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Huang Y, Feng S, Zhao Y, Wang H, Jiang H. Preferences for COVID-19 Vaccines: Systematic Literature Review of Discrete Choice Experiments. JMIR Public Health Surveill 2024; 10:e56546. [PMID: 39073875 DOI: 10.2196/56546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/01/2024] [Accepted: 05/26/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Vaccination can be viewed as comprising the most important defensive barriers to protect susceptible groups from infection. However, vaccine hesitancy for COVID-19 is widespread worldwide. OBJECTIVE We aimed to systematically review studies eliciting the COVID-19 vaccine preference using discrete choice experiments. METHODS A literature search was conducted in PubMed, Embase, Web of Science, Scopus, and CINAHL Plus platforms in April 2023. Search terms included discrete choice experiments, COVID-19, and vaccines and related synonyms. Descriptive statistics were used to summarize the study characteristics. Subgroup analyses were performed by factors such as high-income countries and low- and middle-income countries and study period (before, during, and after the pandemic wave). Quality appraisal was performed using the 5-item Purpose, Respondents, Explanation, Findings, and Significance checklist. RESULTS The search yield a total of 623 records, and 47 studies with 53 data points were finally included. Attributes were grouped into 4 categories: outcome, process, cost, and others. The vaccine effectiveness (21/53, 40%) and safety (7/53, 13%) were the most frequently reported and important attributes. Subgroup analyses showed that vaccine effectiveness was the most important attribute, although the preference varied by subgroups. Compared to high-income countries (3/29, 10%), a higher proportion of low- and middle-income countries (4/24, 17%) prioritized safety. As the pandemic progressed, the duration of protection (2/24, 8%) during the pandemic wave and COVID-19 mortality risk (5/25, 20%) after the pandemic wave emerged as 2 of the most important attributes. CONCLUSIONS Our review revealed the critical role of vaccine effectiveness and safety in COVID-19 vaccine preference. However, it should be noticed that preference heterogeneity was observed across subpopulations and may change over time. TRIAL REGISTRATION PROSPERO CRD42023422720; https://tinyurl.com/2etf7ny7.
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Affiliation(s)
- Yiting Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- Department of Medical Statistics, School of Basic Medicine and Public Health, Jinan University, Guangzhou, China
| | - Shuaixin Feng
- Outpatient department of Baogang, the First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Yuyan Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Haode Wang
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
- Institute for Global Health, University College London, London, United Kingdom
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She B, Lu F, Zhao R, Lin S, Sun J, He S, Liu Y, Su S, Zhang L. Examining the Effects of PrEP Use on Sexual Behaviors and Sexually Transmitted Infections Among Chinese Men who have Sex with Men: A Cross-Sectional Study. AIDS Behav 2024:10.1007/s10461-024-04398-9. [PMID: 39066859 DOI: 10.1007/s10461-024-04398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/30/2024]
Abstract
Men who have sex with men (MSM) is a high-risk population for HIV and sexually transmitted infections (STIs). Pre-exposure prophylaxis (PrEP) is effective in HIV prevention. This study aims to examine the differences in sexual behaviors, STI prevalence and HIV/STI testing across subgroups of MSM with various PrEP use. Data were collected via a cross-sectional survey in an MSM community in Xi'an, Shaanxi, from 2022.01 to 2022.09. Participants were categorized as 'PrEP-naïve and unwilling to use', 'PrEP-naïve but willing to use', and 'current or former PrEP users'. Shannon index was used to assess sexual act diversity and multivariate logistic regression analyzed factors associated with PrEP use. Of the 1,131 MSM participants, 23.52% were PrEP-naïve and unwilling, 64.98% were PrEP-naïve but willing, and 11.49% were current or former PrEP users. The PrEP-naïve but willing group had the highest recent STI testing rates at 73.06% and showed greater sexual act diversity (Shannon index 1.61). This group also had the highest syphilis rates (7.49% vs. 6.47% and2.54%, p < 0.01). Younger age (18-30: OR = 0.39 (0.18-0.85); 31-40: OR = 0.43 (0.20-0.96)) and lower education (high school/vocational: OR = 0.15 (0.04-0.58); associate degree: OR = 0.21 (0.06-0.71)) were factors that negatively influenced PrEP use. Current or former PrEP users had the highest oropharyngeal gonorrhea (14.39% vs. 9.68% and 5.80%, p < 0.01) and overall gonorrhea rates (20.86% vs. 17.17% and 8.37%, p < 0.001). 'PrEP-naïve but willing' participants consistently demonstrated high-risk sexual behavior, increased STI testing, and more diverse sexual acts, whereas PrEP users had the highest STI prevalence.
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Affiliation(s)
- Bingyang She
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Fang Lu
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Rui Zhao
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Siqi Lin
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Jiajun Sun
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Shiyi He
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Yi Liu
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Shu Su
- Department of Epidemiology and Biostatistics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China.
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
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McGuire C, Atieno MA, Hoke T, Jeckonia P, K'orimba K, Lorenzetti L, Ngure K, Niyibeshaho MM, Njuguna N, Torjesen K, Fonner V. PrEP Method Switching: Will it Yield Greater Coverage of HIV Protection? Applying Lessons Learned from Family Planning to Guide Future Research in the Context of PrEP Choice. Curr HIV/AIDS Rep 2024:10.1007/s11904-024-00704-1. [PMID: 39046639 DOI: 10.1007/s11904-024-00704-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
PURPOSE OF REVIEW Despite the growing availability of oral PrEP, coverage remains suboptimal. Through the introduction of additional PrEP methods, including vaginal rings and long-acting injectable formulations, health systems globally are on the cusp of offering PrEP methods that vary by route of administration, efficacy, and frequency of use. With PrEP choice, it will be important to explore PrEP use patterns to better understand how the ability to choose and switch products affects coverage and continuation. In this review, we draw parallels with family planning (FP) by summarizing how method choice and product switching affected contraceptive coverage globally, synthesize what is known about PrEP product switching, and outline evidence gaps to help guide future research on PrEP switching in the context of choice. RECENT FINDINGS Decades of research in FP has demonstrated that product switching is common and can lead to more satisfaction and increases in contraceptive use. While research on PrEP product switching is nascent, findings suggest switching is common, and that providing more than one PrEP option can increase coverage. Key evidence gaps include understanding product switching in the context of full versus constrained choice, switching in the context of temporary need, and developing interventions that promote product switching for those who could benefit. Providing choice and allowing people to start, stop, and switch products according to their needs and desires is a core component of a rights-based approach to HIV prevention. More research is needed to better understand what drives use patterns, including switching, and how to leverage choice to improve coverage. Standard definitions -some of which have been proposed in this review-are needed to inform comparable measurement. Finally, there is a need to holistically frame PrEP use to acknowledge changes in need over the life course, thus making method switching a standard part of HIV prevention.
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Affiliation(s)
- Courtney McGuire
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
| | | | - Theresa Hoke
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | | | | | - Lara Lorenzetti
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, USA
| | | | | | | | - Virginia Fonner
- FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
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Mugambi ML, Odhiambo BO, Dollah A, Marwa MM, Nyakina J, Kinuthia J, Baeten JM, Weiner BJ, John‐Stewart G, Barnabas RV, Hauber B. Women's preferences for HIV prevention service delivery in pharmacies during pregnancy in Western Kenya: a discrete choice experiment. J Int AIDS Soc 2024; 27 Suppl 1:e26301. [PMID: 38965978 PMCID: PMC11224584 DOI: 10.1002/jia2.26301] [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: 09/01/2023] [Accepted: 05/16/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Pharmacy-delivered HIV prevention services might create more options for pregnant women to use HIV prevention tools earlier and more consistently during pregnancy. We quantified preferences for attributes of potential HIV prevention services among women of childbearing age in Western Kenya. METHODS From June to November 2023, we administered a face-to-face discrete choice experiment survey to women aged 15-44 in Kenya's Homa Bay, Kisumu and Siaya counties. The survey evaluated preferences for HIV prevention services, described by seven attributes: service location, travel time, type of HIV test, sexually transmitted infection (STI) testing, partner HIV testing, pre-exposure prophylaxis (PrEP) and service fee. Participants answered a series of 12-choice questions. Each question asked them to select one of two service options or no services-an opt-out option. We used hierarchical Bayesian modelling levels to estimate each attribute level's coefficient and understand how attributes influenced service choice. RESULTS Overall, 599 participants completed the survey, among whom the median age was 23 years (IQR: 18-27); 33% were married, 20% had a job and worked regularly, and 52% had been pregnant before. Participants, on average, strongly preferred having any HIV prevention service option over none (opt-out preference weight: -5.84 [95% CI: -5.97, -5.72]). The most important attributes were the availability of PrEP (relative importance 27.04% [95% CI: 25.98%, 28.11%]), followed by STI testing (relative importance 20.26% [95% CI: 19.52%, 21.01%]) and partner HIV testing (relative importance: 16.35% [95% CI: 15.79%, 16.90%]). While, on average, participants preferred obtaining services at the clinic more than pharmacies, women prioritized the availability of PrEP, STI testing and partner HIV testing more than the location or cost. CONCLUSIONS These findings suggest the importance of providing comprehensive HIV prevention services and ensuring PrEP, STI testing and partner HIV testing are available. If pharmacies can offer these services, women are likely to access those services at pharmacies even if they prefer clinics.
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Affiliation(s)
| | - Ben O. Odhiambo
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Kenyatta National HospitalNairobiKenya
| | | | | | | | - John Kinuthia
- Department of Research and ProgramsKenyatta National HospitalNairobiKenya
| | - Jared M. Baeten
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Gilead SciencesFoster CityCaliforniaUSA
| | - Bryan J. Weiner
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Grace John‐Stewart
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Ruanne Vanessa Barnabas
- Harvard Medical School and Division of Infectious DiseasesMassachusetts General HospitalBostonMassachusettsUSA
| | - Brett Hauber
- The Comparative Health OutcomesPolicy and Economics (CHOICE) InstituteDepartment of PharmacyUniversity of WashingtonSeattleWashingtonUSA
- Pfizer, IncNew York CityNew YorkUSA
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Makarova N, Singletary T, Peet MM, Mitchell J, Bachman S, Holder A, Dinh C, Lipscomb J, Agrahari V, Mendoza M, Pan Y, Heneine W, Clark MR, García-Lerma JG, Doncel GF, Smith JM. Extended Postexposure Protection Against Vaginal Simian/Human Immunodeficiency Virus Infection With Tenofovir Alafenamide Fumarate/Elvitegravir Inserts in Macaques. J Infect Dis 2024; 229:1791-1795. [PMID: 38134382 DOI: 10.1093/infdis/jiad599] [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: 09/22/2023] [Revised: 12/15/2023] [Accepted: 12/20/2023] [Indexed: 12/24/2023] Open
Abstract
Vaginal inserts that can be used on demand before or after sex may be a desirable human immunodeficiency virus (HIV) prevention option for women. We recently showed that inserts containing tenofovir alafenamide fumarate (TAF, 20 mg) and elvitegravir (EVG, 16 mg) were highly protective against repeated simian/human immunodeficiency virus (SHIV) vaginal exposures when administered to macaques 4 hours before or after virus exposure (93% and 100%, respectively). Here, we show in the same macaque model that insert application 8 hours or 24 hours after exposure maintains high efficacy (94.4% and 77.2%, respectively). These data extend the protective window by TAF/EVG inserts and inform their clinical development for on-demand prophylaxis in women.
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Affiliation(s)
- Natalia Makarova
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tyana Singletary
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Melissa Peet
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia
| | - James Mitchell
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shanon Bachman
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela Holder
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Chuong Dinh
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jonathan Lipscomb
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vivek Agrahari
- CONRAD, Eastern Virginia Medical School, Norfolk, Virginia
| | - Maria Mendoza
- Quantitative Sciences Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yi Pan
- Quantitative Sciences Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Walid Heneine
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - J Gerardo García-Lerma
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - James M Smith
- Laboratory Branch, Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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Mayanja Y, Kayesu I, Kamacooko O, Lunkuse JF, Muturi-Kioi V, Price M, Kosidou K, Ekström AM. Preference for novel biomedical HIV pre-exposure prophylaxis methods among adolescent girls and young women in Kampala, Uganda: a mixed methods study. Front Public Health 2024; 12:1369256. [PMID: 38846614 PMCID: PMC11153736 DOI: 10.3389/fpubh.2024.1369256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024] Open
Abstract
Background Novel HIV pre-exposure prophylaxis (PrEP) methods including a potential future HIV vaccine, will increase prevention options for adolescent girls and young women (AGYW) at high risk of HIV infection in Eastern and Southern Africa, yet data on AGYW's preferences for various PrEP methods is limited. We investigated preferences for five biomedical PrEP methods (oral, injectable, vaginal ring, implant, HIV vaccine) among 14-24-years-old AGYW in Kampala, Uganda. Methods From January to December 2019, we conducted a mixed methods study including 265 high-risk AGYW. After receiving two education sessions on the five PrEP methods, participants were asked about their "most preferred PrEP method." Multinomial logistic regression (oral PrEP as reference category) was used to determine participant characteristics associated with method preference. Results are presented as adjusted relative risk ratios (aRRR) with 95% confidence intervals (CI). In-depth interviews were conducted with 20 selected participants to examine reasons influencing PrEP preferences and suggestions for method improvements. Transcripts were analyzed thematically. Results Participants preferred methods were: HIV vaccine (34.7%), oral PrEP (25.7%), injectable PrEP (24.9%), PrEP implant (13.6%), and vaginal ring (1.1%). Preference for injectable PrEP increased with every year of age (aRRR 1.22; 95% CI 1.04-1.44) and among participants with chlamydia or gonorrhoea (aRRR 2.53; 95% CI 1.08-5.90), while it was lower among participants having sexual partner(s) living with HIV or of unknown HIV status (aRRR 0.30; 95% CI 0.10-0.91). Preference for PrEP implants also increased with age (aRRR 1.42; 95% CI 1.14-1.77) and was strong among participants having ≥10 sexual partners in the past 3 months (aRRR 3.14; 95% CI 1.16-8.55), while it was lower among those with sexual partner(s) living with HIV or of unknown HIV status (aRRR 0.25; 95% CI 0.07-0.92). PrEP method preference was influenced by product attributes and prior experiences with similar product forms commonly used in health care. Conclusion AGYW have varied preferences for biomedical PrEP method and those with higher sexual behavioral risk prefer long-acting methods. As we anticipate more available PrEP options, oral PrEP use should be supported among AGYW, especially for those with sexual partners living with HIV or of unknown HIV status.
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Affiliation(s)
- Yunia Mayanja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ivy Kayesu
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Onesmus Kamacooko
- Child Health and Development Centre, School of Medicine, Makerere University, Kampala, Uganda
| | - Jane Frances Lunkuse
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | | | - Matt Price
- 4IAVI, New York, NY, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases/Venhälsan, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
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Psaros C, Goodman GR, Lee JS, Rice W, Kelley CF, Oyedele T, Coelho LE, Phanuphak N, Singh Y, Middelkoop K, Griffith S, McCauley M, Rooney J, Rinehart AR, Clark J, Go V, Sugarman J, Fields SD, Adeyeye A, Grinsztejn B, Landovitz RJ, Safren SA. HPTN 083-02: factors influencing adherence to injectable PrEP and retention in an injectable PrEP study. J Int AIDS Soc 2024; 27:e26252. [PMID: 38783534 PMCID: PMC11116478 DOI: 10.1002/jia2.26252] [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: 06/16/2023] [Accepted: 04/12/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION HPTN 083 demonstrated the superiority of long-acting cabotegravir (CAB-LA) versus daily oral emtricitabine/tenofovir disoproxil fumarate (TDF/FTC) as pre-exposure prophylaxis (PrEP) among cisgender men and transgender women who have sex with men (MSM/TGW). HPTN 083 provided the first opportunity to understand experiences with injectable PrEP in a clinical trial. METHODS Participants from two US sites (Chicago, IL and Atlanta, GA) and one international site (Rio de Janeiro, Brazil) were purposively sampled for individual qualitative interviews (N = 40), between November 2019 and March 2020, to explore trial experiences, barriers to adherence and other factors that may have impacted study implementation or outcomes. The blinded phase ended early due to efficacy; this analysis includes interviews conducted prior to unblinding with three groups defined by adherence (i.e. injection visit attendance): adherent (n = 27), non-adherent (n = 12) and early discontinuers (n = 1). Data were organized using NVivo software and analysed using content analysis. RESULTS Participants (mean age: 27) were primarily cisgender MSM (90%) and Black/African American (60%). Reasons for trial enrolment and PrEP use included a preference for using HIV prevention medication versus treatment in the event of HIV acquisition; the ability to enhance health via study-related education and services; access to a novel, convenient HIV prevention product at no cost; and contributing to MSM/TGW communities through research. Participants contrasted positive experiences with study staff with their routine clinical care, and emphasized increased scheduling flexibility, thorough communication, non-judgemental counselling and open, affirming environments (e.g. compassion, less stigma) as adherence facilitators. Injection experiences were positive overall; some described early injection-related anxiety, which abated with time and when given some measure of control (e.g. pre-injection countdown), and minimal injection site discomfort. Some concerns and misperceptions about injectable PrEP were reported. Barriers to adherence, across all adherence categories, included structural factors (e.g. financial constraints, travel) and competing demands (e.g. work schedules). CONCLUSIONS Respondents viewed injectable PrEP trial participation as a positive experience and a means of enhancing wellbeing. Study site flexibility and affirming clinic environments, inclusive of non-judgemental counselling, were key facilitators of adherence. To support injection persistence, interventions that address structural barriers and promote flexible means of injection delivery may be most effective.
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Affiliation(s)
- Christina Psaros
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | - Georgia R. Goodman
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
- Department of Emergency MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | - Jasper S. Lee
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Whitney Rice
- Department of BehavioralSocial and Health Education SciencesEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Colleen F. Kelley
- Division of Infectious DiseasesDepartment of MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | | | - Lara E. Coelho
- Instituto Nacional de Infectologia Evandro Chagas‐FiocruzRio de JaneiroBrazil
| | - Nittaya Phanuphak
- Institute of HIV Research and InnovationBangkokThailand
- Center of Excellence in Transgender HealthChulalongkorn UniversityBangkokThailand
| | - Yashna Singh
- Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
| | - Keren Middelkoop
- Desmond Tutu HIV CentreUniversity of Cape TownCape TownSouth Africa
- Department of MedicineUniversity of Cape TownCape TownSouth Africa
| | | | | | | | | | - Jesse Clark
- Division of Infectious DiseasesDepartment of MedicineDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
| | - Vivian Go
- Department of Health BehaviorUniversity of North Carolina Gillings School of Global Public HealthChapel HillNorth CarolinaUSA
| | - Jeremy Sugarman
- Berman Institute of Bioethics and School of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Sheldon D. Fields
- Ross and Carol Nese College of NursingThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Adeola Adeyeye
- Nigeria Country OfficeUS Centers for Disease Control and PreventionAbujaNigeria
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas‐FiocruzRio de JaneiroBrazil
| | - Raphael J. Landovitz
- Center for Clinical AIDS Research and EducationDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCaliforniaUSA
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8
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Massud I, Nishiura K, Ruone S, Holder A, Dinh C, Lipscomb J, Mitchell J, Khalil GM, Heneine W, Garcίa-Lerma JG, Dobard CW. Weekly Oral Tenofovir Alafenamide Protects Macaques from Vaginal and Rectal Simian HIV Infection. Pharmaceutics 2024; 16:384. [PMID: 38543278 PMCID: PMC10974356 DOI: 10.3390/pharmaceutics16030384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/26/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Pre-exposure prophylaxis (PrEP) with a weekly oral regimen of antiretroviral drugs could be a suitable preventative option for individuals who struggle with daily PrEP or prefer not to use long-acting injectables. We assessed in macaques the efficacy of weekly oral tenofovir alafenamide (TAF) at doses of 13.7 or 27.4 mg/kg. Macaques received weekly oral TAF for six weeks and were exposed twice-weekly to SHIV vaginally or rectally on day 3 and 6 after each dose. Median TFV-DP levels in PBMCs following the 13.7 mg/kg dose were 3110 and 1137 fmols/106 cells on day 3 and 6, respectively. With the 27.4 mg/kg dose, TFV-DP levels were increased (~2-fold) on day 3 and 6 (6095 and 3290 fmols/106 cells, respectively). Both TAF doses (13.7 and 27.4 mg/kg) conferred high efficacy (94.1% and 93.9%, respectively) against vaginal SHIV infection. Efficacy of the 27.4 mg/kg dose against rectal SHIV infection was 80.7%. We estimate that macaque doses of 13.7 and 27.4 mg/kg are equivalent to approximately 230 and 450 mg of TAF in humans, respectively. Our findings demonstrate the effectiveness of a weekly oral PrEP regimen and suggest that a clinically achievable oral TAF dose could be a promising option for non-daily PrEP.
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Affiliation(s)
- Ivana Massud
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (I.M.); (K.N.); (S.R.); (A.H.); (C.D.); (J.L.); (J.M.); (W.H.); (J.G.G.-L.)
| | - Kenji Nishiura
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (I.M.); (K.N.); (S.R.); (A.H.); (C.D.); (J.L.); (J.M.); (W.H.); (J.G.G.-L.)
| | - Susan Ruone
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (I.M.); (K.N.); (S.R.); (A.H.); (C.D.); (J.L.); (J.M.); (W.H.); (J.G.G.-L.)
| | - Angela Holder
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (I.M.); (K.N.); (S.R.); (A.H.); (C.D.); (J.L.); (J.M.); (W.H.); (J.G.G.-L.)
| | - Chuong Dinh
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (I.M.); (K.N.); (S.R.); (A.H.); (C.D.); (J.L.); (J.M.); (W.H.); (J.G.G.-L.)
| | - Jonathan Lipscomb
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (I.M.); (K.N.); (S.R.); (A.H.); (C.D.); (J.L.); (J.M.); (W.H.); (J.G.G.-L.)
| | - James Mitchell
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (I.M.); (K.N.); (S.R.); (A.H.); (C.D.); (J.L.); (J.M.); (W.H.); (J.G.G.-L.)
| | - George M. Khalil
- Quantitative Sciences and Data Management Branch, Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA;
| | - Walid Heneine
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (I.M.); (K.N.); (S.R.); (A.H.); (C.D.); (J.L.); (J.M.); (W.H.); (J.G.G.-L.)
| | - J. Gerardo Garcίa-Lerma
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (I.M.); (K.N.); (S.R.); (A.H.); (C.D.); (J.L.); (J.M.); (W.H.); (J.G.G.-L.)
| | - Charles W. Dobard
- Laboratory Branch, Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA; (I.M.); (K.N.); (S.R.); (A.H.); (C.D.); (J.L.); (J.M.); (W.H.); (J.G.G.-L.)
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9
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Wong CM, Munthali T, Mangunje FG, Katoka ML, Burke HM, Musonda B, Musonda M, Todd CS. Creating allies: qualitative exploration of young women's preferences for PrEP methods and parents' role in PrEP uptake and user support in urban and rural Zambia. BMC Womens Health 2024; 24:71. [PMID: 38273282 PMCID: PMC10809647 DOI: 10.1186/s12905-024-02913-7] [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: 05/11/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Zambian adolescent girls and young women (AGYW) have high HIV incidence and face barriers to the use of pre-exposure prophylaxis (PrEP). Parental support improves PrEP use and adherence in some settings, but negative parental attitudes toward HIV prevention may inhibit engagement with AGYW. We explored perceptions of future PrEP methods among AGYW and parents and parent-youth engagement on HIV prevention and PrEP use. METHODS We conducted a qualitative descriptive study among AGYW and parents of AGYW in five provinces in Zambia in September-October 2021. We conducted 10 focus group discussions (FGDs) and four in-depth interviews (IDIs) with AGYW participants (n = 87) and seven FGDs and four IDIs among parents of AGYW (n = 62). All FGDs and IDIs were audio-recorded, transcribed verbatim, and analyzed to identify qualitative themes. RESULTS Most AGYW participants preferred the discreet nature and longer duration of injectable PrEP compared to the PrEP ring and oral PrEP. Many AGYWs reported inability to disclose PrEP use to their parents due to lack of parental support based on cultural taboos against premarital sex. Nevertheless, AGYW participants said they would like to talk to their parents about PrEP so their parents could support their use. Many parents also described difficulties discussing PrEP with their daughters because of cultural and religious beliefs about abstinence from sex before marriage. However, parents acknowledged that the threat of HIV is real and said they need PrEP knowledge and guidance on speaking with their children about HIV prevention and PrEP. CONCLUSIONS Although many parents are currently not playing a role in daughters' decisions about PrEP use, both parents and AGYW are willing to engage with each other on HIV prevention issues. To foster parent-child engagement, HIV prevention programs should not only provide information about PrEP but also address social norms that impede discussion of HIV prevention and equip both parents and AGYW with skills and support for such conversations. Community sensitization is also needed as new PrEP products are introduced, to create an enabling environment for parent-child engagement by increasing awareness, countering misconceptions, and reducing stigma.
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Affiliation(s)
- Christina Misa Wong
- Global Health & Population, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA.
| | - Tendai Munthali
- Ministry of Health, Government of the Republic of Zambia, Ndeke House, Haile Selassie Avenue, P.O. Box 30205, Lusaka, Zambia
| | - Featherstone G Mangunje
- FHI 360 Zambia, Tiyende Pamodzi Road, Off Nangwenya Road, Farmers Village, Showgrounds Area, P.O. Box 320303, Lusaka, 10101, Zambia
| | - Mercy L Katoka
- FHI 360 Zambia, Tiyende Pamodzi Road, Off Nangwenya Road, Farmers Village, Showgrounds Area, P.O. Box 320303, Lusaka, 10101, Zambia
| | - Holly M Burke
- Reproductive, Maternal, Newborn, and Child Health, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
| | - Bupe Musonda
- Ministry of Health, Government of the Republic of Zambia, Ndeke House, Haile Selassie Avenue, P.O. Box 30205, Lusaka, Zambia
| | - Musonda Musonda
- United States Agency for International Development (USAID), Embassy of the United States of America, Subdivision 694/Stand 100 Ibex Hill Road, P.O. Box 320373, Lusaka, 10101, Zambia
| | - Catherine S Todd
- Global Health & Population, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, USA
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10
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Jin G, Shi H, Du J, Guo H, Yuan G, Yang H, Zhu Z, Zhang J, Zhang K, Zhang X, Lu X, Xu W, Wang S, Hao J, Sun Y, Su P, Zhang Z. Pre-Exposure Prophylaxis Care Continuum for HIV Risk Populations: An Umbrella Review of Systematic Reviews and Meta-Analyses. AIDS Patient Care STDS 2023; 37:583-615. [PMID: 38011347 DOI: 10.1089/apc.2023.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is an effective biomedical strategy for HIV prevention. This umbrella review is aimed at providing a comprehensive summary of the current status of each stage of the PrEP care cascade. A systematic literature search was conducted in PubMed, Embase, and Cochrane. Additionally, a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) tool and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist were used to evaluate their methodological and reporting quality, respectively. A total of 30 systematic reviews met the inclusion criteria. According to the results of methodological quality assessment, 3 reviews were rated as low, while 27 as critically low. Furthermore, the results of the reporting quality evaluation revealed a mean score of 23.03 for the included reviews. Across all the reviews, awareness of PrEP was generally moderate in all populations, and the acceptability was even higher compared with awareness. Unfortunately, the PrEP uptake among different groups was even less optimal, although the adherence was almost above moderate, and several barriers that hindered the utilization of PrEP were identified, and the most common are as follows: cost, stigma, lack of knowledge, mistrust, low risk perception, and more. Although PrEP has proven to be an effective prevention method to date, the promotion of PrEP failed to achieve the anticipated outcome. To reinforce the generalization of and use of PrEP, and effectively control HIV transmission, it is urgent to identify the underlying causes of low uptake rates so that efficient interventions can be implemented.
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Affiliation(s)
- Guifang Jin
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Haiyan Shi
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jun Du
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Haiyun Guo
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Guojing Yuan
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Huayu Yang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihui Zhu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jianghui Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Kexin Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Xueqing Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Xiaoyan Lu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Wenzhuo Xu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Sainan Wang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jiahu Hao
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Ying Sun
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Puyu Su
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihua Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
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11
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Daly MB, Wong-Sam A, Li L, Krovi A, Gatto GJ, Norton C, Luecke EH, Mrotz V, Forero C, Cottrell ML, Schauer AP, Gary J, Nascimento-Seixas J, Mitchell J, van der Straten A, Heneine W, Garcίa-Lerma JG, Dobard CW, Johnson LM. Pharmacokinetic Study of Islatravir and Etonogestrel Implants in Macaques. Pharmaceutics 2023; 15:2676. [PMID: 38140017 PMCID: PMC10747562 DOI: 10.3390/pharmaceutics15122676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/02/2023] [Accepted: 11/16/2023] [Indexed: 12/24/2023] Open
Abstract
The prevention of HIV and unintended pregnancies is a public health priority. Multi-purpose prevention technologies capable of long-acting HIV and pregnancy prevention are desirable for women. Here, we utilized a preclinical macaque model to evaluate the pharmacokinetics of biodegradable ε-polycaprolactone implants delivering the antiretroviral islatravir (ISL) and the contraceptive etonogestrel (ENG). Three implants were tested: ISL-62 mg, ISL-98 mg, and ENG-33 mg. Animals received one or two ISL-eluting implants, with doses of 42, 66, or 108 µg of ISL/day with or without an additional ENG-33 mg implant (31 µg/day). Drug release increased linearly with dose with median [range] plasma ISL levels of 1.3 [1.0-2.5], 1.9 [1.2-6.3] and 2.8 [2.3-11.6], respectively. The ISL-62 and 98 mg implants demonstrated stable drug release over three months with ISL-triphosphate (ISL-TP) concentr54ations in PBMCs above levels predicted to be efficacious for PrEP. Similarly, ENG implants demonstrated sustained drug release with median [range] plasma ENG levels of 495 [229-1110] pg/mL, which suppressed progesterone within two weeks and showed no evidence of altering ISL pharmacokinetics. Two of the six ISL-98 mg implants broke during the study and induced implant-site reactions, whereas no reactions were observed with intact implants. We show that ISL and ENG biodegradable implants are safe and yield sufficient drug levels to achieve prevention targets. The evaluation of optimized implants with increased mechanical robustness is underway for improved durability and vaginal efficacy in a SHIV challenge model.
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Affiliation(s)
- Michele B. Daly
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Andres Wong-Sam
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Linying Li
- RTI International, Durham, NC 27709, USA
| | | | | | | | | | - Victoria Mrotz
- Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Catalina Forero
- Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Mackenzie L. Cottrell
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Amanda P. Schauer
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Joy Gary
- Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Josilene Nascimento-Seixas
- Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - James Mitchell
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Ariane van der Straten
- ASTRA Consulting, Kensington, CA 94708, USA
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA 94104, USA
| | - Walid Heneine
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - J. Gerardo Garcίa-Lerma
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Charles W. Dobard
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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12
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Henderson M, Schmidt HMA, Chitembo L, Peralta H, Alaama AS, Johnson C, Baggaley R, Schaefer R. The Future of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention: A Global Qualitative Consultation on Provider Perspectives on New Products and Differentiated Service Delivery. AIDS Behav 2023; 27:3755-3766. [PMID: 37351685 PMCID: PMC10589125 DOI: 10.1007/s10461-023-04093-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/24/2023]
Abstract
Differentiated service delivery and new products, such as long-acting injectable cabotegravir (CAB-LA) and the dapivirine vaginal ring (DVR), could increase uptake and use of pre-exposure prophylaxis (PrEP) for HIV prevention. We explored PrEP provider perspectives on differentiated PrEP service delivery and new PrEP products to inform World Health Organization (WHO) guidelines and programme implementation. 150 PrEP providers who participated in a WHO survey were randomly selected and 67 were invited for interviews based on geographic representation, provider cadre, gender, experience with community-based PrEP service delivery, and familiarity with new PrEP products. Semi-structured interviews were conducted virtually. Key themes were inductively extracted relating to differentiated service delivery and benefits and concerns regarding new PrEP products. 30 PrEP providers from 24 countries were interviewed. Across regions, providers were supportive of differentiated service delivery to respond to clients' needs and preferences, maintain services during COVID-19, and ensure access for priority populations that may face access challenges. Providers welcomed prospects of offering CAB-LA to their clients but had concerns about HIV testing, costs, and the need for clinic-based services, including staff who can administer injections. Providers felt the DVR was potentially important for some cisgender women, especially young clients and female sex workers, and raised fewer concerns compared to injectable PrEP. Providers' views are critical for the development of guidelines and implementing programmes that will best serve PrEP users. Understanding areas where provider capacities and biases may create barriers can define opportunities for training and support to ensure that providers can deliver effective programmes.
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Affiliation(s)
| | - Heather-Marie A Schmidt
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland
- UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
| | | | | | - Ahmed S Alaama
- World Health Organization Office for the Eastern Mediterranean Region, Cairo, Egypt
| | - Cheryl Johnson
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland
| | - Robin Schaefer
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland.
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13
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Ahmed A, Dujaili JA, Chuah LH, Hashmi FK, Le LKD, Khanal S, Awaisu A, Chaiyakunapruk N. Cost-Effectiveness of Anti-retroviral Adherence Interventions for People Living with HIV: A Systematic Review of Decision Analytical Models. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2023; 21:731-750. [PMID: 37389788 PMCID: PMC10403422 DOI: 10.1007/s40258-023-00818-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Although safe and effective anti-retrovirals (ARVs) are readily available, non-adherence to ARVs is highly prevalent among people living with human immunodeficiency virus/acquired immunodeficiency syndrome (PLWHA). Different adherence-improving interventions have been developed and examined through decision analytic model-based health technology assessments. This systematic review aimed to review and appraise the decision analytical economic models developed to assess ARV adherence-improvement interventions. METHODS The review protocol was registered on PROSPERO (CRD42022270039), and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Relevant studies were identified through searches in six generic and specialized bibliographic databases, i.e. PubMed, Embase, NHS Economic Evaluation Database, PsycINFO, Health Economic Evaluations Database, tufts CEA registry and EconLit, from their inception to 23 October 2022. The cost-effectiveness of adherence interventions is represented by the incremental cost-effectiveness ratio (ICER). The quality of studies was assessed using the quality of the health economics studies (QHES) instrument. Data were narratively synthesized in the form of tables and texts. Due to the heterogeneity of the data, a permutation matrix was used for quantitative data synthesis rather than a meta-analysis. RESULTS Fifteen studies, mostly conducted in North America (8/15 studies), were included in the review. The time horizon ranged from a year to a lifetime. Ten out of 15 studies used a micro-simulation, 4/15 studies employed Markov and 1/15 employed a dynamic model. The most commonly used interventions reported include technology based (5/15), nurse involved (2/15), directly observed therapy (2/15), case manager involved (1/15) and others that involved multi-component interventions (5/15). In 1/15 studies, interventions gained higher quality-adjusted life years (QALYs) with cost savings. The interventions in 14/15 studies were more effective but at a higher cost, and the overall ICER was well below the acceptable threshold mentioned in each study, indicating the interventions could potentially be implemented after careful interpretation. The studies were graded as high quality (13/15) or fair quality (2/15), with some methodological inconsistencies reported. CONCLUSION Counselling and smartphone-based interventions are cost-effective, and they have the potential to reduce the chronic adherence problem significantly. The quality of decision models can be improved by addressing inconsistencies in model selection, data inputs incorporated into models and uncertainty assessment methods.
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Affiliation(s)
- Ali Ahmed
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
| | - Juman Abdulelah Dujaili
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
- Swansea University Medical School, Singleton Campus, Swansea University, Wales, UK
| | - Lay Hong Chuah
- School of Pharmacy, Monash University, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia
| | - Furqan Khurshid Hashmi
- University College of Pharmacy, University of Punjab, Allama Iqbal Campus, Lahore, 54000, Pakistan
| | - Long Khanh-Dao Le
- Monash University Health Economics Group (MUHEG), School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Saval Khanal
- Health Economics Consulting, University of East Anglia, Coventry, UK
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Nathorn Chaiyakunapruk
- College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- IDEAS Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
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14
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Hsu J, Ku SW, Chen T, Li C, Huang P, Wu H, Bourne A, Strong C. Preferences for long-acting pre-exposure prophylaxis among gay, bisexual and other men who have sex with men in Taiwan: findings from the 2021 HEART Survey. J Int AIDS Soc 2023; 26:e26163. [PMID: 37675767 PMCID: PMC10483501 DOI: 10.1002/jia2.26163] [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: 03/19/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
INTRODUCTION While various antiretrovirals have been studied as potential candidates for long-acting pre-exposure prophylaxis (PrEP), the bimonthly injectable cabotegravir-the first long-acting form of PrEP-was approved in 2021. Event-driven (ED) PrEP has been the most prevalent dosing regimen among gay, bisexual and other men who have sex with men (GBMSM) in Taiwan, providing a unique setting to observe the preferences for long-acting PrEP in a community where the daily regimen is not the mainstream method. This study aimed to determine the preferences for the different forms and dosing intervals of long-acting PrEP that are currently in the development pipeline. METHODS We conducted a survey in 2021 by convenience sampling the users of social networking applications for GBMSM in Taiwan. Our survey included questions on sexual behaviours, current PrEP regimens and the preferences for potential candidates of long-acting PrEP, such as implants, intramuscular and subcutaneous injections. We compared the Likert-scale preference ratings for potential long-acting options, and conducted logistic regression analysis to examine the factors associated with a preference for bimonthly intramuscular injections (2M IM) over ED and daily PrEP regimens, respectively. RESULTS A total of 1728 responses were eligible for analysis. Three percent of respondents (n = 52) were daily PrEP users; 11.5% (n = 198) were ED PrEP users. When not considering cost, current PrEP users-regardless of their original dosing regimen-were most likely to express preferences for monthly oral PrEP, followed by a 6-month subcutaneous injectable (6M SC) and 2M IM. However, among non-current PrEP users, monthly oral PrEP was the most preferred form, followed by ED, daily oral and 6M SC injectable. Multivariable logistic regression revealed that current daily users, those willing to take PrEP in the next 6 months and those with more sex partners in the last 12 months had a significant correlation with preferences for the 2M IM injectable over the ED PrEP. CONCLUSIONS The monthly oral form was the most preferable long-acting PrEP among GBMSM in Taiwan. Current daily PrEP users preferred the 2M IM injectable over the ED PrEP, which made the 2M IM injectable a potential alternative. Further studies should focus on how the cost and delivery affect PrEP preferences and their actual uptake.
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Affiliation(s)
- Jing‐Hao Hsu
- Department of Public HealthCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Stephane Wen‐Wei Ku
- Division of Infectious DiseasesDepartment of MedicineTaipei City Hospital Renai BranchTaipeiTaiwan
- HIV Education and Research Taiwan (HEART) AssociationTaipeiTaiwan
| | - Tsai‐Wei Chen
- Department of Public HealthCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Chia‐Wen Li
- Infection Control Center and Department of Internal MedicineNational Cheng Kung University HospitalCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
| | - Poyao Huang
- Institute of Health Behaviors and Community SciencesNational Taiwan UniversityTaipeiTaiwan
| | - Huei‐Jiuan Wu
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
| | - Adam Bourne
- The Kirby InstituteUNSW SydneySydneyNew South WalesAustralia
- Australian Research Centre in SexHealth and SocietyLa Trobe UniversityMelbourneVictoriaAustralia
| | - Carol Strong
- Department of Public HealthCollege of MedicineNational Cheng Kung UniversityTainanTaiwan
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Ortblad KF, Bardon AR, Mogere P, Kiptinness C, Gakuo S, Mbaire S, Thomas KK, Mugo NR, Baeten JM, Ngure K. Effect of 6-Month HIV Preexposure Prophylaxis Dispensing With Interim Self-testing on Preexposure Prophylaxis Continuation at 12 Months: A Randomized Noninferiority Trial. JAMA Netw Open 2023; 6:e2318590. [PMID: 37318803 PMCID: PMC10273023 DOI: 10.1001/jamanetworkopen.2023.18590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/27/2023] [Indexed: 06/16/2023] Open
Abstract
Importance Daily oral HIV preexposure prophylaxis (PrEP) delivery requires quarterly clinic visits for HIV testing and drug refilling that are costly to health systems and clients. Objective To evaluate whether 6-month PrEP dispensing supported with interim HIV self-testing (HIVST) results in noninferior PrEP continuation outcomes at 12 months compared with standard quarterly clinic visits. Design, Setting, and Participants This randomized noninferiority trial was conducted from May 2018 to May 2021 with 12 months of follow-up among PrEP clients aged 18 years or older who were returning for their first refill at a research clinic in Kiambu County, Kenya. Intervention Participants were randomized 2:1 to (1) 6-month PrEP dispensing with semiannual clinic visits and interim HIVST at 3 months or (2) standard-of-care (SOC) PrEP delivery with 3-month dispensing, quarterly clinic visits, and clinic-based HIV testing. Main Outcomes and Measures Prespecified 12-month outcomes included recent HIV testing (any in past 6 months), PrEP refilling, and PrEP adherence (detectable tenofovir-diphosphate concentrations in dried blood spots). Binomial regression models were used to estimate risk differences (RDs), and a 1-sided 95% CI lower bound (LB) of -10% or greater was interpreted as noninferior. Results A total of 495 participants were enrolled, with 329 enrolled in the intervention group and 166 enrolled in the SOC group; 330 (66.7%) were women, 295 (59.6%) were in serodifferent relationships, and the median (IQR) age was 33 (27-40) years. At 12 months, 241 individuals in the intervention group (73.3%) and 120 in the SOC group (72.3%) returned to clinic. In the intervention group, recent HIV testing was noninferior (230 individuals [69.9%]) compared with the SOC group (116 [69.9%]; RD, -0.33%, 95% CI LB, -7.44%). PrEP refilling in the intervention group (196 [59.6%]) was inconclusive compared with the SOC group (104 [62.7%]; RD, -3.25%; 95% CI LB, -10.84%), and PrEP adherence was noninferior in the intervention group (151 [45.9%]) compared with the SOC group (70 [42.2%]; RD, 4.96%; 95% CI LB, -2.46%). No HIV seroconversions were observed over the follow-up period. Conclusions and Relevance In this analysis of secondary trial end points at 1 year, semiannual PrEP dispensing with interim HIVST resulted in noninferior recent HIV testing and PrEP adherence compared with SOC quarterly PrEP dispensing. This novel model has the potential to optimize PrEP delivery. Trial Registration ClinicalTrials.gov Identifier: NCT03593629.
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Affiliation(s)
- Katrina F. Ortblad
- Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Ashley R. Bardon
- Department of Global Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Peter Mogere
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Stephen Gakuo
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sarah Mbaire
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Nelly R. Mugo
- Department of Global Health, University of Washington, Seattle
- Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
- now with Gilead Sciences, Foster City, California
| | - Kenneth Ngure
- Department of Global Health, University of Washington, Seattle
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
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Chen Y, Saldarriaga EM, Montano MA, Ngure K, Thuo N, Kiptinness C, Rafferty M, Terris-Prestholt F, Stergachis A, Mugambi ML, Ortblad KF, Sharma M. Assessing preferences for HIV pre-exposure prophylaxis (PrEP) delivery services via online pharmacies in Kenya: protocol for a discrete choice experiment. BMJ Open 2023; 13:e069195. [PMID: 37012008 PMCID: PMC10083853 DOI: 10.1136/bmjopen-2022-069195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition, but coverage remains low in high prevalence settings. Initiating and continuing PrEP via online pharmacies is a promising strategy to expand PrEP uptake but little is known about user preferences for this strategy. We describe methods for a discrete choice experiment (DCE) to assess preferences for PrEP delivery from an online pharmacy. METHODS AND ANALYSIS This cross-sectional study is conducted in Nairobi, Kenya, in partnership with MYDAWA, a private online pharmacy retailer with a planned sample size of >400 participants. Eligibility criteria are: ≥18 years, not known HIV-positive and interested in PrEP. Initial DCE attributes and levels were developed via literature review and stakeholder meetings. We conducted cognitive interviews to assess participant understanding of the DCE survey and refined the design. The final DCE used a D-efficient design and contained four attributes: PrEP eligibility assessment, HIV test type, clinical consultation type and user support options. Participants are presented with eight scenarios consisting of two hypothetical PrEP delivery services. The survey was piloted among 20 participants before being advertised on the MYDAWA website on pages displaying products indicating HIV risk (eg, HIV self-test kits). Interested participants call a study number and those screened eligible meet a research assistant in a convenient location to complete the survey. The DCE will be analysed using a conditional logit model to assess average preferences and mixed logit and latent class models to evaluate preference heterogeneity among subgroups. ETHICS AND DISSEMINATION This study was approved by the University of Washington Human Research Ethics Committee (STUDY00014011), the Kenya Medical Research Institute, Nairobi County (EOP/NMS/HS/128) and the Scientific and Ethics Review Unit in Kenya (KEMRI/RES/7/3/1). Participation in the DCE is voluntary and subject to completion of an electronic informed consent. Findings will be shared at international conferences and peer-reviewed publications, and via engagement meetings with stakeholders.
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Affiliation(s)
- Yilin Chen
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
| | - Enrique M Saldarriaga
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
| | - Michalina A Montano
- Vaccine and Infectious Diseases Division (VIDD), Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Kenneth Ngure
- School of Public Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Nicholas Thuo
- Partners in Health Research and Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Catherine Kiptinness
- Partners in Health Research and Development, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Andy Stergachis
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Katrina F Ortblad
- Public Health Science Division, Fred Hutchinson Cancer Center, Seattle, Washington, USA
| | - Monisha Sharma
- Department of Global Health, University of Washington, Seattle, Washington, USA
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Bonney EY, Lamptey H, Kyei GB. HIV cure: an acceptability scientific agenda. Curr Opin HIV AIDS 2023; 18:12-17. [PMID: 36503877 PMCID: PMC9757853 DOI: 10.1097/coh.0000000000000771] [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] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Recent years have seen major investments into HIV cure research, seeking a permanent cure or remission. The purpose of this review is to consider how this important research agenda could be broadened to include issues of acceptability and appropriateness for different populations. RECENT FINDINGS We discuss how the definitions of cure such as functional cure (remission) or complete cure (viral elimination) could be interpreted differently by various populations. We also discuss the different methods of cure and the importance of including Africa in cure research to ensure that emerging remedies could be trialled and utilized on the continent that bears the brunt of the AIDS pandemic. SUMMARY We propose that the social science research of HIV cure acceptability should be done concurrently with the basic and clinical sciences, to ensure that cure methods consider stakeholder preferences.
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Affiliation(s)
- Evelyn Y. Bonney
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Helena Lamptey
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine in St Louis, Missouri, USA
| | - George B. Kyei
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
- Departments of Medicine and Molecular Microbiology, Washington University School of Medicine in St Louis, Missouri, USA
- Medical and Scientific Research Center, University of Ghana Medical Center, Accra, Ghana
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Kerkhoff AD, Muiruri C, Geng EH, Hickey MD. A world of choices: preference elicitation methods for improving the delivery and uptake of HIV prevention and treatment. Curr Opin HIV AIDS 2023; 18:32-45. [PMID: 36409315 PMCID: PMC9772083 DOI: 10.1097/coh.0000000000000776] [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] [Indexed: 11/22/2022]
Abstract
PURPOSE OF REVIEW Despite the growing availability of effective HIV prevention and treatment interventions, there are large gaps in their uptake and sustained use across settings. It is crucial to elicit and apply patients' and stakeholders' preferences to maximize the impact of existing and future interventions. This review summarizes quantitative preference elicitation methods (PEM) and how they can be applied to improve the delivery and uptake of HIV prevention and treatment interventions. RECENT FINDINGS PEM are increasingly applied in HIV implementation research; however, discrete choice experiments (DCEs) have predominated. Beyond DCEs, there are other underutilized PEM that may improve the reach and effectiveness of HIV prevention and treatment interventions among individuals by prioritizing their barriers to engagement and determining which attributes of interventions and delivery strategies are most valued. PEM can also enhance the adoption and sustained implementation of strategies to deliver HIV prevention and treatment interventions by assessing which attributes are the most acceptable and appropriate to key stakeholders. SUMMARY Greater attention to and incorporation of patient's and stakeholders' preferences for HIV prevention and treatment interventions and their delivery has the potential to increase the number of persons accessing and retained in HIV prevention and treatment services.
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Affiliation(s)
- Andrew D. Kerkhoff
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, San Francisco, CA, USA
| | - Charles Muiruri
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Matthew D. Hickey
- Division of HIV, Infectious Diseases and Global Medicine Zuckerberg San Francisco General Hospital and Trauma Center University of California, San Francisco, San Francisco, CA, USA
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