Pre-exposure prophylaxis (kana kuti PrEP) chirongwa chekudzivirira HIV apo kushandiswa kwezuva nezuva kwemishonga inorwisa mabhakitiriya kunozivikanwa nekuderedza zvakanyanya mukana wekuwana HIV. Nzira yehupfungwa-inotaridzika inoonekwa sechikamu chinokosha chegadziriro yehutachiwana hweHIV, iyo inosanganisira kuramba kuri kushandiswa kwemakondomu nekuderedza kuwanda kwevakomana nevarume.
PrEP haisati yashandiswa kushandiswa muga woga.
Kubva muna 2010, ruzhinji rwezvikwata zvekuchirapa zvakakura zvakaratidza kuti PrEP inogona kuderedza hutachiona hwehutachiwana hweHIV mune varume vanoita zvepabonde nevarume (MSM) , vanhu vakuru vane hutano hwakanyanya, uye vanoshandisa mishonga yemishonga (IDUs). Mukupindura kwehuchapupu, kuenderera mberi kwekutungamira kwakapiwa kwakabudiswa neUnited States Centers for Disease Control and Protection (CDC).
Uchapupu Mukutsigira PrEP
Muna 2010, iPrEx Yokudzidza yakaongorora kushandiswa kwePrEP pakati pe 2,499 HIV-seronegative MSM. Iko huru, yakawanda-nyika yeruzhinji yakawana kuti kushandiswa kwemuromo zuva nezuva kweTruvada (tenofovir + emtricitabine) kwakaderedza ngozi yekutapukira kweHIV ne 44%. Pakati pa 51% yevatori vechiedza vanoona zvikamu zveTruvada muropa-kureva avo vakanga vatora mishonga yavo sekurayirwa-mungozi yehutachiona yakaderedzwa ne68%.
Kutevera pazvitsitsinho zvePrEX Yokudzidza, miedzo yezvipatara yakawanda yakagadzirirwa kutsvaga kubudirira kwePPR pane vasina kuonekwa, varume nevakadzi vanoita zvepabonde.
Chokutanga chezvi, Chidzidzo cheTDF2 muBotswana, chakawana kuti kushandiswa kwemuromo zuva nezuva kweTruvada kwakaderedza ngozi yekutengesa ne 62%.
Zvichakadaro, veW Partners PrEP Yokudzidza muKenya nekuUganda vakaongorora kushandiswa kwemitemo miviri yakasiyana-siyana yeTV (Truvada yeboka rimwe uye tenofovir pachayo kune imwe) mumasaridiscordant , vanhu vakaroorana vanoparadzana mukati momuviri wavo ane HIV uye mumwe wacho ane HIV -iyo.
Kakawanda, njodzi yakaderedzwa ne75% ne 67%, zvichienderana.
Muna June 2013, Chidzidzo cheBanglean Tenofovir chakaongorora kubudirira kwePrEP pane 2 413 IDUs vachizvipira kubva kumakliniki ekurapa zvinodhaka muBangkok. Migumisiro kubva mukutongwa yakaratidza kuti chirwere chemazuva ose cheTruvada chakadzikisa dambudziko ne 49% pakati pevarume nevakadzi mukudzidza. Zvinopesana nekutsvakurudza kwepakutanga, vatori vechikamu vakakwanisa kuchengetedza kushandiswa kwezvinodhaka vaiva 74% vashoma vanoita kunge vane utachiona.
Zvidzidzo Zvatinodzidza Kubva Mumiedzo Yechipiri yePEPEP Isingakundi
Pakati kubudirira kwezviongorori izvi kwakanga kune zvikanganiso zviviri zvakaparidzirwa kwazvo. Zvose izvi zvakagadzirirwa kutsvaga kubudirira kwePREP mune vakadzi vasina HIV, nzira inofungidzirwa kusimbisa vakadzi vanotambura mune zvevanhu.
Zvinonyadzisa, zvose FEM-PrEP Yokudzidza muKenya, South Africa neTanzania, uye VOICE Studies muSouth Africa, Uganda neZimbabwe dzakagadziriswa apo vatsvakurudzi vakawana kuti vatori vechikamu paPPR PR vakashaya kudzivirirwa neHIV. Zviratidzo zvekuongorora zvinodhaka zvinodaro zvakaratidza kuti vakadzi vasingasviki makumi mana kubva ku40% vaiomerera kune rimwe zuva remishonga yemishonga, uye kunyange vashomanana (12%) vakachengetedza zviyero zvakakwana zve tenofovir panguva yekutongwa.
Ndezvipi zvidzidzo zve FEM-PrEP uye VOICE zvakasimbiswa ndeimwe yezvinetso zvakakosha zveraretroviral therapy, ihwohwo hukama husinganzwisisiki pakati pekuchengetwa kwezvinodhaka uye kukwanisa komunhu kukwanisa kugadzirisa zvakagadziriswa-munyaya iyi, kudzivirira utachiona.
MuPrEx Yokudzidza, somuenzaniso, vatsvakurudzi vakawana kuti vatori vechikamu vane pasi pe50% kuomerera vakamira mukana we 84% wekutapukirwa. Izvi zvaive zvakasiyana zvakanyanya kune avo vakatora mapiritsi avo kupfuura 90% yenguva, iyo ngozi yavo yakaderera kusvika 32%. Vatsvakurudzi vanofungidzira kuti kana boka rimwechete richitora mapiritsi ose sezvakaratidzwa, njodzi inodonha kusvika 8% kana pasi.
Kuongororwa kusinganzwisisi kwakaitwa mukucherechedza zviitiko zvinowanzoitika uye / kana zvitendero zvingangodaro zvakakonzera kubatana pakati pevatori vechidzidzo. Pakati pavo:
- 10% vanotya vamwe vaizofunga kuti vane HIV
- 15% vakaudzwa nomumwe munhu kuti asatora mapiritsi, kazhinji kacho nhengo yemhuri
- 16% aiva nezvimwe zvinhu zvakawanda zvekutya nazvo
- 17% vakafunga kuti mapiritsi akanga akakura zvikuru
- 28% vakaona vari pangozi yakanyanya yeHIV
- 32% vaifunga kuti kuterera zuva nezuva kwakanga kwakaoma
Iyi nhau inoshanda chete kusimbisa kukosha kwekuteerera mazano, pamwe nekuongororongedzwa kwehutachiona hweHIV, chiremera chekuita mishonga, kushandiswa kwemishonga, migumisiro, uye maitiro ekuzvipira kune ani zvake akaiswa kuPrEP.
Zvimwe Zvinonetseka uye Zvinetso
Mukuwedzera pakunamatira zvipingamupinyi, vamwe vakaratidza kunetseka pamusoro pemigumisiro yehutsika yePPR-kunyanya kana ichitungamirira kumazinga akakwirira ekuita zvepabonde asina kudzivirirwa uye mamwe maitiro akaipisisa . Uchapupu hukuru hunoratidza kuti izvi hazvisizvo.
Mune mwedzi wemwedzi makumi maviri nemana, kutaridzika kwakaitwa muSan Francisco, Boston, neAtlanta, ngozi yehutano pakati peMSM yakaratidza kuti inorambidzwa kana inoramba isina kuchinja mushure mekutanga kwePPR. Zvimwe zvakawanikwa zvakaratidzwa mukugadzirisa kuongorora kwevakadzi paPrEP muGhana.
Munguva iyi, vamwe vane hanya vakakurudzirwa pamusoro pekubuda kwemishonga inopesana nemishonga yeHIV nekuda kwekushandisa PrEP mune vanhu vasina kuziva vane HIV. Kutanga kwemasvomhu yekufananidzira kunoratidza kuti, kupfuura makore gumi-siyana muhuwandu hwekupararira (kufanana neSouth Africa neSahara), vanenge 9% vevanhu vatsva vanotapukirwa vanogona kuwana kune imwe nzvimbo yekutapukiswa kwemishonga inokonzerwa nePPR. Nyaya yakanakisisa / yakaipa mamiriro ezvinhu yakabva kune yakaderera se2% kusvika kumusoro 40%.
Kusiyana neizvi, mune imwe nyika yakagadziridzwa, kuongorora kumwe (kubatanidza mashoko kubva kuUnited Collaborative HIV Cohort neUK UK Drug Resistance Database) yakaronga kuti PrEP ingangove ine "kusagadzikana" kunopararira kwekusagadzikana kweHIV pakati peMSM, inowanzoonekwa se boka rakanyanya ngozi kune dzimwe nyika dzakabudirira.
PrEP Mazano
ICDC yakabudisa mazano pamusoro pekushandiswa kwePPREP mu MSM, vanhu vanoita zvepabonde vanhu vakuru, uye IDUs. Pamberi pekumbwa kwePrEP, chiremba achatanga kutanga kugona kukodzera kwemunhu kuburikidza ne:
- Kuita kuongororwa kweHIV kuti ave nechokwadi chehutachiwana hweHIV
- Kuongororwa kwehutachiona kana munhu ane zviratidzo zvehutachionversion yakaoma, kana kuti ave nekugona kuonekwa kweHIV mukati memwedzi wapfuura (zvichida kuburikidza nekuita zvepabonde kusingadziviriki kana kugoverana nesero).
- Kuongorora kana munhu wacho ane dambudziko rakakura, rinoramba riripo, rakanyanya kuwana HIV.
- Kusimbisa kuti munhu wacho ane chikonzero chokufungidzirwa kwechisiki chinopfuura 60mL paminiti.
- Kuchengetedza hepatitis B (HBV) uye STDs .
Uyezve, vanachiremba vachaongorora kana mukadzi ari pamuviri kana kuti anoda kutora pamuviri. Nepo pakange kusina ruzivo rwekuti vacheche vakaratidzirwa kuTruvada vakuvadzwa, kuchengetedzwa kwemishonga hakuchina kuongororwa zvakazara. Izvozvo zvakati, CDC haina kukurudzira PrEP yevakadzi vari kuyamwa.
Pakusimbiswa kwekufanirwa, munhu wacho acharongedzerwa kamwe chete zuva nezuva reTruvada. Kupedza njodzi kuderedza kupiwa njodzi kwaizoitwa (kusanganisira kugadzirisa kuchengetedzwa kwepabonde kune IDUs kudzivirira utachiona kuburikidza nepabonde risina kudzivirirwa).
Kazhinji, mishonga yacho ingadai isiri kwemazuva makumi mapfumbamwe, iyo inogona kudzorerwa chete pashure pekuongororwa kweHIV inopupurira kuti munhu anoramba ari seronegative.
Kuwedzeresa, chirongwa chepachirwere cheSDD chinofanirwa kuitwa kanomwe gore negore, pamwe nekuedzwa kwekudzivirira kwevakadzi. Serum creatinine uye kubvumirwa kwekusika kunofanirawo kuongororwa, zvakakodzera nekutanga kutevera uye zvakare kaviri gore negore pashure.
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