In the medical world exists an impossible problem: although US black women face a disproportionately high risk of HIV infection compared to white women, the incidence of HIV infection among them is not high enough for researchers to carry out comprehensive studies, which require prohibitively high sample sizes, of prevention drugs tailored specifically to black women.
Research shows that HIV prevention programs work. But little is known about what treatments work for one of the United State’s most at-risk populations for HIV infection.
Luckily, UNC’s Dr. Adaora Adimora likes solving problems with no obvious solution, and she especially likes solving problems for populations in need.
The professor of medicine and epidemiology teamed up with Dr. Stephen Cole and Dr. Joseph Eron, also from UNC, to come up with a proposal to change the way clinical trials for HIV prevention are approached in lower-incidence settings.
Traditionally, randomized clinical trials (RCTs) studying thousands and thousands of participants are conducted to determine the effectiveness of new drugs. But in situations where that’s not feasible, Adimora and her team suggests a combination of clinical and pharmacological data from traditional clinical trials and smaller studies to estimate the effectiveness of drugs.
It’s a controversial idea — RCTs are considered the gold standard of drug experiments. Altering the traditional formula, and the challenging the status quo in the process, is no small task.
“I can’t say that I know our proposal would be effective,” Adimora admitted. “But it would be an attempt to provide information for a population where there is currently very little direct information.”
If the research proves sound, guidelines for US black women at risk for HIV infection could be refined, which could help decrease the racial disparities in HIV rates.
A prevention method tested on men and women in sub-Saharan Africa showing particular promise is preexposure prophylaxis, or PrEP. As of right now, there is little direct information about how US black women would choose to use the drug, which is difficult to take and requires very high adherence. With Adimora’s proposal, PrEP could be studied more fully.