PrEPsmart + Truvada for HIV Prevention

Overseen By Juwann Moss

Age: 18+

Sex: Male

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Phase 2

Recruiting

Sponsor: Public Health Foundation Enterprises, Inc.

Must be taking: On-demand PrEP

Disqualifiers: Reactive HIV, Acute HIV symptoms, others

No Placebo Group

Prior Safety Data

Approved in 4 Jurisdictions

Trial Summary

What is the purpose of this trial?

This is a pilot study to assess the feasibility, acceptability, and preliminary effectiveness of pre-exposure prophylaxis (PrEP)smart among cisgender sexual minority males (SMM) taking on-demand PrEP over a 6-month period. Upon project completion, the investigators will have developed a highly innovative tool to support men who have sex with men (MSM) using on-demand PrEP ready for testing in a larger efficacy trial

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. However, it does require that you have no contraindications (reasons not to take) to TDF/FTC, which is the medication used in the study.

Is Truvada safe for use in humans?

Truvada, a combination of tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC), is generally considered safe for use in humans for HIV prevention. Some side effects observed in clinical trials include nausea, increased levels of certain enzymes in the blood, and reduced bone mineral density. ^{1 2 3 4 5}

How is the drug Truvada unique for HIV prevention?

Truvada is unique for HIV prevention because it combines two drugs, tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC), and is taken daily as a pre-exposure prophylaxis (PrEP) to effectively reduce the risk of HIV infection in various populations, including men who have sex with men and heterosexual couples. ^{3 5 6 7 8}

Research Team

Albert Liu

Principal Investigator

[e-mail]

Eligibility Criteria

This trial is for cisgender sexual minority males (SMM) who are interested in using a mobile app to help manage on-demand pre-exposure prophylaxis (PrEP) over six months. Participants should be men who have sex with men (MSM), but specific inclusion and exclusion criteria details were not provided.

Inclusion Criteria

Able to attend study visits at a local research site in San Francisco (Bridge HIV) (prescribed and non-prescribed groups) or virtual visits via a HIPAA-compliant teleconferencing platform (non-prescribed group)

Have PrEP clinical and laboratory monitoring by another provider or clinic by self-report (non-prescribed group)

Owns an iOS or Android mobile phone with a camera and has private access to the internet

Exclusion Criteria

Unable to commit to study participation for the duration of the study

Currently enrolled in another PrEP intervention study

Repeatedly reactive HIV test at screening or enrollment or self-reported reactive HIV test (prescribed group)

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

1 visit (in-person)

Enrollment and Randomization

Participants are enrolled and randomized to either the PrEPsmart intervention or control group

1 week

1 visit (in-person or virtual)

Treatment

Participants receive the PrEPsmart app and are monitored for PrEP use and app usability

6 months

Follow-up visits at 3 and 6 months (in-person or virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment

4 weeks

Treatment Details

Interventions

• Truvada (Antiretroviral)

Trial Overview The PrEPsmart pilot study is testing the use of a mobile app designed to support MSM taking Truvada as on-demand PrEP against HIV. The goal is to see if the app is easy to use, acceptable to participants, and effective at supporting medication management.

Participant Groups

Group I: PrEPsmart intervention (N=40) Experimental Treatment 2 Interventions

Participants will be randomized in a 2:1 ratio to the intervention (N=40) For the pre-exposure prophylaxis (PrEP)smart intervention group, a study clinician will perform a medical history and limited physical exam to confirm eligibility to enroll in the study, a 4th generation rapid Human immunodeficiency virus (HIV) test will be performed, and labs drawn for creatinine, sexual transmitted infection (STI) testing (Neisseria gonorrhoeae/Chlamydia trachomatis (GC/CT)), syphilis), and hepatitis B testing. For participants newly starting 2-1-1 PrEP (PrEPsmart intervention group), study drug will be offered to participants to ensure that they will have access to PrEP during the study to be able to adequately test the app.

Group II: control (N=20) Active Control 1 Intervention

For the non-prescribed group, study staff will request documentation of an HIV-negative test within the last 3 months OR evidence of pre-exposure prophylaxis (PrEP) prescription within the last 6 months from medical records or pharmacy/provider communication. Additionally, study staff will confirm via self-report that the participant's 2-1-1 PrEP use will be clinically monitored by another clinician or clinic for the duration of the study. Any individual with a positive HIV test will have a confirmation test sent to the lab and be referred immediately for HIV care and initiation of treatment. For participants already on PrEP (control group) may choose to continue to use their own supply of Truvada (tenofovir disoproxil fumarate/emtricitabine, or TDF/FTC).

Truvada is already approved in Canada for the following indications:

Approved in Canada as Truvada for:

• HIV pre-exposure prophylaxis

Who Is Running the Clinical Trial?

Public Health Foundation Enterprises, Inc.

Lead Sponsor

Trials

15

Recruited

1,600+

Gilead Sciences

Industry Sponsor

Trials

1,150

Recruited

878,000+

Daniel O'Day

Gilead Sciences

Chief Executive Officer since 2019

MBA from Columbia University

Dietmar Berger

Gilead Sciences

Chief Medical Officer

MD and PhD from Albert-Ludwigs University School of Medicine

Findings from Research

Tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) are effective in reducing the risk of HIV infection by 74 to 92% when taken as pre-exposure prophylaxis (PrEP) with detectable drug levels.

While TDF-FTC can cause side effects like nausea and decreased bone mineral density, these risks can be managed through regular monitoring by healthcare providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Drug safety evaluation of oral tenofovir disoproxil fumarate-emtricitabine for pre-exposure prophylaxis for human immunodeficiency virus infection. Trang, TP., Dong, BJ., Kojima, N., et al.[2017]

Tenofovir disoproxil fumarate-emtricitabine (TDF/FTC) has been approved for HIV pre-exposure prophylaxis (PrEP) since 2012, and while initial uptake was slow, recent surveys indicate growing acceptance among key populations.

Ongoing studies aim to improve PrEP implementation by identifying at-risk individuals in primary care settings and evaluating its use in HIV-discordant couples, highlighting the need for better education among healthcare providers and addressing financial barriers for underinsured patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Antiretroviral pre-exposure prophylaxis implementation in the United States: a work in progress. Mayer, KH., Hosek, S., Cohen, S., et al.[2022]

Truvada (FTC/TDF) is an effective preexposure prophylaxis (PrEP) for HIV, but only a small fraction of the 1.2 million adults who could benefit from it are currently using it, highlighting a gap in preventative care.

The article emphasizes the importance of primary care providers (PCPs) in discussing and prescribing PrEP, aiming to enhance their confidence in managing patient care for high-risk groups to further reduce HIV incidence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

PrEParing for Preexposure Prophylaxis. Zappas, MP., Foreman, RM.[2021]

Oral tenofovir disoproxil and emtricitabine (FTC) for HIV preexposure prophylaxis (PrEP) is generally safe and well tolerated, with common gastrointestinal side effects that typically resolve within weeks.

While there is a slight decline in kidney function (eGFR) and bone mineral density (BMD) associated with the treatment, these changes are not clinically significant and tend to resolve after stopping the medication, making it a viable option for most adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety of oral tenofovir disoproxil - emtricitabine for HIV preexposure prophylaxis in adults. Liegeon, G.[2022]

A peri-coital regimen of Truvada (FTC and TDF) was shown to fully protect macaques from vaginal SHIV infection after 18 exposures, indicating its efficacy in preventing HIV transmission.

Despite lower concentrations of the drug in vaginal tissues compared to rectal tissues, the treatment was effective, suggesting that simplified PrEP regimens could be developed for women to prevent HIV transmission.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Prevention of vaginal SHIV transmission in macaques by a coitally-dependent Truvada regimen. Radzio, J., Aung, W., Holder, A., et al.[2021]

Tenofovir disoproxil fumarate (TDF) and its combination with emtricitabine (FTC), marketed as Truvada®, have been shown to be effective in preventing HIV infection when taken orally, either daily or intermittently, in various populations including men who have sex with men and serodiscordant couples.

Topical tenofovir gel has also demonstrated effectiveness in preventing HIV infection in women, highlighting the versatility of tenofovir-based interventions in HIV prophylaxis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Pre-exposure chemoprophylaxis of HIV infection: quo vadis? Clercq, ED.[2015]

Using tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for preexposure prophylaxis (PrEP) is effective in preventing HIV-1 infections, with resistance to the drugs being rare if PrEP is started before infection occurs.

However, starting PrEP during an undiagnosed acute HIV-1 infection can lead to higher rates of drug resistance, particularly to tenofovir, highlighting the importance of screening for HIV before initiating PrEP.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Should we fear resistance from tenofovir/emtricitabine preexposure prophylaxis? Parikh, UM., Mellors, JW.[2018]

The study found that the combination of emtricitabine and tenofovir alafenamide (F/TAF) was safe and well-tolerated among HIV-uninfected women, with significantly lower gastrointestinal side effects compared to the older F/TDF combination.

F/TAF demonstrated higher concentrations of the active form of tenofovir (TFV-DP) in peripheral blood mononuclear cells and vaginal tissues compared to F/TDF, suggesting it may be a more effective option for HIV pre-exposure prophylaxis in women.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Safety and Pharmacokinetics of a Tenofovir Alafenamide Fumarate-Emtricitabine based Oral Antiretroviral Regimen for Prevention of HIV Acquisition in Women: A Randomized Controlled Trial. Thurman, AR., Schwartz, JL., Cottrell, ML., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

Drug safety evaluation of oral tenofovir disoproxil fumarate-emtricitabine for pre-exposure prophylaxis for human immunodeficiency virus infection. [2017]

2. Switzerland pubmed.ncbi.nlm.nih.gov

Antiretroviral pre-exposure prophylaxis implementation in the United States: a work in progress. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

PrEParing for Preexposure Prophylaxis. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Safety of oral tenofovir disoproxil - emtricitabine for HIV preexposure prophylaxis in adults. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

Prevention of vaginal SHIV transmission in macaques by a coitally-dependent Truvada regimen. [2021]

6. England pubmed.ncbi.nlm.nih.gov

Pre-exposure chemoprophylaxis of HIV infection: quo vadis? [2015]

7. United States pubmed.ncbi.nlm.nih.gov

Should we fear resistance from tenofovir/emtricitabine preexposure prophylaxis? [2018]

8. England pubmed.ncbi.nlm.nih.gov

Safety and Pharmacokinetics of a Tenofovir Alafenamide Fumarate-Emtricitabine based Oral Antiretroviral Regimen for Prevention of HIV Acquisition in Women: A Randomized Controlled Trial. [2022]