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Px Wire Vol 12 No 2

PrEP and Beyond: HIV prevention from 2022 onwards

Vol 12 No 2

PxWire Cover

PxWire is AVAC’s quarterly update covering the latest in the field of biomedical HIV prevention research and development, implementation and advocacy. Each issue includes updates, emerging issues and features upcoming events.

PrEP Tracker Data / Oral PrEP Progress

  • The world has surpassed 3,000,000 PrEP initiations over the past decade. This milestone represents the 2020 target for PrEP uptake around the world, but reached two years late. This is progress, but definitely not success—and PrEP uptake must continue to accelerate to reach the 2025 targets.
  • In Q3, South Africa reached 570,000 PrEP initiations and replaced the US as the country with the highest total number. The majority of this uptake followed scale-up of a national PrEP program.
  • Nigeria, Uganda, and Zambia have each exceeded 300,000 cumulative initiations. All three countries have seen rapid growth since 2020, largely attributable to PEPFAR support.
  • Mozambique and Zimbabwe broke 100,000 cumulative initiations this quarter. Rapid growth in these countries is also attributable to PEPFAR support.
  • Liberia and Panama recorded their first initiations, with PEPFAR here also providing primary and essential support.

bar chart of PrEP uptake

PrEParing for New Products

three panel graphic

HIV Prevention Pipeline

A serious disappointment in September was Merck’s announcement that they are ending two efficacy trials (IMPOWER-22 and IMPOWER-24) testing a once-a-month oral pill of islatravir (ISL) for HIV prevention. The decision stems from a treatment trial with ISL in combination showing a drop in participants’ CD4+ cell counts. The end of these prevention trials comes at a time when the larger HIV prevention research pipeline has few products moving into Phase III clinical trials. The implications of this news for the research pipeline deserves careful thinking and action.

At the same time, early phase research remains dynamic across ARVs, vaccines, antibodies and multipurpose prevention technologies (MPTs). Following are a few items that caught our eye this quarter.

  • An ongoing Phase I HIV vaccine study designed for infants 0-5 days, HVTN 135, is scheduled to report findings in 2023.
  • The 90-day dapivirine vaginal ring for PrEP is being tested for bioequivalence compared to the 30-day formulation in a new Phase I trial, IPM 054.
  • Results from a Phase I trial of a 90-day tenofovir plus levonorgestrel vaginal ring for HIV, unintended pregnancy and HSV-2 prevention, CONRAD A15-138/ENRICH show that this multipurpose prevention technology (MPT) is capable of releasing in a controlled manner two very different drugs in differing amounts, and warrants continued study.
  • Multiple mRNA HIV vaccine candidates are now in Phase I trials.
  • The USAID-funded MATRIX project held stakeholder consultations in Kenya, South Africa and Zimbabwe to introduce their evolving pipeline of new HIV prevention products for women.

hiv prevention pipeline graph

Prevention Playlist

The most effective advocacy is based on smart analysis and accurate information. AVAC develops a wide range of materials and resources to inform decision making and action. Be sure to read, join or listen in on what AVAC sees as essential to the current HIV prevention and global health equity conversations of the quarter.

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  • AVAC’s Advocates’ Network offers timely updates on developments in biomedical HIV prevention and the field that supports it to a network for organizations, advocates and activists. Sign up today.
  • The Choice Agenda (TCA) has a full program from its webinar series to check out. Coming up: More than Vessels: Pregnant people deserve inclusion in HIV prevention clinical and implementation research. Register here. Join the The Choice Agenda listserv with nearly 900 members by emailing

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About AVAC

Founded in 1995, AVAC is a non-profit organization that uses education, policy analysis, advocacy and a network of global collaborations to accelerate the ethical development and global delivery of HIV prevention options as part of a comprehensive response to the pandemic. Follow AVAC on Twitter @HIVpxresearch and find more at and