Keeping the Focus on Key Populations: CLAC with LINKAGES Overhauls Important Online Resource Hub

LINKAGES joins The Global Forum on MSM & HIV (MSMGF) in celebrating the release of the redesigned website for the Community Action and Leadership Collaborative (CLAC).

Below is a reposting of the press release from the MSMGF on the recent release of the newly designed CLAC.

CLACThe MSMGF is proud to announce the launch of a redesigned website for the Community Action and Leadership Collaborative (CLAC). As a member of CLAC, the MSMGF has collaborated with the USAID– and PEPFAR-supported LINKAGES project to update and maintain a resource library for key population-related policy and practice. It will serve as an online hub for accessing the best information and resources on HIV for sex workers, men who have sex with men (MSM), people who inject drugs, and transgender people. The library contains a curated set of tools and materials to serve a range of audiences working to address the needs of key populations, including policymakers, advocates, program planners and implementers, health care workers, and peer educators. This includes linking beneficiaries with tools and resources that build and strengthen communities with a focus on organizational and technical capacity.

“We are happy to see this improved resource library in support of key population-focused work,” said Dr. George Ayala, Executive Director of MSMGF.

“The partnership between CLAC and LINKAGES, ensures greater coverage of vital information and tools that can support scale-up of evidence-informed and rights-based approaches for addressing HIV among men who have sex with men, sex workers, people who inject drugs and transgender people.”

CLAC is a unique collaboration between AIDS and Rights Alliance for Southern Africa (ARASA), the Global Network of People Living with HIV (GNP+), Global Action for Trans* Equality (GATE), the Global Forum on MSM & HIV (MSMGF), the Global Network for Sex Work Projects (NSWP), the International Network of People Who Use Drugs (INPUD), and the International Treatment Preparedness Coalition (ITPC). Working together, we are able to link our first-hand knowledge of key populations to strong expertise in the areas of prevention, HIV and tuberculosis treatment access, human rights and community engaged programming.

“Knowledge sharing is fundamental for creating action at scale,” said Kevin Osborne, LINKAGES Project Director. “LINKAGES is thrilled to have worked with CLAC to strengthen this important resource library where policymakers, funders, advocates, implementers and other stakeholders can go to access accurate and up-to-date tools, share lessons and promote best practices on HIV prevention, care and treatment for key populations.”
The new, redesigned CLAC website can be reached at www.clac.cab.

New Look at PrEP Study Points to Efficacy for Transgender Women

Below is a reposting of the press release from UC San Francisco (UCSF) on the findings of a recent PrEP study. Access to the full research article published by the Lancet can be found here: http://bit.ly/PrEPLancet 

In a new look at the groundbreaking iPrEx (Pre-exposure Prophylaxis Initiative) trial for people at high risk of HIV infection, UC San Francisco researchers have identified strong evidence of efficacy for transgender women when PrEP, a two-drug antiretroviral used to prevent HIV, is used consistently.

“We re-examined the data using a more sophisticated method for determining which participants in the trial were transgender women and found a larger number than the original analysis,” said study senior author, Robert M. Grant, MD, UCSF professor of medicine. In addition, we looked at blood levels of the drug in a sub-group of participants.  We found no drug in the transgender women who became infected. And, no transgender woman participant with drug levels equal to four or more doses a week became infected with HIV.  While this analysis did not include a large enough sample group to draw firm conclusions, we did find strong evidence pointing to efficacy.  Additional research designed specifically for transgender women is needed to confirm this finding.”

The study enrolled 2,499 HIV negative gay and bisexual men and transgender women in Peru, Ecuador, Brazil, Thailand, South Africa and the United States between 2007 and 2011, with an open label extension that ended in 2013.  The new analysis identified 339 transgender women participants,310 more than originally included in the initial report of the trial.

Compared with men who have sex with men (MSM) in the iPrEx study, transgender women had lower drug levels in their blood and were less likely to take PrEP on a daily basis.  While MSM who reported sexual practices with the highest risk of contracting HIV were more likely to have PrEP detected in their blood, the opposite was true for transgender women.

“We think that one factor leading to lower rates of pill-taking may be due to either a fear of, or lack of information about drug-drug interactions between PrEP and gender-affirming hormone medications. For transgender women, their gender-affirming medications are a higher priority,” said study first author, Madeline B. Deutsch, MD MPH, assistant clinical professor of Family and Community Medicine at the UCSF Center of Excellence For Transgender Health.  “And while there may be a negative behavioral interaction between the two therapies that is affecting pill-taking, we have no evidence to date for a biological interaction between the two, though further research is needed.”

The iPrEx trial in 2010 was the first to show efficacy for a daily single pill oral antiretroviral medication consisting of emtricitabane and tenfovir disoproxil fumarate for use in HIV negative gay and bisexual men.  On an intent-to-treat basis, efficacy was not found for the transgender women in the trial.

The FDA approved and the U.S. Centers for Disease Control and Prevention recommends this medication for use in gay and bisexual men and heterosexual men and women at risk for acquiring HIV.  The U.S. CDC recommendations for PrEP use do not mention transgender women.

Transgender women are at high risk of HIV infection.  An analysis from 2008 found that over a quarter of transgender women in the U.S. are HIV positive.  A 2013 analysis looking at fifteen countries found a fifth of transgender women are HIV positive.  And, the U.S. Centers for Disease Control and Prevention reported that transgender women have the highest percentage of new infections of any sub-group in their testing programs.

“Transgender women face several structural barriers including lack of legal protection against discrimination and resulting difficulties in employment, access to income, food and housing.  They desperately need a tool that they control, one they can use without their partners’ consent or knowledge,” said Deutsch.

PrEP research and interventions are generally designed to encourage MSM to participate and consider use of PrEP.   No evidence based HIV prevention interventions specifically designed for transgender women exist.

“When transgender women take PrEP as prescribed, it appears to work, but to retain and encourage PrEP use, research should be conducted and interventions should be delivered in gender affirming environments.  One example would be to integrate PrEP delivery with gender affirming services, including provision of gender affirming hormone therapies.  Social marketing campaigns and PrEP delivery programs should not lump transgender women in with MSM but should be explicitly designed to support transgender women,” said study co-author JoAnne Keatley, MSW, director of the UCSF Center of Excellence for Transgender Health.

The study’s co-authors are Suwat Chariyalertsak, MD, from the University of Chiang Mai, Thailand; Esper G. Kallas, MD, University of Sao Paolo, Brazil; Juan Guanira, MD, IMMENSA, Lima, Peru; Vanessa McMahan, the Gladstone Institutes, San Francisco; and Jae Sevelius, PhD, and David V. Glidden, PhD, from the University of California, San Francisco.

The National Institutes of Health and the Bill and Melinda Gates Foundation funded this research.

The UCSF Center of Excellence for Transgender Health is dedicated to increasing access to comprehensive, effective, and affirming healthcare for trans communities.

About UCSF: UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco. Please visit www.ucsf.edu/news.