Pre-exposure prophylaxis (kapena PrEP) ndi njira yopewera kachilombo ka HIV komwe kugwiritsira ntchito mankhwala a antiretroviral tsiku ndi tsiku kumadziwika kuti kuchepetsa kwambiri chiopsezo cha munthu kuti adziwe kachilombo ka HIV. Njira yowonjezera umboni imatengedwa kuti ndi mbali yofunika kwambiri yothetsera HIV, yomwe imaphatikizapo kugwiritsa ntchito makondomu mosalekeza komanso kuchepetsa chiwerengero cha anthu ogonana.
PrEP sikuti ikhale yogwiritsidwa ntchito padera.
Kuchokera mu 2010, mndandanda wa mayesero akuluakulu a zachipatala wasonyeza kuti PrEP ikhoza kuchepetsa chiopsezo cha kachilombo ka HIV kwa amuna omwe amagonana ndi amuna (MSM) , akuluakulu ogwira ntchito, omwe amagwiritsa ntchito mankhwala osokoneza bongo (IDUs). Poyankha umboniwo, kutsogolera kwanthawi yayitali kwatulutsidwa ndi US Centers for Disease Control and Protection (CDC).
Umboni Pothandizira PrEP
Mu 2010, iPrEx Study inagwiritsa ntchito PrEP pakati pa MSM 2,499 HIV-seronegative MSM. Chiwopsezo chachikulu, chochulukitsa dziko, chimapeza kuti kugwiritsa ntchito tsiku ndi tsiku kwa Truvada (tenofovir + emtricitabine) kunachepetsa chiopsezo chotenga kachirombo ka HIV ndi 44%. Pakati pa 51% mwa anthu omwe ali ndi kachilombo koyambitsa matendawa omwe amapezeka ndi Truvada m'magazi-kutanthauza kuti omwe adatenga mankhwala awo monga momwe adalangizira - chiopsezo cha matendawa chinachepetsedwa ndi 68%.
Pambuyo pa pulogalamu ya iPrEX Phunziro, mayesero angapo a zachipatala adapangidwa kuti afufuze kuti PREP ikugwira ntchito mwa abambo ndi amayi omwe sagwirizane.
Yoyamba mwa izi, Phunziro la TDF2 ku Botswana, adapeza kuti kugwiritsa ntchito tsiku ndi tsiku kwa Truvada kunachepetsa chiopsezo chotenga matenda mwa 62%.
Panthawiyi, a Partners PrEP Study ku Kenya ndi Uganda anafufuza kugwiritsa ntchito mitundu yosiyanasiyana ya mankhwala (Truvada kwa gulu limodzi ndi tenofovir payekha) m'mabanja omwe ali ndi HIV komanso wina ali ndi kachilombo ka HIV -simali.
Zowonjezera, chiopsezo chinachepetsedwa ndi 75% ndi 67%, motero.
Mu June 2013, Phunziro la Bangkok Tenofovir linayesa kuchuluka kwa PrEP pa 2,413 IDUs mwaufulu omwe analembera kuzipatala zamankhwala ku Bangkok. Zotsatira za mlanduwo zinasonyeza kuti mlingo wa tsiku ndi tsiku wa Truvada unachepetsa chiopsezo ndi 49% mwa amuna ndi akazi mu phunziroli. Mogwirizana ndi kafukufuku wakale, ophunzira adatha kusunga mankhwala osokoneza bongo anali 74% ocheperako kutenga kachilomboka.
Zomwe Taphunzira Kuchokera pa Mayesero Awiri a PrEP Olephera
Pa kupambana kwa maphunzirowa panali zolephera ziwiri zofalitsidwa kwambiri. Zonsezi zinalinganiziridwa kuti ziwone momwe OPEP aliri ndi amai omwe alibe kachilombo ka HIV, njira yomwe akuganiza kuti iwalimbikitse amayi omwe ali pachiopsezo.
Zopweteka, zonse za FEM-PrEP Study ku Kenya, South Africa ndi Tanzania, ndi Phunziro la VOICE ku South Africa, Uganda ndi Zimbabwe linaimitsidwa pamene ofufuza adapeza kuti ophunzira omwe ali pamwambo wa PrEP sanatetezedwe ndi HIV. Kuyeza kwapakati pa mankhwala osokoneza bongo kunatsimikizira kuti amayi osachepera 40% amatsatira nthawi ya mankhwala osokoneza bongo, ngakhale zochepa (12%) zinasunga miyezo ya tenofovir yosagwirizana nthawi yonse ya yesero.
Zomwe maphunziro a FEM-PrEP ndi VOICE adayimiliridwa ndi imodzi mwa mavuto akuluakulu a mankhwala opatsirana pogonana, omwe ndi ubale wosagwirizana pakati pa kugwiritsira ntchito mankhwala osokoneza bongo ndi momwe munthu angathe kukhalira ndi zotsatira zake-payekha, kupewa matenda.
Mu PrEx Phunziro, mwachitsanzo, ofufuza adapeza kuti ophunzira omwe ali ndi chiwerengero choposa makumi asanu ndi awiri (50%) amatsatira mwayi wokhala ndi kachilombo ka 84%. Izi zinali zosiyana kwambiri ndi omwe anatenga mapiritsi awo oposa 90 peresenti ya nthawi, omwe chiopsezo chawo chinachepetsedwa kukhala 32%. Ofufuza akuganiza kuti ngati gulu lomwelo likanatenga mapiritsi onse monga momwe amasonyezera, chiopsezo chikhoza kugwera mpaka 8% kapena kupatula.
Kufufuza kosavuta kunapangidwa pozindikira zinthu zambiri zomwe zakhala zikuchitika komanso / kapena zikhulupiliro zomwe zinkakhudza kugwirizana pakati pa ophunzira. Mwa iwo:
- 10% amawopa ena angaganize kuti ali ndi HIV
- 15% anauzidwa ndi munthu kuti asatenge mapiritsi, kawirikawiri wothandizira
- 16% anali ndi zinthu zina zambiri zoti azidandaula nazo
- 17% ankawona kuti mapiritsi anali aakulu kwambiri
- 28% ankaona kuti ali pangozi yaikulu ya HIV
- 32% ankaganiza kuti kumatira tsiku ndi tsiku kunali kovuta kwambiri
Nkhanizi zimangowonjezera kufunika kokalandira uphungu, komanso kuyang'anitsitsa nthawi zonse za HIV, kukhala ndi mimba, kulumikizana ndi mankhwala, zotsatira zoyipa, ndi makhalidwe omwe angayidwe pa PrEP.
Zovuta zina ndi Mavuto
Kuphatikiza pa zolepheretsa kutsata, ena awonetsa nkhaŵa za zotsatira za khalidwe la PrEP-makamaka ngati zidzatsogolera kugonana kosatetezeka ndi makhalidwe ena oopsa . Umboni umasonyeza kuti izi siziri choncho.
Mlandu wa miyezi 24 womwe unachitikira ku San Francisco, Boston, ndi Atlanta, kuopsa kwa khalidwe pa MSM, unayesedwa kuti sagonjetsedwa pambuyo poyambitsa PrEP. Zotsatira zofananako zinawonetsedwa poyesedwa moyenera kwa amayi pa PrEP ku Ghana.
Pakalipano, ena akudandaula za kutuluka kwa mankhwala osagwiritsidwa ntchito ndi HIV chifukwa cha kugwiritsa ntchito PrEP mwa anthu omwe alibe kachilombo ka HIV. Maphunziro oyambirira a masamu amasonyeza kuti, pa zaka khumi (10) zapakati pazomwe zimachitika (monga sub-Saharan Africa), pafupifupi 9 peresenti ya anthu omwe angoyamba kumene kutenga kachilomboka akhoza kukhala ndi vuto linalake lokhazikitsa mankhwala chifukwa cha PrEP. Zochitika zabwino kwambiri / zochitika zovuta kwambiri zimakhala zochepa monga 2% mpaka kufika 40%.
Mosiyana ndi zimenezi, m'mayiko olemera, kafukufuku wina (kugwirizanitsa chiwerengero kuchokera ku UK ogwirizanitsa HIV Cohort ndi UK Drug Resistance Database) adatsimikiza kuti PrEP angakhale ndi "zopanda pake" pakufalitsa kachirombo ka HIV pakati pa MSM, gulu loopsa kwambiri m'mayiko ambiri otukuka.
Malingaliro a PREP
CDC imapereka malangizo othandizira pulogalamu ya PrEP ku MSM, akuluakulu ogonana amuna kapena akazi okhaokha, ndi IDUs. Asanayambe mwambo wa PrEP, adokotala amayamba kuzindikira kuti munthu ali woyenerera ndi:
- Kuyezetsa HIV kuti atsimikizire kuti alibe HIV
- Kuyezetsa matenda ngati munthuyo ali ndi zizindikiro za seroconversion yoopsa, kapena atha kutenga kachilombo ka HIV mwezi watha (mwina kudzera mu kugonana kosateteza kapena pogwiritsa ntchito singano).
- Kuwona ngati munthuyo ali ndi chiopsezo chachikulu, chopitirira, choopsa chopeza HIV.
- Kutsimikizira kuti munthuyo ali ndi chilolezo chowoneka kuti ali wamkulu kuposa 60mL pa mphindi.
- Kuyeza kwa hepatitis B (HBV) ndi matenda opatsirana pogonana .
Komanso, madokotala adzafufuza ngati mkazi ali ndi pakati kapena akufuna kutenga pakati. Ngakhale pakhala palibe malipoti kuti makanda omwe amapezeka ku Truvada avulazidwa, chitetezo cha mankhwalawa sichinayesedwe bwinobwino. Izi zati, CDC sichitchula kuti PrEP kwa amayi omwe akuyamwitsa.
Patsimikiziridwa kuti ali woyenerera, munthuyo adzalangizidwa kuti awonongeke Truvada nthawi imodzi. Kuwongolera kupatsirana kwa pangozi kudzachitidwa (kuphatikizapo chithandizo chabwino chogonana kwa IDU pofuna kuteteza matenda kudzera mu kugonana kosateteza).
Kawirikawiri, mankhwalawa angakhale osapitirira masiku 90, omwe angabwererenso pokhapokha atayesedwa kachirombo ka HIV amatsimikizira kuti munthuyo amakhalabe wosakanizidwa.
Kuonjezera apo, kuyezetsa kachilombo ka HIV nthawi zonse kumachitika kawiri pachaka, komanso kuyesedwa kwa amayi. Serum creatinine ndi ufulu wa creatinine iyeneranso kuyang'aniridwa, mosamala ndi kutsatiridwa koyamba ndi kawiri pachaka pambuyo pake.
> Zotsatira:
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