title: US Black Women and Human Immunodeficiency Virus Prevention: Time for New Approaches to Clinical Trials.
abstract: Black women bear the highest burden of human immunodeficiency virus (HIV) infection among US women. Tenofovir/emtricitabine HIV prevention trials among women in Africa have yielded varying results. Ideally, a randomized controlled trial (RCT) among US women would provide data for guidelines for US women's HIV preexposure prophylaxis use. However, even among US black women at high risk for HIV infection, sample size requirements for an RCT with HIV incidence as its outcome are prohibitively high. We propose to circumvent this large sample size requirement by evaluating relationships between HIV incidence and drug concentrations measured among participants in traditional phase 3 trials in high-incidence settings and then applying these observations to drug concentrations measured among at-risk individuals in lower-incidence settings, such as US black women. This strategy could strengthen the evidence base to enable black women to fully benefit from prevention research advances and decrease racial disparities in HIV rates.
authors.affiliation: Department of Medicine, University of North Carolina School of Medicine.|Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
authors.forename: Adaora A
authors.initials: AA
authors.lastname: Adimora
authors.affiliation: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Cole
authors.affiliation: Department of Medicine, University of North Carolina School of Medicine.|Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Eron
mesh_terms: D000328:Adult; D001741:Black or African American; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017326:Clinical Trials, Phase III as Topic; D000068679:Emtricitabine / Q000097:blood / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000208:ethnology* / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D055118:Medication Adherence; D065129:Pre-Exposure Prophylaxis; D063505:Racism; D012107:Research Design; D018401:Sample Size; D000068698:Tenofovir / Q000097:blood / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D000068698:Tenofovir; D000068679:Emtricitabine
keywords: HIV and racial disparities; HIV epidemiology and African Americans; HIV prevention; black women and HIV prevention; clinical trial designs