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Cornelisse VJ, Armishaw J, Catton M, Murphy D, Wright EJ. Barriers to accessing HIV pre-exposure prophylaxis for Medicare-ineligible people in Melbourne, Australia: analysis of patients attending the PrEPMe Clinic. Med J Aust 2022; 216:320-321. [PMID: 35279838 PMCID: PMC9415101 DOI: 10.5694/mja2.51455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 12/16/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022]
Affiliation(s)
| | | | - Mike Catton
- Victorian Infectious Diseases Reference Laboratory, Melbourne, VIC.,Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC
| | - Dean Murphy
- Alfred Hospital, Melbourne, VIC.,Kirby Institute, UNSW Sydney, Sydney, NSW
| | - Edwina J Wright
- Alfred Hospital, Melbourne, VIC.,Monash University, Melbourne, VIC.,Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC.,Burnet Institute, Melbourne, VIC
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Mizushima D, Takano M, Ando N, Uemura H, Yanagawa Y, Aoki T, Watanabe K, Ishizuka N, Oka S. A four-year observation of HIV and sexually transmitted infections among men who have sex with men before and during pre-exposure prophylaxis in Tokyo. J Infect Chemother 2022; 28:762-766. [DOI: 10.1016/j.jiac.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 01/11/2022] [Accepted: 02/16/2022] [Indexed: 10/18/2022]
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COVID-19 Vaccine Uptake and Its Impacts in a Cohort of Gay and Bisexual Men in Australia. AIDS Behav 2022; 26:2692-2702. [PMID: 35132480 PMCID: PMC8821860 DOI: 10.1007/s10461-022-03611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/21/2022]
Abstract
Successful use of biomedical forms of HIV risk-reduction may have predisposed many gay and bisexual men (GBM) to vaccination against COVID-19, which may, in turn, affect their sexual behavior. A total of 622 Australian GBM provided weekly data on COVID-19 vaccination history and sexual behaviour between 17 January 2021 and 22 June 2021. We identify factors associated with COVID-19 vaccination, and compare sexual behavior before and since vaccination. Mean age was 47.3 years (SD 14.0). At least one-dose vaccination coverage had reached 57.2%, and 61.3% reported that the majority of their friends intended to be vaccinated. Vaccinated men reported a mean of 1.11 (SD 2.10) weekly non-relationship sex partners before vaccination and 1.62 (SD 3.42) partners following vaccination. GBM demonstrated high confidence in COVID-19 vaccines. Their sexual activity increased following vaccination suggesting that greater sexual freedom may be a specific motivation for vaccine uptake among some men.
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Higher sexually transmissible infection test yield among men who have sex with men attending a community-based testing site compared with a clinical service in Sydney, Australia. Sex Transm Dis 2022; 49:e104-e106. [DOI: 10.1097/olq.0000000000001609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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55
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Killelea A, Johnson J, Dangerfield DT, Beyrer C, McGough M, McIntyre J, Gee RE, Ballreich J, Conti R, Horn T, Pickett J, Sharfstein JM. Financing and Delivering Pre-Exposure Prophylaxis (PrEP) to End the HIV Epidemic. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:8-23. [PMID: 35902089 PMCID: PMC9341207 DOI: 10.1017/jme.2022.30] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The U.S. has the tools to end the HIV epidemic, but progress has stagnated. A major gap in U.S. efforts to address HIV is the under-utilization of medications that can virtually eliminate acquisition of the virus, known as pre-exposure prophylaxis (PrEP). This document proposes a financing and delivery system to unlock broad access to PrEP for those most vulnerable to HIV acquisition and bring an end to the HIV epidemic.
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Beyrer C, McCormack S, Grulich A. Pre-Exposure Prophylaxis for HIV Infection as a Public Health Tool. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:24-28. [PMID: 35902085 PMCID: PMC9341191 DOI: 10.1017/jme.2022.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The efficacy of pre-exposure prophylaxis, PrEP, with antiviral agents for prevention of HIV infection has been demonstrated in multiple randomized controlled trials and demonstration projects. These trials have studied prevention at the individual level. The effectiveness of PrEP as a public health intervention to reduce HIV incidence at community and population levels is being actively evaluated but is less well described. In reviewing the available data on PrEP as a public health intervention, three significant examples have demonstrated success, and all have been among communities of gay, bisexual and other men who have sex with men (MSM).
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Philpot SP, Murphy D, Chan C, Haire B, Fraser D, Grulich AE, Bavinton BR. Switching to Non-daily Pre-exposure Prophylaxis Among Gay and Bisexual Men in Australia: Implications for Improving Knowledge, Safety, and Uptake. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1979-1988. [PMID: 35730059 PMCID: PMC9203261 DOI: 10.1007/s13178-022-00736-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Preexposure prophylaxis (PrEP) dosing options such as event-driven PrEP hold promise to increase PrEP uptake among gay, bisexual, and queer men (GBQM), but their impacts have not yet been realized and uptake by GBQM suitable for PrEP remains slow in countries where it is only considered an alternative option to daily PrEP. METHODS We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBQM in Australia to understand PrEP dosing behaviors, knowledge, and preferences. RESULTS All participants commenced PrEP daily; 35% had ever switched to non-daily PrEP, mostly taking it event-driven. GBQM who preferred non-daily PrEP had infrequent or predictable sex, were concerned about cost given infrequency of sex, and/or wanted to minimize unnecessary drug exposure. Accurate knowledge of event-driven PrEP was poor. However, reflecting concepts underpinning critical pedagogy, having accurate knowledge was supported by access to consistent messaging across clinical, social, community, and public settings. Several participants who switched to event-driven PrEP had condomless sex events in which they were unable to adhere to pills due to unanticipated sex. CONCLUSIONS AND POLICY IMPLICATIONS Implementation of comprehensive and consistent education about correct dosing for event-driven PrEP across multiple settings is needed to ensure increased uptake and safe use. GBQM require messaging about non-condom based HIV prevention strategies when they cannot access daily or event-driven PrEP.
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Affiliation(s)
| | - Dean Murphy
- The Kirby Institute, UNSW, Sydney, Australia
| | - Curtis Chan
- The Kirby Institute, UNSW, Sydney, Australia
| | | | - Doug Fraser
- The Kirby Institute, UNSW, Sydney, Australia
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Oka S. HIV testing in COVID-19 pandemic and beyond in Japan. Glob Health Med 2021; 3:356-357. [PMID: 35036615 PMCID: PMC8692090 DOI: 10.35772/ghm.2021.01103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/08/2021] [Accepted: 11/10/2021] [Indexed: 06/14/2023]
Abstract
In Japan, HIV testing has been offered anonymously and free-of-charge at local public health centers, together with pre- and post-test counseling since 1993. Since then, the number of HIV tests increased steadily to reach a peak in 2008 but has since decreased by 30% during the last decade. The number of tests further decreased in 2020 during the COVID-19 pandemic and steeply by 50% this year compared with the previous year, mostly due to a shift in the workload at these centers to COVID-19-related services. To deal with this decline and thinking beyond the current pandemic, more options for HIV testing are needed, such as self-testing/postal delivery of dried blood spot specimen, a method that is yet to be approved in Japan, in addition to the conventional plasma/serum-based HIV testing.
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Affiliation(s)
- Shinichi Oka
- Address correspondence to:Shinichi Oka, AIDS Clinical Center, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. E-mail:
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Chan C, Fraser D, Vaccher S, Yeung B, Jin F, Amin J, Dharan NJ, Carr A, Ooi C, Vaughan M, Holden J, Power C, Grulich AE, Bavinton BR. Overcoming barriers to HIV pre-exposure prophylaxis (PrEP) coverage in Australia among Medicare-ineligible people at risk of HIV: results from the MI-EPIC clinical trial. Sex Health 2021; 18:453-459. [PMID: 34895427 DOI: 10.1071/sh21096] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022]
Abstract
Background Overseas-born people who are ineligible for government-subsidised health care experience barriers to accessing HIV pre-exposure prophylaxis (PrEP) in Australia. This study aimed to assess a program providing free PrEP to overseas-born adults at risk of acquiring HIV. Methods Medicare-Ineligible Expanded Implementation in Communities (MI-EPIC) was a single-arm, open-label trial of daily tenofovir disoproxil fumarate/emtricitabine as PrEP. Six clinics recruited Medicare-ineligible adults who met HIV risk criteria in New South Wales, Australia. We recorded data on HIV and sexually transmitted infection (STI) diagnoses, and PrEP dispensing from July 2019 to June 2020. PrEP adherence as a medication possession ratio (MPR) was calculated as pills dispensed divided by days. We administered an optional survey on behaviours and attitudes to PrEP and sexual health. Results The 221 participants (206 men; 93.2%) had a median age of 29years (IQR 26-34). Participants were mostly born in Asia (53.4%), Latin America or the Caribbean (25.3%), or Europe (10.9%). Adherence was high; 190 participants (86.0%) had an MPR of >60%. Of 121 survey participants, 42 (34.7%) completed the survey in a language other than English. Of participants who had not used PrEP in the 6months before enrolment (n=45, 37.2%), the most common reasons were cost (n=22, 48.9%), and lack of knowledge about accessing PrEP (n=20, 44.4%). Conclusions Medicare-ineligible people at risk of HIV demonstrate high adherence when given access to free PrEP and translated information. Increasing PrEP awareness and reducing barriers to accessing PrEP in this high-risk population should be priorities in HIV prevention.
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Affiliation(s)
- Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Doug Fraser
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | | | - Barbara Yeung
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Fengyi Jin
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Janaki Amin
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia; and Department of Health Systems and Populations, Macquarie University, North Ryde, NSW, Australia
| | - Nila J Dharan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia
| | - Andrew Carr
- St Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
| | | | | | - Jo Holden
- NSW Ministry of Health, Sydney, NSW, Australia
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