scholarly journals Factors associated with knowledge of pre-exposure prophylaxis in pregnant women in Cape Town, South Africa

2019 ◽  
Vol 30 (11) ◽  
pp. 1063-1070
Author(s):  
David J DiTullio ◽  
Elise Farley ◽  
Yolanda Gomba ◽  
Thomas J. Coates ◽  
Linda-Gail Bekker ◽  
...  
Keyword(s):  
Cape Town ◽  
Health Clinic ◽  
Postpartum Women ◽  
Factors Associated ◽  
Increased Risk ◽  
Pregnancy And Postpartum ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Exposure Prophylaxis ◽  
In Pregnancy

Pregnant and postpartum women in Southern Africa are at increased risk of HIV infection. Pre-exposure prophylaxis in pregnancy and postpartum periods could significantly reduce the risk of HIV acquisition and transmission in pregnancy. Participants at a community health clinic in Cape Town completed a survey about demographic and sexual risk behaviors, and prior knowledge of pre-exposure prophylaxis. We evaluated factors associated with knowledge of pre-exposure prophylaxis using multivariable logistic regression. We enrolled 50 pregnant and 37 postpartum women, of whom 51% were HIV-uninfected. Twenty-nine (33%) knew about pre-exposure prophylaxis, most from their healthcare provider (69%). Older age (adjusted odds ratio [aOR]/year = 1.09, 95% CI = 1.00–1.19), unintended pregnancy (aOR = 3.36, 95% CI = 1.06–12.12), and more than one sex partner in the last year (aOR = 5.31, 95% CI = 1.12–30.07) were associated with pre-exposure prophylaxis knowledge. Our study identified low levels of pre-exposure prophylaxis knowledge in pregnant and breastfeeding women, but increased knowledge in higher risk women. These results provide guidance to develop interventions to increase pre-exposure prophylaxis knowledge and uptake.

High uptake of pre-exposure prophylaxis (PrEP) during early roll-out in Belgium: results from surveillance reports

Sexual Health ◽  
2019 ◽  
Vol 16 (1) ◽  
pp. 80 ◽  
Author(s):  
Bea Vuylsteke ◽  
Thijs Reyniers ◽  
Catherine Lucet ◽  
Christiana Nöstlinger ◽  
Jessika Deblonde ◽  
...  
Keyword(s):  
Disability Insurance ◽  
Aggregated Data ◽  
Increased Risk ◽  
Event Driven ◽  
Sub Saharan ◽  
Sex With Men ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Exposure Prophylaxis ◽  
Roll Out

Background Since 1 June 2017, oral pre-exposure prophylaxis (PrEP) could be prescribed and reimbursed in Belgium as prophylactic medication for people who are at increased risk of HIV acquisition. The aim of this study was to determine the uptake of daily and event-driven PrEP in Belgium during the first 9 months of roll-out. Methods: Routine aggregated data on the number of reimbursement requests and the number of boxes of Truvada (Gilead Sciences, Cambridge, UK) delivered for PrEP through the Belgian pharmacies were obtained from the National Institute for Health and Disability Insurance. We also collected aggregated data from seven Aids Reference Centres (ARCs) currently providing most of the PrEP care in Belgium. Results: From 1 June 2017 to 28 February 2018, 1352 requests for reimbursement were approved by the National Institute for Health and Disability Insurance. Almost 98% of those who bought at least one box of 30 tablets of emtricitabine 200mg/tenofovir disoproxil fumarate 300mg (FTC/TDF) in a Belgian pharmacy were male, and most (67%) were between 30 and 50 years of age. According to data obtained from ARCs, the proportion of those choosing event-driven PrEP initially ranged between 29% and 73%. Conclusions: The uptake of PrEP in Belgium since the start of the roll-out in June 2017 has been high, and almost entirely limited to men who have sex with men, of whom 43% initially prefer a non-daily regimen. A better understanding is needed as to why other populations, such as sub-Saharan African migrants, are not accessing PrEP, as well as the development of a more sustainable PrEP delivery model.

scholarly journals Retention Strategies and Factors Associated with Missed Visits Among Low Income Women at Increased Risk of HIV Acquisition in the US (HPTN 064)

2014 ◽  
Vol 28 (4) ◽  
pp. 206-217 ◽  
Author(s):  
Danielle F. Haley ◽  
Jonathan Lucas ◽  
Carol E. Golin ◽  
Jing Wang ◽  
James P. Hughes ◽  
...  
Keyword(s):  
Low Income ◽  
Retention Strategies ◽  
Factors Associated ◽  
Increased Risk ◽  
The Us ◽  
Missed Visits ◽  
Low Income Women ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition

scholarly journals Plasma and intracellular pharmacokinetics of tenofovir disoproxil fumarate and emtricitabine in transgender women receiving feminizing hormone therapy

2020 ◽  
Vol 75 (5) ◽  
pp. 1242-1249 ◽  
Author(s):  
Lauren R Cirrincione ◽  
Anthony T Podany ◽  
Joshua P Havens ◽  
Sara H Bares ◽  
Shetty Ravi Dyavar ◽  
...  
Keyword(s):  
Tenofovir Disoproxil Fumarate ◽  
Geometric Mean ◽  
Increased Risk ◽  
And Gender ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Exposure Prophylaxis ◽  
Tissue Compartments ◽  
Tenofovir Diphosphate ◽  
Hiv Negative

Abstract Background Transwomen have an increased risk of HIV acquisition compared with other adults. Drug–drug interactions between pre-exposure prophylaxis (PrEP) and gender-affirming therapy are cited as a reason for poor PrEP uptake among transwomen. We evaluated plasma tenofovir and emtricitabine pharmacokinetics and their active intracellular anabolites, tenofovir-diphosphate and emtricitabine-triphosphate, in transwomen receiving feminizing hormones. Methods We enrolled HIV-negative transwomen (≥19 years) not receiving PrEP. Participants took oral tenofovir disoproxil fumarate/emtricitabine 300/200 mg daily for 14 days. Plasma was collected at 0 h (pre-dose), 0.5, 1, 2, 3, 4, 6, 8 and 12 h on day 14 post-tenofovir disoproxil fumarate/emtricitabine dose. The plasma AUC0–24 was calculated using the trapezoidal rule and compared with historical HIV-negative cisgender adults as geometric mean ratios (GMRs, 90% CI). Secondarily, tenofovir-diphosphate and emtricitabine-triphosphate from PBMCs collected at 0 h and 12 h were reported descriptively as geometric means (90% CI). Clinical trials registration: NCT03270969. Results Among 15 transwomen (mean age 32 years), geometric mean tenofovir and emtricitabine plasma AUC0–24 were lower compared with controls: tenofovir, 2.10 versus 2.76 mg·h/L, GMR 0.76 (0.65–0.90), P = 0.01; emtricitabine, 9.15 versus 10.64 mg·h/L, GMR 0.86 (0.75–0.98), P = 0.07. Tenofovir-diphosphate and emtricitabine-triphosphate concentrations were higher than previously reported in the literature: 167.1 (146.6–190.5) fmol/106 cells and 15.4 (13.8–17.3) pmol/106 cells, respectively. Conclusions We observed lower plasma tenofovir and emtricitabine concentrations in transwomen compared with historical cisgender adults, yet intracellular tenofovir-diphosphate and emtricitabine-triphosphate concentrations were higher than previously reported in PBMCs. Understanding the differences of PrEP pharmacokinetics in plasma and tissue compartments and the resultant impact on efficacy remains important for transwomen.

Acute neurological disorders in women during pregnancy and peurperium

2021 ◽  
Vol 12 (2) ◽  
pp. 58-64
Author(s):  
Akhil Kulkarni M ◽  
Keyword(s):  
Neurological Disorders ◽  
Physiological Mechanism ◽  
Postpartum Women ◽  
Physiological Changes ◽  
Imaging Findings ◽  
Posterior Reversible Encephalopathy ◽  
Increased Risk ◽  
Neurological Conditions ◽  
Reversible Encephalopathy ◽  
In Pregnancy

Neurological disorders in women during pregnancy and puerperium are a significant cause of morbidity and mortality in pregnancy. There are certain neurological conditions which are specifically related to physiological changes during this period (eg: eclampsia, Sheehan’s syndrome, posterior reversible encephalopathy syndrome) and some disorders which have increased risk but not specific to women in pregnancy and puerperium (eg: cerebral venous thrombosis, infarction). As radiologists, an understanding of the patho physiological mechanism and imaging findings associated with these various conditions is necessary in timely diagnosis and initiating therapy which in turn helps prevent complications to both them other and the fetus. Any prophylaxis against these events should be particularly targeted to postpartum women, indicating the need to better identify pregnant women at increased risk.

Defining the PrEP care continuum among recently incarcerated men at high risk for HIV infection (Preprint)

2021 ◽  
Author(s):  
Matthew Murphy ◽  
Colette Sosnowy ◽  
Brooke Rogers ◽  
Siena Napoleon ◽  
Drew Galipeau ◽  
...  
Keyword(s):  
Public Health ◽  
High Risk ◽  
Hiv Infection ◽  
Care Continuum ◽  
Increased Risk ◽  
Biomedical Intervention ◽  
Prep Implementation ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Prospective Longitudinal

BACKGROUND HIV disproportionately impacts criminal justice (CJ)-involved individuals, including men who experience incarceration. Men make up the vast majority of those experiencing incarceration as well as those newly diagnosed with HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention that significantly reduces the risk of HIV acquisition. However, implementation in CJ-systems is limited. Little is known about effective PrEP implementation and use in this unique public health context. OBJECTIVE This article describes a PrEP care continuum for men experiencing incarceration who are at increased risk of HIV acquisition, which can help conceptualize approaches to evaluating PrEP implementation. METHODS Men incarcerated in the Rhode Island Department of Corrections, a correctional system composed of all of the state's sentenced and awaiting trial population, are screened for HIV acquisition risk during the course of routine clinical care. Those identified at high risk for HIV acquisition are referred for evaluation for PrEP initiation and enrollment in this study. Individuals who express interest in initiating PrEP and consent to the study are then followed in a prospective longitudinal cohort. RESULTS The outlined study will enroll 100 men experiencing incarceration at high risk for HIV acquisition prior to release into the community. The goal is to initiate PrEP prior to incarceration and link individuals to PrEP providers in the community, capturing barriers and facilitators to PrEP use during this uniquely vulnerable time period for HIV acquisition. CONCLUSIONS Based on the proposed care continuum and what is known about HIV risk and prevention efforts in the CJ-context, we outline key future research efforts to better understand effective approaches to preventing HIV infection among this vulnerable population. The described approach presents a powerful public health opportunity to help end the HIV epidemic.

scholarly journals Intimate partner violence among postpartum women at a teaching hospital in Nigeria’s Federal Capital City: pattern and materno-fetal outcomes

2020 ◽  
Vol 14 ◽  
pp. 263349412092834
Author(s):  
Godwin O. Akaba ◽  
Habiba I. Abdullahi
Keyword(s):  
Intimate Partner Violence ◽  
Teaching Hospital ◽  
Partner Violence ◽  
Intimate Partner ◽  
Sexual Partners ◽  
Postpartum Women ◽  
Fetal Outcomes ◽  
The Past ◽  
Increased Risk ◽  
In Pregnancy

Background: Intimate partner violence is an important public health and human rights issue. Previous studies have considered intimate partner violence in pregnancy mainly among pregnant women attending antenatal clinics thereby missing out a few who may encounter this problem in late pregnancy or just before delivery. This study had the objective of ascertaining the prevalence, pattern of intimate partner violence, and associated materno-fetal outcomes. Method: This was a cross-sectional study conducted between January 2017 and June 2017 among postpartum mothers at a Nigerian Teaching Hospital just before being discharged home. The abuse assessment score was adapted and used to interview women regarding possible intimate partner violence experiences within the past 1 year and during the pregnancy after obtaining written consent. Results: Out of 349 postpartum women interviewed, 102/349 (29.2%) experienced intimate partner violence in the past 1 year, while 18/349 (5.2%) of intimate partner violence occurred in the index pregnancy. Sexual partners were the main perpetuators of intimate partner violence, 67/102 (65.7%), while 35/102 (34.3%) were by someone else other than their sexual partners. Among those abused in the current pregnancy, 10/18 (55.6%) were abused once and the remaining 8/18 (44.4%) were abused more than once. Intimate partner violence was associated with higher chances of cesarean section ( p = 0.001), increased risk of lesser birth weight babies ( p = 0.014), and maternal complications in pregnancy ( p = 0.030). Conclusion: The prevalence of intimate partner violence in pregnancy in Abuja is high with associated poor materno-fetal outcomes. Enforcing existing legislations and screening for intimate partner violence during routine antenatal care may help reduce its prevalence and ensure a positive pregnancy experience for Nigerian women.

scholarly journals Lower Birth Weight-for-age and Length-for-age Z-scores in Infants With in-utero HIV and ART Exposure: A Prospective Study in Cape Town, South Africa

2020 ◽  
Author(s):  
Dorothy Chiwoniso Nyemba ◽  
Emma Kalk ◽  
Hlengiwe P. Madlala ◽  
Thokozile R. Malaba ◽  
Amy L. Slogrove ◽  
...  
Keyword(s):  
South Africa ◽  
Scale Up ◽  
Cape Town ◽  
In Utero ◽  
Women Living With Hiv ◽  
Z Scores ◽  
Hiv Exposed ◽  
Hiv Acquisition ◽  
Weight For Age ◽  
In Pregnancy

Abstract Background: Successful scale-up of antiretroviral therapy (ART) during pregnancy has minimized infant HIV acquisition, and over 1 million infants are born HIV-exposed but uninfected (HEU), with an increasing proportion also exposed in utero to maternal ART. While benefits of ART in pregnancy outweigh risks, some studies have reported associations between in utero ART exposure and impaired fetal growth, highlighting the need to identify the safest ART regimens for use in pregnancy. Methods: We compared birth anthropometrics of infants who were HEU with those HIV-unexposed (HU) in Cape Town, South Africa. Pregnant women had gestational age assessed by ultrasound at enrolment. Women living with HIV were on ART (predominately tenofovir-emtricitabine-efavirenz) either prior to conception or initiated during pregnancy. Birth weights and lengths were converted to weight-for-age (WAZ) and length-for-age (LAZ) z-scores using Intergrowth-21st software. Linear regression was used to compare mean z-scores adjusting for maternal and pregnancy characteristics. Results: Among 888 infants, 49% (n=431) were HEU and 51% (n=457) HU. Of 431 HEU infants, 62% (n=268) were exposed to HIV and antiretroviral (ARVs) from conception and 38% (n=163) were exposed to ARVs during gestation but after conception (median fetal ARV exposure of 21 weeks [IQR; 17-26]). In univariable analysis, infants who were HEU had lower mean WAZ compared with HU [β= -0.15 (95% Confidence Interval (CI): -0.28, -0.020)]. After adjustment for maternal age, gravidity, alcohol use, marital and employment status the effect remained [adjusted β -0.14 (95%CI: -0.28, -0.01]. Similar differences were noted for mean LAZ in univariable [β -0.20 (95%CI: -0.42, -0.01] but not multivariable analyses [adjusted β -0.18 (95%CI: -0.41, +0.04] after adjusting for the same variables. Mean WAZ and LAZ did not vary by in utero ARV exposure duration among infants who were HEU. Conclusion: In a cohort with high prevalence of ART exposure in pregnancy, infants who were HEU had lower birth WAZ compared with those HU. Studies designed to identify the mechanisms and clinical significance of these disparities, and to establish the safest ART for use in pregnancy are urgently needed.

scholarly journals Knowledge of HIV pre-exposure prophylaxis among immigrant Asian gay men living in New Zealand

2019 ◽  
Vol 11 (4) ◽  
pp. 351 ◽  
Author(s):  
Jeffery Adams ◽  
Rommel Coquilla ◽  
Jed Montayre ◽  
Stephen Neville
Keyword(s):  
Health Promotion ◽  
New Zealand ◽  
Gay Men ◽  
Individual Level ◽  
Care Services ◽  
Primary Care Services ◽  
The Individual ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Exposure Prophylaxis

ABSTRACT INTRODUCTIONHIV pre-exposure prophylaxis (PrEP) is a new bio-medical means of reducing the risk of HIV infection. It’s use by individuals at high risk of HIV acquisition is recommended. AimsThis study identifies the ways immigrant Asian gay men living in New Zealand talk about and understand issues related to PrEP. METHODSA qualitative descriptive methodology was used. Individual interviews were conducted with 18 immigrant Asian gay men who were not users of PrEP. Participants were aged 21 – 36 years and one-third had arrived in New Zealand within 3 years of completing the interview. Data were analysed using thematic analysis. RESULTSThree themes evident across the men’s talk in relation to pre-exposure prophylaxis were identified: ‘I’m not sure what PrEP is’; ‘PrEP is not proven’; and ‘PrEP is for others, not me’. DISCUSSIONPrEP is necessary for working towards the elimination of HIV. To improve uptake among Asian gay men, improved literacy around HIV and pre-exposure prophylaxis is required. This knowledge needs to be improved at both the individual level in primary care services and collectively through health promotion initiatives. These services and health promotion initiatives need to be provided in ways that encourage engagement by Asian gay men.

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.

Missed opportunities for HIV pre-exposure prophylaxis during a rapid scale-up program at Sydney Sexual Health Centre

Sexual Health ◽  
2019 ◽  
Vol 16 (6) ◽  
pp. 591
Author(s):  
David Atefi ◽  
Ruthy McIver ◽  
Christopher Bourne
Keyword(s):  
Sexual Health ◽  
Medical Records ◽  
Health Centre ◽  
Scale Up ◽  
Missed Opportunities ◽  
Standard Component ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Exposure Prophylaxis ◽  
Missed Opportunity

We aimed to estimate HIV pre-exposure prophylaxis (PrEP) uptake and missed opportunities for PrEP through a retrospective review of medical records of clients at high risk of HIV attending the Sydney Sexual Health Centre. Most clients (69%) were taking PrEP, and 7% of those eligible for PrEP were classified as a missed opportunity for PrEP. Although missed opportunities were uncommon, PrEP discussions should be a standard component of care for all clients at risk of HIV acquisition.

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