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Rogers BG, Harkness A, Satyanarayana S, Pachankis J, Safren SA. Individual, Interpersonal, and Structural Factors That Influence Intentions to Use Pre-exposure Prophylaxis Among Sexual Minority Men in Miami. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:741-750. [PMID: 35536492 PMCID: PMC10463180 DOI: 10.1007/s10508-021-02263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Pre-exposure prophylaxis for HIV or "PrEP" holds great promise for reducing HIV incidence. However, in certain geographic settings, like Miami, a US HIV epicenter, uptake of PrEP has been paradoxically very low compared to other areas of the country. The goal of the current study was to examine factors associated with low uptake of PrEP in young sexual minority men in Miami. Qualitative data were extracted from conversations during voluntary HIV/STI counseling and testing sessions with 24 young sexual minority men, most of whom identified as racial/ethnic minorities. These sessions were completed as part of a baseline visit for a combined mental and sexual health intervention trial. Thematic analysis of transcripts revealed barriers and facilitators associated with PrEP uptake at multiple levels (individual, interpersonal, and economic and healthcare systems barriers). Individual-level themes included concerns about the safety of PrEP, risk compensation, and taking daily oral medication; and potential benefits of PrEP as a backup plan to condom use to reassure and reduce worry about HIV. Interpersonal-level themes included lack of knowledgeable and affirming medical providers, changing norms within the community around "safe sex," and PrEP use in serodiscordant partnerships. Economic and healthcare systems barriers included challenges to accessing PrEP because of a lack of insurance and high out-of-pocket cost. These data can be used to inform the development of interventions aligned with Ending the HIV Epidemic priorities to increase PrEP use among young sexual minority men living in an HIV epicenter.
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Affiliation(s)
- Brooke G Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, 11 Fourth Street, Providence, RI, 02906, USA.
- Department of Medicine, Infectious Diseases, The Miriam Hospital, Providence, RI, USA.
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA.
| | - Audrey Harkness
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
- Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Satyanand Satyanarayana
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
| | - John Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Steven A Safren
- Department of Psychology, College of Arts and Sciences, University of Miami, Coral Gables, FL, USA
- The Fenway Institute, Boston, MA, USA
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2
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Giorlando KK, Arnold T, Barnett AP, Leigland A, Whiteley L, Brock JB, Brown LK. Acceptability and Comfort Regarding Remotely Delivered PrEP Services in Mississippi. J Int Assoc Provid AIDS Care 2023; 22:23259582231186868. [PMID: 37415442 PMCID: PMC10331183 DOI: 10.1177/23259582231186868] [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: 02/03/2023] [Accepted: 06/21/2023] [Indexed: 07/08/2023] Open
Abstract
Despite the prevalence of human immunodeficiency virus (HIV) in Mississippi, access to pre-exposure prophylaxis (PrEP) is mostly limited to urban areas. Remote PrEP care via telemedicine, HIV self-testing, and prescription mail delivery can improve care in underserved communities. This mixed methods study assessed the acceptability and feasibility of using remote PrEP care, compared to alternatives. This consisted of (1) a cross-sectional survey and (2) interviews. PrEP-eligible adults were recruited from community-based organizations across Mississippi while accessing HIV testing between December 2019 and May 2022. Those surveyed (n = 63) indicated the greatest comfort in receiving PrEP via mail delivery (m = 5.14) and telemedicine (m = 4.89) and least comfort at gyms (m = 3.92). Comfort significantly differed between mail delivery and gyms (F = 2.90; P < .01). Those interviewed (n = 26) expressed relatively high comfort with remote PrEP care citing enhanced accessibility, privacy, simplicity, and quality. Remote PrEP services were acceptable and feasible among our sample, thus, should be expanded in Mississippi to address unmet needs.
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Affiliation(s)
| | - Trisha Arnold
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Andrew P. Barnett
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Avery Leigland
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Laura Whiteley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - James B. Brock
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Larry K. Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
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3
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Eliciting Preferences for HIV Prevention Technologies: A Systematic Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:151-174. [PMID: 33319339 PMCID: PMC7884379 DOI: 10.1007/s40271-020-00486-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 01/10/2023]
Abstract
Background Many human immunodeficiency virus (HIV) prevention technologies (pre-exposure prophylaxis, microbicides, vaccines) are available or in development. Preference elicitation methods provide insight into client preferences that may be used to optimize products and services. Given increased utilization of such methods in HIV prevention, this article identifies and reviews these methods and synthesizes their application to HIV prevention technologies. Methods In May 2020, we systematically searched peer-reviewed literature in PubMed, CINAHL, and Web of Science for studies employing quantitative preference elicitation methods to measure preferences for HIV prevention technologies among populations of any age, sex, or location. Quality assessment used an existing checklist (PREFS) and a novel adaptation of the Newcastle–Ottawa Scale (PROSPERO #CRD42018087027). Results We screened 5022 titles and abstracts, reviewed 318 full texts, and included 84 studies. Common methods employed were discrete-choice experiment (33%), conjoint analysis (25%), and willingness-to-participate/try/accept (21%). Studies were conducted in 25 countries and had a mean of 768 participants (range = 26–7176), two-thirds of them male. Common HIV prevention technologies included pre-exposure prophylaxis (23%), voluntary testing and counseling (19%), HIV self-testing (17%), vaccines (15%), and topical microbicides (9%). Most attributes focused on product design (side effects, frequency), service design (provider type, location), acceptability or willingness to accept/pay; results are summarized in these categories, by prevention type. Mean quality-adapted Newcastle–Ottawa Scale score was 4.5/8 (standard deviation = 2.1) and mean PREFS scores was 3.47/5 (standard deviation = 0.81). Conclusions This review synthesizes extant literature on quantitative measurement of preferences for HIV prevention technologies. This can enable practitioners to improve prevention products and interventions, and ultimately reduce HIV incidence.
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Whiteley L, Healy MG, Lowery A, Haubrick KK, Brown LK. An evaluation and review of English language pre-exposure prophylaxis websites and YouTube videos. Int J STD AIDS 2020; 31:460-466. [DOI: 10.1177/0956462420905271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a promising HIV prevention strategy in which antiretroviral medications are taken to prevent HIV infection. PrEP was approved as an HIV prevention method in the United States in 2012 for individuals aged 18 years and older. Since its approval, there has been a growing amount of online content about PrEP targeted to general, non-medical, audiences. However, this online information is under-studied and under-evaluated. Two raters catalogued and coded PrEP material written in the English language from 61 websites and 58 YouTube videos for educational content, credibility, usability, and interactivity. The online material was catalogued and searched for between September 2017 and April 2018. Online PrEP material showed deficiencies in each of these content areas, however, there is a significant amount of publicly accessible online content available about PrEP. This content could be packaged, used, and tested in a prevention intervention to improve PrEP uptake and engagement in care.
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Affiliation(s)
- Laura Whiteley
- Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Meredith G Healy
- Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, USA
| | - Ashley Lowery
- Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, USA
| | - Kayla K Haubrick
- Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, USA
| | - Larry K Brown
- Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, USA
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Rouffiac AE, Whiteley L, Brown L, Mena L, Craker L, Healy M, Haubrick K. A Mobile Intervention to Improve Uptake of Pre-Exposure Prophylaxis for Southern Black Men Who Have Sex With Men: Protocol for Intervention Development and Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e15781. [PMID: 32130196 PMCID: PMC7059079 DOI: 10.2196/15781] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/22/2019] [Accepted: 11/22/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The uptake of pre-exposure prophylaxis (PrEP) has been slow for young black men who have sex with men (BMSM) living in the southern United States. This is a significant issue because 8 of the 10 states with the highest rates of new HIV infections are in the South. Jackson, Mississippi (MS), the site of this project, has the second highest AIDS diagnosis rate in the nation and the highest rate of HIV infection for young, urban BMSM. This study will develop and test an engaging, interactive, and cost-effective mobile messaging intervention to improve engagement in PrEP care for BMSM aged 18 to 35 years living in Jackson, MS. OBJECTIVE The goals of this mixed methods study are to (1) conduct qualitative interviews with young BMSM in Jackson, MS, to understand individual, community, and structural barriers affecting engagement in PrEP-related care, (2) assemble a PrEP mobile messaging intervention that includes text messages with publicly available internet content (websites and YouTube videos) that provide factual information, motivational materials, and behavioral skills related to PrEP and HIV prevention, and (3) evaluate the preliminary efficacy of the intervention in a randomized controlled study with PrEP-eligible BMSM receiving care in STI/HIV testing clinics in Jackson, MS. METHODS This research protocol will be conducted in 2 phases. A development phase will involve in-depth interviews (n=30) with PrEP-eligible BMSM who receive care in STI/HIV testing clinics in MS. These interviews will allow researchers to select the texted material that will be sent out during the intervention. The second phase will consist of an unblinded, small, randomized controlled trial among 66 new participants to examine the preliminary efficacy of the intervention compared with enhanced standard of care (ESC) on attendance at a PrEP services appointment (the first step in initiating PrEP care) and receipt of a PrEP prescription, based on self-report and electronic medical records. The free, publicly available material will be sent to PrEP-eligible BMSM in 8 to 16 interactive text messages over 4 weeks. Study assessments will occur at enrollment and at 4- and 16-weeks postenrollment and can be completed online or in person. All participants will be recruited from a local clinic. RESULTS Institutional review board approval was received on January 16, 2017, and research activities, subsequently, began in February 2018. Recruitment for the study concluded in November 2019. In total, 65 participants were randomized with 33 being assigned to the intervention and 32 to ESC. Collection of follow-up data is ongoing. CONCLUSIONS This PrEP mobile messaging intervention aims to increase uptake of PrEP by BMSM in the southern United States. This intervention uses interactive, tailored text messaging and appealing free Web content (publicly accessible educational websites and YouTube videos) to promote linkage to PrEP care and increase HIV preventative behaviors. A cost-effective PrEP mobile messaging intervention has great potential to improve information about PrEP, improve motivation to use PrEP, and decrease stigma and structural barriers that often prevent engagement in PrEP-related medical care. TRIAL REGISTRATION ClinicalTrials.gov NCT03308097; https://clinicaltrials.gov/ct2/show/NCT03308097. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/15781.
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Affiliation(s)
- Anne-Emilie Rouffiac
- Young Adult Behavioral Health Program, Rhode Island Hospital, Providence, RI, United States
| | - Laura Whiteley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Larry Brown
- Young Adult Behavioral Health Program, Rhode Island Hospital, Providence, RI, United States
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Leandro Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, United States
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Lacey Craker
- Young Adult Behavioral Health Program, Rhode Island Hospital, Providence, RI, United States
| | - Meredith Healy
- Young Adult Behavioral Health Program, Rhode Island Hospital, Providence, RI, United States
| | - Kayla Haubrick
- Young Adult Behavioral Health Program, Rhode Island Hospital, Providence, RI, United States
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Emmanuel G, Folayan M, Undelikwe G, Ochonye B, Jayeoba T, Yusuf A, Aiwonodagbon B, Bilali C, Umoh P, Ojemeiri K, Kalaiwo A. Community perspectives on barriers and challenges to HIV pre-exposure prophylaxis access by men who have sex with men and female sex workers access in Nigeria. BMC Public Health 2020; 20:69. [PMID: 31941469 PMCID: PMC6964078 DOI: 10.1186/s12889-020-8195-x] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 01/10/2020] [Indexed: 05/09/2023] Open
Abstract
Background Men who have sex with men (MSM), female sex workers (FSW) have critical needs for effective HIV prevention tools. This study identified perspectives of MSM, FSW and policy makers on the needs for, barriers to, and challenges with pre-exposure HIV prophylaxis (PrEP); and the logistics required to support roll-out of PrEP for MSM and FSW in Nigeria. Methods Qualitative and quantitative data were collected through a cross-sectional study. The quantitative data were collected through an online survey administered to 519 MSM, FSW and transgender respondents. The qualitative data were collected through 22 focus group discussions with 140 MSM and 80 FSW, and a two-day consultative workshop with 65 participants. Two open-ended questions in the online survey were also a source of qualitative data. Results of the quantitative data were reported descriptively; the qualitative data were inductively examined with a content analytic approach to construct descriptive categories. The findings from the quantitative and qualitative responses were triangulated. Results Four hundred and ninety-four (95.2%) online respondents had heard about PrEP through community dialogue (71.3%), and 439 (84.6%) supported its use by MSM and FSW. Fewer than half of the respondents were aware of the clinical care required for PrEP, and misconceptions about PrEP were common. Stated barriers to PrEP uptake were stigma, cost, frequency of HIV counseling and treatment services required, and possible drug-drug interactions. Concerns included possible condom migration, increased risk for sexually transmitted infections and pregnancy for FSW, and poor adherence to medication and hospital schedules. Participants felt that trained peer educators and HIV-test counselors could provide information and refer clients to clinics that provide PrEP. PrEP can be provided through peer-led facilities for MSM and FSW, though its access should be expanded to all persons who are at substantial risk for HIV to prevent negative labeling of PrEP. Public awareness about the use of antiretrovirals for HIV prevention is needed to prevent labeling of PrEP users as being HIV positive. Conclusion Although MSM and FSW are interested in the use of PrEP, numerous individual and structural barriers need to be addressed to facilitate access to it in Nigeria.
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Affiliation(s)
- G Emmanuel
- Heartland Alliance International, Chicago, Nigeria
| | - M Folayan
- New HIV Vaccine and Microbicide Advocacy Society, Lagos, Nigeria. .,Department of Child Dental Health, Obafemi Awolowo University, Ife, Nigeria.
| | - G Undelikwe
- Joint United Nations Programme on HIV/AIDS, Lagos, Nigeria
| | - B Ochonye
- Heartland Alliance International, Lagos, Nigeria
| | - T Jayeoba
- Heartland Alliance International, Lagos, Nigeria
| | - A Yusuf
- Heartland Alliance International, Lagos, Nigeria
| | | | - C Bilali
- Heartland Alliance International, Lagos, Nigeria
| | - P Umoh
- Joint United Nations Programme on HIV/AIDS, Lagos, Nigeria
| | - K Ojemeiri
- Heartland Alliance International, Lagos, Nigeria
| | - A Kalaiwo
- United States Agency for International Development, Abuja, Nigeria
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Abstract
Serodiscordant couples play an important role in maintaining the global HIV epidemic. This review summarizes biobehavioral and biomedical HIV prevention options for serodiscordant couples focusing on advances in 2013 and 2014, including World Health Organization guidelines and best evidence for couples counseling, couple-based interventions, and the use of antiviral agents for prevention. In the past few years, marked advances have been made in HIV prevention for serodiscordant couples and numerous ongoing studies are continuously expanding HIV prevention tools, especially in the area of pre-exposure prophylaxis. Uptake and adherence to antiviral therapy remains a key challenge. Additional research is needed to develop evidence-based interventions for couples, and especially for male-male couples. Randomized trials have demonstrated the prevention benefits of antiretroviral-based approaches among serodiscordant couples; however, residual transmission observed in recognized serodiscordant couples represents an important and resolvable challenge in HIV prevention.
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Affiliation(s)
- Kathryn E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
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Cáceres CF, Mayer KH, Baggaley R, O'Reilly KR. PrEP Implementation Science: State-of-the-Art and Research Agenda. J Int AIDS Soc 2015; 18:20527. [PMID: 26198351 PMCID: PMC4581083 DOI: 10.7448/ias.18.4.20527] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Cáceres CF, Koechlin F, Goicochea P, Sow PS, O'Reilly KR, Mayer KH, Godfrey-Faussett P. The promises and challenges of pre-exposure prophylaxis as part of the emerging paradigm of combination HIV prevention. J Int AIDS Soc 2015; 18:19949. [PMID: 26198341 PMCID: PMC4509895 DOI: 10.7448/ias.18.4.19949] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/26/2015] [Accepted: 04/15/2015] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Towards the end of the twentieth century, significant success was achieved in reducing incidence in several global HIV epidemics through ongoing prevention strategies. However, further progress in risk reduction was uncertain. For one thing, it was clear that social vulnerability had to be addressed, through research on interventions addressing health systems and other structural barriers. As soon as antiretroviral treatment became available, researchers started to conceive that antiretrovirals might play a role in decreasing either susceptibility in uninfected people or infectiousness among people living with HIV. In this paper we focus on the origin, present status, and potential contribution of pre-exposure prophylaxis (PrEP) within the combination HIV prevention framework. DISCUSSION After a phase of controversy, PrEP efficacy trials took off. By 2015, daily oral PrEP, using tenofovir alone or in combination with emtricitabine, has been proven efficacious, though efficacy seems heavily contingent upon adherence to pill uptake. Initial demonstration projects after release of efficacy results have shown that PrEP can be implemented in real settings and adherence can be high, leading to high effectiveness. Despite its substantial potential, beliefs persist about unfeasibility in real-life settings due to stigma, cost, adherence, and potential risk compensation barriers. CONCLUSIONS The strategic synergy of behavioural change communication, biomedical strategies (including PrEP), and structural programmes is providing the basis for the combination HIV prevention framework. If PrEP is to ever become a key component of that framework, several negative beliefs must be confronted based on emerging evidence; moreover, research gaps regarding PrEP implementation must be filled, and appropriate prioritization strategies must be set up. Those challenges are significant, proportional to the impact that PrEP implementation may have in the global response to HIV.
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Affiliation(s)
- Carlos F Cáceres
- Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, Peru
- Network for Multidisciplinary Studies in ARV-Based HIV Prevention (NEMUS), Lima, Peru;
| | | | - Pedro Goicochea
- Network for Multidisciplinary Studies in ARV-Based HIV Prevention (NEMUS), Lima, Peru
- Center for AIDS Prevention Studies, University of California - San Francisco, San Francisco, CA, USA
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Stevens DL. Reply to Eljaaly et al. Clin Infect Dis 2015; 60:1732. [DOI: 10.1093/cid/civ127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Eljaaly K, Alshehri S, Mahoney MV. Antibiotic Dosing Discrepancies in the 2014 Skin and Soft Tissue Infections Guidelines. Clin Infect Dis 2015; 60:1731-2. [DOI: 10.1093/cid/civ123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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12
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Dispelling myths and focusing on notable concepts in HIV pathogenesis. Trends Mol Med 2015; 21:341-53. [PMID: 25883070 DOI: 10.1016/j.molmed.2015.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/05/2015] [Accepted: 03/13/2015] [Indexed: 01/01/2023]
Abstract
Since the discovery of HIV over three decades ago, major efforts have been made to control and perhaps eliminate HIV infection worldwide. During these studies, certain myths or misconceptions about this infectious disease have been emphasized and other potentially beneficial concepts have received less attention. A true long-term solution to HIV infection merits an appreciation of alternative ideas and findings that could be beneficial in the ultimate control of HIV/AIDS. Here, I discuss six issues and call for more attention to the science of HIV and well-designed clinical trials.
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13
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Keogh P, Dodds C. Pharmaceutical HIV prevention technologies in the UK: six domains for social science research. AIDS Care 2015; 27:796-803. [PMID: 25559236 PMCID: PMC4732466 DOI: 10.1080/09540121.2014.989484] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 11/12/2014] [Indexed: 11/13/2022]
Abstract
The development of pharmaceutical HIV prevention technologies (PPTs) over the last five years has generated intense interest from a range of stakeholders. There are concerns that these clinical and pharmaceutical interventions are proceeding with insufficient input of the social sciences. Hence key questions around implementation and evaluation remain unexplored whilst biomedical HIV prevention remains insufficiently critiqued or theorised from sociological as well as other social science perspectives. This paper presents the results of an expert symposium held in the UK to explore and build consensus on the role of the social sciences in researching and evaluating PPTs in this context. The symposium brought together UK social scientists from a variety of backgrounds. A position paper was produced and distributed in advance of the symposium and revised in the light this consultation phase. These exchanges and the emerging structure of this paper formed the basis for symposium panel presentations and break-out sessions. Recordings of all sessions were used to further refine the document which was also redrafted in light of ongoing comments from symposium participants. Six domains of enquiry for the social sciences were identified and discussed: self, identity and personal narrative; intimacy, risk and sex; communities, resistance and activism; systems, structures and institutions; economic considerations and analyses; and evaluation and outcomes. These are discussed in depth alongside overarching consensus points for social science research in this area as it moves forward.
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Affiliation(s)
- Peter Keogh
- School of Health and Social Care, University of Greenwich, London, UK
| | - Catherine Dodds
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
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14
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Karris MY. Pre-Exposure Prophylaxis to Prevent HIV Infection: Why Do We Need It, What Are the Limitations, and Can We Successfully Provide It Today? LGBT Health 2014; 1:250-2. [DOI: 10.1089/lgbt.2014.0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Maile Y. Karris
- Department of Medicine, University of California San Diego, La Jolla, California
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15
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Abstract
Preexposure prophylaxis (PrEP) and treatment as prevention (TasP) involve the use of antiretroviral (ARV) drugs by human immunodeficiency virus (HIV)-negative and -positive individuals to reduce HIV acquisition and transmission, respectively. Clinical science has delivered a consistently high effect size for TasP and a range from 0%-73% reduction in incidence across placebo-controlled PrEP trials. However, the quality of evidence for PrEP compares favorably with evidence for postexposure prophylaxis (PEP). It is clear from treatment programs and PrEP trials that daily adherence presents challenges to a large proportion of the population. Although there are factors associated with inconsistent use (ie, younger age), they do not assist clinicians at the point of care. There are additional provider concerns about PrEP (covering cost of drug and delivery, undermining condom promotion, and facilitating resistant strains) that have delayed widespread acceptance. These issues need to be addressed in order to realize the full public health potential of antiretrovirals.
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Affiliation(s)
- Sheena M McCormack
- Medical Research Council, Clinical Trials Unit at University College London, United Kingdom
| | - Mitzy Gafos
- Medical Research Council, Clinical Trials Unit at University College London, United Kingdom
| | - Monica Desai
- Medical Research Council, Clinical Trials Unit at University College London, United Kingdom
| | - Myron S Cohen
- Department of Epidemiology, University of North Carolina at Chapel Hill
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