Gates Foundation to Invest Up to $140M in HIV Prevention Device(wsj.com)
wsj.com
Gates Foundation to Invest Up to $140M in HIV Prevention Device
http://www.wsj.com/articles/gates-foundation-to-invest-up-to-140-million-in-hiv-prevention-device-1483023602
21 comments
Where in the body does the device go? How is it inserted?
And how the heck do they make this cost-effective while still being safe? In Sub-Saharan Africa?
> And how the heck do they make this cost-effective while still being safe? In Sub-Saharan Africa?
PrEP (as in the daily pill) is actually incredibly cost-effective. We already have distribution networks for HIV medications, because we need to treat people who are HIV+ with ARVs. So expanding those to be used by people who are HIV- is really straightforward.
The advantage of this proposed approach (the implantabable pumps), of course, is that it'd be more akin to an IUD, which is preferable in situations where people have reliable, but infrequent, access to medical care. That's a situation that applies a lot of rural and poor areas in developing countries.
We've already been looking into making PrEP available as a vaccine that would be effective for six months at a time, so I don't think this is particularly shocking of a proposal. (Which is not to say that it wouldn't be amazing if it works out - it would!)
PrEP (as in the daily pill) is actually incredibly cost-effective. We already have distribution networks for HIV medications, because we need to treat people who are HIV+ with ARVs. So expanding those to be used by people who are HIV- is really straightforward.
The advantage of this proposed approach (the implantabable pumps), of course, is that it'd be more akin to an IUD, which is preferable in situations where people have reliable, but infrequent, access to medical care. That's a situation that applies a lot of rural and poor areas in developing countries.
We've already been looking into making PrEP available as a vaccine that would be effective for six months at a time, so I don't think this is particularly shocking of a proposal. (Which is not to say that it wouldn't be amazing if it works out - it would!)
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(Re-phrasing.)
Right, but how exactly are they making a surgery/implant kind of thing safe and cost-effective in this area?
Right, but how exactly are they making a surgery/implant kind of thing safe and cost-effective in this area?
> Right, but how exactly are they making a surgery/implant kind of thing safe and cost-effective in this area?
Same way a vaccine becomes cost-effective, I'd imagine.
The article is paywalled, but from what I can tell, they're using Truvada, so the research is specifically for the method of delivery, not developing the drug itself, which cuts the overhead costs dramatically. Stents[0] aren't expensive per se; the expensive part is installing them. But if that only needs to be done every six months, and if it can be done by an RN or NP, then the cost of delivery starts to fall quickly as well.
The main question I have is why they're heading down a fairly different road (subdermal implant) as opposed to a vaccine, since as far as I know, Gilead is already developing the latter. There must be more to this story than what I can find on the WSJ stub and the Quartz article.
[0] This isn't actually a stent, but it looks like it'll be something similar
Same way a vaccine becomes cost-effective, I'd imagine.
The article is paywalled, but from what I can tell, they're using Truvada, so the research is specifically for the method of delivery, not developing the drug itself, which cuts the overhead costs dramatically. Stents[0] aren't expensive per se; the expensive part is installing them. But if that only needs to be done every six months, and if it can be done by an RN or NP, then the cost of delivery starts to fall quickly as well.
The main question I have is why they're heading down a fairly different road (subdermal implant) as opposed to a vaccine, since as far as I know, Gilead is already developing the latter. There must be more to this story than what I can find on the WSJ stub and the Quartz article.
[0] This isn't actually a stent, but it looks like it'll be something similar
If this implant lives up to the promise of being "matchstick sized", then delivery is trivial. Like existing hormonal contraceptive implants, it could be inserted under the skin with a hypodermic needle. There are no shortage of healthcare workers with training in providing vaccination; training them to provide these implants would take a couple of hours.
A device for this exists already. Is he going to invest all that money in Durex or Trojan?
Smug dismissal is a behavior we already have more than enough of; please consider finding a different gear so to speak.
I downvoted you. Since I really hate when people downvote me without providing a reason I thought I would comment:
This is pragmatism in action. I do think it's often easier to get better results by working around people's behaviors than than to try to fight them. (Btw: this applies to more situations involving humans than you're probably assuming.)
You're just being flippant, saying there is a solution, seemingly without even attempting to consider the situation from a holistic system point of view.
This is pragmatism in action. I do think it's often easier to get better results by working around people's behaviors than than to try to fight them. (Btw: this applies to more situations involving humans than you're probably assuming.)
You're just being flippant, saying there is a solution, seemingly without even attempting to consider the situation from a holistic system point of view.
I can think of several reasons why this is better. One being that condoms only work if the man wears them (obviously). In cases of sexual assault or similar this would allow the other person to be protected from hiv.
Another being that condoms aren't 100% effective at preventing hiv, and combining with this provides more sure protection.
Another being that condoms aren't 100% effective at preventing hiv, and combining with this provides more sure protection.
> A device for this exists already. Is he going to invest all that money in Durex or Trojan?
First of all, sex is not the only way to contract HIV.
Second - and most people don't know this - condoms are not FDA approved for anal sex. They're not even tested for anal sex, and the testing requirements for condoms are specifically limited to vaginal sex[0].
But even if we look at vaginal sex, condoms are rather ineffective compared to other prevention methods, even when you look at success rates under perfect use. And perfect use is not what's relevant - what you need to look at are success rates under actual use). In this regard, condoms fail horribly as an HIV prevention tactic.
Decades of unscientific education or education based on faulty science have caused people to subjectively underestimate their risk of contracting HIV when using condoms, and to subjectively overestimate their risk when using other prevention methods.
For example, how would you rank these behaviors in terms of risk levels?
* Having sex, with a condom, with more than one partner of unknown HIV status * Having sex, without a condom and without PrEP, with a single, HIV+ partner with an undetectable viral load * Having sex, without a condom while taking PrEP, with multiple partners of unknown HIV status
Surprisingly, the first is the riskiest, and the second and third are comparable levels of risk. (The second is actually believed to be slightly less risky than the third, but the difference is not even statistically significant, let alone practically significant).
The common counterargument to this is that condoms prevent more than just HIV - except even then, people dramatically overestimate the protection that condoms provide. HIV is pretty much the only (common) sexually transmitted disease that can be transmitted through vaginal or anal intercourse but not through oral sex or other forms of physical and sexual contact. Since most people only use condoms for intercourse, the added protection they provide for other STDs under these scenarios is a lot less than people imagine.
In fact, STD transmission rates are actually lower among people who use PrEP for HIV prevention. The common explanation for this is that people on PrEP have to get routine checkups (every 90 days, usually), and this provides a convenient time to do other STD testing as well. For most people, the problem is that they simply don't do routine STD testing at all, which means they can have asymptomatic STDs (chlamydia, gonorrhea, syphilis, etc.) for much longer, which makes them harder to treat, and pass them on to more people in the interim.
[0] http://www.imstilljosh.com/fda-condoms-not-approved-anal-sex...
First of all, sex is not the only way to contract HIV.
Second - and most people don't know this - condoms are not FDA approved for anal sex. They're not even tested for anal sex, and the testing requirements for condoms are specifically limited to vaginal sex[0].
But even if we look at vaginal sex, condoms are rather ineffective compared to other prevention methods, even when you look at success rates under perfect use. And perfect use is not what's relevant - what you need to look at are success rates under actual use). In this regard, condoms fail horribly as an HIV prevention tactic.
Decades of unscientific education or education based on faulty science have caused people to subjectively underestimate their risk of contracting HIV when using condoms, and to subjectively overestimate their risk when using other prevention methods.
For example, how would you rank these behaviors in terms of risk levels?
* Having sex, with a condom, with more than one partner of unknown HIV status * Having sex, without a condom and without PrEP, with a single, HIV+ partner with an undetectable viral load * Having sex, without a condom while taking PrEP, with multiple partners of unknown HIV status
Surprisingly, the first is the riskiest, and the second and third are comparable levels of risk. (The second is actually believed to be slightly less risky than the third, but the difference is not even statistically significant, let alone practically significant).
The common counterargument to this is that condoms prevent more than just HIV - except even then, people dramatically overestimate the protection that condoms provide. HIV is pretty much the only (common) sexually transmitted disease that can be transmitted through vaginal or anal intercourse but not through oral sex or other forms of physical and sexual contact. Since most people only use condoms for intercourse, the added protection they provide for other STDs under these scenarios is a lot less than people imagine.
In fact, STD transmission rates are actually lower among people who use PrEP for HIV prevention. The common explanation for this is that people on PrEP have to get routine checkups (every 90 days, usually), and this provides a convenient time to do other STD testing as well. For most people, the problem is that they simply don't do routine STD testing at all, which means they can have asymptomatic STDs (chlamydia, gonorrhea, syphilis, etc.) for much longer, which makes them harder to treat, and pass them on to more people in the interim.
[0] http://www.imstilljosh.com/fda-condoms-not-approved-anal-sex...
> For example, how would you rank these behaviors in terms of risk levels?
Under 1% for all examples given.
Under 1% for all examples given.
Penis guillotine
Obviously, this is great news and well-done by the Gates family. But I always wonder if we shouldn't be putting this kind-of money into what I consider society's most pressing problem which is our social intelligence, or in a single word, tolerance.
We can have all the technical/medical/etc intelligence but if our social intelligence lags behind then it creates the problems we have today such as over-population, racism, nationalism, etc. And, seemingly, this gap is increasing; we are now on the cusp of AI, machine-learning, robotics, automation, etc, yet we can't tolerant another person's skin-colour, or their lifestyle, or their life choices, or even their gender. Socially, we are apes with nuclear weapons.
I guess one might say that these innovations help mankind as a whole since they (should) increase quality-of-life. But these innovations only help if they help the entire base of the population pyramid. And as we know, greed and the pursuit of money/power/etc can and usually do create a world of haves/have nots which, again, are symptoms of a selfish, individualistic society. We only have to look at Martin Shkreli as evidence here.
So all these innovations pour out of labs, corporations, universities as the earth temperatures and ocean waters rise-up. We just don't have the political or economic will to understand that our intolerance, and the increasing gap between our social and technical intelligence is the biggest issue of our time.
We can have all the technical/medical/etc intelligence but if our social intelligence lags behind then it creates the problems we have today such as over-population, racism, nationalism, etc. And, seemingly, this gap is increasing; we are now on the cusp of AI, machine-learning, robotics, automation, etc, yet we can't tolerant another person's skin-colour, or their lifestyle, or their life choices, or even their gender. Socially, we are apes with nuclear weapons.
I guess one might say that these innovations help mankind as a whole since they (should) increase quality-of-life. But these innovations only help if they help the entire base of the population pyramid. And as we know, greed and the pursuit of money/power/etc can and usually do create a world of haves/have nots which, again, are symptoms of a selfish, individualistic society. We only have to look at Martin Shkreli as evidence here.
So all these innovations pour out of labs, corporations, universities as the earth temperatures and ocean waters rise-up. We just don't have the political or economic will to understand that our intolerance, and the increasing gap between our social and technical intelligence is the biggest issue of our time.