Prephylaxin prophylaxis (ko PrEP) wani shiri ne na rigakafin cutar HIV wanda ake amfani da shi yau da kullum na maganin rigakafi don rage yawan haɗarin mutum na samun HIV. Sha'anin shaidar da aka fi sani ya zama wani muhimmin ɓangare na tsarin rigakafin cutar HIV, wanda ya hada da ci gaba da yin amfani da kwaroron roba da raguwa cikin adadin masu yin jima'i.
Ba a yi amfani da PEP don amfani dashi ba.
Tun daga shekara ta 2010, jerin gwaje-gwaje na asibitoci sun nuna cewa PREP iya rage haɗarin cutar HIV a cikin maza da suka yi jima'i tare da maza (MSM) , masu amfani da ƙwayoyin cuta da sauransu, da kuma masu amfani da magunguna (IDU). Dangane da hujjoji, Cibiyar Kula da Cututtuka na Kwayoyin cuta (CDC) ta ba da jagorancin gudanarwa.
Shaida a cikin goyon bayan PrEP
A shekara ta 2010, binciken na iPrEx yayi nazarin amfani da PrEP a tsakanin MS4 da kwayoyin cutar HIV. Babban binciken da aka yi a cikin ƙananan hukumomi ya gano cewa amfani yau da kullum na Truvada (tenofovir + emtricitabine) ya rage hadarin kwayar cutar HIV ta kashi 44%. Daga cikin kashi 51 cikin 100 na masu haɗar gwaji da matakan gano kwayoyin cutar Truvada a cikin ma'anar jini-waɗanda suka dauki maganin su kamar yadda aka umurce su - haɓakar kamuwa da cutar ta rage 68%.
Bayan binciken da aka yi a shekaran binciken na iPrEX, an tsara wasu gwaje-gwaje na asibiti don gano tasirin PrEP a cikin marasa lafiya, maza da mata maza da mata.
Da farko, Nazarin TDF2 a Botswana, ya gano cewa amfani da maganin yau da kullum na Truvada ya rage yawan kasuwa 62%.
A halin yanzu, Abokan hulɗa na ABU da ke Kenya da Uganda sun binciko yin amfani da wasu magungunan miyagun kwayoyi biyu (Truvada na daya daga cikin kungiyoyi da tenofovir a kan kansa) a cikin mahaukaci , ma'aurata maza da mata wanda abokin tarayya yake tare da HIV-korau kuma ɗayan HIV -ifi.
A takaice dai, kashi 75% da 67% na raguwa ya ragu.
A watan Yunin 2013, bincike na Bangkok Tenofovir ya binciki tasirin PREP kan 2,413 IDU da aka sanya sunayensu daga asibitin magani a Bangkok. Sakamako daga jarrabawar sun nuna cewa kwayar cutar ta yau da kullum ta Truvada ta rage hadarin da 49% cikin maza da mata a cikin binciken. Dangane da bincike na farko, masu halartar kulawa da maganin miyagun ƙwayoyi sun kasance 74% kasa kamar kamuwa da cutar.
Koyaswa Koyaswa Daga Kwararrun Kwararrun Ɗaukakawa Kasawa
A cikin nasarar da aka samu a cikin wannan binciken, an yi nasarar fitarwa guda biyu. Dukansu an tsara su ne don gano yadda tasirin PREP ke kasancewa a cikin matan HIV, wadanda aka saba da su don samar da karfi ga mata masu fama da cutar kanjamau.
Abin takaici shine, binciken na FEM-PREP a Kenya, Afirka ta Kudu da Tanzania, da kuma binciken VOICE a Afirka ta Kudu, Uganda da Zimbabwe sun tsaya lokacin da masu bincike suka gano cewa mahalarta a kan PrEP ba ta sami kariya daga cutar HIV ba. Jigilar magungunan maganin miyagun ƙwayoyi sun tabbatar da cewa kasa da kashi 40 cikin dari na mata suna biye da tsarin yau da kullum, har ma da (12%) suna kiyaye matakan tenofovir na tsawon lokacin gwaji.
Abinda duka binciken FEM-PrEP da VOICE sune daya daga cikin kalubalen kalubalantar maganin maganin rigakafi, wato dangantakar da ba ta haɓaka tsakanin haɗin magungunan miyagun ƙwayoyi da kuma iyawar mutum don cimma sakamakon da ake so - a wannan yanayin, rigakafin kamuwa da cuta.
A cikin binciken na iPrEx, alal misali, masu bincike sun gano cewa mahalarta da kasa da kashi 50% sun kasance sun sami damar yin amfani da cutar ta 84%. Wannan ya bambanta da waɗanda suka dauki kwayoyin su fiye da 90% na lokaci, wanda lamarin ya rage zuwa 32%. Masu bincike sun kiyasta cewa idan ƙungiyar ta dauki nau'in kwaya kamar yadda aka nuna, hadarin zai sauke zuwa 8% ko žasa.
Binciken da aka yi a cikin binciken da aka gano a gano wasu abubuwan da suka saba da juna da / ko imanin da zai iya tasiri a tsakanin masu karatu. Tsakanin su:
- Mutane 10% suna tsoron cewa wasu suna da kwayar cutar HIV
- 15% sun gaya wa wani baya daukar kwayoyi, mafi yawancin memba na iyali
- 16% na da sauran abubuwan da zasu damu
- 17% ji kwayar cutar ta yi yawa
- 28% ji a low hadarin ga HIV
- 32% sun ji cewa haɗin kai yau da kullum yana da wuya
Wadannan batutuwa kawai suna taimakawa wajen tabbatar da muhimmancin yin shawarwari tare, da kuma kulawa na yau da kullum game da cutar HIV, matsayi na ciki, adadin maganin magani, illa mai lalacewa, da kuma halayyar haɗari ga duk wanda aka sanya a kan PrEP.
Sauran Damuwa da Kalubale
Bugu da ƙari ga shingen haɓaka, wasu sun nuna damuwarsu game da yanayin hali na PrEP - musamman ko zai haifar da matakan da ba a kula da ita ba da kuma sauran halayen haɗari . Shaida ta nuna cewa wannan ba haka ba ne.
A cikin watanni 24, gwajin da aka yi a San Francisco, Boston, da kuma Atlanta, halayen halayyar MSM sun nuna ko dai sun ƙi ko basu canzawa ba bayan kafawar PrEP. Ana ganin irin wannan sakamakon a cikin bincike mai kyau game da mata a kan PrEP a Ghana.
A halin yanzu, an damu da wasu damuwa game da fitowar kwayar cutar ta HIV ta hanyar amfani da PrEP a cikin mutanen da ba a sani ba sun kamu da kwayar cutar HIV. Hanyar lissafin ilmin ilmin lissafi na farko ya nuna cewa, fiye da tsawon shekaru 10 a wani wuri mai zurfi (kamar Saharar Afrika ta Kudu), kimanin kashi 9 cikin dari na sababbin mutanen da suka kamu da cutar sun iya samuwa da wasu matakan maganin jigilar kwayoyi saboda PrEP. Mafi kyawun yanayin / mafi munin yanayi na yanayin kasancewa daga low as 2% har zuwa 40%.
Ya bambanta, a cikin yanayin da aka ci gaba, binciken daya (haɗa bayanai daga Birtaniya Binciken HIV tare da Cibiyar Harkokin Drug Resistance Birtaniya) ya ƙaddara cewa PREP zai iya samun "tasiri mara kyau" a kan yaduwar cutar HIV a cikin MSM, yawanci dauke da babban haɗari a kasashe masu tasowa.
Shirya shawarwarin
CDC ya ba da jagorancin lokaci akan amfani da PrEP a cikin MSM, mazancin maza da mata, da kuma IDUs. Kafin farawa na PrEP, likita zai fara ƙaddamar da cancantar mutum ta hanyar:
- Yin gwajin HIV don tabbatar da matsayin HIV
- Gwaji don kamuwa da cuta idan mutum yana da alamun bayyanar cututtuka mai zurfi, ko kuma yana iya yiwuwar bayyanar cutar HIV a cikin watanni na gaba (ko ta hanyar jima'i ba tare da karewa ba ko kuma ƙwararren asiri).
- Bada la'akari ko mutumin yana da gwaji, ci gaba, babban haɗari don samun HIV.
- Tabbatarwa cewa mutum yana da ƙayyadadden izinin haɓakar halitta fiye da 60mL a minti daya.
- Kulawa ga hepatitis B (HBV) da STDs .
Bugu da ƙari, likitoci zasu tantance ko mace ta kasance ciki ko kuma ta yi nufin yin ciki. Duk da yake babu rahoton cewa an cutar da jariran da ke fama da cutar ta Truvada, ba a kammala nazarin lafiyar miyagun kwayoyi ba. Wannan ya ce, CDC ba ta bayar da shawarar PREP ga mata masu shan nono ba.
Bayan tabbatar da cancanta, za a ba da mutumin a kowace rana ta Truvada. Za a yi amfani da shawarwari na ragowar ƙalubalanci (ciki har da jagorancin jima'i don IDU don hana kamuwa da cuta ta hanyar jima'i ba tare da kare lafiyar) ba.
Kullum magana, takardar sayen magani ba zai wuce kwanaki 90 ba, ba za a sake sakewa ba bayan gwajin HIV ya tabbatar da cewa mutumin ya kasance ba daidai ba.
Bugu da ƙari, za a riƙa nuna saurin STD na yau da kullum, tare da gwajin ciki ga mata. Ya kamata a kula da magungunan halittar halittar da kuma haɓakar halittar halitta, daidai da farko sannan kuma sau biyu a kowace shekara.
> Sources:
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