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Abstract
Four of the largest HIV prevention trials have been conducted in sub-Saharan Africa, enrolling hundreds of thousands of participants in catchment areas of millions of people. The trials have focused on community-level interventions to increase diagnosis and initiation of antiretroviral therapy (ART) to improve health and reduce HIV transmission. Universal test-and-treat strategies are deployed to achieve viral suppression thereby reducing risk to uninfected persons, known as treatment as prevention (TasP).
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Hume M, Lewis LL, Nelson RM. Meeting the goal of concurrent adolescent and adult licensure of HIV prevention and treatment strategies. JOURNAL OF MEDICAL ETHICS 2017; 43:857-860. [PMID: 28507222 PMCID: PMC5685924 DOI: 10.1136/medethics-2016-103600] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 03/23/2017] [Accepted: 04/18/2017] [Indexed: 06/07/2023]
Abstract
The ability of adolescents to access safe and effective new products for HIV prevention and treatment is optimised by adolescent licensure at the same time these products are approved and marketed for adults. Many adolescent product development programmes for HIV prevention or treatment products may proceed simultaneously with adult phase III development programmes. Appropriately implemented, this strategy is not expected to delay licensure as information regarding product efficacy can often be extrapolated from adults to adolescents, and pharmacokinetic properties of drugs in adolescents are expected to be similar to those in adults. Finally, adolescents enrolled in therapeutic HIV prevention and treatment research can be considered adults, based on US Food and Drug Administration (FDA) regulations and the appropriate application of state law. The FDA permits local jurisdictions to apply state and local HIV/sexually transmitted infection minor treatment laws so that adolescents who are HIV-positive or at risk of contracting HIV may be enrolled in therapeutic or prevention trials without obtaining parental permission.
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Affiliation(s)
- Michelle Hume
- Department of Psychiatry, University of Wisconsin, Madison, Wisconsin, USA
| | - Linda L Lewis
- Clinton Health Access Initiative, Boston, Massachusetts, USA
| | - Robert M Nelson
- Office of Pediatric Therapeutics, Office of the Commissioner, Food and Drug Administration, Silver Spring, Maryland, USA
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Helova A, Akama E, Bukusi EA, Musoke P, Nalwa WZ, Odeny TA, Onono M, Spangler SA, Turan JM, Wanga I, Abuogi LL. Health facility challenges to the provision of Option B+ in western Kenya: a qualitative study. Health Policy Plan 2017; 32:283-291. [PMID: 28207061 PMCID: PMC5886182 DOI: 10.1093/heapol/czw122] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 01/03/2023] Open
Abstract
Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty individual gender-matched in-depth interviews with HIV-positive pregnant/postpartum women and their male partners, and four focus groups with thirty health care providers at four health facilities in western Kenya between September-November 2014. Transcripts were coded with the Dedoose software using a coding framework based on the literature, topics from interview guides, and emerging themes from transcripts. Excerpts from broad codes were then fine-coded using an inductive approach. Three major themes emerged: 1) Option B+ specific challenges (same-day initiation into treatment, health care providers unconvinced of the benefits of Option B+, insufficient training); 2) facility resource constraints (staff and drug shortages, long queues, space limitations); and 3) lack of client-friendly services (scolding of patients, inconvenient operating hours, lack of integration of services, administrative requirements). This study highlights important challenges at the health facility level related to Option B+ rollout in western Kenya. Addressing these specific challenges may increase linkage, retention and adherence to life-long ART treatment for pregnant HIV-positive women in Kenya, contribute towards elimination of mother-to-child HIV transmission, and improve maternal and child outcomes.
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Affiliation(s)
- Anna Helova
- Department of Health Care Organization and Policy School of Public Health, University of Alabama at Birmingham, Birmingham, Birmingham, Alabama, US
| | - Eliud Akama
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth A Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Pamela Musoke
- Department of Health Care Organization and Policy School of Public Health, University of Alabama at Birmingham, Birmingham, Birmingham, Alabama, US
| | - Wafula Z Nalwa
- Migori County Referral Hospital, Kenya Ministry of Health, Migori, Kenya
| | - Thomas A Odeny
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, US
| | - Maricianah Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Sydney A Spangler
- Nell Hodgson Woodruff School of Nursing and Department of Global Health, Emory University, Atlanta, Georgia, US
| | - Janet M Turan
- Department of Health Care Organization and Policy School of Public Health, University of Alabama at Birmingham, Birmingham, Birmingham, Alabama, US
| | - Iris Wanga
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lisa L Abuogi
- Department of Pediatrics, University of Colorado Denver, Aurora, Colorado, US
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Hoos D, El-Sadr WM, Dehne KL. Getting the balance right: Scaling-up treatment and prevention. Glob Public Health 2016; 12:483-497. [PMID: 27092884 DOI: 10.1080/17441692.2016.1171887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The goals of the international response to control the HIV epidemic include high antiretroviral therapy (ART) coverage with HIV viral suppression, as well as reduction of new infections. ART use at individual and population levels reduces HIV morbidity and mortality and likely reduces HIV incidence. HIV viral suppression requires high levels of ART adherence, which necessitates support through behavioural and structural interventions to optimise effectiveness of the use of ART for prevention. Many people living with HIV remain unaware that they are HIV-infected, and HIV transmission risk is high during early infection, therefore ART expansion should be accompanied by other interventions in order to achieve the promise of treatment for prevention. Biomedical and behavioural prevention efforts focused on HIV-uninfected individuals at substantial risk of HIV acquisition are also needed to control the epidemic. Maintaining prevention programming is essential during the scale up of ART to reduce HIV transmission.
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Affiliation(s)
- David Hoos
- a ICAP at Columbia University, Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Wafaa M El-Sadr
- a ICAP at Columbia University, Mailman School of Public Health, Columbia University , New York , NY , USA
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McMahon JM, Myers JE, Kurth AE, Cohen SE, Mannheimer SB, Simmons J, Pouget ER, Trabold N, Haberer JE. Oral pre-exposure prophylaxis (PrEP) for prevention of HIV in serodiscordant heterosexual couples in the United States: opportunities and challenges. AIDS Patient Care STDS 2014; 28:462-74. [PMID: 25045996 PMCID: PMC4135325 DOI: 10.1089/apc.2013.0302] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Oral HIV pre-exposure prophylaxis (PrEP) is a promising new biomedical prevention approach in which HIV-negative individuals are provided with daily oral antiretroviral medication for the primary prevention of HIV-1. Several clinical trials have demonstrated efficacy of oral PrEP for HIV prevention among groups at high risk for HIV, with adherence closely associated with level of risk reduction. In the United States (US), three groups have been prioritized for initial implementation of PrEP-injection drug users, men who have sex with men at substantial risk for HIV, and HIV-negative partners within serodiscordant heterosexual couples. Numerous demonstration projects involving PrEP implementation among MSM are underway, but relatively little research has been devoted to study PrEP implementation in HIV-serodiscordant heterosexual couples in the US. Such couples face a unique set of challenges to PrEP implementation at the individual, couple, and provider level with regard to PrEP uptake and maintenance, adherence, safety and toxicity, clinical monitoring, and sexual risk behavior. Oral PrEP also provides new opportunities for serodiscordant couples and healthcare providers for primary prevention and reproductive health. This article provides a review of the critical issues, challenges, and opportunities involved in the implementation of oral PrEP among HIV-serodiscordant heterosexual couples in the US.
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Affiliation(s)
- James M. McMahon
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Julie E. Myers
- Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, New York, New York
- Division of Infectious Diseases, Department of Medicine, Columbia University, New York, New York
| | - Ann E. Kurth
- College of Nursing, New York University, New York, New York
| | - Stephanie E. Cohen
- San Francisco Department of Public Health, STD Prevention and Control, San Francisco, California
| | - Sharon B. Mannheimer
- Department of Medicine, Harlem Hospital, Columbia University College of Physicians and Surgeons, New York, New York
| | - Janie Simmons
- National Development and Research Institutes, New York, New York
| | | | - Nicole Trabold
- School of Nursing, University of Rochester Medical Center, Rochester, New York
| | - Jessica E. Haberer
- Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, Massachusetts
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