the facilitator notes - Canadian Public Health Association

Introduction to New HIV Prevention Technologies
Training Module
Training Module
This training module was developed to enhance frontline providers knowledge of New
HIV Prevention Technologies (NPTs) and is intended to compliment CPHA’s Introduction
to New HIV Prevention Technologies continuing education eLearning course. This
training module is to be used by facilitators in the training of frontline providers on New
HIV Prevention Technologies (NPTs) and as an online resource.
The module presents a general overview of NPTs as of March 2012 and can be
completed in approximately 1 hour. The module comes complete with Power Point
presentation and facilitator notes. Facilitators that have experience working with HIV are
encouraged to adapt the materials to fit the content and purpose of their respective
sessions.
To navigate through the training module material please click on the various sections
listed in the sidebar or simply download the facilitator notes and Power Point
presentation.
Module Overview
The Canadian Public Health Association was funded by the Public Health Agency of
Canada (PHAC) and Canadian HIV Vaccine Initiative (CHVI) to undertake a project
entitled, Preparing the Canadian Public Health Community for New HIV Prevention
Technologies.
The goal of the new HIV prevention technologies (NPTs) project was to develop an
appropriate education and training module that would increase public health workers’
and frontline providers’ knowledge, skills and capacity regarding NPTs as they relate to
public health core competencies and existing prevention technologies and approaches.
Module Objectives
The objectives of the training module are to:
o
improve frontline providers knowledge of what NPTs are, the current state of
evidence for NPTs, how they might work, and their role as part of a
comprehensive approach to HIV prevention;
o
o
understand the services, mechanisms, guidance and resources needed for NPT
implementation; and,
develop frontline providers capacity to communicate effectively about NPTs.
Module Target Audience
This module has been developed for frontline providers working in HIV prevention.
Frontline providers carry out the bulk of day-to-day tasks in the public health
sector. They work directly with clients, including individuals, families, groups and
communities. Responsibilities may include information collection and analysis, fieldwork,
program planning, outreach activities, program and service delivery, and other
organizational tasks.
This includes individuals working in, but not limited to, settings such as public health
units, regional health authorities, AIDS service organizations, community health centres
and other organizations that work with priority populations such as Mental Health
Services, Police Services, Social Housing, Youth Services, Shelters etc.
Production of this eLearning module has been made possible through a financial
contribution from the Public Health Agency of Canada. The views expressed herein do
not necessarily represent the views of Public Health Agency of Canada.
Copyright © 2012
Canadian Public Health Association
For more information, contact:
Canadian Public Health Association
300–1565 Carling Avenue, Ottawa, Ontario K1Z 8R1
Tel: 613-725-3769 Fax: 613-725-9826
E-mail: [email protected] www.cpha.ca
Table of Contents
1. Training Module

Introduction

Section 1: HIV/AIDS in Canada
- HIV/AIDS in Canada
- Existing Prevention Options

Section 2: Why are New HIV Prevention Options Needed?
- Vignette
- Can’t we just Promote Condoms?
- Efficacy vs. Effectiveness
- Condoms and NPTs

Section 3: NPTs as Part of a Comprehensive Approach to HIV Prevention
- NPTs as Part of a Comprehensive Approach
- Imagine a Full Spectrum of Interventions

Section 4: New HIV Prevention Options
- New HIV Prevention Options
- What are “new” HIV Prvention Technologies
- ARV-Based Prevention Options
- HIV Prevention
- Treatment –as-Prevention
- Pre-Exposure Prophylaxis
- Vaginal and Rectal Microbicides
- Vaccines

Section 5: NPT Implementation Issues
- NPT Implementation Issues
- NPTs – Measuring Impact
- Next Steps

Conclusion
2. Acronyms
3. Evaluation
4. Acknowledgments
5. Disclaimer
Introduction: New HIV Prevention Technologies
Introduction: Slide 1
Facilitator Notes: HIV and AIDS represent one of the greatest public health threats in
the last few centuries. Worldwide, almost 60 million have been infected with HIV and 25
million people have been killed by this deadly disease - and in Canada, the number of
people living with HIV continues to rise. The development of vaccines and other new
prevention technologies (or NPTs) to prevent HIV infection offers one of the best hopes
for slowing the epidemic.
In 2010-2011, new HIV prevention technologies began to show great promise. Several
large efficacy trials recently demonstrated proof-of-concept or established efficacy for
vaccines, pre-exposure prophylaxis, microbicides, and treatment-as-prevention.
This introductory module sets the stage for discussion and positive action around new
HIV prevention technologies by providing an overview of key information regarding NPTs
in Canada. This module is also designed to link NPTs to specific core public health
competencies that enhance knowledge and understanding of NPTs, and improves the
capacity of front-line providers to communicate NPT information effectively.
Core Competencies for Public Health: Slide 2
Facilitator Notes: The Core Competencies for Public Health in Canada are the
essential knowledge, skills and attitudes necessary for the practice of public health. They
transcend the boundaries of specific disciplines and are independent of program and
topic. They provide the building blocks for effective public health practice, and the use of
an overall public health approach. There are 36 competencies organized into 7 domains,
including Public Health Sciences; Assessment and Analysis; Policy and Program
Planning, Implementation and Evaluation; Partnerships, Collaboration and Advocacy;
Diversity and Inclusiveness; Communication; and Leadership.
Among other things, the Core Competencies can provide a basis for developing curricula
and training opportunities, encourage service delivery that is collaborative, populationfocused, ethical, equitable, standardized and client-centred, and provide an opportunity
to improve recognition and understanding of practitioners’ roles in public health.
Throughout this presentation, links between course content and the competency
domains will be made though the use of the Core Competency icons. This helps identify
for the learner where the course content is supporting the acquisition or maintenance of
public health core competencies. We invite you to learn more about Core Competencies
by clicking on the highlighted icons embedded on each screen throughout this
presentation.
Learn More: For further information about the public health core competencies, please
consult the Public Health Agency of Canada website: http://www.phac-aspc.gc.ca/phppsp/ccph-cesp/pdfs/cc-manual-eng090407.pdf
Learning Objectives: Slide 3
Facilitator Notes: By the end of this module, participants will be able to describe the
current state of HIV in Canada; describe existing HIV prevention options; describe
emerging HIV prevention options and how they work; explain why there is a need for
additional HIV prevention options in Canada; describe how NPTs fit into comprehensive
prevention and complement the existing spectrum of HIV interventions; and identify
means of taking action, staying informed and getting involved in work related to new HIV
prevention technologies.
Section 1: HIV/AIDS in Canada
HIV/AIDS in Canada: Slide 5
Facilitator Notes: Here is a brief snapshot of HIV in Canada. It is important to note that
these are nationally compiled statistics from 2008, and that the picture at the
provincial/territorial and local levels can be quite different. But this snapshot does
provide important indicators about HIV in Canada.
1. The number of people living with HIV in Canada is increasing as a result of a
combination of new infections and better treatments that allow people to live
longer.
2. We can see that the number of new infections has stabilized between 2005 and
2008. This suggests that either prevention efforts have been successful to some
degree, or there are lower rates of testing.
3. Although the number of new infections have stabilized, they are not decreasing,
which emphasizes the limitations of our current prevention efforts and the need
for HIV prevention in Canada to improve.
4. Gay men and other men who have sex with men (or MSM) still represent the
group with the highest number of new HIV infections in Canada. Heterosexual
transmission accounts for a little over a third of new infections, with a
disproportionate number of these occurring within communities that come from
parts of the world where HIV is endemic. This means countries where the HIV
epidemic is predominantly transmitted through heterosexual contact among the
general population. Injection drug use accounts for a little less than one-fifth of
new infections.
5. In Canada, an estimated one out of four people living with HIV are unaware that
they are infected. They do not know they are carrying the virus. This is an
important point to keep in mind as we think about how to improve HIV prevention
efforts, and the role that new HIV prevention options might play.
Learn More: For further information on HIV epidemiology in Canada, including
information on various populations, consult the Public Health Agency of Canada Epi
Updates. http://www.phac-aspc.gc.ca/aids-sida/publication/epi/2010/index-eng.php
Warm Up Exercise:
Purpose
This exercise can be used as a warm up, ice breaker and bring participants up to date
on epidemiological information regarding the transmission of HIV in Canada.
Materials
Using the Public Health Agency of Canada’s 2010 EPI report split the participants into
several groups and hand out the summary of epidemiological information for each key
population.
Facilitators
Ask the particpants to pass around the summaries when they finish reading them and
then lead an open discussion on the information provided and its significance.
Existing Prevention Options: Slide 6
Facilitator Notes: There are already a range of tools available to Canadians for HIV
prevention. The tools shown in green are the ones that have been proven to be effective
if they are used consistently. The tools that are still being investigated are in blue. The
ones that are in red have recently been shown to be at least partially effective in some
cases, and some trials are still ongoing to obtain further information.
Many existing interventions that have been proven to be effective are still not widely
available to those populations and individuals at highest risk of HIV. Much work remains
to be done in this regard. For example, needle exchange programs are not available in
Canadian prisons. Access to non-occupational post-exposure prophylaxis (or PEP)
varies greatly across the country. Female condoms are often unavailable or unaffordable
to people at risk of HIV. Pre-exposure prophylaxis (or PrEP) would still need to be
prescribed off-label at this time. Also, little to no public health guidance exists for PEP,
PrEP and treatment-as-prevention.
Here is a short description of some of the existing prevention interventions available at
the moment.
Voluntary counselling and testing. Voluntary counselling and testing (VCT) is an
important strategy for both HIV prevention and care. It facilitates behaviour change, and
it is an important entry point for care and support for those who test positive.
Clean injecting equipment. Providing clean injecting equipment to people who inject
drugs, such as through needle exchange, reduces the risk of HIV transmission.
Male and female condoms. Used consistently and correctly, both male and female
condoms protect against HIV, sexually transmitted infections (STIs), and pregnancy by
providing a barrier to prevent the exchange of bodily fluids.
Post-exposure prophylaxis (PEP). Post-exposure prophylaxis is an intervention in
which people who have already been potentially exposed to HIV take a brief course
(usually 28 days) of antiretroviral (ARV) medications as soon as possible after exposure,
(and certainly beginning within 72 hours of exposure).
Prevention of vertical transmission. This is also known as prevention of mother-tochild transmission (PMTCT). Giving the HIV-positive mother antiretroviral drugs before
and during delivery, and giving them to the baby after delivery, have been associated
with a reduced risk of HIV transmission.
Behaviour change. This strategy promotes risk-reducing behaviour, including delaying
sexual debut, reducing the number of sexual partners, using condoms, reducing risky
sexual and drug-using activities, and promoting needle exchange.
Male circumcision. Trial data has shown that HIV-negative circumcised men had
approximately 60-70% less chance of acquiring HIV through penile-vaginal intercourse
than non-circumcised men.
Learn More: For further information about existing prevention technologies and
approaches consult the CATIE website: http://www.catie.ca/en/preventinghiv/preventing-hiv
Section 2: Why are New HIV Prevention Options Needed?
Vignette: Slide 8
Facilitator Notes: Given that we have so many effective HIV prevention options at our
disposal, why do we need new ones? As we will see, there are several reasons why
existing prevention options may have limitations and are not always appropriate for
many individuals and populations at risk.
Some of the most effective tools currently at our disposal have important limitations for
many people most at risk of HIV. For example, male and female condoms prevent
conception. They also require the active consent and cooperation of the insertive partner.
While the receptive partner—whether female or male—can often suggest, negotiate or
insist on condom use, it is ultimately up to the insertive partner to decide whether or not
they will use a male condom. And in many situations, the receptive partner—particularly
women—are not always able to negotiate condom use. Also, many people are unable or
unwilling to use condoms; they do not like to use them, they may not find them
pleasurable, they may have difficulties maintaining an erection, they may be allergic to
latex, they may be tired of condom messaging and want alternatives to reducing risk,
and they may see them as a barrier to intimacy.
Developing HIV prevention tools that would allow conception while still reducing the risk
of HIV infection, that would be more within the control of the receptive partner, and that
would enhance sexual pleasure without forming a physical barrier, would provide critical
new options that are largely missing from current interventions. The experience of
contraception shows us that the more options you provide to people, the more sex acts
are protected since people are more likely to find an option that best suits their
environment, needs and preferences.
Many people do not know that globally, sex with a primary partner is the biggest source
of HIV infection. In fact, it is true all over the world and across populations that once trust
and love enter a relationship, condoms usually exit. With proper condom promotion
programmes, we can help people increase their use of condoms for casual or
commercial sex. But few people continue to use condoms once they establish a regular
partnership. Even with intense condom promotion efforts, consistent condom use
amongst regular partners is difficult to achieve, unless, of course, the couple knows that
one of them is infected and one is not.
Of course, if both partners are HIV-negative or both HIV-positive, and they are
monogamous, this may not be a problem in terms of HIV transmission. However, many
people are unaware of their status, and in many couples, one or both partners have sex
outside of the relationship.
An expanded range of options is needed to fill these HIV prevention gaps.
“Adapted from PowerPoint slides from Global Campaign for Microbicides. www.globalcampaign.org”
Can’t we just Promote Condoms?: Slide 9
Facilitator Notes: Condom promotion is a critical part of HIV prevention. Condoms are
inexpensive and highly effective, yet many people choose not to use condoms.
In the Canadian context, a recent survey of Canadians over the age of 15 showed that
reasons for not using condoms vary quite a bit. But the most common reason is because
people are in a long-term relationship. Other reasons include the desire to conceive or
being unable or unwilling to use condoms.
Some new HIV prevention options, such as microbicides or PrEP, could help overcome
many of these barriers.
Can’t we just Promote Condoms?: Slide 10
Facilitator Notes: This graph shows the percentage of women from various countries
who used a condom in their last sex act.
As you can see by the pink bars, condom use with primary partners was extremely low.
In the Unites States, the rate of reported condom use with a husband or boyfriend was
just greater than 15%.
In the other countries, it was far lower than that. The authors of this graph noted that
surveys of women in 13 countries found that fewer than 7% reported condom use in the
last sex act with their regular partner.
Condoms continue to be a viable option for many people, and should be made readily
available. However, for many people, condom promotion can go only so far. Providing
HIV prevention options that can reduce risk while simultaneously allowing for intimacy,
conception and sexual pleasure could help bridge a prevention gap that condoms simply
cannot cross.
Adapted from PowerPoint slides from Global Campaign for Microbicides. www.globalcampaign.org
(Are People Using Condoms: Current Evidence from Sub-Saharan Africa and Asia and
its Implications for Microbicides. 2003. HIV Tools Research Group, London School of
Hygiene and Tropical Medicine and International Family Health.)
Efficacy vs. Effectiveness: Slide 11
Facilitator Notes: Efficacy and Effectiveness. These two terms are often used
interchangeably, but they express distinctly different concepts.
The key difference is captured in the two questions: “Does the intervention work under
ideal conditions?” This refers to efficacy. And: “Does the intervention work in everyday
life?”. This refers to effectiveness.
Efficacy is the ability of a product to produce a desired clinical effect, such as protection
against a specific infection, at the optimal dosage and schedule in a given population - in
other words, how well an intervention works under controlled situations, such as in a
clinical trial.
Effectiveness refers to how well an intervention works in real-life settings, taking into
account the likelihood that people will adhere to it, use it properly, the tolerability or ease
of use.
For example, condom efficacy is 80-95% when they are used consistently and correctly.
However, their effectiveness is 69% because some people don’t always use them
correctly or consistently.
Let’s try to see how this difference between efficacy and effectiveness might look
visually.
“Source for stats: L. Heise et al. Apples and oranges? Interpreting success in HIV
prevention trials. Contraception. 2011 Jan;83(1):10-5. Epub 2010 Aug 7.”
Condoms and NPTs: Slide 12
Facilitator Notes: When considering the potential introduction of new HIV prevention
tools, people often compare them to condoms. People often assume that since condoms
have a high rate of efficacy, and new HIV prevention tools are usually thought to have
lower rates of efficacy, then the introduction of new HIV prevention technologies must
necessarily be a bad thing since people will potentially replace highly effective tools with
less effective ones.
However, we must carefully examine efficacy and effectiveness, through the relationship
between rates of efficacy and rates of use.
Let’s start off by assuming that condoms reduce the risk of HIV infection by 90%, and a
hypothetical microbicide reduces the risk by 60%. If both are used 100% of the time,
condoms are more effective at preventing HIV.
Adapted from Global Campaign for Microbicides. Microbicides Essentials Course.
www.hivpreventionresearch.org
Condoms and NPTs: Slide 13
Facilitator Notes: However, at those same efficacy rates, you will have the same
amount of protection if condoms are only used 20% of the time, than if you used
microbicides 30% of the time.
Condoms and NPTs: Slide 14
Facilitator Notes: And if you use microbicides 75% of the time, you will get better
protection than using condoms 20% of the time.
So we can see that we must consider the likelihood of people using a product, not only
its inherent efficacy. A 100% effective product that never gets used is not reducing
anyone’s risk—in other words, its effectiveness is diminished. By providing options that
more people are more likely to use, new HIV prevention technologies could fill an
important prevention gap.
Learn More: For further information about condom use consult the AIDSMAP
website.http://www.aidsmap.com/Condoms-and-lubricants/page/1065704/
Suggested Activities
Discussion:
Ask the following questions as a discussion or debate allowing the participants to break
up into groups again and discuss.
What do you believe?


Should we be looking at new technologies?
Should we be focusing on existing prevention interventions?
Section 3: NPTs as Part of a Comprehensive Approach to HIV
Prevention
NPTs as Part of a Comprehensive Approach: Slide 16
Facilitator Notes: Comprehensive HIV prevention is an evidence-based approach that
includes efforts to ensure access to proven interventions, the development of new or
tailored prevention options that can meet a variety of user needs and preferences, and a
focus on structural issues.
First, interventions that have been proven to reduce the risk of HIV are made readily
available to populations most at risk. In the Canadian context, these behavioural and
biomedical interventions typically include HIV education; risk reduction counselling;
provision of male and female condoms and lubricant; needle exchange programs; postexposure prophylaxis; prevention of mother-to-child transmission; promotion of and
access to HIV testing; and testing and treatment of sexually transmitted infections.
Recent studies have added treatment-as-prevention and pre-exposure prophylaxis (or
PrEP) to this list of effective HIV prevention strategies.
Second, an expanded range of HIV prevention options should be developed to meet a
variety of needs, including microbicides and vaccines.
Third, addressing structural factors that exacerbate HIV risk for certain populations is
paramount. A public health approach includes a commitment to equity, social justice and
sustainable development, recognition of the importance of the health of the community
as well as the individual, and respect for diversity, self-determination, empowerment and
community participation. Structural factors include a range of interventions that address
social determinants of health such as housing, socio-economic status, sexism, racism,
homophobia; human rights, stigma and discrimination; and systemic conditions such as
the criminal justice system and healthcare infrastructure.
Combining these elements improves the chances of having a real impact, and allows the
tailoring of approaches to meet the needs and address the vulnerabilities of specific atrisk populations.
Imagine a Full Spectrum of Interventions: Slide 17
Facilitator Notes: A comprehensive approach to HIV prevention should have many
elements. Here is another way to think about what an expanded toolkit of HIV prevention
and treatment options would look like visually.
Right now, we have many tools that people can use before exposure; right at the point of
HIV transmission; and after being infected. We all agree that we need to improve
people’s access to these existing tools that have been proven to work, shown here in
grey.
Advocates and researchers around the world are also working to see what new options
could be added to this toolkit in the near future. These have yet to be definitively proven
to work, and they are shown here in blue.
Our focus will be on recently proven or emerging new HIV prevention tools, namely
PrEP, preventive vaccines, vaginal and rectal microbicides, and treatment-as-prevention.
Learn More: For more information regarding comprehensive approaches to HIV
prevention, please visit CATIE: http://www.catie.ca/en/preventing-hiv/combinationprevention
Section 4: New HIV Prevention Options
New HIV Prevention Options: Slide 19
Facilitator Notes: Over the past few years, several new prevention technologies have
been proven to be effective in large-scale clinical trials. We are going to discuss these
emerging technologies and how they work. The tools shown in green are the ones that
have been proven to be effective if they are used consistently. The tools that are still
being investigated are in blue. The ones that are in red have recently been shown to be
at least partially effective in some cases, and some trials are still ongoing to obtain
further information.
We are going to spend some time taking a look at those tools that are either still being
investigated, such as microbicides and vaccines, or that have recently been shown to be
effective, such as treatment-as-prevention and pre-exposure prophylaxis).
Here is a short description of some emerging prevention technologies at the moment.
Vaccines: A preventive vaccine is a substance that teaches the body to recognize and
defend itself against bacteria and viruses that cause disease.
Microbicides: Microbicides are products designed to reduce the transmission of HIV
and/or other STIs when used in the vagina or rectum.
Pre-Exposure Prophylaxis : Pre-exposure prophylaxis (PrEP) is the ongoing use of
antiretroviral (ARV) drugs, starting before an exposure and continuing afterwards. It is
used by HIV-negative people to reduce their risk of becoming infected.
Treatment-as-Prevention: “Treatment-as-prevention” is a term describing the use of
antiretroviral drugs to reduce the risk of passing HIV to others. The strategy would
function as a secondary benefit of antiretroviral treatment after its primary purpose of
improving an HIV-positive individual’s health.
Learn More: For further information about existing prevention technologies and
approaches, consult the CATIE website: http://www.catie.ca/preventing-hiv/preventiontechnologies
What are “new” HIV Prvention Technologies: Slide 20
Facilitator Notes: The term “new HIV prevention technologies” (or NPTs) can be
ambiguous.
First, the word “technologies” is sometimes replaced with interventions, tools,
approaches or options. Second, alternate phrases are sometimes used, such as
biomedical interventions. Third, the exact meaning of “new” is not always clearly
explained.
One of the reasons for this is that the list of technologies included as NPTs evolves over
time. For example, up until 2007-2008, there were efficacy trials testing whether
treatment of herpes simplex 2 (also called HSV-2, or genital herpes) could reduce the
risk of HIV infection, and whether a diaphragm or cervical barriers could reduce the risk
of acquiring HIV among women. Today, these interventions are no longer included in the
list of potential NPTs, since the trials demonstrated no prevention benefit.
The term “new prevention technologies” generally refers to HIV prevention options that
are still in clinical trials. Their efficacy might not yet be established, or some trials may
have recently demonstrated proof-of-concept, but efficacy still needs to be confirmed
through further study. In some cases, the NPTs have been proven to be effective in
recent trials, but they are not yet widely available or well integrated into existing HIV
prevention programs.
Therefore, today, NPTs typically refer to preventive vaccines, vaginal and rectal
microbicides, pre-exposure prophylaxis, and treatment-as-prevention. Occasionally,
medical male circumcision is still included in discussions of NPTs in some parts of the
world, since its HIV prevention efficacy was only proven in trials in 2005-2007. While
neither non-occupational PEP nor female condoms are generally considered to be NPTs,
the issues around their availability and integration into HIV prevention programs are
sometimes similar, so they are occasionally included in those discussions. However, we
will only focus on the first four items in this course.
ARV-Based Prevention Options: Slide 21
Facilitator Notes: The development of new HIV prevention technologies has
increasingly relied on methods that use antiretroviral drugs (or ARVs). These drugs are
primarily used as treatment for people who are already infected with HIV.
Some methods of using ARVs for HIV prevention are already known to work, such as
post-exposure prophylaxis (or PEP) and prevention of vertical transmission, sometimes
called prevention of mother-to-child transmission (or PMTCT).
Some approaches have recently been proven to work or are still in the research stage,
such as treatment-as-prevention, pre-exposure prophylaxis (or PrEP), and microbicides.
Here is a chart showing all of these interventions, and where the ARV-based prevention
options could be used.
Prevention of vertical transmission of HIV has many components. Among ARV-based
options alone, we know that an HIV-positive woman can receive ARVs during pregnancy
and at the time of delivery to help prevent HIV transmission. The baby receives ARV
syrup in the weeks following birth. So, this method spans all three time periods.
Using PrEP on a routine basis—for example, once a day—would ensure that a constant
level of ARVs is present in a person’s system before possible exposure and at the point
of exposure.
Microbicides could be used well before exposure or immediately before exposure. ARVbased microbicides in the form of gels, suppositories, douches or enemas, for example,
might have to be inserted vaginally or rectally shortly before sex, or they could possibly b
e used on a daily basis. However, if vaginal microbicides were formulated as rings that
slowly release the active ingredient, they could remain in the vagina for weeks at a time,
providing protection when a woman has sex.
Using treatment-as-prevention means that the HIV-positive person takes ARVs on an
ongoing basis to reduce the risk of transmission during sex. We will discuss later how
this could reduce the risk of transmitting HIV.
Finally, PEP must be started soon after a possible exposure to HIV. People taking PEP
after a potential exposure must continue a daily course of ARVs for four weeks.
Adapted from PowerPoint slides from Global Campaign for Microbicides. www.globalcampaign.org
HIV Prevention: Slide 22
Facilitator Notes: This is another visual way of representing HIV prevention options that
are either ARV-based or not ARV-based.
Male and female condoms, medical male circumcision, vaccines, needle exchange, and
voluntary counselling and testing are all examples of prevention interventions that do not
include ARVs.
The tools that rely on ARVs to be effective include PEP, PrEP, and treatment-asprevention.
Some vaginal and rectal microbicides might be based on ARVs, and others might work
in other ways. Prevention of vertical (or mother-to-child) transmission includes some
tools that are based on ARVs, and others that are not. Here you see these methods
listed where the circles overlap, because they may or may not be based on ARVs.
Adapted from PowerPoint slides from Global Campaign for Microbicides. www.globalcampaign.org
Treatment –as-Prevention: Slide 23
Facilitator Notes: We are now going to look more closely at four NPTs: treatment-asprevention, PrEP, microbicides and vaccines. For each one of these four tools, we will
provide a general description, give an overview of what we know about this tool’s
potential for reducing the risk of HIV, and explore some of the questions that remain to
be answered concerning that tool.
So first, let’s start with treatment-as-prevention. “Treatment-as-prevention” is a term
describing the use of antiretroviral drugs to reduce the risk of passing HIV to others. The
strategy would function as a secondary benefit of antiretroviral treatment after its primary
purpose of improving an HIV-positive individual’s health.
We know that individuals who successfully follow an ARV treatment regimen have a
reduced amount of virus in their blood and other bodily fluids. This is called their viral
load. Lower viral load is associated with lower risk of HIV transmission.
The treatment-as-prevention approach has been conceptualized in different ways and
called different things.
“Test and Treat” (sometimes abbreviated as TNT) often refers to the most aggressive
approach to treatment-as-prevention. For example, in San Francisco, public health
guidelines recommend that treatment be offered immediately to anyone who tests HIVpositive.
“Seek and Treat” is one of the abbreviated names of the British Columbia program
“STOP AIDS” (which stands for “Seek and Treat for Optimal Prevention of HIV/AIDS”).
Its goal is to diagnose those who are unaware of their HIV status, to diagnose everyone
as early as possible, and to support ongoing links to care and treatment programs. The
program recommends treatment according to current treatment guidelines.
TLC+ (which stands for Treatment and Linkage to Care, Plus offering Treatment) is the
name of a US pilot project that has similar goals to British Columbia.
What we Know about Treatment-as-Prevention: Slide 24
Facilitator Notes: Treatment for people who are HIV-positive could have prevention
benefits in two ways.
First, it has been proven to work at the individual level. One clinical trial demonstrated a
96% reduction in risk of HIV transmission in serodiscordant couples (couples in which
one partner was HIV-positive and the other was HIV-negative), when the HIV-positive
partner was taking ARVs. Almost all the couples in the trial were heterosexual couples.
Second, it may work at the population or community level. Some people argue that doing
HIV testing on a massive scale, along with providing treatment to those who test HIVpositive, could significantly reduce the number of new infections. Massive testing
campaigns would make more people aware of their status. Once they know their status,
HIV-positive people could then reduce their risk-taking behaviours and seek treatment.
Both a decrease in risk-taking and a decrease in viral load as a result of successful
treatment could decrease the rate of new HIV infections. In San Francisco, decreases in
community viral load have been associated with lower numbers of new HIV infections.
Around the world and in Canada there are demonstration projects, pilot studies and
revised public health guidance that are seeking to demonstrate and capitalize on the
prevention benefits of treatment.
Learn More: For further information about treatment-as-prevention consult the AVAC
and CATIE websites: http://www.avac.org/ht/d/sp/i/421/pid/421/cat_id/458/cids/457,458
and http://www.catie.ca/preventing-hiv/prevention-technologies#treating
On-screen text: Adapted from PowerPoint slides from the Global Campaign for
Microbicides. www.global-campaign.org
Questions about Treatment-as-Prevention: Slide 25
Facilitator Notes: How effective this prevention approach might be at a population level
in Canada depends on having a critical mass of HIV-positive people with an
undetectable viral load. This requires overcoming several hurdles.
First, about one-quarter of HIV-positive Canadians are unaware of their status. Second,
not all HIV-positive Canadians who know their status are taking ARVs. Some are not in
care, either because they are not linked to care once they test positive, or because they
are not retained in care. Some do not want to start treatment or are not eligible for
treatment according to current guidelines. There is still inconclusive evidence about
whether starting treatment earlier than when current treatment guidelines suggest has
positive, negative or neutral clinical benefits for the HIV-positive individual. Third, not all
people on treatment achieve undetectable viral levels. This may be because the drugs
are not effective for them, because they are not achieving high levels of adherence to
treatment, or because they have developed drug resistance.
Recent studies in Ontario and the United States have shown that taking into account all
of these hurdles, only an estimated 19-32% of HIV-positive individuals have
undetectable viral loads.
References (Gardner EM et al. The spectrum of engagement in HIV care and its
relevance to test-and-treat strategies for prevention of HIV infection. Clin Infect Dis 52:
793-800, 2011) (Vital signs: HIV prevention through care and treatment. CDC MMWR.
December 2, 2011 / 60(47);1618-1623) (Barry Adam. Epistemic fault lines in biomedical
and social approaches to HIV prevention. Journal of the International AIDS Society 2011,
14 (Suppl 2):S2)
Adapted from PowerPoint slides from the Global Campaign for Microbicides.
www.global-campaign.org
Pre-Exposure Prophylaxis: Slide 26
Facilitator Notes: Now let’s turn our attention to pre-exposure prophylaxis, or PrEP.
PrEP involves the ongoing use of one or two antiretroviral drugs by HIV-negative
individuals – starting before an exposure and continuing afterwards. This is in contrast to
post-exposure prophylaxis, or PEP, which is the use of antiretrovirals only AFTER a
potential exposure and only for a SHORT period of time (one month).
PrEP is a prevention option that could be used to reduce the risk of HIV infection from
ongoing exposures to HIV. It is not necessarily something that a person would take for
his or her whole life. PrEP may be an option during periods where a person is at higher
risk of becoming infected AND is not able to use other prevention strategies.
We know that infection does not occur instantly after an exposure to HIV. After an
exposure occurs, the virus needs to spread from the site of the exposure (such as the
vagina or rectum) to other parts of the body in order to cause an infection. Research
shows that it can up to 3 days for HIV to spread to other parts of the body.
During this short 3-day “window”, PrEP may be able to stop HIV from spreading past the
site of the exposure to other parts of the body.
Therefore, the goal of PrEP is to get high concentrations of antiretrovirals at places
where a person may be exposed to HIV. The antiretrovirals may be able to stop HIV
from spreading beyond the site of exposure to other parts of the body, thereby
preventing an infection.
Adapted from PowerPoint slides from CATIE: www.catie.ca
What we Know About PrEP: Slide 27
Facilitator Notes: So, what have studies told us? A number of trials have tested
whether PrEP, when provided in combination with a package of prevention services, can
reduce the risks of HIV infection. One trial showed that daily Truvada (which is a pill
containing the ARVs tenofovir and emthricitabine) can reduce the risk of infection among
men who have sex with men (or MSM) and trans women. Two trials showed that daily
Viread (which is tenofovir in pill form) or Truvada can reduce the risk of infection when
used by heterosexual men and women. However, two other trials were unable to show
that either daily Viread or Truvada could reduce the risk of infection when used by
heterosexual women.
The research strongly emphasizes that PrEP needs to be used consistently for it to work.
Participants who used PrEP inconsistently had a much lower level of protection. In fact,
poor adherence may explain the results in the two studies among women; however, this
is not yet known.
No major safety concerns were identified in the studies AND it seems that the risk of
side-effects, toxicity, and drug resistance are low. However, the risk of these may seem
to be low because of poor adherence to the drugs during the study, and we would not
expect participants to experience side effects, toxicity or to develop drug resistance if
they aren’t using the drug.
Adapted from PowerPoint slides from CATIE. www.catie.ca
Learn More: For further information about pre-exposure prophylaxis, consult the AVAC
and CATIE websites: http://www.avac.org/ht/d/sp/i/262/pid/262/cat_id/458/cids/453,458
and http://www.catie.ca/preventing-hiv/prevention-technologies#prep
Questions About PrEP: Slide 28
Facilitator Notes: There are still a lot of things we don’t know about PrEP. We still don’t
know the safety and effectiveness of other important types of PrEP such as non-daily
dosing. For example, someone might take their pill intermittently around the time they
are potentially exposed to HIV (like around sexual activity). However, some studies of
daily PrEP suggest that occasional use of PrEP is much less protective. We also don’t
know the safety and effectiveness of antiretrovirals other than Viread or Truvada.
As we saw, the data for women remains somewhat unclear at this point. We also don’t
know about the safety and effectiveness of daily Viread and Truvada in populations not
included in trials – such as adolescents, pregnant women, and people with underlying
health conditions. And no studies have been completed yet among people who use
injection drugs. We also have to consider that clinical trials are relatively short and don’t
tell us about the safety or effectiveness of PrEP over a longer period of time.
We also don’t know about the safety and effectiveness of PrEP when used outside of the
tightly controlled setting of a clinical trial. PrEP may be less effective and safe if it is not
provided in combination with an intensive package of prevention services such as riskreduction counselling and monitoring of side-effects, toxicity, and HIV status.
Also, PrEP has not yet obtained regulatory approval from Health Canada – which is
Canada’s regulatory agency. However, although PrEP has not been approved, people
may already be using it off-label. PrEP has been submitted for regulatory approval in the
United States, but as of early 2012, the FDA had not yet made its decision.
Adapted from PowerPoint slides from CATIE. www.catie.ca
Vaginal and Rectal Microbicides: Slide 29
Facilitator Notes: A microbicide is any substance that can substantially reduce the risk
of acquiring or transmitting sexually transmitted infections, including HIV, when it is
inserted in the vagina or rectum. It is important to understand that no proven
microbicides are on the market yet. What we are talking about here are products that are
still being researched.
Microbicides might look a lot like some of the over-the-counter products we already
know—the gel, lube, douche or enema that have been on the shelves for years. They
will not contain the same chemicals as these products, but they will come in some of the
same formulations.
Scientists are also working on developing new formulations that may eventually make
microbicides even more user friendly than gels or creams that are inserted with an
applicator. For example, they are working to make formulations that women can leave in
place for long periods of time. One possibility is a vaginal ring—a device that could
slowly release the protective substance over a month and provide round-the-clock
protection.
Almost all most microbicides in the research pipeline now are based on the antiretroviral
drugs, or ARVs, that are used for treating people who are HIV-positive.
Adapted from PowerPoint slides from Global Campaign for Microbicides: www.globalcampaign.org and International Rectal Microbicide Advocates:
www.rectalmicrobicides.org
What we Know About Vaginal Microbicides: Slide 30
Facilitator Notes: The research is still ambivalent about whether a microbicide as a
vaginal gel can reduce the risk of infection among heterosexual women, when provided
in combination with a package of prevention services. One trial showed that it can, while
another trial was unable to show that it can.
The research does strongly emphasize that microbicides need to be used consistently
for them to work. Participants who used the gel inconsistently had a much lower level of
protection. However, no major safety concerns were identified in the trials, AND it seems
that the risk of side-effects, toxicity, and drug resistance are low.
Several acceptability studies among different populations of women and men have
shown that it would be great to have different microbicides that would meet the following
criteria.
First, almost all candidates in development right now are based on ARVs. This means
that they are not contraceptives because—as far as we know—ARVs do not have any
effect on the reproductive potential of sperm. This is good, because a microbicide that is
not contraceptive might enable a woman to become pregnant whilst still protecting
herself from HIV. This cannot be done with condoms, so a non-contraceptive
microbicide would give women a completely new option. This is one reason why people
living with HIV are also interested in microbicides. But many women want something that
can protect them from disease and pregnancy at the same time. Once we have an
effective microbicide, it may be possible to add contraceptive ingredients to make a dualaction product—one that prevents pregnancy and reduces HIV risk.
Second, making sure that microbicides will be affordable and accessible is a
fundamental goal.
Finally, one big advantage of a microbicide would be not needing your partner’s active
cooperation to use it—as you do with male or female condoms. Talking with your partner
about using microbicides could be a one-time conversation, and would not have to occur
right before sex.
Adapted from PowerPoint slides from Global Campaign for Microbicides: www.globalcampaign.org and CATIE. www.catie.ca
Learn More: For further information about microbicides consult the AVAC and CATIE
websites: http://www.avac.org/ht/d/sp/i/178/pid/178/cat_id/458/cids/452,458 and
http://www.catie.ca/preventing-hiv/prevention-technologies#microbicides
Questions About Vaginal and Rectal Microbicides: Slide 31
Facilitator Notes: Several questions remain concerning microbicides. First, could
microbicides protect against STIs other than HIV? Almost all candidates in development
right now are based on ARVs. Therefore, they are unlikely to protect against STIs other
than HIV, without adding additional active ingredients beyond ARVs. The one exception
to this is tenofovir gel, which in one trial reduced the risk of genital herpes (HSV-2) by
half when used vaginally.
Second, we must acknowledge that once a microbicide is available in gel form, it is likely
to be used both vaginally and rectally. Therefore, ideally, such products should be both
safe and effective when used either vaginally or rectally. Research is underway to
determine whether this is feasible.
Third, we need microbicides that people who are HIV-positive can use. They could help
reduce the risk of STIs, and allow for conception, while reducing the risk of infection for
serodiscordant couples. Unfortunately, ARV-based microbicides will not be appropriate
for use by people already living with HIV, because of the potential for drug resistance to
develop. Non-ARV-based microbicides would help alleviate this risk.
No rectal microbicide has been tested in large-scale efficacy trials, although some ARVbased gel products are moving through the research pipeline. For many reasons, rectal
microbicide research lags behind vaginal microbicide research. Rectal microbicides
would be useful for both men and women who have anal sex.
Many people use lubricants during sexual intercourse. Yet we know very little about their
safety, particularly when used during anal intercourse. Very few studies have examined
the effect of lubricants on human rectal tissue, but those that did showed mixed results.
However, given that so little research has been done so far, there is still very little
information that can be usefully provided to individuals in the context of HIV prevention
programmes. More research is urgently needed to determine whether lubricants
increase, decrease or have no effect on the risk of acquiring HIV or other STIs.
Adapted from PowerPoint slides from Global Campaign for Microbicides: www.globalcampaign.org. Lubricant information is from International Rectal Microbicide Advocates:
www.rectalmicrobicides.org
Vaccines: Slide 32
Facilitator Notes: A preventive vaccine is a substance (usually a part of the virus) that
teaches the body to recognize and defend itself against bacteria and viruses that cause
disease.
A vaccine causes a response from the immune system—the body's defense system—
preparing it to fight if exposed to a specific infection.
A vaccine is not a cure, but prevents infection or slows disease progression.
What we Know About Vaccines: Slide 33
Facilitator Notes: After four large-scale clinical trials, one vaccine regimen provided a
slight level of protection, one increased the risk of infection in some people, and two
other trials showed no protective effect. As of early 2012, no simple vaccine regimen has
yet provided a considerable, long-term level of protection.
However, there are some encouraging signs.
Broadly neutralizing antibodies have been recently discovered for the first time. These
are the types of antibodies that could lead to effective vaccine strategies, since they
could potentially neutralize HIV.
There is precedent for other diseases. We have developed highly successful vaccines
against other viral infections.
We also have precedents from animal studies. Long-term control of infection has been
achieved in vaccinated monkeys.
Finally, some individuals, termed “long-term non-progressors”, have the ability to control
their HIV infections. Other groups of individuals carry a gene mutation, and are therefore
rendered “un-infectable” by the virus.
Learn More: For further information about HIV vaccines, consult the AVAC and CATIE
websites: http://www.avac.org/ht/d/sp/i/177/pid/177/cat_id/458/cids/451,458 and
http://www.catie.ca/preventing-hiv/prevention-technologies#vaccines
Adapted from PowerPoint slides from the HIV Vaccine Trials Network: www.hvtn.org
Questions About Vaccines: Slide 34
Facilitator Notes: Many challenges remain. First, traditional approaches for developing
vaccines have either not worked well or would be unsafe when applied to HIV vaccine
development, so scientists are using newer techniques. Using these techniques, there is
no chance that an HIV vaccine will cause infection.
Second, animal models have not yet accurately predicted how vaccine candidates tested
in labs will work in humans.
Third, the correlates of protection for HIV are mostly unknown. In other words, we don’t
know much about what immune responses will protect an individual from infection. So
we don’t know what we’re trying to get an HIV vaccine to do, exactly.
Finally, HIV mutates a great deal, and there are many different subtypes of HIV. This
may mean that a vaccine would not work against all strains of HIV circulating in the
world.
Adapted from PowerPoint slides from the HIV Vaccine Trials Network: www.hvtn.org
Suggested Activities
Discussion
This section will no doubt generate allot of discussion. Be sure to have the relevant trial
information on hand to refer to and to have a somewhat developed knowledge about
these different technologies by reading up on them before hand.
Remember: Many of the questions participants will have regarding NPTs remain
unknown and can only be answered through further trials, demonstration sites and real
world use.
Section 5: NPT Implementation Issues
NPT Implementation Issues: Slide 36
Facilitator Notes: As we think about the role of NPTs in the Canadian HIV prevention
landscape, we must ensure that we derive the maximum benefits and minimize potential
risks. In order to do this, we must develop comprehensive implementation guidelines
that include all the elements listed here. We must also address barriers to access, and
measure the impact of NPTs.
Expanding the range of available prevention options means ensuring that the
characteristics of each prevention option are carefully considered and weighed in
relation to the prevention needs and contexts of individuals and populations at risk.
NPTs will be effective at reducing rates of HIV in Canada only if they can be delivered
and accessed by those who are most at risk.
We should note that “risk compensation” is the increase in risky behaviour that may
occur as a result of real or perceived decreased risk that results from using a prevention
tool, whether that is using condoms, getting vaccinated, or taking PrEP. For example,
people may increase their number of sexual partners; they may use condoms less
frequently; or they may engage in riskier sexual activities that they had previously.
NPTs – Measuring Impact: Slide 37
Facilitator Notes: As NPTs are made available, we must be able to monitor safety and
toxicity, especially for interventions based on ARVs. We need to carefully monitor
adherence and risk compensation to ensure that the introduction of new prevention
options does not have the perverse effect of increasing the number of new infections.
Finally, we must assess the impact of expanded prevention efforts on HIV incidence.
Learn More: For further information about NPT implementation issues, consult the
CPHA and CATIE websites. http://www.cpha.ca/uploads/portals/hiv/npt-hiv_e.pdf and
http://www.catie.ca/pdf/NPTPartialEfficacy-EN.pdf
Next Steps: Slide 38
Facilitator Notes: The introduction of NPTs presents significant challenges. There will
be complexities that must be anticipated and addressed, and, as history has taught us,
there are important reasons to begin planning strategies now to ensure future access to
NPTs as part of a larger comprehensive prevention package. Here is what you can do.
Conclusion: New HIV Prevention Technologies
Conclusion: Slide 39
Facilitator Notes: Recently, biomedical prevention technologies have begun to show
great promise as several large efficacy trials demonstrated proof-of-concept or
established efficacy for vaccines, pre-exposure prophylaxis, microbicides, and
treatment-as-prevention. While some of these products (i.e., vaccines, vaginal
microbicides) are not currently available anywhere outside of clinical trials, other new
HIV prevention technologies such as treatment-as-prevention and pre-exposure
prophylaxis are currently available to Canadians. Though current levels of awareness
and access vary greatly, these technologies have the potential to considerably reduce
the impact of HIV in Canada and around the world.
However, as the Global HIV Prevention Working Group noted, the world is unprepared
to capitalize on the potential success of prevention research currently underway. Very
little has been done to mobilize resources and develop the public health guidance,
provider training and education needed to ensure rapid implementation of new
prevention methods.
Priorities are quickly shifting from scientific research to issues of implementation, and the
success of NPTs will be measured by how well they are introduced, communicated and
adopted.
The front-line workforce needs not only to build its own preparedness, knowledge and
capacity, but to engage more meaningfully in NPT research, policy and planning.
Acronyms: Introduction to New HIV Prevention Technologies
ACRONYMS
AIDS
Acquired Immune Deficiency Syndrome
ARV
Anti-Retroviral Treatment
ASO
AIDS Service Organization
CBO
Community Based Organization
CDC
Centres for Disease Control and Prevention
CHVI
Canadian HIV Vaccine Initiative
CPHA
Canadian Public Health Association
HIV
Human Immunodeficiency Virus
HSV-2
Herpes Simplex Virus 2
IDU
People who Inject Drugs
MSM
Gay, Bisexual and Men Who Have Sex With Men
NPT
New HIV Prevention Technology
PLWHA
People Living With HIV and AIDS
PHAC
Public Health Agency of Canada
RCT
Randomized Control led Trials
PEP
Post Exposure Prophylaxis
nPEP
Non-Occupational Post Exposure Prophylaxis
PMTCT
Prevention of Mother to Child Transmission
PrEP
Pre Exposure Prophylaxis
STI
Sexually Transmitted Infections
TNT
Test and Treat
VCCT
Voluntary Confidential Counseling and Testing
Evaluation: New HIV Prevention Technologies
Evaluation; Pre & Post Test
1. Which of the following statements is INCORRECT?
a) Gay, bisexual and other men who have sex with men still represent the group with
the largest number of new HIV infections in Canada.
b) Heterosexual transmission now accounts for the largest number of new infections in
Canada.
c) The number of Canadians living with HIV keeps increasing.
d) 1 out of 4 HIV-positive Canadians is unaware of their status.
2. Which statement is FALSE? “New HIV prevention options could help to fill an
important prevention gap because they might…
a) provide cheaper options than condoms.”
b) allow conception while still reducing the risk of HIV infection.”
c) enhance sexual pleasure without forming a physical barrier.”
d) be more within the control of the receptive partner.”
3. _______________ can be defined as the regular use of medications used for HIV
treatment by HIV-negative individuals in hopes of preventing an infection.
a) Treatment-as-prevention
b) Pre-Exposure Prophylaxis
c) Post-Exposure Prophylaxis
d) Harm Reduction
4. ______________ can be defined as an intervention in which people who have already
been potentially exposed to HIV take a brief course (usually 28 days) of antiretroviral
(ARV) medications as soon as possible after exposure.
a) Treatment-as-prevention
b) Pre-Exposure Prophylaxis
c) Post-Exposure Prophylaxis
d) Harm Reduction
5. Because microbicide candidates that are furthest along in the research process
today are based on antiretroviral drugs (ARVs), they could possibly (select ONE):
a) Protect against other STIs
b) Be contraceptive
c) Be used by HIV-positive people
d) Be used rectally
6. There are many obstacles to achieving the prevention benefits of treatment-asprevention. Which of the following statements is TRUE in Canada today? “It is
estimated that…
a) Most HIV-positive Canadians are unaware of their status.”
b) Most HIV-positive Canadians chose not to take treatment.”
c) Most HIV-positive Canadians have drug-resistant strains of the virus.”
d) Most HIV-positive Canadians have detectable viral loads.”
7. Efficacy of a NPT refers to:
a) The ability of the NPT to prevent infection or disease in the trial population
b) The ability of the NPT to protect against diseases other than the one it was intended
for
c) The ability of the NPT to protect against the disease 100% of the time
d) The ability of the NPT to produce quick results
8. To avoid the perverse effect of increasing HIV incidence, HIV prevention programs
that include NPTs must promote everything below EXCEPT:
a) Regular testing
b) Adherence
c) Monitoring of drug resistance
d) Risk compensation
Acknowledgments: Introduction to New HIV Prevention
Technologies
Acknowledgments
The Introduction to New HIV Prevention Technologies eLearning Module would not have
been possible without the support of the many participants in the project’s workshops
and consultations, key informants, online surveys and focus groups. We also thank the:
Members of the Project Planning Committee:
 Dr. Terry-Nan Tannenbaum, Assistant Director, Santé Publique de Montréal
 Dr. Darrell Tan, HIV Physician, Toronto General Hospital
 Greg Riehl, Program Head, Basic Critical Care Nursing Program, Saskatchewan
Institute of Applied Science and Technology
 Angus Campbell, Executive Director, Halifax Sexual Health Centre
 Zhaida Uddin, Program Development Officer, Ottawa Public Health
 Katie West Slevin, HIV educator, Consultant
 Anthony Lombardo, Professor, Sir Wilfred Laurier
 David Thompson, Board Member, RÉZO
 Tim Rogers, Director Knowledge Exchange, CATIE
 Jody Jollimore, Program Manager, Health Initiative for Men
Members of the Project Advisory Committee:
 Dr. Kenneth Rosenthal, Professor for the Department of Pathology and Molecular
Medicine, McMaster University
 Greg Riehl, Program Head, Basic Critical Care Nursing Program, Saskatchewan
Institute of Applied Science and Technology
 Angus Campbell, Executive Director, Halifax Sexual Health Centre
 Ken Clement, Executive Director, Canadian Aboriginal AIDS Network
 Bachir Sarr, Programs Consultant, Canadian AIDS Society
 Suzanne Rowland, Nursing Project Officer, Ottawa Public Health
Production of this eLearning module has been made possible through a financial
contribution from the Public Health Agency of Canada. The views expressed herein do
not necessarily represent the views of Public Health Agency of Canada.
Copyright © 2012
Canadian Public Health Association
For more information, contact:
Canadian Public Health Association
300–1565 Carling Avenue, Ottawa, Ontario K1Z 8R1
Tel: 613-725-3769 Fax: 613-725-9826
E-mail: [email protected] www.cpha.ca
Disclaimer: Introduction to New HIV Prevention Technologies
DISCLAIMER
This course has been developed to assist frontline providers who work in HIV
prevention across Canada to better understand and communicate information about
new HIV prevention technologies (NPTs). Material presented herein represents the
state of the science as of March 2012.
This course is intended for educational and informational purposes only and does not
offer detailed information on the clinical management of HIV infection. The goal is to
provide an overview to frontline providers so they understand the science of
emerging HIV technologies and can begin to consider how these may influence their
practices. Scenarios presented in the materials are for illustrative purposes only and
the materials are intended solely to supplement the accumulated medical training,
experience and judgment of the frontline provider. Such professionals will need to
decide on the appropriate response/clinical management based on the particular
circumstances of each case. Users should consult other sources to obtain
comprehensive information on clinical management. None of the materials used in
this course is intended as a substitute for professional medical advice, diagnosis or
treatment.
While care has been taken in the preparation of the materials used in this course, the
Canadian Public Health Association and the affiliates, partners, licensors and content
providers of the foregoing (collectively, the “Contributors”) do not and cannot
guarantee accuracy. Each of the Contributors expressly disclaims any and all
warranties, expressed or implied, including without limitation any warranties for
fitness for a particular purpose with respect to the materials, and assumes no
responsibility or liability arising from any error in or omission from the materials or
use of or reliance upon the materials in any manner, including but not limited to any
liability for personal injury or death or any direct, indirect, special or consequential
damages. Any use of or reliance upon any course materials shall be at the sole risk
of the user.
Links to websites not under the control of any of the Contributors are provided solely
for the convenience of visitors. None of the Contributors are responsible for the
accuracy, currency or reliability of the content of external websites, nor do any of the
Contributors offer any warranties or guarantees in that regard. In addition, none of
the Contributors shall be responsible for any information found through such links,
nor shall any of the Contributors be deemed to endorse any websites or their content.
Visitors should also be aware that information offered by sites owned or operated by
parties other than the Contributors to which this online course links may not be
subject to the Privacy Act (Canada) or the Official Languages Act (Canada), and may
not be accessible to persons with disabilities. The information offered may be
available only in the language(s) used by the sites in question and visitors should
research the privacy policies of the sites before providing personal information.