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Luong, Nguyen Liêm Binh. "Modélisation et analyse en coût-efficacité des stratégies de prévention, de dépistage et de traitement de l'infection par le VIH à Ndhiwa, Kenya." Electronic Thesis or Diss., Université Paris Cité, 2021. http://www.theses.fr/2021UNIP5233.
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Médecin Sans Frontière (MSF) intervient depuis les années 1980 à Ndhiwa, un sous-comté du Sud-Ouest du Kenya, où sévit une épidémie généralisée de VIH, avec une prévalence à 24% et une incidence à 2,2/100 personnes année (PA). Conformément aux objectifs de l’ONUSIDA 90-90-90, puis 95-95-95, MSF a décidé de mettre en place différentes interventions pour diminuer l’incidence de l’infection par le VIH. Dans un premier temps, nous avons développé un modèle mathématique de la transmission et de l’histoire naturelle de l’infection par le VIH à Ndhiwa afin d’étudier l’efficacité et le coût efficacité de trois niveaux d’interventions sur le continuum de soin. Nous avons ainsi estimé qu’en maintenant l’offre de soins à son niveau actuel, sans intervention, l’incidence de l’infection par le VIH diminuerait à 1,51/100 PA en 2032, tandis que seules les interventions de rétention et la combinaison de toutes les stratégies faisaient baisser l’incidence respectivement à 1,03/100 PA et 0,75/100 PA. Comparé au standard de soins, la stratégie de rétention avait un rapport incrémental de coût-efficacité de 130€/année de vie gagnée (AVG) tandis que La combinaison des interventions atteint un ICER de 370€/AVG. Dans un deuxième temps, nous avons modélisé l’efficacité d’une intervention qui améliorerait le continuum de soin de 90-90-90 à 95-95-95, comparée à une intervention qui implémenterait une prophylaxie pré-exposition (PrEP) sur une population à haut risque avec un taux de couverture de 10%. Nous estimons que dans une épidémie généralisée où le continuum de soin atteint 90-90-90, l’amélioration du continuum de soin à 95-95-95 est plus efficace que la PrEP pour diminuer l’incidence de l’infection par le VIH En conclusion, les résultats de notre travail soulignent les effets synergiques e très coût-efficace d’interventions multimodales sur le continuum de soin, et leur rôle important aussi important que la PrEP pour diminuer l’incidence de l’infection par le VIHMédecin Sans Frontière (MSF) have been working since the early 1980’s on HIV care delivery in Ndhiwa, a rural sub-county in Southwest Kenya. This area suffers from a generalized HIV epidemic, with 24% prevalence and 2.2/100 person years (PY) incidence. In line with the UNAIDS 90-90-90 and 95-95-95 targets, MSF has implemented interventions to decrease HIV incidence. In the first part of this work, we have developped a mathematical model of HIV natural history and transmission in Ndhiwa to evaluate the effectiveness and cost-effectiveness of three different interventions on HIV continuum of care. We estimated than current standard of care would decrease HIV incidence to 1.51/100 PY in 2032, whereas only retention intervention and combined interventions would further decrease HIV incidence to 1.03/100 PY and 0,75/100 PY, respectively. Compared to standard of care, retention to care intervention has an incremental cost-effectiveness ratio (ICER) of 130€/years of live saved (YLS) whereas combined intervention has an ICER of 370€/YLS. In the second part, we modeled the effectiveness of the improvement of continuum of care from 90-90-90 to 95-95-95, compared with a Pre-exposure Prophylaxis (PrEP) intervention with 10% coverage in high-risk group. We found that in the context of generalized epidemic where continuum of care reach 90-90-90, an improvement to 95-95-95 would be more effective than PrEP to decrease incidence. To conclude, combined interventions on HIV continuum of care have synergic effects and are very cost-effective. We also underlined the importance of maintaining a high level continuum of care to decrease HIV incidence, which is as important as PrEP to fight the HIV pandemic
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Kokolo, Madzouka B. "HIV oral pre-exposure prophylaxis (PrEP) trials: A systematic review and systematic ethics appraisal." Thesis, University of Ottawa (Canada), 2010. http://hdl.handle.net/10393/28681.
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BACKGROUND. Pre-exposure prophylaxis (PrEP) is an experimental HIV prevention approach whereby antiretroviral pills are used before anticipated exposure. It is unclear how ethical considerations have been addressed by investigators. METHODS. A systematic review of PrEP controlled prospective studies was conducted. Pre-determined data items were extracted from registries, protocols, reports, and consent forms. Study characteristics, methods, and ethics considerations were synthesized. RESULTS. Among sixteen studies included, twelve involved resource-limited countries. Quality scores were generally high and overall risk of bias was low. Considerations for social value were the least reported whereas considerations for the fair selection of study population were the most reported. More ethics considerations tend to be reported with time. No meta-analysis was performed, as few data were available. CONCLUSION. As critical as clinical data generation is for scientific progress, ethics should be monitored and adequately reported, lest lack of consideration for key principles be uncovered after the facts.
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Terry-Smith, Justin B. "Factors Influencing Use of Pre-Exposure Prophylaxis Among Men Who Have Sex With Men." Thesis, Walden University, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10816883.
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Prevention is key to keeping men who have sex with men (MSM) protected from Human Immunodeficiency Virus (HIV). Despite new and innovative HIV prevention resources such as pre-exposure prophylaxis (PrEP), factors such as education level, employment status, number of sexual partners, and access to health resources may inhibit certain populations from using PrEP. The purpose of this cross-sectional study was to examine the association between education level, employment status, number of sexual partners, and access to health resources and the use of PrEP among MSM. The fundamental cause theory was used to examine how socioeconomic barriers are associated with the use of PrEP among MSM in the United States. Secondary data from 217 surveys were collected from the Public Library of Science. Findings from multiple regression analyses indicated that employment status, access to health resources, and number of sexual partners were not associated with use of PrEP among MSM. Those who had at least some high school or a high school diploma were 3.98 times more likely to be likely to extremely likely to use PrEP, compared to those who had less than a high school education (OR = 3.98, p = .048). Those who had some college were 6.91 more likely to be likely to extremely likely to use PrEP, compared to those who had less than a high school education (OR = 6.91, p = .028). Findings may be used to assist public health professionals in identifying factors that prevent the use of PrEP. By addressing these health threats, and social barriers, specialists could have the ability to increase HIV prevention activity in populations that are more susceptible to being infected with HIV and may decrease HIV infections not only within the MSM population but also in other populations.
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Nutland, W. "The acceptability of pre-exposure HIV prophylaxis in men who have sex with men in London." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2016. http://researchonline.lshtm.ac.uk/2837729/.
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Men who have sex with men (MSM) remain the group with the highest incidence of HIV in the UK, with a high concentration of infections in London. Multi-site safety and efficacy trials have demonstrated significant reductions in HIV acquisition among MSM when prescribed a daily pre-exposure prophylaxis (PrEP). Success translating these scientific developments into effective prevention interventions requires an understanding of how acceptable they are to individuals at risk of HIV acquisition. This thesis reports on the findings of twenty in-depth semi-structured qualitative interviews with MSM in London. To participate, men must have had at least one episode of sex without condoms with a known sero-discordant partner or a partner of unknown HIV status in the twelve months prior to interview. The acceptability of a range of PrEP methods were explored, including daily and intermittent oral; topical; and injectable formulations of PrEP and the potential impact of PrEP use upon men’s perceptions of risk and behaviours. Dimensions of acceptability draw on the personal (such as side effects; increased or diminished HIV vulnerability; adherence to drug/medical regimes); the inter-personal (such as negotiation of sex; stigma or discrimination); and community or social concepts of acceptability (such as financial burden and concepts of increased ‘community risk’). The thesis provides a framework for understanding PrEP acceptability, showing that concepts of acceptability are complex and that the different dimensions of acceptability are inter-related. The thesis concludes with recommendations for future policy and service delivery of PrEP to at-risk groups in the UK.
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Schexnayder, Julie Kay. "Disparities in HIV Pre-Exposure Prophylaxis Implementation for Black and Latinx Adults Receiving Care in Public Health Clinics." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case160709474635545.
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Blair, Kevin J., Eddy R. Segura, Alex Garner, Jianchao Lai, Amy Ritterbusch, Sebastian Leon-Giraldo, Vincent Guilamo-Ramos, Jordan E. Lake, Jesse Clark, and Ian W. Holloway. "PrEP Awareness, Use, Intention to Use, and Information Source Among Geosocial Networking Application Users in Mexico in 2018–2019." Springer, 2021. http://hdl.handle.net/10757/655887.
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El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado.Pre-exposure prophylaxis (PrEP) has limited availability across Latin America, though access is increasing. We explored PrEP uptake in Mexico via an online survey completed by Spanish-speaking, Hornet geosocial networking application (GSN app) users without HIV (n = 2020). Most (81.3%) had heard of PrEP, 3.5% were current users, and 34.2% intended to take PrEP within six months. Current PrEP use was associated with PrEP eligibility (aOR 26.07 [95%CI 13.05–52.09], p < 0.001), recent STI testing (aOR 3.79 [95%CI 1.10–13.11], p = 0.035), and recent chemsex (aOR 3.02 [95%CI 1.02–8.93], p = 0.046). Recent STI testing was associated with hearing about PrEP from a doctor (aOR 3.26 [95%CI 1.98–5.36], p < 0.001), and those who lived in large cities were less likely to have learned about PrEP via Hornet (aOR 0.52 [95%CI 0.32–0.85], p = 0.009). Interventions to increase PrEP uptake in Mexico should build upon existing health networks and utilize GSN apps for PrEP information dissemination, particularly in less populated areas.
University of California
Revisión por pares
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Umboh, Lucyan Fransisca. "Awareness, Knowledge and Willingness to use HIV Pre-Exposure Prophylaxis among Men Who Have Sex with Men and Transgender People in Bali, Indonesia." Thesis, The University of Sydney, 2018. http://hdl.handle.net/2123/19468.
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Background: World Health Organisation in 2014 has recommended Pre-Exposure Prophylaxis (PrEP) as HIV prevention tool for men who have sex with men (MSM) along with other prevention strategies. Before PrEP implementation is introduced in Indonesia, it is vitally important to have an evidence base about the awareness, knowledge and acceptability among MSM and transgender people and the differences in knowledge and PrEP acceptability based on sexual risk factors of MSM and transgender people. Methods: A cross-sectional study was conducted between July and November 2017 in an MSM clinic in Denpasar, Bali, Indonesia. Eligible participants were men who identified as MSM or transgender, above 18 years old, who had anal sex (receptive or insertive) within the last six months and HIV status known to be negative. Data were collected anonymously via a self-completed questionnaire using a tablet. The key outcomes were exploring the awareness, knowledge and willingness to use PrEP among MSM and transgender people in Bali, Indonesia and determining demographic and sexual risk factors associated with knowledge and willingness to use PrEP. Results: A total of 164 participants were recruited into the study but only 124 participants were eligible and were included in the analysis. Of these, 69 out of 124 (55.6%) participants had never heard about PrEP and the mean scores were low in both high-risk and low–risk groups (28.4, 19.1, respectively). Among those 55 (44.4%) participants who had heard about PrEP, education and occupation were the only factors associated with PrEP knowledge. Men with the University education showed higher knowledge scores (29.2) and were more likely to use PrEP compared with men with lower education levels. 73 out of 124 participants (58.9%) were willing to take PrEP in the future and education was the only factor associated with PrEP willingness. Conclusion: This is the first study to report data on awareness, knowledge and willingness to use PrEP in Bali and is only the second such study conducted in Indonesia. Consistent with similar studies in other countries, this study found limited knowledge of PrEP among MSM and transgender participants. As PrEP is not yet publicly available in Indonesia, it is crucially important to prepare the community by education and disseminating accurate information.
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Alves, Clélia Carolina. "Dinâmica do título de anticorpos IgG anti-vírus da raiva na resposta à profilaxia pré-exposição /." Araçatuba, 2019. http://hdl.handle.net/11449/180586.
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Orientador: Cáris Maroni NunesCoorientador: Luzia Helena Queiroz
Banca: Adolorata Aparecida Bianco Carvalho
Banca: Rafael Silva Cipriano
Resumo: A raiva é uma zoonose globalmente distribuída que apresenta alta letalidade, constituindo grande problema em saúde pública. A persistência do vírus da raiva nas populações é mantida devido sua capacidade de se replicar em diversas espécies de mamíferos, incluindo os humanos. O controle da raiva urbana tem se baseado na vacinação de cães e gatos, reservatórios importantes no ciclo urbano, bem como no atendimento de indivíduos após exposição ao vírus da raiva. Adicionalmente, a profilaxia pré-exposição (PrPE) tem sido aplicada em indivíduos que podem ser expostos à infecção, por atividade ocupacional. Objetivando proteger os estudantes ingressantes do Curso de Medicina Veterinária, grupo de risco em potencial para a raiva, a Faculdade de Medicina Veterinária (FMVA) da Unesp, Câmpus Araçatuba, promove anualmente a vacinação em esquema PrPE, seguida de avaliação sorológica, a fim de habituá-los a anualmente verificarem a resposta de anticorpos. Assim, a presente pesquisa teve como objetivo avaliar, por meio de levantamento de dados de PrPE dos arquivos do Serviço de Vigilância Epidemiológica da Secretaria de Saúde da Prefeitura Municipal de Araçatuba, SP, Brasil a adesão à PrPE, a proteção conferida e a dinâmica dos anticorpos (IgG) neutralizantes contra o vírus da raiva, nos estudantes da FMVA durante o período de 2000 a 2017. Foram avaliados 2.404 registros, 86,4% dos quais apresentaram título protetor contra o vírus da raiva (≥0,5UI/mL). A PrPE teve boa adesão pelos estudantes... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Rabies is a globally distributed zoonosis that shows high lethality and is also a major public health problem. Persistence of rabies virus in populations is maintained due to its ability to replicate in several mammals species, including humans. Rabies control has been based on dogs and cats' vaccination, the most important reservoirs in the urban cycle, as well as on the treatment of individuals after exposure to the rabies virus. In addition, pre-exposure prophylaxis (PEPr) has been applied in individuals who might be exposed to infection due to their occupational activities. In order to protect the incoming students of the veterinary medicine course, a group of potential risk for rabies, the School of Veterinary Medicine (FMVA) of Unesp, Araçatuba, SP, Brazil, promotes annual vaccination in a PEPr scheme, followed by a serological evaluation, in order to habituate them to annually check their antibody response. Thus, by analyzing the PEPr data from the archives of the Epidemiological Surveillance Service of the Health Department of Araçatuba, SP, Brazil, during the period from 2000 to 2017, the present study aimed at evaluating the adhesion of the students to the rabies PEPr, the protection conferred by it and the dynamics of the neutralizing IgG antibodies against rabies virus. A total of 2,404 records were evaluated, 86.4% of which presented protective titers against rabies (≥0.5 IU/mL). PEPr had good adhesion by the students, has proved to be effective for generating an... (Complete abstract click electronic access below)
Mestre
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Moore, Brandon James. "Becoming PrEPared: How Stigma and Resources Influence PrEP Uptake among Gay and Bisexual Men." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu1562776093484791.
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Brandão, Roberto Rubem da Silva. "Profilaxia Pré-Exposição ao HIV (PrEP) no contexto do processo de individualização e saúde." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/6/6143/tde-15062018-135509/.
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A Profilaxia Pré-exposição ao HIV (PrEP) é uma nova estratégia de prevenção na qual os indivíduos consomem uma combinação de antirretrovirais diariamente para evitar a aquisição do vírus da AIDS. O objetivo deste estudo foi compreender, a partir da experiência dos usuários de PrEP, a produção do processo de individualização e saúde. Analisou-se o conteúdo de discussões de um grupo de usuários de PrEP, e de pessoas interessadas no assunto, numa rede social virtual com predominância de gays, bissexuais e outros homens que fazem sexo com homens. Os resultados e discussão foram distribuídos em três artigos científicos: o primeiro, discute os conflitos da experiência dos usuários no contexto da sociedade do risco e da individualização. O segundo explora a produção das dimensões do desejo e do prazer sexual - mediados pela PrEP - na vida dos indivíduos. O terceiro, aproxima e discute a experiência dos usuários de PrEP com processos identitários autoproduzidos na individualização contemporânea. As considerações finais, por fim, refletem sobre as implicações às repostas sociais e políticas à epidemia de HIV/AIDS no atual contexto de quimioprofilaxias.HIV Pre-exposure Prophylaxis (PrEP) is a new prevention strategy in which individuals take a daily combination of antiretrovirals in order to prevent acquiring HIV. This study aimed to understand, grounded in PrEP users\' experiences, the production of the individualization process and health. We conducted a discussion-content-analysis of PrEP users, and of interested persons on the subject, in a digital social network. Gays, bisexuals and other Men who have sex with Men accounted for the majority of the group members. Results and discussion were presented in three scientific articles: the first discusses conflicts from the experience of PrEP users in the context of risk society and individualization. The second explores productions of sexual desire and sexual pleasure - mediated by PrEP - on individuals\' lives. The third approaches and discusses PrEP users experiences and self-produced identity processes in contemporary individualization. Final remarks reflects on the implications for social and political responses to the HIV / AIDS epidemic given the current context of chemoprophylaxis.
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Flores, Nicholas. "PrEParing and Producing the Queer Medical Subject: An Ethnographic Account of Race, Ethnicity, Gender, Sexuality, and Class in Columbus, Ohio in the Time of Pre-Exposure Prophylaxis (PrEP)." The Ohio State University, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=osu155715931433105.
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Silva, Karen Aline Batista da. "Caracterização de riscos, profilaxia de tromboembolismo venoso e assistência segura na percepção do enfermeiro." Botucatu, 2019. http://hdl.handle.net/11449/191430.
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Orientador: Carmen Maria Casquel Monti JulianiResumo: Objetivos: caracterizar o risco de tromboembolismo venoso e o uso de profilaxia em pacientes clínicos e cirúrgicos, avaliando a conformidade ou não-conformidade da prescrição de profilaxia medicamentosa e desvelar a percepção dos enfermeiros frente ao uso do protocolo de profilaxia de tromboembolismo venoso. Métodos: Estudo descritivo, com abordagem multimétodos ou método misto, utilizando técnicas quantitativas (estudo transversal) e qualitativas (fenomenologia), com a finalidade de realizar a interação entre os métodos, fornecendo melhores possibilidades analíticas. Resultados: A taxa global de profilaxia de tromboembolismo venoso foi 70% e os pacientes clínicos apresentaram maior conformidade de prescrição de profilaxia em relação ao protocolo e a quantidade de fatores de risco/pacientes foi maior em pacientes clínicos em relação aos cirúrgicos. Os enfermeiros costumam preencher o protocolo no momento da admissão do paciente e, quando não conseguem, informam a necessidade durante passagem do plantão. Há um consenso entre os enfermeiros que médicos fixos nos setores prescrevem mais adequadamente a medicação profilática em relação aos rotativos. Conclusão: Para que todos os usuários se beneficiem da profilaxia, é necessária educação permanente/continuada associada a estratégias para envolvimento da equipe multiprofissional, além de divulgação maciça do protocolo de profilaxia de tromboembolismo venoso, a fim de diminuir as lacunas do conhecimento e instrumentalizar as equipe... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Objectives: To characterize the risk of venous thromboembolism and the use of prophylaxis in clinical and surgical patients, to evaluate a measure or non-compliance of prescribing medication prophylaxis and to develop nurses' perceptions regarding the use of venous prophylaxis protocol. Methods: Descriptive study with a multimedia approach or method, using quantitative (cross-sectional) and qualitative (phenomenology) techniques, using an interaction between methods, providing better analytical alternatives. Results: An overall rate of venous thromboembolism prophylaxis was 70% and clinical patients with a higher prevalence of prophylaxis prescription compared to the protocol and a number of risk factors / patients were the highest in clinical patients compared to physicians. Nurses usually complete the protocol at the time of patient admission and, when unable to do so, provide the necessary information during the passage of planting. There is a consensus among nurses that doctors fix in the prescribed sectors more that use prophylactic medication in relation to rotary ones. Conclusion: For all users who benefit from prophylaxis, it is mandatory / continued associated with multiprofessional team participation strategies, in addition to the massive dissemination of venous thromboembolism prophylaxis protocol, an end of loss as knowledge gaps and to instrumentalize as teams with the specific practice in using.
Doutor
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Davalos, Soria Diana Evening, and Chiyón María Arantxa Mares. "Profilaxis preexposición y desarrollo de resistencia a los inhibidores nucleósidos de la transcriptasa reversa: revisión sistemática." Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2020. http://hdl.handle.net/10757/654716.
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Objetivo: sintetizar la evidencia acerca de la resistencia a inhibidores nucleósidos de la transcriptasa reversa (NRTI) en personas que reciben PrEP.
Métodos: se realizó una revisión sistemática de estudios experimentales. Se incluyeron estudios que comparaban el uso de PrEP frente a placebo o su no uso en población de riesgo para la infección de VIH; siendo el outcome evaluado el desarrollo de resistencia a NRTI. La selección de artículos y la extracción de datos fueron realizadas por dos revisores de manera independiente. Se realizó un metaanálisis de efectos aleatorios tanto de manera total como en subpoblaciones y según el momento de seroconversión. Para valorar el riesgo de sesgo se utilizó herramienta Risk of Bias 2.0 (RoB 2.0). Se usó como referencia el Software Review Manager 5.
Resultados: se incluyeron nueve artículos correspondientes a seis estudios. Se encontró que el uso de PrEP no incrementa el riesgo de resistencia a TDF/FTC en la población total que recibió la intervención, haya o no presentado la infección. Sin embargo, en el grupo que seroconvirtió sí se encontró un mayor riesgo de resistencia en los que usaron PrEP (RR: 2,76; IC95%: 1,22 a 6,26; I2: 0%); el cual correspondía sólo al grupo que tenía infección por VIH latente al momento de iniciar la intervención (RR: 3,91; IC95%: 1,30 a 1,70; I2: 0%).
Conclusiones: el uso de PrEP no incrementa el riesgo de resistencia a TDF/FTC en el total de usuarios, pero sí en pacientes con infección latente por el VIH al enrolamiento.Objective: Synthesize the evidence on the development of nucleoside reverse transcriptase inhibitor (NRTI) resistance in people receiving PrEP for the prevention HIV. Methods: We conducted a systematic review of experimental studies, we carried-out a search in electronic databases, as well as a gray literature search. We included studies comparing the use of PrEP against placebo or nothing, in the population at risk of HIV infection; the outcome evaluated was the development of NRTI resistance. The selection of articles and the extraction of data were carried out by two reviewers independently. A meta-analysis of random effects was carried-out for the global populations as well as a sub-analysis according to the risk group and the time of seroconversion. We used The Review Manager 5 Software. Results: We included nine articles corresponding to six studies. We found that the use of PrEP does not increase the risk of resistance to TDF/FTC in the total of population who received the intervention. But, in the group that seroconverted, we found that the use of PrEP increases the risk of resistance (RR: 2,76; IC95%: 1,22 a 6,26; I2: 0%); this risk mainly corresponds to the group that had a latent HIV infection at the time of initiating the intervention (RR: RR: 3,91; IC95%: 1,30 a 1,70, I2: 0%). Conclusions: The use of PrEP does not increase the risk of resistance to TDF / FTC in the total of PrEP users, but it does in patients with latent HIV infection upon enrollment.
Tesis
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Vieira, Vinicius Adriano. "Avaliação da ativação de linfócitos T em indivíduos com infecção anorretal assintomática por Chlamydia trachomatis e/ou Neisseria gonorrhoeae em uma população de homens que fazem sexo com homens." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/5/5146/tde-31012018-083320/.
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A profilaxia pré-exposição (PrEP) ao HIV se consolidou como uma importante estratégia de combate ao avanço da epidemia. Ainda assim, a incidência de casos da infecção vem aumentando na população jovem, assim como a de outras infecções sexualmente transmissíveis (ISTs), que atuam como importante fator de risco para transmissão do HIV-1. Entre as infecções mais frequentemente diagnosticadas estão Chlamydia trachomatis (CT) e Neisseria gonorrhoeae (NG). A presença de lesões na mucosa genital e anal são fatores de risco estabelecidos para a transmissão do HIV-1, porém o impacto das infecções assintomáticas ainda é pouco conhecido. Dados recentes mostram que a ativação sistêmica de linfócitos T é um fator de risco para a aquisição da infecção pelo HIV-1. Nesse estudo, estudamos a ativação de linfócitos T na presença de infecção anorretal assintomática por CT e/ou NG. Células mononucleares do sangue periférico de voluntários do PrEP Brasil, um estudo clínico demonstrativo de PrEP ao HIV em homens que fazem sexo com homens, foram descongeladas para análise da ativação de linfócitos T. Trinta e quatro participantes com swab anorretal positivo para CT e/ou NG foram selecionados, enquanto assintomáticos e negativos para outras ISTs. Trinta e cinco controles foram selecionados randomicamente. Encontramos uma maior frequência de linfócitos T CD8+ HLA-DR+CD38+ (1,5 vs. 0,9% p < 0,005) no grupo com infecção assintomática. Os linfócitos T CD8+ de memória também apresentaram uma maior expressão dos marcadores de ativação. Os marcadores de exaustão e senescência foram significantemente mais expressos no grupo com a infecção. Não foi observado aumento ou diferença nos níveis de CD14 solúvel no plasma. Nossos achados demonstram que as infecções anorretais assintomáticas por CT e NG induzem a ativação sistêmica de linfócitos T CD8+. Considerando a alta prevalência dessas infecções e o risco associado de aquisição da infecção pelo HIV-1, o rastreamento periódico e o tratamento sistemático devem sem explorados em conjunto com as estratégias de prevenção ao HIVOral antiretroviral pre-exposure prophylaxis (PrEP) has been established as a pivotal strategy in the prevention against HIV epidemic. However, the incidence of HIV-1 infections has been rising among the youth, as well as other sexually transmitted infections (STIs), acting as an important risk factor for HIV-1 acquisition. Infection by Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are among the most diagnosed. Although the presence of mucosal lesions is a known risk factor for HIV-1 acquisition, the potential increase in risk associated with asymptomatic STIs is not completely understood. Recent data defined higher T cell activation as a single risk factor for sexually acquired HIV-1 infection. We examined the effect of asymptomatic CT and/or NG anorectal infection on immune activation. Peripheral blood mononuclear cells from participants of PrEP Brasil, a study of daily oral PrEP among healthy men who have sex with men, were analyzed for T cell activation by flow cytometry. Thirty-four participants with positive anorectal swab for CT and/or NG were selected, while negative for other STIs and without any reported symptoms. Thirty-five controls were randomly selected. We found a higher frequency of CD8+ HLA-DR+CD38+ T cells (1.5 vs. 0.9% p < 0.005) in the group with CT and/or NG infection and a greater median proportions of activation markers expression in CD8+ T cells with memory phenotype. Exhaustion and senescence markers were also significant higher in the infected group. No difference was observed in the soluble CD14 levels. Our findings suggest that asymptomatic CT and NG anorectal infection lead to a systemic activation of the T cell compartment. Considering the high prevalence of asymptomatic infection and the risk of HIV-1 acquisition associated, regular screening and treatment should be explored as an adjuvant tool for HIV prevention
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Grilo, Francisco Miguel da Costa. "HIV pre-exposure prophylaxis (PrEP): strategy with future?" Master's thesis, 2018. https://hdl.handle.net/10216/114416.
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Grilo, Francisco Miguel da Costa. "HIV pre-exposure prophylaxis (PrEP): strategy with future?" Dissertação, 2018. https://hdl.handle.net/10216/114416.
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Afassinou, Komi. "Mathematical analysis of pre-exposure prophylaxis on HIV infection." Thesis, 2012. http://hdl.handle.net/10413/10602.
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We develop a mathematical model which seeks to assess the impact of HIV Pre-Exposure
Prophylaxis (PrEP) on the prevalence and incidence of HIV infection. Mathematical analysis
of the model is carried out to establish the threshold conditions that determine the stability of
the steady states. Numerical simulations are performed to gain insight into the use and e cacy
of PrEP. Results from our model reveal that the basic reproduction number is a function of the
rate at which individuals use PrEP and the rate at which PrEP protects individuals from HIV
infection. Furthermore, strategies where either PrEP awareness or PrEP e cacy was low show
potential loop-holes that can lead to more complications than bene ts. The best strategies
revealed by our results is that a high level of awareness and high PrEP e cacy are needed.Thesis (M.Sc.)-University of KwaZulu-Natal, Westville, 2012.
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Nunes, Rute Sofia Gonçalves. "Nanotechnology-based strategies for rectal anti-HIV pre-exposure prophylaxis." Doctoral thesis, 2018. https://repositorio-aberto.up.pt/handle/10216/117712.
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Nunes, Rute Sofia Gonçalves. "Nanotechnology-based strategies for rectal anti-HIV pre-exposure prophylaxis." Tese, 2018. https://repositorio-aberto.up.pt/handle/10216/117712.
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Simpson, Lindsay. "Dynamics of an HIV/AIDS Model that Incorporates Pre-exposure Prophylaxis." 2015. http://hdl.handle.net/1993/30679.
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This thesis is based on the use of mathematical theories, modelling, and simulations to study the transmission dynamics of HIV/AIDS in the presence of PrEP (pre-exposure prophylaxis) in the MSM (men who have sex with men) population in the United States. A new deterministic model for HIV/AIDS that incorporates PrEP is designed and used to assess the population-level impact of the use of PrEP on the transmission dynamics within an MSM population. Conditions for the effective control (or elimination) and persistence of HIV/AIDS in the MSM population are determined by rigorously analyzing this model. Uncertainty and sensitivity analysis is carried out to determine the effect of the uncertainties in the parameter values on the response variable (the associated reproduction number) and to identify the top-five parameters that have the most effect on the disease transmission dynamics. Numerical simulations show that HIV burden decreases with increasing PrEP coverage.October 2015
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McHugh, Holly. "Pre-exposure prophylaxis: primary prevention of HIV in at-risk populations." Thesis, 2016. https://hdl.handle.net/2144/19445.
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It is estimated that 50,000 individuals become newly infected with human immunodeficiency virus (HIV) every year in the United States. HIV is a lentivirus that is primarily spread through sexual contact. If left untreated, this viral infection can lead to decreased CD4+ T cells, increased susceptibility to opportunistic infections, and eventually progression to acquired immunodeficiency syndrome (AIDS) and death. HIV viral loads can be decreased to undetectable levels with the use of combination antiretroviral therapy (cART).
In 2012 the Food and Drug Administration approved cART therapy, Truvada (tenofovir/emtricitabine), for safe use as pre-exposure prophylaxis (PrEP). When detectable levels of drug are present in the blood stream of patients, there is up to a 92% relative risk reduction in HIV infection compared to placebo. The implementation of PrEP has the potential to decrease the incidence of new HIV infections in at-risk populations worldwide.
Because PrEP treatment is relatively new (2012), there are many barriers to administration to patients. Increased risky sexual behavior, known as risk compensation, is one of the concerns providers cite as a reason against prescribing PrEP. Most publications on PrEP have described randomized controlled trials that focused on safety, efficacy, and to a lesser extent, risk compensation behaviors. Now that Truvada is widely available, researchers are starting to elucidate patients’ sexual habits while using PrEP in the outpatient settings. However, there is a need for more longitudinal research regarding the behaviors of individuals using PrEP, specifically to determine how often risk compensation occurs and under what conditions.
This study will initiate a PrEP clinic at Boston Medical Center and run a 3 year, open-label randomized controlled trial of eligible men who have sex with men (MSM) patients, who either start PrEP immediately or are delayed by one year. It is hypothesized that condom usage will decrease among immediate PrEP participants compared to the delayed participants. The study aims to determine if risk compensation occurs in these patients by following condom usage, development of sexually transmitted infections, number of sexual partners, and number/type of sexual encounter. Secondary outcomes will include measurements of medication adherence and number of HIV-seroconverters. These data will be collected through surveys and laboratory testing. The resulting information will help medical professionals better understand the risks and benefits of PrEP and also how to implement it most effectively in the fight to reduce the worldwide HIV burden.
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Wu, Huei-Jiuan, and 吳慧娟. "HIV Pre-Exposure Prophylaxis for Men Who Have Sex with Men in Taiwan: A Mathematical Modeling Study." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/24757060478623395698.
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碩士國立臺灣大學
流行病學與預防醫學研究所
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Background: Men who have sex with men (MSM) are disproportionally affected by the HIV epidemic. There are now around 2,000 new MSM-HIV cases annually in Taiwan, under current HIV testing rate and antiretroviral therapy (ART) coverage. More effective strategy is urgently required to control the HIV epidemic in this vulnerable population. Both PROUD (2015) and IPERGAY (2015) studies demonstrated an 86% efficacy of PrEP, twice better than the 44% efficacy reported by the earlier iPrEX (2010) study. Therefore, previous modeling studies, which were based on iPrEX data, might under-estimated the actual impact of scaling-up PrEP among MSM. We aimed to evaluate the impact and cost-effectiveness of scaling-up PrEP on the MSM-HIV epidemic in Taiwan. Methods: We used the newest HIV surveillance and follow-up data to calibrate our HIV dynamic transmission model for MSM in Taiwan. We simulated the impact of scaling-up PrEP, Test-and-Treat, or both, on the future trajectory of HIV epidemic in MSM. We evaluate whether scaling-up PrEP will eliminate the MSM-HIV epidemic (incidence lower than 1/1000 per year, World Health Organization) in Taiwan, and whether such intervention is cost-effective. Findings: Scaling-up PrEP to 50% coverage or more will eliminate HIV among MSM by 2025. Annual HIV testing followed by immediate ART after HIV diagnosis in 90% of new cases will eliminate HIV epidemic by 2022. PrEP and Test-and-Treat are synergistic: if we target 15- to 44-year-old high-risk group, then 25% PrEP coverage in this group is sufficient to eliminate HIV epidemic by 2030 under biannual HIV testing followed by immediate ART in 75% of new cases. Cost analysis shows that NT$11.2 medical costs can be saved for every NT$1 spent on PrEP. Sensitivity analyses showed that efficacy of PrEP drug is the key factor for its role in HIV elimination, while method of administration (event-driven) and prioritization (high-risk group) are the key factors for its cost-effectiveness. Interpretation: PrEP is a highly effective HIV prevention strategy, and is cost-saving. Our results support the simultaneous expansion of both PrEP and HIV “Test-and-Treat” in Taiwan, with the aim to eliminate HIV epidemic among MSM in the next 10 years.
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Kintu, Alexander. "The Association between Sexual Behavior and Adherence to Hiv Pre-exposure Prophylaxis Medication in Hiv Serodiscordant Couples." 2013. https://scholarworks.umass.edu/theses/1131.
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High levels of adherence have been identified as a key factor for effective pre-exposure prophylaxis medication (PrEP). Because PrEP is a new concept in HIV prevention, there are limited data on predictors of adherence, though initial findings indicate that sexual behavior could be an influencing factor. This study examines different aspects of sexual behavior and their associations with monthly rates and patterns of adherence.
We enrolled 1147 HIV-negative individuals living in long-term serodiscordant relationships at three sites in Uganda. Sexual behavior was assessed via monthly in-person interviews and adherence was measured through electronic monitoring of pill bottle openings. We used generalized estimation equations to adjust for risk factors of low adherence to PrEP medication.
Fifty-three percent of participants were male, 51% were aged between 18 and 34 years, the median number of years they had lived with the HIV-positive partner was 8.5 years and 24.2% were in polygamous relationships. Participants who had sex with other partners and also had less than 100% use of condoms were more than twice as likely to have less than 80% adherence (OR=2.48, 95%CI=1.70-3.62). Per electronic monitoring, 54.7% of cohort participants had at least one 72-hour consecutive gap in adherence. Participants who had sex with other partners and were also had also reported less than 100% use of condoms had a 50% increase in odds of having a 72-hour gap in adherence (OR=1.50, 95%CI=1.19-31.91).
Low overall adherence and extended gaps in adherence were more common in participants that abstained from sex and those that reported sex outside their primary partnership. Despite high monthly adherence rates, many study participants had long periods of non-adherence during which they engaged in risky sexual behavior with potential for HIV acquisition.
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Nurani, Alykhan. "HIV risk and attitudes toward PrEP among MSM-PWID in the U.S. Northeast." Thesis, 2020. https://hdl.handle.net/2144/41340.
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BACKGROUND: Although the total number of new documented HIV diagnoses annually decreased from 2008-2018, the rate of decrease started to slow in 2013, and substantial variation exists across at-risk groups. People who inject drugs (PWID) account for 9% of new diagnoses annually, with increasing incidence in this population starting in 2015. Among PWID, 34% of new HIV diagnoses occurred in individuals who were also classified as men who have sex with men (MSM), indicating that MSM-PWID have elevated HIV risk. Data on MSM-PWID are scarce, and programmatic and advocacy efforts in HIV prevention do not specifically target MSM-PWID, with no CDC-recommended interventions existing for this population.
OBJECTIVE: We sought to characterize the complex, intersecting and unique HIV risks faced by MSM-PWID, including perceptions of HIV risk and attitudes toward antiretroviral pre-exposure prophylaxis (PrEP) among MSM-PWID in urban and non-urban areas of Massachusetts and Rhode Island.
METHODS: We recruited PWID through community-based organizations (CBOs; e.g. syringe service programs) in 18 urban centers and smaller cities and towns across Massachusetts and Rhode Island. Participants completed semi-structured interviews exploring substance use behaviors and HIV prevention needs. This in-depth analysis focused on describing the experiences and HIV prevention needs and attitudes of nine participants in the sample who reported a sexual orientation other than “heterosexual.”
RESULTS: Most participants identified as cisgender, bisexual men. However, the context of their sexual behaviors varied, with some participants only engaging in same-sex behavior during sex work. The relationship between identity and behavior is explored in the context of reported risk behavior. All participants engaged in at least one behavior that increased risk of HIV acquisition, including syringe sharing, inconsistent condom use, and sex work. Participants also described heightened risk when these behaviors overlapped, particularly within contexts of “sex parties” that some individuals described. At the same time, experiences of isolation and exclusion were common in the sample, indicating a potential vulnerability in this population. HIV risk perception varied among participants, but was not consistently aligned with the behaviors described. Many participants did not perceive needing HIV prevention services “yet,” indicating that they did not view their risk to be high enough to warrant prevention services. Alternatively, some described needing to prioritize daily survival and mental health over HIV prevention efforts. Although knowledge of PrEP was low, acceptability of PrEP was high in this sample, and several participants provided specific suggestions for improving the feasibility of PrEP.
CONCLUSION: Data from this study illustrate the HIV risks and prevention needs of this at-risk population and highlight mechanisms to engage them in preventative care. Our main findings are (1) participants had low knowledge of PrEP, but were largely enthusiastic after learning about it from interviewers, (2) varying identity related to same-sex behavior among men who have sex with men and inject drugs may play a role in shaping HIV risk and prevention needs, (3) specific healthcare and prevention service needs of this population emerged, including reducing risk at sex parties and improving access to non-stigmatizing mental health services. An in-depth understanding of the ways in which sexual orientation and gender identity shape HIV risk and prevention needs remains crucial in providing treatment and prevention services to MSM-PWID.
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Shaaban, Ahmed Mohamed Nabil Aly. "Eligibility for HIV Pre-Exposure Prophylaxis among men who have sex with men: portuguese, portuguese migrants and migrants in Portugal." Master's thesis, 2015. https://repositorio-aberto.up.pt/handle/10216/79962.
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Shaaban, Ahmed Mohamed Nabil Aly. "Eligibility for HIV Pre-Exposure Prophylaxis among men who have sex with men: portuguese, portuguese migrants and migrants in Portugal." Dissertação, 2015. https://repositorio-aberto.up.pt/handle/10216/79962.
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Robinson, Davis Suzanne. "Motivations to either accept or reject pre-exposure prophylaxis: awareness, beliefs, and risk perceptions among African American women in New York City." Thesis, 2018. https://doi.org/10.7916/D8QZ3TDN.
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The world has suffered immensely and disproportionately from the ravages of HIV and AIDS. Oral PrEP is a single pill taken once daily that can reduce the risk of sexually transmitted HIV infection by up to 92% (CDC, 2014a).
This study describes African American females’ awareness, beliefs, and perception of PrEP and identifies factors that may motivate women to either accept or reject PrEP. This cross-sectional study occurred over a 3-month period from November 2017 to January 2018, following from a previous pilot study. The sample comprised African American women aged 18 and over receiving STD or HIV screening services at a FQHC in Brooklyn, New York. Women were interviewed using the five characteristics of the Diffusion of Innovation theory and also completed a risk assessment for HIV using CDC recommended guidelines for screening heterosexual women for PrEP.
Awareness of PrEP remained extremely low among the 72 African American women interviewed in the study. Using the CDC guidelines, all women reported one or more risk factors for PrEP indication. Awareness about PrEP, negative reactions from partners and shared experiences from female PrEP users were cited as factors that may predict and motivate African American women to use PrEP. Additionally, skills in pill-taking, cost and insurance, and maintaining privacy while using PrEP were strong enabling factors to support PrEP use. Factors such as initiating couple’s PrEP use as an intervention, medical doctors overtly directing PrEP for women, and the role of older women in promoting PrEP use were persuasive factors in reinforcing the utilization of PrEP among African American women in the study.
Creative programming within high burden communities is critically important to penetrate with messages of new innovations and best practices. The results of the current research speak volumes to the continued work needed to educate communities with prevention messages.
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Nyasulu, Derick Mac Donald. "Exploring the attitude and knowledge (s) of HIV prevention of young, internal ( South African) migrant, Black men who self-identify as gay in Johannesburg: implications for the development of South Africa's Pre Exposure Prophylaxis (PrEP) Programme." Thesis, 2017. https://hdl.handle.net/10539/24568.
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The World Health Organisation Commission for the Social Determinants of Health (CSDH, 2008) report calls upon the need to consider the social determinants of health, including migration in health planning. Unfortunately, the introduction of Pre Exposure Prophylaxis (PrEP) in South Africa is being framed as a stand-alone intervention without incorporating the social determinants of health i.e. migration and structural drivers of HIV, despite numerous evidence of failure of one-dimensional HIV approaches. The study aimed to explore the attitudes and knowledge (s) of HIV prevention amongst young, internal migrant, Black self-identifying gay men and its implications for PrEP.
This study used an interpretive qualitative approach by conducting 12 in-depth interviews with both men who have sex with men (MSM) who self-identify as gay individuals and experts working in the field of HIV. Social determinants of health like migration and homophobic attitudes both within the health care system and beyond could impact the uptake of PrEP and continuity access for PrEP among MSM who self-identity as gay within the context of circular migration. Likewise, the study highlights structural drivers of HIV that if left unaddressed could also have a bearing on PrEP as an HIV intervention vis-à-vis PrEP uptake and continuity to PrEP access within a context of circular migration.
Using Weiss (1979) interactive model, the study points out the need for all actors involved in policy making to take into account evidence, such as empirical data, best practices, insights from various stakeholders as a basis upon which South Africa’s PrEP policy/programme can be based on.A research report submitted to the Faculty of Humanities, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Arts (Development Studies), November 2017
GR2018