Download or read book Optimizing the Delivery of HIV Pre Exposure Prophylaxis PrEP An Evaluation of Risk Compensation Disengagement and the PrEP Cascade written by J. Carlo Hojilla and published by . This book was released on 2017 with total page 87 pages. Available in PDF, EPUB and Kindle. Book excerpt: Methods.

Download or read book Optimizing HIV PrEP Implementation in the Primary Care Setting written by Cara P Nalagan and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Despite compelling evidence behind the efficacy of pre-exposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) acquisition and its introduction in 2012, the prescription of PrEP has remained low (Silapaswan, Krakower, & Mayer, 2016). At the Asian and Pacific Islander Wellness Center (API), an urban primary care clinic in San Francisco, suboptimal PrEP implementation was related to a lack of standardized practice and routine HIV risk screening for PrEP provision. A doctorate of nursing (DNP) project was implemented to initiate a standardized HIV risk screening protocol for identifying HIV risk and PrEP eligibility to increase PrEP implementation at API. The impact of this protocol demonstrated an increase in the PrEP implementation cascade, particularly in HIV risk identification, PrEP offer, and evaluation of at-risk patients for PrEP uptake (initiation). During implementation of the HIV risk screening protocol, however, inconsistent clinical staff compliance with the routine screening tool led to an inadequate increase in PrEP offer for patients who tested positive for a sexually transmitted infection (STI). This indicates a need for further reinforcement of standardized practice and clinical staff education on the importance of combining HIV risk screening and PrEP, with emphasis on the significant risk for HIV infection associated with positive STI, to effectively promote patient outcomes. Implications for further research include validation of the HIV PrEP screening tool used in the HIV risk screening protocol as a model for PrEP implementation in the primary care setting.

Download or read book Remaking HIV Prevention in the 21st Century written by Sarah Bernays and published by Springer Nature. This book was released on 2021-07-26 with total page 305 pages. Available in PDF, EPUB and Kindle. Book excerpt: This edited collection brings together the social dimensions of three key aspects of recent biomedical advance in HIV research: Treatment as Prevention (TasP), new technologies such as Pre-Exposure Prophylaxis (PrEP), and the Undetectable equals Untransmittable (U=U) movement. The growth of new forms of biomedical HIV prevention has created hope for the future, signalling the possibility of a world without AIDS. In this context, the volume discusses the profound social, political and ethical dilemmas raised by such advances, which are to do with readiness, access, equity and availability. It examines how HIV prevention has been, and is, re-framed in policy, practice and research, and asks: How best can new biomedical technologies be made available in a profoundly unequal world? What new understandings of responsibility and risk will emerge as HIV becomes a more manageable condition? What new forms of blame will emerge in a context where the technologies to prevent HIV exist, but are not always used? How best can we balance public health’s concern for adherence and compliance with the rights of individuals to decide on what is best for themselves and others? Few of these questions have thus far received serious consideration in the academic literature. The editors, all leaders in the social aspects of HIV, have brought together an innovative and international collection of essays by top thinkers and practitioners in the field of HIV. This book is an important resource for academics and professionals interested in HIV research. Chapters "Anticipating Policy, Orienting Services, Celebrating Provision: Reflecting on Scotland’s PrEP Journey", "How the science of HIV treatment-as-prevention restructured PEPFAR’s strategy: The case for scaling up ART in ‘epidemic control’ countries", "Stigma and confidentiality indiscretions: Intersecting obstacles to the delivery of Pre-Exposure Prophylaxis to adolescent girls and young women in east Zimbabwe" and "The drive to take an HIV test in rural Uganda: a risk to prevention for young people?" are available open access under a Creative Commons Attribution 4.0 International License via link.springer.com.

Download or read book Structural Interventions for HIV Prevention written by Richard A. Crosby and published by Oxford University Press. This book was released on 2018-10-26 with total page 441 pages. Available in PDF, EPUB and Kindle. Book excerpt: A COMPREHENSIVE NEW REFERENCE WORK ON STRUCTURAL APPROACHES TO PREVENTING HIV Structural interventions -- changes to environment aimed at influencing health behaviors -- are the most universal and cost-effective tool in preventing new incidences of HIV. They are not easy to get right, however. Structural Interventions for HIV Prevention offers an authoritative reference for both understanding these programs and instituting them to greatest effect. Whether through changes to policy, environment, social/community norms, or a combination of each, this volume offers actionable and attainable blueprints to creating and evaluating programs in any setting or country. It is an essential resource for researchers and practitioners in the continuing fights against HIV.

Download or read book Evaluation of Oral Pre exposure Prophylaxis prep Implementation in Public HIV Care Clinics in Kenya written by Elizabeth M. Irungu and published by . This book was released on 2021 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: Daily, oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) is a highly potent HIV prevention intervention with potential to reduce HIV incidence among populations at risk of HIV in Africa if delivered with sufficient coverage. There are extensive data from high-income countries describing diverse settings in which PrEP services are offered. However, data describing PrEP scale-up models in low- and middle-income countries are limited. Public HIV care and treatment programs in Africa have been very successful at scaling up antiretroviral therapy (ART) over the last 15 years and are an attractive choice for integration of PrEP delivery. The main objective of the work described in this dissertation was to evaluate the effectiveness of PrEP implementation and integration in public HIV care clinics. The specific aims include to 1) conduct a step wedge cluster randomized trial of PrEP integration in public health HIV care clinics (the Partners Scale-Up Project) and evaluate impact; 2) conduct a process evaluation of PrEP integration in public HIV care clinics in Kenya, focusing on adaptation; 3) develop and evaluate the effectiveness of an on-site modular training approach to amplify the number of health care providers trained to deliver PrEP in public HIV care clinics in Kenya; and 4) summarize early PrEP rollout in African settings, challenges encountered and opportunities to expand implementation. We found evidence that integration of PrEP in public HIV clinics was feasible. By improving the capacity of health providers in those care clinics to offer PrEP services through training and technical support, PrEP uptake increased more than 20-fold and was sustained. With existing personnel and infrastructure, the high-volume HIV care clinics efficiently reached partners of HIV infected persons and other populations at HIV risk. PrEP users had reasonable continuation rates and objective evidence of high adherence. Using qualitative methods, we found that clinics made pragmatic, effective adaptations to non-core components of PrEP delivery services and to their routine practice to address challenges in PrEP delivery. We established that clinics that instituted some of the adaptations had above average monthly PrEP initiation and continuation rates. To amplify PrEP delivery in public health facilities, we developed and evaluated an innovative on-site modular training approach. We found that this approach was acceptable and it enabled many health providers to receive PrEP training conveniently and at a relatively low cost. Finally, our summary of early PrEP roll out in Africa revealed that there was high interest in PrEP among all populations at risk of acquiring HIV, but individuals did not continue use as expected. We suggested strategies to make PrEP delivery efficient, including delivery within community pharmacies, use of peers, services availed in low tier facilities and exploration of one-stop services to make PrEP delivery less burdensome. The collective results presented in this dissertation illustrate that integration of PrEP services in public HIV care clinics in Kenya is a successful and sustainable model for PrEP implementation. We posit that this model can be scaled up in African countries planning to set up PrEP programs.

Download or read book Differentiated and simplified pre exposure prophylaxis for HIV prevention written by and published by World Health Organization. This book was released on 2022-07-31 with total page 46 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Improving Pre exposure Prophylaxis Delivery for Young Women in Kenya written by Valentine Adhiambo Wanga and published by . This book was released on 2020 with total page 82 pages. Available in PDF, EPUB and Kindle. Book excerpt: The rollout of pre-exposure prophylaxis (PrEP) for HIV prevention to priority populations, including young women, is expanding in sub-Saharan Africa. However, existing barriers to PrEP rollout at the individual, community and policy levels could slow progress and impede the success of PrEP implementation programs. In order to achieve success in HIV prevention, it is crucial to address these barriers, particularly among young women, a population especially vulnerable to HIV. In this dissertation, we evaluated the links among risk perception, sexual behavior and PrEP adherence in serodiscordant couples, evaluated the impact of incorporating HIVST in PrEP delivery for young women and assessed the cost of delivering PrEP to young women. In Aim 1, we used data from HIV-negative adults enrolled in a study of PrEP and antiretroviral therapy for HIV-serodiscordant couples in Kenya and Uganda to examine associations between: 1) condom use and risk perception and 2) risk perception and PrEP adherence. In Aim 2, we offered HIV self-testing (HIVST) to young women enrolled in a PrEP implementation study in two family planning clinics and assessed satisfaction with HIV testing and clinic experience, and the impact of HIVST on PrEP delivery procedures. In Aim 3, using the same population as that in Aim 2, we used micro-costing methods to estimate the incremental cost of delivering PrEP to young women. We found that sexual behavior aligned with perceived HIV risk, which can facilitate an HIV-negative individual's decisions about PrEP use. Additionally, we found HIVST to be feasible and acceptable for young women using PrEP, highlighting the need to evaluate its utility to streamline PrEP delivery and provide more testing options for young women on PrEP. Lastly, using practical data from PrEP implementation, we estimated the cost of delivering PrEP to young women, providing valuable data to inform budget impact and cost-effectiveness analyses as well as local resource allocation for scale-up of PrEP delivery to young women. Collectively, these studies addressed some of the barriers to PrEP delivery, proposed solutions to these barriers and drew attention to priority research needs for PrEP delivery to young women.

Download or read book Modeling to Inform the Delivery of HIV Pre exposure Prophylaxis in Sub Saharan Africa written by David Allen Roberts and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Daily oral tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) as HIV pre-exposure prophylaxis (PrEP) is a safe and effective method for HIV prevention and offers potential to substantially reduce HIV incidence in sub-Saharan Africa. Mathematical models are commonly used to project the cost-effectiveness of investments in PrEP in comparison to alternative resource allocation strategies. Predictive modeling can also identify individuals at elevated risk who may benefit most from PrEP. The studies contained in this dissertation address fundamental issues in estimating the cost and potential impact of PrEP implementation in sub-Saharan Africa. First, we estimated the cost of routine PrEP delivery through maternal and child health (MCH) and family planning (FP) clinics in western Kenya (Chapter 1). PrEP delivery through MCH and FP leverages existing service delivery platforms that reach a large fraction of women at elevated HIV risk. Using data from over 20,000 PrEP encounters through 16 clinics, we estimated that the cost per client-month of PrEP dispensed to be $26.52 (2017 USD), with personnel (43%), drugs (25%), and laboratory testing (14%) accounting for the majority of costs. Postponing creatinine testing from PrEP initiation to the first follow-up visit could save 8% of total program costs. Under Ministry of Health implementation, we projected costs would decrease by 38%, but estimates were sensitive to changes in PrEP uptake and retention. Second, we used an individual-based transmission model calibrated to Eswatini to evaluate the sensitivity of model projections of PrEP impact and efficiency to specification HIV exposure heterogeneity (Chapter 2). A common method for introducing HIV exposure heterogeneity into a model is to stratify the population into “risk group” categories with different average sexual behavior parameters, allowing PrEP coverage to vary by risk group without having to explicitly represent individual partnerships. We found that this specification leads to a sharp tradeoff between total impact and efficiency depending on PrEP coverage levels in each risk group. In comparison, PrEP use among the general population is projected to be two times more efficient if PrEP use is prioritized during partnerships and over six times more efficient if use is further prioritized among individuals with HIV-positive partners. In addition, large incidence reductions can be achieved at low levels of PrEP coverage if PrEP use in the general population is concentrated when HIV exposure is more likely, but high levels of PrEP coverage are needed if time-varying individual risk is ignored. Third, we developed and validated HIV risk prediction models incorporating individual-level and geospatial covariates using data from nearly 20,000 individuals in a population-based cohort in rural KwaZulu-Natal, South Africa (Chapter 3). Individual-level predictors included demographic, socioeconomic, and sexual behavior measures, while geospatial covariates included local estimates of community HIV prevalence and viral load. We compared full models to simpler models restricted to only individual-level covariates or only age and geospatial covariates. Models using only age group and geospatial covariates had similar performance (women: area under the receiver operating characteristic curve (AUROC) = 0.65, men: AUROC = 0.71) to the full models (women: AUROC = 0.68, men: AUROC = 0.72). In addition, geospatial models more accurately identified high incidence regions than individual-level models; the 20% of the study area with the highest predicted risk accounted for 60% of the high incidence areas when using geospatial models but only 13% using models with only individual-level covariates. These findings have implications for PrEP policies. Our primary costing study identified service delivery bottlenecks and cost drivers that can inform efforts to streamline PrEP delivery. By ignoring the alignment of PrEP use with time-varying individual HIV exposure, models using a risk group specification may overestimate the cost and underestimate the impact of widespread PrEP availability. Finally, local estimates of HIV prevalence can help identify individuals and areas to prioritize for PrEP services to maximize impact.

Download or read book Optimizing HIV Treatment in Resource Limited Settings written by Gordon Amed Akudibillah and published by . This book was released on 2016 with total page 99 pages. Available in PDF, EPUB and Kindle. Book excerpt: Apart from the traditional role of preventing progression from HIV to AIDS, antiretroviral drug therapy (ART) has an additional benefit of substantially reducing infectiousness, making them potentially an important strategy in the fight against HIV. Recent advances in drug therapy have also seen the use of antiretroviral drugs as a prophylaxis, administered either as post-exposure prophylaxis (PEP) after high-risk exposure or as pre-exposure prophylaxis (PrEP) in those with ongoing HIV exposure. In this dissertation I developed two models for HIV transmission and parameterized them with data from South Africa to study governmental-level intervention programs in which antiretroviral drugs are given as treatment and prophylaxis. The first model is based on the dynamics of HIV in heterosexual population in Sub- Saharan Africa. The model classifies the male and female adult populations by HIV risk into three categories (low, medium and high) according to their sexual preferences. I used a non-linear optimization method to determine the optimal population-level allocation of ART and PrEP allocations required to minimize four objectives: new infections, infection-years, deaths and cost. I considered several strategies for allocating ART and PrEP. I found that generally for low treatment availability, prevention through PrEP to the general population or PrEP and ART to high-risk females is key to optimize all objectives, while for higher drug availability, an all-ART treatment is optimal. At South Africa’s current level of treatment availability, using prevention is most effective at reducing new infections, infection-years, and cost, while using the treatment as ART to the general population best reduces deaths. At treatment levels that meet the UNAIDS's ambitious new 90-90-90 target in South Africa, using all or almost all treatment as ART to the general population best reduces all four objectives considered. The second model is based on the WHO's five-stage classification of HIV/AIDS disease progression. This models stratified the population by disease status, whether diagnosed and whether on treatment. I used optimal control methods to determine the best time-dependent treatment allocation required to minimize new infections, infection-years, deaths and cost. My results indicated that the treatment strategy to minimize infection-years and new infections is to place emphasis on early treatment (i.e. treatment in Stage II & III) while to minimize cost and death, the emphasis should be on late treatment (i.e. Stage III & IV). Applying the optimal treatment strategy also leads to a substantial reduction in disease incidence and prevalence. The results of this study will hopefully provides some guidance for policymakers in determining how to allocate antiretroviral drugs in order to maximize the benefit of treatment.

Download or read book Pre exposure Prophylaxis for the Prevention of HIV Infection written by Roger Chou and published by . This book was released on 2019 with total page 220 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Effective prevention strategies for HIV infection are an important public health priority. Pre-exposure prophylaxis (PrEP) involves use of antiretroviral therapy (ART) regularly (e.g., daily) or before and after HIV exposure events to decrease the risk of acquiring HIV infection. PURPOSE: To synthesize evidence for the U.S. Preventive Services Task Force (USPSTF) on effects of PrEP on risk of HIV acquisition, mortality, harms, and other clinical outcomes; effects of adherence on PrEP-associated outcomes; and accuracy of methods for identifying potential candidates for PrEP. DATA SOURCES: We searched the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, MEDLINE, and Embase from inception to June 2018 and manually reviewed reference lists; additional surveillance for new literature was conducted through January 25, 2019. STUDY SELECTION: Randomized, controlled trials on the benefits and harms of PrEP versus placebo or no PrEP in adults without HIV infection at high risk of becoming infected; studies on the diagnostic accuracy of instruments for predicting incident HIV infection; studies on effects of adherence to PrEP on risk of HIV infection; and studies on rates of adherence to PrEP in U.S. populations. DATA EXTRACTION: One investigator abstracted data and a second investigator checked data abstraction for accuracy. Two investigators independently assessed study quality using methods developed by the USPSTF. DATA SYNTHESIS (RESULTS): In populations at higher risk of acquiring HIV infection, PrEP was associated with decreased risk of HIV infection versus placebo or no PrEP (11 trials; relative risk [RR], 0.46 [95% confidence interval (CI), 0.33 to 0.66; I2=67%; absolute risk reduction, −2.0% [95% CI, −2.8% to −1.2%] after 4 months to 4 years). Effects were consistent across HIV risk categories and for PrEP with tenofovir disoproxil fumarate plus emtricitabine or tenofovir alone. There was a strong association between higher adherence and greater efficacy (adherence ≥70%: 6 trials; RR, 0.27 [95% CI, 0.19 to 0.39]; I2=0%; adherence >40% to

Download or read book Oral Pre exposure Prophylaxis Delivery Among HIV negative Pregnant and Postpartum Women in Antenatal Clinics of Cape Town South Africa written by Nehaa Khadka and published by . This book was released on 2023 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: HIV acquisition risks remain high for pregnant and breastfeeding populations in South Africa. Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF-FTC) can be used daily during periods of sexual activity to prevent HIV infections for cisgender women. In 2021, oral PrEP became the standard of care for HIV prevention during pregnancy and breastfeeding periods. The objective of this dissertation was to evaluate trends in oral PrEP initiation, continuation, and adherence among adolescent girls and young women, women experiencing intimate partner violence, and by sexual behaviors throughout gestational periods and postpartum. We used data from the PrEP in Pregnancy and Postpartum (PrEP-PP) study, a prospective cohort in Cape Town of 1200 participants without HIV. The PrEP-PP study provided HIV prevention counselling and offered PrEP to pregnant and breastfeeding women.The first study evaluated the oral PrEP cascade framework among adolescent girls and young women (AGYW) in the PrEP-PP study. Approximately 83% of AGYW initiated PrEP at their first antenatal care (ANC) visit, 34% continued PrEP at 6 months, and 11% stopped and restarted. AGYW with a higher HIV risk had an increased adjusted likelihood of continuing PrEP through 6 months (adjusted odds ratio[aOR]:1.91 [95% CI, 1.15-3.16]). About 7% of AGYW had high adherence to PrEP at 6 months. The second study examined the relationship between recent and past-year intimate partner violence (IPV) experienced by pregnant and postpartum women and oral PrEP continuation and adherence. Women who experienced past-year IPV were less likely to discontinue PrEP(adjusted hazards ratio: 0.80 (95% CI: 0.61, 1.06) and had higher adherence(quantifiable tenofovir-diphosphate[TFV-DP] in dried blood spots; aOR=1.82 (95% CI: 1.02, 3.25) at 6-month follow-up visits. The third study evaluated prevention-effective adherence by gestational trimesters of pregnancy and postpartum. Prevention-effective adherence(initiation/quantifiable TFV-DP or reported use during follow-up among those engaging in condomless sex) was 65% overall, with the highest adherence in trimester 1(81%) and lowest at early postpartum(49%). There was a positive association between engaging in condomless sex and PrEP use(quantifiable TFV-DP or self-reported use; adjusted risk ratio:1.88; 95% CI: 1.67, 2.12). In conclusion, AGYW during pregnancy and postpartum had high oral uptake, but retention in PrEP by 6 months was low. Those with higher HIV risks are more likely to continue PrEP. Pregnant/postpartum women who experienced past-year IPV were more likely to stay in the study and had greater adherence. The findings suggest that pregnant and postpartum women align their PrEP use with their potential HIV risks. Implementing violence screening and oral PrEP counselling (with conversations about changing HIV risks) at ANC may improve HIV prevention for women during pregnancy and postpartum in South Africa and beyond.

Download or read book Scaling Up and Out written by Stephanie Roche and published by . This book was released on 2021 with total page 105 pages. Available in PDF, EPUB and Kindle. Book excerpt: In Kenya, daily oral pre-exposure prophylaxis (PrEP) for HIV prevention is a key component of the country’s national HIV/AIDS response. Since its approval by the Kenya national drug regulatory authority in 2015, PrEP has been rolled out predominantly in HIV clinics; however, the country’s 5-year plan for implementing PrEP at scale calls for integration of PrEP into other service delivery models and more efficient use of available resources. Currently, there is limited implementation science research to inform PrEP scale-up (i.e., expansion to additional HIV clinics) and scale-out (i.e., expansion to new service delivery models and populations) in Kenya. Our objective was to identify barriers and facilitators of PrEP integration and/or optimization in three healthcare settings: HIV clinics, family planning (FP) clinics, and retail pharmacies. In Aim 1, we analyzed data from a prospective cohort study delivering integrated PrEP-FP services to adolescent girls and young women (AGYW) at two FP clinics in Kisumu, Kenya. Using the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) compilation, we identified supply-side implementation strategies for integrating PrEP into routine FP services and contextual factors influencing strategy choice and outcome, as captured in routine monitoring and evaluation documents (n=213) and key informant interviews (n=15). We found that, overall, implementing PrEP was more labor intensive at a public FP clinic compared to a private, youth-friendly clinic because it required a series of implementation strategies to make the physical and social environment conductive to offering AGYW-centered care. Nevertheless, provider adoption of PrEP delivery was low at both clinics, likely due to the widespread perception that PrEP was not within their scope of work. We recommend that PrEP implementers approach PrEP implementation, in part, as a behavioral intervention for FP providers and specifically assess the need for implementation strategies that support providers’ clinical decision-making, address workload constraints, and establish clear worker expectations. In Aim 2, we conducted a pilot study of a one-stop shop (OSS) model for PrEP delivery at four public clinics in Western Province, Kenya and evaluated whether this model could improve care efficiency and acceptability without negatively impacting PrEP uptake or continuation. Interviews with clients (n=15) and providers (n=14), technical assistance reports (n=69), and clinic flow maps indicate that the OSS achieved efficiency gains by redirecting PrEP clients away from bottlenecks, moving steps closer together (e.g., relocating supplies; cross-training and task-shifting), and differentiating clients based on the subset of services needed. Analysis of time-and-motion observations (n=47) revealed that, following OSS implementation, median client wait time dropped significantly from 31 minutes to 6 minutes (p=0.02) while median time spent with a provider remained around 23 minutes (p=0.4). Clients and providers expressed a strong preference for the OSS model and additionally identified increased privacy, reduced stigma, and higher quality client-provider interactions as benefits of the OSS model. Controlled interrupted time series analysis of PrEP initiations (n=1227) and follow-up visits (n=2696) revealed no significant difference between intervention and control clinics in terms of trends in PrEP initiation and on-time returns (all p>0.05). We conclude that the OSS model is a promising option for reducing variability in service time and increasing client and provider satisfaction without adding additional human resources. In Aim 3, we conducted a formative research study to understand the acceptability and feasibility of retail pharmacy-based PrEP delivery. Using the CFIR, we conducted and analyzed in-depth interviews with 40 pharmacy clients, 16 pharmacy providers, 16 PrEP clients, and 10 PrEP providers from Kisumu and Kiambu Counties, Kenya. Most participants expressed strong support for expanding PrEP to retail pharmacies, though conditioned their acceptance on assurances that care would be private, respectful, safe, and affordable. Participant-reported determinants of feasibility centered primarily on ensuring that the intervention is compatible with retail pharmacy operations (e.g., adequate staffing; use of documentation systems that meet PrEP reporting requirements). Our findings may inform the development of a tailored package of implementation strategies for integrating PrEP into routine pharmacy practice.

Download or read book Maximizing Effectiveness of HIV Preexposure Prophylaxis Among Men Who Have Sex with Men written by Julia Lenore Marcus and published by . This book was released on 2013 with total page 75 pages. Available in PDF, EPUB and Kindle. Book excerpt: Despite decades of prevention and treatment efforts, human immunodeficiency virus (HIV) infection is a global pandemic, with HIV/acquired immunodeficiency syndrome (AIDS) among the leading causes of death for children and adults in developing countries. HIV/AIDS disproportionately affects men who have sex with men (MSM), including in the United States, where MSM account for over half of all new HIV infections. Existing HIV prevention tools have not been sufficient to curb the pandemic, and biomedical prevention strategies, such as circumcision and microbicides, had not been shown to be effective in preventing HIV infection in MSM until 2010, when the multi-national iPrEx study found that daily oral preexposure prophylaxis (PrEP) using antiretroviral therapy (emtricitabine/tenofovir, or FTC/TDF) prevented HIV infection among MSM and transgender women. Although the success of FTC/TDF PrEP in such trials has given new hope to the HIV prevention field, excitement has been tempered by concerns about low adherence to daily pill use among trial participants. Adherence, as measured by self-reported pill use, was high among participants in the iPrEx trial, but testing for evidence of the drug in blood specimens from a subset of participants indicated that actual pill use was much lower than reported pill use. Adherence is critical for PrEP effectiveness; iPrEx participants in whom antiretroviral drug was detected in blood experienced a substantially greater reduction in HIV risk than was seen overall. The iPrEx results suggest that low adherence may be a barrier to successful implementation of PrEP as an HIV prevention strategy among MSM. Identification of effective strategies for supporting the consistent use of prophylactic medications could provide much needed guidance in the development of interventions to support adherence to PrEP. In addition to concerns about adherence, there is a widespread concern that PrEP could result in an increase in sexual risk behaviors by lowering users' perception of their risk of acquiring HIV infection; such risk compensation could reduce or even negate the benefits of PrEP. Foundational to most models of health behavior is the hypothesis that perceived risk is a primary motivation for self-protective behavior. Based on this theory, when a new prevention strategy, such as PrEP, is introduced, risk compensation could be prevented by sustaining individuals' perceptions of their own HIV risk. While the act of taking PrEP on a daily basis could result in risk compensation, it could also provide a daily opportunity to contemplate and manage HIV risk, thus motivating condom use and other self-protective behaviors. A better understanding of whether, and how, PrEP use affects sexual risk behavior could inform the development of risk-reduction interventions for individuals prescribed PrEP. In addition to preventing HIV infection, there is evidence that FTC/TDF PrEP may also be protective against infection with Herpes simplex virus type 2 (HSV-2). HSV-2 is the primary cause of genital ulcer disease worldwide, and HSV-2 infection is known to increase the risk of sexual transmission and acquisition of HIV infection. In the CAPRISA 004 study, a topical 1% tenofovir gel used as PrEP against HIV infection also reduced the risk of HSV-2 acquisition by 51% in women. In the Partners PrEP study, oral FTC/TDF reduced HSV-2 acquisition by 35% among heterosexual couples. Protection against HSV-2 acquisition or expression could enhance the public health impact of PrEP, but it is unknown whether FTC/TDF has anti-herpetic properties in men who have sex with men. The effectiveness of FTC/TDF PrEP in protecting against HIV infection depends on individual-level behaviors, including adherence and sustained risk reduction, as well as its effect on other sexually transmitted infections (STI) that increase the risk of HIV acquisition. Chapter 1 of this dissertation describes a systematic review that aimed to identify interventions that have been used to support adherence to daily oral medications prescribed to healthy or asymptomatic individuals. This review found evidence of interventions that demonstrated short-term improvements in medication adherence across a variety of prevention settings, thus identifying potential strategies for adherence support among PrEP users. Chapter 2 describes an analysis of data from the randomized phase of the iPrEx study to determine whether sexual risk compensation occurred among trial participants. Consistent with other PrEP studies, this analysis found no evidence of increased sexual risk behavior or STIs among participants who believed they had been assigned to the FTC/TDF arm and that the drug was highly effective. Finally, Chapter 3 describes an analysis that used data from the randomized phase of iPrEx to measure the effect of FTC/TDF on HSV-2 acquisition and expression among men who have sex with men. Although there was no effect of FTC/TDF on HSV-2 acquisition, participants receiving the active drug had a lower prevalence of herpetic ulcers than participants receiving the placebo. Taken together, these papers contribute to the HIV prevention field by providing guidance on behavioral support strategies for daily oral PrEP and identifying anti-herpetic properties of FTC/TDF that could increase its effectiveness as a novel prevention tool.

Download or read book Disparities in HIV Pre Exposure Prophylaxis Implementation for Black and Latinx Adults Receiving Care in Public Health Clinics written by Julie Kay Schexnayder and published by . This book was released on 2021 with total page 176 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pre-exposure prophylaxis (PrEP) effectively reduces the risk of Human Immunodeficiency Virus (HIV) infection. PrEP implementation in public health clinics is suggested for increasing PrEP access; However, it is unclear if these venues can reduce the disparities in PrEP use that are observed for Black and Latinx adults. We analyzed data from health departments completing their first PrEP program year between June 1, 2016 and June 30, 2019. We estimated PrEP coverage and adherence in Black and Latinx clients. Semi-structured interviews were conducted with multidisciplinary public health workers (n=6). The Consolidated Framework for Implementation guided a thematic analysis of interviews. Of the 433 PrEP clients, 52.0% were non-Hispanic Black and 8.9% were Hispanic/Latinx. PrEP to need ratios were greater for White clients than for Black or Latinx clients at five of the nine health departments. The average medication possession ratio for Black and Latinx PrEP clients (.79) approached effective daily adherence levels. However, a single prescription was filled for 25.0% of Black and Latinx clients. Qualitative data indicated compatibility issues between PrEP services delivery and community preferences and needs. Challenges integrating longitudinal follow-up practices, and complex PrEP re-enrollment procedures emerged as additional factors influencing PrEP outcomes. The results of this dissertation indicate that public health clinics vary in their ability to deliver all components of PrEP clinical monitoring and in their ability to increase PrEP coverage in Black and Latinx adults. Tailoring of PrEP services to Black and Latinx adults may be necessary to optimize PrEP coverage and adherence.

Download or read book Theory of Change Model for Clinic Based PrEP Programme Evaluation written by John Saunders and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background:A national programme to provide Truvada HIV pre-exposure prophylaxis (PrEP) is currently being considered in England. Some men already access PrEP and some sexual health clinics already offer PrEP monitoring. Aim(s)/objectives:We created a Theory of Change (ToC) to define the key components of a clinic-based PrEP programme to reduce HIV incidence. We identified indicators, outputs and outcomes to aid programme evaluation for a large London sexual health clinic. Methods:We used a ToC approach to define necessary pre-conditions, indicators, outputs and outcomes for our PrEP delivery programme. Results:The aim of our PrEP programme is to prevent HIV seroconversion in those at greatest risk. There are three broad areas: 1) identifying those eligible; 2) engaging eligibles to initiate PrEP and other HIV prevention activities; 3) maintaining effective adherence in those at continuing risk while advising therapy cessation for those no longer at risk. We estimate that approximately 1,200 men attending our service annually could be eligible for PrEP. Assuming a high level of uptake, these men would require 1,000 follow-up appointments annually in order to fulfil quality measures of three monthly HIV and STI testing in those on PrEP. Conclusions:Using a ToC approach we have defined what a clinic-based PrEP programme might look like against our current service specification to enable us to collect meaningful evaluation data. This ToC might be used by other clinics to evaluate PrEP programmes, and allow comparison across programmes to build understanding of PrEP delivery and enhance new national PrEP surveillance systems.

Download or read book Safety of Oral Tenofovir Disoproxil Fumarate based Pre exposure Prophylaxis for HIV Prevention written by Kenneth K. Mugwanya and published by . This book was released on 2016 with total page 173 pages. Available in PDF, EPUB and Kindle. Book excerpt: Antiretroviral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate (TDF) alone or when co-formulated with emtricitabine (FTC), the same medication used for treatment of HIV infection, is a recommended and highly effective strategy to reduce the risk of sexual acquisition of HIV. The central objective of the studies described in this dissertation was to quantify the risk of potential off-target safety signals associated with TDF-based PrEP use in HIV-uninfected men and women with the overarching goal of providing the evidence base for clinical practice guidelines to accelerate population level delivery of PrEP to fight the global HIV epidemic. The specific aims include to: 1) determine whether TDF-based PrEP causes clinically significant decline in glomerular filtration rate (eGFR), a commonly used-measure of overall kidney function, in HIV-uninfected men and women; 2) determine whether TDF-based PrEP causes proximal tubular dysfunction when used as PrEP and whether proximal tubular dysfunction is associated with clinically relevant decline eGFR; 3) quantify infant exposure to tenofovir and emtricitabine via maternal breast milk when used as PrEP by lactating HIV-uninfected women; 4) determine whether open-label PrEP use for HIV prevention is associated with reduction in safer sex practices (i.e., sexual risk compensation); and 5) review and summarize the totality of empirical literature on the TDF-induced off-target effects when use as PrEP. Findings: Effect of TDF-based PrEP on eGFR: In a large randomized, placebo-controlled trial of daily oral TDF and FTC-TDF PrEP among 4640 heterosexual persons, with median per-protocol follow-up of 18 months and maximum follow-up of 36 months, PrEP resulted in a small but non-progressive decline in eGFR that was not accompanied by a substantial increase in the risk of clinically relevant (≥25%) eGFR decline. The decline quickly resolves within weeks after TDF discontinuation. Effect of FTC-TDF PrEP on proximal tubular dysfunction: In a randomized, placebo-controlled comparison among >1500 HIV-uninfected men and women, FTC-TDF PrEP was not associated with increased risk for proximal tubular dysfunction up to 24 months nor was proximal tubular dysfunction associated with clinically relevant decline in eGFR. Infant exposure to PrEP via breastfeeding: Among lactating women using FTC-TDF PrEP during early postpartum, the estimated infant doses received from breastfeeding and the resultant infant plasma concentrations for both tenofovir and emtricitabine are 12500- and >200-fold below the respective proposed pediatric doses used for therapeutic treatment of infant HIV infection and for prevention of infant postnatal HIV infection and tenofovir was unquantifiable in a majority of infant plasma samples, suggesting that PrEP can be safely used during breastfeeding with minimal infant drug exposure. Sexual risk compensation: The transition from a double-blinded, placebo-controlled phase to one in which all participants were aware that they were receiving active, effective PrEP in the Partners PrEP Study, provided a natural experiment to assess behavioral risk compensation. PrEP given as part of a comprehensive HIV prevention package, did not result in substantial changes in risk-taking sexual behavior by heterosexual couples. Summary of current empirical literature: TDF-based PrEP is generally safe and well tolerated in HIV-uninfected men and women, and infant exposure via breastfeeding is minimal. The risk of the small, non-progressive, and reversible decline in eGFR and bone mineral density as well as the potential for selection of drug resistant viral mutation associated with PrEP are outweighed, at the population level and broadly for individuals, by PrEP’s substantial reduction in the risk of HIV infection. These data support the safety of TDF-based PrEP for prevention HIV combination with safer sex practices.

Download or read book Anticipating the Efficacy of HIV Pre exposure Prophylaxis PrEP and the Needs of at risk Californians written by Greg Szekeres and published by . This book was released on 2004 with total page 35 pages. Available in PDF, EPUB and Kindle. Book excerpt: