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Ousseine YM, Lydié N, Velter A. Pre-exposure prophylaxis in France: How many MSM are eligible and how much will it cost? PLoS One 2022; 17:e0278016. [PMID: 36454940 PMCID: PMC9714876 DOI: 10.1371/journal.pone.0278016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/09/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) was definitively authorized in France in 2017 after a two-year probationary period. The fact that the estimated number of MSM eligible for PrEP is still unknown is a barrier to this prevention tool's roll-out at the national level. This study aimed to estimate the number of MSM eligible for PrEP in France, and to evaluate the direct cost of its roll-out. METHODS We used data from several sources including the Enquête Rapport au Sexe 2019-ERAS 2019 survey, the 2019 French population census from National Institute of Statistics and Economic Studies (INSEE), and the National Public Health Agency's (Santé Publique France) 2016 health barometer survey. We also used data from previous studies which estimated the proportion of MSM who were sexually active in the 12 months prior to the studies, and HIV prevalence in MSM in France. Furthermore, we used data on PrEP drug costs from the French public drug database and data on medical examinations costs from the IPERGAY study. RESULTS For 2019, the number of HIV seronegative MSM in France who were sexually active in the previous 12 months was estimated at 398,015. Of these, 142,379 (95%CI: 139,893-145,241) and 104,645 (95%IC: 102311-106979) were eligible for PrEP, based on the Menza score and on official French criteria, respectively. The overall estimated cost of PrEP roll-out in eligible MSM varied between € 317,685,216 and € 545,903,216 for official French criteria, which was higher than the estimated €432,240,851 and €742,753,074 according to the Menza score. CONCLUSIONS Our estimations will enable policy makers to make evidence-based decisions about PrEP roll-out to MSM in France. To accelerate the process, it is important to decentralize PrEP delivery, authorize general practitioners to write prescriptions, and promote this prevention tool through information campaigns.
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Affiliation(s)
- Youssoufa M. Ousseine
- Santé Publique France, French National Public Health Agency, Saint-Maurice Cedex, France
| | - Nathalie Lydié
- Santé Publique France, French National Public Health Agency, Saint-Maurice Cedex, France
| | - Annie Velter
- Santé Publique France, French National Public Health Agency, Saint-Maurice Cedex, France
- * E-mail:
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2
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Roll-out of HIV pre-exposure prophylaxis use in France: A nationwide observational study from 2016 to 2021. Lancet Reg Health Eur 2022; 22:100486. [PMID: 35990255 PMCID: PMC9386455 DOI: 10.1016/j.lanepe.2022.100486] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Oral HIV pre-exposure prophylaxis (PrEP) has been available and fully reimbursed for people at high risk of sexually acquired HIV infection in France since January 2016. Its dissemination has been widely promoted to reduce HIV incidence in high-risk populations. This study aimed to assess the roll-out of PrEP use in France from its implementation until mid-2021. Methods Using the French National Health Data System (SNDS) covering 99% of people residing in France, all PrEP users defined as individuals aged 15 years or older who received at least one dispensing of PrEP between 1 January 2016 and 30 June 2021 were identified. PrEP users number and their socio-demographic and PrEP use characteristics were assessed over time. Findings As of 30 June 2021, a total of 42 159 individuals had initiated PrEP in France. Monthly PrEP initiations increased steadily up to 1027 in February 2020, and then slowed down sharply from the onset of the COVID-19 epidemic until a recovery in the first half of 2021. PrEP users were overwhelmingly men (97·5%, 41 126/42 159), aged 36 years on average, living in a large metropolitan area (73·8%, 31 096/42 159), and among whom a minority (7·0%, 2966/42 159) were socio-economically disadvantaged. Throughout the study period, 80-90% of users renewed PrEP from one semester to another, suggesting a good level of maintenance among those engaged in treatment. Nevertheless, for 20·1% (7148/35 549) of new PrEP users no prescription renewal was recorded in the first six months after initiation, suggesting a substantial proportion of early treatment discontinuation. Private practitioners accounted for a minority (21·3%, 77 885/366 399) of PrEP renewal prescriptions. Interpretation PrEP roll-out has been markedly impacted by the COVID-19 pandemic in France. Although PrEP deployment has been substantial among men who have sex with men, further action is needed to expand access to PrEP to all other population groups who could benefit from it and to promote adherence to treatment. Funding This research was carried out within EPI-PHARE without external funding.
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Bouza E, Arribas JR, Alejos B, Bernardino JI, Coiras M, Coll P, Del Romero J, Fuster MJ, Górgolas M, Gutiérrez A, Gracia D, Hernando V, Martínez-Picado J, Martínez Sesmero JM, Martínez E, Moreno S, Mothe B, Navarro ML, Podzamczer D, Pulido F, Ramos JT, Ruiz-Mateos E, Suárez García I, Palomo E. Past and future of HIV infection. A document based on expert opinion. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2022; 35:131-156. [PMID: 35018404 PMCID: PMC8972691 DOI: 10.37201/req/083.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/02/2021] [Indexed: 11/15/2022]
Abstract
HIV infection is now almost 40 years old. In this time, along with the catastrophe and tragedy that it has entailed, it has also represented the capacity of modern society to take on a challenge of this magnitude and to transform an almost uniformly lethal disease into a chronic illness, compatible with a practically normal personal and relationship life. This anniversary seemed an ideal moment to pause and reflect on the future of HIV infection, the challenges that remain to be addressed and the prospects for the immediate future. This reflection has to go beyond merely technical approaches, by specialized professionals, to also address social and ethical aspects. For this reason, the Health Sciences Foundation convened a group of experts in different aspects of this disease to discuss a series of questions that seemed pertinent to all those present. Each question was presented by one of the participants and discussed by the group. The document we offer is the result of this reflection.
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Affiliation(s)
- E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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Mabire X, Robin-Radier S, Ferraz D, Preau M. FOREST protocol: a qualitative study exploring health and sexuality of transmasculine individuals in France. BMJ Open 2021; 11:e052748. [PMID: 34848520 PMCID: PMC8634350 DOI: 10.1136/bmjopen-2021-052748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 11/03/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION While current research on sexuality and health often explores sexual behaviours among heterosexual and gay cisgender individuals, little is known about the sexualities of transgender people, especially transmasculine people. When data are available, sexual health is often reduced to risk exposure, not considering in detail social context and determinants that could contribute to a more comprehensive approach, such as general health, class, race, exposure to violence or social representations. Recognising this gap, identified in both national (French) and international scientific literature, this study aims to explore the sexual health of transmasculine people, employing an intersectional approach and considering both positive and negative health determinants. METHODS This 2-year research based in the disciplinary field of social psychology, with a gender perspective, and will apply qualitative methods. We adopt a community-based research approach, integrating one university and one community-based organisation in the coordination of the study. In a triangulation perspective, two rounds of semistructured interviews will be performed with key informants (medical practitioners, community-based support services workers, etc) and with people self-identifying as transmasculine. Focus groups will complement data collection. ETHICS AND DISSEMINATION FOREST protocol was approved by the Comité d'Évaluation Éthique (CEEI) de l'Institut National de la Santé Et de la Recherche Médicale (CEEI/International Review Board 00003888). The research adopts the principles of open science, and findings will be published assuring participants' confidentiality. Informative flyers and videos will be elaborated to communicate study findings to participants, stakeholders and the transcommunities at large, and data will be stored in lasting archives.
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Affiliation(s)
- Xavier Mabire
- PHASE (Psychology of Health, Aging and Sport Examination), University of Lausanne Faculty of Social and Political Science, Lausanne, Vaud, Switzerland
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
| | - Suzanne Robin-Radier
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
- Community-Based Organization, OUTrans NGO, Paris, Île-de-France, France
| | - Dulce Ferraz
- PHASE (Psychology of Health, Aging and Sport Examination), University of Lausanne Faculty of Social and Political Science, Lausanne, Vaud, Switzerland
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
- Escola FIOCRUZ de Governo, Fundação Oswaldo Cruz, Brasília, Brazil
| | - Marie Preau
- UMR 1296 "Radiations: Défense, Santé, Environnement", Université Lyon 2, Lyon, Auvergne-Rhône-Alpes, France
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Chemtob D, Weil C, Hannink Attal J, Hawila E, Noff Sadeh E. HIV Pre-Exposure Prophylaxis (PrEP) purchase patterns and STI occurrence among Israeli men: A cohort analysis. PLoS One 2021; 16:e0259168. [PMID: 34793473 PMCID: PMC8601516 DOI: 10.1371/journal.pone.0259168] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background HIV Pre-exposure prophylaxis (PrEP) is the regular use of antiretroviral medication by people who are not infected with HIV to prevent seroconversion. Israel approved PrEP for continuous use in 2017, and Israeli Health Maintenance Organizations (HMO) offered PrEP with a copayment to eligible members. Methodology This retrospective cohort study included all people who were dispensed PrEP between September 2017 to June 2019 in the second largest HMO in Israel. Statistical analysis, including Kaplan Meier, was conducted to evaluate user PrEP purchase, adherence to medical follow-up, and clinical outcomes. Results In total, a cohort of 757 PrEP users were followed for 657.8 person-years. All but one user were male; median age was 35 years. At baseline, 0.8% had gonorrhea and 1.5% had chlamydia infections and 4.4% had recent syphilis infection. Continuous use of PrEP (without interruption/discontinuation) was observed in 29.9%, while 39.9% interrupted and 30.3% discontinued use. Median time to first interruption/discontinuation was 4.0 months. At 6–12 months after initiation, 79.8% of users had a documented HIV test, 77.3% a Chlamydia-Gonorrhea panel, and 78.9% a creatinine test. There was one new case of HIV among the cohort, five months after PrEP discontinuation. Estimated first-year infection rates were 5.0%, 8.6% and 6.8% for gonorrhea, chlamydia and first-time syphilis, respectively. Conclusions This study shows heterogeneous PrEP purchase patterns and required medical follow-up, and an increase in STIs among consistent PrEP users. Improving adherence to recommended medical follow-up during PrEP use is essential in PrEP’s integration into Israel’s national HIV prevention strategy.
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Affiliation(s)
- Daniel Chemtob
- Department of Tuberculosis and AIDS, Israel Ministry of Health, Jerusalem, Israel
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- * E-mail:
| | - Clara Weil
- Maccabi Healthcare Services, Tel Aviv, Israel
| | - Jordan Hannink Attal
- Department of Tuberculosis and AIDS, Israel Ministry of Health, Jerusalem, Israel
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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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Muwonge TR, Nsubuga R, Brown C, Nakyanzi A, Bagaya M, Bambia F, Katabira E, Kyambadde P, Baeten JM, Heffron R, Celum C, Mujugira A, Haberer JE. Knowledge and barriers of PrEP delivery among diverse groups of potential PrEP users in Central Uganda. PLoS One 2020; 15:e0241399. [PMID: 33112907 PMCID: PMC7592843 DOI: 10.1371/journal.pone.0241399] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/13/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Scale-up of oral pre-exposure prophylaxis (PrEP) for HIV prevention in Uganda began with serodiscordant couples (SDC) and has expanded to other most at-risk populations (MARPs). We explored knowledge, acceptability, barriers and facilitators of PrEP use among potential PrEP users in four MARPs (SDC; men who have sex with men [MSM]; female sex workers [FSW], and fisher folk). METHODS We administered quantitative surveys to potential PrEP users in multiple settings in Central Uganda at baseline and approximately 9 months after healthcare worker (HCW) training on PrEP. RESULTS The survey was completed by 250 potential PrEP users at baseline and 125 after HCW training; 55 completed both surveys. For these 250 participants, mean age was 28.5 years (SD 6.9), 47% were male and 6% were transgender women, with approximately even distribution across MARPs and recruitment locations (urban, peri-urban, and rural). Most (65%) had not heard about PrEP. After HCW training, 24% of those sampled were aware of PrEP, and the proportion of those who accurately described PrEP as "antiretrovirals to be used before HIV exposure" increased from 54% in the baseline survey to 74% in the second survey (p<0.001). The proportion of participants who reported HCW as a source of PrEP information increased after training (59% vs 91%, p<0.001). In both surveys, nearly all participants indicated they were willing to take PrEP if offered. The most common anticipated barriers to PrEP were stigma, transportation, accessibility, busy schedules, and forgetfulness. Closeness to home was a common facilitator for all participant categories. CONCLUSIONS Initial awareness of PrEP was low, but PrEP knowledge and interest increased among diverse MARPs after HCW training. Demand creation and HCW training will be critical for increasing PrEP awareness among key populations, with support to overcome barriers to PrEP use. These findings should encourage the acceleration of PrEP rollout in Uganda.
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Affiliation(s)
- Timothy R. Muwonge
- Infectious Diseases Institute Makerere University, Kampala, Uganda
- * E-mail: ,
| | - Rogers Nsubuga
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Charles Brown
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Agnes Nakyanzi
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Monica Bagaya
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Felix Bambia
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Peter Kyambadde
- Most At-Risk Populations Initiative, Kampala, Uganda
- STD/AIDS Control Program Ministry of Health, Kampala, Uganda
| | - Jared M. Baeten
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Renee Heffron
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Connie Celum
- Department of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Andrew Mujugira
- Infectious Diseases Institute Makerere University, Kampala, Uganda
| | - Jessica E. Haberer
- Department of General Internal Medicine, Massachusetts General Hospital Global Health, Boston, Massachusetts, United States of America
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Balayan T, Begovac J, Skrzat-Klapaczyńska A, Aho I, Alexiev I, Bukovinova P, Salemovic D, Gokengin D, Harxhi A, Holban T, Jevtovic D, Kase K, Lakatos B, Latysheva I, Matulionyte R, Oprea C, Papadopoulos A, Rukhadze N, Sedlacek D, Tomazic J, Vassilenko A, Vasylyev M, Verhaz A, Yancheva N, Yurin O, Horban A, Kowalska JD. Where are we with pre-exposure prophylaxis use in Central and Eastern Europe? Data from the Euroguidelines in Central and Eastern Europe (ECEE) Network Group. HIV Med 2020; 22:67-72. [PMID: 33021049 DOI: 10.1111/hiv.12960] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/03/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pre-exposure prophylaxis (PrEP) for HIV infection is an important intervention for control of the HIV epidemic. The incidence of HIV infection is increasing in the countries of Central and Eastern Europe (CEE). Therefore, we investigated the change in PrEP use in CEE over time. METHODS The Euroguidelines in Central and Eastern Europe (ECEE) Network Group was initiated in February 2016 to compare standards of care for HIV and viral hepatitis infections in CEE. Data on access to PrEP were collected from 23 countries through online surveys in May-June 2017 (76 respondents) and in November 2018-May 2019 (28 respondents). RESULTS About 34.2% of respondents stated that tenofovir/emtricitabine (TDF/FTC) was licensed for use in their country in 2017, and 66.7% that it was licensed for use in 2018 (P = 0.02). PrEP was recommended in national guidelines in 39.5% of responses in 2017 and 40.7% in 2018 (P = 0.378). About 70.7% of respondents were aware of "informal" PrEP use in 2017, while 66.6% were aware of this in 2018 (P = 0.698). In 2018, there were 53 centres offering PreP (the highest numbers in Poland and Romania), whereas six countries had no centres offering PreP. The estimated number of HIV-negative people on PreP in the region was 4500 in 2018. Generic TDF/FTC costs (in Euros) ranged from €10 (Romania) to €256.92 (Slovakia), while brand TDF/FTC costs ranged from €60 (Albania) to €853 (Finland). CONCLUSIONS Although the process of licensing TDF/FTC use for PrEP has improved, this is not yet reflected in the guidelines, nor has there been a reduction in the "informal" use of PrEP. PrEP remains a rarely used preventive method in CEE countries.
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Affiliation(s)
- T Balayan
- National Center for Disease Control and Prevention, Yerevan, Armenia
| | - J Begovac
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - A Skrzat-Klapaczyńska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - I Aho
- Helsinki University Hospital, Helsinki, Finland
| | - I Alexiev
- National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - P Bukovinova
- Deptartment of Infectious Diseases and Geographical Medicine UH, University Hospital, Bratislava, Slovakia
| | - D Salemovic
- Clinic for Infectious Diseases, Belgrade, Serbia
| | | | - A Harxhi
- Department of Infectious Disease, Faculty of Medicine, University Hospital Center of Tirana, Tirana, Albania
| | - T Holban
- Nicolae Testemițanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - D Jevtovic
- Belgrade University School of Medicine Infectious Diseases Hospital, Belgrade, Serbia
| | - K Kase
- Department of Infectious Diseases, West Tallinn Central Hospital, Tallinn, Estonia
| | - B Lakatos
- Saint Laszlo Hospital National Center of HIV, Semmelweis University Faculty of Infectious Diseases, Budapest, Hungary
| | - I Latysheva
- Republican Clinical Hospital of Infectious Diseases of Ministry of Healthcare of Russian Federation, St Petersburg, Russia
| | - R Matulionyte
- Department of Infectious Diseases and Dermatovenerology, Infectious Diseases Centre, Vilnius University, Vilnius, Lithuania
| | - C Oprea
- Victor Babes Clinical Hospital for Infectious Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - A Papadopoulos
- Medical School -National and Kapodistrian University of Athens, University General Hospital "ATTIKON", Athens, Greece
| | - N Rukhadze
- Infectious Diseases, AIDS & Clinical Immunology Research Center, Tbilisi, Georgia
| | - D Sedlacek
- HIV Center University Hospital, Pilsen, Czech Republic
| | - J Tomazic
- Department of Infectious Diseases, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - A Vassilenko
- Belarusian State Medical University, Minsk, Belarus
| | - M Vasylyev
- Lviv Regional Public Health Center, Lviv, Ukraine
| | - A Verhaz
- Clinic for Infectious Diseases, University Clinical Center of the Republic of Srpska, Banja Luka, Banja Luka, RS, Bosnia & Herzegovina, Banja Luka, Bosnia and Herzegovina
| | - N Yancheva
- Department for AIDS, Specialized Hospital for Active Treatment of Infectious and Parasitic Diseases - Sofia, Medical University Sofia, Sofia, Bulgaria
| | - O Yurin
- Central Research Institute of Epidemiology, Federal AIDS Centre, Moscow, Russian Federation
| | - A Horban
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - J D Kowalska
- Department of Adults' Infectious Diseases, Medical University of Warsaw, Warsaw, Poland.,HIV Out-Patient Clinic, Hospital for Infectious Diseases, Warsaw, Poland
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Challenges to a Rights-Based Approach in Sexual Health Policy: A Comparative Study of Turkey and England. SOCIETIES 2020. [DOI: 10.3390/soc10020033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Politics around sexual health have been polarised in recent years, but the policy implications of this polarisation have not yet been examined in depth. Therefore, this article explores political challenges to a rights-based approach in sexual health policies in Turkey and England. Its focus is on two domains: The prevention and treatment of sexually transmitted infections (STI), and sexual health education. Drawing on an interpretive documentary analysis, this article reveals that although social attitudes to sexuality and the levels of overall alignment with a rights-based framework within the selected countries do differ, both face significant political challenges in putting a rights-based approach to sexual health into practice. While common political challenges include heightened domestic controversy regarding sexual health, the specific challenges take the forms of a broader conservative turn that undermines the autonomy of sexual health policy in Turkey (similar to the cases of Hungary and Poland), and neoliberal policy preferences coupled with local discretion and service fragmentation that create access inequities in England (similar to the case of Germany). This study concludes that implementing a rights-based approach is a complex political task requiring a nuanced approach that incorporates the political dimension.
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10
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Dias S, Gama A, Loos J, Roxo L, Simões D, Nöstlinger C. The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities. PLoS One 2020; 15:e0228584. [PMID: 32023309 PMCID: PMC7001961 DOI: 10.1371/journal.pone.0228584] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 01/18/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Migrants from high endemic countries accounted for 18% of newly diagnosed HIV infections in Europe in 2017. Knowledge on the link between HIV risk and post-migration travels and their impact on HIV acquisition is scarce, but critical to inform prevention. This study aims to explore risky sexual behaviour and HIV-acquisition among sub-Saharan African migrants, and to assess post-migration mobility as a determinant of sexual risk behaviour. METHODS Data from two cross-sectional bio-behavioural surveys to assess HIV-prevalence conducted in Lisbon and Antwerp were analysed to explore migration-related characteristics, travel patterns, and sexual risk taking in the host country and abroad. Bi- and multivariate associations were estimated through adjusted odds ratios and 95% confidence intervals; multivariable logistic regression determined factors associated with condomless sexual intercourse. RESULTS Among N = 1508 participants above 18 years (58% males), 68% travelled post-migration (49.2% reported intercourse abroad). The overall proportion of condomless sex at last sexual intercourse was high (68.1%). The odds of condomless sex in the host country was five times higher when the last sexual intercourse abroad was also condomless [OR:5.32; 95%CI:2.98-9.25]. About half of the travellers reported concurrency, i.e. a regular partner in the host country while having other sexual partners abroad. Almost three percent of the participants reported being HIV+, but 5% had a reactive HIV test-result, with similar proportions among travellers and non-travellers. Also, among the n = 75 participants with reactive HIV test-results, condomless sex occurred (n = 40) and was associated with mobility. CONCLUSIONS Sub-Saharan African migrants are mobile and engage in sexual risk behaviours in the countries of residence and while travelling, increasing risk of post-migration HIV-acquisition. A transnational perspective on HIV prevention and sexual health promotion is needed for effectively reducing migrants' HIV risk related to their mobility.
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Affiliation(s)
- Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
- * E-mail:
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
| | - Jasna Loos
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Luis Roxo
- NOVA National School of Public Health, Public Health Research Centre & Global Health and Tropical Medicine, Universidade NOVA de Lisboa, Lisboa, Portugal
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11
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Hambrick HR, Park SH, Palamar JJ, Estreet A, Schneider JA, Duncan DT. Use of poppers and HIV risk behaviours among men who have sex with men in Paris, France: an observational study. Sex Health 2019; 15:370-373. [PMID: 29852927 DOI: 10.1071/sh17217] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 01/31/2018] [Indexed: 11/23/2022]
Abstract
The use of inhaled nitrites, or poppers, among men who have sex with men (MSM) is prevalent, yet has been associated with HIV seroconversion. We surveyed 580 MSM from a geosocial networking smartphone application in Paris, France, in 2016. Of the respondents, 46.7% reported popper use within the previous 3 months. Regression models adjusted for sociodemographic characteristics found that the use of poppers was significantly (P<0.05) associated with the following during the prior 3 months: condomless anal intercourse (adjusted relative risk (aRR) 1.27, 95% confidence interval (CI) 1.07-1.50), use of alcohol and/or drugs during sex once or twice (adjusted relative risk ratio (aRRR) 2.33, 95% CI 1.44-2.03), three to five times (aRRR 5.41, 95% CI 2.98-9.84) or six or more times (aRRR 4.09, 95% CI 2.22-7.56), participation in group sex (aRRR 3.70, 95% CI 2.33-5.90) and self-reported diagnosis with any sexually transmissible infection over the previous year (aRR 1.63, 95% CI 1.18-2.27), specifically chlamydia (aRR 2.75, 95% CI 1.29-4.29) and syphilis (aRR 2.27, 95% CI 1.29-4.29).
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Affiliation(s)
- H Rhodes Hambrick
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, Room 621, New York, NY 10016, USA
| | - Su Hyun Park
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, Room 621, New York, NY 10016, USA
| | - Joseph J Palamar
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, Room 621, New York, NY 10016, USA
| | - Anthony Estreet
- Department of Social Work, Morgan State University School of Social Work, 1700 E. Cold Spring Lane, Jenkins Behavioral Science Building, Room 343, Baltimore, MD 21251, USA
| | - John A Schneider
- Departments of Medicine and Public Health Sciences, University of Chicago School of Medicine, and Chicago Center for HIV Elimination, 5841 S. Maryland Avenue, MC 5065 Room L-330, Chicago, IL 60637, USA
| | - Dustin T Duncan
- Spatial Epidemiology Lab, Department of Population Health, New York University School of Medicine, 227 East 30th Street, 6th Floor, Room 621, New York, NY 10016, USA
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12
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Mgbako O, Park SH, Mayer KH, Schneider JA, Goedel WC, Hambrick HR, Duncan DT. Transactional Sex and Preferences for Pre-Exposure Prophylaxis (PrEP) Administration Modalities Among Men Who Have Sex With Men (MSM). JOURNAL OF SEX RESEARCH 2019; 56:650-658. [PMID: 29634362 PMCID: PMC6179954 DOI: 10.1080/00224499.2018.1449190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an important biomedical human immunodeficiency virus (HIV) prevention tool gaining more popularity among Parisian men who have sex with men (MSM) who engage in transactional sex. This study examines the knowledge of, and willingness to use, different modalities of PrEP among this subgroup. Broadcast advertisements were placed on a geosocial-networking smartphone application with a link to a Web-based survey during three 24-hour periods in October 2016. Modified Poisson regression models were used to assess the association between engagement in transactional sex and preferences for each of these PrEP modalities. A total of 444 respondents were included. About 14% reported engagement in transactional sex. In all, 90% of MSM who engaged in transactional sex were knowledgeable of daily oral PrEP, while 13.3% were knowledgeable about long-acting injectable PrEP or penile or rectal microbicides. They were more likely to be aware of long-acting injectable PrEP (aRR = 2.52, 95% CI = 1.16 to 5.47) and willing to use daily oral PrEP (aRR = 1.48; 95% CI = 1.11 to 1.98) or long-acting injectable PrEP (aRR = 1.40; 95% CI = 1.09 to 1.81) than MSM who had not engaged in transactional sex. Long-acting injectable PrEP may be an important HIV-prevention option for MSM who engage in transactional sex if this modality is proven effective.
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Affiliation(s)
- Ofole Mgbako
- Department of Internal Medicine, School of Medicine, New York
University, New York, New York
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - Su Hyun Park
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - Kenneth H. Mayer
- Departments of Medicine and Global Health and Population, Harvard
Medical School and Harvard T.H. Chan School of Public Health, and Fenway Health,
Boston, Massachusetts
| | - John A. Schneider
- Departments of Medicine and Public Health Sciences, School of
Medicine, University of Chicago, Chicago, Illinois
- Chicago Center for HIV Elimination, University of Chicago, Chicago,
Illinois
| | - William C. Goedel
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - H. Rhodes Hambrick
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
| | - Dustin T. Duncan
- Spatial Epidemiology Lab, Department of Population Health, School of
Medicine, New York University, New York, New York
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13
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Coleman R, Prins M. Options for affordable pre-exposure prophylaxis (PrEP) in national HIV prevention programmes in Europe. ACTA ACUST UNITED AC 2018; 22. [PMID: 29067904 PMCID: PMC5710114 DOI: 10.2807/1560-7917.es.2017.22.42.17-00698] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Rosalind Coleman
- PrEP consultant, The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Maria Prins
- Public Health Service of Amsterdam and Academic Medical Center, Amsterdam, The Netherlands
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14
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Luz PM, Benzaken A, de Alencar TM, Pimenta C, Veloso VG, Grinsztejn B. PrEP adopted by the brazilian national health system: What is the size of the demand? Medicine (Baltimore) 2018; 97:S75-S77. [PMID: 29794605 PMCID: PMC5991536 DOI: 10.1097/md.0000000000010602] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Brazil's response to the HIV epidemic now includes free access to preexposure prophylaxis (PrEP) to populations at substantial risk for HIV infection including men who have sex with men (MSM). We used nationally representative demographic, epidemiologic, and surveillance data to offer estimates for the number of MSM at substantial risk for HIV infection who might be eligible and willing to use PrEP in Brazil. METHODS Starting from the age/sex-stratified population, we calculated the number of men aged 15 to 64 years, in 5-year age groups, and the proportion of those who report sex with other men during their lifetime. We focused on 11 cities (representing all regions) that are responsible for a significant fraction of the HIV burden of the country and used city-specific HIV prevalence estimates to infer the fraction of MSM who are HIV-negative. We then derived the proportion of HIV-negative MSM under substantial risk for HIV infection defined as having unprotected receptive anal intercourse in the 6 months before study participation. Finally, PrEP uptake among the eligible was inferred from the PrEP Brazil study. RESULTS Our results show that PrEP demand in these 11 cities is of 66,120 men aged 15 to 64 years. When we consider the lower and upper bounds for the available parameters, we find that PrEP demand in these 11 cities might vary from 33,378 to 97,962 men. If PrEP is restricted to those aged 15 to 49 years, demand drops by 20%. PrEP demand varies considerably by city, mostly because of the differences in population size and city-specific HIV prevalence. DISCUSSION We have shed light on the probable size of PrEP demand in Brazil certain that the incorporation of PrEP as part of Brazil's combination prevention for populations at substantial risk for HIV infection is a necessary challenge. PrEP will not only prevent HIV infections, it will also expand testing among the most vulnerable with the added benefit of offering combination prevention for the uninfected and immediate treatment for those already infected. As such, expected added benefits of PrEP will be earlier linkage to care, prompt treatment initiation leading to health benefits and decreased transmission.
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Affiliation(s)
- Paula M. Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro
| | - Adele Benzaken
- Department of Surveillance, Prevention and Control of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Tatianna M. de Alencar
- Department of Surveillance, Prevention and Control of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Cristina Pimenta
- Department of Surveillance, Prevention and Control of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health, Brasília, Brazil
| | - Valdilea G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro
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15
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Thavorn K, Kugathasan H, Tan DHS, Moqueet N, Baral SD, Skidmore B, MacFadden D, Simkin A, Mishra S. Economic evaluation of HIV pre-exposure prophylaxis strategies: protocol for a methodological systematic review and quantitative synthesis. Syst Rev 2018; 7:47. [PMID: 29544530 PMCID: PMC5855998 DOI: 10.1186/s13643-018-0710-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/01/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) with antiretrovirals is an efficacious and effective intervention to decrease the risk of HIV (human immunodeficiency virus) acquisition. Yet drug and delivery costs prohibit access in many jurisdictions. In the absence of guidelines for the synthesis of economic evaluations, we developed a protocol for a systematic review of economic evaluation studies for PrEP by drawing on best practices in systematic reviews and the conduct and reporting of economic evaluations. We aim to estimate the incremental cost per health outcome of PrEP compared with placebo, no PrEP, or other HIV prevention strategies; assess the methodological variability in, and quality of, economic evaluations of PrEP; estimate the incremental cost per health outcome of different PrEP implementation strategies; and quantify the potential sources of heterogeneity in outcomes. METHODS We will systematically search electronic databases (MEDLINE, Embase) and the gray literature. We will include economic evaluation studies that assess both costs and health outcomes of PrEP in HIV-uninfected individuals, without restricting language or year of publication. Two reviewers will independently screen studies using predefined inclusion criteria, extract data, and assess methodological quality using the Philips checklist, Second Panel on the Cost-effectiveness of Health and Medicines, and the International Society for Pharmacoeconomics and Outcomes Research recommendations. Outcomes of interest include incremental costs and outcomes in natural units or utilities, cost-effectiveness ratios, and net monetary benefit. We will perform descriptive and quantitative syntheses using sensitivity analyses of outcomes by population subgroups, HIV epidemic settings, study designs, baseline intervention contexts, key parameter inputs and assumptions, type of outcomes, economic perspectives, and willingness to pay values. DISCUSSION Findings will guide future economic evaluation of PrEP strategies in terms of methodological and knowledge gaps, and will inform decisions on the efficient integration of PrEP into public health programs across epidemiologic and health system contexts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016038440 .
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Affiliation(s)
- Kednapa Thavorn
- Ottawa Health Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, ICES Ottawa, Ottawa, Ontario, Canada
| | - Howsikan Kugathasan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Darrell H S Tan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Nasheed Moqueet
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Stefan D Baral
- Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, 21205, USA
| | - Becky Skidmore
- Ottawa Health Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Derek MacFadden
- Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, 02115, USA
| | - Anna Simkin
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Sharmistha Mishra
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada. .,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada. .,Institute of Health Policy and Management, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Institute of Medical Sciences, University of Toronto, Toronto, Canada.
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16
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Wang Z, Lau JTF, Fang Y, Ip M, Gross DL. Prevalence of actual uptake and willingness to use pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Hong Kong, China. PLoS One 2018; 13:e0191671. [PMID: 29432470 PMCID: PMC5809018 DOI: 10.1371/journal.pone.0191671] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/09/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES This study was to investigate the prevalence of actual uptake of pre-exposure prophylaxis (PrEP), willingness to use daily oral PrEP under two cost scenarios, and potential issues related to PrEP use among men who have sex with men (MSM) with HIV negative/unknown sero-status in Hong Kong, China. Factors associated with the two measures of willingness were also investigated. METHODS 403 eligible MSM completed the anonymous venue-based face-to-face interview/telephone interview. RESULTS Only 1% had ever used PrEP. After being briefed about some facts of PrEP, the prevalence of willingness to use daily oral PrEP was 7.7% if they could purchase PrEP at private hospitals/clinics at HK$8,000 (US$1,032)/month (market rate) and 45.2% if free PrEP was provided by public hospitals/clinics in Hong Kong (free PrEP). After adjusted for significant background variables, significant factors of these two measures of willingness included: (1) number of correct responses to knowledge on PrEP, (2) perceived risk of HIV infection in the next six months, and (3) constructs of the Theory of Planned Behavior: positive and negative attitudes toward PrEP, perceived their significant others would support them take PrEP (perceived subjective norm), perceived number of local MSM who were willing to take PrEP (perceived descriptive norm), and confidence in using PrEP under the two scenarios (perceived behavioral control). Among all participants, 9.7% and 25.1% would start and discontinue using PrEP without consulting doctors; 26.0% would not take PrEP daily if it was provided for free, and 42.4% would not take up HIV testing every 3 months after using PrEP. CONCLUSION Different strategies should be considered for promoting PrEP at market rate and if free PrEP is made available. Future promotion should increase their knowledge about PrEP, modify their perceptions related to HIV and PrEP, and address some potential issues related to PrEP use.
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Affiliation(s)
- Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- Community Research Program on AIDS, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail: (ZW); (JTFL)
| | - Joseph T. F. Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
- * E-mail: (ZW); (JTFL)
| | - Yuan Fang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mary Ip
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Danielle L. Gross
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
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17
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Bourne A, Cassolato M, Thuan Wei CK, Wang B, Pang J, Lim SH, Azwa I, Yee I, Mburu G. Willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Malaysia: findings from a qualitative study. J Int AIDS Soc 2017; 20:21899. [PMID: 28782336 PMCID: PMC5577697 DOI: 10.7448/ias.20.1.21899] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/12/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) continue to be disproportionately affected by HIV in Malaysia. Recent success has been observed within demonstration projects examining the efficacy of HIV pre-exposure prophylaxis (PrEP), an antiretroviral -based medication taken by HIV-negative men to prevent sero-conversion. In order for such promising findings to be translated in real-world settings, it is important to understand the acceptability of PrEP, including perceived barriers to access or uptake. METHODS As part of a larger mixed-methods study exploring acceptability and willingness to use PrEP among MSM in Malaysia, 19 men took part in audio-recorded focus group discussions hosted by a community-based HIV organization and facilitated by a trained researcher. Discussions focussed on awareness and potential information management, general perceptions of PrEP and potential motivations or barriers to the use of PrEP, including those at the personal, social, health system or structural level. Data were transcribed verbatim and underwent a detailed thematic analysis. RESULTS Rather than perceiving PrEP as a replacement for condoms in terms of having safer sex, many participants viewed it as an additional layer protection, serving as a crucial barrier to infection on occasions where condom use was intended, but did not occur. It was also perceived as more valuable to "at-risk" men, such as those in HIV sero-discordant relationships or those with a higher number of sexual partners. Elements of discussion tended to suggest that some men taking PrEP may be subject to stigma from others, on the assumption they may be promiscuous or engage in high-risk sexual behaviours. CONCLUSIONS This qualitative study indicates that, broadly speaking, PrEP may be acceptable to MSM in Malaysia. However, in order for its potential to be realized, and uptake achieved, educative interventions are required to inform the target population as to the efficacy and potential, positive impact of PrEP. Given concerns for how those taking it may be stigmatized, it is crucial that the use of PrEP is presented as a responsible course of action, and one of a range of strategies that men can use to keep themselves safe from HIV.
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Affiliation(s)
- Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | | | | | - Joselyn Pang
- International Program, Australian Federation of AIDS Organisations, Bangko, Thailand
| | - Sin How Lim
- Department of Social and Preventive Medicine, University of Malay, Kuala Lumpur, Malaysia
| | - Iskandar Azwa
- Infectious Diseases Unit, Department of Medicine, Faculty Of Medicine, University Of Malaya, Lancaster, Kuala Lumpur, Malaysia
| | - Ilias Yee
- Malaysian AIDS Council, Kuala Lumpur, Malaysia
| | - Gitau Mburu
- Division of Health Research, University of Lancaster, Lancaster, UK
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18
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Chaillon A, Essat A, Frange P, Smith DM, Delaugerre C, Barin F, Ghosn J, Pialoux G, Robineau O, Rouzioux C, Goujard C, Meyer L, Chaix ML. Spatiotemporal dynamics of HIV-1 transmission in France (1999-2014) and impact of targeted prevention strategies. Retrovirology 2017; 14:15. [PMID: 28222757 PMCID: PMC5322782 DOI: 10.1186/s12977-017-0339-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
Background Characterizing HIV-1 transmission networks can be important in understanding the evolutionary patterns and geospatial spread of the epidemic. We reconstructed the broad molecular epidemiology of HIV from individuals with primary HIV-1 infection (PHI) enrolled in France in the ANRS PRIMO C06 cohort over 15 years. Results Sociodemographic, geographic, clinical, biological and pol sequence data from 1356 patients were collected between 1999 and 2014. Network analysis was performed to infer genetic relationships, i.e. clusters of transmission, between HIV-1 sequences. Bayesian coalescent-based methods were used to examine the temporal and spatial dynamics of identified clusters from different regions in France. We also evaluated the use of network information to target prevention efforts. Participants were mostly Caucasian (85.9%) and men (86.7%) who reported sex with men (MSM, 71.4%). Overall, 387 individuals (28.5%) were involved in clusters: 156 patients (11.5%) in 78 dyads and 231 participants (17%) in 42 larger clusters (median size: 4, range 3–41). Compared to individuals with single PHI (n = 969), those in clusters were more frequently men (95.9 vs 83%, p < 0.01), MSM (85.8 vs 65.6%, p < 0.01) and infected with CRF02_AG (20.4 vs 13.4%, p < 0.01). Reconstruction of viral migrations across time suggests that Paris area was the major hub of dissemination of both subtype B and CRF02_AG epidemics. By targeting clustering individuals belonging to the identified active transmission network before 2010, 60 of the 143 onward transmissions could have been prevented. Conclusion These analyses support the hypothesis of a recent and rapid rise of CRF02_AG within the French HIV-1 epidemic among MSM. Combined with a short turnaround time for sample processing, targeting prevention efforts based on phylogenetic monitoring may be an efficient way to deliver prevention interventions but would require near real time targeted interventions on the identified index cases and their partners. Electronic supplementary material The online version of this article (doi:10.1186/s12977-017-0339-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antoine Chaillon
- University of California, San Diego, 9500 Gilman Drive, Stein Clinical Research Building #325, La Jolla, CA, 92093-0697, USA.
| | - Asma Essat
- INSERM CESP U1018, University Paris Sud, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France
| | - Pierre Frange
- EA7327, Université Paris Descartes, Paris, France.,Laboratoire de Microbiologie Clinique, Hôpital Necker - Enfants Malades, APHP, Paris, France
| | - Davey M Smith
- University of California, San Diego, 9500 Gilman Drive, Stein Clinical Research Building #325, La Jolla, CA, 92093-0697, USA.,Veterans Affairs San Diego Healthcare System, San Diego, CA, USA
| | - Constance Delaugerre
- INSERM U941, Laboratoire de Virologie, Université Paris Diderot, Hôpital Saint-Louis, AP-HP, CNR VIH associé Primo infection, Paris, France
| | - Francis Barin
- INSERM U966 and National Reference Center for HIV, CHU Bretonneau and Université François Rabelais, Tours, France
| | - Jade Ghosn
- EA7327, Université Paris Descartes, Paris, France.,UF de Thérapeutique en Immuno-Infectiologie, Hôpital Hôtel Dieu, APHP, Paris, France
| | - Gilles Pialoux
- Service des Maladies Infectieuses et Tropicales, Hôpital Tenon, APHP, Paris, France
| | - Olivier Robineau
- Service Universitaire des Maladies infectieuses et du Voyageur, Centre Hospitalier de Tourcoing, Tourcoing, France
| | | | - Cécile Goujard
- INSERM CESP U1018, University Paris Sud, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France.,Service de Médecine interne et Immunologie clinique, Hôpital Bicêtre, APHP, Le Kremlin-Bicêtre, France
| | - Laurence Meyer
- INSERM CESP U1018, University Paris Sud, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (APHP), Le Kremlin-Bicêtre, France
| | - Marie-Laure Chaix
- INSERM U941, Laboratoire de Virologie, Université Paris Diderot, Hôpital Saint-Louis, AP-HP, CNR VIH associé Primo infection, Paris, France
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No one left behind: how are we doing in the roll-out of PrEP as part of combination HIV prevention? J Int AIDS Soc 2016; 19:21364. [PMID: 27760690 PMCID: PMC5071753 DOI: 10.7448/ias.19.7.21364] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges. J Int AIDS Soc 2016. [DOI: 10.7448/ias.19.7.21479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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