accessible, and affordable.

It is important to continue research and development in HIV pre-exposure prophylaxis (PrEP) to ensure there are safe and effective HIV prevention options available for all individuals, and I was glad to see how PrEP studies from the recent HIVR4P meeting have implications for individuals in the Asia-Pacific region and beyond.

Prevention With PURPOSE 
We’ve already seen, from the PURPOSE 1 study, that the twice-yearly capsid inhibitor, lenacapavir (LEN) subcutaneous injection, was effective at preventing HIV acquisition among cisgender women in Africa. At HIVR4P 2024, the PURPOSE 2 study reported on the efficacy of LEN among cisgender gay men, transgender women, transgender men, and gender nonbinary individuals who have sex with partners assigned male at birth.

For the Asia-Pacific region, these results are particularly relevant because the PURPOSE 2 study intentionally included participants from diverse geographic backgrounds, including Thailand (35.6% Brazil, 20.6% US, 13.7% Peru, 11.9% Thailand, 10.9% South Africa, 6.9% Argentina, and 0.4% Mexico).

PrEP Choice
How might the availability of another long-acting (LA) PrEP option like LEN affect uptake in the Asia-Pacific Region? We might gain some insights from an older study, PrEP APPEAL, which examined PrEP preferences among men who have sex with men and transgender women in 15 countries/territories in the Asia-Pacific region. Among 1260 transgender women, most (32%) preferred oral daily PrEP, but a substantial proportion (21%) preferred 6-monthly injections. This was also true among 10,689 men who have sex with men in Asian low and middle-income countries, where a similar proportion (20%) preferred 6-monthly injections.

Coupled with the efficacy demonstrated in PURPOSE 2, we might conclude that a twice-yearly option could have a place in prevention of HIV in the region, alongside daily oral options like FTC/TDF and FTC/TAF and other LA injectables like LA CAB.

Option vs Choice
Another study at HIVR4P, among 1013 men who have sex with men in China, suggested that cost could be a critical factor in PrEP choice. The investigators pointed out that cost could be particularly important in countries like China, where PrEP and medical care are paid for by patients—they are entirely unsubsidized.

Turning options for HIV prevention into choices is not an automatic process. Choice is the ability of an individual to select from an array of options. Choice, therefore, needs policymakers, donors, governments, and implementers to make options available, accessible, and affordable, especially in low- and middle-income countries such as some of those in the Asia-Pacific region.

That’s why I believe countries/territories in the Asia-Pacific must be proactive in engaging local and regional stakeholders to get ready to turn PrEP options, which are now available at a global level, into choices for individuals in this region. An inclusive and concerted effort is needed to ensure people of all genders, including cisgender women, in the Asia-Pacific have all available options offered to them and are empowered to make their own HIV prevention choice.

Your Thoughts?
Which PrEP study, focusing on the Asia-Pacific region, is the most impactful to you? Get involved in the discussion by posting a comment below.