PreP and nPEP – CHIPTS – Center for HIV Identification, Prevention and Treatment Services

24Jan

Friends Care I

Friends Care combines the biomedical intervention of Post-exposure Prophylaxis (PEP) for HIV prevention with the behavioral intervention Contingency Management (CM), which targets reduction of methamphetamine use as a way of reducing concomitant high-risk sexual behaviors for HIV-negative, methamphetamine-using MSM.

Friends Care will enroll 49 HIV-negative, methamphetamine-using MSM into the CM component of the dual intervention. Participants receive a baseline assessment including urine analysis for the presence of methamphetamine metabolites, a rapid oral HIV antibody test, a physical examination including a comprehensive metabolic panel and complete blood count, HIV/STI prevention information, and medication adherence information. Following baseline assessments, participants begin an 8-week, 3x/week, CM intervention and are given a 4-day starter pack of tenofivir with emtricitabine (i.e., Truvada). Participants earn vouchers for methamphetamine metabolite-free urine samples, which are redeemable for goods and services.

In the event of an unexpected high-risk sexual exposure to HIV, i.e., unprotected anal intercourse with an HIV-positive or status unknown partner, participants are instructed to immediately call the clinic and begin the 4-dose starter pack of Truvada. An appointment with the physician is scheduled within 96 hours of the participant’s first dose of Truvada; participants then receive a second rapid oral HIV antibody test and are given the additional 24-day pack of Truvada. Participants return to the clinic at 3-months post baseline for a follow-up evaluation and a third rapid oral HIV antibody test.

In combining these two interventions in this unique program, Friends Care aims to reduce methamphetamine use and concomitant high-risk sexual behaviors, while reducing potential seroconversions.

prep

24Jan

P-QUAD Study

PQUAD is a pilot project to evaluate the acceptability, safety, and feasibility of delivering community-based HIV post-exposure prophylaxis in diverse Los Angeles County communities. It is a joint venture of UCLA, the Los Angeles Office of AIDS Programs and Policy (OAPP), the Department of Public Health Sexually Transmitted Disease Program, AIDS Project Los Angeles (APLA), and pharmaceutical industry partners.

Originally conceived in December, 2007, P-QUAD is now operational at 2 sites in epicenters of the HIV epidemic in Los Angeles: The Los Angeles Gay and Lesbian Center (opened March 2, 2010 in the Hollywood/West Hollywood area of Los Angeles with a largely MSM catchment), and The OASIS Clinic (opened April 15, 2010 in the south central area of Los Angeles with a largely lower socioeconomic status, at risk African-American and Latino catchment). The study provides dual or triple-agent ART for 28 days as post-exposure prophylaxis for HIV infection to individuals exposed sexually or via injection-drug works sharing, when presenting within 72 hours of an appropriately high-risk exposure. Additionally, substance use, mental health, and behavioral risk reduction referrals/linkages are provided as appropriate. Efficacy, safety, adherence, tolerability and behavioral outcomes are being collected. In the event of seroconversions, longitudinal specimens are stored for virologic analyses.

The program currently is providing Truvada (tenofovir + emtricitabine), or Combivir (zidovudine + lamivudine) with or without Kaletra (ritonavir + lopinavir). An upcoming amendment will offer Isentress (raltegravir) as an alternative to Kaletra for intolerance. An IND has been filed with the FDA for the use of these agents in a non-FDA approved study context (IND # 104,989) and the study is overseen and all study documents approved by the UCLA Institutional Review Board. Since opening the program, the P-QUAD has enrolled 30 participants as of May 6, 2010 [29 at LAGLC and 1 at OASIS], with an initially planned enrollment of 100 participants (50 at each site).

PQUAD Study Protocol

24Jan

Feasibility and Acceptability of PrEP and Non-occupational Npep for HIV Prevention in Los Angeles

This is a qualitative study of knowledge, attitudes, beliefs, and perceived barriers to implementation of biomedical prevention strategies among MSM in metropolitan Los Angeles, California. Three focus groups comprised of sixteen unique individual participants were conducted at the UCLA Center for Clinical AIDS Research and Education between April 2008 and June 2008. Additionally, five key informants were interviewed individually. Three interviews were performed face-to-face, and two were performed via telephone for participant convenience.

MSM in metropolitan Los Angeles were recruited via Craigslist (www.craigslist.com), newspaper/magazine advertising, and palm-card and flyer distribution at MSM-focused locations including bars, restaurants, dance clubs, and commercial sex venues. Twenty men responded to advertising and were scheduled for three focus group dates; 16 men presented for focus group participation. Key Informants were recruited on a first-responder basis from a master list of HIV providers and community based organization staff and activists who attend UCLA HIV-related symposia and events. Each participant (focus group and key informant) was compensated $20 for their time.

Interventions, Training Manuals, etc. :

Feasibility and Acceptability of PrEP and Non-occupational PEP for HIV Prevention - Final Study Report

20Jan

Optimizing Access to nPEP for HIV Using Contingency Management in Stimulant-Using MSM

The majority of new HIV infections across Los Angeles County continue to be found among men who have sex with other men (MSM). Within MSM, stimulant abuse, particularly methamphetamine abuse, is the major factor in driving new infections, primarily via behavioral disinhibition contributing MSM methamphetamine users to engage in extremely high-risk sexual transmission behaviors. Friends Care combines the biomedical intervention of Post-exposure Prophylaxis (PEP) for HIV prevention with the behavioral intervention Contingency Management (CM), which targets reduction of methamphetamine use as a way of reducing concomitant high-risk sexual behaviors for HIV-negative, methamphetamine-using MSM.

Participants return to the clinic at 3-months post baseline for a follow-up evaluation and a third rapid oral HIV antibody test. In combining these two interventions in this unique program, Friends Care aims to reduce methamphetamine use and concomitant high-risk sexual behaviors, while reducing potential seroconversions.

Posts classified under: PreP and nPEP