'I make sure my doctor doesn't know that I use meth': perceived barriers to pre-exposure prophylaxis (PrEP) uptake among community peer educators in Seattle (WA, USA)

Sexual Health ◽  
2020 ◽  
Vol 17 (1) ◽  
pp. 29
Author(s):  
Vanessa M. McMahan ◽  
Lauren R. Violette ◽  
Michele P. Andrasik ◽  
Aleks Martin ◽  
Lindsay Garske ◽  
...  
Keyword(s):  
Hiv Infections ◽  
Perceived Barriers ◽  
Peer Educators ◽  
Harm Reduction Program ◽  
Stigma Reduction ◽  
Transgender People ◽  
Treatment Cascade ◽  
Related Stigma ◽  
Sex With Men ◽  
Exposure Prophylaxis

Background HIV disproportionately affects cisgender men and transgender people who have sex with men (MSM/TG) and use methamphetamine. Pre-exposure prophylaxis (PrEP) uptake has been slow in this group. It is important to understand perceptions about PrEP and barriers to its use among MSM/TG who use methamphetamine to reduce new HIV infections. Methods: We conducted four focus groups with peer educators of a harm reduction program. We assessed their perspectives of PrEP and barriers across the PrEP continuum among MSM/TG who use methamphetamine. Results: Notably, stigma related to the multiple marginalised identities of MSM/TG who use methamphetamine (e.g. MSM/TG-related stigma, methamphetamine-related stigma) was a barrier at each step. We developed a framework that combined the PrEP continuum and a stigma-based treatment cascade to explore these themes and describe the effects of stigma on PrEP engagement. Methamphetamine-related barriers were also identified. Conclusions: The findings of this study emphasise the importance of incorporating stigma reduction into PrEP delivery for MSM/TG who use methamphetamine.

scholarly journals Cost-Effectiveness Analysis of the Daily HIV Pre-Exposure Prophylaxis in Men who Have Sex with Men in Barcelona

2021 ◽  
Author(s):  
Francesc López Seguí ◽  
Unai Oyon Lerga ◽  
Laura Laguna Marmol ◽  
Pep Coll ◽  
Angels Andreu ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Cost Saving ◽  
Time Horizon ◽  
Cost Savings ◽  
Health Indicators ◽  
Hiv Infections ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Oral Prep

Introduction: Pre-Exposure Prophylaxis (PrEP) for HIV prevention has been implemented in several countries. Previous literature has shown that its cost-effectiveness (and, under some specifications, cost-saving character) is dependent on the reduction in price due to generics, the time-horizon and its effectiveness. The intervention has never been studied in Catalonia, a territory with extensive implementation. Methods: Economic evaluation of the implementation of HIV pre-exposition prophylaxis using administrative data from Men who have Sex with Men (MSM) who receive the treatment (at the generic price). A deterministic compartmental model and a social perspective with a micro-costing approach over the time horizon 2022-2062 are used. A baseline 86% effectiveness of PrEP is assumed. Results: Daily oral PrEP is found to be cost-saving: discounted savings in costs are attained after 16 years, and after 40 years they reach 81 million euros. In terms of health indicators, 10,322 additional discounted QALYs are generated by the intervention. Results are sensitive to sexual behavioral patterns among MSM, the price of PrEP (reduced if offered on-demand), its effectiveness and the discount rate. Conclusions: The use and promotion of PrEP in Catalonia is predicted to result in substantial health and monetary benefits because of reductions in HIV infections. Short-term investments in the promotion of PrEP will result in important cost-savings in the long term.

scholarly journals Perceived barriers to pre-exposure prophylaxis use among HIV-negative men who have sex with men in Tijuana, Mexico: A latent class analysis

PLoS ONE ◽  
2019 ◽  
Vol 14 (8) ◽  
pp. e0221558
Author(s):  
Rudy Patrick ◽  
Jennifer Jain ◽  
Alicia Harvey-Vera ◽  
Shirley J. Semple ◽  
Gudelia Rangel ◽  
...  
Keyword(s):  
Latent Class Analysis ◽  
Latent Class ◽  
Perceived Barriers ◽  
Class Analysis ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Hiv Negative

Implementing pre-exposure prophylaxis could prevent most new HIV infections in transsexual women and men who have sex with men

2019 ◽  
Vol 219 (7) ◽  
pp. 360-366
Author(s):  
O. Ayerdi Aguirrebengoa ◽  
M. Vera García ◽  
J.A. Portocarrero Nuñez ◽  
T. Puerta López ◽  
M. García Lotero ◽  
...  
Keyword(s):  
Hiv Infections ◽  
Sex With Men ◽  
Exposure Prophylaxis

scholarly journals Challenging the HIV Epidemic in Ontario Through PrEP and HIV Testing

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Steven Winkelman
Keyword(s):  
Hiv Testing ◽  
Hiv Infections ◽  
Hiv Treatment ◽  
Annotated Bibliography ◽  
Hiv Care ◽  
Post Exposure Prophylaxis ◽  
Non Profit ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Priority Populations

The Ontario HIV Treatment Network (OHTN) is a non-profit network which collaborates with health clinics, AIDS service and community organizations, and policy leaders in order to improve the health and wellbeing of people living with and at risk of HIV. I joined the OHTN as a member of the Collective Impact team, with a focus on examining the barriers and facilitators to Pre-Exposure Prophylaxis (PrEP) uptake in Ontario. PrEP is a once-daily pill which is highly effective in preventing HIV infections for HIV-negative people, however usage remains relatively low in Ontario. In this role, I liaised with the Knowledge Synthesis team at OHTN to collect, analyse, and synthesize recent scientific literature on Pre and Post-exposure prophylaxis (PEP) in order to create a comprehensive annotated bibliography on PrEP research. Key findings were drawn from the research to identify potential next steps to increase PrEP use for priority populations in Ontario. Findings from the annotated bibliography were presented to OHTN staff, and have been used to assist in the development of two PrEP study proposals; 1) a cisgender and transgender women-focused PrEP education package and HIV risk screening tool, and 2) a pharmacist-led PrEP delivery pilot. I also worked with the Testing and Clinical Initiatives team at the OHTN, to aid in the implementation and evaluation of two HIV-testing projects: the GetaTest pharmacy-based HIV-testing study, and the GetaKit HIV self-testing pilot program. In this role I drafted health communication materials; analysed survey data and drafted project reports for stakeholders; and provided perspectives on the HIV-care continuum, particularly on PrEP initiation, adherence, and efficacy. My work with the OHTN was important to public health because it sought to expand access to HIV testing and prevention services for priority populations in Ontario, including men who have sex with men, and cis and trans women.

scholarly journals Implementation of pre-exposure prophylaxis programme in Spain. Feasibility of four different delivery models

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246129
Author(s):  
Carlos Iniesta ◽  
Pep Coll ◽  
María Jesús Barberá ◽  
Miguel García Deltoro ◽  
Xabier Camino ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Cost Effective ◽  
Hiv Infections ◽  
Sexually Transmitted ◽  
Participant Satisfaction ◽  
Prep Implementation ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Delivery Models

Background Pre-exposure prophylaxis (PrEP) is an effective and cost-effective strategy for HIV prevention. Spain carried out an implementation study in order to assess the feasibility of implementing PrEP programmes within its heterogeneous health system. Methods Observational longitudinal study conducted on four different types of health-care setting: a community centre (CC), a sexually transmitted infections clinic (STIC), a hospital-based HIV unit (HBHIVU) and a hospital-based STI unit (HBSTIU). We recruited gay, bisexual and other men who have sex with men (GBSM) and transgender women at risk of HIV infections, gave them PrEP and monitored clinical, behavioural PrEP-related and satisfaction information for 52 weeks. We collected perceptions on PrEP implementation feasibility from health-care professionals participating in the study. Results A total of 321 participants were recruited, with 99.1% being GBMSM. Overall retention was 87.2% and it was highest at the CC (92.6%). Condom use decreased during the study period, while STIs did not increase consistently. The percentage of people who did not miss any doses of PrEP during the previous week remained at over 93%. No HIV seroconversions occurred. We observed overall decreases in GHB (32.5% to 21.8%), cocaine (27.5% to 21.4%), MDMA (25.7% to 14.3%), speed (11.4% to 5.7%) and mephedrone use (10.7% to 5.0%). The overall participant satisfaction with PrEP was 98.6%. Health-care professionals’ perceptions of PrEP feasibility were positive, except for the lack of personnel. Conclusions PrEP implementation is feasible in four types of health-care settings. Local specificities have to be taken into consideration while implementing PrEP.

Early experience of implementing a national HIV pre-exposure prophylaxis service in Wales, United Kingdom 2017

Sexual Health ◽  
2019 ◽  
Vol 16 (1) ◽  
pp. 56 ◽  
Author(s):  
Laia Fina ◽  
Amy L. Phillips ◽  
Adam T. Jones ◽  
Zoë M. Couzens ◽  
Rachel Drayton ◽  
...  
Keyword(s):  
Sexual Health ◽  
Early Experience ◽  
Hiv Positive ◽  
Transgender People ◽  
Positive Individual ◽  
Sexually Transmissible Infections ◽  
Sex With Men ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Exposure Prophylaxis

Background Pre-exposure prophylaxis (PrEP) was introduced in Sexual Health Services of the Welsh National Health Service (NHS Wales) in July 2017 as a 3-year pilot service. Methods: Data were collected through the pre-existing Sexual Health in Wales Surveillance System, to which codes were added to capture PrEP eligibility, outcome of offer of PrEP, reasons for declining and adherence. Eligibility categories were defined based on nationally agreed criteria: men who have sex with men (MSM) and transgender people at high risk of HIV acquisition; partners of HIV-positive individuals not known to be virally suppressed; and heterosexuals reporting condomless intercourse with a HIV-positive individual not known to be virally suppressed. Results: During the first 6 months, 516 people were eligible, 96% of which were MSM. Overall, 57% of those eligible (296/516) started PrEP. Reasons for declining PrEP were given by 88 (56%) of 157 people; 50 (57%) of whom did not believe themselves to be at risk. Of the available adherence assessments, 89% considered that all risk episodes had been covered. Persistence at 3 months was assessed for 141 people, of which 93 (66%) were still using PrEP. There were no HIV diagnoses in people taking PrEP during the first 6 months. Twenty-nine people were diagnosed with 37 episodes of sexually transmissible infections (STIs) while on PrEP. STI incidence was 105.7 per 100 person-years. Conclusions: The early trend indicates that implementation of PrEP is progressing as planned, and the service has been utilised by clients. This analysis can help refine implementation, inform planning and research around uptake, use and effect in Wales and internationally.

scholarly journals Healthcare providers’ knowledge, readiness, prescribing behaviors, and perceived barriers regarding routine HIV testing and pre-exposure prophylaxis in DeLand, Florida

2019 ◽  
Vol 7 ◽  
pp. 205031211983603 ◽  
Author(s):  
Laura H Gunn ◽  
Brittani Janson ◽  
Ismode Lorjuste ◽  
Lindsay Summers ◽  
Paula Burns ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Hiv Testing ◽  
Healthcare Providers ◽  
Hiv Infections ◽  
The United States ◽  
Perceived Barriers ◽  
Department Of Health ◽  
Florida Department ◽  
Routine Hiv Testing ◽  
Exposure Prophylaxis

Objectives: Florida ranks highest in the United States among newly diagnosed HIV infections. This ranking reflects the need for investigation of healthcare providers’ knowledge, readiness, prescribing behaviors, and perceived barriers to routine HIV testing and pre-exposure prophylaxis. Methods: We adapted national questionnaires with questions co-developed with Florida Department of Health to form a 25-item instrument. Questionnaires were distributed to the population of eligible healthcare providers in DeLand, Florida. Results: Results from an approximate 20% response rate that encompasses 12 providers demonstrate baseline findings to inform future studies. For example, 75% of respondents were aware of FL Administrative Code 64D-3.042 that pregnant women should receive HIV testing during first and third trimesters. However, 50% of respondents rarely or never offer tests to pregnant women according to practice guidelines. About 75% of respondents strongly agree or agree with willingness to prescribe pre-exposure prophylaxis to high-risk patients, yet 8.3% always or very often prescribe pre-exposure prophylaxis. Conclusions: Results convey the importance of and need for greater collaboration between providers and the Florida Department of Health to enhance providers’ knowledge, readiness, and, ultimately, behaviors regarding routine HIV testing and pre-exposure prophylaxis prescription.

Estimating the impact of HIV combination prevention in men who have sex with men, the Bangkok MSM Cohort Study, Thailand

2020 ◽  
Vol 31 (7) ◽  
pp. 637-641
Author(s):  
Sarika Pattanasin ◽  
Betsy L Cadwell ◽  
Dawn K Smith ◽  
Wichuda Sukwicha ◽  
Philip A Mock ◽  
...  
Keyword(s):  
Condom Use ◽  
Hiv Infections ◽  
Substantial Impact ◽  
Combination Prevention ◽  
Hiv Epidemic ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
The Impact ◽  
Combined Interventions

In Thailand, pre-exposure prophylaxis (PrEP) is recommended for human immunodeficiency virus (HIV) prevention among at-risk men who have sex with men (MSM). We modeled the impact of PrEP and condom use as independent and combined interventions on the estimated number of HIV infections among a hypothetical population of 10,000 MSM in Bangkok, Thailand. Our model demonstrated a 92% (95% confidence interval 89.7, 94.2) reduction in HIV infections among Thai MSM who took daily PrEP and self-reported using condoms correctly and consistently (100% condom use). Increased use of PrEP and condoms likely would have a substantial impact on the HIV epidemic in Thailand.

scholarly journals Preventive HIV Vaccines-Leveraging on Lessons from the Past to Pave the Way Forward

Vaccines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1001
Author(s):  
Parveen Sobia ◽  
Derseree Archary
Keyword(s):  
Immune Responses ◽  
Female Genital Tract ◽  
Hiv Infections ◽  
Hiv Vaccine ◽  
Effective Vaccine ◽  
Hiv Vaccines ◽  
The Past ◽  
Sex With Men ◽  
Exposure Prophylaxis ◽  
Female Genital

Almost four decades on, since the 1980’s, with hundreds of HIV vaccine candidates tested in both non-human primates and humans, and several HIV vaccines trials later, an efficacious HIV vaccine continues to evade us. The enormous worldwide genetic diversity of HIV, combined with HIV’s inherent recombination and high mutation rates, has hampered the development of an effective vaccine. Despite the advent of antiretrovirals as pre-exposure prophylaxis and preventative treatment, which have shown to be effective, HIV infections continue to proliferate, highlighting the great need for a vaccine. Here, we provide a brief history for the HIV vaccine field, with the most recent disappointments and advancements. We also provide an update on current passive immunity trials, testing proof of the concept of the most clinically advanced broadly neutralizing monoclonal antibodies for HIV prevention. Finally, we include mucosal immunity, the importance of vaccine-elicited immune responses and the challenges thereof in the most vulnerable environment–the female genital tract and the rectal surfaces of the gastrointestinal tract for heterosexual and men who have sex with men transmissions, respectively.

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