scholarly journals Biomedical prevention: what is the current status?

2010 ◽  
Vol 4 (5) ◽  
pp. 679-682
Author(s):  
David D. Celentano ◽  
Wendy W. Davis ◽  
Chris C. Beyrer
Keyword(s):  
Male Circumcision ◽  
Hiv Transmission ◽  
Sub Saharan Africa ◽  
Current Status ◽  
Post Exposure Prophylaxis ◽  
Biomedical Hiv Prevention ◽  
Hiv Prevention Strategies ◽  
Biomedical Prevention ◽  
Sub Saharan ◽  
Exposure Prophylaxis

Abstract Biomedical HIV prevention strategies for primary or secondary prevention of HIV transmission can be seen as an adjunct to behavioral prevention approaches. These interventions include vaccination, female controlled vaginal microbicides, male circumcision, treatment of sexually transmitted infections that cause genital ulceration, Pre-Exposure Prophylaxis (PREP) and Post-Exposure Prophylaxis (PEP). This article reviews results from recent randomized controlled trials of novel biomedical prevention approaches and discusses interpretation of the results. The only intervention consistently demonstrating reductions in HIV transmission was adult male circumcision in Sub-Saharan Africa. Results of PREP trials will be available in the next several years.

scholarly journals Challenges and potential barriers to the uptake of antiretroviral-based prevention in Asia and the Pacific region

Sexual Health ◽  
2014 ◽  
Vol 11 (2) ◽  
pp. 126 ◽  
Author(s):  
Ying-Ru Lo ◽  
Masaya Kato ◽  
Nittaya Phanuphak ◽  
Masami Fujita ◽  
Duong Bui Duc ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Sub Saharan Africa ◽  
Treatment As Prevention ◽  
The Pacific ◽  
Prep Implementation ◽  
Sub Saharan ◽  
Hiv Acquisition ◽  
Operational Issues ◽  
Exposure Prophylaxis ◽  
Firm Evidence

Evidence has emerged over the past few years on the effectiveness of antiretroviral-based prevention technologies to prevent (i) HIV transmission while decreasing morbidity and mortality in HIV-infected persons, and (ii) HIV acquisition in HIV-uninfected individuals through pre-exposure prophylaxis (PrEP). Only few of the planned studies on treatment as prevention (TasP) are conducted in Asia. TasP might be more feasible and effective in concentrated rather than in generalised epidemics, as resources for HIV testing and antiretroviral treatment could focus on confined and much smaller populations than in the generalised epidemics observed in sub-Saharan Africa. Several countries such as Cambodia, China, Thailand and Vietnam, are now paving the way to success. Similar challenges arise for both TasP and PrEP. However, the operational issues for PrEP are amplified by the need for frequent retesting and ensuring adherence. This paper describes challenges for the implementation of antiretroviral-based prevention and makes the case that TasP and PrEP implementation research in Asia is much needed to provide insights into the feasibility of these interventions in populations where firm evidence of ‘real world’ effectiveness is still lacking.

scholarly journals What is the benefit of the biomedical and behavioral interventions in preventing HIV transmission?

2015 ◽  
Vol 18 (suppl 1) ◽  
pp. 26-42 ◽  
Author(s):  
Ricardo Kuchenbecker
Keyword(s):  
Behavioral Interventions ◽  
Hiv Transmission ◽  
Number Needed To Treat ◽  
Complete Suppression ◽  
Protective Effects ◽  
Serodiscordant Couples ◽  
Biomedical Hiv Prevention ◽  
Hiv Prevention Strategies ◽  
Exposure Prophylaxis ◽  
Biomedical Interventions

ABSTRACTIntroduction:Scientific evidence supports the sinergy between biomedical and behavioral interventions aimed at preventing the transmission of HIV as a strategy to eradicate AIDS.Objective:To characterize comparatively the benefits from biomedical and behavioral interventions to prevent HIV transmission.Methods:Narrative review. We performed a comparative analysis of the benefits of studied interventions by means of estimating the number needed to treat (NNT). Evaluated interventions: counseling activities for behavior change to prevent exposure to HIV; antiretroviral pre-exposure prophylaxis (PrEP) and antiretroviral post-exposure prophylasis (PEP) for HIV and treatment of serodiscordant couples as a strategy for prevention of HIV transmission (TasP).Results:counseling interventions and TasP have smaller NNTs, equal to, respectively, 11 (95%CI 9 - 18) at 12 months and 34 (95%CI 23 - 54) in 42 months comparatively to PrEP interventions, that resulted in 41 (95%CI 28 - 67) individuals receiving antiretrovirals in order to prevent one case of HIV infection at 36 months for men and serodiscordant couples. PEP interventions are associated with protective effects estimated at 81%. Lack of trials evaluating PEP prevents estimate of NNT.Conclusion:The estimate of the NNT can be a helpful parameter in the comparison between the effectiveness of different behavioral and biomedical HIV prevention strategies. Studies evaluating the benefit and safety of combined behavioral and biomedical interventions are needed, especially considering the attributable fraction of each component. Integration of behavioral and biomedical interventions is required to achieve complete suppression of the virus, and thus reducing viral replication, infectivity and the number of cases.

scholarly journals Lessons from a decade of voluntary medical male circumcision implementation and their application to HIV pre-exposure prophylaxis scale up

2018 ◽  
Vol 29 (14) ◽  
pp. 1432-1443 ◽  
Author(s):  
Jason B Reed ◽  
Rupa R Patel ◽  
Rachel Baggaley
Keyword(s):  
Male Circumcision ◽  
Scale Up ◽  
Health Impact ◽  
Lessons Learned ◽  
Sub Saharan Africa ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Prep Implementation ◽  
Sub Saharan ◽  
Exposure Prophylaxis

Oral pre-exposure prophylaxis (PrEP) has the ability to curb HIV incidence worldwide and bring us closer to ending the HIV epidemic. Scale up of PrEP service delivery has many similar challenges to those faced by voluntary medical male circumcision (VMMC) services roll-out. This article outlines ten important lessons learned during the scale up of VMMC services in sub-Saharan Africa and their application to current oral PrEP implementation efforts to promote faster expansion for public health impact.

Cutting-Edge Success in Preventing Heterosexual HIV Transmission in Africa: Voluntary Medical Male Circumcision Has Reached 15 Million Men

2018 ◽  
Vol 30 (3) ◽  
pp. 232-242
Author(s):  
Inon Schenker
Keyword(s):  
Male Circumcision ◽  
Randomized Clinical Trials ◽  
Hiv Transmission ◽  
Hiv Infections ◽  
High Volume ◽  
Sub Saharan Africa ◽  
Voluntary Medical Male Circumcision ◽  
Medical Male Circumcision ◽  
Sub Saharan ◽  
A Minor

Male circumcision is a minor surgery performed for religious and medical reasons. Three randomized clinical trials demonstrated it could reduce heterosexual HIV transmission from infected females to males by over 60%, paving the way in 2006 for multinational efforts to circumcise 27 million men in sub-Saharan Africa by 2021. It is estimated that by 2030 male circumcision will avert at least 500,000 HIV infections in Africa, saving lives and budgets. Voluntary medical male circumcision (VMMC) of adults and adolescents has challenged policy makers, implementers, funders, and civil society in bringing surgery to the frontline of HIV prevention. Five key challenges are discussed: policy, clinical, demand, supply, and scaling up. A unique Israel-Senegal-South Africa collaboration, which enhanced high-volume (100 VMMCs per day) and high-quality (less than 2% minor adverse events) procedures, is described, highlighting VMMC as one of the most impressive public health collaborative interventions in HIV/AIDS prevention globally.

scholarly journals Pregnant and breastfeeding women’s prospective acceptability of two biomedical HIV prevention approaches in Sub Saharan Africa: A multisite qualitative analysis using the Theoretical Framework of Acceptability

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259779
Author(s):  
Mandeep Sekhon ◽  
Ariane van der Straten ◽  
Keyword(s):  
Qualitative Analysis ◽  
Theoretical Framework ◽  
Sub Saharan Africa ◽  
Group Discussions ◽  
Biomedical Hiv Prevention ◽  
Affective Attitude ◽  
Positive Attitudes ◽  
Vaginal Rings ◽  
Sub Saharan ◽  
Exposure Prophylaxis

HIV infection during pregnancy and breastfeeding has implications for maternal health. Between May- November 2018, we explored prospective acceptability of two novel HIV Pre-exposure Prophylaxis (PrEP) products, oral pills and vaginal rings, through focus group discussions with 65 pregnant and breastfeeding women in Malawi, South Africa, Uganda, Zimbabwe. Qualitative analysis was completed, guided by the Theoretical Framework of Acceptability (TFA). First, a deductive thematic analysis was applied to relevant coded data, into the seven TFA constructs (Affective Attitude; Burden; Ethicality, Intervention Coherence; Opportunity Costs; Perceived Effectiveness; Self-efficacy). Next, an iterative analysis was completed to generate themes within each of the TFA constructs. Women’s positive attitudes towards daily oral PrEP highlighted the familiarity of taking pills, understanding the purpose of taking pills, and the perception that it is an effective method to protect mothers and babies from HIV during pregnancy and breastfeeding. Women emphasized the ease of using the ring given its monthly duration that lowers burden on the user, its discreetness and invisibility once in place. The TFA analysis highlighted how acceptability of both methods could be enhanced by focusing on perceptions of the end users (i.e. the women) and not just the products themselves. This approach provided insights into how to refine the intervention materials and plans for implementation.

scholarly journals Ask the Way From Those Who Have Walked It Before – Grandmothers’ Roles in Health-related Decision Making and HIV Pre-exposure Prophylaxis (PrEP) Use Among Pregnant and Breastfeeding Women in Africa

2021 ◽  
Author(s):  
Krishnaveni Reddy ◽  
Doreen Kemigisha ◽  
Miria Chitukuta ◽  
Sufia Dadabhai ◽  
Florence Mathebula ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Sub Saharan Africa ◽  
Sources Of Information ◽  
Maternal Experience ◽  
Biomedical Hiv Prevention ◽  
Health Related ◽  
Sub Saharan ◽  
Hiv Acquisition ◽  
The Right ◽  
Exposure Prophylaxis

Abstract Background: HIV acquisition among pregnant and breastfeeding women in sub-Saharan Africa (SSA) and vertical transmission rates remain high despite established strategies for HIV prevention. Methods: We explored grandmothers’ (mothers/mothers-in-law) influence on pregnant and breastfeeding women’s health-related decisions and their potential to support use of HIV prevention products utilizing qualitative data collected from grandmothers, HIV-uninfected, currently/recently pregnant or breastfeeding women and male partners of currently/recently pregnant or breastfeeding women during the MTN-041/MAMMA study. Results: Grandmothers were described as important sources of information, playing both supportive and influencer roles, due to personal maternal experience and generational knowledge. Grandmothers expressed willingness to support pre-exposure prophylaxis (PrEP) use and agreed with other groups that this decision should be made by women themselves and/or with partners. Conclusion: With the right framing and approach, grandmothers’ supportive roles can optimise uptake and adherence to biomedical HIV prevention and reduce HIV acquisition among pregnant and breastfeeding women in these communities.

scholarly journals What do patients consulting in a free sexual health center know about HIV transmission and post-exposure prophylaxis?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christelle Duteil ◽  
Elise de La Rochebrochard ◽  
Prescillia Piron ◽  
Christophe Segouin ◽  
Pénélope Troude
Keyword(s):  
Hiv Transmission ◽  
Post Exposure Prophylaxis ◽  
False Beliefs ◽  
Transmitted Infection ◽  
Cross Sectional ◽  
Unprotected Sexual Intercourse ◽  
Post Exposure ◽  
Hiv Prevention Strategies ◽  
Exposure Prophylaxis ◽  
Lack Of Knowledge

Abstract Background Screening, condom use and post-exposure prophylaxis (PEP) are among existing HIV prevention strategies. However, efficient use of these strategies requires that patients have an adequate knowledge of HIV transmission routes and awareness of risk behaviors. This study aimed to assess knowledge about HIV transmission among patients who attended a free HIV and sexually transmitted infection (STI) screening center in Paris, France, and to explore the patient profiles associated with HIV-related knowledge. Methods This observational cross-sectional study included 2002 patients who attended for STI testing from August 2017 through August 2018 and completed a self-administered electronic questionnaire. Based on incorrect answers regarding HIV transmission, two outcomes were assessed: lack of knowledge and false beliefs. Factors associated with these two outcomes were explored using univariate and multivariate logistic regressions. Results Only 3.6% of patients did not know about HIV transmission through unprotected sexual intercourse and/or by sharing needles. More than one third of patients (36.4%) had at least one false belief, believing that HIV could be transmitted by sharing a drink (9.7%), kissing (17.6%) or using public toilets (27.5%). A low educational level and no previous HIV testing were associated in multivariate analyses with both lack of knowledge and false beliefs. Age and sexual orientation were also associated with false beliefs. Furthermore, 55.6% of patients did not know that post-exposure prophylaxis consists of taking emergency treatment as soon as possible after risky intercourse. Conclusions Although the main HIV transmission routes are well known, false beliefs persist and knowledge regarding PEP needs to be improved. Prevention campaigns must focus on these themes which appear as a complementary strategy to pre-exposure prophylaxis to reduce HIV infection.

scholarly journals 986. Improvement in Administration of HIV Post-Exposure Prophylaxis in the Emergency Department Following Sexual Assault

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S521-S522
Author(s):  
Jennifer R Silva-Nash ◽  
Stacie Bordelon ◽  
Ryan K Dare ◽  
Sherrie Searcy
Keyword(s):  
Emergency Department ◽  
Sexual Assault ◽  
Hiv Transmission ◽  
Post Exposure Prophylaxis ◽  
Intervention Period ◽  
Post Intervention ◽  
Post Exposure ◽  
Assault Victims ◽  
Exposure Prophylaxis

Abstract Background Nonoccupational post exposure prophylaxis (nPEP) following sexual assault can prevent HIV transmission. A standardized Emergency Department (ED) protocol for evaluation, treatment, and follow up for post assault victims was implemented to improve compliance with CDC nPEP guidelines. Methods A single-center observational study of post sexual assault patients before/after implementation of an ED nPEP protocol was conducted by comparing the appropriateness of prescriptions, labs, and necessary follow up. A standardized order-set based on CDC nPEP guidelines, with involvement of an HIV pharmacist and ID clinic, was implemented during the 2018-2019 academic year. Clinical data from pre-intervention period (07/2016-06/2017) was compared to post-intervention period (07/2018-08/2019) following a 1-year washout period. Results During the study, 147 post-sexual assault patients (59 Pre, 88 Post) were included. One hundred thirty-three (90.4%) were female, 68 (46.6%) were African American and 133 (90.4%) were candidates for nPEP. Median time to presentation following assault was 12.6 hours. nPEP was offered to 40 (67.8%) and 84 (95.5%) patients (P< 0.001) and ultimately prescribed to 29 (49.2%) and 71 (80.7%) patients (P< 0.001) in pre and post periods respectively. Renal function (37.3% vs 88.6%; P< 0.001), pregnancy (39.0% vs 79.6%; P< 0.001), syphilis (3.4% vs 89.8%; P< 0.001), hepatitis B (15.3% vs 95.5%; P< 0.001) and hepatitis C (27.1% vs 94.3%) screening occurred more frequently during the post period. Labratory, nPEP Prescription and Follow up Details for Patients Prescribed nPEP Conclusion The standardization of an nPEP ED protocol for sexual assault victims resulted in increased nPEP administration, appropriateness of prescription, screening for other sexually transmitted infectious and scheduling follow up care. While guideline compliance dramatically improved, further interventions are likely warranted in this vulnerable population. Disclosures Ryan K. Dare, MD, MS, Accelerate Diagnostics, Inc (Research Grant or Support)

Sign in / Sign up

Export Citation Format

Share Document