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Sherman EM, Agwu AL, Ambrosioni J, Behrens GMN, Chu C, Collins LF, Jimenez HR, Koren DE, McGorman L, Nguyen NN, Nicol MR, Pandit NS, Pierre N, Scarsi KK, Spinner GF, Tseng A, Young JD, Badowski ME. Consensus recommendations for use of long-acting antiretroviral medications in the treatment and prevention of HIV-1: Endorsed by the American Academy of HIV Medicine, American College of Clinical Pharmacy, Canadian HIV and Viral Hepatitis Pharmacists Network, European AIDS Clinical Society, and Society of Infectious Diseases Pharmacists. Pharmacotherapy 2024; 44:494-538. [PMID: 39005160 DOI: 10.1002/phar.2922] [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: 12/01/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 07/16/2024]
Abstract
Five long-acting (LA) antiretrovirals (ARVs) are currently available in a limited number of countries worldwide for HIV-1 prevention or treatment-cabotegravir, rilpivirine, lenacapavir, ibalizumab, and dapivirine. Implementing use of LA ARVs into routine clinical practice requires significant changes to the current framework of HIV-1 prevention, treatment, and service provision. Given the novelty, complexity, and interdisciplinary requirements needed to safely and optimally utilize LA ARVs, consensus recommendations on the use of LA ARVs will assist clinicians in optimizing use of these agents. The purpose of these recommendations is to provide guidance for the clinical use of LA ARVs for HIV-1 treatment and prevention. In addition, future areas of research are also identified and discussed.
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Affiliation(s)
- Elizabeth M Sherman
- Barry and Judy Silverman College of Pharmacy, Nova Southeastern University, Fort Lauderdale, Florida, USA
- Division of Infectious Disease, Memorial Healthcare System, Hollywood, Florida, USA
| | - Allison L Agwu
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Juan Ambrosioni
- HIV Unit and Infectious Disease Service, Hospital Clinic and Fundació de Recerca Clínic Barcelona-IDIBAPS, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Georg M N Behrens
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
- German Center for Infection Research (DZIF), Partner Site Hannover-Braunschweig, Hannover, Germany
- Centre for Individualized Infection Medicine (CiiM), Hannover Medical School, Hannover, Germany
| | - Carolyn Chu
- University of California San Francisco, San Francisco, California, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Emory School of Medicine, Grady Ponce de Leon Center, Atlanta, Georgia, USA
| | - Humberto R Jimenez
- Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey, USA
- Comprehensive Care Center, St. Joseph's University Medical Center, Paterson, New Jersey, USA
| | - David E Koren
- Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Leslie McGorman
- American Academy of HIV Medicine, Washington, District of Columbia, USA
| | - Nancy N Nguyen
- Thomas J. Long School of Pharmacy, University of the Pacific, Stockton, California, USA
| | - Melanie R Nicol
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, Minnesota, USA
| | - Neha Sheth Pandit
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland Baltimore School of Pharmacy, Baltimore, Maryland, USA
| | - Natacha Pierre
- Department of Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Kimberly K Scarsi
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gary F Spinner
- Southwest Community Health Center, Bridgeport, Connecticut, USA
| | - Alice Tseng
- Immunodeficiency Clinic, University Health Network, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jeremy D Young
- Division of Infectious Diseases, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Melissa E Badowski
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
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Garcia M, Roberts ST, Mayo AJ, Scheckter R, Mansoor LE, Palanee-Phillips T, Reddy K, Naidoo Y, Akello CA, Gaffoor Z, Siva S, Rushwaya C, Hlahla K, Jambaya J, Makoni R, Kachale E, Ndovie M, Zuma J, Montgomery ET. Integrating Gender-Based Violence Screening and Support into the Research Clinic Setting: Experiences from an HIV Prevention Open-Label Extension Trial in Sub-Saharan Africa. AIDS Behav 2023; 27:1277-1286. [PMID: 36178556 PMCID: PMC10036410 DOI: 10.1007/s10461-022-03864-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2022] [Indexed: 11/24/2022]
Abstract
HIV and gender-based violence (GBV) are syndemic in sub-Saharan Africa and provision of support for participants who disclose GBV constitutes part of comprehensive care. Consequently, a process was undertaken to develop, implement, and evaluate standard operating procedures (SOPs) in MTN-025/HOPE, a study of the dapivirine vaginal ring for HIV prevention. The SOP was developed using needs assessment surveys in addition to World Health Organization (WHO) guidelines and other literature. Sites tailored and implemented the SOP through HOPE implementation. At study end, staff reported increased training 32/35 (91.43%); improved confidence (18/26; 69.23%); and improved vicarious trauma prevention onsite (17/28; 60.71%). Leadership reported increased staff competence in GBV response. Obstacles included limited referral organizations and time for follow-up, continued training needs, and cultural norms. Development and implementation of an SOP is a feasible strategy to build a GBV response to improve health systems and support sustained effective use of HIV prevention products.
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Affiliation(s)
- Morgan Garcia
- Global Health Population and Nutrition, FHI 360, Durham, NC, USA.
- Global Health Population and Nutrition, FHI 360, 359 Blackwell St, Ste 200, Durham, NC, 27701, USA.
| | - Sarah T Roberts
- Women's Global Health Imperative (WGHI) RTI International, Berkeley, CA, USA
| | - Ashley J Mayo
- Global Health Population and Nutrition, FHI 360, Durham, NC, USA
| | - Rachel Scheckter
- Global Health Population and Nutrition, FHI 360, Durham, NC, USA
| | - Leila E Mansoor
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
| | - Thesla Palanee-Phillips
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
- University of Washington School of Public Health, Seattle, WA, USA
| | - Krishnaveni Reddy
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
| | - Yuthika Naidoo
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute (Wits RHI), University of the Witwatersrand, Johannesburg, South Africa
| | - Carolyne Agwau Akello
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda
| | - Zakir Gaffoor
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Samantha Siva
- HIV Prevention Research Unit (HPRU), South African Medical Research Council (SAMRC), Durban, South Africa
| | - Chenai Rushwaya
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Kudzai Hlahla
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Jane Jambaya
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Rujeko Makoni
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Evans Kachale
- College of Medicine - Johns Hopkins Bloomberg School of Public Health, Blantyre, Malawi
| | | | - Jabulisile Zuma
- Desmond Tutu HIV Foundation (DTHF) - Emavundleni Clinical Research Site, Cape Town, South Africa
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Montgomery ET, Roberts ST, Reddy K, Tolley E, Hartmann M, Wilson E, Mathebula F, Wagner LD, Zissette S, Lanham M, Wilcher R, Baeten JM, Palanee-Phillips T. Integration of a Relationship-focused Counseling Intervention with Delivery of the Dapivirine Ring for HIV Prevention to Women in Johannesburg: Results of the CHARISMA Pilot Study. AIDS Behav 2022; 26:752-763. [PMID: 34546473 PMCID: PMC8840958 DOI: 10.1007/s10461-021-03434-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 12/21/2022]
Abstract
Biomedical, female-initiated HIV prevention methods can help reduce disproportionately high HIV rates among women in sub-Saharan Africa, but male partner resistance and intimate partner violence (IPV) may impact ability to ensure effective use. To support consistent use of the dapivirine vaginal ring (VR), we pilot-tested the impact of the CHARISMA relationship counseling intervention ("CHARISMA") with women enrolled in the multi-site open-label Microbicide Trials Network (MTN) 025/HOPE trial at the Wits Reproductive Health and HIV Research Institute (Wits RHI) site in Johannesburg, South Africa. Lay counselors used a 42-item tool with five subscales to assess relationships and IPV and provide tailored counseling at enrolment, followed by a booster counselling session at Month 1 and follow-up checks at Months 3 and 6. We evaluated potential impact by examining self-reported ring disclosure to partners, partner clinic attendance, self-reported incident social harms (SH) and IPV, and biomarkers of ring adherence at Wits RHI. We subsequently compared these outcomes at three comparator HOPE study sites using multivariable regression models. Comparator study sites were purposively selected as those most similar to Wits RHI for baseline characteristics identified a priori. At Wits RHI, 95 of 96 (99%) HOPE participants enrolled into the CHARISMA pilot study. Mean age was 30, 36.8% lived with a partner, and 85.3% received their partner's financial support. During the six months of pilot study follow-up, participants reported: ring use disclosure to partners at 72.7% visits; 4.3% partners attending the research clinic; one partner-related SH; and 9.5% experienced incident IPV. The mean level of dapivirine released from returned used rings was 3.4 mg (SD 1.56), suggesting moderate adherence. Participants in the CHARISMA pilot had high background prevalence and incidence of IPV but were nevertheless able to adhere to ring use, and some male partners came to the research clinic. In adjusted regression models, compared to Wits RHI, partner clinic attendance was lower at all comparator sites; and significantly so at Site A (aRR 0.12, 95% CI 0.00-0.98). Sites B and C had lower levels of dapivirine released (suggesting lower adherence), but this difference was not significant. Site B women were more likely to report ring disclosure to partners at FU visits (aRR 1.12, 95% CI 1.00-1.25). IPV reported during follow-up was significantly lower at Site B (aRR 0.20, 95% CI 0.04-0.98, p = 0.047). CHARISMA taught women skills to decide on levels of ring-use disclosure to partners or others; therefore it is difficult to interpret differences in ring disclosure to partners with other sites. Similarly, CHARISMA heightened participants' awareness of abuse, possibly increasing IPV reports. Testing CHARISMA under fully-powered controlled conditions will improve understanding of its impact on women's relationships and ability to use female-initiated HIV prevention methods.
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Affiliation(s)
| | - Sarah T Roberts
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Krishnaveni Reddy
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Miriam Hartmann
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Ellen Wilson
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | - Florence Mathebula
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - L Danielle Wagner
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
| | | | | | | | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
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Evidence for use of a healthy relationships assessment tool in the CHARISMA pilot study. PLoS One 2022; 16:e0261526. [PMID: 34972141 PMCID: PMC8719706 DOI: 10.1371/journal.pone.0261526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 12/03/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction The CHARISMA intervention, nested within the MTN-025/HOPE vaginal ring trial in Johannesburg, South Africa, seeks to facilitate women’s use of HIV prevention products by promoting partner dialogue and mitigating intimate partner violence (IPV). We developed “HEART”, a lay counselor-administered relationship assessment tool, for the CHARISMA pilot. The five-scale tool assesses participants’ endorsement of Traditional Values (TV), her HIV Prevention Readiness (HPR) and levels of partner support (PS), abuse and control (PAC), and resistance to HIV prevention (PR), guiding decisions about which of three counselling modules to offer (partner communication/A; ring disclosure/B; and IPV prevention/C). Methods We correlated baseline scores on HEART subscales with a) independent measures of relationship stability, disclosure and IPV to assess construct validity, and b) with specific modules offered to determine how HEART was used in the pilot. We examined changes in HEART scores at three and six months. Finally, we ran separate growth models for each subscale to examine changes in scores, accounting for partnership changes and counseling module(s) received. Results Baseline HEART scores correlated as predicted among subscales and with other measures. Reliabilities for four subscales were 0.75 or higher. Women who disclosed study participation and ring use scored higher on PS and lower on PR. Women experiencing IPV scored lower on PS, and higher on PAC and PR. During the pilot, 82% of women received one and 17% received two or more modules; over half received the IPV module. Women with higher PAC and PR scores were more likely to receive the IPV than the communication or disclosure modules. Over time, the TV, PAC and PR scores decreased, and PS score increased. Receiving the IPV module was associated with a decreased PAC score. Conclusions These data offer preliminary evidence for HEART construct and predictive validity and support its further evaluation to guide implementation and monitor the impact of the CHARISMA intervention in a randomized controlled evaluation.
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Harrison A, Bhengu N, Miller L, Exner T, Tesfay N, Magutshwa S, Khumalo S, Bergam S, Hoffman S, Hanass-Hancock J. “You tell him that ‘baby, I am protecting myself’”: Women’s agency and constraint around willingness to use pre-exposure prophylaxis in the Masibambane Study. WOMEN'S HEALTH 2022; 18:17455057221087117. [PMID: 35306944 PMCID: PMC8935570 DOI: 10.1177/17455057221087117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: To explore women’s willingness to consider using pre-exposure prophylaxis for HIV prevention in the context of gendered relationship dynamics, in Durban, South Africa. Methods: As formative research prior to development of a gender-informed intervention to introduce pre-exposure prophylaxis to young, urban, educated women, we conducted six focus-group discussions and eight in-depth interviews with 46 women ages 18–25 years, who were not current pre-exposure prophylaxis users. Women were recruited from clinic and community settings using a criterion-based snowball sampling technique. Qualitative data were coded and analyzed thematically, with a team-based consensus approach for final coding, analytical decisions, and data interpretation. Results: Women clearly understood the benefits of pre-exposure prophylaxis for themselves and their partners, focusing on promoting health and their right to protect themselves from HIV infection. At the same time, and in accordance with findings from other studies, women were realistic about the concerns that would arise among male partners, including disapproval, loss of trust, possible loss of the relationship, and in some instances, the potential for violence, if they were to propose pre-exposure prophylaxis use. To resolve this tension, some women advocated for covert use as the best option for themselves and others argued for disclosure, proposing various approaches to working with partners to adopt pre-exposure prophylaxis. The suggestion that both partners use pre-exposure prophylaxis was made repeatedly. Thus, women sought to avoid discussions of trust or lack of trust and a partner’s possible infidelities, choosing instead to focus on preserving or even building a relationship through suggesting pre-exposure prophylaxis use. Conclusion: Women offered diverse narratives on agency and constraint in relation to choosing pre-exposure prophylaxis as a future prevention strategy, as well as ways to engage with their male partners about pre-exposure prophylaxis. These findings speak to the need for interventions to bolster women’s confidence, sense of empowerment, and their communication and decision-making skills for successful HIV prevention.
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Affiliation(s)
- Abigail Harrison
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI, USA
| | - Nonhlonipho Bhengu
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Lori Miller
- HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Theresa Exner
- HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Nonkululeko Tesfay
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Slindile Magutshwa
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Silindile Khumalo
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
| | - Scarlett Bergam
- Brown University, School of Public Health, International Health Institute, Providence, RI, USA
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York, NY, USA
| | - Jill Hanass-Hancock
- Gender and Health Research Unit, South African Medical Research Council, Durban, South Africa
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Fonner VA, Ntogwisangu J, Hamidu I, Joseph J, Fields J, Evans E, Kilewo J, Bailey C, Goldsamt L, Fisher CB, O'Reilly KR, Ruta T, Mbwambo J, Sweat MD. "We are in this together:" dyadic-level influence and decision-making among HIV serodiscordant couples in Tanzania receiving access to PrEP. BMC Public Health 2021; 21:720. [PMID: 33853559 PMCID: PMC8045366 DOI: 10.1186/s12889-021-10707-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 03/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A substantial number of new HIV infections in sub-Saharan Africa occur within stable couples. Biomedical prevention (pre-exposure prophylaxis, PrEP) and treatment (antiretroviral therapy, ART) can provide benefits to sexual partners and can be used to prevent infection within HIV serodiscordant couples. However, research is typically focused on individuals, not dyads, even when the intervention may directly or indirectly impact sexual partners. Gaps remain in understanding best practices for recruitment, informed consent, and intervention implementation in studies involving HIV prevention and treatment among heterosexual serodiscordant couples. This qualitative study was undertaken to understand and describe decision-making and dyadic-level influence among members of serodiscordant couples regarding (1) participation in a dyadic-based research study involving HIV self-testing and access to PrEP, and (2) utilization of PrEP and ART. METHODS This qualitative study was nested within an observational cohort study assessing the acceptability of home-based couples' HIV self-testing and uptake of dyadic care for serodiscordant couples involving facilitated referral for HIV-positive partners and access to PrEP for HIV-negative partners. Semi-structured in-depth interviews were conducted among a subset of study participants (n = 22) as well as individuals involved in serodiscordant relationships who chose not to participate (n = 9). Interviews focused on couples' decision-making regarding study participation and dyadic-level influence on medication use. Interviews were transcribed verbatim and translated from Kiswahili into English. Data were analyzed using thematic analysis. RESULTS Three major themes were identified: (1) HIV as "two people's secret" and the elevated role of partner support in serodiscordant relationships; (2) the intersectional role of HIV-status and gender on decision-making; (3) the relational benefits of PrEP, including psychosocial benefits for the couple that extend beyond prevention. CONCLUSIONS The study found that couples made joint decisions regarding study participation and uptake of HIV-related medication. Relational autonomy and dyadic-level influence should be considered within research and programs involving HIV serodiscordant couples.
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Affiliation(s)
- Virginia A Fonner
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Charleston, SC, USA.
| | - Jacob Ntogwisangu
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Isihaka Hamidu
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Juliet Joseph
- Medical University of South Carolina, College of Medicine, Charleston, SC, USA
| | - Joshua Fields
- Medical University of South Carolina, College of Medicine, Charleston, SC, USA
| | - Evans Evans
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jordan Kilewo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Claire Bailey
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Charleston, SC, USA
| | - Lloyd Goldsamt
- New York University, Rory Meyers College of Nursing, New York, NY, USA
| | - Celia B Fisher
- Fordham University, Department of Psychology and Center for Ethics Education, Bronx, NY, USA
| | - Kevin R O'Reilly
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Charleston, SC, USA
| | - Theonest Ruta
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Jessie Mbwambo
- Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Michael D Sweat
- Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Division of Global and Community Health, Charleston, SC, USA
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