Keerti Gedela

The session focused on the WHO guidance for long-acting (LA) cabotegravir (CAB) for HIV prevention (pre-exposure prophylaxis/PrEP), updated differentiated guidance for oral tenofovir-based PrEP and treatment of cryptococcal meningitis. Additionally, COVID-19 vaccine-related issues for people living with HIV and an overview of the consolidated guidelines for HIV strategic information.

Rachel Baggley provided an overview of new recommendations for LA CAB as PrEP, highlighting data demonstrating LA CAB as superior to oral PrEP for HIV prevention given ‘near perfect’ adherence comparatively. Mixed results regarding cost-effectiveness were highlighted and the need for monitoring CAB LA adherence and real-world data; and lack of data in populations such as pregnant women. The use of HIV antibody testing (as opposed to molecular testing) is acceptable to facilitate uptake in LMICs. WHO is collaborating on global efforts for product availability and access and acknowledges gaps in Asia. Robin Schaefer provided an update on differentiated oral tenofovir-based PrEP delivery. Updates include; event-based PrEP for cis-gender men and transgender women not on gender-affirming hormones, optional kidney function monitoring for those with a low risk for kidney disease, the removal of hepatitis B infection as a contraindication and integrating HIV self-testing. Guidelines for new HIV Strategic Information, highlighted information priorities as we progress towards 95-95-95. Recommendations call for ‘person-centred data to support person-centred health services.’ Prioritising equity enabled by principles for developing unique identifiers; access to own health data to increase trust in healthcare and managing the digital divide to include communities with low digital connectivity and literacy.

Guidance for the provision of CAB LA for PrEP globally is greatly welcomed and provides game-changing innovation for HIV prevention. However, oral PrEP is still highly effective and the updated simplified guidance will enable delivery models and drive uptake and acceptability. Enabling protected, person-centred data platforms and strategies to improve access to HIV treatment and prevention services and retention in care will help to close health inequality gaps. It will be essential to build patient trust and ensure data protection, especially in settings affected by punitive laws and high levels of HIV discrimination which risks undermining progress.