Monthly Archives: April 2012

National AIDS Trust releases survey of local councils’ HIV social care funding

NAT, the National AIDS Trust, launched its survey into local council’s funding of HIV care across England last week.

‘HIV social care in England – a survey of local council funding’ looks into how HIV social care spending and services have changed over time. This report compares results with a similar survey from NAT in 2008.

Social care can include help coming to terms with diagnosis, managing treatment, or relationships, as well as peer support, counselling, and personal care.

In a time of severe cuts in local authority funding, the report shows that many local councils still recognise the real social care needs of people with HIV, and aim to meet them.

This is largely due an indicative allocation for HIV social care within local council funding from central Government as well as a case made at the local level by people with HIV and organisations which support them.

However, the report says restricted budgets are having a negative impact on HIV social care provisions.

Money is being diverted from the HIV social care allocation to make up for cuts in other areas meaning some services are less available. In addition, it says, people with HIV must now be determined to have ‘substantial need’ to qualify for any individual social care support. This may mean people with HIV are neglected until they reach crisis point, when it is less easy and more costly to help.

Key recommendations from the report include:

  • Local councils must improve their needs assessments and their evaluation of the impact of the social care they provide to people with HIV.
  • Individual assessments for eligibility for social care must take full account of the complexities of HIV, including the psychological impact, stigma and fluctuating
  • Funding for voluntary sector organisation to provide low threshold open access services for anyone with HIV in need is more important than ever and must be continued.
  • Social workers and other relevant local council staff need appropriate HIV training if they are to meet people’s needs effectively – there remains a vital role for HIV specialist social workers

Deborah Jack, Chief Executive of NAT, said: “It is encouraging to see that many local councils have not forgotten the vital social care needs of people living with HIV. However, this does not mean that services are without threat in this time of cuts.

“It is crucial for local councils to ensure that the specific allocation for HIV social care within the Formula Grant is spent on meeting the needs of people with HIV and not divert to other areas. In addition, everyone working in social care should have a good knowledge of HIV so they are confident in dealing with the related issues.

“The preventive value of social care for should also not be overlooked by local councils. By investing in simple low cost social care interventions, people with HIV are more likely to stay well, adhere to treatment and take the necessary steps to avoid passing the infection on – which saves the NHS money in the long term.”

Original Article via Pink News

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Education for awareness of and attitudes to HIV

Positive? (www.learningpositive.com) is a HIV information service website and the end work of the commitment and hard work of many UK Stakeholders, Partners and key players who in many different ways gave of their time, skills and expertise to help put together this innovative teaching and learning resource.

This highly accessible teaching and learning tool will challenge you, engage you, and empower you. By working through the different sections of the website, on your own, with friends or under the direction of your teacher, you will deepen your understanding of the facts about HIV whilst increasing your awareness of its social impact.

The interactive website is a tool to teach young people about HIV, how it affects people in the UK, how to prevent it spreading and how to reduce the discrimination experienced by those living with HIV. It also provides insights into the global dimension of the epidemic and introduces a series of interactive activities to raise awareness among the new generation and encourage positive, campaigning action to be taken.

As well as learning about HIV for yourself, you will also use your knowledge and understanding to develop an original campaign to advocate for people with HIV. As you work through the various activities, remember to think about which information would work well in raising awareness about key issues related to HIV.

The site helps to educate issues such as prejudice and stigma, discrimination, criminalisation and human rights and many more.  Check it out, it’s very useful for yourself and to pass to others.

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Giving preventive drug to men at high risk for HIV would be cost-effective, study shows

A once-a-day pill to help prevent HIV infection could significantly reduce the spread of AIDS, but only makes economic sense if used in select, high-risk groups, Stanford University researchers conclude in a new study.

The researchers looked at the cost-effectiveness of the combination drug tenofovir-emtricitabine, which was found in a landmark 2010 trial to reduce an individual’s risk of HIV infection by 44 percent when taken daily. Patients who were particularly faithful about taking the drug reduced their risk to an even greater extent — by 73 percent.

The results generated so much interest that the Stanford researchers decided to see if it would be cost-effective to prescribe the pill daily in large populations, a prevention technique known as pre-exposure prophylaxis, or PrEP. They created an economic model focused on men who have sex with other men, or MSM, as they account for more than half of the estimated 56,000 new infections annually in the United States, according to the Centers for Disease Control and Prevention.

“Promoting PrEP to all men who have sex with men could be prohibitively expensive,” said Jessie Juusola, a PhD candidate in management science and engineering in the School of Engineering and first author of the study. “Adopting it for men who have sex with men at high risk of acquiring HIV, however, is an investment with good value that does not break the bank.”

For instance, using the pill in the general MSM population would cost $495 billion over 20 years, compared to $85 billion when targeted to those at particularly high risk, the researchers found. The study was published in the April 17 issue of the Annals of Internal Medicine.

Senior author Eran Bendavid, MD, assistant professor of medicine in the School of Medicine, said the results are a departure from a previous study, which found PrEP was not cost-effective when compared with other commonly accepted prevention programs. The new Stanford study differs in a few important respects, taking into consideration the decline in transmission rates over time as more individuals take the pill. The Stanford team also assumed individuals would stop taking PrEP after 20 years, not stay on the drug for life, as the previous study had assumed.

The pill combination, marketed under the brand name Truvada, is widely used for treating HIV infection. But it wasn’t until a landmark trial, published in the New England Journal of Medicine in November 2010, that individuals and their doctors began to seriously consider using the drug as a preventive therapy. The drug’s maker, Foster City, Calif.-based Gilead Sciences Inc., has filed a supplemental new drug application to market it for prevention purposes.

The CDC issued interim guidelines on the drug’s use in January 2011, suggesting that if practitioners prescribe it as a preventive measure, they regularly monitor patients for side effects and counsel them about adherence, condom use and other methods to reduce their risk of infection.

In developing their model, the Stanford researchers took into account the cost of the drug — about $26 a day, or almost $10,000 a year — as well as the expenses for physician visits, periodic monitoring of kidney function affected by the drug, and regular testing for HIV and sexually transmitted diseases.

“We’re talking about giving uninfected people a drug that has some toxicities, so it’s crucial to have them monitored regularly,” Bendavid said, who is also an affiliate of Stanford Health Policy, which is part of the Freeman Spogli Institute for International Studies.

Without PrEP, the researchers calculated there would be more than 490,000 new infections among the MSM population in the United States in the next 20 years. If just 20 percent of these men took the pill daily, there would be nearly 63,000 fewer infections.

However, the costs are substantial. Use of the drug by 20 percent of the MSM population would cost $98 billion over 20 years; if every man in this group took PrEP for 20 years, the costs would be a staggering $495 billion.

Given these figures, the researchers looked at the option of giving PrEP only to men who are at high risk — those who have five or more sexual partners in a year. If just 20 percent of these high-risk individuals took the drug, 41,000 new infections would be prevented over 20 years at a cost of about $16.6 billion.

At less than $50,000 per quality-adjusted life year gained (a measure of how long people live and their quality of life), that strategy represents relatively good value, according to Juusola.

“However, even though it provides good value, it is still very expensive,” she said. “In the current health-care climate, PrEP’s costs may become prohibitive, especially given the other competing priorities for HIV resources, such as providing treatment for infected individuals.”

She said the costs could be significantly reduced if the pill is found to be effective when used intermittently, rather than on a daily basis. Current trials are examining the effectiveness of the drug when used less often.

Other co-authors are Margaret Brandeau, PhD, the Coleman F. Fung Professor
of Engineering, and Douglas Owens, MD, MS, the Henry J. Kaiser, Jr. Professor at Stanford and senior investigator at the Veterans Affairs Palo Alto Health Care System. Owens also is director of Stanford’s Center for Health Policy/Primary Care and Outcomes Research.

The study was funded by the National Institutes of Health and the Department of Veterans Affairs.

Information about Stanford’s departments of Management Science and Engineering and of Medicine, which also supported the work, is available at http://www.stanford.edu/dept/MSandE/ and at http://medicine.stanford.edu/.

Original Article by Ruthann Richter at Standford School of Medicine

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Cannabinoid Receptors Give Cells The Tools They Need To Defend Against HIV Infection

Researchers have reported that when healthy cells were placed in a sample dish with the human immunodeficiency virus (HIV), along with a dose of cannabinoids, the cells, which normally would rather quickly become infected, simply denied entry to the virus, and responded as if it were not a threat at all.

The cannabinoids themselves don’t act anti-virally. They are not responsible for killing the virus, the tissue sample takes that claim. The cannabinoids stimulate a part of the cells that bears an endogenous resemblance to the chemical structure of the cannabinioids themselves. Pairing between naturally occurring substances and receptors in the human brain works the same way as the formation of anti-bodies does; contact evokes adaptation in the receptors, causing them to bear an imprint of the experience. It is unknown if these receptors exist in cells because of the inclusion of the cannabis plant in the diets and pharmacopoeia of earlier human ancestors. In any case, receptors that are designed to respond to cannabinoids are found in the cell structure of every human. When the receptors were stimulated in the tissue culture, in rate of infection by the HIV virus was greatly impeded.

The stimulation of the receptors wasn’t just detrimental to HIV, it increased the cells abilities to defend itself against any number of viruses and bacteria. This has a great amount of potential for individuals experiencing the more advanced stages of HIV infection.

The use of cannabinoids might be able to provide these patients with much needed assistance with defending themselves against viral attack, without draining them of all other reserves.

Successful studies in apes
Surprisingly, at the beginning of the experimentation, the researchers had expected the application of cannabis’ THC to increase the speed at which the HIV took hold, and so it came as a general shock when the cannabinoids not only didn’t foster the virus’ strength, but also attenuated the symptoms that are generally associated with the infection. While ethics laws prevent these tests from being conducted in humans, a nearly identical virus, which is thought to be the original source of the human immunodeficiency virus, exists in other species of great ape, called the simian immunodeficiency virus, or SIV. Tests indicate that SIV is inhibited by cannabinoids, and the progression and mortality rates are greatly reduced.

Brief studies on humans have been limited to verification that inhalation of cannabis smoke, on of the treatments that HIV patients may rely on for pain relief, had no noticeable detrimental effects with regards to the potency of HIV.

Article Sources
http://www.plosone.org
http://www.enewspf.com
http://norml.org

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PrEP acceptable to UK gay men, studies find

Pre-exposure prophylaxis (PrEP) would be an acceptable HIV prevention strategy for large numbers of gay, bisexual and other men who have sex with men in major UK cities, according to two studies presented to the British HIV Association (BHIVA) conference in Birmingham this week.

The conference also heard details of a small pilot PrEP study, likely to start recruiting later this year.

A cross-sectional survey of 842 HIV-negative gay and bisexual men, recruited at bars, clubs and saunas in London, suggested that half the respondents would be interested in taking PrEP.

Respondents were given information about pre-exposure prophylaxis and asked: “If PrEP were available, how likely is it that you would take a pill (oral dose) on a daily basis to prevent HIV infection?”.

Half said yes, with 16% saying they were likely to take PrEP and 34% saying they were very likely to. Men interested in PrEP were slightly more likely to be under the age of 35 (AOR adjusted odds ratio 1.58), have attended a sexual health clinic in the past year (AOR 1.59) and to have previously taken post-exposure prophylaxis (PEP) (AOR 1.96). After statistical adjustment, various measures of risky sex were no longer associated with interest in PrEP.

In this survey, 17 men (2.1% of those answering the question) said that they had previously taken antiretroviral drugs to reduce their risk of HIV infection.

Secondly, clinicians at the Manchester Centre for Sexual Health surveyed HIV-negative men attending their service who reported unprotected receptive anal intercourse. Of the 121 men who responded, 36% said they would be “very willing” to take PrEP while only 14% said they would not take the treatment. Daily dosing was perceived as a better option by four fifths of respondents – just one fifth would prefer taking a dose before sexual activity.

These data confirm and reinforce findings from a study reported in November 2011, which found that half the gay men surveyed would consider taking PrEP. Once again, daily dosing was preferred to taking a dose before sex. In the qualitative data, men commented that sex is often spontaneous and that they felt daily dosing would facilitate adherence.

However these data are all based on giving men a few key facts about PrEP and presenting it as a hypothetical option. In real-life circumstances, where men think more seriously about PrEP as an option and hear friends’ experience of taking it, actual uptake and sustainability may be very different.

While the Manchester respondents largely assured the researchers that they would take all their doses of PrEP and wouldn’t have more risky sex, real-life experience needs to be tested in research.

To this end, the Medical Research Council are seeking funding for a 5000-participant, two-year study which would randomise HIV-negative gay men who report unprotected anal intercourse to either take PrEP (Truvada) and attend motivational interviewing (intervention group) or to be put on a one-year waiting list for PrEP and to have motivational interviewing in the meantime (control group).

For the researchers, it is crucial that this is an open label but randomised study, in which participants know whether they are receiving the actual drug. This unusual research design would, they argue, tell us more about the real-world effectiveness of PrEP than a blinded study as it would take into account the possible impact of participants taking more sexual risks because they felt that PrEP afforded some protection. (Researchers call this ‘risk compensation’ or ‘behavioural disinhibition’).

Rather than test efficacy in artificial conditions, the study would therefore test effectiveness in more realistic UK conditions.

So far, however, the potential funders of this costly study have not been persuaded by this argument and it is unclear whether the study will be able to go ahead.

What will, however, start recruiting later this year is a pilot version of the same study, aiming to include 500 men who attend one of around twelve sexual health clinics.

As well as allowing the researchers to have a dry run of the main trial and identify teething problems with its strategy, it should also provide valuable information on the number of men who actually follow through on a clinician’s offer of PrEP. Data on the characteristics of men who seek PrEP, drop-out rates and risk compensation will also be collected.

The researchers intend to take some of these data back to the main study’s potential funders, in order to support a revised application.

Acceptability of taking HIV treatment for prevention purposes

As well as asking people hypothetical questions about PrEP, researchers have also been asking people waiting for an HIV test result hypothetical questions about treatment as prevention.

Individuals from high-risk groups attending the Jefferiss Wing at St Mary’s Hospital for HIV testing were given an explanatory paragraph about treatment, infectiousness and safer sex. They were then asked: “If you were diagnosed with HIV would you consider taking treatment to reduce the risk of passing on infection (even if you did not need to take treatment for your own health)?”.

Four out of five respondents said ‘yes’. Encouragingly, gay men who reported unprotected anal intercourse in the past three months were more likely than others to be interested in the idea. Less encouragingly, people who had had a sexually transmitted infection or who had previously taken PEP were slightly less likely to say that they would take treatment for prevention.

The researchers suggested that the latter factor may be associated with PEP users’ experience of side-effects. It contrasts with the findings of the London PrEP attitudes study described above which found people who had previously taken PEP more likely to be interested in PrEP.

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Contraceptive requirement may have compromised FEM-PrEP study

A requirement that all participants take hormonal contraceptives may have been what led to the disappointing failure of a study of pre-exposure prophylaxis (PrEP) targeted at single women, the International Microbicides Conference in Sydney was told today.

The FEM-PrEP study was stopped in April 2011 because almost as many HIV infections had occurred in women given tenofovir/FTC (Truvada) pills (33 infections) as in women given inert placebo pills (35). This result contradicted efficacy results seen previously in gay men and subsequently in two other PrEP trials involving women, Partners PrEP and TDF2, where Truvada stopped between a half and two-thirds of the HIV infections that would otherwise have occurred in female trial participants.

Why such a different result in FEM-PrEP? A study presented recently at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle showed that fewer than 40% of women actually took the pills with reasonable frequency. Since then, as Connie Celum (principal researcher in the Partners PrEP study) told the conference today, drug level studies have established it was even worse: only 26% of participants who did not acquire HIV took the drug as prescribed.

There was also an extraordinary contradiction between participants’ adherence based on pill counts and self-reports, and their actual adherence. Self-reported adherence is usually higher than it is in reality, as are other ‘good’ behaviours like condom use or not breastfeeding, but are usually correlated with actual adherence to some extent. In FEM-PrEP there was no relationship between the two: self-reported adherence was 95% and adherence based on pill count was 86%.

Why was adherence so low in FEM-PrEP and misreporting it so disproportionately high? One answer may lie in the requirement that all participants take hormonal contraception. Because safety requirements around drugs in pregnancy are so strict, PrEP trials in women have required either that they drop out of the trial if pregnant or use contraception in order not to become pregnant.

If pregnancy leads to trial exclusion, this may make the trial too small to produce a meaningful result, as may have happened in the first-ever trial of PrEP in west Africa. So the FEM-PrEP researchers required all participants either to be on hormonal contraception or to start it.

At the start of the trial, 38% of participants were using injectable hormonal contraceptives, 8% were using the contraceptive pill and 2.5% other non-barrier methods like IUDs. Of the other 50% of participants, one-third (17% of participants) were using condoms as their birth control method and two-thirds were not practising birth control.

In the women not already using hormonal contraceptives, 55% (28% of participants) decided to take an injectable contraceptive but 43% (22% of participants) took the oral contraceptive pill, a much higher proportion than that of existing users of contraceptives. Previous non-users tended to be younger (23.5 versus 25 years) and were much less likely to be married (22 versus 40%) than existing users. They were at just as much risk of HIV, had the same number of sexual experiences, and had the same high rate of STIs (one woman in six had an STI diagnosed).

Despite this, 70% thought they were “not at high risk of HIV” even though local background incidence is five infections per 100 women a year.

Women starting contraception were therefore starting two new medications – the contraceptive and PrEP – and if they were taking the contraceptive pill, both medications had to be taken every day. Far more of the women who were new to hormonal contraception (6%) than women who were already using contraception (2%) told the researchers they had switched the method of contraception they were using during the trial. Among women taking oral contraception, 13% of those who were new to contraception and 8% of women already using contraception switched during the trial.

Rates of adherence to oral contraceptives must have been much lower than this. The pregnancy rate in trial participants was high, despite the contraceptive requirement. Overall, 8% of participants became pregnant per year. In new initiators of contraception it was higher – 14% – and in those who started oral contraceptives it was a sky-high 30% a year. In contrast, it was 2% in those taking injectable contraceptives, regardless of whether they were new or existing users. Clearly, adherence to the contraceptive pill must have been very low.

Was there a link to low Truvada adherence? Yes, there was, to the extent that if FEM-PrEP had been restricted to women already using injectable contraception, the study would have very nearly produced a positive result. The risk of HIV acquisition was 80% higher than average in women who initiated the oral contraceptive pill; conversely, it was 53% lower than average in current users of injectable contraceptives. Because of the small number of infections, neither of these differences was statistically significant, but the 53% reduction nearly was (95% confidence interval 79% to minus 4%).

Pill-count adherence to Truvada was modestly lower in contraceptive initiators and they were, as already pointed out, younger and more likely to be single and, if they became pregnant, to do so for the first time. These effects moderate the lower adherence to Truvada and to contraceptives.

In summary, adherence to contraception was extremely low in those taking contraceptive pills as well as in general to Truvada. These results don’t imply a causal link between the contraception requirement and the trial failure but they could help to explain why self-reported adherence was so unreliable; women applying to the trial, who may already not think themselves at enough risk of HIV to remember a daily PrEP pill, may also have to remember to take an oral contraceptive pill – or may have had no intention of taking it. They then also have to ‘confess’ to researchers that they have taken neither of their medications.

In conclusion, presenter Douglas Taylor said, the results of the FEM-PrEP study require researchers to reflect on how better to screen trial applicants and to support adherence non-judgementally during the trial.


Original Article by Gus Cairns at NAM

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We’re re-introducing volunteer induction meetings!

On 26th April, and each month thereafter, we’ll be holding volunteer induction meetings for all new and current volunteers, who wish to stay up to date with the events and activities at LASS.

Meetings shall be in two parts; to begin with, we’ll ensure all new volunteers have an induction to LASS and our services where we’ll talk about our aims and objectives, an overview of our teams, confidentiality/policies, and checking paperwork like applications and CRB checks (if necessary).

Once these basics are covered, we’ll explain HIV basics and talk about volunteer involvement and plan for our current and future projects.  Previously we’ve shared our collective knowledge about volunteering within a health and social care environment, provided details of free training courses ranging from HIV information, to mentoring, to computer skills (some of these award certificates or qualifications).

LASS can be a busy place at times, and these monthly meetings are ideal to stay updated with our work and engage with us while socialising and staying active with new and interesting projects.

We have a very interesting year ahead, it’s our 25th anniversary and LASS has changed with the times, we work across the whole range of communities in Leicester and Leicestershire, tackling wider health, poverty and inequalities that impact on individuals living with HIV.  Throughout our 25 year celebrations, we plan to raise our profile higher by increasing the understanding and awareness of the changes in the reality of living with HIV over the past 25 years.

Some of our upcoming projects include the re-introduction of famous friends, documenting 25 years of LASS, developing our social enterprise further, a football match and even a walking boat race!

We request all new volunteers to attend at least one meeting so we can ensure new people are familiar with our service, and for everyone else, we hope you’ll become a regular so we can plan ahead and really make an impact like we have been doing over the past 25 years.

We hope you’ll join us on Thursday, 26th April at 11:00am at The Michael Wood Centre, we’d love to hear from you.

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