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Pesquisa : Doenças and Sexualmente and Transmissíveis [Palavras]
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  1 / 20150 MEDLINE  
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[PMID]:24074605
[Au] Autor:Ford CA; Skiles MP; English A; Cai J; Agans RP; Stokley S; Markowitz L; Koumans EH
[Ad] Endereço:Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. Electronic address: fordc@email.chop.edu....
[Ti] Título:Minor consent and delivery of adolescent vaccines.
[So] Source:J Adolesc Health;54(2):183-9, 2014 Feb.
[Is] ISSN:1879-1972
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To explore whether, and to what extent, minor consent influences adolescent vaccine delivery in the United States. METHODS: A telephone survey was completed by 263 professionals with responsibilities for adolescent health care and/or vaccination in 43 states. Measures included perceived frequency of unaccompanied minor visits and perceived likelihood of vaccine delivery to unaccompanied minors in hypothetical scenarios that varied by adolescent age, vaccine type, visit type, and clinical setting. RESULTS: Among the 76 respondents most familiar with private primary care clinics, 47.1% reported perceptions that 17-year-old patients often present without a parent/legal guardian. Among the 104 respondents most familiar with public primary care clinics, 56.7% reported that 17-year-old patients often present alone. In response to hypothetical scenarios, approximately 30% of respondents familiar with private clinics and 50% of respondents familiar with public clinics reported perceptions that unaccompanied 17-year-old adolescents would not receive influenza, Tdap, or human papillomavirus vaccines during routine check-ups because they could not provide consent. Perceived likelihood of unaccompanied minors receiving vaccines when seen for confidential services in primary care, sexually transmitted disease, and Title X/family planning clinics varied significantly by vaccine type and clinical setting. On average, respondents reported that they would support minors having the ability to self-consent for vaccines at age 14. CONCLUSIONS: The inability of minors to consent for vaccines is likely one barrier to vaccination. Interventions to increase adolescent vaccination should consider strategies that increase the ability of unaccompanied minors, particularly older minors, to receive vaccines within the context of legal, ethical, and professional guidelines.
[Mh] Termos MeSH primário: Atitude do Pessoal de Saúde
Pessoal de Saúde
Consentimento Informado por Menores
Atenção Primária à Saúde
Vacinação
[Mh] Termos MeSH secundário: Adolescente
Instituições de Assistência Ambulatorial
Feminino
Pesquisas sobre Serviços de Saúde
Humanos
Entrevistas como Assunto
Masculino
Aceitação pelo Paciente de Cuidados de Saúde
Doenças Sexualmente Transmissíveis
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1408
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140121
[St] Status:MEDLINE


  2 / 20150 MEDLINE  
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[PMID]:24209579
[Au] Autor:Narayanan P; Das A; Morineau G; Prabhakar P; Deshpande GR; Gangakhedkar R; Risbud A
[Ad] Endereço:FHI 360, India Country Office, New Delhi, India. p.narayanan@rediffmail.com.
[Ti] Título:An exploration of elevated HIV and STI risk among male sex workers from India.
[So] Source:BMC Public Health;13:1059, 2013.
[Is] ISSN:1471-2458
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Men who have sex with men (MSM) who also report transactional sex (male sex workers or MSWs) are known to be at higher risk for HIV and sexually transmitted infections (STIs). The study aimed to profile socio-demographic characteristics and risk factors associated with high HIV prevalence among MSWs. METHODS: A cross-sectional study was conducted in 2008-9 among 483 high-risk MSM who attended STI clinics at Mumbai and Hyderabad, two large cities in India. RESULTS: About 70% of the MSM reported transactional sex. As compared to other MSM, MSWs had more male partners (8.9 versus 2.5, p < 0.001) and higher rates of receptive anal sex (96% versus 72%, p < 0.001). HIV prevalence among MSWs and other MSM was 43.6% and 18.1% respectively. HIV prevalence among MSWs was associated with the place of residence (MSWs from Hyderabad were 7.3 times more likely to be infected), positive syphilis serology (3.8 times) and duration of sex work (increased by 8% for every additional year). CONCLUSION: The study showed that MSWs are at high risk for HIV acquisition/transmission, which highlights the need for intensified interventions for personalized risk-reduction counselling and STI screening. Newer biomedical interventions such as pre-exposure prophylaxis and treatment as prevention could also be considered.
[Mh] Termos MeSH primário: Infecções por HIV/etiologia
Profissionais do Sexo/estatística & dados numéricos
Doenças Sexualmente Transmissíveis/etiologia
[Mh] Termos MeSH secundário: Adulto
Preservativos/utilização
Estudos Transversais
Infecções por HIV/epidemiologia
Homossexualidade Masculina/estatística & dados numéricos
Humanos
Índia/epidemiologia
Masculino
Prevalência
Fatores de Risco
Comportamento Sexual/estatística & dados numéricos
Doenças Sexualmente Transmissíveis/epidemiologia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1408
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140117
[St] Status:MEDLINE
[do] DOI:10.1186/1471-2458-13-1059


  3 / 20150 MEDLINE  
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[PMID]:22872432
[Au] Autor:Davey-Rothwell MA; Villarroel MA; Grieb SD; Latkin CA
[Ad] Endereço:Department of Health, Behavior and Society, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, 21205, USA, mdavey@jhsph.edu.
[Ti] Título:Norms, attitudes, and sex behaviors among women with incarcerated main partners.
[So] Source:J Urban Health;90(6):1151-65, 2013 Dec.
[Is] ISSN:1468-2869
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Incarceration has been extensively linked with HIV and sexually transmitted infections (STIs). While a great deal of attention has been given to the risk behaviors of people who have been incarcerated, examination of the behaviors of partners of incarcerated individuals is also needed to understand the direct and indirect links between incarceration and HIV and to identify prevention avenues. In the present study, we hypothesize that incarceration is associated with risk behavior through attitudes and norms. The purpose of this paper is: (1) to describe the attitudes and norms about sexual behaviors that women have when a sexual partner is incarcerated; and (2) to examine the association between attitudes and norms with the behavior of having other sex partners while a main partner is incarcerated. In our sample (n = 175), 50 % of women reported having other sex partners while their partner was incarcerated. Our findings show that attitudes, descriptive norms (i.e., norms about what other people do), and injunctive norms (i.e., norms about what others think is appropriate) were associated with having other partners. Interventions designed for couples at pre- and post-release from prison are needed to develop risk reduction plans and encourage HIV/STI testing prior to their reunion.
[Mh] Termos MeSH primário: Atitude/etnologia
Prisioneiros
Comportamento Sexual/etnologia
Parceiros Sexuais
Doenças Sexualmente Transmissíveis/prevenção & controle
Meio Social
[Mh] Termos MeSH secundário: Adulto
Afro-Americanos
Preservativos/utilização
Estudos Transversais
Feminino
Infecções por HIV/prevenção & controle
Humanos
Meia-Idade
Assunção de Riscos
Autoeficácia
Comportamento Sexual/psicologia
Fatores Socioeconômicos
Abuso de Substâncias por Via Intravenosa/etnologia
Saúde da População Urbana
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL
[Em] Mês de entrada:1408
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:131206
[St] Status:MEDLINE
[do] DOI:10.1007/s11524-012-9749-8


  4 / 20150 MEDLINE  
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[PMID]:23972055
[Au] Autor:Leon N; Lewin S; Mathews C
[Ad] Endereço:Health Systems Research Unit (HSRU), Medical Research Council of South Africa (MRC), P,O, Box 19070, Tygerberg, 7505 Cape Town, Republic of South Africa. natalie.leon@mrc.ac.za.
[Ti] Título:Implementing a provider-initiated testing and counselling (PITC) intervention in Cape town, South Africa: a process evaluation using the normalisation process model.
[So] Source:Implement Sci;8:97, 2013.
[Is] ISSN:1748-5908
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Provider-initiated HIV testing and counselling (PITC) increases HIV testing rates in most settings, but its effect on testing rates varies considerably. This paper reports the findings of a process evaluation of a controlled trial of PITC for people with sexually transmitted infections (STI) attending publicly funded clinics in a low-resource setting in South Africa, where the trial results were lower than anticipated compared to the standard Voluntary Counselling and Testing (VCT) approach. METHOD: This longitudinal study used a variety of qualitative methods, including participant observation of project implementation processes, staff focus groups, patient interviews, and observation of clinical practice. Data were content analysed by identifying the main influences shaping the implementation process. The Normalisation Process Model (NPM) was used as a theoretical framework to analyse implementation processes and explain the trial outcomes. RESULTS: The new PITC intervention became embedded in practice (normalised) during a two-year period (2006 to 2007). Factors that promoted the normalising include strong senior leadership, implementation support, appropriate accountability mechanisms, an intervention design that was responsive to service needs and congruent with professional practice, positive staff and patient perceptions, and a responsive organisational context. Nevertheless, nurses struggled to deploy the intervention efficiently, mainly because of poor sequencing and integration of HIV and STI tasks, a focus on HIV education, tension with a patient-centred communication style, and inadequate training on dealing with the operational challenges. This resulted in longer consultation times, which may account for the low test coverage outcome. CONCLUSION: Leadership and implementation support, congruent intervention design, and a responsive organisational context strengthened implementation. Poor compatibility with nurse skills on the level of the clinical consultation may have contributed to limiting the size of the trial outcomes. A close fit between the PITC intervention design and clinical practices, as well as appropriate training, are needed to ensure sustainability of the programme. The use of a theory-driven analysis promotes transferability of the results, and the findings are therefore relevant to the implementation of HIV testing and to the design and evaluation of complex interventions in other settings. TRIAL REGISTRATION: Current controlled trials ISRCTN93692532.
[Mh] Termos MeSH primário: Aconselhamento
Infecções por HIV/diagnóstico
Aceitação pelo Paciente de Cuidados de Saúde
Relações Profissional-Paciente
Desenvolvimento de Programas/métodos
[Mh] Termos MeSH secundário: Grupos Focais
Pessoal de Saúde/psicologia
Humanos
Liderança
Estudos Longitudinais
Modelos Organizacionais
Motivação
Pesquisa Qualitativa
Doenças Sexualmente Transmissíveis
África do Sul
[Pt] Tipo de publicação:EVALUATION STUDIES; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1408
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:131115
[St] Status:MEDLINE
[do] DOI:10.1186/1748-5908-8-97


  5 / 20150 MEDLINE  
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[PMID]:24480721
[Au] Autor:Ten Hoor G; Hoebe CJ; van Bergen JE; Brouwers EE; Ruiter RA; Kok G
[Ad] Endereço:Maastricht University, Department of Work & Social Psychology, Maastricht, Netherlands. gill.tenhoor@maastrichtuniversity.nl.
[Ti] Título:The influence of two different invitation letters on Chlamydia testing participation: randomized controlled trial.
[So] Source:J Med Internet Res;16(1):e24, 2014.
[Is] ISSN:1438-8871
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: In The Netherlands, screening for chlamydia (the most prevalent sexually transmitted infection worldwide) is a relatively simple and free procedure. Via an invitation letter sent by the public health services (PHS), people are asked to visit a website to request a test kit. They can then do a chlamydia test at home, send it anonymously to a laboratory, and, within two weeks, they can review their test results online and be treated by their general practitioner or the PHS. Unfortunately, the participation rates are low and the process is believed to be not (cost-) effective. OBJECTIVE: The objective of this study was to assess whether the low participation rate of screening for chlamydia at home, via an invitation letter asking to visit a website and request a test kit, could be improved by optimizing the invitation letter through systematically applied behavior change theories and evidence. METHODS: The original letter and a revised letter were randomly sent out to 13,551 citizens, 16 to 29 years old, in a Dutch municipality. Using behavior change theories, the revised letter sought to increase motivation to conduct chlamydia screening tests. The revised letter was tailored to beliefs that were found in earlier studies: risk perception, advantages and disadvantages (attitude), moral norm, social influence, and response- and self-efficacy. Revisions to the new letter also sought to avoid possible unwanted resistance caused when people feel pressured, and included prompts to trigger the desired behavior. RESULTS: No significant differences in test package requests were found between the two letters. There were also no differences between the original and revised letters in the rates of returned tests (11.80%, 581/4922 vs. 11.07%, 549/4961) or positive test results (4.8%, 23/484 vs. 4.1%, 19/460). It is evident that the new letter did not improve participation compared to the original letter. CONCLUSIONS: It is clear that the approach of inviting the target population through a letter does not lead to higher participation rates for chlamydia screening. Other approaches have to be developed and pilot tested.
[Mh] Termos MeSH primário: Infecções por Chlamydia/diagnóstico
Internet
Kit de Reagentes para Diagnóstico/utilização
Doenças Sexualmente Transmissíveis/diagnóstico
[Mh] Termos MeSH secundário: Adolescente
Adulto
Feminino
Humanos
Masculino
Países Baixos
Autoeficácia
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Reagent Kits, Diagnostic)
[Em] Mês de entrada:1408
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140131
[St] Status:MEDLINE
[do] DOI:10.2196/jmir.2907


  6 / 20150 MEDLINE  
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[PMID]:24400345
[Au] Autor:Mercer CH; Aicken CR; Cassell JA; Hartnell V; Davies L; Ryan J; Keane F
[Ti] Título:Not so different after all? Comparing patients attending general practice-based locally enhanced services for sexual health with patients attending genitourinary medicine.
[So] Source:Int J STD AIDS;24(2):106-11, 2013 Feb.
[Is] ISSN:1758-1052
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:We did a cross-sectional survey of patients attending genitourinary (GU) medicine clinics (n = 933) and general practice-based Locally Enhanced Services for Sexual Health (GP-LESSH, n = 111) in Cornwall, England, in 2009/2010, to compare patients' characteristics and experiences. Patients completed a pen-and-paper questionnaire that was then linked to an extract of their clinical data. GP-LESSH patients took longer both to seek and to receive care: medians of nine and seven days, respectively, versus GU medicine patients: medians of seven and one day, respectively. GP-LESSH patients were less likely than GU medicine patients to report symptoms (19.6% versus 30.6%) and sexual risk behaviours (33.3% versus 44.7% reported new partners) since recognizing needing to seek care; 5.0% versus 10.2% were men who have sex with men). However, they were equally likely to have sexually transmitted infections (STIs) diagnosed (23.3% versus 24.8%). As GP-LESSH may operate infrequently, local services must work collaboratively to ensure that those seeking care for suspected STIs receive it promptly. Failing to do so facilitates avoidable STI transmission.
[Mh] Termos MeSH primário: Medicina Geral/organização & administração
Acesso aos Serviços de Saúde/estatística & dados numéricos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
Saúde Reprodutiva
Comportamento Sexual
Venereologia
[Mh] Termos MeSH secundário: Adulto
Assistência Ambulatorial
Estudos Transversais
Assistência à Saúde
Inglaterra
Feminino
Inquéritos Epidemiológicos
Humanos
Masculino
Questionários
População Rural
Doenças Sexualmente Transmissíveis/epidemiologia
Doenças Sexualmente Transmissíveis/prevenção & controle
Fatores Socioeconômicos
Listas de Espera
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1405
[Cu] Atualização por classe:140821
[Lr] Data última revisão:
140821
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:140106
[St] Status:MEDLINE
[do] DOI:10.1177/0956462412472301


  7 / 20150 MEDLINE  
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[PMID]:24337698
[Au] Autor:Henderson G; Maman S; Huang Y; Muessig K; Pan S
[Ad] Endereço:Department of Social Medicine, University of North Carolina School of Medicine, 333 South Columbia St., 347 MacNider, Chapel Hill, NC, 27599-7240, USA, gail_henderson@med.unc.edu.
[Ti] Título:Social contexts of heterosexual transmission of HIV/STI in Liuzhou City, China.
[So] Source:AIDS Behav;18 Suppl 2:S111-7, 2014 Feb.
[Is] ISSN:1573-3254
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:In this special issue of AIDS and Behavior, we focus on the social contexts of sexual transmission of HIV/STI in one South China city. Our multiple projects grew from partnerships across the social and biomedical sciences, and with public health experts in Liuzhou City, to address critical gaps in knowledge about how social factors drive heterosexual transmission. The eleven articles that comprise this special issue feature multidisciplinary and mixed method approaches, collecting data in Liuzhou from different populations, environments, and social venues where individuals often find sexual partners. They document heterosexual behaviors and their meanings. They investigate the experiences and behaviors of women and men in social venues, exploring the networks of people within these venues, how they relate to one another, share information, and influence each other. The articles also examine the experiences of people living with HIV, again collecting data from multiple levels and sources, and revealing the ongoing power of stigma to shape these lives. Taken together, the articles demonstrate the critical role of social contexts in shaping behaviors and meanings, which are linked to heterosexual transmission of HIV/STI, and which must be taken into account for the development of appropriate and effective public health interventions.
[Mh] Termos MeSH primário: Infecções por HIV/transmissão
Heterossexualidade
Parceiros Sexuais
Meio Social
[Mh] Termos MeSH secundário: Feminino
Humanos
Masculino
Doenças Sexualmente Transmissíveis/transmissão
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T; RESEARCH SUPPORT, U.S. GOV'T, NON-P.H.S.
[Em] Mês de entrada:1407
[Cu] Atualização por classe:140820
[Lr] Data última revisão:
140820
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140224
[St] Status:MEDLINE
[do] DOI:10.1007/s10461-013-0666-y


  8 / 20150 MEDLINE  
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[PMID]:25038358
[Au] Autor:Marrazzo JM; del Rio C; Holtgrave DR; Cohen MS; Kalichman SC; Mayer KH; Montaner JS; Wheeler DP; Grant RM; Grinsztejn B; Kumarasamy N; Shoptaw S; Walensky RP; Dabis F; Sugarman J; Benson CA; International Antiviral Society-USA Panel
[Ad] Endereço:University of Washington, Seattle....
[Ti] Título:HIV prevention in clinical care settings: 2014 recommendations of the International Antiviral Society-USA Panel.
[So] Source:JAMA;312(4):390-409, 2014 Jul 23-30.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:IMPORTANCE: Emerging data warrant the integration of biomedical and behavioral recommendations for human immunodeficiency virus (HIV) prevention in clinical care settings. OBJECTIVE: To provide current recommendations for the prevention of HIV infection in adults and adolescents for integration in clinical care settings. DATA SOURCES, STUDY SELECTION, AND DATA SYNTHESIS: Data published or presented as abstracts at scientific conferences (past 17 years) were systematically searched and reviewed by the International Antiviral (formerly AIDS) Society-USA HIV Prevention Recommendations Panel. Panel members supplied additional relevant publications, reviewed available data, and formed recommendations by full-panel consensus. RESULTS: Testing for HIV is recommended at least once for all adults and adolescents, with repeated testing for those at increased risk of acquiring HIV. Clinicians should be alert to the possibility of acute HIV infection and promptly pursue diagnostic testing if suspected. At diagnosis of HIV, all individuals should be linked to care for timely initiation of antiretroviral therapy (ART). Support for adherence and retention in care, individualized risk assessment and counseling, assistance with partner notification, and periodic screening for common sexually transmitted infections (STIs) is recommended for HIV-infected individuals as part of care. In HIV-uninfected patients, those persons at high risk of HIV infection should be prioritized for delivery of interventions such as preexposure prophylaxis and individualized counseling on risk reduction. Daily emtricitabine/tenofovir disoproxil fumarate is recommended as preexposure prophylaxis for persons at high risk for HIV based on background incidence or recent diagnosis of incident STIs, use of injection drugs or shared needles, or recent use of nonoccupational postexposure prophylaxis; ongoing use of preexposure prophylaxis should be guided by regular risk assessment. For persons who inject drugs, harm reduction services should be provided (needle and syringe exchange programs, supervised injection, and available medically assisted therapies, including opioid agonists and antagonists); low-threshold detoxification and drug cessation programs should be made available. Postexposure prophylaxis is recommended for all persons who have sustained a mucosal or parenteral exposure to HIV from a known infected source and should be initiated as soon as possible. CONCLUSIONS AND RELEVANCE: Data support the integration of biomedical and behavioral approaches for prevention of HIV infection in clinical care settings. A concerted effort to implement combination strategies for HIV prevention is needed to realize the goal of an AIDS-free generation.
[Mh] Termos MeSH primário: Infecções por HIV/diagnóstico
Infecções por HIV/prevenção & controle
HIV-1
[Mh] Termos MeSH secundário: Adolescente
Adulto
Antirretrovirais/uso terapêutico
Aconselhamento
Feminino
Infecções por HIV/quimioterapia
Redução do Dano
Humanos
Masculino
Profilaxia Pós-Exposição
Risco
Comportamento de Redução do Risco
Doenças Sexualmente Transmissíveis/prevenção & controle
[Pt] Tipo de publicação:JOURNAL ARTICLE; PRACTICE GUIDELINE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-Retroviral Agents)
[Em] Mês de entrada:1408
[Cu] Atualização por classe:140820
[Lr] Data última revisão:
140820
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:140720
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2014.7999


  9 / 20150 MEDLINE  
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[PMID]:24613084
[Au] Autor:Buchbinder SP; Glidden DV; Liu AY; McMahan V; Guanira JV; Mayer KH; Goicochea P; Grant RM
[Ad] Endereço:Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA; Department of Medicine, University of California, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA. Electronic address: susan.buchbinder@sfdph.org....
[Ti] Título:HIV pre-exposure prophylaxis in men who have sex with men and transgender women: a secondary analysis of a phase 3 randomised controlled efficacy trial.
[So] Source:Lancet Infect Dis;14(6):468-75, 2014 Jun.
[Is] ISSN:1474-4457
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: For maximum effect pre-exposure prophylaxis should be targeted to the subpopulations that account for the largest proportion of infections (population-attributable fraction [PAF]) and for whom the number needed to treat (NNT) to prevent infection is lowest. We aimed to estimate the PAF and NNT of participants in the iPrEx (Pre-Exposure Prophylaxis Initiative) trial. METHODS: The iPrEx study was a randomised controlled efficacy trial of pre-exposure prophylaxis with coformulated tenofovir disoproxil fumarate and emtricitabine in 2499 men who have sex with men (MSM) and transgender women. Participants aged 18 years or older who were male at birth were enrolled from 11 trial sites in Brazil, Ecuador, Peru, South Africa, Thailand, and the USA. Participants were randomly assigned (1:1) to receive either a pill with active pre-exposure prophylaxis or placebo, taken daily. We calculated the association between demographic and risk behaviour during screening and subsequent seroconversion among placebo recipients using a Poisson model, and we calculated the PAF and NNT for risk behaviour subgroups. The iPrEx trial is registered with ClinicalTrials.gov, NCT00458393. FINDINGS: Patients were enrolled between July 10, 2007, and Dec 17, 2009, and were followed up until Nov 21, 2010. Of the 2499 MSM and transgender women in the iPrEx trial, 1251 were assigned to pre-exposure prophylaxis and 1248 to placebo. 83 of 1248 patients in the placebo group became infected with HIV during follow-up. Participants reporting receptive anal intercourse without a condom seroconverted significantly more often than those reporting no anal sex without a condom (adjusted hazard ratio [AHR] 5·11, 95% CI 1·55-16·79). The overall PAF for MSM and transgender women reporting receptive anal intercourse without a condom was 64% (prevalence 60%). Most of this risk came from receptive anal intercourse without a condom with partners with unknown serostatus (PAF 53%, prevalence 54%, AHR 4·76, 95% CI 1·44-15·71); by contrast, the PAF for receptive anal intercourse without a condom with an HIV-positive partner was 1% (prevalence 1%, AHR 7·11, 95% CI 0·70-72·75). The overall NNT per year for the cohort was 62 (95% CI 44-147). NNTs were lowest for MSM and transgender women self-reporting receptive anal intercourse without a condom (NNT 36), cocaine use (12), or a sexually transmitted infection (41). Having one partner and insertive anal sex without a condom had the highest NNTs (100 and 77, respectively). INTERPRETATION: Pre-exposure prophylaxis may be most effective at a population level if targeted toward MSM and transgender women who report receptive anal intercourse without a condom, even if they perceive their partners to be HIV negative. Substance use history and testing for STIs should also inform individual decisions to start pre-exposure prophylaxis. Consideration of the PAF and NNT can aid in discussion of the benefits and risks of pre-exposure prophylaxis with MSM and transgender women. FUNDING: National Institute of Allergy and Infectious Diseases and the Bill & Melinda Gates Foundation.
[Mh] Termos MeSH primário: Antivirais/administração & dosagem
Infecções por HIV/prevenção & controle
Homossexualidade Masculina/estatística & dados numéricos
Doenças Sexualmente Transmissíveis/prevenção & controle
Pessoas Transgênero/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adenina/administração & dosagem
Adenina/análogos & derivados
Adolescente
Adulto
Preservativos/utilização
Desoxicitidina/administração & dosagem
Desoxicitidina/análogos & derivados
Feminino
Soropositividade para HIV
Humanos
Masculino
Ácidos Fosforosos/administração & dosagem
Parceiros Sexuais
África do Sul
América do Sul
Tailândia
Estados Unidos
Adulto Jovem
[Pt] Tipo de publicação:CLINICAL TRIAL, PHASE III; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (9-(2-((bis(pivaloyloxymethoxy)phosphinoyl)methoxy)propyl)adenine); 0 (Antiviral Agents); 0 (Phosphorous Acids); 0 (emtricitabine); 0W860991D6 (Deoxycytidine); JAC85A2161 (Adenine)
[Em] Mês de entrada:1407
[Cu] Atualização por classe:140819
[Lr] Data última revisão:
140819
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140522
[St] Status:MEDLINE


  10 / 20150 MEDLINE  
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[PMID]:24752791
[Au] Autor:Wagner GJ; Tohme J; Hoover M; Frost S; Ober A; Khouri D; Iguchi M; Mokhbat J
[Ad] Endereço:RAND Corporation, 1776 Main St., Santa Monica, CA, 90407, USA, gwagner@rand.org.
[Ti] Título:HIV prevalence and demographic determinants of unprotected anal sex and HIV testing among men who have sex with men in Beirut, Lebanon.
[So] Source:Arch Sex Behav;43(4):779-88, 2014 May.
[Is] ISSN:1573-2800
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The limited epidemiological data in Lebanon suggest that HIV incident cases are predominantly among men who have sex with men (MSM). We assessed the prevalence of HIV and demographic correlates of condom use and HIV testing among MSM in Beirut. Respondent-driven sampling was used to recruit 213 participants for completion of a behavioral survey and an optional free rapid HIV test. Multivariate regression analysis was used to examine demographic correlates of unprotected anal sex and any history of HIV testing. Nearly half (47 %) were under age 25 years and 67 % self-identified as gay. Nearly two-thirds (64 %) reported any unprotected anal intercourse (UAI) with men in the prior 3 months, including 23 % who had unprotected anal intercourse with men whose HIV status was positive or unknown (UAIPU) to the participant. Three men (1.5 % of 198 participants tested) were HIV-positive; 62 % had any history of HIV testing prior to the study and testing was less common among those engaging in UAIPU compared to others (33 % vs. 71 %). In regression analysis, men in a relationship had higher odds of having UAI but lower odds of UAIPU and any university education was associated with having UAI; those with any prior history of HIV testing were more likely to be in a relationship and have any university education. HIV prevention efforts for MSM need to account for the influence of relationship dynamics and promotion of testing needs to target high-risk MSM.
[Mh] Termos MeSH primário: Infecções por HIV/epidemiologia
Homossexualidade Masculina/estatística & dados numéricos
Sexo sem Proteção/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Infecções por HIV/diagnóstico
Inquéritos Epidemiológicos
Humanos
Líbano/epidemiologia
Masculino
Meia-Idade
Prevalência
Análise de Regressão
Assunção de Riscos
Doenças Sexualmente Transmissíveis/epidemiologia
Fatores Socioeconômicos
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, N.I.H., EXTRAMURAL; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1407
[Cu] Atualização por classe:140819
[Lr] Data última revisão:
140819
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:140505
[St] Status:MEDLINE
[do] DOI:10.1007/s10508-014-0303-5



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