RESUMEN
BACKGROUND: Pre-exposure prophylaxis (PrEP) uptake among trans people to date has been low. Recommendations implemented in San Francisco to offer PrEP with feminizing hormones have not led to improvement of PrEP uptake in trans communities. New delivery models may be needed. The aim of this study was to examine whether a PrEP-only clinic was more likely to serve trans people at highest risk of HIV than trans-affirming primary care clinics. METHODS: Participants were recruited between 2017 and 2019 as part of a PrEP demonstration project in the San Francisco Bay Area. Survey data including sociodemographics, HIV-related risk behavior, barriers to PrEP, and self-reported PrEP adherence were collected at baseline, 3 months, and 6 months for all participants. Bivariable Poisson regression models were used to examine differences between participants in the primary care clinics and PrEP-only clinic delivered to participants. RESULTS: Baseline survey data were collected from 153 participants. Those with a higher number of sexual partners were significantly more likely to use the PrEP-only clinic rather than the primary care clinics. Participants with higher perceived HIV risk and those who engaged in sex work were also more likely to use the PrEP-only clinic compared with the primary care clinic. Medical mistrust was higher at baseline among participants of the PrEP-only clinic. PrEP adherence was not significantly different by delivery model. Few participants identified PrEP barriers, such as interactions with feminizing hormones, to be determinants of PrEP uptake. CONCLUSIONS: A PrEP-only delivery model could improve PrEP uptake and may better meet the needs of trans people who could most benefit from PrEP.
Asunto(s)
Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Humanos , Masculino , San Francisco , ConfianzaRESUMEN
To improve health outcomes among transgender women of color living with HIV, the Health Resources and Services Administration's Special Programs of National Significance program funded the Enhancing Engagement and Retention in Quality HIV Care for Transgender Women of Color Initiative in 2012. Nine demonstration projects in four US urban areas implemented innovative, theory-based interventions specifically targeting transgender women of color in their jurisdictions. An evaluation and technical assistance center was funded to evaluate the outcomes of the access to care interventions, and these findings will yield best practices and lessons learned to improve the care and treatment of transgender women of color living with HIV infection.
Asunto(s)
Infecciones por VIH/etnología , Servicios Urbanos de Salud/organización & administración , Femenino , Infecciones por VIH/terapia , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Disparidades en Atención de Salud , Humanos , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud , Factores de Riesgo , Servicio Social/organización & administración , Personas Transgénero , Estados Unidos , United States Health Resources and Services Administration , Servicios Urbanos de Salud/estadística & datos numéricos , Población UrbanaRESUMEN
Triple nucleoside reverse transcriptase inhibitors are recommended as an alternative regimen for HIV-infected patients undergoing tuberculosis treatment in resource-limited settings. Few data exist on the efficacy of such regimens in tuberculosis patients. In 34 tuberculosis/HIV-co-infected patients treated with zidovudine/lamivudine/abacavir, 76% achieved HIV RNA less than 50 copies/ml at 24 weeks. No cases of hypersensitivity or immune reconstitution syndrome were observed. These data support the continuing evaluation of nucleoside-based antiretroviral regimens as an alternative treatment for this population.
Asunto(s)
Didesoxinucleósidos/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Lamivudine/uso terapéutico , Inhibidores de la Transcriptasa Inversa/uso terapéutico , Tuberculosis Pulmonar/tratamiento farmacológico , Zidovudina/uso terapéutico , Adulto , Antituberculosos/uso terapéutico , Recuento de Linfocito CD4 , Didesoxinucleósidos/efectos adversos , Hipersensibilidad a las Drogas/etiología , Quimioterapia Combinada , Femenino , Infecciones por VIH/complicaciones , Infecciones por VIH/inmunología , Humanos , Lamivudine/efectos adversos , Masculino , Persona de Mediana Edad , Neutropenia/inducido químicamente , ARN Viral/análisis , Inhibidores de la Transcriptasa Inversa/efectos adversos , Resultado del Tratamiento , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/inmunología , Zidovudina/efectos adversosRESUMEN
With the expansion and convergence of the HIV and TB epidemics worldwide, clinicians will increasingly will be called to manage and treat co-infected patients. TB and HIV medications have overlapping and additive toxicities that can complicate therapy. Additional clinical challenges include choice of optimal first and second line antiretroviral therapy, appropriate timing of antiretroviral initiation, management of immune reconstitution disease, and TB diagnosed after initiation of HIV therapy. Despite the complexities presented by co-infection, many programmes have integrated care and are successfully treating patients with both HIV and TB.