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Augusto GF, Hodges-Mameletzis I, Karanikolos M, Abrantes A, Martins MRO. HIV prevention and treatment in Southern Europe in the aftermath of bailout programmes. Eur J Public Health 2021; 30:967-973. [PMID: 32363377 DOI: 10.1093/eurpub/ckaa062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The global financial crisis impacted public health in Europe, and had a particularly critical detriment to health systems in Southern Europe. We aim to describe HIV response and progress towards the current global HIV targets in specific Southern European countries, which received financial adjustment programmes. METHODS We examined and compared a set of HIV indicators in Cyprus, Greece, Portugal and Spain. The indicators included: (i) HIV epidemiology; (ii) adoption of WHO's 'Treat All' recommendation; (iii) progress towards the UNAIDS global targets of 90-90-90; (iv) adoption/implementation of pre-exposure prophylaxis (PrEP); and (v) adoption/implementation of WHO's HIV self-testing (HIVST) recommendation. RESULTS HIV incidence varied across countries since 2010, with sustained declines in Portugal and Spain, and marked increases in Greece and Cyprus. By 2016, all four countries have adopted WHO's 'Treat All' recommendation, leading to a marked increase in people receiving ART. Improvements were seen in all 90-90-90 targets, with Portugal achieving those in 2017, but Greece lagging somewhat behind, as of 2016. Portugal and Spain have also started implementing PrEP, and Greece has completed a pilot with no additional access to PrEP for pilot participants and no national programme in place. Cyprus has been the slowest in terms of adopting PrEP and HIVST. CONCLUSIONS Countries need to focus on prioritizing effective and comprehensive prevention measures, including HIVST and PrEP, and scale-up access to quality treatment and care for those diagnosed, in order to accelerate the reduction of new HIVs infections and successfully meet the global targets for HIV treatment.
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Affiliation(s)
- Gonçalo F Augusto
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical - Universidade NOVA de Lisboa (IHMT-UNL), Lisbon, Portugal
| | | | - Marina Karanikolos
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
| | - Alexandre Abrantes
- Department of Health Policy and Administration, Escola Nacional de Saúde Pública - Universidade NOVA de Lisboa (ENSP-UNL), Lisbon, Portugal
| | - Maria R O Martins
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical - Universidade NOVA de Lisboa (IHMT-UNL), Lisbon, Portugal
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Iniesta C, Coll P, Barberá MJ, García Deltoro M, Camino X, Fagúndez G, Díaz A, Polo R. Implementation of pre-exposure prophylaxis programme in Spain. Feasibility of four different delivery models. PLoS One 2021; 16:e0246129. [PMID: 33556085 PMCID: PMC7870089 DOI: 10.1371/journal.pone.0246129] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective and cost-effective strategy for HIV prevention. Spain carried out an implementation study in order to assess the feasibility of implementing PrEP programmes within its heterogeneous health system. METHODS Observational longitudinal study conducted on four different types of health-care setting: a community centre (CC), a sexually transmitted infections clinic (STIC), a hospital-based HIV unit (HBHIVU) and a hospital-based STI unit (HBSTIU). We recruited gay, bisexual and other men who have sex with men (GBSM) and transgender women at risk of HIV infections, gave them PrEP and monitored clinical, behavioural PrEP-related and satisfaction information for 52 weeks. We collected perceptions on PrEP implementation feasibility from health-care professionals participating in the study. RESULTS A total of 321 participants were recruited, with 99.1% being GBMSM. Overall retention was 87.2% and it was highest at the CC (92.6%). Condom use decreased during the study period, while STIs did not increase consistently. The percentage of people who did not miss any doses of PrEP during the previous week remained at over 93%. No HIV seroconversions occurred. We observed overall decreases in GHB (32.5% to 21.8%), cocaine (27.5% to 21.4%), MDMA (25.7% to 14.3%), speed (11.4% to 5.7%) and mephedrone use (10.7% to 5.0%). The overall participant satisfaction with PrEP was 98.6%. Health-care professionals' perceptions of PrEP feasibility were positive, except for the lack of personnel. CONCLUSIONS PrEP implementation is feasible in four types of health-care settings. Local specificities have to be taken into consideration while implementing PrEP.
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Affiliation(s)
- Carlos Iniesta
- Spanish HIV/AIDS Research Network, National Centre of Epidemiology, Health Institute Carlos III, Madrid, Spain
- National AIDS Programme, Ministry of Health, Madrid, Spain
| | - Pep Coll
- BCN Checkpoint, Barcelona, España
| | - María Jesús Barberá
- STI Unit Vall d´Hebron-Drassanes, Infectious Diseases Department, University Hospital Vall d’Hebron, Barcelona, Spain
| | - Miguel García Deltoro
- Infectious Disease Service, Consortium General University Hospital of Valencia, Valencia, Spain
| | - Xabier Camino
- Infectious Disease Service, University Hospital of Donostia, San Sebastian, Spain
| | | | - Asunción Díaz
- HIV and STI Surveillance Unit, National Centre of Epidemiology, Health Institute Carlos III, Madrid, Spain
| | - Rosa Polo
- National AIDS Programme, Ministry of Health, Madrid, Spain
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Knowledge, Attitudes, and Intentions towards HIV Pre-Exposure Prophylaxis among Nursing Students in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197151. [PMID: 33003632 PMCID: PMC7578937 DOI: 10.3390/ijerph17197151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 11/17/2022]
Abstract
Human immunodeficiency virus (HIV) infection is one of the main causes of morbidity and mortality worldwide. Among the preventive approaches proposed to control this disease is pre-exposure prophylaxis (PrEP), whose effectiveness depends on the medication adherence. The aim of the present study was to determine the knowledge and attitudes about PrEP among a sample of Spanish nursing students as well as their intentions of receiving it in case it was indicated. An observational cross-sectional descriptive study was carried out. A total of 570 nursing students from the University of Santiago de Compostela (Spain), ≥18 years old and of both sexes were invited to self-complete a questionnaire between February and March 2020. A total of 352 students decided to participate in the study. Participants had low knowledge [overall knowledge score 1(0-2)] and a neutral attitude towards PrEP. The intention of receiving PrEP improved significantly after the completion of the questionnaire and the administration of information about PrEP (p = 0.039; before: 23.58% and after: 93.77%). Nursing staff play an important role in the prevention of sexually transmitted diseases, so their training in preventive strategies, such as PrEP, could help to reduce the incidence of new cases of HIV infection.
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Iniesta C, Álvarez-del Arco D, García-Sousa LM, Alejos B, Díaz A, Sanz N, Garrido J, Meulbroek M, Pujol F, Moreno S, Fuster-Ruiz de Apocada MJ, Coll P, Antela A, del Romero J, Ayerdi O, Riera M, Hernández J, del Amo J. Awareness, knowledge, use, willingness to use and need of Pre-Exposure Prophylaxis (PrEP) during World Gay Pride 2017. PLoS One 2018; 13:e0204738. [PMID: 30339690 PMCID: PMC6195256 DOI: 10.1371/journal.pone.0204738] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/13/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the awareness, knowledge, use, and willingness to use and need of PrEP among men who have sex with men (MSM) and transgender women (TW) who attended World Gay Pride (WGP) 2017 in Madrid. DESIGN AND METHODS Online survey. Participants were recruited through gay-oriented dating apps and HIV Non-Governmental Organizations´ social media. Inclusion criteria included being MSM or TW, age 18 years old or above, and having attended WGP in Madrid. Information regarding the participant's awareness and knowledge, use or willingness to use, and need for PrEP was collected, as well as sociodemographic characteristics. Participants were considered to be in need of PrEP if they met one of the following indication criteria: having practiced unprotected anal intercourse with more than 2 partners, having practiced chemsex, or having engaged in commercial sex-all in the preceding 6 months. Descriptive and multivariable analyses with logistic regression were conducted. RESULTS 472 participants met the inclusion criteria and completed the questionnaire. The mean age was 38, 97.7% were MSM, 77% had a university education, and 85% were living in Spain, mostly in big cities. Overall, 64% of participants were aware of PrEP, but only 33% knew correctly what PrEP was. 67% of HIV-negative participants were willing to take PrEP, although only 5% were taking it during WGP, mostly due to lack of access. 43% of HIV-negative respondents met at least one PrEP indication criteria. For HIV-negative men living in Spain, university education and living in big cities was associated with PrEP awareness. Lower education level and meeting PrEP criteria was associated with willingness to use PrEP. CONCLUSIONS Our study shows that among MSM attending WGP 2017 in Madrid, there was limited PrEP awareness, low accuracy of PrEP knowledge, and a high need and willingness to use PrEP. Health authorities should strengthen existing preventive strategies and implement PrEP.
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Affiliation(s)
- Carlos Iniesta
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Débora Álvarez-del Arco
- Universidad Complutense de Madrid, Madrid, Spain
- La Doctora Álvarez Communication Agency, Madrid, Spain
| | | | - Belén Alejos
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | - Asunción Díaz
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
| | | | | | | | - Ferran Pujol
- Projecte dels NOMS, Hispanosida, Barcelona, Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Madrid, Spain
- Universidad Alcalá de Henares, Madrid, Spain
| | | | - Pep Coll
- AIDS Research Institute-IrsiCaixa, Barcelona, Spain
| | - Antonio Antela
- Hospital Clinico Universitario de Santiago de Compostela, Infectious Diseases Department, Santiago de Compostela, Spain
| | | | - Oskar Ayerdi
- Centro Sanitario Sandoval IdISSC, Unidad ITS/VIH, Madrid, Spain
| | | | - Juanse Hernández
- Grupo de Trabajo sobre Tratamientos del VIH -gTt-VIH, Barcelona, Spain
| | - Julia del Amo
- National Center of Epidemiology, Carlos III Health Institute, Madrid, Spain
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