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and directing business development for UrSure, a Cambridge, Mass., startup that has introduced a tool for improving PrEP adherence. The noninvasive diagnostic test measures the tenofovir in a patient’s urine and identifies individuals who need more support to ensure that they take the pill as prescribed. A major challenge is patients “not understanding how the disease and the drug work, or the importance of staying on it,” Bahalim says. As well as providing an objective measure of adherence, the test reassures patients, who might not feel different when taking the medication, that they’re protected. “There are hurdles from distrust and poor healthcare literacy that need to be overcome through better PrEP education and support,” says UrSure co-founder Giffin Daughtridge. “Without peace of mind that the drug is in their system and protecting them, many people don’t have enough motivation to take it consistently.” Irregular use is not a minor concern. Daughtridge is a physician, as is the company’s other co-founder, who ran a clinic that continued to see patients contract HIV while using PrEP haphazardly. UrSure is betting that by making adherence easier, it can help realize PrEP’s promise of near-perfect efficacy. Currently, UrSure’s test requires analysis in a partner laboratory with a three-day turnaround. Within the next year, Daughtridge expects to roll out a point-of-care test, similar to a pregnancy dipstick. “Our goal,” he says, “is to show results right in the doctor’s office, so discussions can happen immediately with patients who need more extensive adherence tools.” UrSure has raised around $2 million from small-business innovation research grants from the National Institutes of Health, startup incubators, and Harvard University innovation challenges. It’s focused on the U.S. market but is assessing the feasibility of expanding into international settings. UrSure is also piloting marketing to individuals for home-based tests and developing a

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smartphone scanner so that patients can upload and relay results to their physicians in real time. Controversy and Its Costs Historically, PrEP’s loudest critic has been Michael Weinstein, founder and director of the AIDS Healthcare Foundation (AHF), the largest and most controversial AIDS organization in the world. He has taken an unorthodox position in decrying PrEP as a “party drug” that will lead to a decline in condom use and a catastrophic surge in risky sex, and in lobbying against measures to mandate PrEP education. More recently, AHF has softened its stance on PrEP and has created a walk-in PrEP clinic in partnership with Broward County, Fla. However, the Prevention305 staff still contends with the consequences of this campaign. “Weinstein runs the biggest HIV testing center in southern Florida,” Byrne says, “but they won’t necessarily mention PrEP during HIV testing, even to those who admit to inconsistent condom use.” Prevention305 steers people to centers where they’ll be thoroughly counseled. Though they have long been the gold standard in HIV prevention, condoms aren’t foolproof. According to the CDC, 68 percent of HIV infections occur among men who have sex with other men. When used correctly, condoms reduce their risk of acquiring HIV by around 70 percent — that’s highly effective, but less than what’s possible on Truvada. The CDC is clear that using condoms along with PrEP provides greater protection — it’s not a zero-sum game. But PrEP might have the advantage of meeting many who shun condoms where they are. Byrne says it’s time to acknowledge reality. “In my experience, no one is using them,” he says. “We don’t expect straight people to, especially in monogamous relationships. And, because of the politics of the AIDS epidemic, there’s a question tied up in that double

“A M A J O R CHALLENGE IS PAT I E N T S N O T U N D E R S TA N D I N G HOW THE DISEASE AND THE DRUG WORK, OR THE I M P O R TA N C E O F S T A Y I N G O N I T.” A D I L B A H A L I M ’0 2

standard of whether gay people are entitled to intimacy.” For Byrne, the fact that gay men on PrEP have stopped having to ask their partners about HIV status is a giant step toward ending the stigma associated with HIV. “In Miami, people are still dying of AIDS,” he says, “but to say we’re not

P H OTO BY C O L E + K I E R A

10/11/18 9:10 AM

Profile for Concord Academy

CA Magazine Fall 2018 Issue  

In the fall 2018 CA Magazine, the focus is on passion — for art, for change, and for shaping the future of Concord Academy. This issue intro...

CA Magazine Fall 2018 Issue  

In the fall 2018 CA Magazine, the focus is on passion — for art, for change, and for shaping the future of Concord Academy. This issue intro...

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