Transcript HIV Post Exposure Prophylaxis - Regional Network

HIV Post Exposure Prophylaxis
ADJUNCT A/PROF LEVINIA CROOKS AM
CHIEF EXECUTIVE OFFICER
AUSTRALASIAN SOCIETY FOR HIV, VIRAL HEPATITIS & SEXUAL HEALTH MEDICINE
PUBLIC HEALTH AND HUMAN BIOSCIENCES, LA TROBE UNIVERSITY
CENTRE FOR SOCIAL RESEARCH IN HEALTH, UNIVERSITY OF NEW SOUTH WALES
Supporting the HIV, viral hepatitis and sexual health workforce
ASHM and our role in PrEP

Professional society supporting and representing the HIV, viral
hepatitis and sexual health workforce

Work closely with sector partners, professional and community
organisations

Australia and New Zealand and work collaboratively with
professional and workforce development oranisations in the
Asia and Pacific regions

Coordinated Australian National PEP Guidelines in 2001

National PrEP Guidelines in 2015 (being updated now)

Communiques, training and resources for clinicians

Partner with community agencies providing advice to
consumers
PrEP Status in Australasia

Truvada ® approved by the Australian
Therapeutic Goods Administration (TGA) in May
2016. It is now listed on the Australian Register of
Therapeutic Goods (ARTG). Not listed in New
Zealand

Application before the Pharmaceutical Benefits
Advisory Committee (PBAC), if supported will be
subsidised under the Pharmaceutical Benefits
Scheme. Next meeting July 2016, if supported
likely to be available late 2016 – early 2017.

PrEP is not licensed in New Zealand
Ways drugs can be accessed

The Australian government allows people to
import drugs for personal use through the Personal
Importations Scheme
https://www.tga.gov.au/personal-importationscheme

This means that proprietary drug as well as
generic drug can be imported

Online internet pharmacies sell Truvada and
generic bioequivalents

Now that the drug is on the ARTG it will also be
able to be purchased for full price from the
manufacturer
Demonstration Projects

A number of research projects make PrEP
available

VicPrep 115 – Victoria - 2600

PreLude 300 – New South Wales - 3700

QPREP 50 – Queensland - 2000

Each of these has now been extended and a less
extensive protocol used to scale-up with the view
to realising a public health outcome of reducing
new infections.
Quality when buying on line

FDA has approved a number of generic providers
for supply to PEPFAR programs

Gilead has drugs produced under licence by
Mylan and marketed through Alphapharm (in
some countries)

Drug being used in Australia extension projects a
mix of Gilead and Mylan/Alphapharm

Community organisations can provide information
about approved suppliers

Avoid on-line services which make false claims

Can test drug to determine bioequivalence
Guidelines and Guidance

ASHM Australian Guidelines

Jurisdictional Guidelines

Study Protocols (more stringent in first phase)

Study protocols (less stringent in second phase)

Guidance to clinicians assisting people to self
import
Who should access PrEP

It is thought that many people acquire and then
transmit HIV before they know they are infected
SO WHO SHOULD HAVE PREP:

People at greatest risk of acquiring and transmitting
HIV, if they were to acquire it

People at risk of acquiring HIV

People who find consistent condom use difficult
Some observations

People (mainly MSM) are going on PrEP and staying
on for duration of studies so far

MSM interested in PrEP already have high STI burden,
and this continues

Study participants are taking pills at a regular rate
with the majority always maintaining therapeutic
dose

Self report acceptability and feeling of taking control

Bone mineral density and renal complications low

Very low or no transmissions, means there is no
transmitted resistance
Next iteration of Guidelines
Will include:

Focus on transgender persons

Discussion of consideration of intermittent PrEP

Hepatitis C testing while on PrEP

Consideration of access for people outside of
highest priority research participants
PrEP: part of comprehensive
prevention strategy



Increase testing

Newly infected

Identification of people with established infection
Increase number of people on treatment

Reduce time between diagnosis and treatment

Remove barriers to starting treatment

Maintain people on treatment
Increase promotion of other prevention strategy

Condom use

STI screening
Regional Network

Establish PrEP page on Regional Network Website

Upload and link regional and country information

Can also link information for patients

Website launched today 17 May 2016

http://www.regionalnetwork.ashm.org.au/