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cost effectiveness of pre exposure prophylaxis

Kednapa Thavorn, Howsikan Kugathasan, Darrell H S Tan, Nasheed Moqueet, Stefan D Baral, Becky Skidmore, Derek MacFadden, Anna Simkin, Sharmistha Mishra
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...
March 15, 2018: Systematic Reviews
James Wilton, Syed W Noor, Alexandre Schnubb, James Lawless, Trevor A Hart, Troy Grennan, Shawn Fowler, John Maxwell, Darrell H S Tan
BACKGROUND: To maximize public health impact and cost-effectiveness, HIV pre-exposure prophylaxis (PrEP) must reach individuals at high HIV risk. Referrals for PrEP can be self- or provider-initiated, but there are several challenges to both. We assessed whether HIV risk differed by referral source among gay, bisexual and other men who have sex (gbMSM) screening for an HIV PrEP demonstration project. METHODS: PREPARATORY-5 was an open-label PrEP demonstration project enrolling gbMSM at high risk of HIV acquisition in Toronto, Canada...
February 27, 2018: BMC Public Health
Janneke P Bil, Elske Hoornenborg, Maria Prins, Arjan Hogewoning, Fernando Dias Goncalves Lima, Henry J C de Vries, Udi Davidovich
Background: Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV infections, but is not yet implemented in the Netherlands. As the attitudes of health-care professionals toward PrEP can influence future PrEP implementation, we studied PrEP knowledge and beliefs and their association with PrEP acceptability among professionals in clinics for sexually transmitted infection (STI professionals) and HIV treatment centers (HIV specialists). In addition, we examined preferred regimens, attitudes toward providing PrEP to key populations and to reimbursement of PrEP costs...
2018: Frontiers in Public Health
Aleksandar Kecojevic, Corey Basch, Charles Basch, William Kernan
BACKGROUND: Antiretroviral (ARV) medicines reduce the risk of transmitting the HIV virus and are recommended as daily pre-exposure prophylaxis (PrEP) in combination with safer sex practices for HIV-negative individuals at a high risk for infection, but are underused in HIV prevention. Previous literature suggests that YouTube is extensively used to share health information. While pre-exposure prophylaxis (PrEP) is a novel and promising approach to HIV prevention, there is limited understanding of YouTube videos as a source of information on PrEP...
February 16, 2018: JMIR Public Health and Surveillance
Beatriz Grinsztejn, Brenda Hoagland, Ronaldo I Moreira, Esper G Kallas, Jose V Madruga, Silvia Goulart, Iuri C Leite, Lucilene Freitas, Luana M S Martins, Thiago S Torres, Ricardo Vasconcelos, Raquel B De Boni, Peter L Anderson, Albert Liu, Paula M Luz, Valdiléa G Veloso
BACKGROUND: PrEP Brasil was a demonstration study to assess feasibility of daily oral tenofovir diphosphate disoproxil fumarate plus emtricitabine provided at no cost to men who have sex with men (MSM) and transgender women at high risk for HIV within the Brazilian public health system. We report week 48 pre-exposure prophylaxis (PrEP) retention, engagement, and adherence, trends in sexual behaviour, and incidence of HIV and sexually transmitted infections in this study cohort. METHODS: PrEP Brasil was a 48 week, open-label, demonstration study that assessed PrEP delivery at three referral centres for HIV prevention and care in Rio de Janeiro, Brazil (Fundação Oswaldo Cruz), and São Paulo, Brazil (Universidade de São Paulo and Centro de Referência e Treinamento em DST e AIDS)...
February 16, 2018: Lancet HIV
Millicent Atujuna, Peter A Newman, Melissa Wallace, Megan Eluhu, Clara Rubincam, Ben Brown, Linda-Gail Bekker
BACKGROUND: New biomedical prevention technologies (NPTs) may contribute to substantially reducing incident HIV infections globally. We explored acceptability and preferences for NPTs among key and other vulnerable populations in two South African townships. METHODS: We conducted six focus groups and 12 in-depth interviews with adolescents, and adult heterosexual men, women, and men who have sex with men (MSM) (n = 48), and eight in-depth interviews with key informant healthcare workers...
2018: PloS One
Thomas H F Whitfield, Steven A John, H Jonathon Rendina, Christian Grov, Jeffrey T Parsons
Literature concerning pre-exposure prophylaxis (PrEP) among gay and bisexual identifying men (GBM) has explored facilitators and barriers to uptake and adherence. Far less reported are the reasons why GBM discontinue PrEP use. A national sample of 1071 GBM completed surveys about PrEP use and discontinuation. Participants who were still taking PrEP the 24-month follow up were compared to those that had stopped. Eighteen percent (n = 31) of GBM who reported ever using PrEP discontinued use. Younger (AOR = 0...
February 5, 2018: AIDS and Behavior
Rui Fu, Douglas K Owens, Margaret L Brandeau
BACKGROUND: Oral HIV pre-exposure prophylaxis (PrEP) has been recommended as a means of HIV prevention among people who inject drugs (PWID) but, at current prices, is unlikely to be cost-effective for all PWID. OBJECTIVE: To determine the cost-effectiveness of alternative strategies for enrolling PWID in PrEP. DESIGN: Dynamic network model that captures HIV transmission and progression among PWID in a representative US urban center. OUTCOME MEASURES: HIV infections averted, discounted costs and quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs)...
January 13, 2018: AIDS
Rubén Allende, María Paz Acuña
INTRODUCTION: Increasing rates of HIV infection remain of concern, especially for high-risk groups such as men who have sex with men. Oral pre-exposure prophylaxis has emerged as an alternative to prevention. However, doubts persist in patients and physicians about its effectiveness. METHODS: To answer this question we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others...
December 27, 2017: Medwave
Monica Desai, Nigel Field, Robert Grant, Sheena McCormack
Although pre-exposure prophylaxis (PrEP)-the use of antiretroviral drugs by non-infected people to prevent the acquisition of HIV-is a promising preventive option, important public health questions remain. Daily oral emtricitabine (FTC)-tenofovir disoproxil fumarate (TDF) is highly efficacious in preventing the acquisition of HIV in people at risk as a result of a range of different types of sexual exposure. There is good evidence of efficacy in women and men, and when men who have sex with men use event based dosing...
December 11, 2017: BMJ: British Medical Journal
Alex Dubov, Liana Fraenkel, Roman Yorick, Adedotun Ogunbajo, Frederick L Altice
Ukrainian men who have sex with men (MSM) remain highly stigmatized group with HIV prevalence as high as 23%. Despite documented effectiveness of pre-exposure prophylaxis (PrEP), PrEP remains unavailable in Ukraine. The aim of this study was to elicit MSM preferences in order to inform program development to facilitate successful delivery of PrEP to Ukrainian MSM. 1184 MSM were recruited through social networking applications to complete a stated preference (choice-based conjoint) survey. Respondents completed 14 choice tasks presenting experimentally-varied combinations of five attributes related to PrEP administration (dosing frequency, dispensing venue, prescription practices, adherence support, and costs)...
December 6, 2017: AIDS and Behavior
C K Uthappa, R R Allam, R Pant, S Pal, M Dinaker, G Oruganti, V V Yeldandi
OBJECTIVES: This exploratory study examined the facilitators of and barriers to acceptance of pre-exposure prophylaxis (PrEP) and potential risk compensation behaviour emerging from its use among men who have sex with men (MSM) and transgender individuals (TGs) in India. METHODS: A questionnaire was administered to 400 individuals registered with a targeted intervention programme. Logistic regression models were used to identify facilitators of and barriers to PrEP acceptance...
November 27, 2017: HIV Medicine
Koh Jun Ong, Sarika Desai, Nigel Field, Monica Desai, Anthony Nardone, Albert Jan van Hoek, Owen Noel Gill
Clinical effectiveness of pre-exposure prophylaxis (PrEP) for preventing HIV acquisition in men who have sex with men (MSM) at high HIV risk is established. A static decision analytical model was constructed to inform policy prioritisation in England around cost-effectiveness and budgetary impact of a PrEP programme covering 5,000 MSM during an initial high-risk period. National genitourinary medicine clinic surveillance data informed key HIV risk assumptions. Pragmatic large-scale implementation scenarios were explored...
October 2017: Euro Surveillance: Bulletin Européen sur les Maladies Transmissibles, European Communicable Disease Bulletin
Valentina Cambiano, Alec Miners, David Dunn, Sheena McCormack, Koh Jun Ong, O Noel Gill, Anthony Nardone, Monica Desai, Nigel Field, Graham Hart, Valerie Delpech, Gus Cairns, Alison Rodger, Andrew N Phillips
BACKGROUND: In the UK, HIV incidence among men who have sex with men (MSM) has remained high for several years, despite widespread use of antiretroviral therapy and high rates of virological suppression. Pre-exposure prophylaxis (PrEP) has been shown to be highly effective in preventing further infections in MSM, but its cost-effectiveness is uncertain. METHODS: In this modelling study and economic evaluation, we calibrated a dynamic, individual-based stochastic model, the HIV Synthesis Model, to multiple data sources (surveillance data provided by Public Health England and data from a large, nationally representative survey, Natsal-3) on HIV among MSM in the UK...
January 2018: Lancet Infectious Diseases
Elske Hoornenborg, Douglas S Krakower, Maria Prins, Kenneth H Mayer
: Pre-exposure prophylaxis (PrEP) is a potent and underutilized HIV prevention tool. In this paper we review the state of knowledge regarding PrEP implementation for men who have sex with men and transgender persons in early adopting countries. We focus on implementation of PrEP in demonstration projects and clinical care, and describe the status of PrEP availability and uptake. We report on approaches to identifying appropriate PrEP candidates in real-world settings and on best practices for clinical monitoring...
October 23, 2017: AIDS
Katie B Biello, Sybil Hosek, Morgan T Drucker, Marvin Belzer, Matthew J Mimiaga, Elliot Marrow, Julia Coffey-Esquivel, Jennifer Brothers, Kenneth H Mayer
Young men who have sex with men account for approximately 20% of incident HIV infections in the U.S. Antiretroviral pre-exposure prophylaxis (PrEP) administered as a daily pill has been shown to decrease HIV acquisition in at-risk individuals. New modalities for PrEP are being developed and tested, including injectable PrEP; however, acceptability of these emerging modalities has not yet been examined in youth. We conducted six focus groups with 36 young men and transgender men and women who have sex with men in Boston, Chicago, and Los Angeles in 2016 to assess interest in and preference for different PrEP modalities...
September 19, 2017: Archives of Sexual Behavior
Michael Weinstein, Otto O Yang, Adam C Cohen
No abstract text is available yet for this article.
October 23, 2017: AIDS
Randolph D Hubach, Joseph M Currin, Carissa A Sanders, André R Durham, Katherine E Kavanaugh, Denna L Wheeler, Julie M Croff
Biomedical intervention approaches, including antiretroviral pre-exposure prophylaxis (PrEP), have been demonstrated to reduce HIV incidence among several at-risk populations and to be cost effective. However, there is limited understanding of PrEP access and uptake among men who have sex with men (MSM) residing in relatively rural states. Twenty semistructured interviews were conducted (August-November 2016) to assess opinions of and perceived barriers to accessing and adopting PrEP among MSM residing in Oklahoma...
August 2017: AIDS Education and Prevention: Official Publication of the International Society for AIDS Education
Bridget L Draper, Zaw Min Oo, Zaw Win Thein, Poe Poe Aung, Vanessa Veronese, Claire Ryan, Myo Thant, Chad Hughes, Mark Stoové
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...
July 26, 2017: Journal of the International AIDS Society
Roman Shrestha, Pramila Karki, Frederick L Altice, Oleksandr Dubov, Liana Fraenkel, Tania Huedo-Medina, Michael Copenhaver
Although people who use drugs (PWUD) are one of the key risk populations who could benefit from the use of pre-exposure prophylaxis (PrEP), to date, little attention has been given to incorporating PrEP into HIV prevention approaches targeting this underserved group. This study investigated the acceptability of PrEP based on a number of known PrEP attributes among high-risk PWUD in a drug treatment setting. A total of 400 HIV-negative PWUD, who reported drug- and/or sex-related risk behaviors were recruited from a methadone clinic to complete a stated preference (full-profile conjoint) survey...
July 10, 2017: AIDS and Behavior
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