A rapid review of pre-exposure prophylaxis for HIV in the Asia–Pacific region: recommendations for scale up and future directions

Sexual Health ◽  
2021 ◽  
Vol 18 (1) ◽  
pp. 31 ◽  
Author(s):  
Partha Haldar ◽  
Sushena Reza-Paul ◽  
Roy Arokiam Daniel ◽  
Lisa Lazarus ◽  
Bharat Bhushan Rewari ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hiv Prevention ◽  
World Health ◽  
Asia Pacific ◽  
Rapid Review ◽  
Pacific Region ◽  
Prevention Strategies ◽  
Asia Pacific Region ◽  
Effective Prevention ◽  
Exposure Prophylaxis

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.

The key role of adherence for the effectiveness of antiretroviral-based prevention: state of the science and implications for the Asia-Pacific region

Sexual Health ◽  
2014 ◽  
Vol 11 (2) ◽  
pp. 155 ◽  
Author(s):  
K. Rivet Amico
Keyword(s):  
At Risk ◽  
Hiv Treatment ◽  
Asia Pacific ◽  
Treatment As Prevention ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Effective Prevention ◽  
Widespread Access ◽  
Hiv Treatment As Prevention ◽  
Exposure Prophylaxis

Remarkable advances have been made in the last few years in biomedical strategies to prevent onward transmission of HIV (treatment as prevention (TasP)) and prevent infection among at-risk populations through pre-exposure prophylaxis (PrEP). Numerous issues remain heavily debated, primarily concerning the feasibility of leveraging resources for both widespread access to antiretroviral therapy (ART) for those living with HIV and access to effective prevention antiretrovirals (ARVs) among those at risk for infection. Even with consistent and wide-spread access to ARVs, the behavioural pathway from ARV access to successful rapid and durable suppression or reaching levels of PrEP adherence that confer high rates of protection is increasingly well recognised. For either ‘biobehavioural’ strategy to have maximal individual and community benefit, individuals accessing them must actually use them. In this review, the unique and overlapping factors influencing adherence to ART and PrEP are identified, with an emphasis on the behavioural, social and structural facilitators and barriers to TasP and PrEP success. The implications of the current research base and evidence generated specifically within the Asia-Pacific region are discussed.

HIV pre-exposure prophylaxis and treatment as prevention: a review of awareness and acceptability among men who have sex with men in the Asia-Pacific region and the Americas

Sexual Health ◽  
2014 ◽  
Vol 11 (2) ◽  
pp. 166 ◽  
Author(s):  
Martin Holt
Keyword(s):  
The United States ◽  
Hiv Treatment ◽  
Asia Pacific ◽  
Treatment As Prevention ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Acceptability Research ◽  
Prevention Trials ◽  
Sex With Men ◽  
Exposure Prophylaxis

This review assesses acceptability research for HIV pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP) among men who have sex with men (MSM) in the Asia-Pacific region and the Americas, evaluating awareness and attitudes. There has been limited research on the acceptability of PrEP outside the United States and no research to date evaluating the acceptability of TasP since the findings of the HIV Prevention Trials Network 052 trial were released. Existing research suggests that PrEP is reasonably acceptable to MSM, but few men are likely to perceive the need for it. Studies of HIV treatment optimism suggest that MSM are likely to be sceptical of TasP.

Empowering Dementia Carers with an iSupport Virtual Assistant (e-DiVA): Study protocol for a pilot randomised controlled trial in Asia Pacific Region countries (Preprint)

2021 ◽  
Author(s):  
Tuan Anh Nguyen ◽  
Kham Tran ◽  
Adrian Esterman ◽  
Bianca Brijnath ◽  
Lily Xiao ◽  
...  
Keyword(s):  
New Zealand ◽  
Digital Health ◽  
Controlled Trial ◽  
Skills Training ◽  
World Health ◽  
Asia Pacific ◽  
Pacific Region ◽  
Global Public Health ◽  
Asia Pacific Region ◽  
Care Needs

BACKGROUND Dementia is a global public health priority with prevalence estimated to be 150 million by 2050; nearly two-thirds of whom will live in the Asia Pacific region. Dementia creates significant care needs for people with the disease, their families and carers. iSupport is a self-help platform developed by the World Health Organization to provide education, skills training and support to dementia carers. It has been adapted in some contexts (Australia, India, Netherland and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems in real-time quickly. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT). OBJECTIVE This protocol outlines how a technologically enhanced version of the WHO iSupport program - the iSupport VA will be evaluated METHODS Seven versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand and Vietnam using a pilot RCT involving 140 carers (20 carers per iSupport VA version). Feasibility, acceptability, intention to use, and preliminary impact on carer perceived stress of the iSupport VA intervention will be assessed RESULTS Study findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. CONCLUSIONS The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions. CLINICALTRIAL Australian New Zealand Clinical Trial (http://www.anzctr.org.au), Identifier: 381146.

Dietary Guidelines for the Asia Pacific Region

2017 ◽  
Vol 29 (2) ◽  
pp. 98-101 ◽  
Author(s):  
Colin W. Binns ◽  
Mi Kyung Lee ◽  
Masaharu Kagawa ◽  
Wah Yun Low ◽  
Qiu Liqian ◽  
...  
Keyword(s):  
Public Health ◽  
Infant Nutrition ◽  
Dietary Guidelines ◽  
World Health ◽  
Asia Pacific ◽  
Health Programs ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Public Health Programs ◽  
The World

Nutrition is a major determinant of health throughout all stages of life and together with smoking is the most important risk factor for morbidity and mortality in the Asia Pacific Region. The workshop participants examined Dietary Guidelines and Food Guides that are in use in our region, together with additional materials from the World Health Organization, UNICEF and the World Cancer Research Foundation. The resulting set of guidelines is meant as a reminder of the main issues to be covered in a general public health education program. It may also be of value in reminding public health practitioners, educators, administrators, and policy makers of current nutrition issues. It may additionally be useful as a checklist of the issues to be considered in public health programs and regulations. The main areas of nutrition that are included in the Guidelines are eating a variety of foods, including vegetables, fruits, whole grain cereals, and nuts. Choose fish, poultry, and meats grown in a sustainable way. Appropriate growth, including avoiding obesity, and physical activity are important. Breastfeeding is the basis of infant nutrition and nutrition of mothers is an important public health measure. Negative factors in the Asian diet include salt, refined sugar, alcohol and fats. The APACPH Dietary Guidelines will need to be kept under review and modified to meet regional differences in food supply. The Guidelines will be useful as a checklist of the issues to be considered in public health programs, addressing both acute and chronic diseases.

scholarly journals APSIC guidelines for the prevention of surgical site infections

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Moi Lin Ling ◽  
Anucha Apisarnthanarak ◽  
Azlina Abbas ◽  
Keita Morikane ◽  
Kil Yeon Lee ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Surgical Site Infections ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Effective Prevention ◽  
Healthcare Facilities ◽  
Quality Improvement Process ◽  
Improvement Process ◽  
Guidelines And Recommendations

Abstract Background The Asia Pacific Society of Infection Control (APSIC) launched the APSIC Guidelines for the Prevention of Surgical Site Infections in 2018. This document describes the guidelines and recommendations for the setting prevention of surgical site infections (SSIs). It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in preoperative, perioperative and postoperative practices. Method The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results It recommends that healthcare facilities review specific risk factors and develop effective prevention strategies, which would be cost effective at local levels. Gaps identified are best closed using a quality improvement process. Surveillance of SSIs is recommended using accepted international methodology. The timely feedback of the data analysed would help in the monitoring of effective implementation of interventions. Conclusions Healthcare facilities should aim for excellence in safe surgery practices. The implementation of evidence-based practices using a quality improvement process helps towards achieving effective and sustainable results.

scholarly journals Cost-effectiveness evaluation of add-on dapagliflozin for heart failure with reduced ejection fraction from perspective of healthcare systems in Asia–Pacific region

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Chia-Te Liao ◽  
Chun-Ting Yang ◽  
Han Siong Toh ◽  
Wei-Ting Chang ◽  
Hung-Yu Chang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cost Effectiveness ◽  
Standard Care ◽  
Cost Effective ◽  
Healthcare Systems ◽  
Asia Pacific ◽  
Pacific Region ◽  
Asia Pacific Region ◽  
Reduced Ejection Fraction ◽  
The Cost

Abstract Background With emerging evidence on the efficacy of adding dapagliflozin to standard care for patients with heart failure with reduced ejection fraction (HFrEF), this study assessed the cost-effectiveness of add-on dapagliflozin to standard care versus standard care alone for HFrEF from the perspective of healthcare systems in the Asia–Pacific region. Methods A Markov model was applied to project the outcomes of treatment in terms of lifetime medical cost and quality-adjusted life-years. The transition probabilities between health states in the model were obtained from the Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction trial. Country-specific costs and utilities were extracted for modeling. The incremental cost-effectiveness ratio against a country-specific willingness-to-pay threshold was applied to determine the cost-effectiveness of treatment. A series of sensitivity analyses were performed to ensure the robustness of the study results. Costs are presented in 2020 United States dollars. Results The incremental cost-effectiveness ratios for add-on dapagliflozin versus standard care alone were $5277, $9980, $12,305, $16,705, and $23,227 per quality-adjusted life-year gained in Korea, Australia, Taiwan, Japan, and Singapore, respectively. When using add-on dapagliflozin to standard care versus standard care alone, ~ 100% of simulations were cost-effective at a willingness-to-pay threshold of one gross domestic product per capita of the given Asia–Pacific country; however, the probability of being cost-effective for using add-on dapagliflozin decreased when the time horizon for simulation was restricted to 18 months and when the cardiovascular mortality for the two treatments (43.8% and 33.0%, respectively) was assumed to be the same. The cost-effectiveness results were most sensitive to cardiovascular mortality of treatment. Conclusions Adding dapagliflozin to standard care is cost-effective for HFrEF in healthcare systems in the Asia–Pacific region, which supports the rational use of dapagliflozin for HFrEF in this region.

Sign in / Sign up

Export Citation Format

Share Document