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Fitzgerald N, Coltart H, Dominguez L, Flanagan K, Gilleece Y. PrEP for women in Europe: a systematic literature review. HIV Med 2023. [PMID: 37088558 DOI: 10.1111/hiv.13458] [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: 06/21/2022] [Accepted: 01/03/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Prevention of HIV transmission is fundamental to ending the HIV epidemic. Pre-exposure prophylaxis (PrEP) with oral tenofovir-emtricitabine (TDF-FTC) is an established HIV-prevention method; however, most PrEP services in Europe have been targeted at men who have sex with men (MSM). A survey in 2021 by Women Against Viruses in Europe (WAVE) showed considerable variation in PrEP access and guidance for women throughout Europe. WAVE therefore commissioned this systematic review to provide insight into PrEP provision and barriers to uptake for women in Europe. METHODS PubMed, Embase, and Scopus were searched for studies (January 2013-May 2021) that reported on actual (e.g., efficacy and safety) or hypothetical (e.g., awareness, barriers, PrEP impact models) use of oral PrEP involving women (including cis, transgender, pregnant, migrant, and breastfeeding women). Search terms included HIV, pre-exposure prophylaxis (specifically TDF-FTC), and women. Studies performed outside of the World Health Organization European region were excluded. RESULTS The search identified 4716 unique citations, and 45 peer-reviewed articles (44 studies) were included. The majority of these studies (34/44 [77%]) included recipients or potential recipients of PrEP, representing 4699 women (243 transgender women). However, few studies were women focused (4/34 [12%]) or took place outside of Western Europe (3/34 [9%]). Across the three clinical studies that reported women-specific outcomes (60 transgender women, 13 pregnant, and 19 cis women), no breakthrough infections were recorded during the use of PrEP. Lack of awareness of PrEP, low self-estimation of HIV acquisition risk, concerns about stigma, lack of protection against other sexually transmitted infections, and PrEP interaction with hormones (for transgender women) were identified as barriers to use. The remaining studies examined healthcare professionals' perceptions of PrEP (9/44 [20%]), asked for public opinion (2/44 [5%]), or modelled the potential of PrEP for HIV prevention (1/44 [2%]). CONCLUSIONS This review revealed a notable lack of literature on PrEP for cis and transgender women in Europe. This is synonymous with a lack of PrEP provision for women in this region. Barriers to PrEP uptake are complex and rooted in institutional and societal stigma, which must be addressed at policy level. HIV prevention with PrEP is not 'one size fits all' and requires a nuanced gender-responsive approach. Further research into the use of PrEP in cis, pregnant, breastfeeding, and transgender women is essential if we are to stop HIV transmission by 2030.
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Affiliation(s)
| | | | | | | | - Yvonne Gilleece
- Brighton & Sussex Medical School, Brighton, UK
- The Lawson Unit, Royal Sussex County Hospital, Brighton, UK
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Gallego-Márquez N, Iniesta C. Targeting fast-track goals: Missed opportunities for HIV testing in the Community of Madrid. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:138-141. [PMID: 34969654 DOI: 10.1016/j.eimce.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION In Spain HIV testing is recommended to people with risk behaviors for HIV and with indicator conditions (IC) related to HIV infection. Missed diagnostic opportunities (MO) are defining as situations where these recommendations are not followed. OBJECTIVE To characterize MO due to risk behaviors (directed) and due to IC (indicated) among people diagnosed with HIV in the Region of Madrid. METHODS A total of 109 participants newly diagnosed with HIV were recruited from 7 health centers (April 2018-March 2019) by a telephone survey. Diagnostic opportunities were defined as any contact with the healthcare system in which an HIV test should have been carried out. Frequency of MO was calculated within the previous 2 years from HIV diagnosis. RESULTS Of the 32 directed and indicated diagnostic opportunities, 96.9% and 57.8% respectively resulted in MO. Overall, 83.8% of diagnostic opportunities resulted in MO. CONCLUSION MO, both directed and indicated, are an important area for improvement to reduce late diagnosis.
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Affiliation(s)
- Nuria Gallego-Márquez
- Unidad de Vigilancia de VIH, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain; Master of Science in Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Carlos Iniesta
- Unidad de Coordinación de la Cohorte de la Red de Investigación en Sida (CoRIS), Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, Spain.
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Ayerdi Aguirrebengoa O, Vera Garcia M, Puerta López T, Clavo Escribano P, Ballesteros Martín J, Lejarrag Cañas C, Fuentes Ferrer E, Raposo Utrilla M, Estrada Perez V, Del Romero Guerrero J, Rodríguez Martín C. Changes in the profile of newly HIV-diagnosed men who have sex with men, Madrid, 2014 to 2019. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2021; 26. [PMID: 34823642 PMCID: PMC8619870 DOI: 10.2807/1560-7917.es.2021.26.47.2001501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Knowing the factors associated with HIV transmission is necessary in order to design preventive programmes tailored to the epidemiological situation in each region and population. Aim Our objective was to study the sociodemographic, clinical and behavioural characteristics of men who have sex with men (MSM) who were newly diagnosed with HIV infection. Methods We carried out an observational, descriptive, study on all MSM newly diagnosed with HIV infection in one clinic for sexually transmitted infections (STI) and HIV clinic in Madrid between 2014 and 2019. Information on sociodemographic, clinical, and behavioural characteristics of participants per year of diagnosis was collected. Results We detected a total of 1,398 people with HIV infection, 253 of whom were recent seroconverters (rSCV) with a median duration of documented seroconversion of 6 months. From the total, 97.9% infections were sexually transmitted and 2.1% involved injected drugs, i.e. slam practices. The average age was 32.9 years (range: 15.6–74.9), 51.8% were Spanish and 40% Latin American. These diagnoses decreased in Spanish people and increased in Latin Americans during the study period. Of the rSCV, 73.9% had condomless sex under the influence of drugs and 28.9% participated in chemsex sessions. Apps were used by 92.6% rSCV for sexual encounters and 70.4% of them attributed HIV transmission to their use. Conclusions Combination of HIV prevention strategies, as pre-exposure prophylaxis, should be reinforced among young MSM, especially those born in Latin America, those who use drugs for sex, and those who use apps in search of sexual contacts.
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Affiliation(s)
- Oskar Ayerdi Aguirrebengoa
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Mar Vera Garcia
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | - Teresa Puerta López
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain
| | | | | | | | - Enrique Fuentes Ferrer
- Servicio de Medicina Preventiva, Insituto de investigación Sanitaria San Carlos, Universidad Alfonso X el Sabio, Madrid, Spain
| | | | - Vicente Estrada Perez
- Universidad Complutense de Madrid, Madrid, Spain.,Unidad de Infecciosas, Medicina Interna, Hospital San Carlos, IdISSC, Madrid, Spain
| | | | - Carmen Rodríguez Martín
- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
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- Centro Sanitario Sandoval, Hospital Clínico San Carlos, IdISSC, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,Servicio de Medicina Preventiva, Insituto de investigación Sanitaria San Carlos, Universidad Alfonso X el Sabio, Madrid, Spain.,Unidad de Infecciosas, Medicina Interna, Hospital San Carlos, IdISSC, Madrid, Spain
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Gallego-Márquez N, Iniesta C. Targeting fast-track goals: Missed opportunities for HIV testing in the Community of Madrid. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00181-6. [PMID: 34112557 DOI: 10.1016/j.eimc.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION In Spain HIV testing is recommended to people with risk behaviors for HIV and with indicator conditions related to HIV infection. Missed diagnostic opportunities (MO) are defining as situations where these recommendations are not followed. OBJECTIVE To characterize MO due to risk behaviors (directed) and due to indicator conditions (indicated) among people diagnosed with HIV in the Region of Madrid. METHODS A total of 109 participants newly diagnosed with HIV were recruited from 7 health centers (April 2018-March 2019) by a telephone survey. Diagnostic opportunities were defined as any contact with the healthcare system in which an HIV test should have been carried out. Frequency of MO was calculated within the previous 2 years from HIV diagnosis. RESULTS Of the 32 directed and indicated diagnostic opportunities, 96.9 and 57.8% respectively resulted in MO. Overall, 83.8% of diagnostic opportunities resulted in MO. CONCLUSION MO, both directed and indicated, are an important area for improvement to reduce late diagnosis.
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Affiliation(s)
- Nuria Gallego-Márquez
- Unidad de Vigilancia de VIH, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España; Master of Science in Public Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, EE. UU
| | - Carlos Iniesta
- Unidad de coordinación de la Cohorte de la Red de Investigación en Sida (CoRIS), Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Madrid, España.
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Chemsex Practices and Health-Related Quality of Life in Spanish Men with HIV Who Have Sex with Men. J Clin Med 2021; 10:jcm10081662. [PMID: 33924530 PMCID: PMC8068924 DOI: 10.3390/jcm10081662] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 11/23/2022] Open
Abstract
Chemsex, a new risky sexual behavior involving participation in sexual relations under the influence of drugs, has shown a significantly increased prevalence in recent years. This fact entails a serious public health issue, especially when Chemsex is practiced by individuals with an HIV (Human Immunodeficiency Virus) diagnosis. Hence, analyzing the characteristics of Chemsex practices, associated sexual practices and the health outcomes of individuals who participate in Chemsex, is extremely important. The main aim of the present study is to analyze the prevalence and characteristics of the practice of Chemsex in a sample of 101 men with HIV who have sex with men who attended the Department of Infectious Diseases of the General University Hospital of Alicante (Spain). Furthermore, the association between Chemsex and Health-Related Quality of Life (HRQoL) was also assessed. Chemsex and sexual practices were evaluated by employing a questionnaire applied on an ad hoc basis. HRQoL was assessed by employing the Medical Outcomes Study HIV Health Survey (MOS-HIV). In total, 40.6% of the participants had practiced Chemsex during the last year. When sexual practices were compared between those individuals who practiced Chemsex and those who did not, the former presented a higher level of risky sexual behaviors, especially with occasional and multiple sexual partners. Regarding HRQoL, those individuals who practiced Chemsex exhibited a poorer HRQoL in the majority of domains, especially those participants who practiced it with a higher intensity. The present study points out the high prevalence of Chemsex practice between men with HIV who have sex with men in Spain. Moreover, this study highlights the negative effects of Chemsex on HRQoL, probably due to the mixed effects of higher levels of risky sexual practices and the consequences of drug consumption.
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Meireles P, Plankey M, Rocha M, Brito J, Mendão L, Barros H. Different guidelines for pre-exposure prophylaxis (PrEP) eligibility estimate HIV risk differently: an incidence study in a cohort of HIV-negative men who have sex with men, Portugal, 2014-2018. Euro Surveill 2020; 25:1900636. [PMID: 32700673 PMCID: PMC7376846 DOI: 10.2807/1560-7917.es.2020.25.28.1900636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 05/15/2020] [Indexed: 11/20/2022] Open
Abstract
IntroductionGuidelines for pre-exposure prophylaxis (PrEP) provide criteria to identify individuals at higher risk of HIV infection. We compared the ability to predict HIV seroconversion of four guidelines: the World Health Organization (WHO), the United States Public Health Service and Centers for Disease Control and Prevention (US CDC), the European AIDS Clinical Society (EACS) and the Portuguese National Health Service (PNHS).AimWe aimed to measure the association between guideline-specific eligibility and HIV seroconversion.MethodsWe studied 1,254 participants from the Lisbon Cohort of men who have sex with men with at least two evaluations between March 2014 and March 2018, corresponding to 1,724.54 person-years (PY) of follow-up. We calculated incidence rates (IR) according to each guideline eligibility definition and incident rate ratios (IRR) to test the association between eligibility at baseline and HIV seroconversion.ResultsWe found 28 incident cases (IR: 1.62/100 PY; 95% confidence interval (CI) 1.12-2.35). Guidelines' sensitivity varied from 60.7% (EACS) to 85.7% (PNHS) and specificity varied from 31.8% (US CDC) to 51.5% (EACS). IR was highest among those defined as eligible by the PNHS guideline (2.46/100 PY; IRR = 4.61; 95% CI: 1.60-13.27) and lowest for the WHO guideline (1.89/100 PY; IRR = 1.52; 95% CI: 0.69-3.35).ConclusionsBeing identified as eligible for PrEP was associated with a higher risk of infection. The magnitude of risk varied according to the guideline used. However, the number of HIV infections identified among ineligible participants highlights the potential for missing people who need PrEP.
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Affiliation(s)
- Paula Meireles
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Michael Plankey
- Georgetown University Medical Center, Georgetown University, Washington DC, United States
| | - Miguel Rocha
- GAT-Grupo de Ativistas em Tratamentos, Lisboa, Portugal
- Coalition PLUS Community-Based Research Laboratory, Patin, France
| | - João Brito
- GAT-Grupo de Ativistas em Tratamentos, Lisboa, Portugal
- Coalition PLUS Community-Based Research Laboratory, Patin, France
| | - Luís Mendão
- GAT-Grupo de Ativistas em Tratamentos, Lisboa, Portugal
- Coalition PLUS Community-Based Research Laboratory, Patin, France
| | - Henrique Barros
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
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Martín-Carbonero L, Montes M. When should pre-exposure prophylaxis against HIV be implemented in Spain? Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Martín-Carbonero L, Montes M. ¿Para cuándo la implantación de la profilaxis pre-exposición frente al VIH en España? Rev Clin Esp 2019; 219:396-397. [DOI: 10.1016/j.rce.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 03/19/2019] [Indexed: 11/16/2022]
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