scholarly journals Pre-exposure prophylaxis recent adherence with real-time adherence feedback and partner HIV self-testing: A pilot trial among postpartum women

2021 ◽  
Author(s):  
Dvora Leah Joseph Davey ◽  
Kathryn Dovel ◽  
Rufaro Mvududu ◽  
Dorothy Nyemba ◽  
Nyiko Mashele ◽  
...  
Keyword(s):  
Real Time ◽  
Pilot Trial ◽  
Intervention Group ◽  
Standard Of Care ◽  
Postpartum Women ◽  
Urine Test ◽  
The Past ◽  
Self Testing ◽  
Secondary Outcomes ◽  
Exposure Prophylaxis

Abstract Background Pre-exposure prophylaxis (PrEP) is safe and effective in postpartum women. HIV self-testing (HIVST) for male partners combined with biofeedback counselling through real-time adherence measures may improve PrEP use among postpartum women. Methods Between August-2020-April-2021 we randomized postpartum women who initiated PrEP in pregnancy 1:1 to the intervention group (HIVST + biofeedback counselling following urine tenofovir test) or to standard of care (SOC: facility-based HIV tests and routine counselling without biofeedback). The outcomes of interest were PrEP adherence in the past 48-72 hours via urine tenofovir tests and partner HIV testing, measured 1-month after randomisation. Secondary outcomes included proportion of partners who tested for HIV and discrepancy between self-reported PrEP adherence and urine tenofovir result. Results We enrolled 106 women (median age=26yrs). At enrolment 72% of women reported missing <2 doses in the past 7-days; 36% of women had tenofovir present in her urine. One month after enrolment, 62% (n=33) of women in the intervention arm had tenofovir present in their urine compared to 34% (n=18) in SOC (RR=1.83; 95% CI=1.19-2.82; p=0.001). Two-thirds of women in the intervention arm reported that her partner tested for HIV (66%; n=35); compared to 17% (n=9) in SOC (RR=3.89; 95% CI=2.08-7.27; p<0.001). Self-reported PrEP adherence (took PrEP >5 of last week) with no tenofovir in urine test was lower in the intervention group (17% vs 46%; RR=0.33; 95% CI=0.17-0.67; p=0.03). No social or clinical adverse events were reported in the intervention arm. Conclusions HIVST for partners and biofeedback counseling increased levels of recent PrEP adherence, pointing to the importance of these interventions to support PrEP use in this population.

scholarly journals Pre-exposure prophylaxis adherence with real-time adherence feedback and partner HIV self-testing: A pilot trial among postpartum women

2021 ◽  
Author(s):  
Dvora L Joseph Davey ◽  
Kathryn Dovel ◽  
Rufaro Mvududu ◽  
Dorothy Nyemba ◽  
Nyiko Mashele ◽  
...  
Keyword(s):  
Pilot Study ◽  
Real Time ◽  
Pilot Trial ◽  
Intervention Group ◽  
Standard Of Care ◽  
Postpartum Women ◽  
Care Clinic ◽  
The Past ◽  
Self Testing ◽  
Exposure Prophylaxis

Background: Pre-exposure prophylaxis (PrEP) is safe and effective in postpartum women. HIV self-testing (HIVST) for partners combined with biofeedback counselling through real-time adherence measures may improve daily PrEP use among postpartum women. Methods: Between August 2020 and April 2021 we conducted a pilot study in one primary care clinic in Cape Town, South Africa. We randomized postpartum women who initiated PrEP in pregnancy 1:1 to the intervention group (HIVST + biofeedback counselling following urine tenofovir test) or to standard of care (facility-based HIV tests and routine counselling without biofeedback). The outcomes of interest were PrEP adherence in the past 48-72hours via urine tenofovir tests and partner HIV testing, measured 1-month after randomisation. Secondary outcomes included proportion of partners who tested for HIV and discrepancy between self-reported PrEP adherence and urine tenofovir result. Results: We enrolled 106 women (median age=26 years; median months postpartum=2). Almost half of women reported having sex since giving birth (48%); 76% of those reported condomless sex at last sex. At enrolment most women (72%) reported missing <2 doses in the past 7-days; 36% of women had tenofovir present in her urine (no significant differences by arm). One month after enrolment, 62% (n=33) of women in the intervention arm had tenofovir present in their urine compared to 34% (n=18) in the standard of care arm (RR=1.83; 95% CI=1.19, 2.82). Two-thirds of women in the intervention arm reported that her partner tested for HIV (66%; n=35); compared to 17% (n=9) in the standard of care arm (RR=3.89; 95% CI=2.08, 7.27). The proportion of women with a discrepant adherence result (self-reported good recent adherence with no tenofovir in urine test) was significantly lower in the intervention group (n=8; 17%) compared to the standard of care group (n=24; 46%) (RR=0.33; 95% CI=0.17, 0.67). No social or clinical adverse events were reported in the intervention arm. Conclusions: In this pilot study, HIVST for partners and biofeedback counseling increased levels of recent PrEP adherence, pointing to the importance of these interventions to support PrEP use in this population.

scholarly journals Effectiveness of a Novel HIV Self-Testing Service with Online Real-Time Counseling Support (HIVST-Online) in Increasing HIV Testing Rate and Repeated HIV Testing among Men Who Have Sex with Men in Hong Kong: Results of a Pilot Implementation Project

2021 ◽  
Vol 18 (2) ◽  
pp. 729
Author(s):  
Paul Shing-fong Chan ◽  
Andrew Chidgey ◽  
Jason Lau ◽  
Mary Ip ◽  
Joseph T.F. Lau ◽  
...  
Keyword(s):  
Hiv Testing ◽  
Real Time ◽  
Linkage To Care ◽  
Standard Of Care ◽  
Multiple Sources ◽  
Self Testing ◽  
Post Test ◽  
Pilot Implementation ◽  
Sex With Men ◽  
Testing Coverage

HIV self-testing (HIVST) with online real-time counseling (HIVST-online) is an evidence-based intervention to increase HIV testing coverage and to ensure linkage to care for men who have sex with men (MSM). A community-based organization (CBO) recruited 122 MSM who had ever used HIVST-online (ever-users) and another 228 new-users from multiple sources and promoted HIVST-online. A free oral fluid-based HIVST kit was sent to all the participants by mail. Experienced HIVST administrators implemented HIVST-online by providing real-time instruction, standard-of-care pre-test and post-test counseling via live-chat application. The number of HIVST-online sessions performed was documented by the administrators. The post-test evaluation was conducted 6 months after the pre-test survey. At month 6, 63.1% of ever-users and 40.4% of new-users received HIVST-online. Taking other types of HIV testing into account, 79.4% of ever-users and 58.6% of new-users being followed up at month 6 received any HIV testing during the project period. Ever-users were more likely to receive HIVST-online and any HIV testing as compared to new-users. Four HIVST-online users were screened to be HIV positive and linked to the treatment. The process evaluation of HIVST-online was positive. Implementation of HIVST-online was helpful to improve HIV testing coverage and repeated HIV testing among Chinese MSM. A larger scale implementation should be considered.

A Comparative Study of 50-Millesimal Potencies and Centesimal Potencies in the Treatment of Tinea Corporis: An Open, Randomised, Pilot Trial

2021 ◽  
Vol 34 (04) ◽  
pp. 267-277
Author(s):  
Pallavi Hazra ◽  
Shyamal Kumar Mukherjee ◽  
Subhasish Ganguly ◽  
Aniket Singha Roy ◽  
Souvik Dutta ◽  
...  
Keyword(s):  
Rating Scale ◽  
Pilot Trial ◽  
Intervention Group ◽  
Tinea Corporis ◽  
Repeated Measure ◽  
Feasibility Trial ◽  
Group Differences ◽  
Serious Adverse Events ◽  
Significant Group ◽  
Secondary Outcomes

Abstract Introduction Standard management of dermatophytosis involves the use of topical antifungals in limited disease and oral therapy for more extensive cases. Despite the evidences favouring homeopathy in tinea corporis (TC) is inadequate, patients are increasingly opting for it. This trial attempts to assess the feasibility of a trial evaluating individualised homeopathic (IH) medicines in centesimal and 50-millesimal potencies in treating TC. Methods An open, randomised, pilot feasibility trial was conducted at the dermatology outpatient of D. N. De Homoeopathic Medical College and Hospital, West Bengal, India. Patients were randomised to receive IH medicines in either centesimal potencies (n = 30) or in 50-millesimal potencies (n = 30). Primary outcome measure was intensity of pruritus on a 0 to 10 numeric rating scale; secondary outcomes were Skindex-29 and dermatology life quality index questionnaires—all measured at baseline, and after 6 and 12 weeks of intervention. Group differences were calculated on intention-to-treat (ITT) sample as well as following per protocol (PP) analysis. Results Recruitment and attrition rates were 69 and 16.7% respectively. Both ITT and PP analysis revealed that intra-group changes in both the primary and secondary outcomes to be statistically significant in both the groups (all p < 0.05, one-way repeated measure analysis of variance). There were no significant group differences over 6 and 12 weeks (all p > 0.05, unpaired t-tests); thus, indicating similar pattern of improvement in both the groups. Most frequently used medicines were Natrum sulphuricum (28.3%), Natrum muriaticum (25%), Sulphur (8.3%) and Bacillinum (6.7%). No harms, unintended effects, homeopathic aggravations or any serious adverse events were reported from either group. Conclusion An adequately powered trial exploring effectiveness of both scales in TC appeared to be feasible in future. Though the sample size was too small to arrive at any definite conclusion, both centesimal and 50-millesimal potencies of IH medicines appeared to be equally useful in improving pruritus intensity and quality of life in patients suffering from TC.

Effectiveness of Acupressure on Pruritus and Lichenification Associated with Atopic Dermatitis: A Pilot Trial

2012 ◽  
Vol 30 (1) ◽  
pp. 8-11 ◽  
Author(s):  
Kachiu Cecilia Lee ◽  
Ashley Keyes ◽  
Jennifer R Hensley ◽  
Jennifer R Gordon ◽  
Mary J Kwasny ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Analogue Scale ◽  
Pilot Trial ◽  
Intervention Group ◽  
Standard Of Care ◽  
Severity Index ◽  
Control Group ◽  
Significant Change ◽  
Experimental Group

Background Pruritus is a debilitating aspect of atopic dermatitis (AD). Acupuncture has been reported to diminish pruritus, but self-administered acupressure has not been previously evaluated. Objectives To evaluate the effectiveness of acupressure on the severity of eczema in a pilot trial. Methods Adult patients with AD were randomised to an intervention group (acupressure with standard of care) or a control group (standard of care alone). Subjects in the intervention group performed acupressure using a 1.2 mm acupellet at the LI11 point, applying pressure for 3 min three times per week for 4 weeks. The severity of itching and AD at baseline and at 4 weeks were measured on a visual analogue scale (VAS), the Investigator's Global Assessment (IGA) and the Eczema Area and Severity Index (EASI). Results Fifteen subjects were enrolled, 12 of whom completed the study between November 2009 and May 2011. There was no significant change between baseline and follow-up survey scores within the control group. In the investigation group there was a decrease in the VAS score (p=0.05) and EASI lichenification (p=0.03), although without significant change in the overall EASI score. Comparison of the scores between groups showed a greater decrease in VAS in the experimental group than in the control group (p=0.04), and a decrease in the IGA (p=0.03) and EASI lichenification score (p=0.03). The overall EASI scores were unchanged. Conclusion Subjects using acupressure at LI11 for 4 weeks had improvement in pruritus and lichenification. Acupressure may prove to be an easily administered alternative treatment, but larger-scale studies are needed to confirm these preliminary findings.

Video real-time imaging of artificial membranes during freeze-drying by cryo-electron microscopy

1988 ◽  
Vol 46 ◽  
pp. 16-17
Author(s):  
Alan S. Rudolph ◽  
Ronald R. Price
Keyword(s):  
Real Time ◽  
Self Assembly ◽  
Freeze Drying ◽  
Video Capture ◽  
Drying Process ◽  
Artificial Membranes ◽  
The Past ◽  
Cryo Electron Microscopy ◽  
Spherical Structures ◽  
Capture Techniques

We have employed cryoelectron microscopy to visualize events that occur during the freeze-drying of artificial membranes by employing real time video capture techniques. Artificial membranes or liposomes which are spherical structures within internal aqueous space are stabilized by water which provides the driving force for spontaneous self-assembly of these structures. Previous assays of damage to these structures which are induced by freeze drying reveal that the two principal deleterious events that occur are 1) fusion of liposomes and 2) leakage of contents trapped within the liposome [1]. In the past the only way to access these events was to examine the liposomes following the dehydration event. This technique allows the event to be monitored in real time as the liposomes destabilize and as water is sublimed at cryo temperatures in the vacuum of the microscope. The method by which liposomes are compromised by freeze-drying are largely unknown. This technique has shown that cryo-protectants such as glycerol and carbohydrates are able to maintain liposomal structure throughout the drying process.

Between Jerusalem and Athens

2018 ◽  
Author(s):  
Nurit Yaari
Keyword(s):  
Real Time ◽  
Social Conditions ◽  
Cultural Events ◽  
Greek Drama ◽  
The Past ◽  
Key Points ◽  
Mise En Scene ◽  
Dramatic Writing ◽  
Artistic Performance

How does a theatrical tradition emerge in the fields of dramatic writing and artistic performance? Can a culture, in which theatre played no part in the past, create a theatrical tradition in real time—and how? What was the contribution of classical Greek drama to the evolution of Israeli theatre? How do political and social conditions affect the encounter between cultures—and what role do they play in creating a theatre with a distinctive identity? This book, the first of its kind, attempts to answer these and other questions, by examining the reception of classical Greek drama in the Israeli theatre over the last seventy years. It deals with dramatic and aesthetic issues while analysing translations, adaptations, new writing, mise-en-scène, and ‘post dramatic’ performances of classical Greek drama that were created and staged at key points of the development of Israeli culture amidst fateful political, social, and cultural events in the country’s history.

scholarly journals Protocol for a multicenter randomized controlled trial comparing a non-opioid prescription to the standard of care for pain control following arthroscopic knee and shoulder surgery

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Aaron Gazendam ◽  
◽  
Seper Ekhtiari ◽  
Nolan S. Horner ◽  
Nicole Simunovic ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Pain Control ◽  
Shoulder Arthroscopy ◽  
Controlled Trial ◽  
Arthroscopic Surgery ◽  
Standard Of Care ◽  
Opioid Prescription ◽  
Randomized Controlled ◽  
Secondary Outcomes ◽  
Arthroscopic Knee

Abstract Background Opioids continue to be the analgesic of choice for postoperative pain control following arthroscopic knee and shoulder surgery. Despite their widespread use, there are limited evidence-based clinical practice guidelines for postoperative opioid prescribing. The Non-Opioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) Trial is a randomized controlled trial (RCT) designed to determine whether a non-opioid analgesia approach to postoperative pain, compared to usual care, reduces oral morphine equivalents (OME) consumed in patients undergoing outpatient knee and shoulder arthroscopy. Methods This is a multi-centre, RCT with a target sample size of 200 patients. Adult (18+ years of age) patients undergoing outpatient knee and shoulder arthroscopy will be randomized to a non-opioid postoperative protocol (intervention) or the current standard of care (control). The intervention will consist of a standardized non-opioid analgesic prescription, a limited rescue opioid prescription, and a patient education infographic. The control is defined as the treating surgeons’ pre-trial postoperative analgesic regimen. Exclusion criteria include chronic opioid use, concomitant open surgery, contraindications to the prescribed analgesics or ongoing workers compensation/litigation. The primary outcome is OMEs consumed at 6 weeks postoperatively. Secondary outcomes will include patient-reported pain and satisfaction, quantity of OMEs prescribed, number of opioid refills, and any adverse events up to 6 weeks postoperatively. Utilizing the intention to treat principle for all analyses, independent samples t-test and presented with a p-value as well as a mean difference (MD) with 95% confidence intervals (CIs) will be performed for primary and secondary outcomes. Discussion The ongoing opioid epidemic and overprescribing of opioids in orthopaedics serve as the rationale for this trial. There is a lack of evidence upon which to develop post-operative pain management guidelines for patients undergoing arthroscopic surgery. A prospective evaluation of this relatively inexpensive intervention will demonstrate whether an explicit effort to reduce the number of opioids prescribed results in a reduction in the amount of opioids consumed and help to inform future studies and guidelines. Trial registration The NO PAin trial has been prospectively registered with clinicaltrials.gov (NCT04566250).

scholarly journals Healthy eating and lifestyle in pregnancy (HELP): a cluster randomised trial to evaluate the effectiveness of a weight management intervention for pregnant women with obesity on weight at 12 months postpartum

2021 ◽  
Author(s):  
Sharon A. Simpson ◽  
Elinor Coulman ◽  
Dunla Gallagher ◽  
Karen Jewell ◽  
David Cohen ◽  
...  
Keyword(s):  
Weight Management ◽  
Healthy Eating ◽  
Primary Outcome ◽  
Intervention Group ◽  
Control Group ◽  
Risky Drinking ◽  
Management Intervention ◽  
Cluster Randomised ◽  
Secondary Outcomes ◽  
Weight Management Intervention

Abstract Objective To assess whether a weight management intervention for pregnant women with obesity was effective in reducing body mass index (BMI) 12 months after giving birth. Methods Pragmatic, cluster randomised controlled trial (RCT) with embedded cost-effectiveness analysis. 598 women with a BMI of ≥30 kg/m2 (between 12 and 20 weeks gestation) were recruited from 20 secondary care maternity units in England and Wales. BMI at 12 months postpartum was the primary outcome. A range of clinical and behavioural secondary outcomes were examined. Interventions Women attending maternity units randomised to intervention were invited to a weekly weight management group, which combined expertise from a commercial weight loss programme with clinical advice from midwives. Both intervention and control participants received usual care and leaflets on diet and physical activity in pregnancy. Results Mean (SD) BMI at 12 months postpartum was 36.0 kg/m2 (5.2) in the control group, and 37.5 kg/m2 (6.7) in the intervention group. After adjustment for baseline BMI, the intervention effect was −0.02 (95% CI −0.04 to 0.01). The intervention group had an improved healthy eating score (3.08, 95% CI 0.16 to 6.00, p < 0.04), improved fibre score (3.22, 1.07 to 5.37, p < 0.01) and lower levels of risky drinking at 12 months postpartum compared to the control group (OR 0.45, 0.27 to 0.74, p < 0.002). The net incremental monetary benefit was not statistically significantly different between arms, although the probability of the intervention being cost-effective was above 60%, at policy-relevant thresholds. Conclusions There was no significant difference between groups on the primary outcome of BMI at 12 months. Analyses of secondary outcomes indicated improved healthy eating and lower levels of risky drinking. Trial registration: Current Controlled Trials ISRCTN25260464.

scholarly journals Improved PrEP Awareness and Use among Trans Women in San Francisco, California

2021 ◽  
Author(s):  
Erin C. Wilson ◽  
Christopher J. Hernandez ◽  
Susan Scheer ◽  
Dillon Trujillo ◽  
Sean Arayasirikul ◽  
...  
Keyword(s):  
San Francisco ◽  
Anal Intercourse ◽  
Receptive Anal Intercourse ◽  
The Past ◽  
National Hiv Behavioral Surveillance ◽  
Trans Women ◽  
Gender Based ◽  
Prep Awareness ◽  
Almost All ◽  
Exposure Prophylaxis

AbstractTransgender women face a serious risk of HIV infection. Despite this, there is limited knowledge and use of Pre-exposure prophylaxis (PrEP). We measured the continuity of prevention across services in the PrEP cascade and correlates of PrEP use among trans women in San Francisco enrolled in the 2019/20 National HIV Behavioral Surveillance Study. Knowledge and use of PrEP among trans women in San Francisco increased in recent years; almost all (94.0%) had heard about PrEP, 64.7% had discussed PrEP with a healthcare provider, and 44.8% had taken PrEP in the past 12 months. PrEP use was associated with participation in a PrEP demonstration project (aOR = 31.44, p = 0.001) and condomless receptive anal intercourse (aOR = 3.63, p = 0.024). Injection drug use was negatively associated (aOR = 0.19, p = 0.014). Efforts are needed to combat the gender-based stigma and discrimination faced by trans women, which can result in avoidance and mistrust of the medical system.

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