Uses of pre-exposure prophylaxis for HIV-negative adults - PowerPoint Presentation

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Uses of pre-exposure prophylaxis for HIV-negative adults

NURS RESEARCH POROJECT PROPOSA

NURS 503

Name:…………

Ana G Mendez University

Facilitator: Nancy Woelki DNP, APRN, MSN, RNDate:………..

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The purpose of this research was to evaluate the advantage and disadvantage using of PrEP for HIV-negative adults with high risk for HIV.

Significance of the Practice Problem

Research question

Theoretical Framework

Synthesis of the Literature

Practice RecommendationsProject DescriptionProject Evaluation Results

Implications for Nursing and Healthcare

Plans for DisseminationConclusion

References

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A correct and aware use of prophylactic care in the treatment and prevention of HIV reduces the risk of contracting it via sexual by 90% (CDC, 2018).

Among those who use intravenous drugs, the reduction increases up to 70% (CDC, 2018).

These risks of contracting HIV can be further reduced if concomitant with these prophylactic cares is added to the use of condoms (CDC, 2018).

(CDC, 2018).

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Practice Problem

If the medication is taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk of HIV (U.S. Department of Health & Human Services, 2017).

 

(U.S. Department of Health & Human Services, 2017).

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(Truvada for HIV PrEP: Prescription Fills Drop 30% Since 2015, 2018)

(Truvada for HIV PrEP: Prescription Fills Drop 30% Since 2015, 2018)

The prices for Truvada have increased by nearly 10% at the beginning of the past four years. Should this trend continue, the monthly cash price for Truvada could cross $2,200 in 2019.

According to a representative sample of US prescription fills, prices for Truvada have increased by 45% since 2013, with cash prices now above $2,000 for a month’s supply.

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Research question

Objectives:

Identify the advantages of PrEP drugs used in high risk population for HIV.

Determine the disadvantages of PrEP drugs used in high risk population for HIV.

Analyze if the benefits using of the PrEP drugs used in high risk population for HIV surpass the risks.

What are the advantages and disadvantages of using the PrEP drugs among high risk population for HIV?

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Theoretical Framework

The theory of Orem includes self-care, which is the practice of activities that an individual initiates and performs on his or her own behalf to maintain well-being, life, health, and self-care. (“Self-care Deficit Theory”, 2016).

(“Self-care Deficit Theory”, 2016).

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Synthesis of the Literature

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Pre-exposure prophylaxis, or PrEP, is a method for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking the medication daily.

When somebody is exposed to HIV through sex or injection drug use, these drugs can work to retain the virus from determining a constant infectious disease (CDC, 2014).

PrEP has been indicated to reduce the risk of HIV infection in people who are at elevated risk by up to 92%.

(CDC, 2014).

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According to the new federal guidelines for healthcare providers, it is recommended to consume PrEP by people who are HIV-negative as well as substantial risk for HIV infectious disease.

(Kirby &

Thornber-Dunwell

, 2014; Smith et al, 2015).

Anybody who is not in a commonly monogamous relationship with a partner who in recent times confirmed HIV-negative (Kirby &

Thornber-Dunwell, 2014; Smith et al, 2015).

Anyone who is in an ongoing relationship with an HIV-positive partner.

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Bisexual or gay man who has had anal sex without a condom or been diagnosed with a sexual transmitted disease

Woman or man who does not frequently use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection.

People who have bisexual male partners or inject drugs (Kirby &

Thornber-Dunwell, 2014; Smith et al, 2015).

(Kirby & Thornber-Dunwell, 2014; Smith et al, 2015).

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PrEP is a strong HIV prevention tool according to the evidences and can be combined with condoms and other prevention methods to provide even greater protection than when used alone (U.S. Department of Health & Human Services, 2017).

However, the patients that use PrEP must obligate to take the drug every day and check their health with the provider every three months (Van der

Straten

et al., 2014). (U.S. Department of Health & Human Services, 2017). (Van der Straten et al., 2014).

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In this way, the programs that are propelled towards fighting HIV transmission must be more focused on the youth, especially colleges as well as higher institutions of learning.

(ACHA Guidelines, 2016)

According to ACHA Guidelines (2016), the youth record the highest number of new cases of HIV infections. The data collected showed that persons aged between 13-24 account for 21% of HIV infections.

It would also be worthwhile if the health specialists in colleges discuss with students matters relating to HIV transmission and significance of

PrEP.

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Inconveniencies of PrEP were identified as the complication of the choice, reassurance of sex with risky partners, increased burden, newness of the drug, and promotion of unprotected sex (Bond & Gunn, 2017).

Some research shows that there have been safety concerns concerning the consumption of PrEP drugs. Such safety concerns include the side effects, such as kidney dysfunction, nausea, bone, hepatic, as well as renal toxicity (Tetteh et al., 2017).

(“Self-care Deficit Theory”, 2016).

(Bond & Gunn, 2017). (Tetteh et al., 2017).

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Such communication paints a bad picture to the users and lowers their self-esteem and few users can withstand the pressure and continue using PrEP.

(Spieldenner, 2016)

A study carried out by Spieldenner (2016) claims that there are so many misconceptions about the

PrEP.

Some people believe that those who use these drugs are probably promiscuous.The main drawback is that PrEPs do not safeguard from the transmission of STIs. Therefore, a change in sexual behavior in individuals is highly advised to minimize as well as mitigate the new cases of HIV infections.

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The available evidence considers that the introduction of event-based PrEP reduces the cumulative HIV cost (Smith et al., 2015).

(Smith et al., 2015). (“Pre-

exposure

Prophylaxis”, 2018).(Spooner et al., 2016)16).

Practice

Recommendations

(Smith et al., 2015). (“Pre-

exposure

Prophylaxis”, 2018). (Spooner et al., 2016)

PrEP should be included as much as possible into current programs to bring people closer to their goal of complete prevention (Spooner et al., 2016)

Pre-exposure prophylaxis (PrEP) has been highly effective and efficacious (“Pre-exposure Prophylaxis”, 2018).

PrEP should always be interpreted as a component of prevention but not a substitute for existing methods.

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(“Self-care Deficit Theory”, 2016).

Project

Description

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(“Self-care Deficit Theory”, 2016).

Project Evaluation

Results

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Nursing and Healthcare Implications

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It is crucial for nursing and healthcare to be familiar with prescribing PrEP and comfort with PrEP precursor activities among PCPs.

PCP-directed education should be more expansive and include all aspects of knowledge and skills needed to prescribe PrEP as prophylaxis for preventing HIV infection.

Rapid testing, development, and implementation of appropriate provider-directed PrEP educational interventions could significantly increase PrEP accessibility, thereby preventing the occurrence of HIV infections.

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Plans for Dissemination

.

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After reviewing the 30 sources include in the literature review, I select 20 sources for the study sown in Appendix A and B.

14 highlighted the benefits of using PrEP outweighing the disadvantages of using it.

On the other hand, 6 sources highlighted the disadvantages of using PrEP outweighing its advantages.

Based on the insight, the exist a substantial difference in the between the benefits or PrEP outweighing disadvantages and the disadvantages of PrEP outweigh its benefits. Therefore, the study hypothesis is accepted which holds that the benefits using of the PrEP drugs used in high risk population for HIV surpass the risks.

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References

ACHA Guidelines. (2016). Journal of American College Health, 64(2), 162-164.

doi

: 10.1080/07448481.2016.1141017 (PrEP). Journal Of Homosexuality, 63(12), 1685-1697.

doi

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Ali, I.B.H. (2018). Application of Orem self-care deficit theory on psychiatric patient. Retrieved from https://www.jscimedcentral.com/Nursing/nursing-5-1093.pdf

Auerbach, J.D., Kinsky

, S., Brown, G., & Charles, V. (2015). Knowledge, attitudes, and likelihood of pre-exposure prophylaxis (PrEP) use among US women at risk of acquiring HIV. AIDS Patient Care and STDS, 29(2), 102–110. http://doi.org/10.1089/apc.2014.0142

Bond, KT., & Gunn, A.J. (2016). Perceived advantages and disadvantages of using pre-exposure prophylaxis (PrEP) among sexually active black women. An exploratory study.

doi

: 10.1353/bsr.2016.0019

Calabrese, S.K., Underhill, K., Earnshaw, V.A., Hansen, N.B., Kershaw, T.S., Magnus, M., Krakower, D.S., Mayer, K.H., Betancourt, J.R., & Dovidio, J.F. (2016). Framing HIV pre-exposure prophylaxis (PrEP) for the general public: How inclusive messaging may prevent prejudice from diminishing public support. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4903888/

CDC. (2014). US public health services: Preexposure prophylaxis for the prevention of HIV infection in the United States–2014. Retrieved from http://www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf

Centers for Disease Control and Prevention. (2014). Pre-exposure prophylaxis (PrEP) for HIV prevention. Retrieved from http://www.cdc.gov/hiv/pdf/PrEP_fact_sheet_final.pdf.

Cousins, S. (2017). PrEP on demand reduces HIV infections, study finds. BMJ, j3619.

doi

: 10.1136/bmj.j3619

Charlene A Flash, C.A. et al. (2018). HIV pre-exposure [

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[

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implementation using intervention mapping. https://doi.org/10.1016/j.amepre.2017.12.015

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Joel, M., Sonia,

J.,Michael

,

D.,Eric

, S,D.,

Xiaoying,S., Katya, C., Eric, E., Jill, B., Richard, H., Moore, DJ., & Morris, S, R. (2018). Sexual Risk Compensation in a Pre-exposure Prophylaxis Demonstration Study Among Individuals at Risk of HIV. Retrieved from

doi: 10.1097/QAI.0000000000001885Kelen, M., &

Cresswell, F. (2017). HIV pre-exposure prophylaxis (PrEP): Effective but controversial. Trends in Urology &

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Kirby T,

Thornber-Dunwell

M. Lancet (London, England) England. (2014). Feb, Uptake of PrEP for HIV slow among MSM. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24494225

Krakower,

DS.,Cohen

, SE.,&

Mayer,KH

. (2017). Top Questions in ID: Pre-exposure Prophylaxis for HIV. Retrieved from

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: 10.1093/

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/ofx185

McMahon, J,M., Myers, J,E.,

Kurth

, A,E., Cohen, S,E.,

Mannheimer

, S,B., Simmons, J., &

Haberer

, J,E. (2014). Oral pre-exposure prophylaxis (PrEP) for prevention of HIV in

serodiscordant

heterosexual couples in the United States: opportunities and challenges. AIDS Patient Care and STDS. 2014;28(9):462–474. Retrieved from http://doi.org/10.1089/apc.2013.0302

Michael S.

Saag

, MD1; Constance A. Benson, MD2; Rajesh T. Gandhi, MD3; et al…(2018). Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults2018 Recommendations of the International Antiviral Society–USA Panel. Retrieved from doi:10.1001/jama.2018.8431

Morgan,A

. (2015). The pros and cons of

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Newsome, V., Davis, Z.,&

Dinac

, J. (2015). Re-Search: The Missing Pieces in Investigating African-American Relationship Dynamics and Implications for HIV Risk. Journal of Black Sexuality and Relationships. 2015;1(3):113–128. Retrieved from http://doi.org/10.1353/bsr.2015.0001.

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Ouellet, E., Durand, M., Guertin, J.R.,

LeLorier

, J., & Tremblay, C.L. (2015). Cost effectiveness of ‘on demand’ HIV pre-exposure prophylaxis for non-injection drug-using men who have sex with men in Canada. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4353265/

Park, C., Taylor, T., Rios, N.,

Khedimi

, R., Weiss, C., Dolce, E., … & Blackstock, O. (2017). Perspectives of women prescribed HIV pre-exposure prophylaxis (PrEP). Open Forum Infectious Diseases, 4(suppl_1).

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Pre-Exposure Prophylaxis (PrEP). (2018). Retrieved from https://www.cdc.gov/hiv/risk/prep/index.html

Pre-exposure prophylaxis of HIV in adults at high risk: Truvada (emtricitabine/tenofovir disoproxil). (2016). Retrieved from https://www.nice.org.uk/advice/esnm78/chapter/Key-points-from-the-evidence

Pre-Exposure Prophylaxis. (2018). Retrieved from https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxisSelf Care Deficit Theory. (2016). Retrieved from http://www.nursing-theory.org/theories-and-models/orem-self-care-deficit-theory.php

Secretary’s Minority AIDS Initiative Fund. (2018). Retrieved from https://www.hiv.gov/federal-response/smaif/overview

Smith, D,K., Van Handel, M.,

Wolitski

, R,J., Stryker, J,E., Hall. H,I., Prejean, J., Koenig, L,J.,&

Valleroy

, L,A. (2015). Vital Signs: Estimated Percentages and Numbers of Adults with Indications for Preexposure Prophylaxis to Prevent HIV Acquisition—United States, 2015. MMWR Morbidity and Mortality Weekly Report. 2015;64(46):1291–1295. Retrieved from http://doi.org/10.15585/mmwr.mm6446a4.

Spieldenner

, A. (2016). PrEP whores and HIV prevention: The queer communication of HIV pre-exposure prophylaxis (PrEP). Journal Of Homosexuality, 63(12), 1685-1697.

doi

: 10.1080/00918369.2016.1158012

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Spooner, C.,

Saktiawati

, A.M.I.,

Lazuardi

, E., Worth, H.,

Subronto, Y.W., & Padmawati

, R.S. (2016). Impacts of stigma on HIV risk for women who inject drugs in Java: A qualitative study. International Journal of Drug Policy, 26(12), 1244–1250. http://doi.org/10.1016/j.drugpo.2015.07.011.Tetteh, R. A.,

Yankey, B. A., Nartey, E. T., Lartey, M., Leufkens

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Van der

Straten

, A., Stadler, J.,

Luecke

, E., Laborde, N., Hartmann, M., Montgomery E,T. (2014). Perspectives on use of oral and vaginal antiretrovirals for HIV prevention: the VOICE-C qualitative study in Johannesburg, South Africa. Journal of the International AIDS Society. 2014. Retrieved from http://doi.org/10.7448/ias.17.3.19146

Young,

I.,Flowers

, P., &

McDaid,LM

. (2014). Barriers to uptake and use of pre-exposure prophylaxis (PrEP) among communities most affected by HIV in the UK: findings from a qualitative study in Scotland. Retrieved from https://bmjopen.bmj.com/content/4/11/e005717

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