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Hanass-Hancock J, Carpenter B, Reddy T, Nzuza A, Gaffoor Z, Goga A, Andrasik M. Participants' characteristics and motivations to screen for HIV vaccine and monoclonal antibody trials in KwaZulu-Natal, South Africa. Trials 2021; 22:897. [PMID: 34895272 PMCID: PMC8665490 DOI: 10.1186/s13063-021-05792-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 11/03/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND HIV is one of the greatest public health challenges in South Africa. Potential HIV vaccines and antibodies are thought to be cost-effective biomedical HIV prevention methods and are currently under investigation in phase I, II, and III trials. Consequently, current and future clinical trials need to ensure sufficient recruitment and retention. To achieve this goal, clinical trial staff need to understand the socio-demographic and behavioural characteristics of people volunteering to screen for these trials and their reasons for volunteering. METHODS We conducted a secondary analysis of participant screening data across five vaccine and monoclonal antibody trials at four sites in KwaZulu-Natal, South Africa. Our study reviewed the demographic, behavioural, motivational, and health-related data from the case report forms and screening questionnaires. Descriptive statistics, chi-squared, and one-way ANOVA tests were used to analyse participants' characteristics and motivation to participate in HIV vaccine and monoclonal antibody trials. Analyses were conducted using R version 3.5.2. RESULTS Screening data from 1934 participants, including 79.2% of women, were obtained across all five trials (1034 enrolled, 900 screened out/declined). Screened participants predominately self-identified as black, heterosexual, cisgender women or men, many with lower educational backgrounds (43.9% did not complete secondary/high school), and several self-reported HIV-risk behaviours among themselves and their partners. 10.8% of the screened participants were living with HIV. Avoiding HIV risk was the main motivation to participate in clinical trials, followed by altruistic reasons such as a desire to help the community or helping to find a vaccine. DISCUSSION The current recruitment approach of these trials attracts heterosexual participants who seek to reduce HIV risk and support their community. Hence, the data suggest the need for and potential acceptance of continued ongoing HIV prevention efforts. Current trials attract participants with lower educational levels, which may be driven by the site locations, current community mobilisation strategies and research site opening hours. The sites could consider more flexible working hours to accommodate working participants and find ways to connect participants to educational support and opportunities to upgrade education levels for the current clientele. TRIAL REGISTRATION HVTN 100: A Safety and Immune Response Study of 2 Experimental HIV Vaccines, NCT02404311 . Registered on March 17, 2015. HVTN 111: Safety and Immune Response to a Clade C DNA HIV Vaccine, NCT02997969. Registered on December 16, 2016. HVTN 108: Evaluating the Safety and Immunogenicity of HIV Clade C DNA Vaccine and MF59- or AS01B-Adjuvanted Clade C Env Protein Vaccines in Various Combinations in Healthy, HIV-Uninfected Adults, NCT02915016. Registered on September 22, 2016. HVTN 702: Pivotal Phase 2b/3 ALVAC/Bivalent gp120/MF59 HIV Vaccine Prevention Safety and Efficacy Study in South Africa, NCT02968849. Registered on November 1, 2016. HVTN 703/HPTN 081: Evaluating the Safety and Efficacy of the VRC01 Antibody in Reducing Acquisition of HIV-1 Infection in Women, NCT02568215 . Registered on October 1, 2015.
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Affiliation(s)
- Jill Hanass-Hancock
- South African Medical Research Council, Gender and Health Research Unit, Cape Town, South Africa. .,University of KwaZulu Natal School of Health Science, Durban, South Africa.
| | - Bradley Carpenter
- South African Medical Research Council, Gender and Health Research Unit, Cape Town, South Africa.,University of KwaZulu Natal School of Health Science, Durban, South Africa
| | - Tarylee Reddy
- South African Medical Research Council, Biostatistics Research Unit, Seattle, USA
| | - Ayanda Nzuza
- South African Medical Research Council, Gender and Health Research Unit, Cape Town, South Africa
| | - Zakir Gaffoor
- South African Medical Research Council, HIV Prevention Research Unit, Seattle, USA
| | - Ameena Goga
- South African Medical Research Council, HIV Prevention Research Unit, Seattle, USA
| | - Michele Andrasik
- HIV Vaccine Trials Network, Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, USA
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Sepodes B, Rocha J, Batista J, Figueira ME, Dráfi F, Torre C. Implementation and Access to Pre-exposure Prophylaxis for Human Immunodeficiency Virus by Men Who Have Sex With Men in Europe. Front Med (Lausanne) 2021; 8:722247. [PMID: 34513883 PMCID: PMC8424070 DOI: 10.3389/fmed.2021.722247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) is a significant public health intervention with proven efficacy and safety in the prevention of human immunodeficiency virus (HIV) infection, which has taken a considerable amount of time to reach Europe in relation to their transatlantic counterparts, namely, the United States of America (USA). There, it is perceived as being an essential prevention tool to be integrated within existing medical, behavioral and structural interventions in place for the management and containment of HIV infection in men who have sex with men (MSM). In a region such as Europe, with approximately double the USA population, it is estimated that not even 10% have proper access to PrEP, and given the lack of coordination with healthcare, taking PrEP has to be at their own expense. Here, we identify the reasons behind the 4-year lag in the approval of PrEP in the European Union/European Economic Area (and Europe in general) and explore the efficacy and effectiveness of PrEP needed to be confirmed with some implementation or demonstration studies conducted in the region. Independent of the data gathered, access of MSM to PrEP is far from ideal in Europe and much still needs to be done. The demonstration of the cost-effectiveness of PrEP alongside other social and behavioral factors needs to be addressed, while the clear populations within MSM that will benefit from this intervention are properly identified and make use of the latest recommendations of the World Health Organization that consider not only daily PrEP but also event-driven PrEP. The momentum for the proper implementation of PrEP in the EU is not lost, and with the existence of generics and even new formulations, there is a renewed opportunity for unleashing the public health benefits arising from this pharmacological tool with other interventions in place (e.g., condoms, testing, and counseling).
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Affiliation(s)
- Bruno Sepodes
- Faculdade de Farmácia da Universidade de Lisboa, Department of Pharmacy, Pharmacology and Health Technologies, Lisbon, Portugal.,Laboratory of Systems Integration Pharmacology, Clinical & Regulatory Science-Research Institute for Medicines of the University of Lisbon (iMED.ULisboa), Lisbon, Portugal
| | - João Rocha
- Faculdade de Farmácia da Universidade de Lisboa, Department of Pharmacy, Pharmacology and Health Technologies, Lisbon, Portugal.,Laboratory of Systems Integration Pharmacology, Clinical & Regulatory Science-Research Institute for Medicines of the University of Lisbon (iMED.ULisboa), Lisbon, Portugal
| | - Jorge Batista
- Unidade de Saúde Pública Internacional e Bioestatística, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Maria-Eduardo Figueira
- Laboratory of Systems Integration Pharmacology, Clinical & Regulatory Science-Research Institute for Medicines of the University of Lisbon (iMED.ULisboa), Lisbon, Portugal.,Faculdade de Farmácia da Universidade de Lisboa, Department of Pharmaceutical Sciences and Medicines, Lisbon, Portugal
| | - František Dráfi
- Institute of Experimental Pharmacology and Toxicology, Centre of Experimental Medicine of the Slovak Academy of Sciences, Bratislava, Slovakia
| | - Carla Torre
- Faculdade de Farmácia da Universidade de Lisboa, Department of Pharmacy, Pharmacology and Health Technologies, Lisbon, Portugal.,Laboratory of Systems Integration Pharmacology, Clinical & Regulatory Science-Research Institute for Medicines of the University of Lisbon (iMED.ULisboa), Lisbon, Portugal
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Watson CWM, Pasipanodya E, Savin MJ, Ellorin EE, Corado KC, Flynn RP, Opalo C, Lampley E, Henry BL, Blumenthal J, Bolan R, Morris S, Moore DJ. Barriers and Facilitators to PrEP Initiation and Adherence Among Transgender and Gender Non-Binary Individuals in Southern California. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:472-485. [PMID: 33779208 PMCID: PMC10953836 DOI: 10.1521/aeap.2020.32.6.472] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
While transgender and gender non-binary (trans/nb) individuals are disproportionately affected by HIV, pre-exposure prophylaxis (PrEP) uptake remains low in this underserved population. We conducted four focus groups with 37 trans/nb individuals in San Diego and Los Angeles to assess barriers and facilitators of PrEP usage. Transcripts were coded for qualitative themes. Although overall PrEP awareness was high, participants reported limited knowledge and misinformation about PrEP. Barriers to PrEP use included: structural access (e.g., discrimination from health care providers, lack of trans-inclusive services, financial barriers), mental health struggles limiting ability to access PrEP, and concerns about potential side effects, drug-drug interactions with hormone therapy, and lack of other STI protection. Facilitators of PrEP usage included: increased PrEP availability, prior experience taking daily medications, and motivation to have active and healthy lives without fear of contracting HIV. Addressing both structural and psychosocial/behavioral factors in trans-affirming health care environments is crucial to designing inclusive, effective PrEP interventions.
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Affiliation(s)
- C Wei-Ming Watson
- University of California, San Diego
- San Diego State University/University of California San Diego
| | - Elizabeth Pasipanodya
- University of California, San Diego
- Santa Clara Valley Medical Center, Fruitdale, California
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Reza-Paul S, Lazarus L, Maiya R, Haldar P, Rewari BB, Venugopal MS, Hafeez Ur Rahman S, Venukumar KT, Ramaiah M, Pasha A, Sharma M, Steen R, Lorway R. The Ashodaya PrEP project: Lessons and implications for scaling up PrEP from a community-led demonstration project among female sex workers in Mysore, India. Glob Public Health 2020; 15:889-904. [PMID: 32070217 PMCID: PMC7261403 DOI: 10.1080/17441692.2020.1724316] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
To inform PrEP roll out, Ashodaya Samithi, a sex workers' collective, conducted a community-led prospective demonstration project among female sex workers in Mysore and Mandya, India. Following a community preparedness phase and pre-screening, participants were recruited for clinical screening and enrolment, provided PrEP as part of combination HIV prevention, and followed for 16 months. Adherence was measured by self-reported pill intake and by tenofovir blood level testing among a subset of participants. Of the 647 participants enrolled, 640 completed follow-up. Condom use remained stable and no HIV seroconversions occurred. Self-reported daily PrEP intake over the last month was 97.97% at the end of the study. Tenofovir blood levels >40 ng/mL (consistent with steady state dosing) were detected among 80% (n = 68/85) and 90.48% (n = 76/84) of participants at month 3 and 6, respectively. Our study holds important insights for rolling out PrEP in community settings as part of targeted HIV prevention interventions.
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Affiliation(s)
- Sushena Reza-Paul
- Centre for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Ashodaya Samithi, Mysuru, India
| | - Lisa Lazarus
- Centre for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | | | - Partha Haldar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | | | - Richard Steen
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Robert Lorway
- Centre for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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Abstract
PURPOSE OF REVIEW Pre-exposure prophylaxis (PrEP) is highly efficacious for preventing HIV. Demonstrations worldwide show growing acceptability with nonoral formulations in the pipeline. Despite these successes, oral PrEP scale-up in sub-Saharan Africa (SSA), the region hardest hit by HIV, remains sub-optimal. This review details emerging practises and addresses challenges in PrEP scale-up and delivery within SSA. RECENT FINDINGS PrEP scale-up varies across SSA. Some countries face implementation challenges, whereas most have not applied for or received regulatory approval. As governments balance treatment and prevention costs, PrEP advocacy is growing. Demand has been slow, because of low-risk perception, HIV treatment conflation or poor information. Challenges in SSA are markedly different than elsewhere, as delivery is targeted to generalized heterosexuals, rather than only key populations. SSA requires public sector engagement and innovative delivery platforms. SUMMARY PrEP scale-up in SSA is sub-optimal, hindered by regulatory processes, implementation challenges, poor community engagement and inadequate funding. Approaches that acknowledge overburdened, under-resourced health sectors, and seek opportunities to integrate, task-shift, decentralize and even de-medicalize, with a tailored approach, while campaigning to educate and stimulate demand are most likely to work. Solutions to oral PrEP scale-up will apply to other formulations, opening new avenues for ARV (microbicides and injectables) and non-ARV-based (future vaccine) biomedical prevention provision.
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Mayer KH, Vanderwarker R, Grasso C, Boswell SL. Emerging models of clinical services for men who have sex with men: focused versus comprehensive approaches. Sex Health 2019; 14:133-138. [PMID: 27567639 DOI: 10.1071/sh16119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 06/28/2016] [Indexed: 11/23/2022]
Abstract
By the early 1970s, it was increasingly recognised that men who have sex with men (MSM) were at risk for specific sexually transmissible infections (STI), and clinician awareness regarding MSM STI grew significantly after the AIDS epidemic was first recognised in 1981. In many urban centres in the USA and other resource-rich countries, the development of clinical infrastructure to address the AIDS epidemic led to the creation of clinics that provided services for large numbers of MSM. During the same time period, other health centres were created that were community-focused, providing comprehensive behavioural health and medical services for all sexual and gender minority patients. Over the next few years, multiple models for MSM sexual health will evolve, ranging from centres that embed STI care in primary care, to more focused centres that can use new technology to provide an efficient assessment for at-risk MSM desiring quick screening services.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
| | - Rodney Vanderwarker
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
| | - Stephen L Boswell
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
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Chai PR, Pereira LM, Jambaulikar GD, Carrico AW, O'Cleirigh C, Mayer KH, Boyer EW. Short Communication: Bioequivalence of Tenofovir Component of Tenofovir/Rilpivirine/Emtricitabine in Digital Pills. AIDS Res Hum Retroviruses 2019; 35:361-363. [PMID: 30693811 DOI: 10.1089/aid.2018.0073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Digital pills, gelatin capsules with radiofrequency transmitters activated by stomach chloride ions, directly measure antiretroviral therapy adherence. In individuals with substance use disorders and HIV, real-time nonadherence detected by digital pills creates a platform to deliver substance use and adherence interventions. In this study, we determined the bioequivalence of tenofovir (TFV), administered as tenofovir disoproxil fumarate (TDF) in healthy human volunteers administered a commercial drug product and a digital pill formulation. We adhered generally to the US FDA Analytical Procedures and Methods for Validation for Drugs and Biologics guidelines. Ten HIV-uninfected adults without reported allergy to TFV, emtricitabine, or rilpivirine were enrolled. Participants ingested a digital pill containing TDF/emtricitabine/rilpivirine. Peripheral venous blood samples were collected at 0.5, 1, 2, 4, 8, and 24 h postingestion. After a 14-day washout period, the same participants ingested Complera™. Serial venous blood samples were collected using the same protocol as the digital pill. Liquid chromatography/mass spectrometry was used to determine a maximum concentration (Cmax), area under curve from time zero to last measured concentration (AUCo-t), and area under curve from time zero to infinity (AUCoo) of TFV. Ten participants with an average age of 27 and body mass index of 25.4 successfully completed the study. Predose TFV was undetectable before the second administration of Complera confirming adequate washout period after ingestion of the digital pill. The geometric means of AUCo-t, AUCoo, and Cmax for test and reference products were within the 95% confidence intervals and, therefore, bioequivalent. TFV overencapsulated in digital pills are bioequivalent to TFV in commercial formulations.
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Affiliation(s)
- Peter R. Chai
- Harvard Medical School, Boston, Massachusetts
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Luis M. Pereira
- Pharmacometrics Research Core, Department of Anesthesia, Boston Children's Hospital, Boston, Massachusetts
| | - Guruprasad D. Jambaulikar
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Conall O'Cleirigh
- Harvard Medical School, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Massachusetts General Hospital, Boston, Massachusetts
| | - Kenneth H. Mayer
- Harvard Medical School, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Edward W. Boyer
- Harvard Medical School, Boston, Massachusetts
- Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
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Abstract
BACKGROUND The success of an intervention to prevent syphilis will depend on the context and the goal of the intervention. To help programs choose interventions, we reviewed major changes in context and types of interventions that may be effective. METHODS We reviewed the literature on the changing context of syphilis in the United States and interventions to prevent syphilis, focusing on articles that included evidence of effectiveness. RESULTS Populations acquiring syphilis are constantly changing. Currently, incidence is very high among men who have sex with men (MSM). Among adults, late disease caused by syphilis has become rare. Congenital syphilis incidence has been low but is increasing, and morbidity and mortality remain high when babies are infected. Congenital syphilis now causes more deaths than syphilis among adults.Routine screening of MSM can identify and treat infections before they progress to disease (secondary prevention). Screening rates are highest when done as part of routine standing orders. Partner notification effectiveness has decreased, partly because many partners are anonymous. Most congenital syphilis can be prevented by screening pregnant women; it has been eliminated in areas where intense primary prevention efforts eliminated syphilis among women. CONCLUSIONS So far, no program has stopped the increasing rates of infection among MSM, but secondary prevention efforts have prevented most disability. Congenital syphilis is increasing, and can be decreased by screening pregnant women and stopped by intensive efforts to prevent infection among women.
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Affiliation(s)
- Thomas A Peterman
- From the Division of STD Prevention, National Center for HIV, Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta GA
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Venter WDF. Pre-exposure Prophylaxis: The Delivery Challenge. Front Public Health 2018; 6:188. [PMID: 30035106 PMCID: PMC6043793 DOI: 10.3389/fpubh.2018.00188] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/13/2018] [Indexed: 01/14/2023] Open
Abstract
HIV pre-exposure prophylaxis (PrEP), despite its efficacy, has been slow in uptake throughout the world. This article discusses the operational and service delivery complexity, based on early real-world experience, with some recommendations on how this promising intervention could be made more available. Currently, access to PrEP is made complex by restricting delivery to dedicated health facilities, as well as requirements around HIV testing and toxicity monitoring. Expanding to verticalized services that focus on well-defined populations where HIV testing and treatment programmes already exist, has proven relatively simple. Providing PrEP outside of this environment has yet to be demonstrated at any scale, and will likely require innovative thinking addressing the regulatory and clinical environment, so as to ensure easier access to this promising HIV prevention tool.
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Affiliation(s)
- Willem D F Venter
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Mayer KH, de Vries H. HIV and sexually transmitted infections: responding to the "newest normal". J Int AIDS Soc 2018; 21:e25164. [PMID: 29989338 PMCID: PMC6038147 DOI: 10.1002/jia2.25164] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 06/27/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Kenneth H Mayer
- Fenway HealthThe Fenway InstituteBostonMAUSA
- Department of Infectious DiseasesBeth Israel Deaconess Medical CenterBostonMAUSA
- Harvard Medical SchoolHarvard UniversityBostonMAUSA
| | - Henry de Vries
- Department of Infectious DiseasesPublic Health Service of AmsterdamAmsterdamThe Netherlands
- Department of DermatologyAcademic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
- Amsterdam Infection and Immunity Institute (AI&II)Academic Medical CentreUniversity of AmsterdamAmsterdamThe Netherlands
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11
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Calabrese SK, Earnshaw VA, Underhill K, Krakower DS, Magnus M, Hansen NB, Mayer KH, Betancourt JR, Kershaw TS, Dovidio JF. Prevention paradox: Medical students are less inclined to prescribe HIV pre-exposure prophylaxis for patients in highest need. J Int AIDS Soc 2018; 21:e25147. [PMID: 29939488 PMCID: PMC6016621 DOI: 10.1002/jia2.25147] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 05/22/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Despite healthcare providers' growing awareness of pre-exposure prophylaxis (PrEP), prescription rates remain low. PrEP is an efficacious HIV prevention strategy recommended for use with condoms but still protective in their absence. Concern about the impact of PrEP on condom use and other risk behaviour is, nonetheless, among the barriers to prescription commonly reported. To understand the implications of this concern for PrEP access, we examined how medical students' willingness to prescribe PrEP varied by patients' condom use and partnering practices. We also assessed the perceived acceptability of various reasons for condom discontinuation with PrEP. METHODS An online survey was distributed to 854 medical students in the Northeastern US in 2015. Participants (n = 111) were surveyed about their willingness to prescribe PrEP for each of six male patients who systematically differed in their reported condom use (sustained use, sustained nonuse, or discontinuation with PrEP) and partnering practices (single male partner with untreated HIV or multiple male partners of unknown HIV status). Participants also reported perceived acceptability of four reasons for condom discontinuation: pleasure, sexual functioning, intimacy, and conception. RESULTS Willingness to prescribe PrEP was inconsistent with patient risk: When the patient used condoms and planned to sustain condom use, most participants were willing to prescribe PrEP - 93% if the patient had a single partner and 86% if the patient had multiple partners. Fewer were willing to prescribe if the patient did not use condoms and planned to sustain nonuse (53% and 45%, respectively) or used condoms but planned to discontinue use (27% and 28%). Significantly fewer participants were willing to prescribe for a patient with multiple partners versus a single partner when the patient reported sustained condom use or sustained condom nonuse. The number of participants who were willing to prescribe was similarly low for a patient with multiple partners versus a single partner when the patient reported that he planned to discontinue condom use. More participants accepted a patient discontinuing condoms for conception (69%) than for intimacy (23%), pleasure (14%), or sexual functioning (13%). CONCLUSION Medical students' clinical judgments were misaligned with patient risk and suggest misconceptions or personal values may undermine provision of optimal HIV prevention services.
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Affiliation(s)
- Sarah K Calabrese
- Department of PsychologyGeorge Washington UniversityWashingtonDCUSA
- Social and Behavioral Sciences DepartmentYale School of Public HealthYale UniversityNew HavenCTUSA
| | - Valerie A Earnshaw
- Department of Human Development and Family StudiesUniversity of DelawareNewarkDEUSA
| | - Kristen Underhill
- Columbia Law SchoolColumbia UniversityNew YorkNYUSA
- Heilbrunn Department of Population & Family HealthMailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | - Douglas S Krakower
- The Fenway InstituteFenway HealthBostonMAUSA
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolHarvard UniversityBostonMAUSA
- Department of Population MedicineHarvard Medical SchoolHarvard UniversityBostonMAUSA
| | - Manya Magnus
- Department of Epidemiology and BiostatisticsMilken Institute School of Public HealthGeorge Washington UniversityWashingtonDCUSA
| | - Nathan B Hansen
- Department of Health Promotion and BehaviorCollege of Public HealthUniversity of GeorgiaAthensGAUSA
| | - Kenneth H Mayer
- The Fenway InstituteFenway HealthBostonMAUSA
- Beth Israel Deaconess Medical CenterHarvard Medical SchoolHarvard UniversityBostonMAUSA
- Department of Global Health and PopulationHarvard TH Chan School of Public HealthHarvard UniversityBostonMAUSA
| | - Joseph R Betancourt
- Disparities Solutions CenterMassachusetts General HospitalHarvard Medical SchoolHarvard UniversityBostonMAUSA
| | - Trace S Kershaw
- Social and Behavioral Sciences DepartmentYale School of Public HealthYale UniversityNew HavenCTUSA
| | - John F Dovidio
- Social and Behavioral Sciences DepartmentYale School of Public HealthYale UniversityNew HavenCTUSA
- Department of PsychologyYale UniversityNew HavenCTUSA
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Schranz AJ, Barrett J, Hurt CB, Malvestutto C, Miller WC. Challenges Facing a Rural Opioid Epidemic: Treatment and Prevention of HIV and Hepatitis C. Curr HIV/AIDS Rep 2018; 15:245-254. [PMID: 29796965 PMCID: PMC6085134 DOI: 10.1007/s11904-018-0393-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW This article reviews recent epidemiologic trends in HIV and hepatitis C virus (HCV) and strategies for treatment and prevention of these infections as they relate to the opioid epidemic. RECENT FINDINGS Among people who inject drugs (PWID) in the United States (US), HIV diagnoses are decreasing, while HCV is increasing. Care for HIV and HCV relies heavily on specialist infrastructure, which is lacking in rural areas. Antiretrovirals for HIV and direct-acting antivirals for HCV are effective among PWID, yet multiple barriers make it difficult for rural injectors to access these treatments. Similarly, access to syringe service programs, medication-assisted therapy for opioid addiction, and pre-exposure prophylaxis for HIV are all limited in rural areas. Previous research on HIV and HCV among PWID has focused on urban or international populations, yet the US opioid epidemic is moving away from metropolitan centers. Increasing rurality of opioid injection brings unique challenges in treatment and prevention. Research into the care of HIV, HCV, and opioid use disorder among rural populations is urgently needed.
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Affiliation(s)
- Asher J Schranz
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd. Bioinformatics Building CB# 7030, Chapel Hill, NC, 27599-7030, USA.
| | - Jessica Barrett
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Christopher B Hurt
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill, 130 Mason Farm Rd. Bioinformatics Building CB# 7030, Chapel Hill, NC, 27599-7030, USA
| | - Carlos Malvestutto
- Division of Infectious Diseases, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - William C Miller
- Division of Epidemiology, Ohio State University College of Public Health, 302 Cunz Hall, 1841 Neil Avenue, Columbus, OH, 43220, USA.
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Bártolo I, Diniz AR, Borrego P, Ferreira JP, Bronze MR, Barroso H, Pinto R, Cardoso C, Pinto JF, Diaz RC, Broncano PG, Muñoz-Fernández MA, Taveira N. Evaluation of the fusion inhibitor P3 peptide as a potential microbicide to prevent HIV transmission in women. PLoS One 2018; 13:e0195744. [PMID: 29668740 PMCID: PMC5905968 DOI: 10.1371/journal.pone.0195744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/28/2018] [Indexed: 01/22/2023] Open
Abstract
Microbicides are an important strategy for preventing the sexual transmission of HIV but, so far, the most advanced tenofovir-based microbicides have had modest efficacy. This has been related to adherence problems and high prevalence of tenofovir-resistant HIV-1 strains. P3 is a new peptide with potent activity against HIV that may be a good microbicide candidate. In this work P3 was formulated in a gel of hydroxyethyl cellulose and its activity, stability and safety profile in Balb/c mice were evaluated. HIV infection was fully blocked by a 1.5% gel containing P3 at the IC90 (366.4 nM) concentration. The antiviral activity did not change at 4°C during 4 months and at 25, 37 and 65°C for 1 week. P3 was stable and fully functional at acidic pH up to 24h, under different concentrations of hydrogen peroxide and in the presence of genital fluids up to 48h. P3 had no antibacterial activity and did not affect sperm motility and vitality. Finally, P3 didn't cause significant alterations in the vaginal epithelium of Balb/c mice at 0.06 (456.8 μM) and 0.2 mg/day (1522.7 μM) doses. These findings indicate that P3 is an excellent candidate for further development as a microbicide gel for the prevention of HIV transmission in women.
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Affiliation(s)
- Inês Bártolo
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia da Universidade de Lisboa, Lisboa, Portugal
| | - Ana Rita Diniz
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia da Universidade de Lisboa, Lisboa, Portugal
| | - Pedro Borrego
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia da Universidade de Lisboa, Lisboa, Portugal
- Centro de Administração e Políticas Públicas (CAPP), Instituto Superior de Ciências Sociais e Políticas (ISCSP) da Universidade de Lisboa, Lisboa, Portugal
| | - João Pedro Ferreira
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia da Universidade de Lisboa, Lisboa, Portugal
| | - Maria Rosário Bronze
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia da Universidade de Lisboa, Lisboa, Portugal
| | - Helena Barroso
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Caparica, Portugal
| | - Rui Pinto
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia da Universidade de Lisboa, Lisboa, Portugal
- Laboratório de Análises Clínicas Dr. Joaquim Chaves, Joaquim Chaves Saúde, Miraflores-Algés, Portugal
| | - Carlos Cardoso
- Laboratório de Análises Clínicas Dr. Joaquim Chaves, Joaquim Chaves Saúde, Miraflores-Algés, Portugal
| | - João F. Pinto
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia da Universidade de Lisboa, Lisboa, Portugal
| | - Rafael Ceña Diaz
- Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón. Spanish HIV-HGM Biobank, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Pilar Garcia Broncano
- Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón. Spanish HIV-HGM Biobank, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Maria Angel Muñoz-Fernández
- Laboratorio InmunoBiología Molecular, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón. Spanish HIV-HGM Biobank, Madrid, Spain
- Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Nuno Taveira
- Research Institute for Medicines (iMed.ULisboa), Faculdade de Farmácia da Universidade de Lisboa, Lisboa, Portugal
- Centro de Administração e Políticas Públicas (CAPP), Instituto Superior de Ciências Sociais e Políticas (ISCSP) da Universidade de Lisboa, Lisboa, Portugal
- * E-mail:
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14
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Floridia M, Frisina V, Ravizza M, Marconi AM, Pinnetti C, Cetin I, Sansone M, Molinari A, Cervi F, Meloni A, Luzi K, Masuelli G, Tamburrini E. Evolving treatment implementation among HIV-infected pregnant women and their partners: results from a national surveillance study in Italy, 2001-2015. J Glob Health 2018; 7:010407. [PMID: 28567279 PMCID: PMC5441443 DOI: 10.7189/jogh.07.010407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The current global and national indications for antiretroviral treatment (ART, usually triple combination therapy) in adolescent and adults, including pregnant women, recommend early ART before immunologic decline, pre-exposure chemoprophylaxis (PrEP), and treatment of HIV-negative partners in serodiscordant couples. There is limited information on the implementation of these recommendations among pregnant women with HIV and their partners. METHODS The present analysis was performed in 2016, using data from clinical records of pregnant women with HIV, followed between 2001 and 2015 at hospital or university clinics within a large, nationally representative Italian cohort study. The study period was divided in three intervals of five years each (2001-2005, 2006-2010, 2011-2015), and the analysis evaluated temporal trends in rates of HIV diagnosis in pregnancy, maternal antiretroviral treatment at conception, prevalence of HIV infection among partners of pregnant women with HIV, and proportion of seronegative and seropositive male partners receiving antiretroviral treatment. RESULTS The analysis included 2755 pregnancies in women with HIV. During the three time intervals considered the rate of HIV diagnosis in pregnancy (overall 23.3%), and the distribution of HIV status among male partners (overall 48.7% HIV-negative, 28.6% HIV-positive and 22.8% unknown) remained substantially unchanged. Significant increases were observed in the proportion of women with HIV diagnosed before pregnancy who were on antiretroviral treatment at conception (from 62.0% in 2001-2005 to 81.3% in 2011-2015, P < 0.001), and in the proportion of HIV-positive partners on antiretroviral treatment (from 73.3% in 2001-2005 to 95.8% in 2011-2015, P = 0.002). Antiretroviral treatment was administered in 99.1% of the pregnancies that did not end early because of miscarriage, termination, or intrauterine death, and in 75.3% of those not ending in a live birth. No implementation of antiretroviral treatment was introduced among male HIV-negative partners. CONCLUSIONS The results suggest good implementation of antiretroviral treatment among HIV-positive women and their HIV-positive partners, but no implementation, even in recent years, of Pre-Exposure Prophylaxis (PrEP) among uninfected male partners. Further studies should assess the determinants of this occurrence and clarify the attitudes and the potential barriers to PrEP use.
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Affiliation(s)
- Marco Floridia
- National Center for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Valentina Frisina
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, and Universiy of Turin, Turin, Italy
| | - Marina Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | - Anna Maria Marconi
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School, University of Milan, Milan, Italy
| | | | - Irene Cetin
- Department of Obstetrics and Gynaecology, Luigi Sacco Hospital and University of Milan, Milan, Italy
| | - Matilde Sansone
- Department of Neurosciences, Reproductive and Dentistry Science, University Federico II, Naples, Naples Italy
| | - Atim Molinari
- Department of Infectious Diseases and Hepatology, Azienda Ospedaliera di Parma, Parma, Italy
| | - Francesca Cervi
- Department of Medical and Surgical Sciences, Policlinico Sant'Orsola-Malpighi and University of Bologna, Bologna, Italy
| | - Alessandra Meloni
- Division of Gynaecology and Obstetrics, S. Giovanni di Dio Hospital and University of Cagliari, Cagliari, Italy
| | - Kety Luzi
- Department of Infectious Diseases, Misericordia e Dolce Hospital, Prato, Italy
| | - Giulia Masuelli
- Department of Obstetrics and Neonatology, Città della Salute e della Scienza Hospital, and Universiy of Turin, Turin, Italy
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15
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Braksmajer A, Fedor TM, Chen SR, Corales R, Holt S, Valenti W, McMahon JM. Willingness to Take PrEP for HIV Prevention: The Combined Effects of Race/Ethnicity and Provider Trust. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:1-12. [PMID: 29481300 DOI: 10.1521/aeap.2018.30.1.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Blacks and Hispanics/Latinos are disproportionately burdened by HIV compared to non-Hispanic Whites, as evidenced by higher HIV incidence, prevalence, and deaths attributable to AIDS. Increasing the use of novel prevention techniques such as Truvada for pre-exposure prophylaxis (PrEP) could greatly help in reducing these disparities by lowering HIV incidence among these higher risk groups. Trust in providers, which may differ by race and ethnicity, may influence willingness to take PrEP. This study explores the moderating effect of race/ethnicity on trust in one's primary care provider (PCP) on PrEP willingness. This study found a significant association between PCP trust and PrEP willingness, with those with greater trust having 3.24 times the adjusted odds of being willing to try PrEP. Results regarding the effects of race and ethnicity on these outcomes, however, were inconclusive. Results indicate the importance of fostering trust between PrEP-prescribing PCPs and their patients.
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Affiliation(s)
- Amy Braksmajer
- School of Nursing, University of Rochester, Rochester, New York
| | - Theresa M Fedor
- Department of Sociology, Universidad de Los Andes, Bogotá, Colombia
| | | | | | | | | | - James M McMahon
- School of Nursing, University of Rochester, Rochester, New York
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16
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Vermeersch S, Callens S, De Wit S, Goffard JC, Laga M, Van Beckhoven D, Annemans L. Health and budget impact of combined HIV prevention - first results of the BELHIVPREV model. Acta Clin Belg 2018; 73:54-67. [PMID: 28673201 DOI: 10.1080/17843286.2017.1339978] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES We developed a pragmatic modelling approach to estimate the impact of treatment as prevention (TasP); outreach testing strategies; and pre-exposure prophylaxis (PrEP) on the epidemiology of HIV and its associated pharmaceutical expenses. METHODS Our model estimates the incremental health (in terms of new HIV diagnoses) and budget impact of two prevention scenarios (outreach+TasP and outreach+TasP+PrEP) against a 'no additional prevention' scenario. Model parameters were estimated from reported Belgian epidemiology and literature data. The analysis was performed from a healthcare payer perspective with a 15-year-time horizon. It considers subpopulation differences, HIV infections diagnosed in Belgium having occurred prior to migration, and the effects of an ageing HIV population. RESULTS Without additional prevention measures, the annual number of new HIV diagnoses rises to over 1350 new diagnoses in 2030 as compared to baseline, resulting in a budget expenditure of €260.5 million. Implementation of outreach+TasP and outreach+TasP+PrEP results in a decrease in the number of new HIV diagnoses to 865 and 663 per year, respectively. Respective budget impacts decrease by €20.6 million and €33.7 million. CONCLUSION Foregoing additional investments in prevention is not an option. An approach combining TasP, outreach and PrEP is most effective in reducing the number of new HIV diagnoses and the HIV treatment budget. Our model is the first pragmatic HIV model in Belgium estimating the consequences of a combined preventive approach on the HIV epidemiology and its economic burden assuming other prevention efforts such as condom use and harm reduction strategies remain the same.
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Affiliation(s)
| | - Steven Callens
- Department of Internal Medicine and Infectious Diseases, Ghent University Hospital, Gent, Belgium
| | - Stéphane De Wit
- Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium
| | | | - Marie Laga
- HIV and Sexual Health Unit, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Dominique Van Beckhoven
- Epidemiology of Infectious Diseases Unit, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium
| | - Lieven Annemans
- Faculty of Medicine and Health Science, Department of Public Health, Ghent University, Gent, Belgium
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17
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Transgender People and HIV Prevention: What We Know and What We Need to Know, a Call to Action. J Acquir Immune Defic Syndr 2017; 72 Suppl 3:S207-9. [PMID: 27429184 PMCID: PMC4969053 DOI: 10.1097/qai.0000000000001086] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Transgender people have been disproportionally affected by HIV, particularly transgender women. Their increased vulnerability to HIV is due to multiple issues, including biological (eg, increased efficiency of HIV transmission through receptive anal sex), epidemiological (eg, increased likelihood of having HIV-infected partners), structural (eg, social stigma limiting employment options), and individual factors (eg, internalized stigma leading to depression and substance use and risk-taking behaviors). There have been limited culturally appropriate HIV prevention interventions for transgender people, with many key prevention studies (eg, the iPrEx PrEP study) enrolling transgender women in a study focusing on men who have sex with men. This has resulted in limited understanding of the optimal ways to decrease transgender people's risk for HIV acquisition. The current supplement of JAIDS is designed to review what is known about HIV prevention for transgender people and to highlight new insights and best practices. The study reviews recent epidemiologic data, the pharmacology of HIV prophylactic agents in individuals who may be using exogenous hormones, and several recent multi-component interventions designed to address the lived experience of transgender people. Additionally, the study reviews the work going on at the NIH to address transgender health in general and HIV prevention in specific, as well as two important papers related to clinical trial design issues and the ethical conduct of research in this frequently disenfranchised population. It is the hope of the HIV Prevention Trials Network (HPTN) that this supplement will promote new knowledge around transgender health and the requisite issues that need to be addressed in order to conduct optimal clinical trials. The ultimate hope is that the information distilled in this supplement will inform investigators, clinicians, and public health officials in order to design further research to develop optimal prevention interventions for transgender people and to implement these interventions in ways that are culturally congruent and health promoting.
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18
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Calabrese SK, Magnus M, Mayer KH, Krakower DS, Eldahan AI, Hawkins LAG, Underhill K, Hansen NB, Kershaw TS, Betancourt JR, Dovidio JF. "Support Your Client at the Space That They're in": HIV Pre-Exposure Prophylaxis (PrEP) Prescribers' Perspectives on PrEP-Related Risk Compensation. AIDS Patient Care STDS 2017; 31:196-204. [PMID: 28414261 PMCID: PMC5404273 DOI: 10.1089/apc.2017.0002] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Despite the demonstrated effectiveness of HIV pre-exposure prophylaxis (PrEP) and evidence that most PrEP users do not engage in risk compensation (i.e., increased risk behavior due to a perceived decrease in HIV susceptibility), some healthcare providers report patient risk compensation to be a deterrent to prescribing PrEP. Overcoming this barrier is essential to supporting PrEP access and uptake among people at risk for HIV. To inform such efforts, this qualitative study explored PrEP-related risk compensation attitudes among providers with firsthand experience prescribing PrEP. US-based PrEP providers (n = 18), most of whom were HIV specialists, were recruited through direct outreach and referral from colleagues and other participants. Individual 90-min semistructured interviews were conducted by phone or in person from September 2014 through February 2015, transcribed, and thematically analyzed. Three attitudinal themes emerged: (1) providers' role is to support patients in making informed decisions, (2) risk behavior while taking PrEP does not fully offset PrEP's protective benefit (i.e., PrEP confers net protection, even with added behavioral risk), and (3) PrEP-related risk compensation is unduly stigmatized within and beyond the healthcare community. Participants were critical of other healthcare providers' negative judgment of patients and reluctance to prescribe PrEP due to anticipated risk compensation. Several providers also acknowledged an evolution in their thinking from initial ambivalence toward greater acceptance of PrEP and PrEP-related behavior change. PrEP providers' insights about risk compensation may help to address unsubstantiated concerns about PrEP-related risk compensation and challenge the acceptability of withholding PrEP on these grounds.
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Affiliation(s)
- Sarah K. Calabrese
- Department of Psychology, George Washington University, Washington, District of Columbia
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Douglas S. Krakower
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Adam I. Eldahan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Columbia School of Nursing, New York, New York
| | - Lauren A. Gaston Hawkins
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Kristen Underhill
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Yale Law School, New Haven, Connecticut
- Columbia Law School, New York, New York
| | - Nathan B. Hansen
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Trace S. Kershaw
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
| | - Joseph R. Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John F. Dovidio
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, Connecticut
- Department of Psychology, Yale University, New Haven, Connecticut
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19
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Jarmolowicz DP, Reed DD, Bruce AS, Catley D, Lynch S, Goggin K, Lim SL, Strober L, Glusman M, Norouzinia AN, Bruce JM. Using EP50 to forecast treatment adherence in individuals with multiple sclerosis. Behav Processes 2016; 132:94-99. [PMID: 27702587 DOI: 10.1016/j.beproc.2016.09.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 09/09/2016] [Accepted: 09/15/2016] [Indexed: 11/29/2022]
Abstract
Much like delay discounting, probability discounting may be related to a host of pro-health behaviors. In a recent report, a Medical Decision Making Questionnaire (MDMQ) was developed that leveraged this insights of probability discounting to both describe ways that multiple sclerosis (MS) patients weigh costs and benefits when making adherence choices, and predicted their self-reported treatment adherence. The current re-analysis of those data use a novel EP50 measure as a framework of a model that predicted the cost/benefit ratios necessary for the choices of typically non-adherent patients to become indistinguishable from those of typically adherent patients (and vice versa). These analytic tools may aid in the development/evaluation of both novel therapeutics and treatment adherence strategies for chronic conditions.
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Affiliation(s)
- David P Jarmolowicz
- Department of Applied Behavioral Science, University of Kansas, 4050 Dole Developmental Center, 1000 Sunnyside Ave., Lawrence, KS 66045, USA.
| | - Derek D Reed
- Department of Applied Behavioral Science, University of Kansas, 4050 Dole Developmental Center, 1000 Sunnyside Ave., Lawrence, KS 66045, USA.
| | - Amanda S Bruce
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, 610 E. 22nd St., Kansas City, MO, 64108, USA.
| | - Delwyn Catley
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospital, 610 E. 22nd St., Kansas City, MO, 64108, USA.
| | - Sharon Lynch
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, 66160, USA.
| | - Kathy Goggin
- Health Services and Outcomes Research, Children's Mercy Hospital and Clinics, University of Missouri - Kansas City, 2401 Gillham Road 610, Kansas City, MO, 64108, USA.
| | - Seung-Lark Lim
- Department of Psychology, University of Missouri, 5030 Cherry St., Kansas City, MO 64110, USA.
| | | | - Morgan Glusman
- Department of Psychology, University of Missouri, 5030 Cherry St., Kansas City, MO 64110, USA.
| | - Abigail N Norouzinia
- Department of Psychology, University of Missouri, 5030 Cherry St., Kansas City, MO 64110, USA.
| | - Jared M Bruce
- Department of Psychology, University of Missouri, 5030 Cherry St., Kansas City, MO 64110, USA.
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20
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Calabrese SK, Underhill K, Earnshaw VA, Hansen NB, Kershaw TS, Magnus M, Krakower DS, Mayer KH, Betancourt JR, Dovidio JF. Framing HIV Pre-Exposure Prophylaxis (PrEP) for the General Public: How Inclusive Messaging May Prevent Prejudice from Diminishing Public Support. AIDS Behav 2016; 20:1499-513. [PMID: 26891840 PMCID: PMC4903888 DOI: 10.1007/s10461-016-1318-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Strategic framing of public messages about HIV pre-exposure prophylaxis (PrEP) may influence public support for policies and programs affecting access. This survey study examined how public attitudes toward PrEP differed based on the social group PrEP was described as benefiting ("beneficiary") and the moderating effect of prejudice. Members of the general public (n = 154) recruited online were randomly assigned to three beneficiary conditions: general population, gay men, or Black gay men. All participants received identical PrEP background information before completing measures of PrEP attitudes (specifying beneficiary), racism, and heterosexism. Despite anticipating greater PrEP adherence among gay men and Black gay men and perceiving PrEP as especially beneficial to the latter, participants expressed lower support for policies/programs making PrEP affordable for these groups vs. the general population. This disparity in support was stronger among participants reporting greater prejudice. Inclusive framing of PrEP in public discourse may prevent prejudice from undermining implementation efforts.
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Affiliation(s)
- Sarah K Calabrese
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
| | - Kristen Underhill
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Yale Law School, Yale University, New Haven, CT, USA
| | - Valerie A Earnshaw
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nathan B Hansen
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Douglas S Krakower
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Kenneth H Mayer
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Joseph R Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - John F Dovidio
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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21
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Calabrese SK, Magnus M, Mayer KH, Krakower DS, Eldahan AI, Gaston Hawkins LA, Hansen NB, Kershaw TS, Underhill K, Betancourt JR, Dovidio JF. Putting PrEP into Practice: Lessons Learned from Early-Adopting U.S. Providers' Firsthand Experiences Providing HIV Pre-Exposure Prophylaxis and Associated Care. PLoS One 2016; 11:e0157324. [PMID: 27304883 PMCID: PMC4909282 DOI: 10.1371/journal.pone.0157324] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/29/2016] [Indexed: 12/12/2022] Open
Abstract
Optimizing access to HIV pre-exposure prophylaxis (PrEP), an evidence-based HIV prevention resource, requires expanding healthcare providers' adoption of PrEP into clinical practice. This qualitative study explored PrEP providers' firsthand experiences relative to six commonly-cited barriers to prescription-financial coverage, implementation logistics, eligibility determination, adherence concerns, side effects, and anticipated behavior change (risk compensation)-as well as their recommendations for training PrEP-inexperienced providers. U.S.-based PrEP providers were recruited via direct outreach and referral from colleagues and other participants (2014-2015). One-on-one interviews were conducted in person or by phone, transcribed, and analyzed. The sample (n = 18) primarily practiced in the Northeastern (67%) or Southern (22%) U.S. Nearly all (94%) were medical doctors (MDs), most of whom self-identified as infectious disease specialists. Prior experience prescribing PrEP ranged from 2 to 325 patients. Overall, providers reported favorable experiences with PrEP implementation and indicated that commonly anticipated problems were minimal or manageable. PrEP was covered via insurance or other programs for most patients; however, pre-authorization requirements, laboratory/service provision costs, and high deductibles sometimes presented challenges. Various models of PrEP care and coordination with other providers were utilized, with several providers highlighting the value of clinical staff support. Eligibility was determined through joint decision-making with patients; CDC guidelines were commonly referenced but not considered absolute. Patient adherence was variable, with particularly strong adherence noted among patients who had actively sought PrEP (self-referred). Providers observed minimal adverse effects or increases in risk behavior. However, they identified several barriers with respect to accessing and engaging PrEP candidates. Providers offered a wide range of suggestions regarding content, strategy, and logistics surrounding PrEP training, highlighting sexual history-taking and sexual minority competence as areas to prioritize. These insights from early-adopting PrEP providers may facilitate adoption of PrEP into clinical practice by PrEP-inexperienced providers, thereby improving access for individuals at risk for HIV.
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Affiliation(s)
- Sarah K. Calabrese
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States of America
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States of America
- * E-mail:
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, United States of America
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Douglas S. Krakower
- The Fenway Institute, Fenway Health, Boston, MA, United States of America
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Adam I. Eldahan
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Lauren A. Gaston Hawkins
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States of America
| | - Nathan B. Hansen
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States of America
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, GA, United States of America
| | - Trace S. Kershaw
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States of America
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States of America
| | - Kristen Underhill
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States of America
- Yale Law School, Yale University, New Haven, CT, United States of America
| | - Joseph R. Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - John F. Dovidio
- Department of Chronic Disease Epidemiology, Yale School of Public Health, Yale University, New Haven, CT, United States of America
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, United States of America
- Department of Psychology, Yale University, New Haven, CT, United States of America
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22
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Kovarova M, Swanson MD, Sanchez RI, Baker CE, Steve J, Spagnuolo RA, Howell BJ, Hazuda DJ, Garcia JV. A long-acting formulation of the integrase inhibitor raltegravir protects humanized BLT mice from repeated high-dose vaginal HIV challenges. J Antimicrob Chemother 2016; 71:1586-96. [PMID: 27002074 PMCID: PMC4867102 DOI: 10.1093/jac/dkw042] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/11/2016] [Accepted: 01/29/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pre-exposure prophylaxis (PrEP) using antiretroviral drugs (ARVs) has been shown to reduce HIV transmission in people at high risk of HIV infection. Adherence to PrEP strongly correlates with the level of HIV protection. Long-acting injectable ARVs provide sustained systemic drug exposures over many weeks and can improve adherence due to infrequent parenteral administration. Here, we evaluated a new long-acting formulation of raltegravir for prevention of vaginal HIV transmission. METHODS Long-acting raltegravir was administered subcutaneously to BALB/c, NSG (NOD-scid-gamma) and humanized BLT (bone marrow-liver-thymus) mice and rhesus macaques. Raltegravir concentration in peripheral blood and tissue was analysed. Suppression of HIV replication was assessed in infected BLT mice. Two high-dose HIV vaginal challenges were used to evaluate protection from HIV transmission in BLT mice. RESULTS Two weeks after a single subcutaneous injection of long-acting raltegravir in BLT mice (7.5 mg) and rhesus macaques (160 mg), the plasma concentration of raltegravir was comparable to 400 mg orally, twice daily in humans. Serum collected from mice 3 weeks post-administration of long-acting raltegravir efficiently blocked HIV infection of TZM-bl indicator cells in vitro. Administration of long-acting raltegravir suppressed viral RNA in plasma and cervico-vaginal fluids of infected BLT mice, demonstrating penetration of active raltegravir into the female reproductive tract. Using transmitted/founder HIV we observed that BLT mice administered a single subcutaneous dose of long-acting raltegravir were protected from two high-dose HIV vaginal challenges 1 week and 4 weeks after drug administration. CONCLUSIONS These preclinical results demonstrated the efficacy of long-acting raltegravir in preventing vaginal HIV transmission.
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Affiliation(s)
- Martina Kovarova
- Division of Infectious Diseases, Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Michael D Swanson
- Division of Infectious Diseases, Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Rosa I Sanchez
- Merck Research Laboratories, Merck & Co., Inc., West Point, PA 19486, USA
| | - Caroline E Baker
- Division of Infectious Diseases, Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Justin Steve
- Merck Research Laboratories, Merck & Co., Inc., West Point, PA 19486, USA
| | - Rae Ann Spagnuolo
- Division of Infectious Diseases, Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Bonnie J Howell
- Merck Research Laboratories, Merck & Co., Inc., West Point, PA 19486, USA
| | - Daria J Hazuda
- Merck Research Laboratories, Merck & Co., Inc., West Point, PA 19486, USA
| | - J Victor Garcia
- Division of Infectious Diseases, Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, NC, USA
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23
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Braksmajer A, Senn TE, McMahon J. The Potential of Pre-Exposure Prophylaxis for Women in Violent Relationships. AIDS Patient Care STDS 2016; 30:274-81. [PMID: 27286296 PMCID: PMC4913495 DOI: 10.1089/apc.2016.0098] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
HIV and intimate partner violence (IPV) are significant intersecting threats to women's health. Women in violent relationships have few feasible HIV risk reduction options as traditional prevention methods are largely dependent on a partner's cooperation. The purpose of this review is to explore potential benefits and drawbacks of pre-exposure prophylaxis (PrEP) use among women in the United States experiencing IPV. Advantages of PrEP use in this population include the potential for covert or autonomous use, coital independence, dual protection against sexual and injection risk, and facilitated connections to social services. A number of barriers, however, may interfere with the effective use of PrEP, including partner resistance, cost, frequent medical visits, gendered norms regarding sexuality, and stigma. To realize its potential for women in violent relationships, it will be necessary to incorporate PrEP into behavioral and structural interventions that encourage uptake, facilitate adherence, ensure women's safety, and challenge existing gender norms.
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Affiliation(s)
- Amy Braksmajer
- University of Rochester School of Nursing , Rochester, New York
| | - Theresa E Senn
- University of Rochester School of Nursing , Rochester, New York
| | - James McMahon
- University of Rochester School of Nursing , Rochester, New York
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24
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA; Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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