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Pittsburgh Team Monitors Drug Resistance Of HIV Prevention Drugs During Rollout

In 2014, an estimated 1.4 million people in sub-Saharan Africa became newly infected with HIV, according to the foundation for AIDS research (amfAR). A University of Pittsburgh research team is studying ways to prevent these numbers from rising.

Infectious diseases researchers at Pitt are leading a five-year, $5 million initiative to monitor drug resistance during the large-scale rollout of HIV prevention drugs in sub-Saharan Africa, focusing in South Africa, Zimbabwe, Kenya and Uganda because the epidemic is large in these areas.

25.8 million people have HIV in sub-Saharan Africa, accounting for nearly 70 percent of the global total, according to the World Health Organization (WHO).

The grant awarded by the U.S. Agency for International Development (USAID) will allow the Pitt team to conduct laboratory research and monitor resistance of drugs and microbicides that prevent HIV infection.

“The hope is that after these five years, we’ll have a low-cost test in place to do this monitoring on a large scale,” said Dr. Urvi Parikh, senior project advisor and an assistant professor of medicine at Pitt.

For the first two years, the team will focus on laboratory research and computer modeling, and then use the data collected to create policy recommendations about how often someone should be tested for HIV to make sure the drugs keep working.

The Pitt team will go to Africa in year three of the project to share their findings with community leaders, doctors and health policy professionals. That research team will then work with their partners, including USAID, WHO, and the United Nations Programme on HIV/AIDS, to implement recommendations in the regions where the microbicides are distributed.

According to Parikh, they are concerned that a strain of HIV could arise that resists drugs needed for treatment in the future and then spread. The trick is catching it early.

“Our job is to make sure that the prevention tools that are being used keep working by making sure that if drug resistance is happening then we know that it is happening and that people stop using a prevention product as soon as possible if they become infected,” she said.

The new preventative measures include a daily pill, a monthly vaginal ring that slowly releases the medicine, or a medicated gel that’s used before and after sex. All of these methods specifically block HIV from infecting someone.

None of these preventative measures has been implemented into Africa before, according to Parikh.

“That’s part of what makes this so exciting and important: the field of HIV prevention itself is relatively new … so we hope that this will make a huge impact on the number of new infections that are occurring,” said Parikh.

The final step in the project is training local clinics in using low-cost tests to detect drug resistance so data can continue to be collected and guide future HIV prevention initiatives.

But barriers in these countries exist, including access to health care, HIV medications and education, according to Parikh.

“It’s important for the people there to be able to do this themselves in the long run … and then help them implement that locally,” said Parikh.

Pitt’s collaborators, including WHO and USAID are focusing on the educational component. Their emphasis is making sure women have access to the HIV prevention products and that they have the knowledge needed to take it properly, according to Parikh.

The funding for the project comes from the U.S. President’s Emergency Plan for AIDS relief through the USAID, which will cover the large cost of monitoring drug resistance in thousands of people.

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