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Paudel K, Kanak MP, Gautam K, Bhandari P, Dhakal M, Wickersham J, Valente PK, Ha T, Shrestha R. Awareness and Uptake of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention Among Men who have Sex with Men in Nepal. J Community Health 2024; 49:514-525. [PMID: 38127298 DOI: 10.1007/s10900-023-01318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention strategy that remarkably reduces HIV transmission risk. Although PrEP has been available in Nepal since 2019, very little is known about PrEP use among MSM in Nepal. This study aimed to examine PrEP awareness and its use among Nepali MSM and the factors influencing its adoption. A cross-sectional survey was conducted among MSM in Nepal between October and December 2022 (N = 250). Bivariate analysis and logistic regression were performed to determine factors associated with awareness and use of PrEP. In the study population, 59.6% of participants were aware of PrEP, however, only 30.4% of them had utilized it. The odds of PrEP awareness were higher among participants who had completed high school or above (aOR = 4.1; 95% CI = 1.8-9.6), those with health insurance coverage (aOR = 6.9; 95% CI = 2.1-22.3) and had tested for HIV (aOR = 21.2; 95% CI = 8.3-53.9). Similarly, participants who identified as gay (aOR = 3.4; 95% CI = 1.4-8.4), had visited a doctor within the past 6 months (aOR = 2.9; 95% CI = 1.2-6.5), had previously tested for HIV (aOR = 12.3; 95% CI = 3.4-44.7), and had been diagnosed with sexually transmitted infections (aOR = 7.0; 95% CI = 2.5-19.5) were more likely to have used PrEP. Our results highlight the critical importance of healthcare providers engaging in providing care for MSM, including facilitating as well as discussions about PrEP. In addition, there is a pressing need for innovative strategies (e.g., peer educators, social media, online facilitating technologies) to disseminate PrEP knowledge and reduce stigma surrounding PrEP.
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Affiliation(s)
- Kiran Paudel
- Nepal Health Frontiers, Tokha-5, Kathmandu, Nepal
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, USA
| | | | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, USA
| | | | | | - Jeffrey Wickersham
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, 135 College St., Suite 323, New Haven, CT, 06510, USA
| | - Pablo Kokay Valente
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, USA
| | - Toan Ha
- Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, 15261, USA
| | - Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Unit 1101, Storrs, CT, 06269, USA.
- Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, 135 College St., Suite 323, New Haven, CT, 06510, USA.
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Kebede S, Brazier E, Freeman AM, Muwonge TR, Choi JY, de Waal R, Poda A, Cesar C, Munyaneza A, Kasozi C, Pasayan MKU, Althoff KN, Shongo A, Low N, Ekouevi D, Veloso VG, Ross J. Preexposure prophylaxis availability among health facilities participating in the global International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. AIDS 2024; 38:751-756. [PMID: 38133656 PMCID: PMC10939841 DOI: 10.1097/qad.0000000000003824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
BACKGROUND While recognized as a key HIV prevention strategy, preexposure prophylaxis (PrEP) availability and accessibility are not well documented globally. We aimed to describe PrEP drug registration status and the availability of PrEP services across HIV care sites participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) research consortium. METHODS We used country-level PrEP drug registration status from the AIDS Vaccine Advocacy Coalition and data from IeDEA surveys conducted in 2014, 2017 and 2020 among participating HIV clinics in seven global regions. We used descriptive statistics to assess PrEP availability across IeDEA sites serving adult patients in 2020 and examined trends in PrEP availability among sites that responded to all three surveys. RESULTS Of 199 sites that completed the 2020 survey, PrEP was available in 161 (81%). PrEP availability was highest at sites in North America (29/30; 97%) and East Africa (70/74; 95%) and lowest at sites in Central (10/20; 50%) and West Africa (1/6; 17%). PrEP availability was higher among sites in countries where PrEP was officially registered (146/161; 91%) than where it was not (14/32; 44%). Availability was higher at health centers (109/120; 90%) and district hospitals (14/16; 88%) compared to regional/teaching hospitals (36/63). Among the 94 sites that responded to all three surveys, PrEP availability increased from 47% in 2014 to 60% in 2017 and 76% in 2020. CONCLUSION PrEP availability has substantially increased since 2014 and is now available at most IeDEA sites. However, PrEP service provision varies markedly across global regions.
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Affiliation(s)
- Samuel Kebede
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Ellen Brazier
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | | | | | - Jun Yong Choi
- Division of Infectious Diseases, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea
| | - Renee de Waal
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Armel Poda
- Hôpital de Jour, Service des Maladies Infectieuses, CHU Sourô Sanou, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alisho Shongo
- School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Nicola Low
- Institute of Social and Preventive Medicine, Bern, Switzerland
| | | | - Valdiléa G. Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Rio de Janerio, Brazil
| | - Jonathan Ross
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Witzel TC, Charoenyang M, Bourne A, Guadamuz TE. Hi-fun among men who have sex with men in Bangkok: A scoping study exploring key informants' perspectives on hi-fun contexts, harms and support strategies. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002295. [PMID: 37624762 PMCID: PMC10456137 DOI: 10.1371/journal.pgph.0002295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 07/21/2023] [Indexed: 08/27/2023]
Abstract
The use of specific drugs (e.g. methamphetamine, GHB/GBL and other stimulants) to enhance sex among men who have sex with men (MSM), is the focus of global public health concern because of links to social harms, poor mental and sexual health. Often called 'chemsex' in Western settings or 'hi-fun' in Southeast Asia, this type of sexualised drug use is increasingly visible in Thailand where the unique sociocultural and legislative environments shape sexual cultures and harms. This study aimed to develop an understanding of key informants' perspectives on hi-fun contexts, harms and current responses in Bangkok. In-depth interviews were conducted with thirteen key informants from clinical, community, policy and development organisations. Four key informants had personal experience of hi-fun. Interviews covered hi-fun contexts, harms and support, were transcribed verbatim, translated to English (where necessary) and analysed using a thematic framework. MSM hi-fun 'influencers' shape norms and provide support online, primarily through Twitter. Hi-fun was linked to Westernisation and wealth; complex hierarchies emerged from asymmetries in social/financial capital. Police coercion towards MSM engaged in hi-fun was a concern. Given the nature of their funding, HIV/HCV/STI transmission was the most pressing focus for many organisations, however key informants were concerned especially about drug overdoses and mental health/well-being impacts. The political and economic context means funding for MSM health in Thailand focuses primarily on HIV prevention/treatment; restrictions on development aid constrain holistic hi-fun focused service development. Most hi-fun support was informally developed; successful strategies relied on partnership working and peer developed/delivered services, some of which were adapted from high-income settings. Despite substantial barriers, organisations developed services responding to the needs of MSM engaged in hi-fun. Given that many were informally developed or adapted from high-income settings, establishing a theoretical basis for further interventions that is grounded in this unique context is a priority.
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Affiliation(s)
- T. Charles Witzel
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Faculty of Social Sciences and Humanities, Center of Excellence in Research on Gender, Sexuality and Health, Mahidol University, Bangkok, Thailand
- Institute for Global Health, University College London, London, United Kingdom
| | - Mookarpa Charoenyang
- Faculty of Social Sciences and Humanities, Center of Excellence in Research on Gender, Sexuality and Health, Mahidol University, Bangkok, Thailand
| | - Adam Bourne
- Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Australia
- Kirby Institute, University of New South Wales, Sydney, Australia
| | - Thomas E. Guadamuz
- Faculty of Social Sciences and Humanities, Center of Excellence in Research on Gender, Sexuality and Health, Mahidol University, Bangkok, Thailand
- John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts, United States of America
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Santos LAD, Unsain RF, Brasil SA, Silva LAVD, Duarte FM, Couto MT. PrEP perception and experiences of adolescent and young gay and bisexual men: an intersectional analysis. CAD SAUDE PUBLICA 2023; 39Suppl 1:e00134421. [PMID: 36995863 DOI: 10.1590/0102-311xen134421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/11/2021] [Indexed: 03/29/2023] Open
Abstract
Studies indicate gaps in knowledge about the barriers to access and adhere to HIV pre-exposure prophylaxis (PrEP) in adolescents. In this article, we explore the perceptions and experiences of young gay, bisexual, and other men who have sex with men (YGBMSM) of the search, use and adherence to PrEP, considering their positions according to social markers of difference such as race/skin color, gender, sexuality, and social status. Intersectionality provides theoretical and methodological tools to interpret how the interlinking of these social markers of difference constitutes barriers and facilitators in the PrEP care continuum. The analyzed material is part of the PrEP1519 study and is comprised of 35 semi-structured interviews with YGBMSM from two Brazilian capitals (Salvador and São Paulo). The analyses suggest connections between social markers of difference, sexual cultures, and the social meanings of PrEP. Subjective, relational and symbolic aspects permeate the awareness of PrEP in the range of prevention tools. Willingness to use and adhere to PrEP is part of a learning process, production of meaning, and negotiation in the face of getting HIV and other sexually transmittable infections and the possibilities of pleasure. Thus, accessing and using PrEP makes several adolescents more informed about their vulnerabilities, leading to more informed decision-making. Interlinking the PrEP continuum of care among YGBMSM with the intersections of the social markers of difference may provide a conceptual framework to problematize the conditions and effects of implementing this prevention strategy, which could bring advantages to HIV prevention programs.
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Edinger A, Valdez D, Walsh-Buhi E, Bollen J. Deep learning for topical trend discovery in online discourse about Pre-Exposure Prophylaxis (PrEP). AIDS Behav 2023; 27:443-453. [PMID: 35916950 PMCID: PMC9344253 DOI: 10.1007/s10461-022-03779-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2022] [Indexed: 11/16/2022]
Abstract
Pre-Exposure Prophylaxis (PrEP) interventions are increasingly prevalent on social media. These data can be mined for insights about PrEP that may not be as apparent in surveys including personal musings about PrEP and barriers/facilitators to PrEP uptake. This study explores online discourse about PrEP using an interdisciplinary public health and computational informatics approach. We collected (N = 4,020) tweets using Twitter's Application Programming Interface (API). These data underwent a three-step neural network/deep learning process to identify clusters within these tweets and relative similarity/dissimilarity between clusters. We identified 25 distinct clusters from our original collection of tweets. These clusters represent general information about PrEP, how PrEP is communicated among diverse groups, and potential pockets of misinformation and disinformation regarding PrEP. Specific clusters of interest include discussions of medication side effects, social perception of PrEP usage, and concerns with costs and barriers to access of PrEP interventions. Our approach revealed diverse ways PrEP is contextualized online. Importantly this information can be leveraged to identify points of possible intervention for disinformation and misinformation about PrEP.
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Affiliation(s)
- Andy Edinger
- grid.411377.70000 0001 0790 959XDepartment of Applied Health Science, Indiana University School of Public Health, 47405 Bloomington, IN USA
| | - Danny Valdez
- Luddy School of Informatics and Computer Engineering, Indiana University, 47405, Bloomington, IN, USA.
| | - Eric Walsh-Buhi
- grid.411377.70000 0001 0790 959XDepartment of Applied Health Science, Indiana University School of Public Health, 47405 Bloomington, IN USA
| | - Johan Bollen
- grid.411377.70000 0001 0790 959XLuddy School of Informatics and Computer Engineering, Indiana University, 47405 Bloomington, IN USA ,grid.411377.70000 0001 0790 959XDepartment of Psychological and Brain Sciences, Indiana University, 47405 Bloomington, IN USA
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Shrestha R, Wickersham JA, Khati A, Azwa I, Ni Z, Kamarulzaman A, Sullivan PS, Jadkarim L, Eger WH, Gautam K, Altice FL. Clinic-Integrated Mobile Health Intervention ("JomPrEP" App) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Protocol for an Intervention Development and Multiphase Trial. JMIR Res Protoc 2022; 11:e43318. [PMID: 36542425 PMCID: PMC9813821 DOI: 10.2196/43318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately affected by the HIV epidemic in Malaysia and globally. Cross-cutting prevention strategies such as mobile health (mHealth), particularly smartphone apps, hold great promise for HIV prevention efforts among Malaysian MSM, especially when linked to HIV testing and pre-exposure prophylaxis (PrEP). OBJECTIVE This study aims to adapt an existing app to create and test a clinic-integrated app (JomPrEP), a virtual platform to deliver HIV testing and PrEP services for MSM in Malaysia. METHODS The JomPrEP project involves developing and testing an app-based platform for HIV prevention among Malaysian MSM and will be conducted in 2 phases. In phase I (development phase), we will adapt an existing mHealth app (HealthMindr) to create a new clinic-integrated app called "JomPrEP" to deliver holistic HIV prevention services (eg, HIV testing, PrEP, support services for mental health and substance use) among MSM in Malaysia. During phase II (testing phase), we will use a type I hybrid implementation science trial design to test the efficacy of JomPrEP while gathering information on implementation factors to guide future scale-up in real-world settings. RESULTS As of September 2022, we have completed phase I of the proposed study. Based on a series of formative work completed during phase I, we developed a fully functional, clinic-integrated JomPrEP app, which provides a virtual platform for MSM in Malaysia to facilitate their engagement in HIV prevention in a fast and convenient manner. Based on participant feedback provided during phase I, we are currently optimizing JomPrEP and the research protocols for a large-scale efficacy trial (phase II), which will commence in January 2023. CONCLUSIONS Scant HIV prevention resources coupled with entrenched stigma, discrimination, and criminalization of same-sex sexual behavior and substance use hamper access to HIV prevention services in Malaysia. If found efficacious, JomPrEP can be easily adapted for a range of health outcomes and health care delivery services for MSM, including adaptation to other low- and middle-income countries. TRIAL REGISTRATION ClinicalTrials.gov NCT05325476; https://clinicaltrials.gov/ct2/show/NCT05325476. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43318.
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Affiliation(s)
- Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | | | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Iskandar Azwa
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zhao Ni
- School of Nursing, Yale University, West Haven, CT, United States
| | | | | | - Luzan Jadkarim
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
| | - William H Eger
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA, United States.,College of Health and Human Services, San Diego State University, San Diego, CA, United States
| | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
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Suen YT, Chan RCH, Wong EMY. Sex Conservatism, Internalized Homonegativity, PrEP Stigma, and Intention to Use PrEP: A Study of Chinese-Speaking Gay and Bisexual Male Youth in Hong Kong. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:467-480. [PMID: 36454136 DOI: 10.1521/aeap.2022.34.6.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Pre-exposure prophylaxis (PrEP) stigma has been found to be a major barrier to PrEP acceptability and uptake. Research has found that different ethnic/cultural groups display varying levels of PrEP stigma. This article studies sex conservatism and internalized homonegativity as two sexuality- and culture-related aspects that influence PrEP stigma and intention to use PrEP. An online survey of 279 young gay and bisexual men in Hong Kong found that internalized homonegativity was positively associated with PrEP stigma. Respondents who were more conservative about sex showed lower intention to use PrEP, whereas those who had higher income and more positive attitudes about PrEP were more likely to express intention to use PrEP. This study provides novel empirical evidence for understanding PrEP stigma and uptake from a sexuality and cultural perspective. The influence of sexuality- and culture-related factors on PrEP stigma and uptake warrants greater attention, especially in the Asia-Pacific region.
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Affiliation(s)
- Yiu Tung Suen
- Gender Studies Programme, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Randolph C H Chan
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Eliz Miu Yin Wong
- Department of Social Policy, London School of Economics and Political Science, London, UK
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Eger WH, Adaralegbe A, Khati A, Azwa I, Wickersham JA, Osborne S, Shrestha R. Exploring drivers of pre-exposure prophylaxis uptake among gay, bisexual, and other men who have sex with men in Malaysia. Int J STD AIDS 2022; 33:821-828. [PMID: 35772943 PMCID: PMC10069270 DOI: 10.1177/09564624221106535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a valuable HIV prevention strategy, particularly among men who have sex with men (MSM); however, PrEP uptake is below the threshold needed to curb the HIV epidemic among this group, especially in settings like Malaysia, where same-sex sexual behavior is illegal. METHODS A sample of 355 participants completed an online survey between June and July 2020, recruited through geosocial networking apps for MSM and social networking websites (e.g. Facebook). We used descriptive and multivariable analyses to examine correlates of PrEP use within this population. RESULTS The sample was predominantly Malay (53.5%), had monthly incomes greater than RM 3000 (USD 730) (52.7%), and a tertiary level of education (84.5%). About 80% of participants heard of PrEP prior to the survey, with significantly less (18.3%) having ever taken PrEP. In the adjusted multivariable logistic model, using drugs before or during sexual intercourse ("chemsex") (AOR: 3.37; 95% CI: 1.44-7.89), being diagnosed with a sexually transmitted infection in the last 12 months (AOR: 2.08; 95% CI: 1.13-3.85), HIV testing in the previous 6 months (AOR: 3.23; 95% CI: 1.74-5.99), and disclosure of sexual orientation (AOR: 1.85; 95% CI: 1.02-3.34) were associated with having taken PrEP in the past. CONCLUSIONS This study revealed that PrEP use among Malaysian MSM is relatively low, despite high awareness, and is associated with healthcare engagement and high-risk behaviors. These results highlight the need to tailor outreach activities for individuals at increased risk for HIV and those disengaged with the health system.
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Affiliation(s)
- William H Eger
- Department of Internal Medicine, Section of Infectious Diseases, 12228Yale School of Medicine, New Haven, CT, USA
| | - Adeleye Adaralegbe
- Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA
| | - Antoine Khati
- Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA
| | - Iskandar Azwa
- Department of Medicine, Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia.,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Jeffrey A Wickersham
- Department of Internal Medicine, Section of Infectious Diseases, 12228Yale School of Medicine, New Haven, CT, USA.,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia
| | - Sydney Osborne
- Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA
| | - Roman Shrestha
- Department of Internal Medicine, Section of Infectious Diseases, 12228Yale School of Medicine, New Haven, CT, USA.,Department of Allied Health Sciences, 7712University of Connecticut, Mansfield, CT, USA.,Centre of Excellence for Research in AIDS (CERiA), Faculty of Medicine, 37447University of Malaya, Kuala Lumpur, Malaysia.,Institute for Collaboration on Health, Intervention, and Policy (InCHIP), 7712University of Connecticut, Mansfield, CT, USA
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Saxton PJW, Azariah S, Cavadino A, Forster RF, Jenkins R, Werder SF, Southey K, Rich JG. Adherence, Sexual Behavior and Sexually Transmitted Infections in a New Zealand Prospective PrEP Cohort: 12 Months Follow-up and Ethnic Disparities. AIDS Behav 2022; 26:2723-2737. [PMID: 35167038 PMCID: PMC8853116 DOI: 10.1007/s10461-022-03617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/29/2022]
Abstract
Inequities in pre-exposure prophylaxis (PrEP) experiences will impede HIV epidemic elimination among gay and bisexual men (GBM). Ethnicity is a strong marker of inequity in the United States, but evidence from other countries is lacking. We investigated experiences on-PrEP to 12 months follow-up in a prospective cohort of 150 GBM in Auckland, New Zealand with an equity quota of 50% non-Europeans. Retention at 12 months was 85.9%, lower among Māori/Pacific (75.6%) than non-Māori/Pacific participants (90.1%). Missed pills increased over time and were higher among Māori/Pacific. PrEP breaks increased, by 12 months 35.7% of Māori/Pacific and 15.7% of non-Māori/Pacific participants had done so. Condomless receptive anal intercourse partners were stable over time. STIs were common but chlamydia declined; 12-month incidence was 8.7% for syphilis, 36.0% gonorrhoea, 46.0% chlamydia, 44.7% rectal STI, 64.0% any STI. Structural interventions and delivery innovations are needed to ensure ethnic minority GBM gain equal benefit from PrEP. Clinical trial number ACTRN12616001387415.
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Affiliation(s)
- Peter J W Saxton
- School of Population Health, University of Auckland, 28 Park Ave, Auckland, 1023, New Zealand.
| | - Sunita Azariah
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
| | - Alana Cavadino
- School of Population Health, University of Auckland, 28 Park Ave, Auckland, 1023, New Zealand
| | - Rose F Forster
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Renee Jenkins
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
| | - Suzanne F Werder
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
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Wang H, Wang Z, Huang X, Chen Y, Wang H, Cui S, Zhang J, Chu Z, Hu Q, Ding H, Qian H, Zou H, Tang W, Gao Y, Jin X, Liu Z, Zhang L, Zhao J, He X, Jiang Y, Geng W, Xu J, Shang H. Association of HIV Preexposure Prophylaxis Use With HIV Incidence Among Men Who Have Sex With Men in China: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e2148782. [PMID: 35171258 PMCID: PMC8851305 DOI: 10.1001/jamanetworkopen.2021.48782] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Evidence on HIV preexposure prophylaxis (PrEP) among Chinese men who have sex with men (MSM) is critical to guide its large-scale implementation in low- and middle-income countries. OBJECTIVE To evaluate incident HIV infection, adherence, safety, and changes in sexual behaviors among MSM using daily PrEP (D-PrEP) and event-driven PrEP (ED-PrEP) in 4 cities in China. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled trial was conducted among HIV-seronegative MSM from December 11, 2018, to November 30, 2020, in Beijing, Shenyang, Chongqing, and Shenzhen. Participants self-chose D-PrEP or ED-PrEP regimens at baseline and could switch regimens during the 12-month study period. HIV-negative MSM who declined to initiate PrEP (nonusers) in the same cities joined a separate parallel prospective cohort and served as control individuals. INTERVENTIONS PrEP consisted of coformulated tenofovir disoproxil fumarate, 300 mg, and emtricitabine, 200 mg. MAIN OUTCOMES AND MEASURES The main outcome was incident HIV infection. Poisson regression was used to obtain the HIV incidence rate ratio (IRR). RESULTS A total of 1530 MSM were included in the analysis (median age, 30 [IQR, 25-37] years). At baseline, 520 MSM chose D-PrEP (median age, 29 [IQR, 25-35] years) and 503 chose ED-PrEP (median age, 29 [IQR, 25-36] years). The median HIV Risk Index score was 18 (IQR, 12-22) among D-PrEP users and 18 (IQR, 11-22) among ED-PrEP users. Among 507 PrEP nonusers, the median age was 33 (IQR, 27-43) years, and the median HIV Risk Index score was 12 (IQR, 7-18). Although PrEP users had more baseline behaviors associated with HIV risk, the HIV incidence was lower among all PrEP users (adjusted IRR, 0.09 [95% CI, 0.04-0.21]), ED-PrEP users (adjusted IRR, 0.05 [95% CI, 0.01-0.22]), and D-PrEP users (adjusted IRR, 0.12 [95% CI, 0.04-0.33]) compared with PrEP nonusers. There was no difference in HIV incidence between D-PrEP users and ED-PrEP users (IRR, 0.33 [95% CI, 0.06-2.04]). Event-driven PrEP users consumed 40% fewer tablets than D-PrEP users during the study period. Adherence, defined as the proportion of self-reported days with sexual intercourse in which PrEP was taken according to prescription of at least 90%, increased over time among ED-PrEP users (from 57.4% to 77.8%; P < .001 for trend) and decreased over time among D-PrEP users (from 75.1% to 72.1%; P = .02 for trend). Daily PrEP users reported fewer adverse events than ED-PrEP users (193 of 520 [37.1%] vs 241 of 503 [47.9%]). CONCLUSIONS AND RELEVANCE The findings of this study suggest that D-PrEP and ED-PrEP regimens are associated with lower incidence of HIV and a good safety profile among high-risk MSM in China. TRIAL REGISTRATION Chinese Clinical Trial Registry number: ChiCTR-IIN-17013762.
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Affiliation(s)
- Hongyi Wang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zixin Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yaokai Chen
- Chongqing Public Health Medical Center, Chongqing, China
| | - Hui Wang
- Department of Infectious Diseases, National Clinical Center for Infectious Diseases, Third People’s Hospital of Shenzhen (Second Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Sitong Cui
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jing Zhang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhenxing Chu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qinghai Hu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Haibo Ding
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hanzhu Qian
- School of Public Health, Yale University, New Haven, Connecticut
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project–China, Guangzhou, China
| | - Yangyang Gao
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xia Jin
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhaozhen Liu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Lukun Zhang
- Department of Infectious Diseases, National Clinical Center for Infectious Diseases, Third People’s Hospital of Shenzhen (Second Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention Shenzhen, Guangdong, China
| | - Xiaoqing He
- Chongqing Public Health Medical Center, Chongqing, China
| | - Yongjun Jiang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wenqing Geng
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Junjie Xu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
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11
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Restar A, Surace A, Adia A, Goedel W, Ogunbajo A, Jin H, Edeza A, Hernandez L, Cu-Uvin S, Operario D. Characterizing Awareness of Pre-Exposure Prophylaxis for HIV Prevention in Manila and Cebu, Philippines: Web-Based Survey of Filipino Cisgender Men Who Have Sex With Men. J Med Internet Res 2022; 24:e24126. [PMID: 34994705 PMCID: PMC8783281 DOI: 10.2196/24126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/14/2020] [Accepted: 09/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Philippines is experiencing an HIV crisis and is considering implementing pre-exposure prophylaxis (PrEP) as a national public health strategy for HIV prevention for cisgender men who have sex with men (cis-MSM). However, critical information on the awareness of PrEP among cis-MSM is needed to roll out this public health initiative. Objective This study aims to assess PrEP awareness and related correlates (ie, sociodemographic variables, social factors, and health care access and use) among Filipino cis-MSM. Methods We conducted a web-based survey with Filipino cis-MSM (n=179) residing in the cities of Manila and Cebu, Philippines. Multivariable analysis procedures were performed to examine the factors associated with PrEP awareness. Results Our sample demonstrated high awareness (134/179, 74.9%) and interest (159/179, 88.8%) in taking PrEP. The adjusted model showed that greater odds of PrEP awareness were associated with having a college education or higher versus a high school education or lower (adjusted odds ratio [aOR] 7.30, 95% CI 1.01-52.47), earning between PHP 10,000 (US $198.6) and PHP 20,000 (US $397.2) versus <PHP 10,000 (US $198.60; aOR 9.32, 95% CI 1.41-6.22), having had a prior HIV test (aOR 6.06, 95% CI 1.20-13.55), having high HIV knowledge (aOR 3.50, 95% CI 1.11-10.98), and having friends who discussed PrEP (aOR 11.17, 95% CI 2.73-14.5). Conclusions Our findings demonstrate that Filipino cis-MSM are aware of and interested in taking PrEP, but there is currently an unmet need for such biomedical HIV prevention technologies among this population. Incorporating PrEP education into routine HIV screening and leveraging cis-MSM social networks may be useful in optimizing potential PrEP implementation in the Philippines.
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Affiliation(s)
- Arjee Restar
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States.,amFAR, The Foundation of AIDS Research, Washington, DC, United States.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.,Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, United States.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, United States
| | - Anthony Surace
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Alexander Adia
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States
| | - William Goedel
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Adedotun Ogunbajo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Harry Jin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Alberto Edeza
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Laufred Hernandez
- Department of Behavioral Sciences, University of Philippines in Manila, Manila, Philippines
| | - Susan Cu-Uvin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States.,Providence-Boston Center for AIDS Research, Providence, RI, United States.,Department of Medicine, Miriam Hospital, Providence, RI, United States
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.,Brown University Global Health Initiative, The Philippine Health Initiative for Research, Service, and Training, Providence, RI, United States
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12
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Songtaweesin WN, LeGrand S, Bandara S, Piccone C, Wongharn P, Moonwong J, Jupimai T, Saisaengjan C, Theerawit T, Muessig K, Hightow-Weidman L, Puthanakit T, Phanuphak N, Tangmunkongvorakul A. Adaptation of a Theory-Based Social Networking and Gamified App-Based Intervention to Improve Pre-Exposure Prophylaxis Adherence Among Young Men Who Have Sex With Men in Bangkok, Thailand: Qualitative Study. J Med Internet Res 2021; 23:e23852. [PMID: 34734828 PMCID: PMC8603178 DOI: 10.2196/23852] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 07/05/2021] [Accepted: 07/21/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND HIV disproportionately affects young Thai men who have sex with men (YMSM). Recent studies report a high incidence and prevalence of HIV among Thai YMSM. The Thai national guidelines have recommended pre-exposure prophylaxis (PrEP) since 2014 for key populations; free PrEP has been piloted since 2019. Smartphone-based mobile health (mHealth) interventions provide an optimal platform for innovative PrEP adherence interventions for Thai YMSM. OBJECTIVE This study aims to adapt the P3 (Prepared, Protected, emPowered) app, developed with YMSM and transwomen in the United States to improve PrEP adherence and persistence for YMSM in Thailand. The app aims to provide daily adherence support and addresses gaps in staff available for large-scale PrEP rollout needed to see population-level effects of HIV prevention. METHODS We conducted focus group discussions (FGDs) with YMSM and key informant interviews (KIIs) with PrEP care providers in Bangkok, Thailand, to investigate PrEP adherence facilitators and barriers, preferences for functions and features in mHealth apps among YMSM, and how to best adapt the P3 app to the Thai context. We conducted four FGDs with 4-8 participants per group and 15 KIIs. RESULTS For FGDs, 23 YMSM participated with a mean age of 20 years (range 18-21), 96% (22/23) enrolled in full-time education, and all owned smartphones. The mean age of KII participants was 40 (range 26-60) years; most were state health service providers, with the majority being counselors (6/15, 40%) and physicians (6/15, 40%). Overall, the facilitators and barriers for PrEP adherence identified were similar to those of MSM and YMSM globally including the United States. Key themes included general recommendations for improving mHealth apps in Thailand, such as presenting reliable information in an appealing format, minimizing privacy risks, and addressing connectivity challenges. Additional themes focused on P3 Thailand adaptations and were related to cultural and stylistic preferences, engagement strategies, and recommendations for new functions. To develop the adapted app, P3 Thailand, these findings were balanced with resource limitations resulting in the prioritization of minor modifications: changes in app esthetics (color scheme, iconography, and imagery) and changes in the presentation of information in two of the app's features. FGDs identified similar PrEP adherence facilitators and barriers to those already addressed within the app. CONCLUSIONS The core elements of the P3 app address major PrEP facilitators and barriers for Thai YMSM; however, changes to the app features, including stylistic presentation, were needed to appropriately customize the app to the Thai context. Given the similarities of facilitators and barriers for PrEP adherence globally, adapting existing PrEP mHealth solutions based on input from end users and key informants provides a promising approach. However, partnerships with local app designers and developers can improve the adaptation process and final product. TRIAL REGISTRATION ClinicalTrials.gov NCT04413708; http://clinicaltrials.gov/ct2/show/NCT04413708.
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Affiliation(s)
- Wipaporn Natalie Songtaweesin
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Sara LeGrand
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Shashika Bandara
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Caitlin Piccone
- Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, NC, United States
| | - Prissana Wongharn
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Juthamanee Moonwong
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Thidarat Jupimai
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Chutima Saisaengjan
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Tuangtip Theerawit
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Kathryn Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lisa Hightow-Weidman
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Behavior and Technology Lab, Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Thanyawee Puthanakit
- Faculty of Medicine, Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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13
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Lubis DS, Conn C, Andajani S. Developing HIV prevention online using a habermasian 'lifeworld' approach with young men who have sex with men from Bali. SOCIAL WORK IN PUBLIC HEALTH 2021; 36:749-757. [PMID: 34241581 DOI: 10.1080/19371918.2021.1939830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Internet is a promising medium to strengthen participation in Human Immunodeficiency Virus (HIV) prevention among young men who have sex with men (YMSM). This study engaged YMSM from Bali in codesigning online HIV prevention using a series of participatory action research focus groups. Further, this research utilized Habermasian critical theory of communicative action to interpret the findings. This was framed around the current mismatch between HIV prevention, the "systemworld", and the lived reality, or "lifeworld", of YMSM in Bali. Using a model of intervention called "So Us", YMSM aspired to HIV prevention which reflects their identity, language, and interaction style.
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Affiliation(s)
- Dinar Saurmauli Lubis
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia
| | - Cath Conn
- School of Public Health & Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
| | - Sari Andajani
- School of Public Health & Psychosocial Studies, Auckland University of Technology, Auckland, New Zealand
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14
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Wansom T, Muangnoicharoen S, Nitayaphan S, Kitsiripornchai S, Crowell TA, Francisco L, Gilbert P, Rwakasyaguri D, Dhitavat J, Li Q, King D, Robb ML, Smith K, Heger EA, Akapirat S, Pitisuttithum P, O'Connell RJ, Vasan S. Risk Factors for HIV sero-conversion in a high incidence cohort of men who have sex with men and transgender women in Bangkok, Thailand. EClinicalMedicine 2021; 38:101033. [PMID: 34505031 PMCID: PMC8413240 DOI: 10.1016/j.eclinm.2021.101033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We measured Human Immunodeficiency (HIV) incidence, retention, and assessed risk factors for seroconversion among two previously unreported cohorts of men who have sex with men (MSM) and Transgender Women (TGW) in Bangkok, Thailand between 2017 and 2019. METHODS We conducted an 18-month prospective cohort study of HIV-uninfected Thai cisgender men and TGW aged between 18 and 35 years who reported sex with men in the past six months and at least one additional risk factor for HIV infection. HIV and syphilis testing and computer-based behavioral questionnaires were administered at each visit. We utilized Poisson regression to calculate HIV incidence rates. A survival random forest model identified the most predictive risk factors for HIV sero-conversion and then used in a survival regression tree model to elucidate hazard ratios for individuals with groups of selected risk factors. Cox proportional hazards (pH) regression evaluated the strength of association between individual covariates and risk of sero-conversion. FINDINGS From April 2017-October 2019, 1,184 participants were screened, 167 were found ineligible, and 1,017 enrolled. Over the 18-month study, visit retention was 93·4% (95% CI 91·6%-94·8%) and HIV incidence was 3·73 per 100 person-years (95% CI 2·79-5·87). Utilizing survival regression tree modeling, those who were 18-20 years of age, reported sexual attraction to mostly or only men, and had five or more lifetime sexual partners were 4·9 times more likely to seroconvert compared to other cohort participants. Factors associated with HIV incidence utilizing Cox pH regression included sexual attraction to mostly or only men (adjusted hazard ratio (aHR) 14·9 (95% CI 20·1-107·9), younger age (18-19 years, aHR 10·88 (95% CI 4·12-28·7), five or greater lifetime sexual partners (aHR 2·0, 95%CI 1·1-3·6), inconsistent condom use with casual partners (aHR 2·43, 95% CI 1·3-4·5), and prior HIV testing (adjusted HR 2·0, 95% CI 1·1-3·5). INTERPRETATION Interpretation HIV incidence remains high among Bangkok-based MSM and TGW. These key populations expressed high interest in participating in efficacy evaluation of future prevention strategies and had high retention in this 18 month study. FUNDING Funding US National Institute of Allergy and Infectious Diseases (NIAID), Division of AIDS Interagency Agreements (DAIDS) and U.S. Department of the Army.
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Affiliation(s)
- Tanyaporn Wansom
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States
- Current affiliation: HIV-NAT, Thai Red Cross AIDS Research Centre, and Dreamlopments Social Enterprise and Foundation, Bangkok, Thailand
| | - Sant Muangnoicharoen
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Sorachai Nitayaphan
- Royal Thai Army Component, Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | | | - Trevor A. Crowell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States
| | - Leilani Francisco
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States
| | - Paileen Gilbert
- US Army Medical Research Development Command (USAMRDC) Office of Regulated Activities (ORA) Special Operations Branch, Fort Detrick, Fort Detrick, MD, USA
| | - Dixion Rwakasyaguri
- US Army Medical Research Development Command (USAMRDC) Office of Regulated Activities (ORA) Special Operations Branch, Fort Detrick, Fort Detrick, MD, USA
| | - Jittima Dhitavat
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Qun Li
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States
| | - David King
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States
| | - Merlin L. Robb
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States
| | - Kirsten Smith
- US Army Medical Research and Development Command, Fort Detrick, Maryland, USA
| | - Elizabeth A. Heger
- US Army Medical Materiel Development Activity, Fort Detrick, Maryland, USA
| | - Siriwat Akapirat
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Robert J. O'Connell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand
| | - Sandhya Vasan
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, United States
- Corresponding author.
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15
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Lane J, Brezak A, Patel P, Verani AR, Benech I, Katz A. Policy considerations for scaling up access to HIV pre-exposure prophylaxis for adolescent girls and young women: Examples from Kenya, South Africa, and Uganda. Int J Health Plann Manage 2021; 36:1789-1808. [PMID: 34159630 DOI: 10.1002/hpm.3252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/09/2020] [Accepted: 05/10/2021] [Indexed: 11/06/2022] Open
Abstract
Adolescent girls and young women (aged 15-24 years; AGYW) continue to carry a disproportionate burden of HIV in sub-Saharan Africa. Pre-exposure prophylaxis (PrEP) helps reduce the risk of acquiring HIV for persons at substantial risk, including AGYW. As countries plan for the rollout of PrEP across sub-Saharan Africa, PrEP policies and programs could address the unique needs of AGYW. The purpose of this analysis was to identify policy considerations to improve AGYW access to PrEP. After reviewing the literature, we identified 13 policy considerations that policymakers and stakeholders could evaluate when developing or reviewing PrEP-related policies. We sorted these considerations into five categories, which together comprise an AGYW Access to PrEP Framework: AGYW-friendly delivery systems, clinical eligibility and adherence support, legal barriers and facilitators, affordability, and community and AGYW outreach. We also reviewed policies in three countries (Kenya, South Africa, and Uganda) to explore how PrEP-related policies addressed these considerations. Some of these policies addressed some of the 13 policy considerations, but none of the policies directly addressed the unique needs of AGYW for accessing PrEP. To improve access to PrEP for AGYW, country policies could include specific components that address these 13 considerations. To reach AGYW effectively, each country could use the 13 considerations we have identified to analyze current policies to identify existing programmatic barriers to AGYW accessing HIV services and address these barriers in PrEP-related policies.
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Affiliation(s)
- Jeff Lane
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Audrey Brezak
- University of Washington School of Public Health, Seattle, Washington, USA
| | - Pragna Patel
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Andre R Verani
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Irene Benech
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Aaron Katz
- University of Washington School of Public Health, Seattle, Washington, USA
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16
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Nguyen LH, Nguyen HLT, Tran BX, Larsson M, Rocha LEC, Thorson A, Strömdahl S. A qualitative assessment in acceptability and barriers to use pre-exposure prophylaxis (PrEP) among men who have sex with men: implications for service delivery in Vietnam. BMC Infect Dis 2021; 21:472. [PMID: 34030652 PMCID: PMC8147440 DOI: 10.1186/s12879-021-06178-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/12/2021] [Indexed: 11/20/2022] Open
Abstract
Background HIV Pre-exposure prophylaxis (PrEP) is being considered for implementation among MSM nationwide in Vietnam. However, there may be concerns about potential obstacles for PrEP adherence among Vietnamese MSM. This study aims to assess the acceptability to use PrEP, potential barriers and facilitators, and the preferences for PrEP service accessibility and delivery among Vietnamese MSM. Methods Four focus group discussions (FGDs) were conducted with 30 HIV-negative MSM in January 2018 in Hanoi, Vietnam. FGDs explored MSM’s awareness regarding PrEP, perceived benefits and barriers of PrEP use, and willingness to use PrEP. FGDs were audio-recorded and transcribed verbatim. Content analysis was used. Results The mean age of participants was 23.9 years old. Most participants realized the advantages of PrEP given its efficacy in HIV risk reduction and expressed high motivation and interest to use PrEP in the future. PrEP was considered as a supplement alongside condoms. Common concerns about PrEP included side-effects, forgetting to take the pill daily, stigmatization due to using PrEP, negative attitudes toward PrEP from other MSM and accessibility of PrEP. Participants would prefer an injectable PrEP regime if available as it was seen as easier to adhere to. Concerns were also raised that PrEP usage could be interpreted as an indication of engaging in sexual risk behavior for HIV, potentially causing suspicion in love relationships or by family and friends. Participants preferred to receive PrEP in civil business organizations and MSM-friendly clinics, and recommended that pharmacy stores would not be suitable for PrEP implementation due to lack of trust and fear of fake drugs. Conclusion This study indicated a high level of willingness to use PrEP among MSM in Vietnam in combination with condom. Strategies to raise awareness of PrEP, reduce stigma towards PrEP, and improve the accessibility among MSM in Vietnam is needed. Existing MSM-friendly clinics were recommended to implement PrEP programs in Vietnam.
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Affiliation(s)
- Long Hoang Nguyen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden. .,VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
| | - Huong Lan Thi Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam.,Faculty of Nursing, Duy Tan University, Da Nang, Vietnam
| | - Bach Xuan Tran
- Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.,Department of Health, Behaviours, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Mattias Larsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Luis E C Rocha
- Department of Economics & Department of Physics and Astronomy, Ghent University, Ghent, Belgium
| | - Anna Thorson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Susanne Strömdahl
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
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Socio-Sexual Experiences and Access to Healthcare Among Informal PrEP Users in the Netherlands. AIDS Behav 2021; 25:1236-1246. [PMID: 33196938 PMCID: PMC7973587 DOI: 10.1007/s10461-020-03085-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2020] [Indexed: 10/25/2022]
Abstract
The aim of this qualitative study was to explore the experiences of informal PrEP users regarding access to PrEP and PrEP-related healthcare, community responses, sexual behavior and well-being. We interviewed 30 men who have sex with men (MSM) in semi-structured online interviews between March and August 2018. Interviews were analyzed using interpretive description. Informal PrEP users were well informed about the use of PrEP, but sometimes did not make use of renal testing. Participants reported a lack of PrEP knowledge among healthcare providers, which limited their access to PrEP and put them at risk, as they received incorrect information. Although some participants reported negative reactions from potential sex partners, most received positive reactions and were sometimes seen as more desirable sex partners. PrEP healthcare services should not only be accessible to formal PrEP users, but also to PrEP users who procure PrEP informally.
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van Griensven F, de Lind van Wijngaarden JW, Eustaquio PC, Wignall S, Azwa I, Veronese V, Ferradini L, Phanuphak N, Mills S. The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming. Sex Health 2021; 18:21-30. [PMID: 33632379 DOI: 10.1071/sh20134] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022]
Abstract
Men who have sex with men (MSM) in Western urban areas have seen substantive decreases in new diagnoses of HIV infection. This paper explores whether such declines are present among MSM and transgender women (TGW) in Southeast Asia and discusses implications for HIV policies and programming. A scoping review was conducted of scientific publications and selected documents regarding the spread of HIV infection among MSM and TGW in major urban centres of the Association of Southeast Asian Nations (ASEAN) region. Continued high HIV prevalence and incidence among MSM are found in integrated behavioural and biological surveillance (IBBS) and research studies. HIV prevalence among MSM under IBBS decreased only in Bangkok from 28.6% in 2014 to 10.3% in 2018, whereas it was increasing in Kuala Lumpur, Ho Chi Minh City, Vientiane, and Phnom Penh. HIV/AIDS case reports regarding new HIV infection diagnoses among MSM have started to decrease in Singapore since 2011 and have been plateauing in Metropolitan Manila since 2017. Where data were available, it was found that HIV prevalence among TGW was high and if IBBS was conducted, it was increasing. HIV prevalence among TGW under IBBS in Jakarta had risen to 34.0% (2015) and 14.0% (2019) in Phnom Penh. These findings suggest that most ASEAN member states have so far failed to effectively implement and scale-up scientifically proven biomedical HIV prevention measures and counter stigma and discrimination that impedes access to appropriate HIV prevention and treatment services for MSM and TGW.
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Affiliation(s)
- Frits van Griensven
- Institute of HIV Research and Innovation, 319 Phayathai Road, Pathumwan, Bangkok 10330, Thailand; and Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand; and Department of Epidemiology and Biostatistics, University of California at San Francisco, Mission Hall, Box 1224, 550 16th Street, San Francisco, CA 94158, USA; and Corresponding author.
| | | | | | - Stephen Wignall
- FHI 360 Cambodia, Phnom Penh Center, Building F, Samdach Sothearos Boulevard (3), Phnom Penh HW3M+9H, Cambodia
| | - Iskandar Azwa
- Infectious Diseases Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| | - Vanessa Veronese
- Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia
| | - Laurent Ferradini
- FHI 360 Asia-Pacific Regional Office, 9 Witthayu Road, Bangkok 10330, Thailand
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, 319 Phayathai Road, Pathumwan, Bangkok 10330, Thailand; and Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Pathumwan, Bangkok 10330, Thailand
| | - Stephen Mills
- FHI 360 Asia-Pacific Regional Office, 9 Witthayu Road, Bangkok 10330, Thailand
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Haldar P, Reza-Paul S, Daniel RA, Lazarus L, Rewari BB, Lorway R, Steen R. A rapid review of pre-exposure prophylaxis for HIV in the Asia-Pacific region: recommendations for scale up and future directions. Sex Health 2021; 18:31-40. [PMID: 33632382 DOI: 10.1071/sh20058] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 01/13/2021] [Indexed: 01/10/2023]
Abstract
Decline in new HIV infections in the Asia-Pacific region (APAC) continues to be slow, emphasising the importance of scaling up new HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). To help inform PrEP rollout in APAC, we conducted a rapid review of published literature on PubMed from 2015 to 2020, to assess feasibility, implementation strategies, cost-effectiveness, and availability of national policies and guidelines; for the latter, we also did an expanded Internet search. This review focussed on nine countries contributing >95% of new infections in this region. A total of 36 PrEP-related studies conducted among men who have sex with men, female sex workers, and transgender women were included, of which 29 were quantitative, six were qualitative and one was a mixed-method study. Most of the studies have addressed the availability and acceptability of PrEP, whereas cost-effectiveness of any approach was assessed by limited studies. Limited published information was available about national PrEP policies and guidelines; of the selected nine countries, five have adopted the recommended World Health Organization PrEP policy of which four have integrated it in their national HIV response. HIV risk perception concerns about safety, side-effects, stigma, and affordability were major challenges to PrEP acceptance. Community-based implementation has the potential to address these. Limited evidence suggested merging PrEP implementation with ongoing targeted intervention and treatment programs could be a cost-effective approach. To stem the epidemic, newer effective prevention strategies, like PrEP, should be urgently adopted within the context of combination HIV prevention approaches.
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Affiliation(s)
- Partha Haldar
- All India Institute of Medical Sciences, Centre for Community Medicine, New Delhi, India
| | - Sushena Reza-Paul
- University of Manitoba, Institute for Global Public Health, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada; and Corresponding author.
| | - Roy Arokiam Daniel
- All India Institute of Medical Sciences, Centre for Community Medicine, New Delhi, India
| | - Lisa Lazarus
- University of Manitoba, Institute for Global Public Health, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Bharat Bhushan Rewari
- World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Robert Lorway
- University of Manitoba, Institute for Global Public Health, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - R Steen
- Erasmus Medical Center, Department of Public Health, Rotterdam, Zuid-Holland, Netherlands
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Janamnuaysook R, Green KE, Seekaew P, Ngoc Vu B, Van Ngo H, Anh Doan H, Pengnonyang S, Vannakit R, Phanuphak P, Phanuphak N, Ramautarsing RA. Demedicalisation of HIV interventions to end HIV in the Asia-Pacific. Sex Health 2021; 18:13-20. [PMID: 33632380 DOI: 10.1071/sh20172] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/30/2020] [Indexed: 02/04/2023]
Abstract
Despite the challenges to the HIV response in the Asia-Pacific, a demedicalisation of HIV intervention has been demonstrated to be an important strategy to maximise the uptake of HIV prevention tools among key populations in this region. Demedicalisation of HIV interventions translates medical discourse and shifts the paradigm from a disease-focused to a people-centred approach. It also recognises real-life experiences of key populations in the HIV response by empowering them to voice their needs and be at the forefront of the epidemic control. We further categorise a demedicalisation approach into three frameworks: (1) the demystification of clinical or medical concerns; (2) the destigmatisation of people living with HIV; and (3) the decentralisation of healthcare services. This article reviewed the demedicalisation framework by looking at the HIV intervention examples from countries in the Asia-Pacific, which included: (1) a study on drug-drug interaction between pre-exposure prophylaxis and feminising hormone treatment for transgender women; (2) the roles of key population-led health services; and (3) certification of key population lay providers.
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Affiliation(s)
- Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand; and Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand; and Corresponding author.
| | | | - Pich Seekaew
- Institute of HIV Research and Innovation, Bangkok, Thailand; and Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
| | | | | | | | | | | | | | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand; and Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
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21
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Galka JM, Wang M, Azwa I, Gibson B, Lim SH, Shrestha R, Wickersham JA. Willingness to Use Pre-Exposure Prophylaxis (PrEP) for HIV Prevention and PrEP Implementation Preferences Among Transgender Women in Malaysia. Transgend Health 2020; 5:258-266. [PMID: 33644315 DOI: 10.1089/trgh.2020.0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Transgender women (TW) face one of the highest HIV burdens worldwide. In Malaysia, 12.4% of TW are HIV infected, ∼30-fold higher than in the Malaysian adult population. Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention strategy, however, little is known about TW's willingness to use PrEP or their preferences for receiving PrEP. This study examined the correlates of Malaysian TW's willingness to use PrEP and their attitudes and preferences related to delivery of PrEP and PrEP-related care. Methods: Between June and August 2017, 361 TW in Malaysia completed an online survey about their knowledge of and willingness to use PrEP for HIV prevention. Results: Only 20.2% of participants had ever previously heard of PrEP and none were currently taking PrEP. The majority (82.5%) expressed high willingness to take PrEP and most participants met the World Health Organization (WHO) indication for PrEP (82.3%). In the multivariate model, lifetime hormone use, prior postexposure prophylaxis use, and having completed a high school education were associated with higher willingness to use PrEP, while injection drug use, older age, and Chinese ethnicity were associated with lower PrEP willingness. Conclusion: TW in Malaysia are highly willing to use PrEP for HIV prevention. Differences in willingness to use PrEP identified by education, ethnicity, substance abuse, and age suggest different strategies may be needed to scale-up PrEP for this diverse community of TW.
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Affiliation(s)
- Jonathan M Galka
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of History of Science, Harvard University, Cambridge, Massachusetts, USA
| | - Melinda Wang
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Iskandar Azwa
- Department of Medicine, Faculty of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
| | - Britton Gibson
- Quinnipiac University School of Medicine, Hamden, Connecticut, USA
| | - Sin How Lim
- Department of Medicine, Faculty of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia.,Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Roman Shrestha
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Jeffrey A Wickersham
- Section of Infectious Diseases, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.,Department of Medicine, Faculty of Medicine, Centre of Excellence for Research in AIDS, University of Malaya, Kuala Lumpur, Malaysia
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PrEP Use Awareness and Interest Cascade among MSM and Transgender Women Living in Bali, Indonesia. Trop Med Infect Dis 2020; 5:tropicalmed5040158. [PMID: 33050477 PMCID: PMC7709693 DOI: 10.3390/tropicalmed5040158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022] Open
Abstract
Indonesia has not implemented HIV pre-exposure prophylaxis (PrEP) despite global calls for its scale-up, and there is limited information about attitudes towards PrEP among its potential users. We aim to present a PrEP cascade among men who have sex with men (MSM) and transgender women (known locally as “waria”) in Denpasar, Bali, from a cross-sectional survey with 220 HIV-negative MSM/waria recruited from one clinic in Denpasar. Only 16.4% of participants had heard of PrEP before. From first-to-last steps included in the cascade, we found 77.3% (170/220) of participants were classified with HIV high risk, 75.9% (129/170) perceived themselves as being at high risk, 81.4% (105/129) expressed interest in using PrEP, 78.1% (82/105) were willing to do PrEP procedures, 48.8% (40/82) were willing to pay 500,000–600,000 IDR, and only two participants had ever been on PrEP before (5.0% of those willing to pay and 0.9% of the total sample). Multivariate logistic regression analysis showed that self-perception of high HIV risk was lower among older age groups (p < 0.001 among 30–39; p = 0.002 among > 40) and higher among participants with multiple sex partners (p = 0.016). Interest in using PrEP was lower among participants with high social engagement as MSM/waria (p = 0.002) and was higher among participants with multiple sex partners (p = 0.020) and inconsistent condom use (p = 0.011). This study has shown a significantly low level of PrEP awareness among its participants and decreases in interest in PrEP use due to procedure and cost. It suggested that an appropriate PrEP campaign is needed if PrEP is going to be introduced in Indonesia.
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Songtaweesin WN, Kawichai S, Phanuphak N, Cressey TR, Wongharn P, Saisaengjan C, Chinbunchorn T, Janyam S, Linjongrat D, Puthanakit T. Youth-friendly services and a mobile phone application to promote adherence to pre-exposure prophylaxis among adolescent men who have sex with men and transgender women at-risk for HIV in Thailand: a randomized control trial. J Int AIDS Soc 2020; 23 Suppl 5:e25564. [PMID: 32869511 PMCID: PMC7459171 DOI: 10.1002/jia2.25564] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Strategies are needed to curb the increasing HIV incidence in young men who have sex with men (YMSM) and transgender women (YTGW) worldwide. We assessed the impact of youth-friendly services (YFS) and a mobile phone application (app) on adherence to pre-exposure prophylaxis (PrEP) in YMSM and YTGW in Thailand. METHODS A randomized control trial was conducted in YMSM and YTGW aged 15 to 19 years. Participants were provided daily oral tenofovir disoproxil fumerate/emtricitabine (TDF/FTC), condoms and randomized to receive either YFS or YFS plus a PrEP app (YFS + APP), whose features included self-assessment of HIV acquisition risk, point rewards and reminders for PrEP and clinic appointments. Clinic visits occurred at zero, one, three and six months and telephone contact at two, four and five months. HIV testing was performed at every clinic visit. PrEP adherence was evaluated with intracellular tenofovir diphosphate (TFV-DP) concentrations in dried blood spot (DBS) samples at months 3 and 6. The primary endpoint assessed was "PrEP adherence" defined as TFV-DP DBS concentrations ≥700 fmol/punch (equivalent to ≥4 doses of TDF/week). RESULTS Between March 2018 and June 2019, 489 adolescents were screened at three centres in Bangkok. Twenty-seven (6%) adolescents tested positive for HIV and 200 (41%) adolescents participated in the study. Of these, 147 were YMSM (74%) and 53 YTGW (26%). At baseline, median age was 18 years (IQR 17 to 19), 66% reported inconsistent condom use in the past month. Sexually transmitted infection prevalence was 23%. Retention at six months was 73%. In the YFS + APP arm, median app use duration was three months (IQR 1 to 5). PrEP adherence at month 3 was 51% in YFS and 54% in YFS + APP (p-value 0.64) and at month 6 was 44% in YFS and 49% in YFS + APP (p-value 0.54). No HIV seroconversions occurred during 75 person years of follow-up. CONCLUSIONS Youth-friendly PrEP services enabled good adherence among half of adolescent PrEP users. However, the mobile phone application tested did not provide additional PrEP adherence benefit in this randomized trial. Adolescent risk behaviours are dynamic and require adaptive programmes that focus on "prevention-effective adherence."
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Affiliation(s)
- Wipaporn Natalie Songtaweesin
- Center of Excellence for Pediatric Infectious Diseases and VaccinesFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Surinda Kawichai
- Center of Excellence for Pediatric Infectious Diseases and VaccinesFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | - Tim R Cressey
- PHPT/IRD UMI 174Faculty of Associated Medical SciencesChiang Mai UniversityChiang MaiThailand
- Department of Immunology & Infectious DiseasesHarvard T.H. Chan School of Public HealthBostonMAUSA
- Department of Molecular & Clinical PharmacologyUniversity of LiverpoolLiverpoolUnited Kingdom
| | - Prissana Wongharn
- Center of Excellence for Pediatric Infectious Diseases and VaccinesFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | - Chutima Saisaengjan
- Center of Excellence for Pediatric Infectious Diseases and VaccinesFaculty of MedicineChulalongkorn UniversityBangkokThailand
| | | | - Surang Janyam
- The Service Workers IN Group FoundationBangkokThailand
| | | | - Thanyawee Puthanakit
- Center of Excellence for Pediatric Infectious Diseases and VaccinesFaculty of MedicineChulalongkorn UniversityBangkokThailand
- Department of PediatricsFaculty of MedicineChulalongkorn UniversityBangkokThailand
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Vannakit R, Andreeva V, Mills S, Cassell MM, Jones MA, Murphy E, Ishikawa N, Boyd MA, Phanuphak N. Fast-tracking the end of HIV in the Asia Pacific region: domestic funding of key population-led and civil society organisations. Lancet HIV 2020; 7:e366-e372. [PMID: 32386723 DOI: 10.1016/s2352-3018(20)30077-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 02/17/2020] [Accepted: 03/02/2020] [Indexed: 01/26/2023]
Abstract
Ending AIDS in Asia Pacific by 2030 requires countries to give higher priority to financing community-based and key population-led service delivery. Mechanisms must be developed for civil society organisations to deliver health and HIV/AIDS services for key populations, especially men who have sex with men, and transgender people, within national health policy frameworks. Current investments in the HIV response in the Asia Pacific region reflect inadequate HIV financing for key populations, particularly for civil society and key population-led organisations that are optimally positioned to advance HIV epidemic control. These organisations are typically supported by international agencies whose investments are starting to decline. Domestic investments in key population-led organisations are often hampered by punitive laws against their communities, pervasive stigma and discrimination by policy makers, an insufficient understanding of the most effective HIV epidemic control strategies, and financing systems that limit access to funding for these organisations from the national budget. Countries in the Asia Pacific region are evolving their community-based and key population policies and programmes. We need accessible, disaggregated financial data and in-depth case studies that showcase effective key population-led programmes, to enable countries to learn from each other.
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Affiliation(s)
| | | | | | | | - Melissa A Jones
- US Agency for International Development, Regional Development Mission for Asia, Bangkok, Thailand
| | | | - Naoko Ishikawa
- WHO Regional Office for Western Pacific, Manila, Philippines
| | - Mark A Boyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
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Gay and Bisexual Men's Perceptions of Pre-exposure Prophylaxis (PrEP) in a Context of High Accessibility: An Australian Qualitative Study. AIDS Behav 2020; 24:2369-2380. [PMID: 31970582 DOI: 10.1007/s10461-020-02796-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report on Australian gay and bisexual men's (GBM) perceptions of preexposure prophylaxis (PrEP). Drawing on an online longitudinal cohort study, 1,404 free-text responses from HIV-negative or untested Australian GBM were qualitatively analysed. The chi-square statistic was then used to assess differences regarding PrEP-perceptions by participants' demographic and behavioral characteristics. Positive views of PrEP were twice more common than negative. Those with positive views thought PrEP helped overcome HIV fear and anxiety, enhanced sexual pleasure, and was a 'socially responsible' course of action. Those with negative views believed that people without medical conditions did not need medication and expressed concern that PrEP was replacing condoms, representing 'dangerous' behavior. Descriptive statistics revealed differences in PrEP-perceptions relating to age, recency of HIV testing, and PrEP eligibility. This study is the first to use free-text data to examine the frequency of Australian GBM's PrEP-perceptions, highlighting the potential benefits and challenges to its promotion.
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Tan RKJ, Teo AKJ, Kaur N, Harrison-Quintana J, I-Cheng Chen M, Wong CS. Cost and anonymity as factors for the effective implementation of pre-exposure prophylaxis: an observational study among gay, bisexual and other men who have sex with men in Singapore. Sex Health 2019; 15:533-541. [PMID: 30249316 DOI: 10.1071/sh18059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 05/26/2018] [Indexed: 11/23/2022]
Abstract
Background HIV pre-exposure prophylaxis (PrEP) is currently offered by several public and private clinics at unsubsidised prices in Singapore, but to date, no information is available on the effect of these services. This study sought to assess the knowledge and uptake of, and willingness to use PrEP among gay, bisexual and other men who have sex with men (GBMSM) in Singapore. METHODS Recruitment was conducted through Grindr®, a geosocial networking application for GBMSM. Results were quantitatively analysed through descriptive statistics and multivariate Poisson regression models, while open-ended responses were qualitatively coded and categorised. RESULTS Of the 1339 participants who responded, 1098 participants who indicated their knowledge and use of PrEP were included in the analytic sample. Overall, 15.0% (n=154) had taken PrEP, 66.2% (n=678) had heard of but not taken PrEP, while 18.8% (n=193) had never heard of PrEP. Of those who had ever taken PrEP, 59.6% (n=90) had obtained PrEP from overseas or other unofficial sources. Of those who had heard of but never taken PrEP, 73.3% (n=486) reported that they would consider taking PrEP. Those who had taken PrEP were older and had higher educational attainment. CONCLUSIONS The gap between the willingness to use PrEP and its uptake may be attributed to the cost of PrEP and issues of anonymity at healthcare settings in Singapore. National financing schemes are needed to expand access to PrEP if it is to make a meaningful effect to the Singapore HIV/AIDS response.
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Affiliation(s)
- Rayner Kay Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549 Singapore
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549 Singapore
| | - Nashwinder Kaur
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442 Singapore
| | | | - Mark I-Cheng Chen
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549 Singapore
| | - Chen Seong Wong
- National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, 308442 Singapore
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Grangeiro A, do Nascimento MMP, Zucchi EM, Ferraz D, Escuder MM, Arruda É, Lotufo D, Munhoz R, Couto MT. Nonoccupational post-exposure prophylaxis for HIV after sexual intercourse among women in Brazil: Risk profiles and predictors of loss to follow-up. Medicine (Baltimore) 2019; 98:e17071. [PMID: 31574806 PMCID: PMC6775357 DOI: 10.1097/md.0000000000017071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Access to antiretroviral-based HIV prevention has been marked by sex asymmetries, and its effectiveness has been compromised by low clinical follow-up rates. We investigated risk profiles of women who received nonoccupational post-exposure prophylaxis (nPEP), as well as the rates and predictive factors of loss to follow-up after nPEP initiation.Retrospective study evaluating 501 women who received nPEP between 2014 and 2015 at 5 HIV centers (testing centers-VCT, outpatient clinics, and infectious diseases hospital). Risk profiles were drawn based on the characteristics of the women and their sexual partners, and then stratified by sociodemographic indicators and previous use of HIV prevention services. Loss to follow-up (LTFU) was defined as not presenting for follow-up visits or for HIV testing after nPEP initiation. Predictors of LTFU were analyzed by calculating adjusted prevalence ratios (aPRs).Approximately 90% of women had sexual encounters that met the criteria established in the Brazilian guidelines for nPEP. Those who declared to be sex workers (26.5%) or drug users (19.2%) had the highest social vulnerability indicators. In contrast, women who had intercourse with casual partners of unknown HIV risk (42.7%) had higher education and less experience with previous HIV testing (89.3%) or nPEP use (98.6%). Of the women who received nPEP after sexual intercourse with stable partners, 75.8% had HIV-infected partners. LTFU rate was 72.8% and predictors included being Black (aPR = 1.15, 95% confidence interval [CI]: 1.03-1.30), using drugs/alcohol (aPR = 1.15, 95% CI: 1.01-1.32) and having received nPEP at an HIV outpatient clinic (aPR = 1.35, 95% CI: 1.20-1.51) or at an infectious diseases hospital (aPR = 1.37, 95% CI: 1.11-1.69) compared with a VCT. The risk of LTFU declined as age increased (aPR 41-59 years = 0.80, 95% CI: 0.68-0.96).Most women who used nPEP had higher socioeconomic status and were not part of populations most affected by HIV. In contrast, factors that contribute to loss to follow-up were: having increased social vulnerability; increased vulnerability to HIV infection; and seeking nPEP at HIV treatment services as opposed to at a VCT.
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Affiliation(s)
| | | | - Eliana Miura Zucchi
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos
| | | | | | - Érico Arruda
- Faculdade de Medicina da Universidade Estadual do Ceará, Universidade de Fortaleza e Hospital São José de Doenças Infecciosas, Fortaleza
| | - Denize Lotufo
- Centro de Referência e Treinamento DST e Aids, Secretaria de Estado da Saúde, São Paulo, Brazil
| | - Rosemeire Munhoz
- Centro de Referência e Treinamento DST e Aids, Secretaria de Estado da Saúde, São Paulo, Brazil
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Kwan TH, Lee SS. Bridging Awareness and Acceptance of Pre-Exposure Prophylaxis Among Men Who Have Sex With Men and the Need for Targeting Chemsex and HIV Testing: Cross-Sectional Survey. JMIR Public Health Surveill 2019; 5:e13083. [PMID: 31271148 PMCID: PMC6636239 DOI: 10.2196/13083] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/02/2019] [Accepted: 06/03/2019] [Indexed: 11/23/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is currently an important tool for HIV prevention, especially in communities with higher risk of infection, notably men who have sex with men (MSM). To date, PrEP has remained generally unavailable in many cities around the world. In the planning of strategies for PrEP targeting MSM, community assessment is crucial to understand members’ responses to the new intervention. Objective Awareness and acceptance are 2 different but intricately linked contexts of PrEP. The aim of this study was to identify the determinants of awareness and acceptance of PrEP among MSM and to delineate their interrelationships in Hong Kong where PrEP services have not been developed. Methods A Web-based questionnaire survey was administered in light of the popularity of the internet as a platform for information and networking in the MSM community. Factors associated with PrEP acceptance and awareness were separately analyzed, and their predictors were subsequently tested by multivariate logistic regression. Associations between acceptance and awareness of PrEP were examined by factor network analysis. Results Between August and September 2016, results from a total of 453 HIV-negative MSM were analyzed. Half (49.7%, 225/453) of the respondents were aware of PrEP, and 78.3% (355/453) would consider using PrEP when it becomes available. Awareness of PrEP was associated with recent (P=.01) and ongoing (P=.04) use of psychotropic drugs for sex (chemsex). MSM who used online forums to seek sex partners had lower awareness (P=.04) than those visiting physical venues for sex networking. MSM who accepted PrEP were more likely users of internet channels for sex networking (P=.049), especially location-based social network apps (P=.04). MSM accepting PrEP were more concerned about their partners’ HIV status (P=.002), history of sexually transmitted infections (P=.01), condom use (P=.02), and HIV testing behavior (P=.02). Multivariate logistic regressions revealed that PrEP awareness was related to one’s networking pattern, whereas its acceptance was associated with inclination to self-protect from HIV. Factor network analysis highlighted the importance of chemsex, which was linked by over half of the edges, whereas the rest were contributed by HIV testing behaviors. Conclusions In Hong Kong, the overall awareness among MSM toward PrEP was only moderate but their acceptance was higher. Targeting MSM with chemsex behaviors through Web-based platforms and parallel development of tailored HIV testing services are important when introducing PrEP in the community.
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Affiliation(s)
- Tsz Ho Kwan
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, China (Hong Kong)
| | - Shui Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, China (Hong Kong)
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Anand T, Nitpolprasert C, Jantarapakde J, Meksena R, Phomthong S, Phoseeta P, Phanuphak P, Phanuphak N. Implementation and impact of a technology-based HIV risk-reduction intervention among Thai men who have sex with men using "Vialogues": a randomized controlled trial. AIDS Care 2019; 32:394-405. [PMID: 31154811 DOI: 10.1080/09540121.2019.1622638] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
We conducted a randomized control trial to evaluate the impact of a novel technology-based intervention on HIV risks and condom use behaviors among Thai men who have sex with men (MSM). Between April 2016 and August 2017, participants aged 18 years and above, and having engaged in unprotected sex in past six months were randomly assigned to control and intervention arm, and received HIV testing at baseline, month 6 and 12. Intervention arm participants engaged in 12-monthly HIV/STI prevention educational sessions delivered via Vialogues.com. Of 76 MSM enrolled, 37 were randomized to intervention and 39 to control arm. Median age was 28 (IQR 24-32) years. Thirty-three (89.2%) intervention arm participants completed all 12-monthly Vialogues sessions. At month 12, intervention arm had higher retention rate (p = 0.029) and higher median percentage of condom use for anal intercourse (p = 0.023) versus control arm. Over the 12-month period, intervention arm reported significant reduction in self-perceived HIV risk (p = 0.001), popper usage (p = 0.002), median number of sexual partners (p = 0.003), and increased median condom use percentage (p = 0.006). Our study highlights that "Vialogues" intervention significantly reduced number of sexual partners and condomless anal intercourse rates among Thai MSM, and has positive implications for reducing epidemic among key populations.
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Affiliation(s)
- Tarandeep Anand
- PREVENTION, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Adam's Love Global Foundation for MSM and Transgender Health (ALGO), Bangkok, Thailand
| | - Chattiya Nitpolprasert
- PREVENTION, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand.,Adam's Love Global Foundation for MSM and Transgender Health (ALGO), Bangkok, Thailand
| | | | | | - Sangusa Phomthong
- PREVENTION, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Petchfa Phoseeta
- PREVENTION, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Praphan Phanuphak
- PREVENTION, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
| | - Nittaya Phanuphak
- PREVENTION, The Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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30
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Seekaew P, Nguyen E, Sungsing T, Jantarapakde J, Pengnonyang S, Trachunthong D, Mingkwanrungruang P, Sirisakyot W, Phiayura P, Panpet P, Meekrua P, Praweprai N, Suwan F, Sangtong S, Brutrat P, Wongsri T, Nakorn PRN, Mills S, Avery M, Vannakit R, Phanuphak P, Phanuphak N. Correlates of nonadherence to key population-led HIV pre-exposure prophylaxis services among Thai men who have sex with men and transgender women. BMC Public Health 2019; 19:328. [PMID: 30898095 PMCID: PMC6429797 DOI: 10.1186/s12889-019-6645-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 03/11/2019] [Indexed: 11/18/2022] Open
Abstract
Background Based on government estimates from the Asian Epidemic Model, new infections among men who have sex with men (MSM) and transgender women (TGW) in Thailand are forecast to proportionally increase over time. Daily oral Pre-exposure prophylaxis (PrEP) protects against HIV acquisition when used as prescribed. The “Princess PrEP” program is the first key population-led (PrEP) initiative under Thai royal patronage with an aim to scale up countrywide implementation of PrEP. Methods Retention in and adherence to key population-led HIV PrEP services among HIV-uninfected Thai MSM and TGW was examined in four provinces: Bangkok, Chonburi, Chiang Mai, and Songkhla. HIV, HBsAg, creatinine tests, and self-administered questionnaires were performed during baseline measures. Participants were followed up after month 1, at month 3, then every 3 months. Correlates of nonadherence and loss to follow up at 1 month were assessed using linear regression models. Results 37.4% of the participants reported low adherence to services (≤ 3 pills/week or missed clinic schedule at month 1). Factors associated with low adherence included younger age (25 years and under) (adjusted odds ratio (aOR): 1.49, 95% confidence interval (95% CI: 1.01–2.21, p = 0.044), being a TGW (aOR: 2.2, 95% CI: 1.27–3.83, p = 0.005), and whether the participant had not previously accessed services at the clinic (aOR = 1.68, 95% CI: 1.03–2.76, p = 0.04). Additionally, participants in Chonburi (the only TGW site) showed significantly lower adherence than those in the other three provinces (aOR: 2.91, 95% CI: 1.55–5.45, p = 0.001). Conclusion Urgent, innovative interventions for early PrEP adherence support among vulnerable sub-populations such as younger users, TGW, and new clients are needed to maximize prevention strategy in Thailand. Electronic supplementary material The online version of this article (10.1186/s12889-019-6645-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pich Seekaew
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand.
| | - Ezie Nguyen
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand.,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Thanthip Sungsing
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Jureeporn Jantarapakde
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Supabhorn Pengnonyang
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Deondara Trachunthong
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Pravit Mingkwanrungruang
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Waraporn Sirisakyot
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Pattareeya Phiayura
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Phubet Panpet
- Rainbow Sky Association of Thailand, Bangkok, Thailand
| | | | | | - Fonthip Suwan
- Rainbow Sky Association of Thailand, Songkhla, Thailand
| | | | | | | | | | | | | | - Ravipa Vannakit
- Office of Public Health, U.S. Agency for International Development Regional Development Mission for Asia, Bangkok, Thailand
| | - Praphan Phanuphak
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
| | - Nittaya Phanuphak
- PREVENTION, the Thai Red Cross AIDS Research Centre, 104 Rajdamri Rd., Pathumwan, Bangkok, 10330, Thailand
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Wimonsate W, Pattanasin S, Ungsedhapand C, Pancharoen K, Luechai P, Satumay K, Winaitham S, Sukwicha W, Sirivongrangsan P, Dunne EF, Holtz TH. Repeat HIV testing among HIV-uninfected men who have sex with men attending Silom Community Clinic, Bangkok, 2011 - 2014. Int J STD AIDS 2018; 29:1417-1423. [PMID: 30115000 PMCID: PMC6409200 DOI: 10.1177/0956462418788724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since 2010, the Thailand Ministry of Public Health has recommended that men who have sex with men (MSM) have an HIV test at least two times a year. We calculated the proportion of, and factors associated with, testing adherence among the HIV-uninfected MSM clients attending Silom Community Clinic @TropMed. We defined testing adherence as repeating at least one HIV test within six months of an initial HIV-negative test, and used log-binomial regression to test for associated factors. We included 1927 clients during 2011–2014; 362 (19%) were adherent with an increased trend (p < 0.01), from 16% to 24%. Clients aged 18–24 years and those having a history of HIV testing were more likely to adhere (aRR: 1.3, 95% CI: 1.1–1.6; and aRR: 1.3, 95% CI: 1.0–1.5, respectively). One-fifth adhered to the recommendation; older clients or naïve testees were less likely to adhere. We need to impress on clients the importance of repeat HIV testing.
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Affiliation(s)
- Wipas Wimonsate
- HIV/STD Research Program, Thailand Ministry of Public Health – U.S., Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Sarika Pattanasin
- HIV/STD Research Program, Thailand Ministry of Public Health – U.S., Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Chaiwat Ungsedhapand
- HIV/STD Research Program, Thailand Ministry of Public Health – U.S., Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Kanokpan Pancharoen
- HIV/STD Research Program, Thailand Ministry of Public Health – U.S., Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Pikunchai Luechai
- HIV/STD Research Program, Thailand Ministry of Public Health – U.S., Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Kesinee Satumay
- HIV/STD Research Program, Thailand Ministry of Public Health – U.S., Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Santi Winaitham
- HIV/STD Research Program, Thailand Ministry of Public Health – U.S., Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | - Wichuda Sukwicha
- HIV/STD Research Program, Thailand Ministry of Public Health – U.S., Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
| | | | - Eileen F Dunne
- HIV/STD Research Program, Thailand Ministry of Public Health – U.S., Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Timothy H Holtz
- HIV/STD Research Program, Thailand Ministry of Public Health – U.S., Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand
- Division of HIV/AIDS Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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32
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Chuang DM, Newman PA. Pre-Exposure Prophylaxis (PrEP) Awareness and Acceptability Among Men Who Have Sex With Men in Taiwan. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:490-501. [PMID: 30966765 DOI: 10.1521/aeap.2018.30.6.490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Gay and other men who have sex with men (MSM) account for the vast majority of new HIV infections in Taiwan, yet utilization of pre-exposure prophylaxis (PrEP) remains low. We examined correlates of PrEP awareness and acceptability among MSM in Taiwan. A cross-sectional survey was conducted with 176 MSM (mean age = 27.4 years) recruited through community-based organizations in two cities. Less than half of participants (47.2%) were aware of PrEP; however, when it was described to them, the majority (72.2%) indicated PrEP acceptability. In multivariable analyses, condomless anal sex was negatively associated with PrEP awareness, and higher levels of vicarious stigma and anticipated PrEP disclosure to sexual partners were positively associated with PrEP acceptability. Our findings indicate the need for targeted interventions to increase PrEP awareness among MSM engaged in high-risk behaviors and implementation strategies that address sociocultural factors to accelerate PrEP utilization among MSM in Taiwan.
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Affiliation(s)
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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33
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HIV pre-exposure prophylaxis in South East Asia: A focused review on present situation. Int J Infect Dis 2018; 77:113-117. [PMID: 30395980 DOI: 10.1016/j.ijid.2018.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 10/31/2018] [Indexed: 02/03/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) with the use of antiretrovirals has been approved for HIV prevention in many western countries and internationally. PrEP is however not yet widely available in South East Asia. Awareness of PrEP among MSM in the region is very variable in different countries. While willingness of PrEP uptake is closely related to the extent of awareness, it is largely affected by factors at the individual level, e.g. financial consideration, risk perception, understanding of PrEP and convenience. Removal of social stigmata and secure data confidentiality can improve willingness of uptake. The diverse religious beliefs in South East Asia could have potential influence on PrEP uptake but there was very limited data in the region. There is no strong evidence suggesting substantial risk compensation among MSM who are on PrEP. As in other parts of the world, education on condom use to prevent other sexually transmitted diseases (STD) should be properly addressed rather than blaming PrEP as a sole cause of rise in STD among MSM.
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34
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Medland NA, Chow EPF, Read THR, Ong JJ, Chen M, Denham I, Gunaratnum P, Fairley CK. Incident HIV infection has fallen rapidly in men who have sex with men in Melbourne, Australia (2013-2017) but not in the newly-arrived Asian-born. BMC Infect Dis 2018; 18:410. [PMID: 30126355 PMCID: PMC6102820 DOI: 10.1186/s12879-018-3325-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 08/13/2018] [Indexed: 12/02/2022] Open
Abstract
Background We examined differences in incident HIV infection between newly-arrived Asian-born and other men who have sex with men (MSM) after the introduction of universal HIV treatment guidelines in 2015 and pre-exposure prophylaxis in 2016. Methods Clinical, demographic, laboratory and behavioural data on MSM presenting for HIV testing at the Melbourne Sexual Health Centre from July 2013 to June 2017 were extracted. We compared the proportion of newly-arrived (four years or less in Australia), Asian-born and other MSM tested each year who were diagnosed with incident HIV infection (negative test within one year or diagnosis with indeterminate or negative Western Blot). Results We analysed 35,743 testing episodes in 12,180 MSM, including 2781 testing episodes in 1047 newly-arrived Asian-born MSM. The proportion of other MSM tested each year who were diagnosed with incident HIV infection fell from 0.83% in 2014 to 0.38% in 2017 (p = .001), but did not fall in newly-arrived Asian-born MSM (from 1.18% in 2014 to 1.56% in 2017, p = .76). In the multivariate logistic regression, in 2016/2017 but not in 2014/2015, being newly-arrived Asian-born was associated with an increased odds of diagnosis of incident HIV infection (aOR 3.29, 95%CI 1.82–5.94, p < .001). Conclusions The epidemiology of HIV in Melbourne Australia has changed dramatically. While there has been an overall reduction amongst MSM, the incidence of HIV in newly-arrived Asian-born MSM remains high. Failing to address these new inequalities leaves individuals at risk and may offset the population benefit of biomedical HIV prevention. Electronic supplementary material The online version of this article (10.1186/s12879-018-3325-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nicholas A Medland
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. .,Central Clinical School, Monash University, Melbourne, Australia. .,The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia.
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Timothy H R Read
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia.,Faculty of Tropical and Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Marcus Chen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Ian Denham
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Praveena Gunaratnum
- The Kirby Institute for Infection and Immunity, University of New South Wales, Sydney, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
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35
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Reed JB, Patel RR, Baggaley R. Lessons from a decade of voluntary medical male circumcision implementation and their application to HIV pre-exposure prophylaxis scale up. Int J STD AIDS 2018; 29:1432-1443. [PMID: 30114997 PMCID: PMC6287252 DOI: 10.1177/0956462418787896] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
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.
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Affiliation(s)
- Jason B Reed
- HIV-Malaria-Infectious Diseases, Jhpiego, Baltimore, MD, USA
| | - Rupa R Patel
- Division of Infectious Diseases, Washington University in St. Louis, St Louis, MO, USA
| | - Rachel Baggaley
- Department of HIV/AIDS, World Health Organization, Geneva, Switzerland
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36
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Zucchi EM, Grangeiro A, Ferraz D, Pinheiro TF, Alencar T, Ferguson L, Estevam DL, Munhoz R. [From evidence to action: challenges for the Brazilian Unified National Health System in offering pre-exposure prophylaxis (PrEP) for HIV to persons with the greatest vulnerability]. CAD SAUDE PUBLICA 2018; 34:e00206617. [PMID: 30043853 DOI: 10.1590/0102-311x00206617] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 05/02/2018] [Indexed: 12/12/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) has been considered a promising strategy for controlling the global HIV epidemic. However, it is necessary to translate the knowledge accumulated from clinical trials and demosntration studies to the reality of health services and the groups most vulnerable to infection in order to achieve broad coverage with PrEP. The article proposes a reflection on this challenge, focusing on three dimensions: users of prophylaxis, with an emphasis on the contexts of sexual practices and the potential exposures to HIV; the advantages of prophylaxis as compared to other methods and the challenges for protective and safe use; and health services, considering the organizational principles to ensure greater success in the supply and incorporation of PrEP as part of combination prevention strategies. The following principles were analyzed: uniqueness of care, freedom of choice and non-hierarchization of prevention methods, sexual risk management, scheduling flexibility, and complementary and multidisciplinary care. These principles can foster organization of the health service and care, facilitating linkage and retention in care. Some comments were offered on the relative incompatibility between the existing structure of services and the Brazilian Ministry of Health guidelines for offering PrEP. The conclusion was that the success of PrEP as a public health policy depends on two essential factors: ensuring that health services are culturally diverse settings, free of discrimination, and the intensification of community-based interventions, including social networks, in order to reduce inequalities in access to PrEP and health services as a whole.
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Affiliation(s)
- Eliana Miura Zucchi
- Programa de Pós-graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brasil
| | | | - Dulce Ferraz
- Escola Fiocruz de Governo, Fundação Oswaldo Cruz, Brasília, Brasil
| | | | - Tatianna Alencar
- Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis, do HIV/Aids e das Hepatites Virais, Ministério da Saúde, Brasília, Brasil
| | - Laura Ferguson
- Keck School of Medicine, University of Southern California, Los Angeles, U.S.A
| | - Denize Lotufo Estevam
- Centro de Referência e Treinamento em DST/AIDS-SP, Secretaria de Estado de Saúde de São Paulo, São Paulo, Brasil
| | - Rosemeire Munhoz
- Centro de Referência e Treinamento em DST/AIDS-SP, Secretaria de Estado de Saúde de São Paulo, São Paulo, Brasil
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37
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Structural barriers to HIV prevention among men who have sex with men (MSM) in Vietnam: Diversity, stigma, and healthcare access. PLoS One 2018; 13:e0195000. [PMID: 29614104 PMCID: PMC5882136 DOI: 10.1371/journal.pone.0195000] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 03/14/2018] [Indexed: 01/22/2023] Open
Abstract
Men who have sex with men (MSM) in Vietnam experience disproportionate rates of HIV infection. To advance understanding of how structural barriers may shape their engagement with HIV prevention services, we draw on 32 in-depth interviews and four focus groups (n = 31) conducted with MSM in Hanoi between October 2015- March 2016. Three primary factors emerged: (1) Diversity, both in relation to identity and income; Vietnamese MSM described themselves as segregated into Bóng kín (hidden, often heterosexually-identified MSM) and Bóng lộ (‘out,’ transgender, or effeminate MSM). Lower-income, ‘hidden’ MSM from rural areas were reluctant to access MSM-targeted services; (2) Stigma: MSM reported being stigmatized by the healthcare system, family, and other MSM; and (3) Healthcare access: this was limited due to economic barriers and lack of MSM-friendly services. Our research suggests the need for multiple strategies to reach diverse types of MSM as well as to address barriers in access to health services such as stigma and costs. While a great deal has been written about the diversity of MSM in relation to gender performance and sexual identities, our research points to the substantial structural-level barriers that must be addressed in order to achieve meaningful and effective HIV prevention for MSM worldwide.
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38
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Thavorn K, Kugathasan H, Tan DHS, Moqueet N, Baral SD, Skidmore B, MacFadden D, Simkin A, Mishra S. Economic evaluation of HIV pre-exposure prophylaxis strategies: protocol for a methodological systematic review and quantitative synthesis. Syst Rev 2018; 7:47. [PMID: 29544530 PMCID: PMC5855998 DOI: 10.1186/s13643-018-0710-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 03/01/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) with antiretrovirals is an efficacious and effective intervention to decrease the risk of HIV (human immunodeficiency virus) acquisition. Yet drug and delivery costs prohibit access in many jurisdictions. In the absence of guidelines for the synthesis of economic evaluations, we developed a protocol for a systematic review of economic evaluation studies for PrEP by drawing on best practices in systematic reviews and the conduct and reporting of economic evaluations. We aim to estimate the incremental cost per health outcome of PrEP compared with placebo, no PrEP, or other HIV prevention strategies; assess the methodological variability in, and quality of, economic evaluations of PrEP; estimate the incremental cost per health outcome of different PrEP implementation strategies; and quantify the potential sources of heterogeneity in outcomes. METHODS We will systematically search electronic databases (MEDLINE, Embase) and the gray literature. We will include economic evaluation studies that assess both costs and health outcomes of PrEP in HIV-uninfected individuals, without restricting language or year of publication. Two reviewers will independently screen studies using predefined inclusion criteria, extract data, and assess methodological quality using the Philips checklist, Second Panel on the Cost-effectiveness of Health and Medicines, and the International Society for Pharmacoeconomics and Outcomes Research recommendations. Outcomes of interest include incremental costs and outcomes in natural units or utilities, cost-effectiveness ratios, and net monetary benefit. We will perform descriptive and quantitative syntheses using sensitivity analyses of outcomes by population subgroups, HIV epidemic settings, study designs, baseline intervention contexts, key parameter inputs and assumptions, type of outcomes, economic perspectives, and willingness to pay values. DISCUSSION Findings will guide future economic evaluation of PrEP strategies in terms of methodological and knowledge gaps, and will inform decisions on the efficient integration of PrEP into public health programs across epidemiologic and health system contexts. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016038440 .
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Affiliation(s)
- Kednapa Thavorn
- Ottawa Health Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical and Evaluative Sciences, ICES Ottawa, Ottawa, Ontario, Canada
| | - Howsikan Kugathasan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Darrell H S Tan
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada.,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada
| | - Nasheed Moqueet
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Stefan D Baral
- Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, 21205, USA
| | - Becky Skidmore
- Ottawa Health Research Institute, The Ottawa Hospital, 501 Smyth Road, Ottawa, Ontario, K1H 8L6, Canada
| | - Derek MacFadden
- Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Ave, Boston, 02115, USA
| | - Anna Simkin
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada
| | - Sharmistha Mishra
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria Street Rm 315, 3rd Floor, Toronto, Ontario, M5B 1T8, Canada. .,Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada. .,Institute of Health Policy and Management, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. .,Institute of Medical Sciences, University of Toronto, Toronto, Canada.
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Zablotska IB, O'Connor CC. Preexposure Prophylaxis of HIV Infection: the Role of Clinical Practices in Ending the HIV Epidemic. Curr HIV/AIDS Rep 2018; 14:201-210. [PMID: 29071519 DOI: 10.1007/s11904-017-0367-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The aim of this study is to summarise the recent evidence from high-income settings about providers' ability to deliver on the UNAIDS goal of at least three million people at substantial risk of HIV infection with PrEP by 2020, including awareness and knowledge about PrEP, willingness to prescribe PrEP, current levels of prescribing and service delivery models and issues. RECENT FINDINGS Awareness about PrEP among health providers is growing, but at different pace depending on provider type. HIV and sexual health specialists are more likely to have knowledge about PrEP than generalists, and to be willing to prescribe it, mainly because of their closer contact with people at high risk for HIV and better risk assessment skills. There is still no consensus as to who should be responsible for providing PrEP, but clearly all hands on deck will be useful in delivering on the international target of three million people at substantial risk for HIV on PrEP by 2020. Only about 5% of the target has been reached so far. Local guidance and large-scale education and information programs for clinicians will be necessary to upskill health providers. High cost of PrEP is still a major barrier for its broad implementation, even in countries were PrEP roll-out has started. Health services are facing major structural challenges due to implementation of PrEP services to a substantial volume of patients. The early implementation experiences demonstrated that PrEP can be successfully delivered across a variety of settings, and a broad range of strategies and models of care can streamline PrEP delivery. Education of the providers and PrEP cost solutions will be essential for rapid roll-out of PrEP.
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Affiliation(s)
- Iryna B Zablotska
- The Kirby Institute, University of New South Wales Sydney, Sydney, 2052, Australia.
| | - Catherine C O'Connor
- The Kirby Institute, University of New South Wales Sydney, Sydney, 2052, Australia
- Sexual Health Service, Sydney Local Health District, Camperdown, 2050, Australia
- Central Clinical School, University of Sydney, Sydney, 2006, Australia
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Purnomo J, Coote K, Mao L, Fan L, Gold J, Ahmad R, Zhang L. Using eHealth to engage and retain priority populations in the HIV treatment and care cascade in the Asia-Pacific region: a systematic review of literature. BMC Infect Dis 2018; 18:82. [PMID: 29454322 PMCID: PMC5816561 DOI: 10.1186/s12879-018-2972-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 01/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The exponential growth in the reach and development of new technologies over the past decade means that mobile technologies and social media play an increasingly important role in service delivery models to maximise HIV testing and access to treatment and care. This systematic review examines the impact of electronic and mobile technologies in medical care (eHealth) in the linkage to and retention of priority populations in the HIV treatment and care cascade, focussing on the Asia-Pacific region. METHODS The review was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement from the Cochrane Collaboration guidelines. Both grey and published scientific literature from five different databases were searched for all original articles in English published from 2010 to 2017. Studies conducted outside the Asia-Pacific region or not including HIV priority populations were excluded. The methodological quality of studies included in the review was assessed using the Quality Assessment Tool for Quantitative Studies. RESULTS The database search identified 7309 records. Of the 224 peer-reviewed articles identified for full text review, 16 studies from seven countries met inclusion criteria. Six cross sectional studies found evidence to support the use of eHealth, via text messages, instant messaging, social media and health promotion websites, to increase rates of HIV testing and re-testing among men who have sex with men (MSM). Evidence regarding the efficacy of eHealth interventions to improve antiretroviral treatment (ART) adherence was mixed, where one randomised controlled trial (RCT) showed significant benefit of weekly phone call reminders on improving ART adherence. Three further RCTs found that biofeedback eHealth interventions that provided estimated ART plasma concentration levels, showed promising results for ART adherence. CONCLUSIONS This review found encouraging evidence about how eHealth can be used across the HIV treatment and care cascade in the Asia-Pacific region, including increasing HIV testing and re-testing in priority populations as well as ART adherence. eHealth interventions have an important role to play in the movement towards the end of AIDS, particularly to target harder-to-reach HIV priority populations, such as MSM.
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Affiliation(s)
- Julianita Purnomo
- The Albion Centre, South Eastern Sydney Local Health District, 150-154 Albion Street, Sydney, NSW, 2010, Australia.
| | - Katherine Coote
- The Albion Centre, South Eastern Sydney Local Health District, 150-154 Albion Street, Sydney, NSW, 2010, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW, Sydney, NSW, 2052, Australia
| | - Ling Fan
- The Albion Centre, South Eastern Sydney Local Health District, 150-154 Albion Street, Sydney, NSW, 2010, Australia
| | - Julian Gold
- The Albion Centre, South Eastern Sydney Local Health District, 150-154 Albion Street, Sydney, NSW, 2010, Australia.,Centre for Neuroscience and Trauma, Blizard Institute, Queen Mary University of London, London, UK
| | - Raghib Ahmad
- The Albion Centre, South Eastern Sydney Local Health District, 150-154 Albion Street, Sydney, NSW, 2010, Australia
| | - Lei Zhang
- Research Center for Public Health, Tsinghua University, Beijing, 100084, China. .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia. .,Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia. .,School of Public Health and Preventive Medicine, Faculty of Medicine, Monash University, Melbourne, Australia.
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Phanuphak N, Sungsing T, Jantarapakde J, Pengnonyang S, Trachunthong D, Mingkwanrungruang P, Sirisakyot W, Phiayura P, Seekaew P, Panpet P, Meekrua P, Praweprai N, Suwan F, Sangtong S, Brutrat P, Wongsri T, Na Nakorn PR, Mills S, Avery M, Vannakit R, Phanuphak P. Princess PrEP program: the first key population-led model to deliver pre-exposure prophylaxis to key populations by key populations in Thailand. Sex Health 2018; 15:542-555. [DOI: 10.1071/sh18065] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 06/19/2018] [Indexed: 11/23/2022]
Abstract
Background No data are available on the feasibility of pre-exposure prophylaxis (PrEP) delivered by trained key population (KP) community health workers. Herein we report data from the KP-led Princess PrEP program serving men who have sex with men (MSM) and transgender women (TGW) in Thailand. Methods: From January 2016 to December 2017, trained MSM and TGW community health workers delivered same-day PrEP service in community health centres, allowing clients to receive one PrEP bottle to start on the day of HIV-negative testing. Visits were scheduled at Months 1 and 3, and every 3 months thereafter. Uptake, retention and adherence to PrEP services and changes in risk behaviours over time are reported. Results: Of 1467 MSM and 230 TGW who started PrEP, 44.1% had had condomless sex in the past 3 months. At Months 1, 3, 6, 9 and 12, retention was 74.2%, 64.0%, 56.2%, 46.7% and 43.9% respectively (lower in TGW than MSM at all visits; P<0.001), with adherence to at least four PrEP pills per week self-reported by 97.4%, 96.8%, 96.5%, 97.5% and 99.5% of respondents respectively (no difference between MSM and TGW). Logistic regression analysis identified age >25 years, being MSM and having at least a Bachelors degree significantly increased retention. Condomless sex did not change over the 12-month period (from 47.2% to 45.2%; P=0.20). New syphilis was diagnosed in 4.9% and 3.0% of PrEP clients at Months 6 and 12 (cf. 7.0% at baseline; P=0.007). Among PrEP adherers and non-adherers, there were one and six HIV cases of seroconversion respectively, which resulted in corresponding HIV incidence rates (95% confidence interval) of 0.27 (0.04–1.90) and 1.36 (0.61–3.02) per 100 person-years. Conclusion: Our KP-led PrEP program successfully delivered PrEP to MSM and TGW. Innovative retention supports are needed, especially for TGW and those who are young or with lower education levels. To scale-up and sustain KP-led PrEP programs, strong endorsement from international and national guidelines is necessary.
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Lee YC, Chang SY, Lin KY, Chang LH, Liu WC, Wu CH, Sun HY, Hung CC, Chang SC. Awareness and willingness towards pre-exposure prophylaxis against HIV infection among individuals seeking voluntary counselling and testing for HIV in Taiwan: a cross-sectional questionnaire survey. BMJ Open 2017; 7:e015142. [PMID: 29042372 PMCID: PMC5652491 DOI: 10.1136/bmjopen-2016-015142] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES We aimed to investigate the awareness and willingness towards pre-exposure prophylaxis (PrEP) among individuals seeking voluntary counselling and testing (VCT) for HIV in Taiwan, where PrEP is currently not reimbursed by the insurance. METHODS Between April and October 2016, a questionnaire interview was conducted among VCT clients to inquire about the attitudes towards PrEP against HIV infection. Multivariate logistic regression analysis was performed to identify the associated factors with willingness to initiate PrEP. RESULTS During the 6-month period, 1173 VCT clients (99.8%) completed the interviews, with 67.4% being homosexual or bisexual male. While 67.2% of the clients knew of postexposure prophylaxis, 40.2% heard of PrEP. Overall, 546 clients (46.5%) were willing to initiate PrEP and 89.5% of them would choose event-driven PrEP. In multivariate analysis, male gender (OR 1.796; 95% CI 1.165 to 2.768), full-time job (OR 1.354; 95% CI 1.052 to 1.742), one-night stand (OR 1.374; 95% CI 1.043 to 1.810), having casual sex partners within 3 months (OR 1.329; 95% CI 1.031 to 1.714), condomless anal sex (OR 1.405; 95% CI 1.122 to 1.878) and ever having chemsex or attending a drug party in the past 1 year (OR 2.571; 95% CI 1.541 to 4.287), regular screening for HIV infection (OR 1.321; 95% CI 1.021 to 1.711) and knowledge of PrEP (OR 1.504; 95% CI, 1.159 to 1.953) were associated with willingness to initiate PrEP. CONCLUSIONS Understanding the willingness to initiate PrEP against HIV among the VCT clients in Taiwan, which was associated with male gender, risky sexual behaviours and awareness of PrEP, will help inform the implementation of PrEP programme.
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Affiliation(s)
- Yi-Chieh Lee
- Department of Internal Medicine, Lotung Poh-Ai Hospital, Medical Lo-Hsu Foundation, I-Lan, Taiwan
| | - Sui-Yuan Chang
- Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Laboratory Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuan-Yin Lin
- Department of Medicine, National Taiwan University Hospital Jin-Shan Branch, New Taipei City, Taiwan
| | - Lan-Hsin Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chun Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hsin Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsin-Yun Sun
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Ching Hung
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Parasitology, National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- China Medical University, Taichung, Taiwan
| | - Shan-Chwen Chang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Lim SH, Mburu G, Bourne A, Pang J, Wickersham JA, Wei CKT, Yee IA, Wang B, Cassolato M, Azwa I. Willingness to use pre-exposure prophylaxis for HIV prevention among men who have sex with men in Malaysia: Findings from an online survey. PLoS One 2017; 12:e0182838. [PMID: 28902857 PMCID: PMC5597127 DOI: 10.1371/journal.pone.0182838] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 07/25/2017] [Indexed: 12/02/2022] Open
Abstract
Objective We examined willingness to use pre-exposure prophylaxis (PrEP) for HIV prevention among men who have sex with men (MSM) in Malaysia. Methods An online survey of 990 MSM was conducted between March and April 2016. Eligibility criteria included being biological male, Malaysian citizen, 18 years of age or above, identifying as MSM, and being HIV negative or unknown status. Participants’ demographics, sexual and drug use behaviors, attitudes towards PrEP, and preferences regarding future access to PrEP were collected. Bivariate analysis and logistic regression were performed to determine factors associated with willingness to use PrEP. Results Fewer than half of participants (44%) knew about PrEP before completing the survey. Overall, 39% of the sample were willing to take PrEP. Multivariate logistic regression indicated that Malay men (AOR: 1.73, 95% CI:1.12, 2.70), having 2 or more male anal sex partners in the past 6 months (AOR: 1.98, 95% CI: 1.29, 3.05), previous knowledge of PrEP (AOR: 1.40, 95%CI: 1.06, 1.86), lack of confidence in practising safer sex (AOR: 1.36, 95% CI: 1.02, 1.81), and having ever paid for sex with a male partner (AOR: 1.39, 95% CI: 1.01, 1.91) were independently associated with greater willingness to use PrEP, while men who identified as heterosexual were less willing to use PrEP (AOR, 0.36, 95% CI: 0.13, 0.97). Majority of participants preferred to access PrEP at affordable cost below 100 Malaysian Ringgit (USD25) per month from community based organisations followed by private or government hospitals. Conclusions Overall, MSM in Malaysia reported a relatively low level of willingness to use PrEP, although willingness was higher among those previously aware of PrEP. There is a need to provide PrEP at affordable cost, increase demand and awareness of PrEP, and to provide access to this preventative medication via diverse, integrated and tailored sexual health services.
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Affiliation(s)
- Sin How Lim
- Center of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Gitau Mburu
- Division of Health Research, University of Lancaster, United Kingdom
| | - Adam Bourne
- Australian Research Centre in Sex, Health & Society, La Trobe University, Melbourne, Australia.,Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Joselyn Pang
- International Programs, Australian Federation of AIDS Organizations, Bangkok, Thailand
| | - Jeffrey A Wickersham
- Center of Excellence for Research in AIDS (CERiA), Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.,Yale School of Medicine, Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, United States of America
| | | | | | - Bangyuan Wang
- Division of Health Research, University of Lancaster, United Kingdom
| | - Matteo Cassolato
- Division of Health Research, University of Lancaster, United Kingdom
| | - Iskandar Azwa
- Infectious Diseases Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Abstract
PURPOSE OF REVIEW Half the world's population has access to Internet and technologies, and utilization is near-ubiquitous among providers and key populations. Despite being so well connected; identifying, reaching and linking vulnerable populations to HIV clinical services remains a global challenge. This review highlights the emerging online-to-offline (O2O) models, their potential in scaling up services, and evaluating impact, and implications for future research. RECENT FINDINGS Globally, four major types of O2O models have been implemented, primarily in the West and Asia, especially among MSM and transgender women. These models have varying levels of impact in terms of reach, engagement, participation, linkage, and ability to track and monitor participants, and assess outcomes. Those integrated with offline sites enable seamless transition, dramatically reduce the O2O linkage time and demonstrate high linkage success (>73%). O2O models are ideal for at-risk, stigmatized, criminalized populations and for scaling-up biomedical prevention interventions such as preexposure and postexposure prophylaxis. SUMMARY O2O models represent novel and powerful solutions to reverse the pandemic and could help fill significant programmatic gaps in tracking individuals through HIV cascades. Providers, especially in resource-limited settings, could choose between a variety of current approaches highlighted in this review and employ no-cost or cost-effective technologies to transform their traditional models and leverage O2O models.
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Draper BL, Oo ZM, Thein ZW, Aung PP, Veronese V, Ryan C, Thant M, Hughes C, Stoové M. Willingness to use HIV pre-exposure prophylaxis among gay men, other men who have sex with men and transgender women in Myanmar. J Int AIDS Soc 2017; 20:21885. [PMID: 28741332 PMCID: PMC5577714 DOI: 10.7448/ias.20.1.21885] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/12/2017] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION HIV pre-exposure prophylaxis (PrEP) has emerged as a key component of contemporary HIV combination prevention strategies. To explore the local suitability of PrEP, country-specific acceptability studies are needed to inform potential PrEP implementation. In the context of Myanmar, in addition to resource constraints, HIV service access by gay men, other men who have sex with men, and transgender women (GMT) continues to be constrained by legislative and community stigma and marginalization. We aimed to determine PrEP acceptability among GMT in Myanmar and explore the factors associated with willingness to use PrEP. METHODS GMT were recruited in Yangon and Mandalay through local HIV prevention outreach programmes in November and December 2014. Quantitative surveys were administered by trained peer educators and collected data on demographics, sexual risk, testing history and PrEP acceptability. A modified six-item PrEP acceptability scale classified self-reported HIV undiagnosed GMT as willing to use PrEP. Multivariable logistic regression identified factors associated with willingness to use PrEP. RESULTS Among 434 HIV undiagnosed GMT, PrEP awareness was low (5%). PrEP acceptability was high, with 270 (62%) GMT classified as willing to use PrEP. GMT recruited in Mandalay (adjusted odds ratio (aOR) = 1.79; 95%CI = 1.05-3.03), who perceived themselves as likely to become HIV positive (aOR = 1.82; 95%CI = 1.10-3.02), who had more than one recent regular partner (aOR = 2.94; 95%CI = 1.41-6.14), no regular partners (aOR = 2.05; 95%CI = 1.10-3.67), more than five casual partners (aOR = 2.05; 95%CI = 1.06-3.99) or no casual partners (aOR = 2.25; 95%CI = 1.23-4.11) were more likely to be willing to use PrEP. The association between never or only occasionally using condoms with casual partners and willingness to use PrEP was marginally significant (aOR = 2.02; 95%CI = 1.00-4.10). GMT who reported concern about side effects and long-term use of PrEP were less likely (aOR = 0.35; 95%CI = 0.21-0.59) to be willing to use PrEP. CONCLUSIONS This is the first study to assess PrEP acceptability in Myanmar. Findings suggest PrEP is an acceptable prevention option among GMT in Myanmar, providing they are not required to pay for it. Implementation/demonstration projects are needed to explore the feasibility and cost-effectiveness of PrEP as a prevention option for GMT in Myanmar.
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Affiliation(s)
- Bridget L. Draper
- Department of Disease Elimination, Burnet Institute, Melbourne, Australia
| | - Zaw Min Oo
- Department of International Development, Burnet Institute, Yangon, Myanmar
| | - Zaw Win Thein
- Department of International Development, Burnet Institute, Yangon, Myanmar
| | - Poe Poe Aung
- Department of International Development, Burnet Institute, Yangon, Myanmar
| | - Vanessa Veronese
- Department of Disease Elimination, Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Claire Ryan
- Department of International Development, Burnet Institute, Yangon, Myanmar
| | - Myo Thant
- Yangon Regional Public Health Department, Yangon, Myanmar
| | - Chad Hughes
- Department of Disease Elimination, Burnet Institute, Melbourne, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark Stoové
- Department of Disease Elimination, Burnet Institute, Melbourne, Australia
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Montaner J, Rojo P, Anand T, Rockstroh J. Highlights of the International Congress on Drug Therapy in HIV Infection, 23-26 October 2016, Glasgow, UK. J Virus Erad 2017; 3:97-100. [PMID: 28435695 PMCID: PMC5384274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS,
Vancouver,
BC,
Canada
| | - Pablo Rojo
- Department of Pediatrics,
Hospital 12 de Octubre,
Madrid,
Spain
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Montaner J, Rojo P, Anand T, Rockstroh J. Highlights of the International Congress on Drug Therapy in HIV Infection, 23–26 October 2016, Glasgow, UK. J Virus Erad 2017. [DOI: 10.1016/s2055-6640(20)30290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Anand T, Nitpolprasert C, Kerr SJ, Muessig KE, Promthong S, Chomchey N, Hightow-Weidman LB, Chaiyahong P, Phanuphak P, Ananworanich J, Phanuphak N. A qualitative study of Thai HIV-positive young men who have sex with men and transgender women demonstrates the need for eHealth interventions to optimize the HIV care continuum. AIDS Care 2017; 29:870-875. [PMID: 28158952 DOI: 10.1080/09540121.2017.1286288] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In Thailand, young men who have sex with men (YMSM) and transgender women (TG) are disproportionately affected by HIV and have suboptimal care continuum outcomes. Although Thai YMSM and young TG are early adopters of emerging technologies and have high Internet and technology access and utilization, the potential of technology has not been harnessed to optimize the HIV treatment cascade. We interviewed 18 behaviorally HIV-infected YMSM and young TG regarding care challenges, identified how eHealth could address care needs, and elicited preferences for eHealth interventions. Participants reported struggling with individual and societal-level stigma which negatively impacted linkage to and retention in care, and antiretroviral therapy adherence. YMSM and young TG described inadequate in-person support services and heavily relied on random online resources to fill information and support gaps, but sometimes viewed them as untrustworthy or inconsistent. Participants universally endorsed the development of eHealth resources and proposed how they could ameliorate individual-level fears over stigma and improve public perceptions about HIV. Personalized and integrated eHealth interventions with interactive, user-driven structures, credible content, rewards for engagement, real-time counseling and reminder support could help overcome barriers YMSM and young TG face in traditional HIV healthcare systems and have the potential to improve care outcomes.
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Affiliation(s)
- Tarandeep Anand
- a The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,b SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | - Chattiya Nitpolprasert
- a The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,b SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | - Stephen J Kerr
- c HIV-NAT, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,d The Kirby Institute, University of New South Wales , Sydney , Australia.,e Department of Global Health, Academic Medical Center , Amsterdam Institute for Global Health and Development, University of Amsterdam , Amsterdam , The Netherlands
| | - Kathryn E Muessig
- f Department of Health Behavior, Gillings School of Global Public Health , University of North Carolina , Chapel Hill , NC , USA
| | | | - Nitiya Chomchey
- b SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | - Lisa B Hightow-Weidman
- g Division of Infectious Diseases, School of Medicine , University of North Carolina , Chapel Hill , NC , USA
| | | | - Praphan Phanuphak
- a The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,c HIV-NAT, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
| | - Jintanat Ananworanich
- b SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,h US Military HIV Research Program , Walter Reed Army Institute of Research , Silver Spring , MD , USA.,i Henry M. Jackson Foundation for the Advancement of Military Medicine , Bethesda , MD , USA
| | - Nittaya Phanuphak
- a The Thai Red Cross AIDS Research Centre , Bangkok , Thailand.,b SEARCH, The Thai Red Cross AIDS Research Centre , Bangkok , Thailand
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DiStefano AS, Takeda M. HIV Pre-Exposure Prophylaxis and Postexposure Prophylaxis in Japan: Context of Use and Directions for Future Research and Action. AIDS Patient Care STDS 2017; 31:60-77. [PMID: 28170304 DOI: 10.1089/apc.2016.0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Biomedical HIV prevention strategies are playing an increasingly prominent role in addressing HIV epidemics globally, but little is known about their use in Japan, where persistent HIV disparities and a recently stable, but not declining, national epidemic indicate the need for evolving approaches. We conducted an ethnographic study to determine the context of pre-exposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) use and to identify directions for future research and action in Japan. We used data from observational fieldwork in the Kansai region and Tokyo Metropolitan Area (n = 178 persons observed), qualitative interviews (n = 32), documents and web-based data sources (n = 321), and email correspondences (n = 9) in the period 2013-2016. Drug approvals by Japan's regulatory agencies, insurance coverage for medications, and policies by healthcare institutions and government agencies were the main factors affecting PrEP and PEP legality, use, and awareness. Awareness and the observable presence of PrEP and PEP were very limited, particularly at the community level. PrEP and PEP held appeal for Japanese scientists and activists, and for study participants who represented various other stakeholder groups; however, significant concerns prevented open endorsements. Japanese health officials should prioritize a national discussion, weigh empirical evidence, and strongly consider formal approval of antiretroviral (ARV) medications for use in PrEP and both occupational and nonoccupational PEP. Once approved, social marketing campaigns can be used to advertise widely and increase awareness. Future research would benefit from theoretical grounding in a diffusion of innovations framework. These findings can inform current and future ARV-based prevention strategies at a critical time in the international conversation.
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Affiliation(s)
- Anthony S. DiStefano
- Department of Health Science, California State University, Fullerton, Fullerton, California
| | - Makiko Takeda
- Program in Comparative Cultures, Graduate School of Humanities, Josai International University, Togane, Japan
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Anand T, Nitpolprasert C, Kerr SJ, Apornpong T, Ananworanich J, Phanuphak P, Phanuphak N. Implementation of an online HIV prevention and treatment cascade in Thai men who have sex with men and transgender women using Adam's Love Electronic Health Record system. J Virus Erad 2017; 3:15-23. [PMID: 28275454 PMCID: PMC5337417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Electronic health record (EHR) systems have been infrequently used to support HIV service delivery models to optimise HIV prevention and treatment cascades. We have studied the implementation, uptake and use of an EHR among Thai men who have sex with men (MSM) and transgender (TG) women. METHODS Participants, e-counselled via the Adam's Love ( www.adamslove.org) support platforms, after having completed risk behaviour questionnaires and being assessed for their HIV risk by online counsellors, were enrolled based on their preference into one of three EHR-supported arms: (1) private clinic-based HIV testing and counselling (HTC); (2) online pretest counselling and private clinic-based HIV testing (hybrid); and (3) online supervised HIV self-testing and counselling (eHTC). RESULTS Between December 2015 and May 2016, of a total of 489 MSM and TG women were introduced to the study, 186 (38%) enrolled into the study, with 89, 72 and 25 participants joining the HTC, hybrid and eHTC arms, respectively. Seeking sex online was reported by 83.9%. HIV prevalence was highest (16%) in the eHTC arm, and participants in this arm were more likely to be younger (median age 25 vs 29 vs 27 years; P=0.01), bisexual (16% vs 9.7% vs 5.6%; P=0.005), with an unknown history of HIV or first-time HIV testers (48% vs 25% vs 19.1%; P=0.01) or had tested >1 year ago (15.8% vs 4.8% vs 3.4%, P=0.04), compared with those in the hybrid and HTC arms. Around half (48.3%) of them revisited the EHR at least once to access laboratory results, read post-test summaries and make an appointment for another HIV test. The participants in the eHTC arm had reduced odds of revisiting the EHR twice or more as compared with participants in the HTC [odds ratio (OR) 0.14, 95% confidence interval (CI) 0.03-0.67, P=0.01] and hybrid arms (OR 0.10, 95% CI 0.02-0.44, P=0.003). Overall the EHR satisfaction was high at 4.4 (SD 0.68) on a Likert scale of 5. CONCLUSIONS Young and high-risk MSM and some TG women engaged successfully with the Adam's Love EHR system, showing its potential to support innovative service delivery models and target hard-to-reach and vulnerable populations.
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Affiliation(s)
- Tarandeep Anand
- Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
- SEARCH,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - Chattiya Nitpolprasert
- Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
- SEARCH,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - Stephen J Kerr
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
- Kirby Institute,
University of New South Wales,
Sydney,
Australia
- Department of Global Health,
Academic Medical Center,
University of Amsterdam,
Amsterdam Institute for Global Health and Development,
Amsterdam,
the Netherlands
| | | | | | - Praphan Phanuphak
- Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
- SEARCH,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
- HIV-NAT,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| | - Nittaya Phanuphak
- Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
- SEARCH,
Thai Red Cross AIDS Research Centre,
Bangkok,
Thailand
| |
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