Author Interviews, HIV, JAMA, STD, USPSTF / 01.09.2023

MedicalResearch.com Interview with: James Stevermer, M.D., M.S.P.H.Vice chair for clinical affairs Professor of family and community medicine University of Missouri Medical director of MU Health Care Family Medicine–Callaway Physicians, Dr. Stevermer joined the U.S. Preventive Service Task Force in January 2021. MedicalResearch.com: What is the background for this study? Response: HIV continues to be a significant public health issue. The good news is that PrEP is a safe, highly effective way to help prevent HIV in people at increased risk. There are now two ways people can take PrEP – as a pill or as a shot. We encourage healthcare professionals to have a conversation with their patients about their individual risk for HIV and determine if they should consider taking whichever form of PrEP would work best for them. (more…)
Author Interviews, CDC, HIV, JAMA, Sexual Health / 14.09.2020

MedicalResearch.com Interview with: Gordon Mansergh, PhD Senior Behavioral Scientist CDC Division of HIV/AIDS Prevention MedicalResearch.com: What would you say is the take home message from the study? Response: A small but notable subgroup of gay and bisexual men are sharing their PrEP medication with others. As PrEP continues to be more commonly used, it is important to better understand and address the context of PrEP sharing, and to emphasize messaging about provider monitoring of medication use over time for health and safety reasons. (more…)
Annals Internal Medicine, Author Interviews, CDC, COVID -19 Coronavirus / 09.09.2020

MedicalResearch.com Interview with: Dr. Nathan Furukawa, MD, MPH Medical officer, Division of HIV/AIDS Prevention CDC MedicalResearch.com: What is the background for this study? Response: The cost of the PrEP medication is the largest driver of the cost of providing PrEP care. Most patients need insurance or help from a medication assistance program to cover the large costs of the PrEP medication. We wanted to describe how these costs were paid by patients (out-of-pocket payments) and insurers (third-party payments) nationally.    MedicalResearch.com: What are the main findings? Response: The study found that the cost for a month of the PrEP medication tenofovir disoproxil fumarate/emtricitabine increased from $1350 to $1638 from 2014 to 2018, an average annual increase of 5%. Out-of-pocket costs increased faster from $54 to $94, an average annual increase of 14.9%. In 2018, at least $2 billion was spent paying for the PrEP medication, and this covered 18% of people that had an indication for PrEP.  (more…)
Author Interviews, HIV, University of Pittsburgh / 14.08.2020

MedicalResearch.com Interview with: James Egan, Ph.D., M.P.H. Assistant Professor Behavioral and Community Health Sciences Pitt Public Health MedicalResearch.com: What is the background for this study? Response: When taken as a daily pill, pre-exposure prophylaxis (PrEP) reduces the risk of getting HIV from sex by about 99%, according to the Centers for Disease Control and Prevention. However, adhering to a daily medication regimen doesn’t work for everyone for reasons that include cost and individual concerns about the biological consequences of long-term medication. Previous studies have shown that there are certain periods when some men who have sex with men may be more vulnerable to contracting HIV, including when traveling, on vacation, moving to a new city or after a break-up. Our team set out to explore whether these men might be more receptive to adhering to PrEP treatment during these times. We followed 48 adult men from Pittsburgh or Boston who have sex with men in a pilot program to test the daily use of PrEP for 30 days that included an out-of-town vacation, with the men starting the medication seven days before the trip and continuing for at least seven days after vacation. The men were also given a brief session introducing them to the use of PrEP and discussion adherence. (more…)
Author Interviews, Global Health, HIV / 14.10.2019

MedicalResearch.com Interview with: Rosalie Hayes Senior Policy & Campaigns Officer NAT (National AIDS Trust) MedicalResearch.com: What is the background for this study? Response: The international community has committed to the Sustainable Development Goal of ending the AIDS epidemic by 2030 (SDG 3.3). Pre-exposure prophylaxis (PrEP) for HIV infection involves the use of antiretroviral drugs by people at high risk of acquiring HIV, and its efficacy of PrEP is well-documented. To help achieve SDG 3.3, the Joint United Nations Programme on HIV/AIDS (UNAIDS) has recommended as one of its global targets that 3 million people access PrEP by 2020. For this paper, we examined European Centre for Disease Prevention and Control (ECDC) and UNAIDS monitoring data from Europe and Central Asia (the 53 countries of the WHO European Region plus Kosovo* and Liechtenstein) to identify what progress has been made in implementing PrEP in these countries. We also used data on self-reported PrEP use and expressed need for PrEP among men who have sex with men (MSM) from the European MSM Internet Survey (EMIS-2017) to calculate an estimate of the level of unmet need for PrEP in each country, what we term the ‘PrEP gap’.  (more…)
Author Interviews, HIV, Infections, STD, UCSD / 05.10.2019

MedicalResearch.com Interview with: Martin Hoenigl, MD Assistant Professor UCSD MedicalResearch.com: What is the background for this study? Response: Technology has changed the way men-who-have-sex-with-men (MSM) seek sex. Over 60% of MSM in the US use the internet and/or smartphone-based geospatial networking apps to find sex partners. Grindr™, a sophisticated geosocial networking app, is the most frequently used dating app among MSM in the United States. Previous research has shown that MSM who use Grindr™ have a greater frequency risky sexual behavior, and more sexual partners, but little is known about the association between Grindr™ use and prevention behavior such as the use of HIV pre-exposure prophylaxis (PrEP). We evaluated risk behavior, PrEP use, and Grindr™ usage among MSM receiving community-based HIV and bacterial sexually transmitted infection (STI) screening in central San Diego. Participants who tested negative for HIV and who were not on PrEP were offered immediate PrEP.  (more…)
Author Interviews, HIV, University of Michigan / 15.07.2019

MedicalResearch.com Interview with: Rogério Meireles Pinto, LCSW, Ph.D. Professor and Associate Dean for Research University of Michigan School of Social Work MedicalResearch.com: What is the background for this study? Response: In order to decrease the rate of HIV infection, interventions to scale up PrEP will need to address identified barriers at multiple ecological levels. In the past decade, interventions proposed to address PrEP implementation barriers were limited to one ecological level or another (e.g., individual or community). The failure to consider interventions targeting multiple ecological levels simultaneously may help explain why PrEP implementation is lagging. This failure is also due to methodological limitations of PrEP implementation studies.This high-quality paper presents a thorough and theoretically grounded review of original research on HIV Pre-Exposure Prophylaxis (PrEP) implementation in the U.S. (more…)
Author Interviews, HIV, USPSTF / 20.06.2019

MedicalResearch.com Interview with: John W. Epling, Jr., M.D., M.S.Ed Professor of Family and Community Medicine Virginia Tech Carilion School of Medicine Roanoke, VA USPSTF Task Force Member Medical Director of Employee Health and Wellness Carilion Clinic Dr. Epling maintains an active clinical primary care practice  MedicalResearch.com: What is the background for this study? Response: HIV continues to be a significant public health issue, with about 40,000 people diagnosed each year. The U.S. Preventive Services Task Force reviewed the most recent evidence on how primary care clinicians can best help prevent HIV and its devastating health consequences. We looked at the research on two different topics: screening for HIV, and pre-exposure prophylaxis—a medication that prevents HIV, commonly known as PrEP.  (more…)
Author Interviews, HIV, University of Michigan / 13.06.2018

MedicalResearch.com Interview with: Rogério M. Pinto, LCSW, Ph.D. Associate Professor Associate Dean for Research School of Social Work University of Michigan Ann Arbor, USA MedicalResearch.com: What is the background for this study? Response: This integrative review, published in the journal AIDS and Behavior, includes content from 47 peer-reviewed scholarly articles reporting multiple barriers to high-risk individuals trying to access pre-exposure prophylaxis (PrEP), the HIV drugs that reduce subsequent risk of infection. We found 31 potential solutions to 30 barriers at the patient, provider and health-system levels. In synthesizing this research from a multi-level perspective, based upon a socioecological model, our report contributes much-needed analysis to the rapidly expanding field of PrEP implementation research. At this stage in the scale-up of U.S. PrEP programs, it is important to systematically and comprehensively analyze and integrate knowledge about the successes of and the barriers to PrEP implementation. Our review provides a comprehensive analysis and informs the direction of PrEP implementation across a variety of settings. (more…)
Author Interviews, Cost of Health Care, HIV, Lancet / 13.11.2017

MedicalResearch.com Interview with: Dr Valentina Cambiano PhD Institute for Global Health University College London London UK MedicalResearch.com: What is the background for this study? Response: Pre-Exposure Prophylaxis (PrEP) which involves the use of drugs, which are used to treat HIV, in people without HIV to prevent them from getting is a critical new advance in HIV prevention. It has been shown to reduce the risk of HIV infection by 86% and the benefits heavily out-weigh any concerns. However, introducing this intervention has a cost. When we started working on this study the National Health Services was discussing whether to introduce PrEP and if so for which populations. Unfortunately, at the moment NHS England is not providing Pre-exposure prophylaxis. However, a large study, the PrEP impact trial, funded by the NHS, has just started and this will provide PrEP to 10,000 people. (more…)
Author Interviews, HIV, Infections / 06.10.2017

MedicalResearch.com Interview with: Paul M. Salcuni, MPH Department of Health and Mental Hygiene New York City MedicalResearch.com: What is the background for this study? What are the main findings? Response: NYC Health Department is committed to ensuring equitable access to HIV pre-exposure prophylaxis (PrEP) for all New Yorkers who are HIV-negative and may be exposed to HIV. We examined trends in PrEP prescribing by 602 ambulatory care practices in New York City from 2014 to 2016, as well as associated patient and practice factors, to inform our comprehensive scale-up efforts. For every 100,000 medical visits in the first three months of 2014, roughly 39 involved a patient being prescribed PrEP. In the second quarter of 2016, 419 of every 100,000 medical visits at those same practices involved a PrEP prescription. Despite this nine-fold increase overall, some groups of patients among these practices were less likely to be prescribed PrEP. Those groups include men of color, women, and people getting health care at smaller private practices or practices outside of the city center. (more…)
Author Interviews, HIV, Pharmacology / 24.05.2017

MedicalResearch.com Interview with: Martin Markowitz MD Clinical Director and Staff Investigator Aaron Diamond AIDS Research Center Aaron Diamond Professor at The Rockefeller University MedicalResearch.com: What is the background for this study? What are the main findings? Response: Cabotegravir ((CAB) is an inhibitor of HIV-1 integrase and is amenable to formulation in both oral and long acting injectable forms. In preclinical studies injectable CAB protected against low dose intrarectal challenge using an HIV-like virus in the rhesus macaque model. These results support the clinical development of CAB as prevention. This study was a first attempt to establish a dosing regimen and evaluate safety and acceptability of intramuscular injections of CAB. The study was a placebo controlled blinded study of approximately 120 subjects with a 5:1 randomization active/placebo. Subjects received 800mg CAB given as 2 2mL injections or placebo every 12 weeks for 3 injections after a 4 week safety lead in of oral therapy. Safety acceptability and PK were assessed. The main findings were that injections were associated with injection site reactions in the vast majority of participants that were mild to moderate and of short duration. Only 4 subjects who entered the injection phase discontinued due to injection intolerance. There were no additional safety signals and the participants considered the injections acceptable when asked to complete questionnaires. PK analysis found that despite modeling that suggested that the 800mg q 12 week dose would be adequate, this was not the case. More rapid uptake and release from the depot resulted in lower than anticipated drug levels at trough. Alternate dosing regimens are under study. Another finding is that there were participants (14%) who had detectable drug in plasma detected at 52 weeks after last injection suggesting the presence of a tail in some individuals. (more…)
Author Interviews, HIV, Pediatrics, PLoS / 28.09.2016

MedicalResearch.com Interview with: Kenneth K. Mugwanya MBChB, MS Department of Epidemiology andDepartment of Global Health University of Washington, Seattle, Washington, USA Division of Disease Control, School of Public Health Makerere University Kampala, Uganda MedicalResearch.com: What is the background for this study? What are the main findings? Response: Women living in regions with high HIV prevalence are at high risk of HIV acquisition in pregnancy and postpartum because they infrequently use condoms, do not know their partner's HIV status, and have biologic changes or changes in their partner's sexual partnerships that increase susceptibility. Moreover, acute HIV infection during pregnancy or breastfeeding period is associated with high rates of mother-to child HIV transmission because of high circulating level of HIV virus in blood. Oral antiretroviral pre-exposure prophylaxis (PrEP) is a powerful HIV prevention strategy recommended by both the World Health organization and US Centers for Diseases Control and Prevention. PrEP is an attractive prevention strategy for women as it can be used discreetly and independent of sexual partners. However, there is limited research about the safety of PrEP in HIV-uninfected pregnant or breastfeeding mothers and their infants. (more…)
Author Interviews, HIV, Infections, STD / 16.09.2016

MedicalResearch.com Interview with: Noah Kojima David Geffen School of Medicine University of California Los Angeles, California MedicalResearch.com: What is the background for this study? What are the main findings? Response: One of the most exciting new methods to prevent human immunodeficiency virus (HIV) type 1 infection is through the use of chemical pre-exposure prophylaxis (PrEP), which has been shown to be safe and effective in randomized-controlled trials and “real world” studies among men who have sex with men (MSM). However, reports of high incidence of sexually transmitted infections (STIs) and condomless sex in PrEP trials has led clinicians and public health advocates to be concerned that the use of PrEP for HIV might lead to higher STI incidence due to increased sexual risk behavior. We found that PrEP for HIV infection is associated with increased risk of STI acquisition among MSM in a meta-analysis of prior studies. (more…)