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Watson DL, Listerud L, Drab RA, Lin WY, Momplaisir FM, Bauermeister JA. HIV pre-exposure prophylaxis programme preferences among sexually active HIV-negative transgender and gender diverse adults in the United States: a conjoint analysis. J Int AIDS Soc 2024; 27:e26211. [PMID: 38332521 PMCID: PMC10853582 DOI: 10.1002/jia2.26211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Current implementation efforts have failed to achieve equitable HIV pre-exposure prophylaxis (PrEP) provision for transgender and gender-diverse (trans) populations. We conducted a choice-based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States. METHODS Between April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out-of-pocket cost; dispensing venue; frequency of visits for PrEP-related care; travel time to PrEP provider; and ability to bundle PrEP-related care with gender-affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt-out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part-worth utility scores for the total sample and by respondents' PrEP status. RESULTS The median age was 24 years (range 18-56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out-of-pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender-affirming hormone therapy services (18.7%). Minimal cost-sharing ($0 out-of-pocket cost) most positively influenced the attribute importance of cost (average conjoint part-worth utility coefficient of 2.5 [95% CI 2.4-2.6]). PrEP-experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP-naïve respondents preferred pharmacies (relative utility score 5.1). CONCLUSIONS Participants preferred programmes that offered PrEP services without cost-sharing and bundled with gender-affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low-barrier PrEP provision are critical to achieving equitable PrEP provision. Community-engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient-centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients.
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Affiliation(s)
- Dovie L. Watson
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Louis Listerud
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ryan A. Drab
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Willey Y. Lin
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Florence Marie Momplaisir
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - José A. Bauermeister
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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2
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Murphy MJ, Rogers BG, Chambers LC, Zanowick-Marr A, Galipeau D, Noh M, Scott T, Napoleon SC, Rose J, Chan PA. Characterization of Risk Factors Among Individuals with a History of Incarceration Presenting to a Sexually Transmitted Infections Clinic: Implications for HIV and STI Prevention and Care. AIDS Patient Care STDS 2022; 36:291-299. [PMID: 35951448 PMCID: PMC9419926 DOI: 10.1089/apc.2022.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
More than 2 million people are incarcerated in the United States with many millions more processed through correctional facilities annually. Communities impacted by incarceration are also disproportionately impacted by the HIV and sexually transmitted infection (STI) epidemics. However, relatively little is known about the behaviors that place individuals with a history of incarceration at risk for HIV/STI acquisition. We utilized clinical data from patients presenting to an STI clinic located in Providence, Rhode Island. A latent class analysis was conducted on reported HIV acquisition risk behavior and STI testing results on a total of 1129 encounters where a history of incarceration was reported. A total of three classes were identified. Class 1 (N = 187, 11%), more frequently reported 10+ sexual partners (45%), an STI diagnosis (48%) and sex while intoxicated (86%) in the past year as well as identifying as a man who has sex with other men (60%). Class 2 (N = 57, 5%) was more likely to report giving (53%) and receiving (44%) money/drugs for sex in the past year as well as a history of injecting drugs (61%) and using methamphetamine (60%). Class 3 (N = 885, 78%) most frequently reported 0-2 sexual partners (48%), identified as Black (27%), Hispanic/Latino (69%) and a man who only has sex with women (80%). Class 1 had significantly higher odds ratio (1.8, 95% confidence interval = 1.3-2.5) of testing HIV/STI positive. The results provide important insights into risk subgroups for those with a history of incarceration at risk of HIV/STI acquisition.
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Affiliation(s)
- Matthew J Murphy
- School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Rhode Island Department of Corrections, Brown University, Providence, Rhode Island, USA
| | - Brooke G Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Laura C Chambers
- School of Public Health, Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Alexandra Zanowick-Marr
- The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Drew Galipeau
- The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Madeline Noh
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Ty Scott
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Siena C Napoleon
- School of Public Health, Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
| | - Jennifer Rose
- Wesleyan University Quantitative Analysis Center, Brown University, Providence, Rhode Island, USA
| | - Philip A Chan
- School of Public Health, Brown University, Providence, Rhode Island, USA.,Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,The Miriam Hospital Department of Medicine, Division of Infectious Diseases, Providence, Rhode Island, USA
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3
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Saxton PJW, Azariah S, Cavadino A, Forster RF, Jenkins R, Werder SF, Southey K, Rich JG. Adherence, Sexual Behavior and Sexually Transmitted Infections in a New Zealand Prospective PrEP Cohort: 12 Months Follow-up and Ethnic Disparities. AIDS Behav 2022; 26:2723-2737. [PMID: 35167038 PMCID: PMC8853116 DOI: 10.1007/s10461-022-03617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/29/2022]
Abstract
Inequities in pre-exposure prophylaxis (PrEP) experiences will impede HIV epidemic elimination among gay and bisexual men (GBM). Ethnicity is a strong marker of inequity in the United States, but evidence from other countries is lacking. We investigated experiences on-PrEP to 12 months follow-up in a prospective cohort of 150 GBM in Auckland, New Zealand with an equity quota of 50% non-Europeans. Retention at 12 months was 85.9%, lower among Māori/Pacific (75.6%) than non-Māori/Pacific participants (90.1%). Missed pills increased over time and were higher among Māori/Pacific. PrEP breaks increased, by 12 months 35.7% of Māori/Pacific and 15.7% of non-Māori/Pacific participants had done so. Condomless receptive anal intercourse partners were stable over time. STIs were common but chlamydia declined; 12-month incidence was 8.7% for syphilis, 36.0% gonorrhoea, 46.0% chlamydia, 44.7% rectal STI, 64.0% any STI. Structural interventions and delivery innovations are needed to ensure ethnic minority GBM gain equal benefit from PrEP. Clinical trial number ACTRN12616001387415.
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Affiliation(s)
- Peter J W Saxton
- School of Population Health, University of Auckland, 28 Park Ave, Auckland, 1023, New Zealand.
| | - Sunita Azariah
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
| | - Alana Cavadino
- School of Population Health, University of Auckland, 28 Park Ave, Auckland, 1023, New Zealand
| | - Rose F Forster
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Renee Jenkins
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
| | - Suzanne F Werder
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
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4
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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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5
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Cannon SM, Graber S, King HL, Hanashiro M, Averbach S, Moore DJ, Blumenthal J. PrEP University: A Multi-Disciplinary University-Based HIV Prevention Education Program. J Community Health 2021; 46:1213-1220. [PMID: 34106369 PMCID: PMC8595182 DOI: 10.1007/s10900-021-01007-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 12/19/2022]
Abstract
The introduction of emtricitabine/tenofovir diphosphate (FTC/TDF) as pre-exposure prophylaxis (PrEP) for HIV prevention has raised questions regarding which clinicians will serve as prescribers and how providers will be educated about this HIV prevention strategy. We piloted an HIV Prevention Education Program called PrEP University (PrEP U) to address knowledge gaps in HIV prevention among medical trainees. We examined PrEP awareness and assessed learning as a result of the program, measuring knowledge before and after the lectures with an anonymous 5-question multiple choice test. A total of 198 learners participated in PrEP University, which included 127 first year medical students, and post-graduate trainees in internal medicine (n = 23), family medicine (n = 16), OBGYN (n = 13) and pharmacy (n = 19). Prior to PrEP U, 27% of all participants were not aware of PrEP and an additional 8% were unsure if they had heard of it. Knowledge increased significantly after the education program among trainees in OBGYN (2.3 vs 3.8, p < 0.001), pharmacy (1.4 vs 2.5, p = 0.012) and school of medicine (3.3 vs 4.4, p < 0.001), with a trend seen in family medicine (2.7 vs. 3.7, p = 0.067) and internal medicine (2.7 vs 3.4, p = 0.068). Overall, an HIV Prevention Education Program was successfully administered to nearly 200 participants and resulted in improved knowledge of HIV prevention and PrEP across. Pharmacists and OBGYN physicians are two groups with an expanding role in the use of PrEP. Similar programs at other medical schools should be implemented to ensure that future physicians and pharmacists are comfortable with PrEP prescription.
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Affiliation(s)
- Sophie M Cannon
- Department of Medicine, Antiviral Research Center, UCSD Medical Center, 220 Dickinson Street, Suite A, San Diego, CA, 92103, USA.
| | - Sara Graber
- Department of Medicine, Antiviral Research Center, UCSD Medical Center, 220 Dickinson Street, Suite A, San Diego, CA, 92103, USA
| | - Helen L King
- Department of Internal Medicine, UT Southwestern, Dallas, TX, 75390, USA
| | - Marvin Hanashiro
- Department of Medicine, Antiviral Research Center, UCSD Medical Center, 220 Dickinson Street, Suite A, San Diego, CA, 92103, USA
| | - Sarah Averbach
- Obstetrics, Gynecology and Reproductive Sciences, University of California, San Diego, San Diego, CA, 92103, USA
| | - David J Moore
- Department of Psychiatry, University of California, San Diego, San Diego, CA, 92103, USA
| | - Jill Blumenthal
- Department of Medicine, Antiviral Research Center, UCSD Medical Center, 220 Dickinson Street, Suite A, San Diego, CA, 92103, USA
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6
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Storholm ED, Siconolfi D, Huang W, Towner W, Grant DL, Martos A, Chang JM, Hechter R. Project SLIP: Implementation of a PrEP Screening and Linkage Intervention in Primary Care. AIDS Behav 2021; 25:2348-2357. [PMID: 33624193 PMCID: PMC8556139 DOI: 10.1007/s10461-021-03197-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 01/16/2023]
Abstract
Nearly a decade after becoming formally available in the U.S., HIV pre-exposure prophylaxis (PrEP) remains underutilized by populations at risk for HIV acquisition. The next generation of PrEP research is pivoting toward implementation research in order to identify the most impactful avenues for scaling up PrEP uptake. Rapid identification of patients who may be at risk for HIV in primary care settings and the ability to provide brief consultation and prescription or referral for PrEP could help to increase PrEP uptake. The current study aimed to develop and pilot-test a PrEP screening instrument that could be integrated into the workflow of busy primary care clinics to help facilitate PrEP uptake among at-risk men. During the study, PrEP screening occurred for 12 months in two primary care clinics nested within a large integrated healthcare delivery system in Southern California. An interrupted time series analysis found a significant increase in PrEP referrals overall during the screening intervention period as compared to the preceding 12 months. Findings suggest that brief HIV risk screening in primary care is acceptable, feasible, and shows preliminary effects in increasing PrEP referral rates for Black and Hispanic/Latinx men.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, USA.
- RAND Corporation, Santa Monica, CA, USA.
- Center for HIV Identification, Prevention, and Treatment Services, University of California, Los Angeles, CA, USA.
| | | | | | - William Towner
- Research and Evaluation, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Deborah Ling Grant
- Research and Evaluation, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Alexander Martos
- Southern California Permanente Medical Group, Los Angeles Medical Center Department of Consulting Services, Los Angeles, CA, USA
| | - John M Chang
- Research and Evaluation, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Rulin Hechter
- Research and Evaluation, Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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7
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A cross-sectional survey of general practitioner knowledge, attitudes, and clinical experience of HIV PrEP. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Abstract
Aim
Norway’s health scheme provides no-cost HIV pre-exposure prophylaxis (PrEP) when prescribed by a specialist, typically preceded by a general practitioner’s (GP) referral. The GP perspective with regard to PrEP implementation in Norway has yet to be captured.
Subject and methods
We explored PrEP knowledge, attitudes, and clinical experience of GPs in the Norwegian capital of Oslo, where HIV incidence and PrEP demand are highest. An anonymous survey was designed and distributed between November 2019 and February 2020. Univariate and multivariate logistic regression analyses were performed to identify determinants of GPs’ previous clinical PrEP experience (PrEP adoption).
Results
One hundred and seventeen GPs responded to the survey. GP PrEP adopters were more likely to: identify as men (aOR 2.1; 95% CI: 1.0–4.5); identify as lesbian, gay, or bisexual (LGB) (aOR 4.4; 95% CI: 1.4–14.5); have ≥ 10 LGB identifying patients on their list (aOR 4.4; 95% CI:1.8–10.4); and self-report higher levels of PrEP knowledge (aOR 2.4; 95% CI: 1.3–4.4).
Conclusion
Our findings suggest that GP PrEP knowledge is crucial to patient PrEP access. Educational interventions ought to be considered to enhance GP PrEP adoption capacities, such as easy-to-access PrEP guidelines and peer-based training opportunities in both online and in-person formats.
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8
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Przybyla S, Fillo J, Kamper-DeMarco K, Bleasdale J, Parks K, Klasko-Foster L, Morse D. HIV pre-exposure prophylaxis (PrEP) knowledge, familiarity, and attitudes among United States healthcare professional students: A cross-sectional study. Prev Med Rep 2021; 22:101334. [PMID: 33680721 PMCID: PMC7930580 DOI: 10.1016/j.pmedr.2021.101334] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/24/2020] [Accepted: 01/24/2021] [Indexed: 11/17/2022] Open
Abstract
The United States' initiative to End the HIV Epidemic by 2030 includes a primary goal to reduce new HIV infections by 90 percent. One key contributor to this plan is HIV pre-exposure prophylaxis (PrEP). While knowledge and acceptance of PrEP among clinicians is growing, few studies have assessed knowledge and awareness among future healthcare professionals in academic training programs. The present study aimed to assess and compare healthcare trainees' awareness, knowledge, and familiarity with PrEP prescribing guidelines to better understand and prevent gaps in academic training regarding PrEP. A cross-sectional web-based survey of medical, nurse practitioner, and pharmacy students enrolled at two universities was conducted between October 2017 and January 2018. The study assessed participants' awareness, knowledge, and familiarity with PrEP prescribing guidelines and willingness to prescribe PrEP and refer to another healthcare provider. The survey was completed by 744 participants (response rate = 36.2%). Overall, PrEP awareness was high though PrEP knowledge was low. There were significant differences among student groups in domains of interest. Pharmacy students had the greatest PrEP knowledge, awareness, and familiarity with prescribing guidelines. However, medical students reported the greatest comfort with performing PrEP-related clinical activities and willingness to refer a candidate to another provider. Study findings enhance our understanding of healthcare professional students' perspectives of PrEP as a biomedical prevention strategy for HIV. The gaps in students' knowledge offer opportunities for the development of educational strategies to support HIV prevention among future healthcare professionals.
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Affiliation(s)
- Sarahmona Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
- Corresponding author at: Director of Undergraduate Public Health Programs, University at Buffalo School of Public Health and Health Professions, 3435 Main Street, 305 Kimball Tower, United States.
| | - Jennifer Fillo
- Clinical and Research Institute on Addictions, University at Buffalo, Buffalo, NY, United States
| | | | - Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, United States
| | - Kathleen Parks
- Department of Psychology, University at Buffalo, Buffalo, NY, United States
| | - Lynne Klasko-Foster
- Department of Psychology and Human Behavior, William Alpert Medical School, Brown University, Providence, RI, United States
- Center for Health Equity Research, School of Public Health, Brown University, Providence, RI, United States
| | - Diane Morse
- Department of Psychiatry, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
- Department of Medicine, University of Rochester School of Medicine & Dentistry, Rochester, NY, United States
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9
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Identifying Missed Opportunities for Human Immunodeficiency Virus Pre-exposure Prophylaxis During Preventive Care and Reproductive Visits in Adolescents in the Deep South. Sex Transm Dis 2020; 47:88-95. [PMID: 31934955 DOI: 10.1097/olq.0000000000001104] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for individuals at significant risk for Human Immunodeficiency Virus acquisition is approved for individuals weighing at least 35 kg by the Food and Drug Administration. This cross-sectional study analyzed indications for PrEP in a clinical setting. METHODS There were 429 charts reviewed from adolescents between 15 and 21 years old seen for preventive care visits at an adolescent primary care center in the Deep South during a 1-year timeframe. Univariate and multivariable regression analyses were completed to identify factors associated with indications for PrEP. RESULTS Forty-four percent of 429 adolescents (between 15 and 21 years) had a PrEP indication; 77% were women and 95% heterosexual. Significant factors associated with an indication for PrEP included living with a nonparent or nonrelative and polysubstance use. No adolescents with an indication for PrEP were prescribed PrEP. A sensitivity analysis comparing indications for PrEP between the 2014 and 2017 The Centers for Disease Control and Prevention Guidelines revealed no significant differences in percent with an indication (44.5% vs. 42.8%) or factors associated with indications. CONCLUSIONS Pre-exposure prophylaxis as a biomedical tool for adolescents and young adults (AYAs) may remain underutilized. A key factor in improving utilization involves providers being able to recognize AYAs who may have an indication for PrEP with a specific focus on those AYAs who do not live in households with parents or a surrogate family member and those who are polysubstance users.
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10
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Health Care Provider Perspectives on Pre-exposure Prophylaxis: A Qualitative Study. J Assoc Nurses AIDS Care 2020; 30:630-638. [PMID: 30958406 DOI: 10.1097/jnc.0000000000000073] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although pre-exposure prophylaxis (PrEP) requires a prescription from a health care provider, we lack unanimity in guidelines for the identification of the ideal provider type to prescribe PrEP. The purpose of our study was to understand clinician perspectives on provider categories to determine who is best suited to prescribe this medication to HIV-uninfected patients. We conducted 28 in-depth interviews between September 2017 and January 2018 with current prescribers of PrEP. Qualitative findings indicated that providers were split on recommended PrEP prescriber type. Five themes emerged that centered on the explicit identification of the issue of opportunity for providers to educate their patients on PrEP and offer this medication to at-risk populations. To effectively maximize presentation for care and subsequently amplify uptake of PrEP, growing the base of providers who offer PrEP to eligible patients can provide a meaningful public health impact on reducing HIV incidence.
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11
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Smith AKJ, Holt M, Hughes SD, Truong HHM, Newman CE. Troubling the non-specialist prescription of HIV pre-exposure prophylaxis (PrEP): the views of Australian HIV experts. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2020; 29:62-75. [PMID: 33411659 DOI: 10.1080/14461242.2019.1703781] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/08/2019] [Indexed: 06/12/2023]
Abstract
The broadening of access to HIV pre-exposure prophylaxis (PrEP) in Australia has rekindled debates about which types of clinicians are best suited to deliver HIV prevention innovations: specialist HIV services or primary care physicians and general practitioners (GPs). We conducted 21 semi-structured qualitative interviews in 2017 with Australian HIV sector experts working across policy, advocacy, clinical service provision, research, and health promotion. These interviews took place before a national policy commitment to subsidising access to PrEP was achieved. We explored how participants conceptualised PrEP, patients and GPs at this key turning point in the history of HIV prevention. Participants expressed varied views regarding GPs' anticipated ability to successfully navigate the potential complexities associated with PrEP roll-out. While participants were supportive of greater patient access to PrEP, they expressed concerns about non-specialist GPs' cultural competence and expertise regarding sexuality and clinical practice, and the potential for patients to experience discrimination and homophobia from non-expert GPs. This study has broad implications for thinking about experts and expertise, the implementation of previously specialised medicine into mainstream settings, and the anticipated challenges of LGBTIQ+ inclusive healthcare.
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Affiliation(s)
- Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Shana D Hughes
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Hong-Ha M Truong
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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12
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Bleasdale J, Wilson K, Aidoo-Frimpong G, Przybyla S. Prescribing HIV pre-exposure prophylaxis: A qualitative analysis of health care provider training needs. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2020; 19:107-123. [PMID: 32908464 PMCID: PMC7478340 DOI: 10.1080/15381501.2020.1712291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Increasing the number of pre-exposure prophylaxis (PrEP) prescriptions will require more health care providers to be willing and trained to prescribe the medication. The purpose of our study was to understand the training needs of clinicians who do not prescribe PrEP. From September 2017 to January 2018, qualitative interviews were conducted with providers who had no experience prescribing PrEP (N = 20). Thematic analysis revealed four themes: three emphasized the temporal nature of training requirements and one identified training preferences of providers. Study findings suggest that clinicians require specific information in order to integrate PrEP into their practices successfully.
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Affiliation(s)
- Jacob Bleasdale
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Kennethea Wilson
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Gloria Aidoo-Frimpong
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Sarahmona Przybyla
- Department of Community Health and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
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Lazarou M, Fitzgerald L, Warner M, Downing S, Williams OD, Gilks CF, Russell D, Dean JA. Australian interdisciplinary healthcare providers' perspectives on the effects of broader pre-exposure prophylaxis (PrEP) access on uptake and service delivery: a qualitative study. Sex Health 2020; 17:485-492. [PMID: 33292927 DOI: 10.1071/sh20156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/18/2020] [Indexed: 12/15/2022]
Abstract
Background The addition of pre-exposure prophylaxis (PrEP) for HIV prevention to the Australian Government-subsidised Pharmaceutical Benefits Scheme (PBS) enables any doctor or nurse practitioner to prescribe it and has increased accessibility options. However, understanding of Australian healthcare providers' (HCP) knowledge and preparedness to prescribe PrEP remains limited. METHODS Semistructured interviews, conducted before PBS listing (October 2016-April 2017), explored PrEP knowledge and prescription experiences of 51 multidisciplinary HCPs involved with the Queensland Pre-Exposure Prophylaxis Demonstration study. RESULTS Thematic analysis revealed that participants viewed PrEP as a necessary HIV prevention option, but there was concern about confusing prevention messages and potential risk compensation. Clinical capacity, stigma, cultural norms, rural access and PrEP-associated costs were identified as barriers to access and uptake. Some of these barriers may be addressed by the PBS listing; nonetheless, there was strong specialist concern about the preparedness of general practitioners without sexual health experience to prescribe PrEP. Participants identified a need to educate all HCPs, implement multidisciplinary supply models and provide timely access to PrEP for vulnerable populations and those ineligible for Medicare (Australia's universal healthcare insurance system). CONCLUSIONS Although PrEP listing on the PBS addressed structural barriers to access, this study highlights the role of nurses and other interdisciplinary healthcare workers in the provision of PrEP in addressing the sociocultural barriers that still affect the access of certain populations to HIV prevention measures. These findings will inform further professional training as PrEP is more widely accessed and requested outside specialist sexual health services. Future work is needed to ensure that the primary healthcare workforce is prepared to provide competent and safe access to PrEP across diverse locations and population groups.
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Affiliation(s)
- Mattea Lazarou
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia
| | - Lisa Fitzgerald
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia
| | - Melissa Warner
- Blood Borne Virus and Sexually Transmissible Infection Unit, Communicable Disease Branch, Queensland Health, Butterfield Street, Herston, Qld 4006, Australia
| | - Sandra Downing
- College of Public Health, Medical and Veterinary Sciences, Division of Tropical Health and Medicine, James Cook University, 1 James Cook Drive, Douglas, Qld 4811, Australia
| | - Owain D Williams
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia
| | - Charles F Gilks
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia
| | - Darren Russell
- Cairns Sexual Health Service, Cairns and Hinterland Hospital and Health Service, 381 Sheridan Street, Cairns North, Qld 4870, Australia; and College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, Douglas, Qld 4811, Australia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston Campus, 288 Herston Road, Herston, Qld 4006, Australia; and Corresponding author.
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Zablotska IB, Vaccher SJ, Bloch M, Carr A, Foster R, Grulich AE, Guy R, McNulty A, Ooi C, Pell C, Poynten IM, Prestage G, Ryder N, Templeton D. High Adherence to HIV Pre-exposure Prophylaxis and No HIV Seroconversions Despite High Levels of Risk Behaviour and STIs: The Australian Demonstration Study PrELUDE. AIDS Behav 2019; 23:1780-1789. [PMID: 30284653 DOI: 10.1007/s10461-018-2290-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PrELUDE study evaluated daily pre-exposure prophylaxis (PrEP) in high-risk individuals in Australia. This open-label, single-arm study tested participants for HIV/STI and collected behavioural information three-monthly. We report trends over 18 months in medication adherence, side-effects, HIV/STI incidence and behaviour. 320 gay/bisexual men (GBM), 4 women and 3 transgender participants, followed on average 461 days, reported taking seven pills/week on 1,591 (88.5%) occasions and 4-6 pills/week on 153 (8.5%) occasions. No HIV infections were observed. STI incidence was high and stable, while gonorrhoea infections declined from 100.0 to 25.8/100 person-years between 6 and 15 months (p < 0.001). The number of HIV-positive and unknown-status sex partners, and condomless anal intercourse, significantly increased. In this high-risk cohort of mainly GBM, increases in risk behaviours and high STI incidence were not accompanied by HIV infections due to high adherence to daily PrEP. The study informed policy and further PrEP implementation among Australian GBM.
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Powell VE, Gibas KM, DuBow J, Krakower DS. Update on HIV Preexposure Prophylaxis: Effectiveness, Drug Resistance, and Risk Compensation. Curr Infect Dis Rep 2019; 21:28. [PMID: 31227999 DOI: 10.1007/s11908-019-0685-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW In 2019, the US government launched an initiative to decrease new HIV infections by 90% over the next decade. Studies have demonstrated the efficacy of HIV preexposure prophylaxis (PrEP) for high-risk populations, and the United States Preventative Services Task Force has issued a grade A recommendation for PrEP, indicating substantial net benefit. However, questions have been raised about the effectiveness of PrEP in clinical settings and whether PrEP use might promote antiretroviral drug resistance and increased sexual risk behaviors, which could increase transmission of bacterial sexually transmitted infections. In this narrative review, we summarize recent evidence of the effectiveness of PrEP when provided in clinical and community settings, the emergence of antiretroviral drug resistance during PrEP use, and associations between PrEP use and increased sexual risk behaviors. We also review novel PrEP modalities that are being developed to optimize PrEP acceptability, adherence, and effectiveness. RECENT FINDINGS Studies suggest that PrEP is effective when provided in clinical settings. However, PrEP uptake and impact have been limited in the USA thus far, and major disparities in access to PrEP exist. In addition, there is evidence that drug resistance can occur with PrEP use, particularly with inadvertent PrEP use during undiagnosed acute HIV infection. Risk compensation can also occur with PrEP use and has been associated with increased sexually transmitted infections. Promising new modalities for PrEP could expand options. PrEP has strong potential to decrease HIV incidence. However, disparities in access must be addressed to ensure equity and impact for PrEP. While drug resistance and risk compensation can occur with PrEP use, these are not valid reasons to withhold PrEP from patients given its substantial protective benefits.
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Affiliation(s)
- Victoria E Powell
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis St. W/LMOB, Suite GB, Boston, MA, 02215, USA
| | - Kevin M Gibas
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis St. W/LMOB, Suite GB, Boston, MA, 02215, USA
| | - Joshua DuBow
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis St. W/LMOB, Suite GB, Boston, MA, 02215, USA
| | - Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, 110 Francis St. W/LMOB, Suite GB, Boston, MA, 02215, USA. .,The Fenway Institute, Fenway Health, Boston, MA, USA. .,Department of Population Medicine, Harvard Medical School, Boston, MA, USA.
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16
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Golub SA, Myers JE. Next-Wave HIV Pre-Exposure Prophylaxis Implementation for Gay and Bisexual Men. AIDS Patient Care STDS 2019; 33:253-261. [PMID: 31094576 DOI: 10.1089/apc.2018.0290] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Data indicate that diffusion of pre-exposure prophylaxis (PrEP) programs for HIV prevention is increasing in the United States; however, persistent disparities in PrEP access remain. Earlier waves of PrEP implementation focused on development (2012-2015) and diffusion (2016-2018). To reduce disparities, the next wave of PrEP implementation should focus on integration; that is, the assimilation of PrEP service as an integral part of HIV prevention, sexual health, and primary care. This review analyzes PrEP implementation literature in the context of three "next-wave" challenges: increasing patient demand, enhancing provider investment and competency, and improving health systems capacity. Our review revealed five activities we consider critical to successful next-wave PrEP implementation efforts: (1) redefining PrEP eligibility assessment, (2) de-emphasizing risk perception as a strategy to increase demand, (3) rejecting risk compensation arguments, (4) altering guidelines to make PrEP follow-up less onerous, and (5) focusing directly on strategies to reduce the cost of PrEP medication. This article ends with a case study of a research-practice partnership designed to instantiate new approaches to integrative implementation efforts.
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Affiliation(s)
- Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, New York
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, New York
| | - Julie E. Myers
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
- Division of Infectious Diseases, Department of Medicine, Columbia University Medical Center, New York, New York
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Drak D, Barratt H, Templeton DJ, O’Connor CC, Gracey DM. Renal function and risk factors for renal disease for patients receiving HIV pre-exposure prophylaxis at an inner metropolitan health service. PLoS One 2019; 14:e0210106. [PMID: 30653509 PMCID: PMC6336260 DOI: 10.1371/journal.pone.0210106] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) significantly reduces the risk of HIV acquisition. TDF is a known nephrotoxin however, renal dysfunction from TDF is mostly reversible following discontinuation. Aims To describe the renal function, risk factors for renal disease and associated clinical testing practices in a cohort of PrEP patients. Methods A retrospective review was conducted of all PrEP patients commenced on TDF/FTC at an inner metropolitan sexual health clinic in Sydney, Australia between April 2016 and July 2017, with follow-up data obtained at 3-monthly intervals until 18 months. Results 525 patients met inclusion criteria. Patients were almost exclusively male and median age was 34 years (IQR: 28 to 42). At baseline, 1.5% had an estimated glomerular filtration rate (eGFR) <70 mL/min/1.73m2. A small significant drop in eGFR of -2.5 mL/min/1.73m2 (p<0.05) occurred between PrEP commencement and the first follow-up period, followed by a progressive decline in eGFR of -0.38 mL/min/1.73m2 per month (95%CI: -0.57 to -0.20; p<0.001). Renal impairment (eGFR <70 mL/min/1.73m2) occurred in 6.5% of patients and persisted across consecutive follow-up periods in five (1.0%) patients. Patients aged ≥40 years had a greater risk of renal impairment than younger patients (HR 3.9, 95%CI: 1.8 to 8.4; p<0.001), despite similar rates of eGFR decline (p = 0.19). PrEP was discontinued in two patients (0.4%) due to renal function concerns. Conclusion PrEP use led to an initial drop in eGFR and a more gradual progressive decline subsequently, but significant renal impairment remained uncommon up to 18 months of follow-up.
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Affiliation(s)
- Douglas Drak
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- * E-mail:
| | - Hamish Barratt
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
- Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - David J. Templeton
- Central Clinical School, University of Sydney, Sydney, NSW, Australia
- RPA Sexual Health, Sydney Local Health District, Sydney, NSW, Australia
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - Catherine C. O’Connor
- Central Clinical School, University of Sydney, Sydney, NSW, Australia
- RPA Sexual Health, Sydney Local Health District, Sydney, NSW, Australia
- Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | - David M. Gracey
- Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Renal Unit, Royal Prince Alfred Hospital, Sydney Local Health District, Sydney, NSW, Australia
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18
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Venter WDF. Pre-exposure Prophylaxis: The Delivery Challenge. Front Public Health 2018; 6:188. [PMID: 30035106 PMCID: PMC6043793 DOI: 10.3389/fpubh.2018.00188] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/13/2018] [Indexed: 01/14/2023] Open
Abstract
HIV pre-exposure prophylaxis (PrEP), despite its efficacy, has been slow in uptake throughout the world. This article discusses the operational and service delivery complexity, based on early real-world experience, with some recommendations on how this promising intervention could be made more available. Currently, access to PrEP is made complex by restricting delivery to dedicated health facilities, as well as requirements around HIV testing and toxicity monitoring. Expanding to verticalized services that focus on well-defined populations where HIV testing and treatment programmes already exist, has proven relatively simple. Providing PrEP outside of this environment has yet to be demonstrated at any scale, and will likely require innovative thinking addressing the regulatory and clinical environment, so as to ensure easier access to this promising HIV prevention tool.
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Affiliation(s)
- Willem D F Venter
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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