1. Vaccine Advocacy and Community Leadership
Pedro Goicochea, MSc, MA
Clinical Trials Unit - Peru Investigaciones Medicas en Salud
Good morning!
I want to thank the organizers to invite me to share the experiences we have had in moving things forward in HIV prevention research in Peru and Ecuador

2. SAMPLE SLIDE 2
“…The services I got in this clinic have been very good, the environment is very pleasant, warm and you feel at home, thus, it made me feel very good. Well I want to thank you for this at iPrEx. I will put all of my effort to collaborate and make something very big for the history of humankind that is to find an alternative to prevent HIV/AIDS. Well, no much else to say, thanks for your attention to this…”
Screened participant at iPrEx in one of the Andean Sites, Computer Assisted Self Applied Interview
I want to start by sharing with you a very inspiring quote from one screenees in the Chemoprophylaxis for HIV Prevention in Men study being implemented in Peru, Ecuador and the US. This is a final comment to a behavioral survey applied by Computer Assisted Self-Applied Interview at the screening visit of the study:
READ
The quote speaks for itself, what HIV prevention participants want to do something about the epidemic but, by doing so, they want to feel comfortable, at home

3. Background
Peru & Ecuador have a concentrated epidemic in gay men, Trans and other men who have sex with men
Prevalence: ~ 14% - 28%
Incidence: ~
Impacta, Lima, Peru, 2000
Community preparedness: Raise awareness on HIV/AIDS & HIV Prevention Research
Community Advisory Board
Community Forums
Community Engagement Activities
Site Expansion
Iquitos, Loreto, Peru, 2001: ACSA
Pucallpa, Ucayali, Peru, 2002: AC Cayetano Heredia
Guayaquil, Guayas, Ecuador, 2006: Equidad/FAMIVIDA
Lima, Peru, 2007: INMENSA
So I want to continue with a little background about the Clinical Trials Unit in Peru.
Peru has a concentrated epidemic in gay men, other MSM and the trans population.
Impacta started in Lima, Peru, back in the year 2000 as an HIV/AIDS research organization with a very large community involvement program to raise awareness of HIV/AIDS and HIV prevention research.
These activities initiated by the creation of a community advisory board
Organization of community forums and community engagement activities
Impacta HIV prevention activities expanded to other cities in the region; especially in the jungle of Peru, Iquitos working with Asociacion Civil Selva Amazonica
Pucallpa working with Asociacion Civil Cayetano Heredia
in Guayaquil, Ecuador working with Fundacion Ecuatoriana Equidad and Amigos por la Vida
And in Lima, Peru working with Investigaciones Medicas en Salud

4. Research Activities 2000 - 2008 Study type # of studies Population
# enrollees
Cross Sectional 6
GTB, women
5430
Prospective cohorts 5
530
Prevention: Vaccines 3
General population GTB
500
Prevention:
Clinical Interventions 2
GTB
2400
Treatment 9
PLWHA
240
Training
Health Care Workers, PEPs
2300
TOTAL 28
11400
This is table that gives and idea of the activities at the CTU. The CTU has enrolled nearly 9,100 people in research studies and nearly 2300 people in research activities.
Among the studies we implemented we had
The SMART study, continuous vs. episodic ART. The study was stopped because it showed that interruption ART was an inferior strategy to continues ART
Herpes suppression for the prevention of HIV infection in HSV-2 positive MSM enrollees. The study did not show the expected outcome
Merck HIV vaccine study, 500 enrollees. Study stopped by the Data Safety Monitoring Board in The study had unexpected outcomes
Chemoprophylaxis for HIV prevention in men, the iPrEx study, starting in July 2007 and enrolled 1010 men so far.
Dealing with these situations have made us work and strategize hardly on different approaches

5. Lessons learned
Involve communities and work with them. Include them in the decision making process. Assess what is it that they want
Do not patronize the communities, they know what they are looking for
Be prepared for the unexpected: communications
Protocols do not always have expected results
Keep community trust
Faithfully continue in the search, communities are observing and still want to do something, do not fail on them
These are the lessons we have learned so far from these challenging experiences

6. “…most of the gay population is willing to participate…[we] are the population that contribute the most [on finding] a solution to HIV…”
(Focus group, Gays y.o. Lima, 2008)
“…[HIV prevention research] build it with them [GTB organizations] and involve the State, we are always open to work together…”
(Interview, AIDS Officer, MoH, Ecuador, Quito, 2008)
I just want to finish with another quote of a Formative Research process we are undergoing recently to assess the feasibility of the implementation of an HIV prevention trial
THANK YOU