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Houser KV, Happe M, Bean R, Coates EE. Vaccines. Clin Immunol 2023. [DOI: 10.1016/b978-0-7020-8165-1.00087-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
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Sudler A, Cournos F, Arnold E, Koester K, Riano NS, Dilley J, Liu A, Mangurian C. The case for prescribing PrEP in community mental health settings. Lancet HIV 2021; 8:e237-e244. [PMID: 33493438 DOI: 10.1016/s2352-3018(20)30273-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/04/2020] [Accepted: 10/08/2020] [Indexed: 11/27/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical HIV prevention modality that is up to 99% effective in preventing HIV acquisition through sex if taken as directed. People with serious mental illness (eg, schizophrenia and bipolar disorder) are at high risk of acquiring HIV due to sexual behaviours, injection drug use, social factors, and structural discrimination that limits access to all types of preventive health services. We seek to show the importance of prioritising access to PrEP for people living with serious mental illness treated in community mental health settings. We describe barriers to prescribing PrEP, including provider attitudes and provider knowledge gaps, patient attitudes and knowledge, and systems issues. We also address the concerns that community mental health clinic administrators might have about taking on the responsibility of offering PrEP. In summary, despite the barriers to prescribing PrEP in these settings, we believe that there is a unique opportunity for community mental health settings to help address the HIV epidemic by facilitating the prescribing of PrEP to the at-risk populations they currently serve.
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Affiliation(s)
- Andrew Sudler
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA; Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Francine Cournos
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, USA; Mailman School of Public Health, Columbia University, New York, NY, USA; Northeast/Caribbean AIDS Education and Training Center, New York, NY, USA
| | - Emily Arnold
- Department of Medicine, University of California, San Francisco, CA, USA; Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Kimberly Koester
- Department of Medicine, University of California, San Francisco, CA, USA; Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Nicholas S Riano
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - James Dilley
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Alliance Health Project, University of California, San Francisco, CA, USA
| | - Albert Liu
- Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA
| | - Christina Mangurian
- Department of Psychiatry, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA; Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA; Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, USA.
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Crosby RA. Dealing with pre-exposure prophylaxis-associated condom migration: changing the paradigm for men who have sex with men. Sex Health 2019; 14:106-110. [PMID: 27585107 DOI: 10.1071/sh16128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 07/29/2016] [Indexed: 11/23/2022]
Abstract
The behavioural aspects of pre-exposure prophylaxis (PrEP) are challenging, particularly the issue of condom migration. Three vital questions are: (1) at the population-level, will condom migration lead to increases in non-viral sexually transmissible infections?; (2) how can clinic-based counselling best promote the dual use of condoms and PrEP?; and (3) in future PrEP trials, what are the 'best practices' that should be used to avoid type 1 and type 2 errors that arise without accounting for condom use behaviours? This communication piece addresses each question and suggests the risk of a 'PrEP only' focus to widening health disparities.
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Affiliation(s)
- Richard A Crosby
- College of Public Health at the University of Kentucky, 151 Washington Avenue, Lexington, KY 40506-0003, USA
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Blaylock JM, Hakre S, Decker CF, Wilson B, Bianchi E, Michael N, Beckett C, Okulicz J, Scott PT. HIV PrEP in the Military: Experience at a Tertiary Care Military Medical Center. Mil Med 2019; 183:445-449. [PMID: 29635556 DOI: 10.1093/milmed/usx143] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 12/22/2017] [Indexed: 01/15/2023] Open
Abstract
Objectives We evaluated human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) administration at the Walter Reed National Military Medical Center (WRNMMC), which serves a geographic area at high risk of HIV infection. Methods Medical records were reviewed for all patients initiating PrEP at WRNMMC from November 1, 2013, to March 30, 2016. Demographic, laboratory, clinical, and risk exposure characteristics and outcomes were described. Results One hundred fifty-nine patients received PrEP; 133 (84%) patients were active duty, 95 (60%) patients were over 28 yr old. The majority were non-Hispanic Whites (n = 87, 55%). The median men who have sex with men (MSM) risk index score was 18.0 (IQR 12.0-22.0); 20 patients scored less than 10. One hundred and thirty-one (82%) patients remained on PrEP through the evaluation period. Patients mainly discontinued PrEP for service-related or toxicity reasons. Incident STIs occurred in 31 (19%) patients. No cases of HIV seroconversion were observed. Conclusions In this first description of PrEP utilization in a U.S. military health care system, a significant number of patients were non-Hispanic Whites, well-educated, were older, or were otherwise at low risk for HIV acquisition. Further effort is needed to enhance PrEP use among the higher risk young African-American MSM population, and further studies are needed to determine the cost-effectiveness of PrEP in individuals who are not categorized as high risk.
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Affiliation(s)
- Jason M Blaylock
- Infectious Disease Service, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Shilpa Hakre
- United States Military HIV Research Program, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD 20817
| | - Catherine F Decker
- Infectious Disease Service, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889.,Department of Internal Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Bryan Wilson
- Internal Medicine Service, Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Elizabeth Bianchi
- United States Military HIV Research Program, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910.,Henry M. Jackson Foundation for the Advancement of Military Medicine, 6720A Rockledge Drive, Suite 400, Bethesda, MD 20817
| | - Nelson Michael
- United States Military HIV Research Program, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910
| | - Charmagne Beckett
- Navy Bloodborne Infection Management Center, 8901 Rockville Pike, Bethesda, MD 20889
| | - Jason Okulicz
- Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234-6200
| | - Paul T Scott
- United States Military HIV Research Program, Walter Reed Army Institute of Research, 503 Robert Grant Avenue, Silver Spring, MD 20910
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Magno L, Dourado I, Sutten Coats C, Wilhite D, da Silva LAV, Oni-Orisan O, Brown J, Soares F, Kerr L, Ransome Y, Chan PA, Nunn A. Knowledge and willingness to use pre-exposure prophylaxis among men who have sex with men in Northeastern Brazil. Glob Public Health 2019; 14:1098-1111. [PMID: 30717633 DOI: 10.1080/17441692.2019.1571090] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Few studies evaluate knowledge and willingness to use pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) in middle-income countries. Brazil added PrEP to public drug formularies in December 2017, but little is known about local knowledge and attitudes about PrEP among MSM outside metropolitan areas in Southern Brazil. The cross-sectional HIV Surveillance Survey Project in Brazil estimates HIV and STD prevalence among MSM in 12 state capitals. Among 32 participants at the Salvador, Bahia study site, we used qualitative interviews to assess knowledge, willingness, and barriers to PrEP use among MSM; few MSM had previous knowledge of PrEP and were willing to use PrEP. Clinical, behavioural, social, and structural factors influencing participants' knowledge and willingness to take PrEP included concerns about efficacy and side effects, access to culturally congruent services for MSM, and stigma. Some participants reported that learning about PrEP online positively influenced their willingness to use PrEP. Participants' opinions about PrEP's contribution to risk compensation varied. Interventions to provide culturally congruent care and destigmatise PrEP for MSM at high risk for HIV acquisition, particularly those conducted collaboratively with Brazil's civil society movement, may enhance the public health effort to expand access to PrEP in Brazil.
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Affiliation(s)
- Laio Magno
- a Departamento de Ciências da Vida, Universidade do Estado da Bahia , Salvador , Brazil.,b Instituto de Saúde Coletiva, Universidade Federal da Bahia , Salvador , Brazil
| | - Inês Dourado
- b Instituto de Saúde Coletiva, Universidade Federal da Bahia , Salvador , Brazil
| | - Cassandra Sutten Coats
- c Department of Behavioral and Social Health Science, Brown University School of Public Health , Providence , RI , USA
| | - Daniel Wilhite
- c Department of Behavioral and Social Health Science, Brown University School of Public Health , Providence , RI , USA
| | - Luís Augusto V da Silva
- b Instituto de Saúde Coletiva, Universidade Federal da Bahia , Salvador , Brazil.,d Instituto de Humanidades, Artes e Ciências , Salvador , Brazil
| | - Oluwadamilola Oni-Orisan
- c Department of Behavioral and Social Health Science, Brown University School of Public Health , Providence , RI , USA
| | - Julianna Brown
- c Department of Behavioral and Social Health Science, Brown University School of Public Health , Providence , RI , USA
| | - Fabiane Soares
- b Instituto de Saúde Coletiva, Universidade Federal da Bahia , Salvador , Brazil
| | - Lígia Kerr
- e Departamento de Saúde Comunitária , Universidade Federal do Ceará , Fortaleza , Brazil
| | - Yusuf Ransome
- f Social and Behavioral Sciences , Yale School of Public Health , New Haven , CT , USA
| | - Philip Andrew Chan
- g Division of Infectious Diseases , The Miriam Hospital, Brown University , Providence , RI , USA
| | - Amy Nunn
- c Department of Behavioral and Social Health Science, Brown University School of Public Health , Providence , RI , USA
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Vaccines. Clin Immunol 2019. [DOI: 10.1016/b978-0-7020-6896-6.00090-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Williamson I, Papaloukas P, Jaspal R, Lond B. ‘There’s this glorious pill’: gay and bisexual men in the English midlands navigate risk responsibility and pre-exposure prophylaxis. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1497143] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Guise A, Albers ER, Strathdee SA. 'PrEP is not ready for our community, and our community is not ready for PrEP': pre-exposure prophylaxis for HIV for people who inject drugs and limits to the HIV prevention response. Addiction 2017; 112:572-578. [PMID: 27273843 PMCID: PMC5145792 DOI: 10.1111/add.13437] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/16/2016] [Accepted: 04/19/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIMS Pre-exposure prophylaxis for HIV, or 'PrEP', is the use of antiretroviral medicines by people who are HIV-negative to protect themselves against acquiring HIV. PrEP has shown efficacy for preventing HIV acquisition. Despite the potential, many concerns have been voiced by people who inject drugs (PWID) and their organizations. There is a need to engage with these views and ensure their integration in to policy and strategy. This paper presents PWID views on PrEP to foster the uptake of these opinions into scientific and policy debate around PrEP METHODS: Critical analysis of a report of a community consultation led by the International Network of People who Use Drugs (INPUD). RESULTS The INPUD report highlights enthusiasm from PWID for PrEP, but also three main concerns: the feasibility and ethics of PrEP, its potential use as a substitute for other harm reduction strategies and how a focus on PrEP heralds a re-medicalization of HIV. Each concern relates to evidenced gaps in essential services or opposition to harm reduction and PWID human rights. CONCLUSIONS People who use drugs have fundamental concerns about the potential impacts of pre-exposure prophylaxis for HIV which reflect a 'fault line' in HIV prevention: a predominance of biomedical approaches over community perspectives. Greater community engagement in HIV prevention strategy is needed, or we risk continuing to ignore the need for action on the underlying structural drivers and social context of the HIV epidemic.
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Affiliation(s)
- Andy Guise
- Department of Medicine, University of California San Diego, 9500 Gilman Drive , La Jolla , 92093-0507, USA
| | - Eliot Ross Albers
- International Network of People who Use Drugs, Unit 2C05, South Bank Technopark, 90 London Road, London, SE1 6LN, United Kingdom
| | - Steffanie A. Strathdee
- Department of Medicine, University of California San Diego, 9500 Gilman Drive , La Jolla , 92093-0507, USA
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“PrEP Makes My Relationship Even More Normal:” The Discursive Production of Hope in the Context of HIV Pre-exposure Prophylaxis Among Young Adults with Partners Living with HIV Infection. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-42725-6_3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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Pre-exposure prophylaxis for HIV infection and new sexually transmitted infections among men who have sex with men. AIDS 2016; 30:2251-2. [PMID: 27314179 DOI: 10.1097/qad.0000000000001185] [Citation(s) in RCA: 138] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We conducted a meta-analysis to summarize rates of sexually transmitted infections among men who have sex with men (MSM) on pre-exposure prophylaxis (PrEP) for HIV versus MSM not using PrEP. Incidence rate ratios showed that MSM using PrEP were 25.3 times more likely to acquire a Neisseria gonorrhoeae infection, 11.2 times more likely to acquire a Chlamydia trachomatis infection, and 44.6 times more likely to acquire a syphilis infection versus MSM not using PrEP.
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Retention in care outcomes for HIV pre-exposure prophylaxis implementation programmes among men who have sex with men in three US cities. J Int AIDS Soc 2016; 19:20903. [PMID: 27302837 PMCID: PMC4908080 DOI: 10.7448/ias.19.1.20903] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/26/2016] [Accepted: 05/12/2016] [Indexed: 01/11/2023] Open
Abstract
Introduction Despite the efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV transmission, few studies have evaluated PrEP use and retention in care outcomes in real-world settings outside of clinical trials. Methods Data were collected from PrEP clinical care programmes in three mid-size US cities: Providence, Rhode Island (RI); Jackson, Mississippi (MS); and St. Louis, Missouri (MO). We assessed the demographic and social characteristics of patients prescribed PrEP and documented their insurance and copayment experiences. We assessed retention in PrEP care at three and six months. Multivariate analyses were used to predict retention in care among men who have sex with men (MSM). HIV acquisition among the cohort was also assessed. Results A total of 267 (RI: 117; MS: 88; MO: 62) patients were prescribed PrEP; 81% filled prescriptions (RI: 73%; MS: 82%; MO: 94%; p<0.001). Patients in MS and MO were more commonly African American than in RI (72% and 26% vs. 7%, respectively), but less frequently Latino (2% and 3% vs. 24%, respectively). More patients reported living below the federal poverty line in MS (52%) compared to MO (23%) and RI (26%). Most patients were MSM (RI: 92%; MS: 88%; MO: 84%). The majority of MSM reported recent condomless anal sex (RI: 70%; MS: 65%; MO: 75%). Among 171 patients prescribed PrEP at least six months beforehand, 72% were retained in care at three months (RI: 68%; MS: 70%; MO: 87%; p=0.12) and 57% were retained in PrEP care at six months (RI: 53%: MS: 61%; MO: 63%; p=0.51). Insurance status and medication costs were not found to be significant barriers for obtaining PrEP. Three patients became infected with HIV during the six-month period after being prescribed PrEP (1.1%; 3/267), including one in RI (suspected acute HIV infection), one in MO (confirmed poor adherence) and one in MS (seroconverted just prior to initiation). Conclusions PrEP initiation and retention in care differed across these distinct settings. In contrast, retention in PrEP care was consistently suboptimal across sites. Further research is needed to identify the individual, social and structural factors that may impede or enhance retention in PrEP care
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Affiliation(s)
- Michael Brady
- Medical Director, Terrence Higgins Trust, 314-320 Grays Inn Road, London WC1X 8DP, UK
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Scott HM, Klausner JD. Sexually transmitted infections and pre-exposure prophylaxis: challenges and opportunities among men who have sex with men in the US. AIDS Res Ther 2016; 13:5. [PMID: 26793265 PMCID: PMC4719214 DOI: 10.1186/s12981-016-0089-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/03/2016] [Indexed: 02/03/2023] Open
Abstract
Pre-Exposure Prophylaxis (PrEP) has shown high efficacy in preventing human immunodeficiency virus (HIV) infection among men who have sex with men (MSM) in several large clinical trials, and more recently in “real world” reports of clinical implementation and a PrEP demonstration project. Those studies also demonstrated high bacterial sexually transmitted infection (STI) incidence and raised the discussion of how PrEP may impact STI control efforts, especially in the setting of increasing Neisseria gonorrhoeae antimicrobial resistance and the increase in syphilis cases among MSM. Here, we discuss STIs as a driver of HIV transmission risk among MSM, and the potential opportunities and challenges for STI control afforded by expanded PrEP implementation among high-risk MSM.
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