With the Indian Council of Medical Research (ICMR) planning to study the effectiveness of Pre-exposure prophylaxis (PrEP) among high-risk groups — ‘men who have sex with men’ (MSM) and transgender women — the National AIDS Control Organisation (NACO) is now toying with the idea of introducing PrEP.
PrEP is a powerful HIV prevention tool for those who are at substantial risk of getting the infection. Following extensive studies, the World Health Organisation (WHO) in 2014 recommended offering PrEP to MSM. In 2015, on the basis of further evidence of the effectiveness and acceptability of PrEP, the WHO broadened the recommendation to include all population groups at substantial risk of getting HIV infection.
“Offering PrEP should be a priority for populations with HIV incidence of about 3 per 100 person-years or higher. PrEP should be an additional prevention choice in a comprehensive package of services that include HIV testing, counselling, male and female condoms, lubricants, ARV treatment for partners with HIV infection, voluntary medical male circumcision, and harm reduction interventions for people who use drugs,” the recommendation stated.
Speaking to The Hindu on the sidelines of the 11th National Conference of AIDS Society of India-ASICON 2018, NACO Deputy Director-General R.S. Gupta said introduction of PrEP is one of the priorities for NACO and it has also been mentioned in the National Strategic Plan for HIV/AIDS and STI 2017-2024.
“We are working on it and if a decision to introduce it is taken, we will develop a model to identify districts requiring introduction of PrEP,” he said.
Nomita Chandhiok, former senior scientist with ICMR, said after a pilot demonstration project on PrEP taken up in Karnataka and Kolkata, the ICMR is now planning to take up another project among high-risk groups of MSM and transgender women in some identified States. “Based on the results of this pilot, we hope NACO will soon take a call on introducing PrEP in the country,” she said.
AIDS Society of India (ASI) president Ishwar Gilada said all possible and available options/tools should be used to reduce HIV infection. “This tool of prevention is crucial in specific vulnerable population groups or situations. We must adopt this as a national policy,” he said.
Nirupama Deshmane Sista, Director of HIV Prevention Trials Network (HPTN), said PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods to provide even greater protection than when used alone. “But people who use PrEP must commit to taking the drug every day as adherence is most important. The pill contains two medicines (tenofovir disoproxil fumarate and emtricitabine - TDF/FTC) that are used in combination with other medicines to treat HIV. When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection,” she explained.
