Preexposure Prophylaxis for HIV Infection Integrated With Municipal- and Community-Based Sexual Health Services.
Preexposure Prophylaxis for HIV Infection Integrated With Municipal- and Community-Based Sexual Health Services.
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DOI：
10.1001/jamainternmed.2015.4683
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发表时间：
2016-01
影响因子：
39
通讯作者：
Kolber, Michael A.
中科院分区：
文献类型：
--
作者：
Liu, Albert Y.;Cohen, Stephanie E.;Vittinghoff, Eric;Anderson, Peter L.;Doblecki-Lewis, Susanne;Bacon, Oliver;Chege, Wairimu;Postle, Brian S.;Matheson, Tim;Amico, K. Rivet;Liegler, Teri;Rawlings, M. Keith;Trainor, Nikole;Blue, Robert Wilder;Estrada, Yannine;Coleman, Megan E.;Cardenas, Gabriel;Feaster, Daniel J.;Grant, Robert;Philip, Susan S.;Elion, Richard;Buchbinder, Susan;Kolber, Michael A.
一些随机试验已经证明了暴露前预防（PrEP）在预防人类免疫缺陷病毒（HIV）获得方面的有效性。在性传播感染（STI）和社区诊所实施PrEP时，对依从性、性行为和总体有效性知之甚少。评估美国一组男男性行为者（MSM）和跨性别女性开始PrEP的PrEP依从性、性行为和性传播感染和艾滋病毒的发病率。示范项目于2012年10月至2015年2月在加利福尼亚州旧金山和佛罗里达州迈阿密的两家性传播感染诊所以及华盛顿特区的一家社区卫生中心对男同性恋者和变性妇女进行了研究。每天免费口服富马酸替诺福韦二吡酯/恩曲他滨48周。所有参与者都接受了HIV检测、简短的以客户为中心的咨询和临床监测。二磷酸替诺福韦（ttfv - dp）在干血斑（DBS）中的浓度；自我报告的肛交伴侣数量和无套接受性肛交次数；性病/艾滋病发病率。总体而言，557名参与者开始了PrEP，其中78%的人坚持了48周。在294名接受DBS测试的参与者中，80-86%在随访时具有保护性DBS水平（与≥4次/周剂量一致）。非裔美国人（57%,p=0.003）和迈阿密站点的人（65%,p<0.001）不太可能有保护水平，而那些有稳定住房的人（87%,p=0.02）和在过去3个月内报告有≥2个无安全套肛交伴侣的人（89%,p=0.01）更可能有保护水平。在随访期间，肛交伴侣的平均数量下降，而参与无套肛交的接受性肛交的比例保持稳定。性传播感染的总体发病率很高（90/100人年），但没有随着时间的推移而增加。2人在随访期间感染HIV (HIV感染率0.43%,95% CI 0.05-1.54)；在血清转化时，他们的ttv - dp水平与<2剂量/周一致。尽管在美国一个大型PrEP示范项目中性传播感染的发病率很高，但艾滋病毒的发病率极低。在报告风险行为较高的人群中，依从性更高。解决种族和地域差异以及住房不稳定的干预措施可能会增加预防PrEP的影响。
Several randomized trials have demonstrated the efficacy of pre-exposure prophylaxis (PrEP) in preventing human immunodeficiency virus (HIV) acquisition. Little is known about adherence, sexual practices, and overall effectiveness when PrEP is implemented in sexual transmitted infection (STI) and community-based clinics. To assess PrEP adherence, sexual behaviors, and incidence of STIs and HIV in a cohort of men who have sex with men (MSM) and transgender women initiating PrEP in the United States. Demonstration project conducted from October 2012 to February 2015, among MSM and transgender women in 2 STI clinics in San Francisco, California and Miami, Florida, and a community health center in Washington, DC. Daily, oral tenofovir disoproxil fumarate/emtricitabine was provided free of charge for 48 weeks. All participants received HIV testing, brief client-centered counseling, and clinical monitoring. Tenofovir diphosphate (TFV-DP) concentrations in dried blood spots (DBS); self-reported numbers of anal sex partners and episodes of condomless receptive anal sex; STI/HIV incidence. Overall, 557 participants initiated PrEP, with 78% retained through 48 weeks. Based on 294 participants with DBS testing, 80-86% had protective DBS levels (consistent with ≥4 doses/week) at follow-up visits. African-Americans (57%, p=0.003) and those from the Miami site (65%, p<0.001) were less likely to have protective levels, while those with stable housing (87%, p=0.02) and reporting ≥2 condomless anal sex partners in the past 3 months (89%, p=0.01) were more likely to have protective levels. Mean anal sex partners declined during follow-up, while the proportion engaging in condomless receptive anal sex remained stable. Overall STI incidence was high (90/100 person-years), but did not increase over time. Two individuals became HIV-infected during follow-up (HIV incidence 0.43%, 95% CI 0.05-1.54); both had TFV-DP levels consistent with <2 doses/week at seroconversion. HIV incidence was extremely low, despite a high incidence of STIs in a large US PrEP demonstration project. Adherence was higher among those with higher reported risk behavior. Interventions that address racial and geographic disparities and housing instability may increase PrEP impact.
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DOI：
10.1097/qai.0b013e3181e19a54
发表时间：
2010-08
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Golub SA;Kowalczyk W;Weinberger CL;Parsons JT
通讯作者：
Parsons JT
DOI：
10.1097/qad.0000000000000460
发表时间：
2014-11-28
期刊：
AIDS (London, England)
影响因子：
--
作者：
Kessler J;Myers JE;Nucifora KA;Mensah N;Toohey C;Khademi A;Cutler B;Braithwaite S
通讯作者：
Braithwaite S
影响因子：
3.2
作者：
Dale, Sannisha K.;Bogart, Laura M.;Klein, David J.
通讯作者：
Klein, David J.
影响因子：
11.8
作者：
Hurt, Christopher B.;Eron, Joseph J., Jr.;Cohen, Myron S.
通讯作者：
Cohen, Myron S.
DOI：
10.1093/cid/ciu266
发表时间：
2014-07
期刊：
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
影响因子：
--
作者：
Amico KR;Stirratt MJ
通讯作者：
Stirratt MJ