I-pre-exposure prophylaxis (noma i-PrEP) isu lokuvimbela i-HIV lapho ukusetshenziswa kwansuku zonke kwemithi ye- antiretroviral kuyaziwa ngokunciphisa kakhulu ingozi yomuntu yokuthola i-HIV. Indlela esekelwe ebufakazini ibhekwa njengengxenye ebalulekile yeqhinga lokuvimbela igciwane lesandulela ngculazi, elibandakanya ukusetshenziswa okuqhubekayo kwamakhondomu nokunciphisa inani labalingani bocansi.
I-PrEP ayihloselwe ukusetshenziselwa ukuzihlukanisa.
Kusukela ngo-2010, uchungechunge lwezilingo ezinkulu zokwelapha luye lwabonisa ukuthi i-PrEP inganciphisa ingozi yokutheleleka ngegciwane lesandulela ngculazi kubantu abesilisa nabesifazane (MSM) , abadala abadala abakhuthele, kanye nabasebenzisi bezidakamizwa (injini). Ekuphenduleni ubufakazi, ukuqondiswa kwesikhashana okuqhubekayo kukhishwe yi-US Centers for Disease Control and Protection (CDC).
Ubufakazi Ekusekelweni kwe-PrEP
Ngo-2010, i- iPrEx Study ihlolisise ukusetshenziswa kwe-PrEP phakathi kwama-MSM angu-2,499 we-HIV-seronegative. Isivivinyo esikhulu, esiningi sezwe sathola ukuthi ukusetshenziswa komlomo nsuku zonke kweTruvada (tenofovir + emtricitabine) kunciphisa ingozi yokudlulisela i-HIV ngo-44%. Phakathi kwabangu-51% abahlanganyeli becala abanamazinga atholakalayo e-Truvada egazini-okusho labo abaye bathatha imithi yabo njengoba kuqondiswe-ingozi yokutheleleka yanciphisa ngo-68%.
Ukulandela izithende ze-iPrEX Study, iningi lezilingo zomtholampilo zenzelwe ukuhlola ukusebenza kwe-PrEP kumadoda nabesifazane abangabathandani, abangashadile.
Eyokuqala kwalokhu, Isifundo se-TDF2 eBotswana, sathola ukuthi ukusetshenziswa komlomo nsuku zonke kweTruvada kunciphise ingozi yokudlulisela ngo-62%.
Phakathi naleso sikhathi, i- Partners PrEP Study eKenya nase-Uganda yahlola ukusetshenziswa kwezidakamizwa ezimbili ezihlukene zezidakamizwa (i-Truvada yeqembu elilodwa kanye ne-tenofovir ngokwabo komunye) kumabhangqwana abesilisa nabesifazane abesilisa nabesilisa abangenalo i-HIV kanti omunye unesandulela ngculaza -kuphephile.
Ngokuvamile, ingozi yanciphisa ngo-75% no-67%, ngokulandelana.
Ngo-June 2013, i- Bangkok Tenofovir Study yahlola ukuphumelela kwe-PrEP kuma-2,413 IDUs ngokuzithandela ababhalisiwe emitholampilo yokwelapha izidakamizwa eBangkok. Imiphumela evela kulesi sivivinyo yabonisa ukuthi umthamo wansuku zonke weTruvada unciphisa ingozi ngo-49% phakathi kwamadoda nabesifazane esifundweni. Ngokuhambisana nophenyo olwedlule, abahlanganyeli abakwazi ukugcina ukunamathela kwezidakamizwa babe ngamaphesenti angaba ngu-74% afana nokutheleleka.
Izifundo Ezifundwa Emibhalweni emibili ye-PrEP Yehlulekile
Phakathi nempumelelo yalezi zifundo kwakukhona ukwehluleka kwecala lokumenyezelwa kakhulu. Zombili zenzelwe ukuhlola ukusebenza kwe-PrEP kwabesifazane abangenayo i-HIV, indlela ehloselwe ukunika amandla abesifazane besifazane abasengozini.
Ngokudabukisayo, kokubili Ucwaningo lwe-FEM-PrEP eKenya, eNingizimu Afrika naseTanzania, kanye neSifundo se-VOICE eNingizimu Afrika, e-Uganda naseZimbabwe sabekwa lapho abacwaningi bethola ukuthi abahlanganyeli be-PrEP ngomlomo abazange bavikeleke nge-HIV. Izivivinyo zokuqapha izidakamizwa zesikhashana zenza ukuthi abesifazane abangaphansi kuka-40% babambelela emithini yemithi yansuku zonke, kanti ngisho nabancane (12%) balondoloza amazinga ajwayelekile we-tenofovir ngesikhathi sobuvivinyo.
Yiziphi izifundo zombili ze-FEM-PrEP ne-VOICE eziqokonyiswe kwaba enye yezinselelo ezisemqoka zokulwashwa kwe-antiretroviral, okuwukuthi ubudlelwane obungavumelani phakathi kokunamathela kwezidakamizwa kanye nokukwazi komuntu ukufeza umphumela oyifunayo-kulokhu, ukuvimbela ukutheleleka.
Esifundweni se-iPrEx, isibonelo, abacwaningi bathola ukuthi ababambiqhaza abanamathele angaphansi kuka-50% babenethuba elingama-84% lokutheleleka. Lokhu kwakuhluke kakhulu kulabo abathatha amaphilisi abo ngaphezu kwezingu-90% zesikhathi, okuyingozi yabo yancipha ibe yi-32%. Abaphenyi balinganisela ukuthi uma iqembu elifanayo lithatha yonke iphilisi njengoba kubonisiwe, ingozi izokwehla ku-8% noma ngaphansi.
Ukuhlaziywa okungahleliwe okuqhutshwe ekuboneni okuhlangenwe nakho okuvamile kanye / noma izinkolelo ezingase zithinte ukunamathela phakathi kwabahlanganyeli bokufunda. Phakathi kwazo:
- U-10% wesaba abanye bazocabanga ukuthi bane-HIV
- U-15% watshelwa umuntu ongathathi amaphilisi, kaningi ilunga lomndeni
- Amaphesenti angu-16 abe nezinto eziningi kakhulu zokukhathazeka ngazo
- 17% bezwa ukuthi iphilisi yayinkulu kakhulu
- 28% bazizwa engozini ephansi ye-HIV
- 32% babecabanga ukuthi ukubambelela nsuku zonke kwakunzima kakhulu
Lezi zinkinga kuphela zifakazela ukubaluleka kokwelulekwa kokunamathela, kanye nokuqapha okujwayelekile isimo se-HIV, isimo sokukhulelwa, ukunamathela kwemithi, imiphumela emibi, kanye nezenzo zokubeka ingozi kunoma ubani obeka ku-PrEP.
Ezinye Izinkathazo Nezinselele
Ngaphandle kwemithango yokunamathela, abanye baye babonisa ukukhathazeka mayelana nokuziphatha kokuziphatha kwe-PrEP-ikakhulukazi ukuthi kuzoholela emazingeni aphezulu wezocansi ezingakhuselekanga nezinye izimo ezibeka engozini enkulu . Ubufakazi buvame ukusikisela ukuthi akunjalo.
Kuvivinyo olwenziwe ngezikhathi ezingu-24 olwenziwa ngokungahleliwe oluqhutshelwa eSan Francisco, eBoston nase-Atlanta, ingozi yokuziphatha phakathi kwe-MSM yaboniswa ukuthi yehla noma ingaguquki ngemuva kokuqala kwe-PrEP. Imiphumela efana nayo yabonakala ekuhlaziyweni okubonakalayo kwabesifazane ku-PrEP eGhana.
Phakathi naleso sikhathi, abanye bakhathazekile mayelana nokuvela kwe-HIV engamelana nezidakamizwa ngenxa yokusetshenziswa kwe-PrEP kubantu abangenwa i-HIV engazi. Ukumiswa kokuqala kwezembalo kubonisa ukuthi, ngaphezu kweminyaka eyishumi esimweni esiphakeme kakhulu (njenge-sub-Saharan Africa), cishe abantu abangu-9% abasanda kutholakala bangathola ukuthi banezinga elithile lokumelana nezidakamizwa ezidluliselwe ngenxa ye-PrEP. Icala elihle kunazo zonke / izimo ezimbi kunazo zonke ziqala ukusuka ngaphansi kwe-2% kuya phezulu ku-40%.
Ngokuphambene nalokho, esimisweni sezwe esithuthukisiwe, isifundo esisodwa (ukuxhumanisa idatha evela ku-UK Cohortner Cohort Database ne-UK Drug Resistance Database) inqume ukuthi i-PrEP ingase ibe "nomthelela ongathandeki" ekusakazweni kwe-HIV emelene ne-MSM, ngokuvamile ebonwa eqenjini eliphakeme kakhulu engozini emazweni amaningi athuthukile.
Iziphakamiso ze-PrEP
I-CDC ikhiphe isiqondiso sesikhashana ekusetshenzisweni kwe-PrEP ku-MSM, abantu abadala abathandana nabo ngokocansi, kanye nama-IDU. Ngaphambi kokuqalwa kwe-PrEP, udokotela uzoqala ukucacisa ukufaneleka komuntu ngo:
- Ukwenza uhlolo lwe- HIV ukuqinisekisa isimo se-HIV
- Ukuvivinywa kokutheleleka uma umuntu enesifo se-seroconversion enkulu, noma kungenzeka ukuthi ukutholakala kwegciwane lesandulela ngculaza kungakapheli inyanga eyandulele (noma ngezocansi ezingavimbelwe noma izinaliti ezabelwana).
- Ukuhlola ukuthi ngabe lowo muntu unengozi enkulu, eqhubekayo, ephezulu yokuthola i-HIV.
- Ukuqinisekisa ukuthi lowo muntu unesidingo esivela ku-creatinine esingaphezu kuka-60mL ngomzuzu.
- Ukuhlolwa kwe- hepatitis B (HBV) ne- STD .
Ukwengeza, odokotela bazohlola ukuthi owesifazane ukhulelwe noma uhlose ukukhulelwa. Nakuba bekungekho imibiko yokuthi izinsana ezivezwe eTruvada ziye zalimaza, ukuphepha kwesidakamizwa akukahlolwa ngokugcwele. Lokho kusho ukuthi i-CDC ayincoma i-PrEP yabesifazane abancancisayo.
Ngemuva kokuqinisekiswa kokufaneleka, lowo muntu uzobe enqunywe umthamo wansuku zonke weTruvada. Ukwelulekwa kokunciphisa ingozi kuzokwenziwa (kubandakanya isiqondiso socansi oluvikelekile kuma-IDU ukuvimbela ukutheleleka ngokusebenzisa ubulili obungavimbelwe).
Ngokuvamile, lo mshini uzobe usuyizinsuku ezingamashumi ayisishiyagalolunye nesishiyagalolunye, okuvuselelwa kuphela ngemva kokuhlolwa kwegciwane lesandulela ngculaza kuqinisekisa ukuthi umuntu uhlala e-seronegative.
Ukwengeza, ukuhlolwa kwe-STD okuvamile kufanele kwenziwe njalo kabili ngonyaka, kanye nokuhlolwa kokukhulelwa kwabesifazane. I-Serum creatinine kanye ne-créinine imvume kufanele ihlolwe futhi, ngokuvumelana nokulandela okulandelayo kuqala kabili ngonyaka ngemuva kwalokho.
> Imithombo:
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