scholarly journals PrEP for women: An update for healthcare providers

2021 ◽  
Vol 9 (2) ◽  
Author(s):  
Danielle P. Clement ◽  
Kara McGee ◽  
Kathryn Trotter
Keyword(s):  
Human Immunodeficiency Virus ◽  
Hiv Risk ◽  
Healthcare Providers ◽  
The United States ◽  
Cultural Factors ◽  
Clinical Encounters ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Social And Cultural Factors ◽  
Exposure Prophylaxis

Women account for almost 20% of all new diagnoses of human immunodeficiency virus (HIV) in the United States, yet their utilization of pre-exposure prophylaxis (PrEP) to prevent HIV infection is highly underutilized. Significant racial, social, and cultural factors further marginalize those who are at increased risk. Women’s healthcare providers should screen for HIV risk and offer PrEP during routine clinical encounters.

‘How come they don’t talk about it in school?’ Identifying adolescent barriers to PrEP use

2021 ◽  
Author(s):  
Leslie Gailloud ◽  
Tatiana Gonzalez-Argoti ◽  
Sophia Philip ◽  
Lena S Josephs ◽  
Joanne E Mantell ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Thematic Analysis ◽  
The United States ◽  
Health Centers ◽  
Perceived Need ◽  
School Based ◽  
Immunodeficiency Virus ◽  
School Based Health Centers ◽  
Exposure Prophylaxis

Abstract Although 21% of new human immunodeficiency virus (HIV) diagnoses in the United States are in youth aged 13–24 years, adolescent awareness and uptake of the HIV prevention medication pre-exposure prophylaxis (PrEP) are low. This study explores the attitudes and challenges that adolescents face while taking PrEP. Thirty interviews were conducted with Black and Latine (we use the gender-inclusive term Latine rather than Latinx for more appropriate Spanish pronunciation) students aged 15–17 who received care at school-based health centers (SBHCs) in the Bronx, NY. Transcripts were coded inductively and deductively using thematic analysis. Most participants were unaware of PrEP, but nearly all were enthusiastic when informed about it; a majority denied that they would feel any stigma when taking PrEP. Despite this high receptivity, multiple barriers were identified, particularly confidentiality from parents, low perceived need of PrEP and concerns about daily adherence and side effects. Adolescents overall were enthusiastic about the availability of PrEP and felt it empowered them to have control over their health. SBHCs were considered trusted sources of confidential, accessible care, and we believe that they can be uniquely positioned to mitigate barriers to PrEP distribution in the future.

scholarly journals Human Immunodeficiency Virus in the State of Texas of the United States: Past Reflections, Present Shortcomings, and Future Needs of the Public Health Response

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Ume L Abbas ◽  
Camden J Hallmark ◽  
Marlene McNeese ◽  
Vagish Hemmige ◽  
Joseph Gathe ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
The United States ◽  
Lessons Learned ◽  
Accelerated Expansion ◽  
Public Health Response ◽  
Treatment And Prevention ◽  
Health Response ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

Abstract A strategy titled “Ending the HIV Epidemic: A Plan for America” aims to reduce human immunodeficiency virus (HIV) incidence in the United States by at least 90% by 2030, using diagnosis, treatment, and prevention strategies. Texas is a Southern state that has one of the highest numbers of new HIV diagnoses and people with HIV in the country, and where HIV disproportionately impacts minorities. We retrace the historical epidemic in its largest city, Houston, to illustrate the lessons learned and milestones accomplished, which could serve as guideposts for the future. We examine the current epidemic in Texas, including the achieved levels of HIV testing, treatment continua, and pre-exposure prophylaxis prescription, and compare and contrast these with the national estimates and Plan targets. Our findings call for urgent and accelerated expansion of efforts to end HIV in Texas.

scholarly journals Use of Intrauterine Devices and Risk of Human Immunodeficiency Virus Acquisition Among Insured Women in the United States

2019 ◽  
Vol 70 (10) ◽  
pp. 2221-2223
Author(s):  
Julia L Marcus ◽  
Jonathan M Snowden ◽  
Mara E Murray Horwitz ◽  
Sengwee Toh ◽  
Casie Horgan ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Intrauterine Device ◽  
The United States ◽  
Hiv Diagnosis ◽  
Health Insurance Data ◽  
Virus Acquisition ◽  
Increased Risk ◽  
Immunodeficiency Virus ◽  
Hiv Acquisition

Abstract Concerns have been raised about progestin-containing contraceptives and the risk of human immunodeficiency virus (HIV) acquisition. Based on health insurance data from women in the United States with intrauterine device (IUD) insertions during 2011–2018, there was no increased risk of incident HIV diagnosis for levonorgestrel-releasing IUDs versus copper IUDs.

Human Immunodeficiency Virus Pre-exposure Prophylaxis and Increased Incidence of Sexually Transmitted Infections in the United States

2019 ◽  
Vol 70 (9) ◽  
pp. 1884-1890 ◽  
Author(s):  
Jose A Serpa ◽  
Gabriel N Huynh ◽  
Julie B Nickell ◽  
Hongyu Miao
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Sexually Transmitted Infections ◽  
State Level ◽  
The United States ◽  
Incidence Rates ◽  
Interrupted Time Series Analysis ◽  
Sexually Transmitted ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

Abstract Background Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) decreases HIV transmission. Some studies have raised concerns about a potential association between the implementation of HIV PrEP and the growing incidence rates of sexually transmitted infections (STIs) in the United States. Methods We conducted a quasi-experimental (interrupted time series) analysis of STI (syphilis, gonorrhea, and chlamydia) rates before (2000–2012) and after (2013–2017) the implementation of HIV PrEP. We also performed correlations between HIV PrEP utilization and STI cases at the national (2012–2017) and state (2017) levels. We defined HIV PrEP utilization as the number of people taking tenofovir disoproxil fumarate/emtricitabine for HIV prevention. Results HIV PrEP implementation was associated with 25% (relative risk [RR] 1.254, 95% confidence interval [CI] 1.245–1.263; P < .001) and 26% (RR 1.260, 95% CI 1.257–1.264; P < .001) increases in syphilis and gonorrhea rates, respectively, and a 12% reduction in chlamydia rates (RR: 0.884, 95% CI 0.883–0.885; P < .001). HIV PrEP utilization was correlated with the numbers of syphilis, gonorrhea, and chlamydia cases (spearman coefficients 1.00, 0.94, and 0.94, respectively; P < .001, P < .01, and P < .01, respectively). At the state level, HIV PrEP was also correlated with the number of cases of syphilis, gonorrhea, and chlamydia (spearman coefficients 0.85, 0.81, and 0.85, respectively; Ps < .001 for all correlations). Conclusions The implementation and utilization of HIV PrEP in the United States were associated with increased rates of STIs. Further studies to confirm these associations and to elucidate potential causes are needed.

scholarly journals Persistence With Human Immunodeficiency Virus Pre-exposure Prophylaxis in the United States, 2012–2017

2020 ◽  
Author(s):  
Ya-Lin A Huang ◽  
Guoyu Tao ◽  
Dawn K Smith ◽  
Karen W Hoover
Keyword(s):  
Human Immunodeficiency Virus ◽  
Proportional Hazards ◽  
Patient Characteristics ◽  
The United States ◽  
Cox Proportional Hazards ◽  
Research Database ◽  
Female Sex ◽  
Younger Age ◽  
Immunodeficiency Virus ◽  
Exposure Prophylaxis

Abstract Background Daily oral pre-exposure prophylaxis (PrEP) is highly effective in preventing human immunodeficiency virus (HIV) infection if used adherently throughout periods of HIV risk. We estimated PrEP persistence among cohorts of persons with commercial or Medicaid insurance. Methods We analyzed data from the IBM MarketScan Research Database to identify persons aged 18–64 years who initiated PrEP between 2012 and 2017. We assessed PrEP persistence by calculating the time period that each person continued filling PrEP prescriptions until there was a gap in prescription fills > 30 days. We used Kaplan-Meier time-to-event methods to estimate the proportion of PrEP users who persisted with PrEP at 3, 6, and 12 months after initiation, and constructed Cox proportional hazards models to determine patient characteristics associated with nonpersistence. Results We studied 11 807 commercially insured and 647 Medicaid insured persons with PrEP prescriptions. Commercially insured patients persisted for a median time of 13.7 months (95% confidence interval [CI], 13.3–14.1), compared to 6.8 months (95% CI, 6.1–7.6) among Medicaid patients. Additionally, female sex, younger age, residence in rural location, and black race were associated with shorter persistence. After adjusting for covariates, we found that female sex (hazard ratio [HR], 1.81 [95% CI, 1.56–2.11]) and younger age (18–24 years: HR, 2.38 [95% CI, 2.11–2.69]) predicted nonpersistence. Conclusions More than half of commercially insured persons who initiated PrEP persisted with it for 12 months, compared to a third of those with Medicaid. A better understanding of reasons for nonpersistence is important to support persistent PrEP use and to develop interventions designed for the diverse needs of at-risk populations.

scholarly journals Prescribing of Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis by HIV Medical Providers in the United States, 2013–2014

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
John Weiser ◽  
Shikha Garg ◽  
Linda Beer ◽  
Jacek Skarbinski
Keyword(s):  
Human Immunodeficiency Virus ◽  
Prevalence Ratio ◽  
The United States ◽  
Hiv Care ◽  
Care Providers ◽  
Persons Who Inject Drugs ◽  
Provider Characteristics ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Exposure Prophylaxis

Abstract Background Clinical trials have demonstrated the effectiveness of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) for reducing HIV acquisition. Understanding how HIV care providers are prescribing PrEP is necessary to ensure success of this prevention strategy. Methods During 2013–2014, we surveyed US HIV care providers who also provided care to HIV-negative patients. We estimated percentages who had prescribed PrEP and assessed associations between provider characteristics and PrEP prescribing. Results An estimated 26% (95% confidence interval [CI], 20–31) had ever prescribed PrEP. Of these, 74% (95% CI, 61–87) prescribed for men who have sex with men (MSM), 30% (95% CI, 21–39) for women who have sex with men, 23% (95% CI, 9–37) for men who have sex with women, 23% (95% CI, 15–30) for uninfected partners in HIV-discordant couples trying to conceive, and 1% (95% CI, 0–2) for persons who inject drugs. The following provider characteristics were significantly associated with having prescribed PrEP: male vs female (32% vs 16%; adjusted prevalence ratio [aPR], 1.5; 95% CI, 1.0–2.2), lesbian/gay/bisexual vs heterosexual orientation (50% vs 21%; aPR, 2.0; 95% CI, 1.3–2.9), and HIV caseload (>200, 51–200, and ≤50 patients, 39%, 29%, and 14%, respectively; >200 vs ≤50 patients, aPR 2.4, 95% CI 1.1–5.2, and 51–200 vs ≤50 patients, aPR 2.2, 95% CI 1.2–4.0). Conclusions In 2013–2014, one quarter of HIV care providers reported having prescribed PrEP, most commonly for MSM and rarely for persons who inject drugs. Lesbian/gay/bisexual providers and male providers were more likely than others to have prescribed PrEP. Additional efforts may enable more providers to prescribe PrEP to underserved clients needing the service.

scholarly journals Evidence of an Association of Increases in Pre-exposure Prophylaxis Coverage With Decreases in Human Immunodeficiency Virus Diagnosis Rates in the United States, 2012–2016

2020 ◽  
Author(s):  
Dawn K Smith ◽  
Patrick S Sullivan ◽  
Betsy Cadwell ◽  
Lance A Waller ◽  
Azfar Siddiqi ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Hiv Infections ◽  
The United States ◽  
Virus Diagnosis ◽  
Hiv Surveillance ◽  
Immunodeficiency Virus ◽  
The Us ◽  
Diagnosis Rate ◽  
Exposure Prophylaxis

Abstract Background Annual human immunodeficiency virus (HIV) diagnoses in the United States (US) have plateaued since 2013. We assessed whether there is an association between uptake of pre-exposure prophylaxis (PrEP) and decreases in HIV diagnoses. Methods We used 2012–2016 data from the US National HIV Surveillance System to estimate viral suppression (VS) and annual percentage change in diagnosis rate (EAPC) in 33 jurisdictions, and data from a national pharmacy database to estimate PrEP uptake. We used Poisson regression with random effects for state and year to estimate the association between PrEP coverage and EAPC: within jurisdictional quintiles grouped by changes in PrEP coverage, regressing EAPC on time; and among all jurisdictions, regressing EAPC on both time and jurisdictional changes in PrEP coverage with and without accounting for changes in VS. Results From 2012 to 2016, across the 10 states with the greatest increases in PrEP coverage, the EAPC decreased 4.0% (95% confidence interval [CI], −5.2% to −2.9%). On average, across the states and District of Columbia, EAPC for a given year decreased by 1.1% (95% CI, −1.77% to −.49%) for an increase in PrEP coverage of 1 per 100 persons with indications. When controlling for VS, the state-specific EAPC for a given year decreased by 1.3% (95% CI, −2.12% to −.57%) for an increase in PrEP coverage of 1 per 100 persons with indications. Conclusions We found statistically significant associations between jurisdictional increases in PrEP coverage and decreases in EAPC independent of changes in VS, which supports bringing PrEP use to scale in the US to accelerate reductions in HIV infections.

scholarly journals Implementation and Access to Pre-exposure Prophylaxis for Human Immunodeficiency Virus by Men Who Have Sex With Men in Europe

2021 ◽  
Vol 8 ◽  
Author(s):  
Bruno Sepodes ◽  
João Rocha ◽  
Jorge Batista ◽  
Maria-Eduardo Figueira ◽  
František Dráfi ◽  
...  
Keyword(s):  
Public Health ◽  
Human Immunodeficiency Virus ◽  
Hiv Infection ◽  
Public Health Intervention ◽  
The United States ◽  
World Health ◽  
European Economic Area ◽  
Immunodeficiency Virus ◽  
Sex With Men ◽  
Exposure Prophylaxis

Pre-exposure prophylaxis (PrEP) is a significant public health intervention with proven efficacy and safety in the prevention of human immunodeficiency virus (HIV) infection, which has taken a considerable amount of time to reach Europe in relation to their transatlantic counterparts, namely, the United States of America (USA). There, it is perceived as being an essential prevention tool to be integrated within existing medical, behavioral and structural interventions in place for the management and containment of HIV infection in men who have sex with men (MSM). In a region such as Europe, with approximately double the USA population, it is estimated that not even 10% have proper access to PrEP, and given the lack of coordination with healthcare, taking PrEP has to be at their own expense. Here, we identify the reasons behind the 4-year lag in the approval of PrEP in the European Union/European Economic Area (and Europe in general) and explore the efficacy and effectiveness of PrEP needed to be confirmed with some implementation or demonstration studies conducted in the region. Independent of the data gathered, access of MSM to PrEP is far from ideal in Europe and much still needs to be done. The demonstration of the cost-effectiveness of PrEP alongside other social and behavioral factors needs to be addressed, while the clear populations within MSM that will benefit from this intervention are properly identified and make use of the latest recommendations of the World Health Organization that consider not only daily PrEP but also event-driven PrEP. The momentum for the proper implementation of PrEP in the EU is not lost, and with the existence of generics and even new formulations, there is a renewed opportunity for unleashing the public health benefits arising from this pharmacological tool with other interventions in place (e.g., condoms, testing, and counseling).

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