Download or read book The Ambiguity of Hiv Risk in Pre exposure Prophylaxis prep Administration in New York written by Elisabeth Arndt and published by . This book was released on 2020 with total page 177 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Risk" has become a ubiquitous concept in American healthcare settings, drawing both on objective biostatistics and on subjective, morally-charged interpretations. In particular, past epidemiological categorizations of a patient's identity or behavior-like their race or sexual practices-as "risk factors" for contracting HIV has promoted the sociocultural interpretation of HIV risk and stigmatized individuals in those groups. Nonetheless, with the advent of the pharmacologic Pre-Exposure Prophylaxis (PrEP) to prevent HIV transmission, such epidemiological categories of HIV risk are being even more broadly applied. The first medication used for PrEP was Truvada (emtricitabine and tenofovir disoproxil fumarate), an antiretroviral manufactured by the pharmaceutical giant Gilead Sciences that was first approved by the FDA in 2004 to treat HIV-positive patients and then approved again in 2012 as PrEP to prevent HIV infection in HIV-negative patients. Currently, the indications for PrEP prescription are impressively broad and vague, allowing much room for interpretation. Given how past identifications of HIV risk factors negatively implicated entire groups of people, there is a significant need to better understand how HIV risk has been conceptualized, how these concepts may be influenced by the interests of public health agencies and healthcare corporations, and how they play out for health professionals and patients in the clinical setting.In this dissertation, I examine the concepts of HIV risk that come into play in the administration of PrEP, considering how these concepts are understood by individual health professionals and patients alike and how such representations may align with the goals of healthcare corporations and public health agencies. Using ethnographic research techniques, I contrast the perspectives of HIV-negative patients identified as candidates for PrEP, HIV- positive patients, and health professionals administering PrEP to capture how they may understand HIV "risk" and PrEP's role in treating it. I conducted the fieldwork for this dissertation in a New York community health center network that provides PrEP and HIV services to diverse patient populations. I interviewed patients, clinic administrators, social workers, public health workers, and pharmaceutical industry members; observed clinical interactions; reviewed medical charts; and analyzed HIV prevention advertisements, publications, and guidelines. Based upon these collected data, I found that the discourse surrounding HIV risk is ambiguous, PrEP distorts and crystallizes this ambiguity, and structural risk (embedded healthcare structures identifying certain people as "at risk") is a reflective "model of" and constructive "model for" this process in a top-down direction. In doing so, I draw attention to the social significance of the pharmaceuticalization of risk by showing how pharmaceutical marketing can impact how risk is conceptualized, communicated, and experienced.

Download or read book Post exposure Prophylaxis PEP to Prevent HIV Infection written by Clinical Guidelines Program and published by . This book was released on 2020 with total page 86 pages. Available in PDF, EPUB and Kindle. Book excerpt: This guideline was developed by the New York State Department of Health (NYSDOH) AIDS Institute (AI) for healthcare practitioners in any medical setting (e.g., emergency department, sexual health clinic, urgent care clinic, inpatient unit primary care practice) who manage the care of individuals who request post-exposure prophylaxis (PEP) after a possible exposure to HIV. Despite the availability of prevention measures, exposures occur that pose the risk of transmission. Fortunately, with rapid initiation of PEP, infection can be blocked. Preventing new HIV infections is crucial to the success of New York State's Ending the Epidemic Initiative. HIV transmission can be prevented through use of barrier protection during sex (e.g., latex condoms), safer drug injection techniques, and adherence to universal precautions in the healthcare setting. HIV infection can also be prevented with use of antiretroviral (ARV) medications taken as pre-exposure prophylaxis (PrEP). After an exposure has occurred, HIV infection can be prevented with rapid administration of ARV medications as PEP. The first dose of PEP should be administered within 2 hours of an exposure (ideal) and no later than 72 hours after an exposure.

Download or read book Remaking HIV Prevention in the 21st Century written by Sarah Bernays and published by Springer. This book was released on 2022-07-28 with total page 0 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 PrEP to Prevent HIV and Promote Sexual Health written by Rona M. Vail and published by . This book was released on 2020 with total page 54 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pre-exposure prophylaxis (PrEP) is a cornerstone of HIV prevention and is strongly endorsed by New York State. However, it is underutilized, particularly by communities disproportionately affected by HIV. In New York State, PrEP is a central component of the standard of care for HIV prevention in those at increased risk. Components of primary HIV prevention include PrEP, along with safer sex and safer injection practices. Some communities at risk have disproportionate barriers to accessing and using PrEP. Medical care provider awareness of and willingness to prescribe PrEP to all patients at risk, regardless of identity, sexual practices, willingness to use condoms, or willingness to cease injection drug use will help reduce some barriers to access and increase uptake of PrEP.

Download or read book HIV Prevention in Primary Care Practice written by Gregory Felzien, MD, AAHIVS and published by Integritas Communications. This book was released on 2020-10-22 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: PrEP is a broad set of clinical tools that can be used to reduce the chances of acquiring HIV. Although it is highly effective, many people who could benefit from PrEP lack access or are not familiar with it. However, primary care providers can remedy this situation and truly make a difference in the lives of their patients who may be at risk of acquiring HIV. This eHealth SourceTM educational activity comprises 5 chapters, covering an overview of HIV epidemiology, practical approaches to sexual history-taking and assessing patient risk of HIV acquisition, initiation and monitoring of PrEP medication, and overcoming the bias and stigma surrounding HIV and PrEP. Throughout the program, our expert faculty will provide their unique insights surrounding sexual health, HIV prevention, and PrEP, and how these may be incorporated into primary care practice.

Download or read book A Review of Pre exposure Prophylaxis PrEP for HIV Prevention written by Celia Moffat Joel Matyanga and published by LAP Lambert Academic Publishing. This book was released on 2014-12-29 with total page 52 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Food and Drug Administration (FDA) approved and licensed a drug to prevent HIV acquisition in 2012. This is the first ever FDA drug approval for HIV prevention. Tenofovir combined with emtricitabine (Truvada (R)) was licensed to be used in conjunction with other HIV prevention methods by HIV negative people at high risk of HIV acquisition. This novel method of HIV prevention is termed HIV pre - exposure prophylaxis (PrEP). Whilst the use of PrEP has been implemented in some countries, this is still a new method and several countries are to still implement PrEP. The use of PrEP will go a long way in globally controlling the ever surging rise of the AIDS epidemic. This book, therefore provides an extensive description of PrEP from basic information to scientific studies. It offers a concise and comprehensive description of how Truvada (R) was tested for safety and efficacy in both animals and humans. In addition, it describes the safety profile of Truvada (R) for PrEP. This book is especially useful to clinicians, medical personnel, pharmacists, regulatory authorities and even consumers who may require more information on this novel and effective drug to prevent HIV.

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:

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 The Production and Governance of Risky Sexual Subjectivity in the Era of Pre Exposure Prophylaxis PrEP to HIV written by William James Schlesinger and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pre-exposure prophylaxis (PrEP) to HIV is a promising yet controversial new technology in the biomedical HIV prevention toolkit. Despite PrEP's demonstrated effectiveness in reducing the risk of HIV acquisition by up to 99% when taken daily, PrEP utilization remains not only modest overall but also inequitably distributed in patterns that directly contradict epidemiological data regarding greatest need and most significant potential benefit. While incidence rates have begun to decrease, disparities are in some cases widening, exacerbating the disproportionate representation of racialized men who have sex with men (MSM) in the epidemic. This dissertation questions: what does the failure of PrEP to catalyze a significant overall reduction in new HIV diagnoses in the United States reveal about the biomedical production and sociopolitical governance of risky sexual subjectivity? Utilizing data collected through semi-structured interviews, participant observation, and autoethnography, this project: i) elucidates PrEP's effects on sexual subjectivity vis-à-vis the historical present of HIV prevention discourse and practice; ii) evaluates how encounters with risk shape access to and persistence on PrEP and vice versa; and iii) contextualizes clinician and PrEP non/user engagement with PrEP within broader processes of biomedicalization. For men who have sex with men (MSM), claims to moral sexual subjectivity are linked to notions of responsible risk management. By enabling condomless anal sex with significantly diminished likelihood of seroconversion, PrEP can work not only as a harm reduction intervention in epidemiological terms, but also to remodel the way MSM experience and relate to risk. The capacity of PrEP as a biopharmaceutical means to achieve these ends, however, is constrained by the risk compensation debate and the "purview paradox," which limit uptake of this vital prevention resource among individuals vulnerable to HIV. While redressing these roadblocks is critical to enhancing PrEP's real-world effectiveness, the goal of ending the HIV epidemic will necessitate addressing the structural conditions that produce HIV acquisition risk. Technological solutions like PrEP to social problems like HIV transmission will continue to exacerbate disparities within a capitalist health care system that profits from pathology.

Download or read book Pre exposure Prophylaxis PrEP Education Improvement Project written by Reginald M Hilarie and published by . This book was released on 2015 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: In 2012, the US Food and Drug Administration approved the pill Truvada for use as pre-exposure prophylaxis or PrEP. Its purpose is to help prevent HIV infection by taking one pill every day. This project aims to improve PrEP patient education provided by the multi-disciplinary team and to decrease new HIV infection and sexually transmitted infections (STIs) to zero. The focus of the study is patients on PrEP at the Infectious Disease and HIV Clinic in San Francisco Veterans Administration Medical Center. The Clinical Nurse Leader, in collaboration with the multidisciplinary team, incorporated Pender's Health Promotion Model Theory in developing the teaching strategies. Strategies include revision of the current PrEP standard operating procedure, development of checklist for providers, two-session risk reduction class, improvement of the tracking system of patients' adherence to scheduled follow-up appointments, and development of a clinic specific educational material. Review of the electronic medical record revealed 100% patient-education by the providers and zero new HIV infections and STIs. Literature review asserts that the use of multi-modal intervention to support PrEP adherence is an effective intervention. Recommendations include review and revision of the SOP and educational material every 6 months based on new evidence-based practices.

Download or read book PrEP written by and published by . This book was released on 2012 with total page 4 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method in which people who do not have HIV infection take a pill daily to reduce their risk of becoming infected. The pill contains medicines that prevent HIV from making new virus as it enters the body. In this way PrEP medicines can help keep the virus from establishing a permanent infection. Providing a preventive medication before exposure to a germ or virus is not a new practice and has been used to prevent other diseases. For example, when individuals travel to an area where malaria is common, they are advised to take malaria medication before and during travel to prevent getting infected if bitten by a mosquito carrying the malaria parasite. However, the use of medication to prevent HIV infection has only recently been evaluated. When used consistently, PrEP has been shown to reduce the risk of HIV infection among adult men and women at very high risk for HIV infection through sex or injecting drug use. For some individuals at very high risk for HIV, PrEP may represent a much-needed additional prevention method -- but it will not be right for everyone. PrEP is an intensive approach that requires strict adherence to daily medication and regular HIV testing. It is not intended to be used in isolation, but rather in combination with other HIV prevention methods. If it is used effectively and by persons at very high risk, PrEP may play a role in helping to reduce the number of new HIV infections in the United States.

Download or read book Acceptability and Correlates of Pre Exposure Prophylaxis Use for HIV Prevention Among High Risk Drug Users in Treatment written by Pramila Karki and published by . This book was released on 2017 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Background Although people who use drugs (PWUD) are a key population recommended to receive pre-exposure prophylaxis (PrEP) to prevent HIV, few data are available to guide PrEP delivery in this underserved group. We therefore examined the willingness to initiate PrEP, the anticipation of HIV risk reduction while on PrEP, and the acceptability of PrEP based on a number of known PrEP attributes among high-risk PWUD. Methods In a cross-sectional study of 400 HIV-negative, opioid dependent individuals enrolled in a methadone program and reporting recent risk behaviors, we examined independent correlates of being willing to initiate PrEP. Participants also ranked the eight hypothetical PrEP program scenarios with varied combinations of six attributes related to PrEP (cost, dosing, efficacy, side-effects, treatment setting, and frequency of HIV testing). Results While only 72 (18%) were aware of PrEP, after being given a description of it, 251 (62.7%) were willing to initiate PrEP. Willingness to initiate PrEP was associated with having neurocognitive impairment (aOR=3.184, p=0.004) and higher perceived HIV risk (aOR=8.044, p Conclusions Our findings showed high acceptability of PrEP in response to different PrEP program scenarios with different attribute profiles. While willingness to initiate PrEP was high and correlated with being at elevated risk for HIV and having NCI, anticipated higher risk behaviors in this group even while on PrEP suggests that the next generation of HIV prevention approaches may need to combine biomedical and behavioral components to improve adherence to PrEP and to sustain HIV risk reduction over time.

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 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 PrEP pre exposure Prophylaxis Adherence Among East African Women written by Maria Pyra and published by . This book was released on 2018 with total page 69 pages. Available in PDF, EPUB and Kindle. Book excerpt: HIV incidence remains disproportionately high for women, particularly young women, in Sub-Saharan Africa; women are also at heightened risk while pregnant, which may account for a substantial portion of their adult lives. Although HIV pre-exposure prophylaxis (PrEP) in pill form is known to be efficacious for women, there remain unanswered questions about adherence in open-label and real-world settings, as well as regarding the effectiveness of PrEP during pregnancy. In the work presented in this dissertation, we first examined how women used PrEP in an open-label demonstration project and particularly, how adherence was related to HIV risk behaviors. Second, to better assess adherence, we evaluated the sensitivity and specificity of a biomarker among East African men and women using PrEP. Finally, we examined the effect of pregnancy on PrEP concentrations. First, we found that women in known serodiscordant relationships were able to take PrEP effectively; more than half took PrEP during their entire risk period, with ≥6 doses for most weeks when on PrEP. HIV incidence was reduced 93% (95% CI 77%-98%) for all women and 91% (95% CI 29%-99%) among women under 25 years old. In further analysis, we found evidence of four adherence trajectories and two risk behavior trajectories over the first six months of PrEP use. Women with a declining risk behavior trajectory were more likely to have a declining adherence trajectory, while women with steady risk were more likely to have high steady adherence; this supports the idea of prevention-effective adherence, which optimizes PrEP use. In the second aim, we found low sensitivities for the adherence biomarker tenofovir-diphosphate, using thresholds established in U.S. populations. Adherence counseling based on biomarkers should carefully consider the trade-offs between sensitivity and specificity. Finally, we found that concentrations of PrEP are significantly lower in pregnant women compared to non-pregnant women, as well as during pregnancy compared to pre-pregnancy, after adjusting for adherence. Additional pharmacology and epidemiology studies are needed to determine if PrEP dosing should be altered to sustain systemic levels of tenofovir during pregnancy.

Download or read book Thinking Ethically about HIV Pre exposure Prophylaxis Retention in Care and Sexually Transmitted Infection Testing in a Southeastern United States Local Health Department in the Time of COVID 19 written by Ellie Purdy and published by . This book was released on 2021 with total page 89 pages. Available in PDF, EPUB and Kindle. Book excerpt: Author's abstract: Local Health Departments (LHDs) are critical providers of Human Immunodeficiency Virus (HIV) and sexually transmitted infection (STI) prevention efforts. HIV Pre-Exposure Prophylaxis (PrEP) is an evolving public health initiative and practitioners should consider PrEP interventions in context of ethical decision-making and a broad STI prevention strategy as global incidence of bacterial STIs remains high and those at-risk for HIV are generally at-risk for other STIs. An evaluation of the Thinking Ethically framework and LHD PrEP services was performed to fill a gap in the literature and support program decision-making. A retrospective review of PrEP user medical records from a LHD in north Georgia from July 2019 to June 2020 was performed and data were assessed using descriptive statistics, negative binomial, and logistic regression. Total STI tests performed by the LHD from July 2018 to June 2020 were calculated to determine the change in STI testing services associated with the onset of the COVID-19 pandemic. The Thinking Ethically framework was valuable to PrEP-related decision-making. There were 63 PrEP users in the study period of which most were White non-Hispanic (60.3%) men who have sex with men (61.9%). Retention in care was associated with clinic site. Most bacterial STI cases diagnosed among PrEP users were asymptomatic (75%). Fifty percent of PrEP users obtained services beyond STI prevention including vaccination and referrals. District STI testing declined between the second quarter of 2020 and 2019 with a decline in HIV testing by 38%, syphilis by 48%, gonorrhea and chlamydia by over 50%. LHD decision-makers can feasibly apply the Thinking Ethically framework to public health practice. Results support the need for LHD continuous quality management as retention in care differed by clinic site, and more resources will be needed to engage hard-to-reach populations at-risk for HIV like injection drug users. The COVID-19 pandemic impacted PrEP and STI services and more data is needed to determine the long-term effects of the COVID-19 pandemic on the STI landscape.

Download or read book Understanding Factors that Influence Pre exposure Prophylaxis Efficacy for HIV 1 Prevention written by Pamela M. Murnane and published by . This book was released on 2014 with total page 81 pages. Available in PDF, EPUB and Kindle. Book excerpt: Pre-exposure prophylaxis (PrEP) is a promising new HIV-1 prevention strategy, with demonstrated efficacy from four randomized clinical trials. However, two trials of PrEP, both among heterosexual African women, did not find efficacy for protection against HIV-1. While adherence to PrEP has been proposed as the primary driver of the range of results across trials, other factors warrant investigation. This dissertation work contributes to our understanding of behavioral and biological factors that influence the effectiveness of PrEP and aims to inform PrEP implementation strategies. This dissertation was conducted within the Partners PrEP Study, a placebo-controlled, randomized trial of daily oral PrEP among 4747 heterosexual HIV-1 serodiscordant couples (one partner is infected with HIV-1 and the other partner is uninfected) in Kenya and Uganda which demonstrated high efficacy for two daily oral PrEP regimens, tenofovir alone and co-formulated tenofovir-emtricitabine. In a series of secondary analyses of data from the Partners PrEP Study, we evaluated the effect of PrEP among high-risk subgroups to determine whether efficacy was sustained in the context of high HIV exposure, we estimated the causal effect of PrEP when adherence was estimated to be high by applying multiple methods to correct for non-adherence in randomized trials, and we assessed whether PrEP adversely impacted hormonal contraceptive effectiveness for pregnancy prevention, as young women are a priority population for HIV prevention. The work presented here supports the hypothesis that the key driver of divergent PrEP trial results was adherence, and indicates that oral PrEP is highly effective for women and men, reducing HIV-1 risk by over 80% when estimated to have been used with high adherence. These analyses contribute to a more nuanced understanding of how PrEP works and inform guidelines for initiating PrEP among persons at risk of HIV-1 acquisition.