Prospectus, July 7, 1993

https://spark.parkland.edu/prospectus_1993/1010/thumbnail.jp

Pre-Exposure Prophylaxis Accessibility Research and Evaluation (PrEPARE Study)

Tenofovir-emtricitabine (TDF-FTC) has demonstrated effectiveness as HIV preexposure prophylaxis (PrEP), but it is not commonly prescribed. Our study was designed to determine the barriers preventing utilization of PrEP among men who have sex with men (MSM), the group at greatest risk for HIV infection in the United States. A population-based sample of MSM presenting for HIV testing at 'Early Test' HIV testing and counseling sites in San Diego, California were offered PrEP and education about potential efficacy. Eligible individuals reported having unprotected sex within the past 12 months and who tested negative for HIV were offered study participation. Despite offering procedures for evaluation and prescription for PrEP to 416 eligible subjects, less than 0.5 % of participants received the drug. Surveys collected from 54 of those who declined study participation revealed multiple barriers to PrEP among MSM including cost, low perceived risk of infection and concerns about taking a daily medication and potential long-term side effects. Efforts should be made to address these barriers, especially lowering the cost of TDF-FTC, education about PrEP side effects and awareness of HIV risks

Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study

Submitted by Fábio Marques ([email protected]) on 2018-12-28T16:36:51Z No. of bitstreams: 1 Uptake of pre-exposure prophylaxis, sexual practices_Beatriz_Grinsztejn_etal_INI_Lapclin_2014.pdf: 346239 bytes, checksum: 393ba9db8bb08907730d633d8e007349 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-01-08T02:03:31Z (GMT) No. of bitstreams: 1 Uptake of pre-exposure prophylaxis, sexual practices_Beatriz_Grinsztejn_etal_INI_Lapclin_2014.pdf: 346239 bytes, checksum: 393ba9db8bb08907730d633d8e007349 (MD5)Made available in DSpace on 2019-01-08T02:03:31Z (GMT). No. of bitstreams: 1 Uptake of pre-exposure prophylaxis, sexual practices_Beatriz_Grinsztejn_etal_INI_Lapclin_2014.pdf: 346239 bytes, checksum: 393ba9db8bb08907730d633d8e007349 (MD5) Previous issue date: 2014-07Gladstone Institutes. San Francisco, CA, USA / University of California. San Francisco, CA, USA / San Francisco AIDS Foundation. San Francisco, CA, USA.University of Colorado. Anschutz Medical Campus. Aurora, CO, USA.Gladstone Institutes. San Francisco, CA, USA.University of California, San Francisco. CA, USA / San Francisco Department of Public Health. San Francisco, CA, USA.University of Connecticut. Storr, CT, USA.Gladstone Institutes. San Francisco, CA, USA.Stroger Hospital of Cook County. Chicago, IL, USA.INMENSA. Lima, Peru.ACSA. Iquitos, Peru.Equidad. Guayaquil, Ecuador.University of California, San Francisco. CA, USA / San Francisco Department of Public Health. San Francisco, CA, USA.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brazil.Fenway Health. Boston, MA, USA.University of Chiang Mai. Chiang Mai, Thailan.Desmond Tutu Health Foundation. Cape Town, South Africa.University of São Paulo. São Paulo, SP, Brazil.Universidade Federal do Rio de Janeiro. Hospital Escola São Francisco de Assis. Rio de Janeiro, RJ, Brazil.INMENSA, Lima, Peru.University of Colorado. Anschutz Medical Campus. Aurora, CO, USA.National Institutes of Health, Bethesda. MD, USA.Gilead Sciences, Foster City. San Francisco, CA, USA.University of California. San Francisco, CA, USABackground The eff ect of HIV pre-exposure prophylaxis (PrEP) depends on uptake, adherence, and sexual practices. We aimed to assess these factors in a cohort of HIV-negative people at risk of infection. Methods In our cohort study, men and transgender women who have sex with men reviously enrolled in PrEP trials (ATN 082, iPrEx, and US Safety Study) were enrolled in a 72 week open-label extension. We measured drug concentrations in plasma and dried blood spots in seroconverters and a random sample of seronegative participants. We assessed PrEP uptake, adherence, sexual practices, and HIV incidence. Statistical methods included Poisson models, comparison of proportions, and generalised estimating equations. Findings We enrolled 1603 HIV-negative people, of whom 1225 (76%) received PrEP. Uptake was higher among those reporting condomless receptive anal intercourse (416/519 [81%] vs 809/1084 [75%], p=0·003) and having serological evidence of herpes (612/791 [77%] vs 613/812 [75%] p=0·03). Of those receiving PrEP, HIV incidence was 1·8 infections per 100 person-years, compared with 2·6 infections per 100 person-years in those who concurrently did not choose PrEP (HR 0·51, 95% CI 0·26–1·01, adjusted for sexual behaviours), and 3·9 infections per 100 person-years in the placebo group of the previous randomised phase (HR 0·49, 95% CI 0·31–0·77). Among those receiving PrEP, HIV incidence was 4·7 infections per 100 person-years if drug was not detected in dried blood spots, 2·3 infections per 100 person-years if drug concentrations suggested use of fewer than two tablets per week, 0·6 per 100 person-years for use of two to three tablets per week, and 0·0 per 100 person-years for use of four or more tablets per week (p<0·0001). PrEP drug concentrations were higher among people of older age, with more schooling, who reported non-condom receptive anal intercourse, who had more sexual partners, and who had a history of syphilis or herpes. Interpretation PrEP uptake was high when made available free of charge by experienced providers. The eff ect of PrEP is increased by greater uptake and adherence during periods of higher risk. Drug concentrations in dried blood spots are strongly correlated with protective benefit