Baaritaanka horay loo soo sheegay (ama PrEP) waa istaraatijiyad ka hortag HIV ah taas oo isticmaalka maalinlaha ah ee dawooyinka antiretroviral lagu yaqaano si aad u yareeya khatarta qofka inuu ku dhaco HIV. Habka caddaynta ku salaysan ayaa loo tixgeliyaa qayb muhiim ah oo ah istiraatiijiyad guud oo ka hortagga HIV, oo ay ku jirto isticmaalka joogtada ah ee isticmaalka kondomka iyo hoos u dhaca tirada lamaanaha galmada.
PrEP looguma talo-galin in lagu isticmaalo gooni-goyn.
Tan iyo sannadkii 2010, tijaabooyin isdaba-joog ah oo kiliinikaro ah ayaa muujiyay in PrEP ay yareyn karto khatarta HIV-ga ee ragga galmoodka leh ee raggu (MSM) , dadka qunyar-socodka ah ee firfircoon, iyo dadka isticmaala daroogooyinka (IDUs). Iyadoo laga jawaabayo caddaynta, hagitaan ku-meel-gaar ah ayaa waxaa soo saaray Xarumaha Xakamaynta iyo Ilaalinta Cudurada ee Maraykanka (CDC).
Caddeynta Taageerada PrEP
Sanadkii 2010, daraasadda iPrEx waxay baaris ku samaysay isticmaalka PrEP oo ka mid ah 2,499 MSM-seronegative MSM. Maxkamad ballaaran oo waddan ah, ayaa waxay ogaatay in isticmaalka maalinlaha ee Truvada (tenofovir + emtricitabine) ay hoos u dhigtay khatarta gudbinta HIV-ga oo ah 44%. Ka mid ah 51% ka qaybgalayaasha tijaabada ah ee heerarka la ogaan karo ee Truvada ee dhiigga micnaheedu yahay kuwa qaatay daawadooda sida loogu talagalay - khatarta caabuqa ayaa hoos u dhacay 68%.
Ka dib markii uu ka soo baxay bogga iPrEX Study, dhowr tijaabo oo caafimaad ayaa loogu talagalay inay sahamiyaan wax ku oolnimada PrEP ee ragga, rag iyo haween aan ra'iisaliyo aheyn.
Marka ugu horeysa, Daraasadda TDF2 ee Botswana, waxay ogaatay in isticmaalka maalinlaha ah ee Truvada uu yaraynayo halista gudbinta 62%.
Dhanka kale, Iskaashatada Iskaashatada PrEP ee Kenya iyo Ugandha ayaa sahamiyey isticmaalka laba dawladood oo kala duwan (Truvada hal koox iyo toban tan oo kale iyada oo u dhiganta midka kale), lammaanaha heterosexual ee hal lamaane ahaa HIV- diidana kan kalena wuxuu ahaa HIV -shiirto.
Guud ahaan, khatarta waxaa hoos u dhacay 75% iyo 67%, siday u kala horreeyaan.
Bishii Juun 2013, Baaritaanka Tenofovir ee Bangkok wuxuu baaray waxtarka PrEP ee 2,413 IDUs oo iskaa-wax-u-qabso ah oo ka diiwaangashan xarumaha daaweynta ee daroogada ee Bangkok. Natiijooyinka ka soo baxa maxkamadeynta ayaa muujiyay in qiyaasta maalinlaha ah ee Truvada halis ugu yareeyo 49% ragga iyo haweenka daraasaddan. Iyadoo la raacayo cilmi-baaris hore, kaqeybgalayaasha karti u leh ilaalinta daroogada ayaa 74% ka yaraa sidii loo qaadi lahaa cudurka.
Casharrada laga Baray Laba Xaliyadoodii PrEPs
Iyadoo ay ku adkaatay guusha daraasaddan waxay ahayd laba guul-darradood oo loo baahnaa. Labadaba waxaa loogu talagalay in ay sahamiyaan wax ku oolnimada PrEP ee haweenka HIV-ga diidmada ah, habka loogu talagalay in lagu xoojiyo haweenka danyarta ah ee jilicsan.
Kala duwanaansho, labadaba Daraasadda FEM-PrEP ee Keenya, Koonfur Afrika iyo Tansaaniya, iyo Daraasadda VOICE ee Koonfur Afrika, Uganda iyo Zimbabwe ayaa la joojiyay markii cilmi-baarayaashu ay ogaadeen in kaqeybgalayaasha afarta PREP aan la kulmin wax difaac ah HIV. Tijaabooyinka kormeerka daroogada ee ku-meel-gaadhka ah ayaa go'aamiyay in in ka yar 40% haweenku ay u hoggaansamaan habka maalinlaha ah ee daroogada, iyada oo xitaa ka yar (12%) lagu hayo heerarka tenofovir ee joogtada ah ee muddada tijaabada.
Waxa labadaba baadhitaanada FEM-PrEP iyo VOICE labaduba waxay ka mid ahaayeen caqabadaha asaasiga ah ee daaweynta antiretroviral, taas oo ah xiriirka aan caadiga ahayn ee u dhexeeya daroogada iyo kartida shakhsiyadeed ee lagu gaari karo natiijada la rabo-kiiskan, ka hortagga cudurka.
Daraasadda iPrEx, tusaale ahaan, cilmi-baarayaashu waxay ogaadeen in kaqeybgalayaasha in ka yar 50% ku-tiirsanaanta ay istaageen 84% oo ah in cudurka la qaado. Taasi waxay ka duwan tahay kuwa qaata kiniinada ka badan 90% waqtigaas, khatartooda hoos loogu dhigay 32%. Baarayaashu waxay qiyaasaan in haddii koox isku mid ah ay qaadatay kiniin kasta sida lagu tilmaamay, khatartu waxay hoos u dhacaysaa 8% ama ka yar.
Falanqeyn aan kala sooc lahayn ayaa lagu sameeyey qeexay tiro khibrad caadi ah iyo / ama aaminaad ah in laga yaabo inay saameyn ku yeeshaan raacitaanka ka qaybgalayaasha daraasadda. Iyaga ka mid ah:
- 10% ka cabsi qabeen dadka kale waxay u maleynayaan inay qabaan HIV
- 15% ayaa qof u sheegay inaysan qaadan kaniiniyada, inta badan xubnaha qoyska
- 16% waxay lahaayeen waxyaabo kale oo badan oo laga walwalo
- 17% waxay dareemeen in kiniinku aad u weyn yahay
- 28% waxay dareemeen khatar yar oo HIV ah
- 32% waxay dareemeen in xajinta maalinlaha ah ay adagtahay
Arrimahaasi waxay kaliya u adeegsanayaan inay hoosta ka xariiqaan muhiimadda la-talinta u hoggaansamida, iyo sidoo kale kormeerka joogtada ah ee xaaladda HIV, xaaladda uurka, qaadashada daawada, saameynaha, iyo dabeecadaha khatarta ah ee qof kasta oo lagu meeleeyay PrEP.
Welwelka iyo Caqabadaha kale
Ka sokow xakamaynta caqabadaha, qaar ayaa waxay muujiyeen walaac ku saabsan habdhaqanka habdhaqanka ee PrEP-gaar ahaan haddii ay u horseedi doonto heerar sare oo galmo aan la ilaalin iyo dabeecado kale oo khatar ah . Caddayn badanaa waxay soo jeedinaysaa in aysan kiisku ahayn.
Muddo 24 bilood ah, tijaabo aan kala sooc lahayn oo lagu qabtay San Francisco, Boston, iyo Atlanta, khatarta habdhaqanka ee MSM ayaa lagu muujiyey inay hoos u dhaceen ama ayan waxba isbeddelin ka dib markii la bilaabay PREP. Natiijooyin isku mid ah ayaa lagu arkay falanqayn tayo leh oo haween ah oo ku saabsan barnaamijka PrEP ee Ghana.
Dhanka kale, welwelka kale ee la soo gudbiyey ayaa soo kordhay oo ku saabsan soo-saarka HIV-ga ee daawada u adkeysata sababtoo ah isticmaalka PrEP ee dadka aan ogeyn HIV. Qaababka hore ee xisaabtu waxay soo jeedinaysaa, in muddo ka badan 10 sanadood oo ah goobo aad u fara badan (sida Afrikada ka hooseeya Saharan), qiyaastii 9% dadka cusub ee cudurka qaba ayaa laga yaabaa inay yeeshaan heer ka mid ah isbeddelada daroogada la isugu gudbiyo ee PrEP. Kiisaska ugu fiican / xaaladaha ugu xun ee kiisaska waxay u dhexeeyaan sida ugu hooseeya 2% ilaa 40%.
Marka la barbardhigo goobaha horumarineed ee dunida, hal daraasad (iskudubarid xogta ka timid UK Cooperative Cohort-ka oo ay la socoto Daraasada Daroogada Daroogada ee UK) ayaa go'aamisay in PrEP ay u badan tahay in ay "saameyn xun" ku fidiso HIV-ga difaaca ee MSM, guud ahaan koox-halis sare ee dalal badan oo horumarsan.
Talooyinka Prere
CDC waxay soo saartay hagid ku-meel-gaadh ah oo ku saabsan isticmaalka PrEP ee MSM, dadka qaan-gaarka ah ee galmada kufsiga, iyo IDUs. Ka hor inta aan la bilaabin PREP, dhakhtarka ayaa marka hore go'aan ka gaaraya u-qalmitaanka qofka adoo:
- Samaynta tijaabada HIV si loo xaqiijiyo xaaladda HIV-ga
- Baaritaanka cudurka haddii qofku leeyahay calaamado xakameyn degdeg ah, ama uu HIV-ga soo gaadhay bishii hore (iyada oo loo marayo galmo aan la ilaalin ama cirbadaha la wadaago).
- In la qiimeeyo in qofku leeyahay khatar badan, oo joogto ah, khatar sare leh oo lagu helo HIV.
- Xaqiijinta in qofku leeyahay wax lagu qiyaaso nashqadaynta qiyaasta ka weyn 60mL daqiiqadii.
- Baaritaanka cagaarshowga B (HBV) iyo STDs .
Intaa waxaa dheer, dhakhaatiirta ayaa qiimeyn doona in haweeney uur leedahay ama uur leedahay. Inkastoo aysan jirin warbixinno sheegaya in dhallaanka kufsiga Truvada ay waxyeello gaartay, ammaanka daroogada ayaan wali la qiimeynin. Taasi waxay tidhi, CDC ma ku talinayso PrEP ee haweenka naas nuujinaya.
Marka la xaqiijiyo u-qalmitaanka, qofka waxaa loo qori doonaa qiyaasta hal mar ah ee Truvada. La talinta dhimista halista ayaa markaa la sameyn doonaa (oo ay ku jirto hagis galmo oo ammaan ah oo loogu talagalay IDUs si looga hortago caabuq iyada oo loo marayo galmo aan la ilaalin).
Guud ahaan, daawada rijeetadu waxay noqon doontaa in ka badan 90 maalmood, dib loo cusbooneysiin karo kaliya ka dib marka la baaro HIV-ga ayaa xaqiijinaysa in qofka uu sii wadi karo.
Waxaa intaa sii dheer, baaritaanka STD waa in la sameeyaa laba jeer sanad walba, iyo sidoo kale baaritaanka uurka dumarka. Serum creatinine iyo nadiifinta kreatinine waa in sidoo kale la kormeero, oo habboon marka la eego dabagalka kowaad iyo ka dibna laba jeer sannadkiiba intaas ka dib.
> Ilo:
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