A promising prevention possibility, but some challenges ahead
The CAPRISA study demonstrates that antiretroviral drugs can be administered via microbicides -- a topical, self-administered method in gel form to prevent HIV infection in women. What is exciting about this study's results is that the investigators established a clear relationship between usage and HIV incidence: Among women who used the gel more than 80 percent of the time, HIV incidence was 54 percent lower than those who did not use the new gel (control group). Even among women who used the gel less than half the time found HIV incidence was reduced twenty-eight percent.
As with any new technology, the application of this new prevention product will depend heavily on how and how often women use the gel. In this study, women were asked to use the gel anytime 12 hours before sexual activity and immediately after. Additional rounds of trials will need to test this and other time periods to understand how women may use the product. Some in the session suggested that women use the gel every day, but this raises a concern in my mind about inadvertently increasing drug resistance in the population if an anti-retroviral is administered as a prevention tool, and especially if women do not adhere to the treatment regimen. (Any interruption in use could lead to resistance.) Clearly, it is time to celebrate this new "discovery" but not yet to time to roll out large scale programs. Repeat studies are needed to assess some new variables and determine the protection gained (or not) with different patterns of use.
South African Research & Donor Funding
As the team of South African researchers presented their results in a crisp, clear presentation to a cheering audience, they described the perfect partnership between the African scientists and the donors, such as USAID. The study would have been impossible without the funding and the talent, and so much credit is due to both. The CAPRISA team comprises South African researchers, and it was exciting to see the country's pride in the many South African participants (including the minister of health, his team, and civil society partners) at the AIDS 2010 meeting. I have written previously about country ownership in global health; how countries can take the lead with a donor supported program to make things work for them. In this case, South Africa has most certainly taken the lead with U.S. and others' support, to develop a product that has the potential to be a game changer - -not just for South Africa, but for much of the world. Now, that's a global development partnership worth talking about!