Let’s talk about a PrEP efficacy trial in Bangkok, Thailand that enrolled HIV-negative injecting drug users (IDUs) and sparked a debate about standards of HIV prevention, care, and treatment in trials. Take some time to read over the case study (attached in the field below) and think about the following questions:
1) What implications did the lack of inclusion of clean needles in the prevention package have for trial results?
There were more participants who seroconverted as the prevention package did not include clean needles which would have come with harm reduction counselling messages and behaviour change even if it was during the trial. But the results was also not acceptable to the stakeholders as the HIV prevention package was limited with not clean needles being provided to the participants. Thus, while the results was good for the HIV prevention field, it was not good for the advocates and community members advocating for the provision of clean needles. But I am hoping that even though the clean needles was not provided, the study team did discuss access via other methods including maybe purchasing these if feasible. If needles were provided than the sustainability would also raise ethical issues for long term impact on HIV prevention.
2) How can researchers engage stakeholders to better negotiate prevention packages that combine various arrays of options tailored to the needs of diverse subgroups?
Researchers may start the process of having mutual understanding of the reasons for countries not including certain interventions in HIV prevention programmes and assess the cultural, social and economical factors contributing to these decisions. Then the researchers should engage the government and policy makers and share options without judging the in country decisions. Researchers may engage with the advocates locally and nationally to assess the feasibility of convincing government to include options for HIV prevention as a long term goal and discuss impact on policies. Eventually, most countries and public health decision makers want the best for the population in terms of reducing HIV prevention but lack of political will is often a limitation. Researchers also need to be patient with the community and allocate resources to work with advocates and stakeholders including government to assist with changes in policies linked to access to HIV prevention methods. Research on acceptability and need of the population for HIV prevention options being conducted with support from government and stakeholders may help with their decision making. This is an issue that needs to be discussed widely as HIV prevention research trials needs to make all options available to participants while at the same time be transparent with participants about the reasons for lack of availability in the population.
