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HIV Connect: Educating primary care physicians on HIV/AIDS

HIV Connect: Educating primary care physicians on HIV/AIDS

According to the 2018 UNAIDS report on Malaysia, from the estimated 87,000 people living with HIV (PLHIV), 39,018 patients are currently on antiretroviral therapy (ART).

This means that only 45% of HIV patients are currently covered by ART. These dismal statistics prove that there are many measures that should be implemented to improve our care and management of HIV/AIDS patients.

We need to figure out why there are patients who are still not covered by ART.

The problem is most likely multifactorial in nature: patients might be afraid or reluctant to get treatment for HIV/AIDS; access to treatment might be lacking in certain parts of Malaysia; and doctors might not be providing an environment that is supportive enough for patients to get the necessary care.

From the 2016 Global AIDS Response Progress Report released by the Ministry of Health, the key populations in Malaysia that are affected by HIV/AIDS are people who inject drugs (PWID), female sex workers (FSW), transgender people (TG), and men who have sex with men (MSM).

If initially the epidemic in Malaysia was due to PWID, over the years, the trend has shifted to be more due to sexual transmission.

It is crucial for healthcare practitioners to approach these key populations and be sensitive of their needs.

Doctors should also be non-judgmental and focus on the health issues that revolve around the patient’s sexual activity so that patients are willing to be honest and get tested for HIV.

If doctors start to act as moral arbiters, he or she will impose his or her values on to the patients’ and deter patients from coming forward to receive the necessary treatment.

As a society, we still attach stigma when it comes to HIV/AIDS and sexually transmitted infections (STIs), which prevent proper diagnosis and management of these patients.

From the 2014 Integrated Bio-Behavioral Surveillance (IBBS) study, only 13.4% to 39% of key populations (FSW, MSM, and TG) had received condoms with HIV-related information. It is obvious that we are still lacking when it comes to advice that we should impart to our patients.

Doctors might avoid talking about safe sexual practices, but they should know that their medical advice can save lives.

Furthermore, the IBBS survey in 2012 and 2014 shows an increased trend of alcohol and psychotropic drug use before sexual intercourse. These behaviours further complicate sexual practices and can prevent proper use of a condom during sexual intercourse.

Thus, doctors should take a thorough history from the patients and give comprehensive advice to them. Doctors should be part of the solution in the HIV/AIDS epidemic, instead of resorting to blaming the patients.

In a cross-sectional study by Kwee Choy Koh et al. (2017) involving 65 patients newly diagnosed with HIV, up to 56.9% of patients had presented with HIV-related conditions at a primary healthcare facility during the three years prior to diagnosis.

This shows that there are missed opportunities to detect, and consequently treat HIV earlier. Therefore, more training should be given to doctors in general and primary care physicians in particular, to ensure that we are more proficient when dealing not only with key populations but also with patients who have the risk to be infected with HIV/AIDS.

Keeping this in mind, the Malaysian AIDS Foundation (MAF) has teamed up with the Malaysian Society for HIV Medicine (MASHM) to create HIV Connect.

It is an online training platform that educates primary care physicians regarding diagnosis and treatment options of HIV/AIDS, pre- and post-exposure prophylaxis of HIV/AIDS, and STIs.

Dr Suresh Kumar Chidambaram, President of MASHM and Infectious Diseases Consultant at Hospital Sungai Buloh said of the programme: “Those successfully completing this online module will be invited for face-face to training. After this training, they will be provided the opportunity to do clinical attachments in the nearest infectious diseases clinic. This way they will be comprehensively trained in management of HIV and STI.

“Because we want to reach out to as many primary care physicians as possible, this platform is free of charge. We hope that this programme can fill in the gaps that may exist in the physicians’ knowledge of HIV/AIDS and STIs and also remind them of the sensitivities involved when it comes to sexual history taking and imparting advice related to sexual health.

“Collaboration with community-based organisations such as MAF will give doctors more holistic training that ensures the concerns of the PLHIV are incorporated in the training.”

Dr Suresh also believes that we should work toward “more PLHIV to be diagnosed and started on effective treatment. Unlike in Western countries, very little HIV treatment is currently being provided by general practitioners in Malaysia”.

In alignment with the Ministry of Health’s commitment to end AIDS by 2030, we hope that this programme will supplement the other programmes that are already in place. We hope that in addition to the government facilities, the private clinics will also step up so that patients will have more choices when it comes to getting and receiving the proper care. This programme is our way to empower primary care physicians – I hope they will take up this call.

The online program can be accessed through https://hivconnect.mashm.net/. If you have any enquiries, email HIVconnect@mac.org.my or call 03-40474312.

A Silicon Valley startup with Chelsea Clinton on its board is launching the first at-home test for an HIV prevention drug, and you can try it right now

A Silicon Valley startup with Chelsea Clinton on its board is launching the first at-home test for an HIV prevention drug, and you can try it right now

  • Nurx, a Silicon Valley prescription drug delivery startup that once solely dispensed birth control, is launching a new service that allows patients who want HIV-prevention drug Truvada to do the required testing at home.
  • It’s a big move for the company, which recently raised $36 million and added Chelsea Clinton to its board of advisers.
  • It’s also a big deal for people seeking HIV-prevention drugs, who currently battle stigma and potentially wait months to get the medication.

In a move that could hint at bigger plans for prescription drug delivery, Silicon Valley startup Nurx on Wednesday launched the first at-home test of its kind for HIV-prevention drug Truvada.

Getting the daily pill, which is estimated to reduce infection among high-risk people by more than 90%, is no easy task. It can take several months for someone who wants PrEP to actually receive the drug. Nurx’s new service is designed to shrink that waiting period to just a few days.

After starting as a birth control-only delivery service in 2015, the California-based startup added a second medication, Truvada (also known as PrEP), to its list of available medications last year.

Last month, Nurx raised $36 million with help from top Silicon Valley venture capital firms. It also added Chelsea Clinton to its board of advisers.

There are a handful of startups offering quick on-demand delivery of prescription medications. But this is the first time one of these companies has tackled at-home lab testing – the hardest part of getting access to PrEP.

“This is a game-changing step towards preventing the spread of HIV,” Hans Gangeskar, co-founder and CEO of Nurx, told Business Insider. “It takes away a key barrier to treatment, and so we really hope to reach the folks that great places like community clinics are still missing.”

Currently, access to PrEP is limited. Beyond simply requiring access to a health care provider, getting a prescription also requires patients visit a clinic, ask about PrEP (which can be a scary conversation for many), and hope the provider can prescribe the drug. Oftentimes, patients are referred to infectious disease specialists who require several visits and extensive testing.

“There’s a big drop off in potential PrEP users at the stage when they need to physically show up for lab testing,” Jessica Horwitz, Nurx’s head of clinical development, said. “Getting in the door in the first place is often the hardest part. We’re missing whole swaths of people who need access.”

How to get PrEP with Nurx

To get PrEP, patients first visit the Nurx website and fill out an assessment with a healthcare provider in the startup’s network to figure out if the drug is a good idea.

Over 1.2 million people in the US have HIV, and men who have sex with men are at the highest risk. Heterosexual men and women who have unprotected sex or use injectable drugs are also at risk.

Then, patients get a testing kit from Nurx in the mail. In a process that’s somewhat similar to at-home genetics testing services like Ancestry or 23andMe, patients collect personal samples and mail them back to Nurx’s certified lab partner for processing. Instead of simply taking a spit sample, the Nurx kit requires patients to also send along small samples of blood and urine. This is done to make sure patients aren’t HIV positive and to ensure their kidneys are functioning properly, both of which are requirements for the drug.

Once those steps are complete, patients get PrEP delivered straight to their door – all without ever stepping foot in a physical clinic.

The ‘GrubHub for prescriptions’ model is gaining steam

The no-visit-required model for prescription drug delivery is a big trend across the US right now.

In June, Amazon inaugurated its latest push into the healthcare industry by buying online pharmacy PillPack.

Just days earlier, pharmacy giant CVS Health announced a plan to deliver prescriptions from nearly 10,000 of its retail stores to customer homes by contracting with the US Postal Service. And a handful of startups like Nimble and Capsule currently provide similar services with independent pharmacies using courier delivery services.

Although Nurx currently dispenses only birth control and PrEP, Horwitz told Business Insider there are plans to expand to other medications.

nurx PrEP Truvada testing kit


“PrEP was the next logical step for us because it can be done seamlessly through telemedicine, but our balance in terms of growth is finding clinical areas where there’s need and where access is an issue,” Horwitz said.

The new at-home testing kits for PrEP will be available in 19 states and Washington, DC as of Thursday; Nurx’s birth control delivery service is currently available in 20 states and is covered by most forms of health insurance – meaning that for most of its customers, the service is free.

The Nurx team is currently looking at adding sexual health screenings, something it plans to do by the end of the year. Horowitz said next year will be dedicated to thinking more about avenues for growth in primary care.

“We’re always thinking about new avenues where we can disrupt things,” she said.

Girls make up two-thirds of HIV-infected teens

Girls make up two-thirds of HIV-infected teens

Every three minutes, a girl between the ages of 15 and 19 is infected with the virus that causes AIDS (acquired immune deficiency syndrome), said a United Nations (UN) report on July 25, 2018, which warned of a “crisis” fuelled by gender inequality.

Girls and young women made up two-thirds of 15- to 19-year-olds infected with HIV (human immunodeficiency virus) in 2017, according to data unveiled at the 22nd International AIDS Conference in Amsterdam, the Netherlands.

Henrietta Fore, head of the UN Children’s Fund (Unicef), referred to it as a “crisis of health”.

“In most countries, women and girls lack access to information, to services, or even just the power to say no to unsafe sex,” she said.

“HIV thrives among the most vulnerable and marginalised, leaving teenage girls at the centre of the crisis.”

Last year, 130,000 youngsters aged 19 and under died from AIDS, while 430,000 – almost 50 every hour – were newly infected, the agency said.

While AIDS-related deaths have decreased since 2010 in all other age groups, they have remained stubbornly constant among older adolescents aged 15 to 19.

About 1.2 million 15- to 19-year-olds were living with the immune system-destroying virus in 2017, three in five of them girls, said Unicef.

“The epidemic’s spread among adolescent girls is being fuelled by early sex, including with older males; forced sex; powerlessness in negotiating about sex; poverty; and lack of access to confidential counselling and testing services,” it pointed out.

Actress and activist Charlize Theron raised the issue in an address to conference delegates on July 24, 2018.

The AIDS epidemic is “not just about sex or sexuality”, the South African celebrity said. “We know it is linked to the second-class status of women and girls worldwide.”

Youth bulge

Robert Matiru, director of operations for Unitaid, which funds HIV drug projects, said young people are disproportionately affected by the epidemic that has claimed some 35 million lives since it erupted in the 1980s.

“They are the most affected now, across sub-Saharan Africa in particular,” he said.

“Unless we can reach young people and curb the epidemic among them… then we’re not going to meet the targets” of the UN to end AIDS as a public health threat by 2030.

This requires limiting infections to 500,000 per year by 2020, yet last year they numbered 1.8 million.

A recent report of the International AIDS Society (IAS) highlighted the epidemic’s “extraordinary impact” on adolescent girls and young women.

“Four in 10 adolescent girls (aged 15-19) in Africa have experienced physical or sexual violence from an intimate partner, and the evidence is that gender-based violence is associated with a significantly greater risk of acquiring HIV,” it said.

“Yet few countries have invested in comprehensive programmes to combat gender-based violence or to ensure ready access to adolescent-friendly sexual and reproductive health services.”

According to IAS president Linda-Gail Bekker, “in young people, it (the AIDS epidemic) is far from over”.

“In certain parts of the world, we are about to go into the youth bulge, so we’ll have more young people than we’ve ever had in the world before,” she said.

“Young people have grown up, they are incredibly mobile, they are moving, they have forgotten that HIV is a risk factor… we can’t let up on that message, otherwise it just blows up again.” — AFP Relaxnews

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