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> 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-eff

> 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!)

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johansch 10y ago
(Re-phrasing.) Right, but how exactly are they making a surgery/implant kind of thing safe and cost-effective in this area?
- chimeracoder 10y ago
  > 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
  - johansch 10y ago
    > Same way a vaccine becomes cost-effective, I'd imagine. Huh? You are comparing the process of scaling up vaccines to the potential process of scaling up implants and saying they are "the same way"? I'm not a medical professional, but you do seem to be glossing over the whole "surgery" bit with all of it risks - even in the best of environments. I don't think you know what you are talking about :/
- jdietrich 10y ago
  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.

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johansch 10y ago

(Re-phrasing.) Right, but how exactly are they making a surgery/implant kind of thing safe and cost-effective in this area?

chimeracoder 10y ago
> 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
- johansch 10y ago
  > Same way a vaccine becomes cost-effective, I'd imagine. Huh? You are comparing the process of scaling up vaccines to the potential process of scaling up implants and saying they are "the same way"? I'm not a medical professional, but you do seem to be glossing over the whole "surgery" bit with all of it risks - even in the best of environments. I don't think you know what you are talking about :/
jdietrich 10y ago
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.