I-pre-exposure prophylaxis (okanye i-PrEP) isicwangciso sokukhusela i-HIV apho ukusetyenziswa kwansuku zonke kwezidakamizwa ze- antiretroviral kwaziwa ngokunciphisa kakhulu umngcipheko womntu wokufumana i-HIV. Indlela yokusekela ubungqina ithathwa njengengxenye ebalulekileyo yeqhinga lokukhusela i-HIV, elibandakanya ukusetyenziswa ngokuqhubekayo kweikhondom kunye nokunciphisa inani lamalingani esondo.
I-PrEP ayilungiselelwe ukuba isetyenziswe.
Ukususela ngo-2010, uchungechunge lwezilingo ezinkulu lweeklinikhi luye lwabonisa ukuba iPPR inganciphisa ingozi yokusuleleka kwintsholongwane kaGawulayo kubantu abalala ngesondo kunye nabesilisa (MSM) , abadala abadala abakhulayo kunye nabasebenzisi beziyobisi beziyobisi (ii-IDU). Ekuphenduleni kobubungqina, ukukhokelwa kwesikhashana okwenziweyo kuhanjiswe ngamaziko e-US for Control and Protection (CDC) yeZifo.
Ubungqina kwiNkxaso ye-PrEP
Ngo-2010, iPrEx Study yahlola ukusetyenziswa kwe-PrEP phakathi kwe-MSM ye-2,499 ye-HIV-seronegative. Ulingo olukhulu, oluninzi lwamazwe lufumene ukuba ukusetyenziswa komlomo kwansuku zonke kweTruvada (tenofovir + emtricitabine) kunciphise umngcipheko we-HIV ngo-44%. Phakathi kwabangama-51% abathathi-nxaxheba abathatyathwa ngamanqanaba athathekayo eTruvada egazini-bathetha abo bathathe amachiza abo njengoko kulandelwe-umngcipheko wokusuleleka usulelo luyancitshiswa ngama-68%.
Ukulandela kwizithende ze-iPrEX Study, inani leemvavanyo zekliniki zenzelwe ukuhlola ukuphumelela kwe-PrEP kumadoda angabandakaliyo, amadoda nabesifazana abasetyhini.
Eyokuqala kwezi, Isifundo seTDF2 eBotswana, safumanisa ukuba ukusetyenziswa komlomo kwansuku zonke kweTruvada kuncitshiselwe umngcipheko wokudlulisa ngo-62%.
Okwangoku, i- Partners PrEP Study eKenya nase-Uganda ihlolisise ukusetyenziswa kwezigulane ezimbini zezidakamizwa (i-Truvada yeqela elinye kunye ne-tenofovir ngokwazo enye) kwi- serodiscordant , imibhangqwana engatshatyalaliswayo kunye nomlingani omnye umntu ongenayo i-HIV kwaye enye i-HIV -iyo.
Ngokubanzi, umngcipheko wanciphisa ngo-75% kunye no-67%, ngokulandelanayo.
NgoJuni ka-2013, i- Bangkok Tenofovir Study yahlola ukuphumelela kwe-PrEP kuma-2,413 ama-IDU ngokuzithandela ababhalise kwiikliniki zonyango zamachiza eBangkok. Iziphumo ezivela kwilingo zabonisa ukuba i-dose yomlomo yemihla ngemihla yaseTruvada yanciphise umngcipheko ngo-49% phakathi kwamadoda nabafazi kwisifundo. Ngokuhambelana nophando olwangaphambili, abathathi-nxaxheba abanakho ukugcina ukunyanzelisa iziyobisi babengama-74% angaphantsi afana nokusuleleka.
Izifundo ezifundwe kwiimvavanyo ezimbini ze-PrEP ezingaphumeleli
Phakathi kweempumelelo zezi zifundo zazingezo zimbini ezithe zatshatyalaliswa. Zombini zenzelwe ukuhlola ukuphumelela kwe-PrEP nabasetyhini abangenayo i-HIV, indlela ebonwe ukuxhobisa abafazi abasetyhini.
Ukuphazamiseka, zombini i- FEM-PrEP Study eKenya, eMzantsi Afrika naseTanzania, kunye neSifundo se- VOICE eMzantsi Afrika, e-Uganda naseZimbabwe sagcinwa xa abaphandi befumene ukuba abathathi-nxaxheba kwi-PrEP yomlomo babengakhange bafumane ukhuselo oluchasene ne-HIV. Iimvavanyo zokujonga izilwanyana zamatyala zenza ukuba ngaphantsi kwe-40% yabasetyhini babambelele kwi-regimen yezilwanyana zemihla ngemihla, kunye ne-12%) yabamba amazinga athile e-tenofovir ngexesha lovavanyo.
Ziziphi iinjongo ze-FEM-PrEP kunye ne-VOICE ezigqityiweyo ziyimingeni ebalulekileyo ye-antiretroviral therapy, okuyiyo ubudlelwane obungapheliyo phakathi kokunyanzeliswa kwezidakamizwa kunye nokukwazi komntu ukuphumeza umphumo ofunwayo-kulolu hlobo, ukuthintela ukhuseleko.
Kwisifundo se-iPrEx, umzekelo, abaphandi bafumanise ukuba abathathi-nxaxheba abangamalungu angaphantsi kwe-50% abambelela kumanqanaba angama-84% okusuleleka. Oku kwahluke kakhulu kwabo bathatha iipilisi zabo ngaphezu kwe-90% yexesha, umngcipheko wabo wehlisiwe waba ngu-32%. Abaphandi banqikelele ukuba ukuba iqela elinye liza kuthatha iipilisi njengoko kubonisiwe, umngcipheko uza kuhla ku-8% okanye ngaphantsi.
Uhlalutyo olungalindelekanga oluqhutywe ekufumaneni amava aqhelekileyo kunye / okanye iinkolelo ezinokuchaphazela ukunamathela phakathi kwabafundi abathatha inxaxheba. Phakathi kwabo:
- U-10% wesaba abanye babecinga ukuba bane-HIV
- I-15% yaxelelwa ngumntu ongazithathi iipilisi, ngokuqhelekileyo ilungu lentsapho
- I-16% yayinezinye izinto ezininzi ezinokukhathazeka ngazo
- I-17% yabona i pilisi yayinkulu kakhulu
- I-28% yabonwa ngengozi ephantsi ye-HIV
- I-32% yabonwa ukuba ukunyamekela kwansuku zonke kwakunzima
Le micimbi ibonisa kuphela ukubaluleka kokuncedisa ukunyanzelisa, kunye nokubeka esweni rhoqo isimo se-HIV, isimo sokukhulelwa, ukunyamezela ngamachiza, iziphumo ezibi, kunye nokuziphatha kwengozi kunoma ubani obeka kwi-PrEP.
Ezinye iinkxalabo kunye nemingeni
Ukongeza kwimithintelo yokuthobela, abanye baye babonisa ukuxhalaba ngeempembelelo zokuziphatha ze-PrEP-ngokukodwa ukuba kuya kubakho amazinga aphezulu okulala ngokwesondo nokungakhuselekanga . Ubu bungqina bubonisa ukuba oku akunjalo.
Kwimizuzu engama-24, ilingo elingenangqiqo elaqhutywa eSan Francisco, eBoston, naseAtlanta, ingozi yokuziphatha phakathi kwe-MSM yaboniswa ukuba iyancipha okanye ingatshintshi emva kokuqala kwe-PrEP. Imiphumo efana nayo ibonwe kuhlalutyo olulungileyo lwabesetyhini kwi-PrEP eGhana.
Okwangoku, ezinye iinkxalabo ziye zaphakanyiswa malunga nokuvela kwe-HIV engaxilwanga yintsholongwane ngenxa yokusetyenziswa kwe-PrEP kubantu abangenayo i-HIV engazi. Imodeli yokuqala yeemathematika ibonisa ukuba, ngaphezu kwexesha eli-10 kwiminyaka ephakamileyo kakhulu (njengasezantsi Afrika yase-Sahara), malunga ne-9% yabantu abasandul 'ukusuleleka banokufumana inqanaba elithile lokuxhatshazwa kweziyobisi ngenxa ye-PrEP. Iimeko ezintle kakhulu / imeko ezimbi kakhulu zivela kwizinga eliphantsi ukuya kwe-2% ukuya phezulu njengama-40%.
Ngokwahlukileyo, kwiindawo eziphambili zehlabathi, uphando oluthile (ukudibanisa idatha esuka kwi-UK Cohort of HIV Cohort kunye ne-UK Drug Resistance Database) lucwangcise ukuba iPPR ingenakho "impembelelo engafanelekanga" ekusasazeni kwe-HIV kwi-MSM, ngokuqhelekileyo ithathwa njengento Iqela elinobungozi obuphezulu kumazwe amaninzi athuthukile.
Iziphakamiso ze-PrEP
I-CDC inikhuphe isesikhokelo esiphezulu malunga nokusetyenziswa kwe-PrEP kwi-MSM, abantu abadala abadala abesinikwa ngokwesini, kunye nee-IDU. Ngaphambi kokuqaliswa kwe-PrEP, ugqirha uya kuqala ukugqiba ukufaneleka komntu ngo:
- Ukuvavanya uvavanyo lwe-HIV ukuqinisekisa isimo sengqondo se-HIV
- Ukuvavanywa kokusuleleka ukuba umntu unempawu ze-seroconversion enzima, okanye uye wakwazi ukukhutshwa yi-HIV kwinyanga edlulileyo (mhlawumbi ngezesondo ezingakhuselekanga okanye iinaliti ezabelwana ngazo).
- Ukuvavanya ukuba umntu unomngcipheko omkhulu, oqhubekayo, ophezulu wokufumana i-HIV.
- Ukuqinisekisa ukuba umntu unesicatshulwa esingaphezulu kwe-60mL ngomzuzu.
- Ukuhlolwa kwe- hepatitis B (HBV) kunye nee- STD .
Ukongezelela, oogqirha baya kuhlola ukuba ngaba umfazi ukhulelwe okanye ufuna ukukhulelwa. Nangona bekungekho ingxelo yokuba iintsana ezityhila kwiTruvada zonakaliswe, ukhuseleko lweziyobisi alukavanywa ngokupheleleyo. Oko kwathiwa, i-CDC ayicebisi i-PrEP yabasetyhini abancancisayo.
Emva kokuqinisekiswa kokufaneleka, umntu uya kumiselwa umlinganiselo wemihla ngemihla yeTruvada. Ukunciphisa ingcebiso yokunciphisa ingozi kuya kuthi kwenziwe (kubandakanywa nesikhokelo sokuziphatha ngokwesondo kwi-IDU ukukhusela usuleleko ngokwesondo esingakhuselekanga).
Ngokuqhelekileyo, umyalelo uza kuba ungengangeentsuku ezingama-90, uhlaziywa kuphela emva kokuba uvavanyo lwe-HIV lugqiba ukuba umntu uhlala e-seronegative.
Ukongezelela, ukuhlolwa kwe-STD rhoqo kufuneka kwenziwe rhoqo kabini ngonyaka, kwakunye nokuvavanya ukukhulelwa kwabafazi. I-Serum creatinine kunye ne-clearinine imvume kufuneka ihlolwe kwakhona, ngokufanelekileyo ngokulandelwa kokuqala kwaye emva koko kabini ngonyaka emva koko.
> Imithombo:
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