Sample Undergraduate 2:2 Nursing Assignment
Pre-Exposure Prophylaxis
Introduction
1.8 million people worldwide receive a new HIV diagnosis each year, and more than 35 million lives have been lost since the 1980s when the human immunodeficiency virus (HIV) first emerged (World Health Organisation, 2018). Furthermore, it’s thought that up to 70% of people are ignorant of their HIV status, which leaves a sizeable fraction of people undiagnosed and consequently vulnerable to unintentional transmission and others at danger of contracting the disease (Riddell et al., 2018). With a frequency of 1.6 per 1000 persons and an 18% decline in new diagnoses that was seen in 2016, HIV confers a very minor epidemic in the UK. However, MSM and black ethnic groups continue to be disproportionately affected by HIV because they commonly engage in risky and hazardous sexual behaviours, such as condomless anal sex, which greatly increases the likelihood of HIV transmission (AVERT, 2018).
Prevention Strategies and Pre-Exposure Prophylaxis
A number of health measures to lower the risk of HIV infection and transmission have been described in the literature, including instruction on safe sexual practises, widespread HIV testing, male circumcision, and the use of highly active antiretroviral medications (Cohen et al., 2011). Pre-exposure prophylaxis (PrEP), which entails the administration of antiretroviral medications like tenofovir and emtricitabine (Truvada) to HIV-negative people who are at high risk of contracting the virus, can significantly lower HIV transmission rates, especially in MSM and other high risk groups (Riddell et al., 2018). In 2012, the Food and Drug Administration approved the use of PrEP in people who are at high risk for contracting HIV as a result of research findings that supported its efficacy and safety. A PrEP trial involving 10,000 individuals thought to be at risk of HIV acquisition began in England in 2017. Prior to these lawsuits, courts had rejected funding for PrEP despite National Health Service England’s efforts to prove its beneficial effects, but this ruling was recently overturned (AVERT, 2018).
Truvada use can be associated with nephrotoxicity due to proximal tubular mitochondrial deoxyribonucleic acid damage and the subsequent acute kidney injury, Fanconi syndrome, or type IV renal acidosis, which has an overall incidence rate of 1.09 per 1000 people per year despite PrEP’s generally favourable side effect profile (Herlitz et al., 2010). Truvada is generally well tolerated, with documented adverse renal effects occurring in 0.5% of patients and changes in serum creatine concentrations being observed in 2.2% of people. Other antiretroviral medications have greater rates of renal impairment. However, studies have shown that this effect may be reversed after drug withdrawal, which thus makes it difficult to utilise PrEP for the prevention of HIV infection. However, if people choose to use condoms as a result, they may be protected from other STIs (Riddell et al., 2018). The benefits of PrEP to the healthcare sector include its associated cost-effectiveness and reduced requirement and demand on service provision for each case of avoidable new HIV infections (Riddell et al., 2018). However, determinations of the cost-effectiveness of PrEP are complex, requiring consideration of the epidemic context, drug adherence, PrEP population coverage, and PrEP prioritisation. Moreover, the use of PrEP, that can be essentially avoided by the use of barrier methods such as condoms, raises issues and controversy around funding in publicly funded health systems, where resources are limited and budget constraints are in effect (Gomez et al., 2013).
In the UK, the lifetime cost of having HIV is estimated to be £360,000, and the National Health Service spends more than £500 million annually on HIV therapy. Additionally, a year of PrEP with Truvada is anticipated to cost between £3000 and $4,000, but the actual cost per person will be much lower because it is not a lifelong treatment and will only be used occasionally. Nevertheless, people may be encouraged to use PrEP more subtly as a daily medication to prevent HIV infection during spontaneous sexual encounters (Riddell et al., 2018).
Conclusion
HIV is still a big public health issue, and cutting-edge programmes like PrEP provide a crucial way to lessen the impact of HIV on high-risk individuals. For each successful avoided case, basic infection prevention plays a critical role in preventing needless morbidity and mortality. Although using PrEP has a number of negative side effects, such as uncommon but serious side effects, increased STI transmission, and stigmatisation, altogether, its effectiveness makes it a remarkably successful preventative method. Introducing intravaginal rings containing dapivirine for women, which has decreased the prevalence of HIV in Africa, and injections of long-acting integrase inhibitors, like cabotegravir, which generally provide a less frequent dosing regime and may confer a better safety and side effect profile than current conventional PrEP therapy, are two examples of drug formulation expansion that may be seen in future PrEP initiatives (Riddell et al., 2018).
References
AVERT. (2018). (2018). [online] HIV And AIDS In The United Kingdom (UK). Accessible from: footnote1 t1a0jt1 https://www.avert.org/professionals/hiv-around-the-world/western-central-europe-north-america/uk [retrieved 20 June 2018].
How Stigma Around HIV Preexposure Prophylaxis Use Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores” Calabrese, S. K. and Underhill, K. (2015) 1960-1964 in American Journal of Public Health, 105 (10). Accessible at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566537 [retrieved 22 June 2018] .
Cohen, M. S., Chen, Y. Q., McCauley, M., Gamble, T., Hosseinipour, M. C., Kumarasamy, N., Hakim, J. G., Kumwenda, J., Grinsztejn, B., Pilotto, J. H. S., Godbole, S. V., Mehendale, S., Chariyalertsak, S.,
