US Black Women and Human Immunodeficiency Virus Prevention: Time for New Approaches to Clinical Trials

Clin Infect Dis. 2017 Jul 15;65(2):324-327. doi: 10.1093/cid/cix313.


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.

Keywords: HIV and racial disparities; HIV epidemiology and African Americans; HIV prevention; black women and HIV prevention; clinical trial designs.

MeSH terms

  • Adult
  • Anti-HIV Agents / administration & dosage
  • Anti-HIV Agents / therapeutic use*
  • Black or African American*
  • Clinical Trials, Phase III as Topic
  • Emtricitabine / blood
  • Emtricitabine / therapeutic use
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • HIV Infections / ethnology*
  • HIV Infections / prevention & control*
  • Humans
  • Incidence
  • Medication Adherence
  • Pre-Exposure Prophylaxis
  • Racism
  • Research Design*
  • Sample Size
  • Tenofovir / blood
  • Tenofovir / therapeutic use
  • United States / epidemiology


  • Anti-HIV Agents
  • Tenofovir
  • Emtricitabine