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Optimizing HIV PrEP Implementation in the Primary Care Setting

Optimizing HIV PrEP Implementation in the Primary Care Setting
Author: Cara P Nalagan
Publisher:
Total Pages:
Release: 2017
Genre:
ISBN:
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Despite compelling evidence behind the efficacy of pre-exposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) acquisition and its introduction in 2012, the prescription of PrEP has remained low (Silapaswan, Krakower, & Mayer, 2016). At the Asian and Pacific Islander Wellness Center (API), an urban primary care clinic in San Francisco, suboptimal PrEP implementation was related to a lack of standardized practice and routine HIV risk screening for PrEP provision. A doctorate of nursing (DNP) project was implemented to initiate a standardized HIV risk screening protocol for identifying HIV risk and PrEP eligibility to increase PrEP implementation at API. The impact of this protocol demonstrated an increase in the PrEP implementation cascade, particularly in HIV risk identification, PrEP offer, and evaluation of at-risk patients for PrEP uptake (initiation). During implementation of the HIV risk screening protocol, however, inconsistent clinical staff compliance with the routine screening tool led to an inadequate increase in PrEP offer for patients who tested positive for a sexually transmitted infection (STI). This indicates a need for further reinforcement of standardized practice and clinical staff education on the importance of combining HIV risk screening and PrEP, with emphasis on the significant risk for HIV infection associated with positive STI, to effectively promote patient outcomes. Implications for further research include validation of the HIV PrEP screening tool used in the HIV risk screening protocol as a model for PrEP implementation in the primary care setting.

Structural Interventions for HIV Prevention

Structural Interventions for HIV Prevention
Author: Richard A. Crosby
Publisher: Oxford University Press
Total Pages: 384
Release: 2018-10-26
Genre: Medical
ISBN: 0190930802
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A COMPREHENSIVE NEW REFERENCE WORK ON STRUCTURAL APPROACHES TO PREVENTING HIV Structural interventions -- changes to environment aimed at influencing health behaviors -- are the most universal and cost-effective tool in preventing new incidences of HIV. They are not easy to get right, however. Structural Interventions for HIV Prevention offers an authoritative reference for both understanding these programs and instituting them to greatest effect. Whether through changes to policy, environment, social/community norms, or a combination of each, this volume offers actionable and attainable blueprints to creating and evaluating programs in any setting or country. It is an essential resource for researchers and practitioners in the continuing fights against HIV.

Disease Control Priorities, Third Edition (Volume 6)

Disease Control Priorities, Third Edition (Volume 6)
Author: King K. Holmes
Publisher: World Bank Publications
Total Pages: 1027
Release: 2017-11-06
Genre: Medical
ISBN: 1464805253
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Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

HIV Prevention in Primary Care Practice

HIV Prevention in Primary Care Practice
Author: Gregory Felzien, MD, AAHIVS
Publisher: Integritas Communications
Total Pages: 40
Release: 2020-10-22
Genre: Medical
ISBN: 0998419443
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PrEP is a broad set of clinical tools that can be used to reduce the chances of acquiring HIV. Although it is highly effective, many people who could benefit from PrEP lack access or are not familiar with it. However, primary care providers can remedy this situation and truly make a difference in the lives of their patients who may be at risk of acquiring HIV. This eHealth SourceTM educational activity comprises 5 chapters, covering an overview of HIV epidemiology, practical approaches to sexual history-taking and assessing patient risk of HIV acquisition, initiation and monitoring of PrEP medication, and overcoming the bias and stigma surrounding HIV and PrEP. Throughout the program, our expert faculty will provide their unique insights surrounding sexual health, HIV prevention, and PrEP, and how these may be incorporated into primary care practice.

Optimizing HIV Treatment in Resource-Limited Settings

Optimizing HIV Treatment in Resource-Limited Settings
Author: Gordon Amed Akudibillah
Publisher:
Total Pages: 99
Release: 2016
Genre: AIDS (Disease)
ISBN:
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Apart from the traditional role of preventing progression from HIV to AIDS, antiretroviral drug therapy (ART) has an additional benefit of substantially reducing infectiousness, making them potentially an important strategy in the fight against HIV. Recent advances in drug therapy have also seen the use of antiretroviral drugs as a prophylaxis, administered either as post-exposure prophylaxis (PEP) after high-risk exposure or as pre-exposure prophylaxis (PrEP) in those with ongoing HIV exposure. In this dissertation I developed two models for HIV transmission and parameterized them with data from South Africa to study governmental-level intervention programs in which antiretroviral drugs are given as treatment and prophylaxis. The first model is based on the dynamics of HIV in heterosexual population in Sub- Saharan Africa. The model classifies the male and female adult populations by HIV risk into three categories (low, medium and high) according to their sexual preferences. I used a non-linear optimization method to determine the optimal population-level allocation of ART and PrEP allocations required to minimize four objectives: new infections, infection-years, deaths and cost. I considered several strategies for allocating ART and PrEP. I found that generally for low treatment availability, prevention through PrEP to the general population or PrEP and ART to high-risk females is key to optimize all objectives, while for higher drug availability, an all-ART treatment is optimal. At South Africa’s current level of treatment availability, using prevention is most effective at reducing new infections, infection-years, and cost, while using the treatment as ART to the general population best reduces deaths. At treatment levels that meet the UNAIDS's ambitious new 90-90-90 target in South Africa, using all or almost all treatment as ART to the general population best reduces all four objectives considered. The second model is based on the WHO's five-stage classification of HIV/AIDS disease progression. This models stratified the population by disease status, whether diagnosed and whether on treatment. I used optimal control methods to determine the best time-dependent treatment allocation required to minimize new infections, infection-years, deaths and cost. My results indicated that the treatment strategy to minimize infection-years and new infections is to place emphasis on early treatment (i.e. treatment in Stage II & III) while to minimize cost and death, the emphasis should be on late treatment (i.e. Stage III & IV). Applying the optimal treatment strategy also leads to a substantial reduction in disease incidence and prevalence. The results of this study will hopefully provides some guidance for policymakers in determining how to allocate antiretroviral drugs in order to maximize the benefit of treatment.

Optimization of Behavioral, Biobehavioral, and Biomedical Interventions

Optimization of Behavioral, Biobehavioral, and Biomedical Interventions
Author: Linda M. Collins
Publisher: Springer
Total Pages: 319
Release: 2018-02-08
Genre: Social Science
ISBN: 3319722069
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This book presents a framework for development, optimization, and evaluation of behavioral, biobehavioral, and biomedical interventions. Behavioral, biobehavioral, and biomedical interventions are programs with the objective of improving and maintaining human health and well-being, broadly defined, in individuals, families, schools, organizations, or communities. These interventions may be aimed at, for example, preventing or treating disease, promoting physical and mental health, preventing violence, or improving academic achievement. This volume introduces the multiphase optimization strategy (MOST), pioneered at The Methodology Center at the Pennsylvania State University, as an alternative to the classical approach of relying solely on the randomized controlled trial (RCT). MOST borrows heavily from perspectives taken and approaches used in engineering, and also integrates concepts from statistics and behavioral science, including the RCT. As described in detail in this book, MOST consists of three phases: preparation, in which the conceptual model underlying the intervention is articulated; optimization, in which experimentation is used to gather the information necessary to identify the optimized intervention; and evaluation, in which the optimized intervention is evaluated in a standard RCT. Through numerous examples, the book demonstrates that MOST can be used to develop interventions that are more effective, efficient, economical, and scalable. Optimization of Behavioral, Biobehavioral, and Biomedical Interventions: The Multiphase Optimization Strategy is the first book to present a comprehensive introduction to MOST. It will be an essential resource for behavioral, biobehavioral, and biomedical scientists; statisticians, biostatisticians, and analysts working in epidemiology and public health; and graduate-level courses in development and evaluation of interventions.

Remaking HIV Prevention in the 21st Century

Remaking HIV Prevention in the 21st Century
Author: Sarah Bernays
Publisher: Springer Nature
Total Pages: 305
Release: 2021-07-26
Genre: Social Science
ISBN: 303069819X
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This edited collection brings together the social dimensions of three key aspects of recent biomedical advance in HIV research: Treatment as Prevention (TasP), new technologies such as Pre-Exposure Prophylaxis (PrEP), and the Undetectable equals Untransmittable (U=U) movement. The growth of new forms of biomedical HIV prevention has created hope for the future, signalling the possibility of a world without AIDS. In this context, the volume discusses the profound social, political and ethical dilemmas raised by such advances, which are to do with readiness, access, equity and availability. It examines how HIV prevention has been, and is, re-framed in policy, practice and research, and asks: How best can new biomedical technologies be made available in a profoundly unequal world? What new understandings of responsibility and risk will emerge as HIV becomes a more manageable condition? What new forms of blame will emerge in a context where the technologies to prevent HIV exist, but are not always used? How best can we balance public health’s concern for adherence and compliance with the rights of individuals to decide on what is best for themselves and others? Few of these questions have thus far received serious consideration in the academic literature. The editors, all leaders in the social aspects of HIV, have brought together an innovative and international collection of essays by top thinkers and practitioners in the field of HIV. This book is an important resource for academics and professionals interested in HIV research. Chapters "Anticipating Policy, Orienting Services, Celebrating Provision: Reflecting on Scotland’s PrEP Journey", "How the science of HIV treatment-as-prevention restructured PEPFAR’s strategy: The case for scaling up ART in ‘epidemic control’ countries", "Stigma and confidentiality indiscretions: Intersecting obstacles to the delivery of Pre-Exposure Prophylaxis to adolescent girls and young women in east Zimbabwe" and "The drive to take an HIV test in rural Uganda: a risk to prevention for young people?" are available open access under a Creative Commons Attribution 4.0 International License via link.springer.com.

Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence

Guidelines for the Psychosocially Assisted Pharmacological Treatment of Opioid Dependence
Author: World Health Organization. Department of Mental Health and Substance Abuse
Publisher: World Health Organization
Total Pages: 133
Release: 2009
Genre: Medical
ISBN: 9241547545
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"These guidelines were produced by the World Health Organization (WHO), Department of Mental Health and Substance Abuse, in collaboration with the United Nations Office on Drugs and Crime (UNODC) a Guidelines Development Group of technical experts, and in consultation with the International Narcotics Control Board (INCB) secretariat and other WHO departments. WHO also wishes to acknowledge the financial contribution of UNODC and the Joint United Nations Programme on HIV/AIDS (UNAIDS) to this project. " - p. iv

Evaluation of Oral Pre-exposure Prophylaxis (prep) Implementation in Public HIV Care Clinics in Kenya

Evaluation of Oral Pre-exposure Prophylaxis (prep) Implementation in Public HIV Care Clinics in Kenya
Author: Elizabeth M. Irungu
Publisher:
Total Pages: 138
Release: 2021
Genre:
ISBN:
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Daily, oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) is a highly potent HIV prevention intervention with potential to reduce HIV incidence among populations at risk of HIV in Africa if delivered with sufficient coverage. There are extensive data from high-income countries describing diverse settings in which PrEP services are offered. However, data describing PrEP scale-up models in low- and middle-income countries are limited. Public HIV care and treatment programs in Africa have been very successful at scaling up antiretroviral therapy (ART) over the last 15 years and are an attractive choice for integration of PrEP delivery. The main objective of the work described in this dissertation was to evaluate the effectiveness of PrEP implementation and integration in public HIV care clinics. The specific aims include to 1) conduct a step wedge cluster randomized trial of PrEP integration in public health HIV care clinics (the Partners Scale-Up Project) and evaluate impact; 2) conduct a process evaluation of PrEP integration in public HIV care clinics in Kenya, focusing on adaptation; 3) develop and evaluate the effectiveness of an on-site modular training approach to amplify the number of health care providers trained to deliver PrEP in public HIV care clinics in Kenya; and 4) summarize early PrEP rollout in African settings, challenges encountered and opportunities to expand implementation. We found evidence that integration of PrEP in public HIV clinics was feasible. By improving the capacity of health providers in those care clinics to offer PrEP services through training and technical support, PrEP uptake increased more than 20-fold and was sustained. With existing personnel and infrastructure, the high-volume HIV care clinics efficiently reached partners of HIV infected persons and other populations at HIV risk. PrEP users had reasonable continuation rates and objective evidence of high adherence. Using qualitative methods, we found that clinics made pragmatic, effective adaptations to non-core components of PrEP delivery services and to their routine practice to address challenges in PrEP delivery. We established that clinics that instituted some of the adaptations had above average monthly PrEP initiation and continuation rates. To amplify PrEP delivery in public health facilities, we developed and evaluated an innovative on-site modular training approach. We found that this approach was acceptable and it enabled many health providers to receive PrEP training conveniently and at a relatively low cost. Finally, our summary of early PrEP roll out in Africa revealed that there was high interest in PrEP among all populations at risk of acquiring HIV, but individuals did not continue use as expected. We suggested strategies to make PrEP delivery efficient, including delivery within community pharmacies, use of peers, services availed in low tier facilities and exploration of one-stop services to make PrEP delivery less burdensome. The collective results presented in this dissertation illustrate that integration of PrEP services in public HIV care clinics in Kenya is a successful and sustainable model for PrEP implementation. We posit that this model can be scaled up in African countries planning to set up PrEP programs.