How the Use of prep (Pre-exposure Prophylaxis) Helps to Prevent HIV Infection in Malaysia.
DOI:
https://doi.org/10.58676/sjmas.v2i6.80Keywords:
Public Health Strategies, HIV prevention, Pre-Exposure Prophylaxis (PREP), Malaysia, Antiretroviral Therapy (Art)Abstract
Background: HIV remains a significant public health challenge in Malaysia, affecting key populations such as men who have sex with men (MSM), transgender individuals, sex workers, and people who inject drugs (PWID). Despite advancements in prevention and treatment, HIV continues to be a leading cause of morbidity and mortality. Pre-exposure prophylaxis (PrEP) has emerged as a promising biomedical intervention, utilizing antiretroviral tablets (ARVs) to significantly reduce the risk of HIV infection in HIV-negative individuals.
Methods and Materials: This study investigates the effectiveness of PrEP in preventing HIV transmission among high-risk groups in Malaysia. The research examines the mechanism of action of the two primary drugs used in PrEP—tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC)—and analyzes data from various studies, including the iPrEx, Partners PrEP, PROUD, and IPERGAY studies. Additionally, it addresses the challenges of implementing PrEP in Malaysia, such as stigma, adherence issues, and integration with existing HIV services.
Results: PrEP has shown to reduce the risk of HIV infection by more than 90% when used consistently. The iPrEx study demonstrated a 44% reduction in HIV risk, increasing to 92% with consistent use. The Partners PrEP study indicated a 75% reduction, with a potential 90% decrease with strict adherence. The PROUD and IPERGAY studies reinforced these findings, showing 86% reductions in HIV risk. Despite its proven efficacy, the implementation of PrEP in Malaysia faces barriers such as stigma, prejudice, and adherence challenges.
Conclusion: PrEP is a highly effective strategy for reducing HIV transmission among high-risk populations in Malaysia. To maximize its potential impact, it is crucial to address barriers to implementation, including stigma, adherence issues, and integration with existing healthcare services. Mathematical modeling suggests that widespread PrEP use could lead to a significant decrease in new HIV infections, potentially reducing cases among MSM by 30% over a decade. Learning from successful PrEP programs in other countries, Malaysia should focus on supportive policies, community engagement, affordability, and adherence support to effectively combat the HIV epidemic.
References
References
Ministry of Health Malaysia. Dr. Anita Suleiman, Dr. Fazidah Yuswan, Dr. Chai Phing Tze. (2023) 2023 Global AIDS Monitoring: Country Progress Report – Malaysia. https://www.moh.gov.my/moh/resources/Penerbitan/Laporan/Umum/Laporan_Global_AIDS_Monitoring_2023.pdf
Centers for Disease Control and Prevention. (2021). Pre-Exposure Prophylaxis (PrEP). Retrieved from https://www.cdc.gov/hiv/basics/prep.html
Baeten, J. M., Donnell, D., Ndase, P., Mugo, N. R., Campbell, J. D., Wangisi, J., ... & Celum, C. (2012). Antiretroviral prophylaxis for HIV prevention in heterosexual men and women. New England Journal of Medicine, 367(5), 399-410. https://doi.org/10.1056/NEJMoa1108524
Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., ... & Glidden, D. V. (2010). Pre-exposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363(27), 2587-2599. https://doi.org/10.1056/NEJMoa1011205
McCormack, S., Dunn, D. T., Desai, M., Dolling, D. I., Gafos, M., Gilson, R., ... & Gill, O. N. (2016). Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): Effectiveness results from the pilot phase of a pragmatic open-label randomized trial. The Lancet, 387(10013), 53-60. https://doi.org/10.1016/S0140-6736(15)00056-2
Molina, J. M., Capitant, C., Spire, B., Pialoux, G., Cotte, L., Charreau, I., ... & Delfraissy, J. F. (2015). On-demand pre-exposure prophylaxis in men at high risk for HIV-1 infection. New England Journal of Medicine, 373(23), 2237-2246. https://doi.org/10.1056/NEJMoa1506273
Centers for Disease Control and Prevention. (2021). Stigma and discrimination. In Pre-exposure prophylaxis (PrEP). Retrieved from https://www.cdc.gov/hiv/basics/prep.html
World Health Organization. (2016). Guidelines on HIV prevention, diagnosis, treatment, and care for key populations. Retrieved from https://www.who.int/publications/i/item/9789241511124
Joint United Nations Programme on HIV/AIDS. (2015). UNAIDS 2016-2021 strategy: On the fast-track to end AIDS. Retrieved from https://www.unaids.org/sites/default/files/media_asset/20151027_UNAIDS_PCB37_15_18_EN_rev1.pdf
Kirby Institute. (2018). Impact of pre-exposure prophylaxis (PrEP) on the HIV epidemic in Malaysia. Retrieved from https://www.kirby.unsw.edu.au/report-impact-prep-hiv-malaysia
World Health Organization. (2016). Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: Recommendations for a public health approach (2nd ed.). Retrieved from https://www.who.int/hiv/pub/arv/arv-2016/en/
UNAIDS. (2019). Communities at the center: Defending rights, breaking barriers, reaching people with HIV services. Retrieved from https://www.unaids.org/en/resources/documents/2019/2019-global-AIDS-update
Medicines Patent Pool. (2020). Public health and IP: HIV, hepatitis C, tuberculosis. Retrieved from https://medicinespatentpool.org/uploads/2020/04/MPP-2020-Annual-Report.pdf
Centers for Disease Control and Prevention. (2019). PrEP: Pre-exposure prophylaxis. Retrieved from https://www.cdc.gov/hiv/basics/prep.html
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Copyright (c) 2024 Dixon Yong Ky'Xuen, Dr Ghassan Salibi, Prof Nikolaos Tzenios
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