Treatment As Prevention Research Articles

Investigating the Reliability of an Existing Top Angle and Seat Pad Semi-Rigid Connection System Using Advanced Modelling Techniques

The investigation introduces an advanced model procedure for evaluating the structural reliability of semi-rigid frame connections in existing aged buildings. Specifically, the focus is on the top angle and seat pad (TA–SP) semi-rigid connection, which was not initially considered in the current design standards. The approach employs a plastic hinge model to predict the ultimate strength of the connection and its beam-to-column behaviour. In order to increase computational efficiency, the investigation leverages the nonlinear behaviour of the finite element (FE) model to validate critical parameters. The statistical properties of the existing connection were obtained based on past experimental data, highlighting the weakest elements in the system. The first-order and second-order reliability methods and Monte Carlo simulations were employed to estimate the reliability index. Percentile errors were assessed to understand their impact on higher-order interactions. This new technique of identification quantifies the probability of the system failure interactions. Notably, a 45% lesser error aligns with the target reliability index, while a 114.5% larger error indicates a significant deviation from actual failure probability values. Each methodology introduced adheres to the current standard, and the system reliability analysis provides a vigorous conclusions scheme framework for assessing the existing TA–SP semi-rigid connection.

Barriers and facilitators influencing the uptake and acceptability of HIV pre-exposure prophylaxis amongst commercial female sex workers in Tshwane district, Gauteng province: A descriptive study

While there have been great advances in HIV prevention methods in recent years, such as daily pre-exposure prophylaxis (PrEP) and combination antiretrovirals used as Treatment as Prevention (TaSP), access to care, compliance, and consistent follow-up with treatment remain barriers to care in high-risk populations. The purpose of this study was to explore the barriers and facilitators for the uptake and acceptability of PrEP among female sex workers in Tshwane District, South Africa. A descriptive qualitative research design was used. Female sex workers (FSW) aged 18 years and above were purposively sampled to participate in the study. The research team approached a minimum of 24 female sex workers until data saturation was achieved. The results showed that barriers such as a shortage of PrEP, side effects of PrEP, unawareness of collection points, reliance on pills, stigmatization, and absence of clinics influenced the uptake and acceptability of PrEP. The study also reported on facilitators that enhance the uptake and acceptability of PrEP among sex workers in Tshwane District. These facilitators include knowledge and awareness, perceived HIV risk, availability of mobile clinics, the effectiveness of PrEP, easier accessibility of information, awareness programmes, fear of infection, and preventative measure. This study established the barriers and facilitators that potentially influence the uptake and acceptability of PrEP among female sex workers in the Tshwane District, Gauteng Province, South Africa.

Is U=U consistently known and implemented? A survey among different medical specialists in Brazil.

Despite solid scientific evidence, the concepts of treatment as prevention (TASP) and Undetectable = Untransmittable (U = U) remain unfamiliar and underutilized for some healthcare providers. We conducted a self-completion survey to evaluate the knowledge of TASP/U = U in different medical specialties. Wilcoxon Rank-Sum, Chi-square and Fisher's exact tests were used for group comparisons and a logistic regression model was used to assess factors independently associated with U = U-non-supportive attitudes. 197 physicians were included; 74% agreed/strongly agreed that people living with HIV (PLHIV) under regular treatment with undetectable viral do not transmit HIV sexually. However, only 66% agree/strongly agree that PLHIV should be informed about that. The knowledge about these concepts was poorer among gynecologists, urologists and internal medicine specialists when compared to infectious diseases specialists after adjustment for age, race/skin color, gender, and sexual orientation. Our study found that knowledge of crucial concepts of HIV prevention may be lacking for some medical specialties. This highlights the need of improvement in medical education.

Trends of HIV and syphilis prevalence among pregnant women in antenatal clinics in Togo: Analysis of sentinel serosurveillance results between 2008 and 2016

RésuméIntroductionLe but de notre étude était d'analyser les tendances de l'infection à VIH et de la syphilis chez les femmes enceintes en consultation prénatale (CPN) dans les structures de soins du Togo.MéthodesIl s'est agi d'une étude rétrospective analytique, couvrant la période de 2008 à 2016 et portant sur les femmes enceintes de 15 à 49 ans vues en CPN pour la première fois dans les services de santé maternelle et infantile au Togo.RésultatsDurant la période d’étude, 41 536 femmes enceintes ont été enregistrées. L’âge moyen des patientes était de 26 ± 6 ans en 2008, 2009 et 2010. La prévalence globale du VIH était passée de 3,4% en 2008 à 2,9% en 2016 (p = 0,0145). Elle est passée de 1% en 2008 à 0,5% en 2016 et de 3,6% en 2008 à 1,4% en 2016 (p < 0,0001) respectivement chez les 15-19 ans et les 20-24 ans. La prévalence de la syphilis baisse de façon significative de 2008 (1,3%) à 2016 (0,6%), (p < 0,0001). Elle est faible et non associée à l’âge en 2008, alors qu'elle était de 0,2% et 0,4% en 2016 respectivement dans la tranche d’âge de 15-19 ans et de 20-24 ans.ConclusionNotre étude documente une prévalence relativement faible de la syphilis et du VIH chez la femme enceinte au Togo, avec une baisse significative chez les adolescentes et les jeunes femmes témoignant de l'efficacité de l'augmentation du dépistage et de la prévention globale des IST, du VIH y compris l'approche traitement antirétroviral comme prévention (TASP, Treatment as prevention), et du programme d’élimination de la syphilis néonatale dans le pays.

Predictors of knowledge of and access to biomedical prevention among MSM and transgender men in Latin America: Results from the Latin American internet survey.

HIV is still a central public health issue in Latin America, disproportionally affecting key populations. Knowledge and access to biomedical prevention strategies, including treatment as prevention (TASP) or undetectable=untransmissible (U=U), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), are the first steps to increasing uptake. We used data from the Latin American MSM Internet Survey (LAMIS) to describe knowledge and access to biomedical HIV prevention strategies among gay, bisexual, transgender and other men who have sex with men (MSM) living in 18 Latin American countries. We compared LAMIS data across countries and according to age categories using frequencies and percentages. We also used multivariable models to explore whether age, gender identity, sexual identity, steady partnership, HIV status and education were independently associated with outcomes. In all, 55924 participants were included. Most were cisgender (99%) and identified as gay/homosexual (77%) or bisexual (17%). Schooling levels were very high, with 89% reporting highest attained education as tertiary level, university or post-graduation. In total, 16% had been previously diagnosed with HIV; of those, rates of undetectable viral load varied from 60% in Venezuela to 83% in Brazil. Overall, 54%, 54% and 52% of participants already knew about PEP, PrEP and U=U, respectively. Participants from Brazil and those aged between 26 and 55years, living with diagnosed HIV and having a gay/homosexual identity had greater levels of awareness about biomedical prevention strategies. Our study highlights gaps in HIV prevention campaigns directed to MSM in Latin America resulting in low uptake of biomedical prevention methods.

Counseling and Condoms for HIV Prevention: A Community Supervision–Based Study

Treatment as prevention and pre-exposure prophylaxis (PrEP) are effective tools for HIV prevention. In the U.S., use of these interventions is low in

70 - Beyond Treatment as Prevention (TASP): Use of a Mobile Unit to Screen for Human Immunodeficiency Virus and Link High-Risk, Negative Adolescents and Young Adults to Prep Services

Purpose: New HIV infections in adolescents and young adults (AYAs) are a widespread public health concern. Despite overall rates declining nationally, young men who have sex with men are experiencing an increase in new HIV diagnoses with male to male sexual contact being cited most commonly as the route for new infections. The Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) encourage the development of an integrated HIV prevention and care plan that addresses the goals of the National HIV/AIDS Strategy (NHAS) which includes preventing new infections, increasing access to care, improving health outcomes, and reducing HIV-related health disparities. This study looked at the efficacy of a mobile testing unit on linking a high risk, urban population to PrEP.

P52 ‘Behind closed doors, no one sees, no one knows’: stigma and treatment as prevention in prison

P52 ‘Behind closed doors, no one sees, no one knows’: stigma and treatment as prevention in prison

What does preexposure prophylaxis mean for treatment; what does treatment mean for preexposure prophylaxis?

Both preexposure prophylaxis (PrEP) and treatment as prevention (TaP) have shown promise in contributing to HIV prevention, in models, observational cohorts and in real-world intervention studies. They share similarities, in that they use the same drugs, toxicity markers and may be focused on the same key populations. How to implement PrEP is still the source of much debate; effective coverage with TaP, with recent data on the positive impact of treatment at high CD4 counts, is still an ongoing challenge. Treatment has demonstrated individual benefit even at CD4 counts above 350 cells/μl; PrEP has shown the effectiveness in real-world use. This article discusses the intersection of the two interventions, some programmatic misconceptions and complexities, and argues that PrEP is a nuanced and useful adjunct to HIV programmes. PrEP can be rolled out in a way that complements treatment, possibly even within primary health clinics, and may be required for the many people in whom TaP currently fails. PrEP will need constant adaptation so as to maintain programmatic and cost-effectiveness, as the epidemiology of HIV changes with TaP rollout and expansion as CD4 restrictions are lifted. Finally, the article also argues that so-called ethical concerns around competing resources are relatively easily resolved.

Efficacy of antiviral therapy on prevention of HIV transmission among sero-discordant couples in Guangxi Zhuang autonomous region

To understand the efficacy of antiviral therapy on prevention of HIV transmission and to assess the feasibility of treatment-as-prevention strategy in public health practice, among sero-discordant couples in Guangxi Zhuang autonomous region (Guangxi). Data was gathered through the AIDS prevention and control information system in Guangxi from January 1, 2008 to December 31, 2014, on HIV sero-discordant couples. Time-dependent Cox Model was used to analyze the efficacy of antiviral treatment. A total of 7 694 sero-discordant couples were followed and 394 appeared positive from those negative spouses. The overall HIV positive seroconversion rate was 2.5 (2.2-2.7) /100 person-year. The HIV positive sero-conversion rates were 4.3 (3.7-4.8) /100 person-year in the untreated cohort and 1.6 (1.4-1.9) per 100 person-year in the treated cohort. Rate of HIV transmission declined by 51% in the treated cohort (HR=0.49, 95%CI: 0.40-0.60) but appeared as 45% (AHR=0.55, 95%CI:0.43-0.69) after adjusting for factors as sex, age, education, marital status, occupation, transmission route and baseline CD4(+)T lymphocyte cell count. The rate of reduction in transmission was significant among couples in which the HIV-positive spouses showing the following features as: aged ≥25 years, married, farmers, with educational level of junior high school or below, baseline CD4(+)T lymphocyte cell count <500 cells/mm(3) and infection was through heterosexual intercourse. Antiviral therapy as a prevention strategy among sero-discordant couples seemed feasible and effective in Guangxi. Expansion of the coverage on antiviral therapy would reduce the spread of HIV in married couples.

Increased Prevalence of Controlled Viremia and Decreased Rates of HIV Drug Resistance Among HIV-Positive People Who Use Illicit Drugs During a Community-wide Treatment-as-Prevention Initiative.

Although treatment-as prevention (TasP) is a new cornerstone of global human immunodeficiency virus (HIV)-AIDS strategies, its effect among HIV-positive people who use illicit drugs (PWUD) has yet to be evaluated. We sought to describe longitudinal trends in exposure to antiretroviral therapy (ART), plasma HIV-1 RNA viral load (VL) and HIV drug resistance during a community-wide TasP intervention. We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services study, a prospective cohort of HIV-positive PWUD linked to HIV clinical monitoring records. We estimated longitudinal changes in the proportion of individuals with VL <50 copies/mL and rates of HIV drug resistance using generalized estimating equations (GEE) and extended Cox models. Between 1 January 2006 and 30 June 2014, 819 individuals were recruited and contributed 1 or more VL observation. During that time, the proportion of individuals with nondetectable VL increased from 28% to 63% (P < .001). In a multivariable GEE model, later year of observation was independently and positively associated with greater likelihood of nondetectable VL (adjusted odds ratio = 1.20 per year; P < .001). Although the proportion of individuals on ART increased, the incidence of HIV drug resistance declined (adjusted hazard ratio = 0.78 per year; P = .011). We observed significant improvements in several measures of exposure to ART and virologic status, including declines in HIV drug resistance, in this large long-running community-recruited cohort of HIV-seropositive illicit drug users during a community-wide ART expansion intervention. Our findings support continued efforts to scale up ART coverage among HIV-positive PWUD.

O19.4 Awareness and interpretation of theending hivcampaign and changing attitudes about treatment as prevention in an online cohort of msm

Introduction Treatment as prevention (TAP) has become a key part of HIV control strategies in Australia. Ending HIV was launched in September 2013 as a combination prevention campaign with three messages: HIV testing, HIV treatment, and condom-reinforcement. The Burnet Institute has maintained a HIV prevention evaluation online cohort of men who have sex with men. We compare pre- and post-campaign evaluation surveys to assess Ending HIV campaign awareness and changes in campaign-related attitudes and beliefs. Methods Participants were surveyed in August 2013 (S1, pre- Ending HIV implementation) and July 2014 (S2, post- Ending HIV implementation). Campaign recall and message recognition were assessed at S2, alongside S1 to S2 changes in attitudes and beliefs regarding a range of prevention topics, including TaP. Results There were 353 respondents at S1 and 328 at S2; 193 completed both surveys. 158 respondents (48%) were aware of Ending HIV at S2, of who 87 (55%) correctly recalled at least one campaign message. Most commonly recalled messages referenced HIV testing (58%), followed by HIV treatment (37%) and condom-reinforcement (29%). Significant increases were seen in the proportion of HIV-negative men reporting positive changes in attitudes/beliefs in 7 out of 9 statements about TaP (p < 0.05). Proportional increases ranged from 5.0–17.0%, and highest for agreeing that PrEP is effective for HIV prevention (17%) and disagreeing that people should delay treatment until absolutely necessary (12%). Changes in attitudes and beliefs did not differ significantly by campaign awareness at S2. Conclusion While awareness of Ending HIV is encouraging, comprehension of different combination prevention messages was inconsistent and modest for some messages. Predominant shifts in beliefs about TAP are likely to be driven by influences beyond campaign exposure. Future implementation of Ending HIV and associated prevention campaigns should ensure sufficient emphasis on primary prevention and early treatment messages as a part of combination prevention. Disclosure of interest statement All authors have no conflicts to declare. The Victorian Department of Health funds the implementation of the Ending HIV campaign by the Victorian AIDS Council, and the evaluation of HIV prevention campaigns by the Burnet Institute. The authors would like to acknowledge the NHMRC who provide funding to Margaret Hellard as a Senior Research Fellow, Anna Wilkinson as a public health scholarship recipient, Alisa Pedrana through the Sidney Sax Post-Doctoral Fellowship and Mark Stoove through a Career Development Fellowship. The authors gratefully acknowledge the contribution to this work of Victorian Operational Infrastructure Support Program received by the Burnet Institute.

Technologies for HIV prevention and care: challenges for health services.

This article aims to consider some relevant challenges to the provision of "new prevention technologies" in health services in a scenario where the "advances" in the global response to AIDS control are visible. We take as material for analysis the information currently available on the HIV post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP), treatment as prevention (TASP) and over the counter. The methodology consisted of the survey and analysis of the Biblioteca Virtual em Saúde (BVS: MEDLINE, LILACS, WHOLIS, PAHO, SciELO) articles that addressed the issue of HIV prevention and care in the context of so-called new prevention technologies. The results of the studies show that there is assistance on the ground of clinics for the treatment of disease responses, but there are several challenges related to the sphere of prevention. The articles list some challenges regarding to management, organization of services and the attention given by health professionals to users. The current context shows evidence of the effectiveness of antiretroviral therapy in reducing the risk of HIV transmission, but the challenges for the provision of preventive technologies in health services permeate health professionals and users in their individual dimensions and health services in organizational and structural dimension. Interventions should be made available in a context of community mobilization; there should be no pressure on people to make HIV testing, antiretroviral treatment or for prevention. In the management is responsible for the training of health professionals to inform, clarify and make available to users, partners and family information about the new antiretroviral use strategies.

HIV-serodiscordant couples desiring a child: ‘treatment as prevention,’ preexposure prophylaxis, or medically assisted procreation?

We sought to assess the residual risk of HIV transmission, cost, and cost-effectiveness of various strategies that can help fertile HIV-uninfected female/HIV-1-infected male on combination antiretroviral therapy with plasma HIV RNA <50 copies/mL couples to have a child: (1) unprotected sexual intercourse (treatment as prevention); (2) treatment as prevention limited to fertile days (targeting fertile days); (3) treatment as prevention with preexposure prophylaxis (tenofovir/emtricitabine); (4) treatment as prevention and preexposure prophylaxis limited to fertile days; or (5) medically assisted procreation (MAP). This was a model-based, cost-effectiveness analysis performed from a French societal perspective. Input parameters derived from international literature included: 85% probability of live births in different strategies, 0.0083%/mo HIV transmission risk with unprotected vaginal intercourse, 1% HIV mother-to-child transmission rate, and 4.4% birth defect risk related to combination antiretroviral therapy when the mother is infected at conception. Targeting fertile days and preexposure prophylaxis were estimated to decrease the risk of HIV transmission by 80% and 67%, respectively, and by 93.4% for preexposure prophylaxis limited to fertile days (the relative risk of transmission considering the combination of both strategies assuming to be (1-80%)*(1-67%) = 16.6% in basecase). Tenofovir/emtricitabine monthly cost was set at €540. The HIV transmission risk was highest with treatment asprevention and lowest for MAP (5.4 and 0.0 HIV-infected women/10,000 pregnancies, respectively). Targeting fertile days was more effective than preexposure prophylaxis (0.9 vs 1.8) and associated with lowest costs. Preexposure prophylaxis limited to fertile days was more effective than targeting fertile days (0.3 vs 0.9) with a cost-effectiveness ratio of €1,130,000/life year saved; MAP cost-effectiveness ratio when compared with preexposure prophylaxis limited to fertile days was €3,600,000/life year saved. Results were robust to multiple sensitivity analyses. Targeting fertile days is associated with a low risk of HIV transmission in fertile HIV-uninfected female/male with controlled HIV-1 infection couples. The risk is lower with preexposure prophylaxis limited to fertile days, or MAP, but these strategies are associated with unfavorable cost-effectiveness ratios under their current costs.

Treatment as prevention: how to make it work?

Treatment as prevention: how to make it work?

Zero transmission of HIV– “Still a long way to go” An Update on TasP : PrEP and PEP of HIV infection

AIDS emerged as one of the most important public health issues of the late twentieth and early twenty-first centuries and is now one of the leading causes of global morbidity and mortality. The AIDS epidemic has prompted wide-reaching changes in public health, clinical practice, and scientific research, and has had a great impact upon societies throughout the world. This review article gives an in site into updates on TasP (Treatment as prevention), PrEP (pre-exposure prophylaxis) and PEP (Post exposure prophylaxis) of HIV infection. Keeping in view of ABC policy (Abstinence, behavioral change, condoms) and all the updates on TasP, PrEP, PEP and Test & Treat policy…,and the sinereio of implementation of zero transmission of HIV, probably we will find a answer with more intense research (RCTs) in near future.

HIV stops with me: helping HIV-positive adolescents maintain undetectable viral loads under a regimen of treatment as prevention

HIV stops with me: helping HIV-positive adolescents maintain undetectable viral loads under a regimen of treatment as prevention

Evaluation of home-based and mobile community HIV testing strategies, linkage to HIV care and treatment initiation in rural Swaziland

Swaziland has an adult HIV prevalence of 31%, yet half of HIV-positive men and a third of all HIV-positive individuals are unaware of their status. In 2012, as part of its focus on treatment as prevention, MSF introduced intensive community-based HIV testing and counselling (HTC) in rural Shiselweni. To reduce transmission rates, individuals who test HIV-positive in the community must be linked to HIV care and initiate antiretroviral therapy (ART) if eligible. In this analysis of routine programme data, we evaluated the feasibility (population reached, costs) and effectiveness (positivity rates, linkage-to-care) of two strategies of communitybased HTC, and traced clients from community HTC to ART initiation.

The impact of anticipated HIV stigma on delays in HIV testing behaviors: findings from a community-based sample of men who have sex with men and transgender women in New York City.

Treatment as prevention (TaSP) is a critical component of biomedical interventions to prevent HIV transmission. However, its success is predicated on testing and identifying undiagnosed individuals to ensure linkage and retention in HIV care. Research has examined the impact of HIV-associated stigma on HIV-positive individuals, but little work has explored how anticipated HIV stigma-the expectation of rejection or discrimination against by others in the event of seroconversion-may serve as a barrier to HIV testing behaviors. This study examined the association between anticipated stigma and HIV testing behaviors among a sample of 305 men who have sex with men (MSM) and transgender women living in New York City. Participants' mean age was 33.0; 65.5% were racial/ethnic minority; and 50.2% earned <$20,000 per year. Overall, 32% of participants had not had an HIV test in the past 6 months. Anticipated stigma was negatively associated with risk perception. In multivariate models, anticipated stigma, risk perception, and younger age were significant predictors of HIV testing behaviors. Anti-HIV stigma campaigns targeting HIV-negative individuals may have the potential to significantly impact social norms around HIV testing and other biomedical strategies, such pre-exposure prophylaxis, at a critical moment for the redefinition of HIV prevention.

Generalizability and scalability of HIV ‘treatment as prevention’

Generalizability and scalability of HIV ‘treatment as prevention’