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      "author": "steemitboard",
      "permlink": "steemitboard-notify-franchb-20190608t104656000z",
      "title": "",
      "body": "Congratulations @franchb! You received a personal award!\n\n<table><tr><td>https://steemitimages.com/70x70/https://steemitboard.com/@franchb/birthday3.png</td><td>Happy Birthday! - You are on the Steem blockchain for 3 years!</td></tr></table>\n\n<sub>_You can view [your badges on your Steem Board](https://steemitboard.com/@franchb) and compare to others on the [Steem Ranking](https://steemitboard.com/ranking/index.php?name=franchb)_</sub>\n\n\n###### [Vote for @Steemitboard as a witness](https://v2.steemconnect.com/sign/account-witness-vote?witness=steemitboard&approve=1) to get one more award and increased upvotes!",
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      "title": "",
      "body": "hey fuckers what do u think now?? https://www.blockcollider.org/ is it a scam?? they r still be sending u ur tokens",
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      "author": "franchb",
      "permlink": "hiv-pre-exposure-prophylaxis-prep-online-course-at-coursera-review-day-12-of-42",
      "title": "HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 12 of 42.",
      "body": "![](https://steemitimages.com/DQmf8EKfzSJf2Pem8hiM5scLbYnXo7ndA4diw8q2zhGag3b/image.png)\n\nIn the 12th lesson of the PrEParing course “PrEP Pipeline,” Neha Pandit from the School of Pharmacy at the University of Maryland has examined clinical studies of new drugs for PrEP in more detail.\n\nClinical studies of new medicines for PrEP have already been discussed in the 10th lesson. If you are interested in learning about the studies of tenofovir alafenamide (TAF), maraviroc, cabotegravir, dapivirin, VRCO1 and EFdA / MK-8591 — feel free to read about it in the review of the 10th lesson of the PrEParing course.\n\n## Vaginal rings\nLet us consider in more detail vaginal rings for PrEP with dapivirine. The polymer ring contains 25 mg of dapivirin, the drug is slowly released through the pores within 30 days within the virginal area of the vagina and enter the vaginal mucosa, protection from exposure to HIV locally.\n![](https://steemitimages.com/DQmf8EKfzSJf2Pem8hiM5scLbYnXo7ndA4diw8q2zhGag3b/image.png)\n_Figure 1 — A silicone vaginal ring with dapivirine for PrEP identical to those used in the ASPIRE trial. Credit: NIAID https://www.flickr.com/photos/niaid/25153111944_\n\nSuch a ring inserted monthly, and it reaches sufficient concentration eight hours after insertion comparing to tablets for PrEP begin to work after 2-7 days of consistent intake. Prescribing vaginal rings for PrEP on the day of assessment provides protection to a woman within eight hours — this is necessary for outreach programs when volunteers and social workers, with the support of charity funds or government programs, visit vulnerable communities at high risk of exposure to HIV. Conducting HIV testing and the distribution of such vaginal rings to the PrEP can potentially reduce the spread of the HIV epidemic in such communities.\n\nIn the tenth lecture, the instructor discussed a clinical study of vaginal rings, which showed a 27% reduction in the risk of HIV transmission among African-American women in the United States. Another study involved 2,000 African-American women showing a 30% drop in the risk of HIV transmission.\n\nAs already noted in the 10th lecture that a spontaneous finding of the first clinical study on 2,600 women showed that vaginal rings for PrEP were less effective in patients who were less than 21. Researchers are testing hypotheses to explain this fact.\n\n## Conclusions\nPre-exposure prophylaxis studies focus on the development of safe and effective drugs and delivery methods. Scientists are looking for ways to reduce the toxic effects, testing methods of local PrEP delivery, such as vaginal and anal rings and gels. They also study how drug concentrations are distributing in the mucosal tissues of the mouth, vagina, cervix, and rectum.\n\nAlso, it’s all about improving the adherence to medication regimens. A lot of effort is focused on the extension of PrEP, which can be taken less often, up to one injection every six months. In this blog on the mobile application for HIV-positive people Life4me+ website, we would like to share our experience.\n\nThe developers of the Life4me+ application have found positive reports in a series of scientific articles, which described implementing mobile health technologies to increase adherence to drugs intake among people living with HIV. For example, this is the article by Donaldson F Conserve with co-authors “Systematic review of mobile health behavioral interventions to improve uptake of HIV testing for vulnerable and key populations,” published April 6, 2016, in the Journal of Telemedicine and Telecare. The developers in Life4me+ tried to apply similar ideas in practice. They introduced the “flexible alarm” into the mobile app — an HIV-positive user needs only to adjust the intervals for taking medications, and the phone will notify about drug intake in random time within range.\n\nUsers of the Life4me+ app found this function helpful. Doctors also evaluated “flexible alarm” function commenting that it is especially useful in the early years of taking antiretroviral drugs. Probably, the experience of the Life4me+ application will be suitable for people taking PrEP not to forget to take pills daily and stay protected from HIV.\n\nSo, lecture of Dr. Neha Pandit came to an end. Tomorrow we will sum up the second week of the PrEParing course.\n\nIf you have not already signed up for the PrEParing course on the Coursera platform — it’s never too late to do it, just go to [https://www.coursera.org/learn/prep](https://www.coursera.org/learn/prep).\n\nStay with us and stay healthy!\n\nP. S. The original article was posted on the [Life4me+ mobile app for HIV-positive persons blog](https://life4me.plus/en/blog/).",
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      "author": "konstantint",
      "permlink": "re-franchb-why-i-think-status-rsk-is-a-scam-20170726t111405343z",
      "title": "",
      "body": "Got an invitation email today as well (mine is #30549 if you care to compare). Scam flags:\n\n  - The site currently says that \"32.29% tokens remaining\", which more or less the same number as what you saw 11 days ago.\n  - The [srsk.co](https://srsk.co/) domain has an invalid certificate (not something you should spare upon when begging for a million dollars).\n  - The [chatbot](https://web.telegram.org/#/im?p=@srskbot) seems to only implement the \"start\", \"account\" and \"send\" commands. Everything else is fake.  \n - The [block explorer](http://explorer.srsk.co/) is fake or broken:\n    -  Unable to browse blocks before [2079](http://explorer.srsk.co/block/2079). Blockchain without a genesis block? No, thank you.\n    -  Give him any account address and it will [tell you](http://explorer.srsk.co/addr/0xblablabla) all the same stats about it.\n - No Github or any indication of actual development.\n - In general, the attempt to \"hide the team\" (not even finding a single person willing to come out as a legitimate representative) aligns much better with the desire to get the money and run without leaving a trace than anything else - the excuses \"we want to be exclusive\" look lame to me. \n\nFor the reference: the email I received came fromAiden Hamil ([email protected]), the srskteam.org domain was registered just a week ago and is bound to a generic mailboxhost.com email provider. Google does not know of any notable developers with this name.",
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      "author": "franchb",
      "permlink": "hiv-pre-exposure-prophylaxis-prep-online-course-at-coursera-review-day-11-of-42",
      "title": "HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 11 of 42.",
      "body": "![](https://steemitimages.com/DQmQYguDEhFYiZsKnGHCdv19fX2weVfecM65xMvNx9AXtWT/image.png)\nThe eleventh lecture of the PrEParing course “Community-Based Implementation of CDC PrEP Guidelines,” presented by Pierre-Cedric Crouch, the Director of Nursing at Magnet over at Strut — a project of the San Francisco AIDS Foundation.\n\nPierre-Cedric offered to talk about the CDC PrEP guidelines and applying them to a community-based clinic. The instructor also prepared to share his experience of providing PrEP in San Francisco.\n\n## Conflict of interests\nPierre-Cedric also reveals a conflict of interest. You could recall from the eighth lesson that disclosing a conflict of interest is beneficial for people listening to a scientific or popular science lecture since they get an exact state of science overview in the speaker’s area of competence. The narrative may be biased if the speaker reports on existing or past contracts with pharmaceutical companies.\n\nThe San Francisco AIDS Foundation, where Dr. Crouch works, does receive funding from the Gilead Sciences pharmaceutical company, but Dr. Crouch does not receive private grants from Gilead.\n\nGilead provides Truvada on the market — the only one approved by the US Food and Drug Administration (FDA) for PrEP. Therefore, the reader of this article understand that the instructor is potentially interested in promoting the drug, but as yet there are no alternatives — PrEP radically reduces a risk of HIV transmission, and the only available drug is Truvada.\n\n## Abbreviations\nNext, would you mind recalling some abbreviations:\n\nPrEP — pre-exposure HIV prophylaxis\n\nnPEP — post-exposure HIV prophylaxis for people whose work is not associated with HIV (for everyone except doctors, nurses, laboratory staff, etc.)\n\nMSM — men who have sex with men\n\nMSW — men who have sex with women\n\nWSM — women who have sex with men\n\nIDUs — injecting drug users\n\nSTI — Sexually Transmitted Infections\n\n## PrEP clinical practice guidelines\nWolters Kluwer’s UpToDate, an evidence-based, physician-authored clinical decision support resource which clinicians trust to make the right point-of-care decisions, gives such a definition of the term:\n\nClinical practice guidelines are recommendations for clinicians about the care of patients with specific conditions. They should be based upon the best available research evidence and practice experience.\n\nThe Institute of Medicine defines clinical practice guidelines as “statements that include recommendations, intended to optimize patient care, that are informed by a systematic review of evidence and an assessment of the benefits and harms of alternative care options”.\n\nBased on this definition, guidelines have two parts:\n\nThe foundation is a systematic review of the research evidence bearing on a clinical question, focused on the strength of the evidence on which clinical decision-making for that condition is based.\nA set of recommendations, involving both the evidence and value judgments regarding benefits and harms of alternative care options, addressing how patients with that condition should be managed, everything else being equal.*\nOver the past year, more than a dozen states announced free providing of PrEP among the citizens of these countries from high-risk groups.\n\nPierre-Cedric notes that clinical recommendations are not always universal. Developers of clinical guidelines tend to standardize PrEP, so that recommended practices to be convenient and safe in any community, but guidelines need to be adjusted locally. Further, Dr. Crouch will describe how the CDC clinical practice guidelines on prescribing PrEP were applied and improved in the Magnet-Strut clinic.\n\nThe Strut Clinic opened in San Francisco in January 2015 and offered sexual health care to gays, bisexuals, queers and transgender men, also providing psychotherapeutic assistance, substance abuse services, prevention of HIV transmission and various community engagement programs for people who are at risk for HIV or are already HIV-positive.\n\nThe clinic advises clients on the use of PrEP and provides the only approved drug for PrEP, a combination of emtricitabine and tenofovir Truvada. In the future, Strut hopes to expand the range of HIV preventing methods.\n\nPrEP, according to the clinical guidelines of the CDC, is shown for:\n\n- **men who have sex with men, MSM**: If they are not in a monogamous relationship with an HIV-negative man, there has been sexual contact in the last six months AND at least one of the conditions:\n - was anal sex without a condom in the last six months;\n - was diagnosed with STI in the last six months;\n - are in an ongoing relationship with an HIV-positive man;\n - **men who have sex with women, MSW**: If they are not in a monogamous relationship with an HIV-negative woman, there has been sexual contact in the last six months AND at least one of the conditions:\n - had sexual intercourse with both women and men in the last six months;\n - infrequently uses condoms during sex with 1 or more partners of unknown HIV status who are known to be at substantial risk of HIV;\n - is in a ongoing relationship with an HIV-positive woman.\n - **women who have sex with men, WSM**: if they are not in a monogamous relationship with an HIV-negative man, there has been sexual contact in the last six months AND at least one of the conditions:\n\n - during sexual intercourse for the last six months, the male partner did not use a condom or did not always use a condom, and the HIV status of this partner is unknown, or the partner is at a substantial risk for HIV;\n - is in an ongoing relationship with an HIV-positive man.\nThe doctor prescribes PrEP only if a person is at substantial risk of getting HIV.\n\nFor injecting drug users, IDUs, PrEP is prescribed in cases where at least one of the following conditions is met:\n\n - injecting drugs have not been prescribed by a doctor for the last six months (if not prohibited by local law) AND for the last six months, at least one of the following conditions has been met:\n - any sharing of injection or drug preparation equipment in past six months;\n - been in a methadone, buprenorphine, or suboxone treatment program in past six months;\n - risk of sexual acquisition;\nSuch guidelines seem logical and consistent, but practical application causes difficulties — in fact, the doctor determines a small category for each client and decides on this — whether to prescribe PrEP or not. However, people are different, and therefore Dr. Crouch shares the experience of the Magnet program in San Francisco. The ultimate goal for the doctor is to determine for every client if there is a substantial risk of getting HIV.\n\nTherefore, in Magnet, doctors expand indications and prescribe PrEP to each person who reported an episode of sex without a condom in the last year. Also, PrEP is prescribed to those whose partner is HIV-positive, although the new data say that if the HIV-positive partner has undetectable viral load, then the risk of HIV transmission in the couple is extremely low. CDC researchers are planning to review recommendations for HIV-negative people who live in conjunction with HIV-positive in the new version of the clinical guidelines for PrEP.\n\nAlso, doctors in Magnet prescribe PrEP to patients who are injecting drug users and at least once shared a syringe in a past year. The Magnet project distributes clean needles so that the staff will give to such patients clean needles; this practice reduces the risk of transmission of HIV and hepatitis C.\n\nPrEP is also provided for someone with a low-risk of exposure to HIV if in an interview such a person will tell about the possible risky behavior in the future.\n\n## Clinical Evaluation and Counseling\nThe CDC recommends that doctor should get a negative HIV antibody test within the last seven days, and also assess for signs of acute HIV infection. These include fever, fatigue, muscle pain, lymph nodes enlargement, skin rashes, sore throat. And for people who actually might have had a recent exposure to HIV, they should be offered PrEP.\n\nPrEP is prescribed if the HIV test is negative, there is no evidence of acute HIV infection, and the client has a substantial risk of getting HIV in the future.\n\nThe doctor also needs to have a recent eGFR greater than 60 and to do Hepatitis B and Hepatitis C serologies as well.\n\neGFR is short for estimated glomerular filtration rate. Your eGFR is a number based on your blood test for creatinine, a waste product in your blood. It tells how well your kidneys are working.\n\nThe eGFR is a useful test, but it’s not right for everyone. For example, this test may not be accurate if you are younger than 18, pregnant, very overweight or very muscular.\n\n##Definition from the American Kidney Fund website\nHepatitis C is not contraindicated for PrEP; The test is made as part of a routine, a sort of panel just to see if there is Hepatitis C. If someone does have Hepatitis C, the doctor could prescribe them PrEP without modifying anything.\n\nIf someone has Hepatitis B, the doctor would need to ensure that this client getting Hepatitis B treated accordingly. Some of the clients can have Hep B, and Hep C at the same time, they just need a little extra medical evaluation to treat their Hep B alongside receiving PrEP.\n\nNext, clients receive PrEP and adherence counseling, but at Magnet they just a little bit more:\n\n - an HIV antibody test within seven days;\n - assessment for acute HIV infection having benefit to access to an HIV RNA test which helps narrow the window of exposure for HIV;\n - a renal and metabolic panel on all clients;\n - Hepatitis B antigen and Hep C antibody testing;\n - a significant amount of PrEP and adherence counseling;\n - gonorrhea, chlamydia, and syphilis testing;\n - detailed benefits navigations.\n\n## Early start of prevention\nStarting people up on the same day in the Magnet-Strut clinic is possible, there is enough testing out there and access to provide people with PrEP that same day, says Dr. Crouch. The clinic is equipped with laboratory equipment thanks to the grants from the San Francisco AIDS Foundation, so the tests are performed during the client’s visit in one place. Recent research, like iPrEx OLE in 2014, led the organizers of the clinic to understand that the long delays just end up frustrating clients and prolongs their risk of HIV, so getting people on PrEP as soon as possible is vital.\n\nIn the iPrEx, OLE study scientists proposed to invite everyone who they all met to put on to PrEP to answer the questionnaire that would reveal an acute retroviral syndrome among the respondents.\n\n![](https://steemitimages.com/DQmZ8rSms7WFVCeJzcYk49o639cvGjS1tnA2pr7PWqzuD5f/image.png)\n\n_Figure 1 — Clinical Screening for Acute Viral Syndromes and Acute HIV Infection in iPrEx OLE. Source: Grant et al, Lancet ID, 2014._\n\nAs seen in the diagram (Figure 1), the study involved 1,603 people, 30 of them showed signs of an acute retroviral syndrome, usually observed in the first weeks of HIV infection, that put up a red flag delaying the initiation of PrEP. Such people were offered to perform blood analysis for HIV, not an express test, but an expensive PCR test for HIV RNA. Two people showed an acute phase of HIV infection. Among the remaining 28 subjects, 25 started the PrEP with a delay, and three people abandoned the PrEP.\n\nPierre-Cedric made three conclusions from the iPrEx OLE study results:\n\n - it is necessary to conduct a survey of those who applied for PrEP to identify signs of possible acute HIV infection of the early phase and, in a case of HIV, offer such people an early start of treatment;\n - delay in putting on PrEP leads to the fact that some people disappear and do not start PrEP while having a substantial risk of exposing to HIV and have all the indications to PrEP;\n - skilled management of the clinical process makes it possible to identify people with an acute phase of HIV infection whereas to provide the bulk of clients with PrEP right on the day of visit;\n\n## Kidney function evaluation\nWhen doctors talk about evaluating kidney function in a patient, they most often mean estimating the glomerular filtration rate — an indicator of the kidneys’ effectiveness in purifying blood from creatinine and removing it from the urine. This test shows the ability of the kidneys to cleanse from harmful substances.\n\nThis indicator does not always give an adequate picture — if the client is under 18 or dehydrated or brawny or takes ibuprofen or exercised before the test or took a nutritional supplement with creatinine — the results will be biased. In such cases, the doctor will try to avoid the risk of kidney damage and possibly will not prescribe PrEP to such a client.\n\nTherefore it is important to do repeated tests, but there are also alternative ways of estimating kidney function. Doctors at Magnet use a new diagnostic test with the Cystatin C protein. The results of evaluating kidney function based on the level of cystatin C give a clearer picture.\n\n“You don’t want not to start someone on PrEP just because they have a high creatinine that has nothing to do with their kidney function at all,” says Pierre-Cedric.\n\n## PrEP counseling\nIn Magnet clinic, doctors start off with three lead questions:\n\n> What have you heard about PrEP?\nThat helps them figure out all the different urban legends that people have around PrEP, and help correct those.\n> What do you want PrEP to do for you?\nIt’s a preferred question in the Magnet clinic; it allows to understand what people want from PrEP, whether the clinic solves the difficulties of clients. And what can be changed in the process to meet people expectations.\n> What have you heard about the PrEP and condoms?\nThe answer helps to understand the client’s sexual behavior and to help him to develop such a behavior for the future, so that a person really is protected from HIV. Often consultants asking clarifying questions:\n> What does the relationship with condoms look like?\n> Do you love them? Do you hate them?\n> Is it easy for you to use condoms?\n> How’s that going to look like when you actually start up on PrEP?\nthe idea is a doctor come up with a client centered sexual health plan that they develop with the help of a client.\n\n## PrEP adherence counseling\nDr. Crouch goes on to describe the adherence to PrEP counseling. Irregular intake of tablets during PrEP carries many risks to the client’s health along with people with having sexual relations with the client. Everything goes well if the tablets are taken accurately, but if you skip the reception — PrEP stops working, and the prophylaxis process is more complicated than “switch on — switch off.”\n\nTherefore, in Magnet they offer consultations, discussing with each client:\n\n - When to start PrEP and at what time and on what day the client is going to take the first pill;\n - If a person missed one dose or seven doses — how to handle these sort of gaps. When to restart and what to do?\n - Doess it easy to take PrEP at home?\n - Does the client live with parents at home and if it possible to take PrEP when parents are at home?\n - Does the client live with a partner who does not know about receiving PrEP?\n - Other issues related to the possible stigma in client’s life and how to avoid stigma.\n\n## PrEP Navigation\nUS Public Health organizations have developed a “PrEP-navigation” program.\n\nPrEP Navigation is to improve recruitment, linkage, and retention to care and health outcomes for people of color living with HIV or at high-risk for HIV. The program is based on the concept that persons in communities trained as HIV and PrEP navigators can be effective in reducing and eliminating barriers to the appropriate prevention, diagnosis, and treatment of HIV in their own communities.\nDr. Crouch says that participation in the PrEP Navigation is essential, especially if you’re not in a single payer system. In the Magnet program, they have an entire PrEP team that does everything for the client. They became trained notaries and insurance enrollment counselors, so they’re able to get all the documents signed and filled out for the clients. The majority of the time the client just signs a form, and they don’t have have to fill out anything. Filling out forms is a huge barrier to accessing care so Dr. Crouch recommends looking into those different options to educate benefits Navigation team to provide as much service as they possibly can.\n\n## PrEP follow up\nPierre-Cedric refers again to the CDC guidelines for PrEP, which recommends every person on PrEP taking an HIV test every three months. Also making pregnancy test for women during a visit, consulting on adherence, and monitoring possible side effects. Once every six months, it is recommended evaluating the kidney function and making a serology for syphilis, gonorrhea, and chlamydia.\n\nSo in Magnet, they slightly complement the CDC guidelines:\n\n - Consultant calls client in the first three days after putting on PrEP, to ensure there are no problems accessing the pills in the pharmacy, or any insurance issues and whether the person does not feel any side effects;\n - The first visit is appointed one month after PrEP started;\n - Next visits are arranged every three months;\n - During each visit, clients are tested for HIV, not an express test, but precise PCR for HIV RNA, which quickly identifies the virus during the “serological window”;\n - STI analysis during each visit if necessary;\n - Making sure that clients are not going to have any lapses in insurance to avoid breaks in PrEP intake;\n - A test for Hepatitis C once a year;\n![](https://steemitimages.com/DQmW1D5VZ4Z2Fj9Ceej1MaRSbBqDZcXp84FrdJZXNCAuFAh/image.png)\n _Figure 2 —Quarterly STI Tests: delayed and detected. Source: Cohen et al. 2016 Quarterly STI Screening Optimizes STI Detection Among PrEP Users in the Demo Project_\n\nSTI tests are made more often than recommended by the CDC, as the clinic offers PrEP to people with high sexual activity. On the graph (Figure 2) presented by Dr. Stephanie Cohen of the San Francisco Department of Public Health, you could see how many bacterial infections are missed when clients tested every six months — a diagnosis and treatment of 20% −40% of STIs was delayed.\n\nThe later doctors diagnose an STI, the higher the chances of transmitting this infection to other people. Pierre-Cedric supplements these statistics — even when testing for STIs during the first visit after starting PrEP, doctors find a substantial amount of infections.\n\nSo Dr. Crouch encourages you to think that there might be some clients who need to get tested every month, depending on their risk factors. So really you want to tailor this to the client and also encourage more frequent testing, and not wait every six months to test somebody.\n\nTherefore, the instructor says, the clinical recommendations are good, but they need to be personalized. It is not necessary to do an analysis on STIs every three months to a person who reliably lives in a monogamous partnership, and vice versa someone from a high-risk group should be invited to perform monthly blood tests.\n\nClinical practice guidelines for PrEP are available for download at the US Centers for Disease Control and Prevention website — [https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf](https://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf)\n\nThis overview of the lecture “Recommendations for the introduction of PrEP in the community” came to an end. The lecture turned out to be voluminous, saturated with information. I hope you found it useful. We thank Dr. Pierre-Tsederik Kruch and the entire PreParing team from the Johns Hopkins University, as well as the Coursera online education platform.\n\nThis overview of the lecture “Community-Based Implementation of CDC PrEP Guidelines” came to an end. The lesson turned out to be some tricky, but we hope you found it useful. Let us thank Dr. Pierre-Cedric Crouch and the PrEParing course team from the Johns Hopkins University, as well as the Coursera online education platform.\n\nWe are waiting for you tomorrow at the lecture “PrEP Pipeline,” which will introduced by the woman you already know, Dr. Neha Pandit from the School of Pharmacy of the University of Maryland.\n\nIf you have not already signed up for the PrEParing course on the Coursera platform — it’s never too late. Just go to [https://www.coursera.org/learn/prep](https://www.coursera.org/learn/prep).\n\nStay with us and stay healthy!\n\nP. S. The original article was posted on the [Life4me+ mobile app for HIV-positive persons blog](https://life4me.plus/en/blog/).",
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      "body": "@@ -266,8 +266,147 @@\n ys here.\n+%0A%0ABut thank you for writing this up; googling %22statusrsk.org%22 lists this post as the fourth entry (and is in fact what brought me here : ).\n",
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      "body": "Yep, got the same email. This ICO bubble is the same exact thing as the dot-com bubble of the Y2K era. I'm patiently holding off on buying any tokens during this speculative time: the house always wins, and most times it's in completely dishonest ways like these guys here.",
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      "body": "It is a scam.   I fell for it, sent them some ETH and never received the tokens.    What convinced me was the Telegram demo,  which is actually pretty interesting.    The thing I don't get is why they don't just send the tokens.    Why go through all that effort and not send out a worthless token?",
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      "permlink": "hiv-pre-exposure-prophylaxis-prep-online-course-at-coursera-review-day-10-of-42",
      "title": "HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 10 of 42.",
      "body": "![](https://steemitimages.com/DQmc3t2WWiT6Kq3hwTa5NwBU8qKjfADVm1pJucLsBfenT3U/image.png)\n\nThe third lecture of the PrEParing course second week is “Emerging Data/Ongoing Trials for PrEP,” introduced by Neha Pandit, Associate Professor of Practical Pharmacology at the School of Pharmacy at the University of Maryland (USA).\n\nThere are three categories currently investigational products for HIV pre-exposure prophylaxis are broken down into three categories:\n\n- Which have already been approved for use as part of antiretroviral therapy;\n- New antiretroviral drugs;\n- Already approved as another class of medicines;\n\nAlso, scientists are trying to develop various modalities for how these drugs are administered including vaginal and rectal rings, gels, self-dissolving films, long-acting soft implants, solutions for the rectal douche.\n\nThe only drug that has already been approved by the US Food and Drug Administration (FDA) for PrEP is Truvada — a combination of tenofovir disoproxil fumarate and emtricitabine. Let’s consider the molecules with which researchers connect the future of PrEP.\n\n## TAF\nTenofovir disoproxil fumarate or TDF is a prodrug for TFV which is tenofovir. TDF requires a transformation so that the medicine begins to work.\n![](https://steemitimages.com/DQmXYLKki9ibKhLwsruaofawYLJUR38WmyNaqQpzciTFLNx/image.png)\n_Figure 1 — TDF and TAF pharmacokinetics in blood plasma and inside the lymphocyte. Source: Mills A, et al. J Acquir Immune Defic Syndr 2015; 69(4):439-45._\n\nWhat you can see from Figure 1 is that TDF is transformed to tenofovir in the plasma and then also transformed to more tenofovir inside the lymphocyte. TAF, or tenofovir alafenamide, has lower levels of tenofovir in the plasma but achieves a higher concentration of tenofovir in the lymphocyte or where the side of action is.\n\nIt turns out that TAF blocks HIV while its blood plasma levels much lower than TDF, which means less toxicity for the liver and kidneys. Researchers aspire to use this TAF feature to develop a drug for PrEP with minimal toxicity. One of the factors to take into consideration is the concentration of both of these medications in mucosal tissue of the mouth, genitals, and rectum where the drug reliably protects the body against HIV exposure.\n![](https://steemitimages.com/DQmcHPBWCZNS4X3Hm7KTqtLuRxxyEm1VGfsN1xuM9QzZvqo/image.png)\n_Figure 2 — Concentration distribution for TDF and TAF in the mucosal tissues of the vagina, cervix and rectum. Source: CROI 2016 Garrett KL, et al. Abstract 102LB Patterson KB, et al. Sci Transl Med 2011;3:112re4._\n\nSo we know that TAF achieves higher concentration within the cell than TDF does. But what happens in mucosal tissues? Take a look at the chart (Figure 2) — the concentration of TAF in the mucous membranes of the vagina, cervix, and rectum is lower than TDF. Rectum levels are of red and green color since TDF reaches high concentrations in this tissue.\n\nHence TDF is better than TAF reaches high levels in mucosal tissues and is probably better suited for PrEP, although TAF is much less toxic.\n\nBut researchers don’t give up, conducting a study for TAF as PrEP on twelve monkeys, six of which receive PrEP as a combination of TAF and emtricitabine (FTC), and the other six do not receive PrEP. These monkeys are periodically injected into the rectum with a solution of the simian/human immunodeficiency virus (SHIV).\n\nThe result is striking — none of those primates that were treated with PrEP actually caught the virus, while six individuals who did not receive PrEP became SHIV-positive. The researchers went further and turned to the third phase of a clinical trial recruiting transgender women and men who have sex with men (MSM).\n\n## Maraviroc\nLast year, a report on the second phase of the clinical trial of Maraviroc for PrEP was published. The investigators tested Maraviroc on 406 men who have sex with men (MSM). Impressive results are already available — five of the subjects caught HIV. Four of them are likely due to noncompliance whereas the one who was compliant to the medication though develop HIV did not have any resistance to maraviroc.\n\nAnother study of Maraviroc as PrEP was done in 188 females Maraviroc, not a single case of HIV transmission was reported.\n\nThe Pharmacokinetics of Maraviroc shows a decreased mucosal tissue concentrations, perhaps a combination with another substance will block HIV better, similar to how tenofovir and emtricitabine are given.\n\n## Cabotegravir\nThe study of cabotegravir for PrEP conducted ingeniously:\n\n- first, participants were prescribed 30 mg of cabotegravir once a day orally (tablets) for four weeks;\n- next, they were provided with injections of 800 mg of Cabotegravir intramuscularly every 12 weeks, for three doses.\n\n127 of the low-risk group were involved in the study where 106 of them were prescribed cabotegravir as PrEP. Transmission of HIV occurred only in one participant. After the study, the subjects were asked to answer the question:\n\n>“Which method would they prefer to receive PrEP: as a daily tablet or injection every 12 weeks?”\n\n62% of the subjects would prefer injections, 23% reported that both methods of PrEP are equally convenient.\n\n## Dapivirine\nDapivirine is a new non-nucleoside reverse transcriptase inhibitor, approved recently by FDA for HIV treatment. For PrEP it comes as a vaginal ring with 25 mg of dapivirine inserted monthly.\n\nThe concentrations of Dapivirine achieve its effective level 8 hours after insertion into vagina. This advantage over oral PrEP medications, which are able to reach sufficient levels in mucosal tissues after 2-7 days. Besides, the ring forms a locus of a high HIV-blocking substance concentration in mucosal tissues of the vagina, without exposing internal organs to toxic effects.\n\nTwo coextending clinical trials were conducted for the study of dapivirine as PrEP. The most comprehensive of them involved 2,629 African-American women. Half of them were offered to use vaginal rings with dapivirine, the other half prescribed vaginal rings with a placebo (without dapivirine).\n\nFinally, researchers reported 168 cases of HIV transmission, where 71 of them were in the dapivirine group, and 97 cases in the placebo group. The reduction in the risk of HIV transmission among women prescribed vaginal rings with dapivirine was 27%.\n\nIn the study report, an interesting finding was described — almost all women whose PrEP was ineffective were younger than 21 years. Researchers suggest several reasons for the difference in age groups:\n\nModels of sexual behavior;\n- Frequency of sexual acts;\n- Number of sexual partners;\n- Age of sexual partners;\n- Vaginal microbiome structure.\n- So understanding why that may have been would be important moving forward.\n\n## VRCO1\nVRCO1 is a neutralizing monoclonal antibody examined to be given as an infusion every two months for PrEP. Neutralizing monoclonal antibodies help the HIV glycoprotein gp120 not binding to CD4-lymphocytes “chemokine” receptors. As a result, the virus loses its ability to bind with the lymphocyte, so HIV reproduction ceases. Similar techniques are explored for the treatment of cancer, diabetes, hereditary diseases.\n\nVRCO1 is currently being studied as PrEP in the MSM population and the women population. It is assumed that this method of PrEP will be more expensive and provided for people in high-risk groups who may not be able to take an oral medication on a daily basis.\n\n## EFdA / MK-8591\nEFdA / MK-8591 is a nucleoside reverse transcriptase inhibitor similar to tenofovir or emtricitabine. The new molecule EFdA / MK-8591 is attractive in virtue of a long half-life so it can potentially be given as PrEP in the form of a tablet every six months or even longer.\n\nThe lesson is coming to an end. Now many new drugs are being studied for pre-exposure prophylaxis with the aim to help overcome non-compliance issues that we see with tenofovir and emtricitabine and to advance tolerability. Medicines for PrEP could potentially be given every 12 weeks or even annually.\n\nSo, Dr. Neha Pandit finished her lecture, and we are waiting for you tomorrow at the lesson “Community-Based Implementation of CDC PrEP Guidelines,” which will be presented by Pierre-Cedric Crouch, the Director of Nursing at Strut San-Francisco AIDS Foundation.\n\nIf you have not already signed up for the PrEParing course on the Coursera platform — it’s never too late. Just go to [https://www.coursera.org/learn/prep](https://www.coursera.org/learn/prep)\n\nP. S. The original article was posted on the [Life4me+ mobile app for HIV-positive persons blog](https://life4me.plus/en/blog/).",
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      "title": "Why I think Status RSK is a scam?",
      "body": "@@ -1,8 +1,453 @@\n+!%5B%5D(https://4.downloader.disk.yandex.ru/disk/2d4cb697e725cd1f58b13af5cad9109fd12d14b312f163084b832a3ee4fc0e1b/5969df8b/psSBY5BtgM5FGaUu0mXe6xw50zee6DLIOAQFsVWz54fAjdFjoURLLAR_Lg1RfhwxTmLze8tH9vHID3ffos3LjQ%253D%253D?uid=0&filename=Screenshot%2520from%25202017-07-15%252008-18-44.png&disposition=inline&hash=&limit=0&content_type=image%252Fpng&fsize=249504&hid=20ab3c03054db654b1c008a2d351d847&media_type=image&tknv=v2&etag=12c0f3e280690cf12dfa95ffff39a4b9)%0A\n Tonight \n",
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      "author": "franchb",
      "permlink": "why-i-think-status-rsk-is-a-scam",
      "title": "Why I think Status RSK is a scam?",
      "body": "Tonight I have got an email about 'Status RSK' ICO.\n\nIt says I was chosen as one of Conony.io user for invitation to a closed Status RSK private tokensale available only for promo-code holders.\n\nTheir web site says it is a Status.im clone, a decentralized chat bot protocol that automatically converts smart contracts into simple chat conversations, compatible with Ethereum but built for the aka \"new Bitcoin smart contract Standart RSK'.\n\nWhy I think this is a scam?\n\n\nBecause their method involves a large set of psychological manipulation\n\n - I set my time zone on Colony.io. They say they found my email on Colony.io. I've got this email late evening, when impulsive behavior is more possible;\n - There are no any information about founders, developers, etc. Only contact email on GMail account.\n - There are a message on their landing site that 32,51% of tokens are already sold. Wow! So I need to buy it immediately? But this number remains from yesterday evening till today 8 a. m. - not even small change. \n - This ICO invites to send money from any wallet, from any exchange, just send promo-code with every transaction. A good idea to get more money from greedy to freebies lame ducks...\n\nAnd more and more and more...\n\nI think this is scam and you should not participate in this ICO.\n\nWhat do you think?",
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      "permlink": "hiv-pre-exposure-prophylaxis-prep-online-course-at-coursera-review-day-9-of-42",
      "title": "HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 9 of 42.",
      "body": "![](https://steemitimages.com/DQma9cBYXgkhVLHgso2A1c5MpReZmZa8RzJLzZqfvRQacjt/image.png)\n\nThe second lecture in this week was \"PrEP: Pharmacodynamics / Pharmacokinetics\" introduced by Neha Pandit, an assistant professor of practical pharmacology at the School of Pharmacy at the University of Maryland (USA).\n\nThe aim of the lesson was to explain the basics of the tenofovir and emtricitabine pharmacodynamics, as well as a mechanism to prevent the transmission of HIV. Also, the instructor will tell about the time to the protective concentration accumulation of the drug in mucosal tissues, sufficient to protect the body from HIV. Finally, the instructor will provide with information on the new medications and administration alternatives already in the approval pipeline for PrEP.\n\nFirst, says Neha, let’s talk about the mechanism of action of tenofovir and emtricitabine — both of these molecules are a component of Truvada, approved by the FDA for HIV pre-exposure prophylaxis.\n\nTenofovir disoproxil fumarate, abbreviated as Tenofovir or TDF, belongs to the class of nucleoside reverse transcriptase inhibitors. Emtricitabine, FTC, belongs to the class of nucleotide reverse transcriptase inhibitors.\n\nTDF and FTC start to work only in the active state. To transform into the active state, they would need to get into the cell. Once a patient takes medication in orally, it then gets absorbed into plasma and then gets converted or pushed into the HIV target cell, such as the lymphocyte, where both emtricitabine and tenofovir undergo a little transformation, named ’phosphorylation,’ using internal cell proteins. Emtricitabine gets converted to emtricitabine 5- triphosphate and tenofovir gets converted to tenofovir diphosphate. Once these medications turn into their active form, they get integrated or incorporated into the HIV DNA, terminating that HIV DNA chain. That’s how it prevents HIV replication from occurring.\n\nNext, the instructor explained the ideal conditions necessary for pre-exposure prophylaxis.\n\n## Tolerance and safety\nLet’s move back a little back and look at the late 90s and early 2000s. Most of the drugs that existed at that time had severe toxic effects to patients and actually should not have been used for a long period. Nowadays, much safer drugs becoming marketed, so that’s budding situation for PrEP comes to play.\n\nTruvada has good tolerability and safety. Studies have shown that in combination, tenofovir and emtricitabine slightly affect the liver and kidneys, in rare cases cause weight loss, and can also cause nausea, vomiting, or diarrhea. Compared with other drugs, the frequency of such incidents of intolerance is much lower. People taking other drugs often complain of depression, hallucinations, skin irritations, local loss of sensitivity. Such adverse drug reactions sometimes encourage skipping pill intake and even stopping the course.\n\nBut the combination of TDF + FTC is devoid of such adverse reactions, and this is good news for PrEP.\n\n## Low pill burden\nLet’s return to the USA. The emergence of new safe drugs that are well tolerated, without serious side effects, has become an ideal situation for discussing PrEP in the professional community. It was necessary to solve one more puzzle to enable the possibility for people without HIV of taking tablets to prevent HIV, — to place therapy in one tablet. After all, until the end of 2000s people had to have drink three or four tablets a day, and at the dawn of antiretroviral therapy, it was necessary to take the pills literally with handfuls several times a day. It would be unthinkable to offer the same form of taking toxic medications for people without HIV. Therefore, professional communities were expecting new breakthroughs from science.\n\nAnd such a breakthrough happened when the Truvada, a combination of emtricitabine and tenofovir, was presented on the market. Studies have shown that for effective prevention of HIV transmission, only one tablet of Truvada per day is sufficient.\n\n## Half-life\nHow had scientists designed antiviral drugs in one tablet achieving high efficacy while taking the pill once a day? They were looking for a way to increase the half-life — the period of time required for the concentration or amount of drug in the body to be reduced by one-half. At the beginning of the lecture, Dr. Pandit said that tenofovir and emtricitabine act only inside the cell. The half-life of tenofovir is 60-150 hours, emtricitabine — 39 hours, thanks to the intracellular transformation of the drug. As we remember — Truvada should be taken once a day, so in the human body there is never happens a drop in concentration more than twice. The concentration of the drug is always 50% or higher since the body will need 39 hours to eliminate more than a half of the phosphorylated active tenofovir from the lymphocyte cells, and at least 60 hours to remove more than a half of the phosphorylated active emtricitabine.\n\nSo, PrEP started to be provided in one tablet, which could be taken once a day.\n\n## High barrier to resistance\nAnother essential demand for pre-exposure prophylaxis is a high impediment to the formation of drug resistance to the drug in the virus. The resistance for tenofovir and emtricitabine is relatively small for the most part. And so those are ideal characteristics for those medications. The study showed that Truvada worked efficiently in the body of macaques, resistant to emtricitabine.\n\n## High concentration in mucous membranes\nAnd the last requirement is whether the drug reaches high levels in the mucosal tissues. Mucosal membranes in the mouth, vagina, and rectum are exposed to the other person’s biological fluids in case of being the receptive anal partner for sexual activity or being an inserted vaginal partner.\n\n![PrEParing-9-1-EN.png](https://steemitimages.com/DQmRANbw92oAPVPwU8VPxKERpxsBsPbS5GFnoX2G1bcEsRq/PrEParing-9-1-EN.png)\n_Figure 1 — AUC Truvada concentrations in mucosa tissues_\n\nThe graph (Figure 1) shows the difference between the AUC-concentrations of tenofovir and emtricitabine in the tissues. The AUC concentration or area under the concentration-time curve (AUC) is the area of ​​the figure bounded by the pharmacokinetic curve of the drug concentration in the tissue at each time point and the coordinate axes. Thus, the numbers that you see on the chart are the total amount of the drug that was in the tissue for 14 days. The more the drug was in the organ’ mucous tissue for 14 days — the more protected from HIV the organ was.\n\nAlthough the plasma concentration was somewhat similar, the differences in concentrations in the vagina are significant. Emitrcitabine works better in the vagina and cervix in women and in seminal vesicles in men. Tenofovir works better in the rectum in humans of both genders. Now it is evident why the combination of two drugs is best suited for PrEP; they build a secure shield against HIV in the mucous membranes of all vulnerable tissues of the body.\n\nIn plasma, the drugs reach the required concentration after two days after initiating the course, in red blood cells (PBMC) — after seven days. Therefore, in theory, to achieve a sufficient concentration in the body, it is necessary to take the drug for at least seven days. In practice, it is advisable to start taking PrEP one month before dangerous contacts happen.\n\nThese days multiple investigational pre-exposure prophylaxis medications are being evaluated. Some of them are already approved antiretroviral drugs that are currently used for HIV treatment are being examined as PrEP like tenofovir alafenamide. There’s also new classes of medications are being evaluated for pre-exposure prophylaxis, that’s noteworthy of neutralizing antibodies.\n\nVarious methods of drug delivery into the body are being studied, such as:\n\n - vaginal rings;\n - anal inserts;\n - rectal gel;\n - vaginal gel;\n - self-dissolving films;\n - implants;\n - long-acting injections;\n - solutions for the rectal douches.\n\nAll things that are relatively early in their stages for evaluation for PrEP. Such techniques and devices can occasionally be used or implanted once a month, six months or a year. The main idea pursued by the authors is to allow a person to avoid the need for daily intake of tablets for PrEP.\n\nThe lesson is over today, and we are waiting for you tomorrow at talk “Emerging Data/Ongoing Trials for PrEP” lecture.\n\nIf you have not already signed up for the PrEParing course on the Coursera platform — it’s never too late. Just go to [https://www.coursera.org/learn/prep](https://www.coursera.org/learn/prep).\n\nP. S. The original article was posted on the [Life4me+ mobile app for HIV-positive persons blog](https://life4me.plus/en/blog/).",
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      "title": "",
      "body": "Hi, @cryptopizza ! What kind of a real hot contend do you prefer? ;)",
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      "body": "Thank you, @playhard . I will post another reviews one per 3-4 days during next two months. Stay healthy!",
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      "body": "Why don't you guys post some real hot content?",
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      "body": "@franchb\nGood Post!\nThanks for sharing.",
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      "title": "HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 8 of 42.",
      "body": "@@ -1305,16 +1305,17 @@\n PEP.%0A%0A##\n+ \n PrEP%0A%0APr\n@@ -1805,16 +1805,17 @@\n ive.%0A%0A##\n+ \n nPEP%0A%0A*N\n@@ -8105,16 +8105,17 @@\n rEP.%0A%0A##\n+ \n Let%E2%80%99s su\n",
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      "title": "HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 8 of 42.",
      "body": "![](https://steemitimages.com/DQmbVdHQWwx3qLGeeaktsLoScJEJGJ5PayV4YHZGM7VJFXY/image.png)\n\nLet continue our journey into HIV prophylaxis with the PrEParing online course introduced by Coursera MOOC platform and Johns Hopkins University. Today is day 8 of 42, and we will be reviewing the lecture “PrEP and nPEP for HIV Prevention: Case Studies.” This lecture was delivered by Dr. Joyce Leitch Jones, Associate Professor of the Department of Infectious Diseases at the Johns Hopkins University School of Medicine (USA).\n\nDr. Jones begins her talk disclosing the conflicts of interests saying she has no conflict of interest, no personal contracts with pharmaceutical companies or other organizations, and the lecture is an independent review of best practices in HIV prevention.\n\nDisclosing the conflict of interests is an integral part of a scientific speech or article, particularly in medicine because it is important for people to accept an honest and up-to-date review of the topic. The presence of contracts with individual stakeholders may distort the real picture. Dr. Jones disclosed there is no conflict of interests so we tend to believe her.\nJoyce begins the lecture with a story about the differences between HIV pre-exposure prophylaxis, PrEP, and nonoccupational post-exposure prophylaxis, nPEP.\n\n##PrEP\n\nPrEP involves a daily intake of an antiretroviral drug before HIV infection for someone without HIV who are at high risk of getting HIV from another person. To prescribe a PrEP course, the doctor makes sure a patient is HIV negative and only then prescribes one pill once a day to prevent possible transmission of HIV in a case of dangerous contact with an HIV-positive individual. The course continues until the risk of HIV transmission is high and as long as patient remain HIV negative.\n\n##nPEP\n\n*Nonoccupational post-exposure prophylaxis*, nPEP, involves taking a combination of antiretroviral medication within 72 hours after exposure to HIV, best as soon as possible. Patients have to take two to three pills a day for 28 days after the exposure and then stop after 28 days. At that point, if the person remains at high risk for HIV infection then the doctor would consider switching the patient to PrEP.\n![](https://steemitimages.com/DQmYrZTkLWgsWnbw1rs24x68kffFtjARcVUjuqHKA4m2QxP/image.png)\n_Figure 1 — Algorithm or evaluating patients who have had a possible nonoccupational exposure to HIV._\n\nIn the next slide, the lecturer shows a slide (Figure 1), which illustrates an algorithm for choosing tactics in case a person immediately came to a doctor after a dangerous contact with an HIV-positive individual. Such an algorithm contrasts prescribing PEP in the case of occupational exposure to HIV among healthcare workers and other persons who work with bodily fluids and are potentially exposed to HIV through their work.\n\n*In the situation of non-occupational risk*, the doctor first determines whether the risk of HIV transmission is substantial or negligible.\n\nFor those patients who are at substantial risk for HIV acquisition, particular risks of substantial exposure to HIV includes exposure of the:\n - vagina;\n - rectum;\n - eye;\n - mouth or other mucous membranes;\n - non-intact skin or percutaneous contact with blood, semen, vaginal secretions, rectal secretions, breast milk or any bodily fluid that is visibly contaminated with blood when the source person is known to be HIV positive.\n\nThe negligible risk for HIV acquisition includes exposure of those same mucous membranes, so vagina, rectum, eye, mouth or other mucous membranes with intact or non-intact skin, or percutaneous contact with bodily secretions that do not pose a risk for HIV transmission. So those bodily secretions include urine, nasal secretions, saliva, sweat or tears if they are not visibly contaminated with blood.\n\nIt does not matter — whether or not the source person is HIV or not, statistics show that the average risk is negligible.\nYou could see from the diagram that in the case of negligible risk nPEP is not recommended. nPEP is prescribed only in case of substantial risk if less than 72 hours have passed since the dangerous contact and it was known that the partner is HIV-positive.\n\nIn the case when a dangerous contact occurred less than 72 hours ago, but the partner’s HIV status is not known, the doctor asks the patient additional questions and makes an individual decision — whether to prescribe nPEP or not.\nSo remember, PrEP is pre, so that means before exposure to HIV, taking Truvada once a day before exposure to HIV versus nPEP which involves taking combination antiretroviral medications within 72 hours after the substantial risk of exposure to HIV.\n\nIn the next few slides, Dr. Jones presented a couple of clinical cases to make us think about the choice — whether the doctor should prescribe PrEP, nPEP or nothing.\n\n>In the first case, a 24-year-old man who had sex with three men and two women one day ago. He engaged in vaginal sex, oral and anal sex in both receptive and insertive intercourse and did not use condoms. The man is unsure of the HIV status of any of his sexual partners and claims that the last HIV test was performed one month ago by the modern 4th generation antigen-antibody test system, the result was negative.What would you recommend to this man? PrEP or nPEP?\n\nLet’s take a look at the algorithm. Does the man have a substantial risk of HIV transmission? Definitely, yes, because he had exposure of his rectum and his mouth, and other mucous membranes so in this case the penis with semen and vaginal secretions. It is unknown whether any of his partners was HIV-positive or not. Since the contact was less than 72 hours and we do not know if there was HIV in the patient’s body at the time of sexual intercourse, the algorithm leads to an individual selection of the prevention strategy. This is where you come to case by case determination.\n\nDr. Joyce Jones recommended thinking about the prevalence of HIV within the community. If this man lives in a place where the prevalence of HIV is high, Joyce would rather prescribe nPEP in this case.\n\nAfter deciding to prescribe nPEP, Joyce would have made an HIV test for this patient, prescribed blood sampling for liver function analysis and serology for hepatitis B, hepatitis C, syphilis, gonorrhea. If there were a woman, a pregnancy test would be required and if the woman is not pregnant — Plan B would be assigned for pregnancy prevention.\n\nThe recommended regimens for nPEP is a combination of two antiretroviral drugs. The first is Truvada — tenofovir disoproxil fumarate and emtricitabine. The second is Raltegravir or Dolutegravir. It will be necessary to make sure the doctor gave a patient adherence counseling. On the other hand, the patient’ responsibility is proper daily pills intake during the 28 days of the nPEP course.\n\nAs Joyce has already noted, if the patient remains dangerous behavior after completing the nPEP course, he or she will be recommended switching to PrEP to reduce the risk of HIV transmission in the future.\n\nDr. Joyce Jones introduced the second clinical case.\n\n>Again a 24-year-old man who had sex with three men and two women three months ago. He reports engaging in the same sexual activity as in the first case, and the last HIV test was made one month ago with a negative result.What would you recommend to this man? PrEP or nPEP?\n\nAgain, let’s return to the algorithm. As in the first case, the risk is substantial. However, the patient asked for a medical consultation much later. Therefore, in this case, nPEP is not recommended.\n\nBut if the HIV test is negative for such a man, the doctor could also prescribe PrEP. To do so, the doctor needs to ask a few questions — does this patient continues or plans unprotected sexual intercourses with several partners? Are there other circumstances in his/her life allowing to be attributed to a high-risk group, such as injecting drug use, commercial sex, or a permanent relationship with an HIV-positive partner? An affirmative answering to one of these questions could potentially benefit for PrEP.\n\n##Let’s sum up.\n\nPrEP is recommended to people of all genders if there is a recent history of:\n - one-time or regular sex with an HIV-positive partner;\n - STI — a sexually transmitted bacterial infection;\n - a high number of sexual partners;\n - an episode of sexual intercourse, in which the condom was not used or used inconsistently;\n - providing commercial sex services;\n - injecting drugs and having an HIV-positive partner who also uses drugs;\n - injecting drugs and sharing injection equipment;\n\nAfter the doctor assesses the risks for acquiring HIV and it looks like the patient could benefit from PrEP, a clinical check-up is necessary.\n\nThe doctor has to ensure that the patient is HIV negative, have no signs and symptoms of acute HIV infection, check renal function, Hepatitis B status. If the patient is clinically eligible, there’s another testing that should be done and other counseling that should be done that is reviewed in the next lectures of the PrEParing online course.\n\nIf no contraindications to PrEP are identified, and the patient gives informed consent, the physician proceeds to provide all of the appropriate supportive services and counseling and risk reduction counseling the next phase of the consultation.\nThat’s a summary for how PrEP is prescribed.\n\nToday the story turned out to be long, and we hope that you read it with unconcealed curiosity and have questions. The instructors of the PrEParing online course and we at the Life4me+ mobile app for HIV-positive persons want you to have a clear understanding of the difference between PrEP and nPEP as methods of preventing HIV infection.\n\nTomorrow you will be the ninth day of the course, a second day of the second module, in which we will immerse ourselves deeper into the PrEP discussing the pharmacokinetics and pharmacodynamics of the Truvada in the human body.\nIf you have not already signed up for the PrEParing course on the Coursera platform — it’s never too late. Just go to [https://www.coursera.org/learn/prep](https://www.coursera.org/learn/prep).\n\nStay with us and stay healthy!\n\nP. S. The original article was posted on the [Life4me+ mobile app for HIV-positive persons blog](https://life4me.plus/en/blog/).",
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      "title": "HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 7 of 42.",
      "body": "<html>\n<p><img src=\"https://cdn-images-1.medium.com/max/1000/1*SS-e862fEnfkzYnu8Fls4w.jpeg\" width=\"1000\" height=\"750\"/></p>\n<p>On the seventh day of the PrEParing MOOC, Coursera online learning platform and John Hopkins School of Nursing propose us to pass an interactive test to check obtained in the first module of knowledge.The participants of the course are obliged not to disclose the tasks and its solutions. So, we suggest that you recall the most important cases about HIV pre-exposure prophylaxis (PrEP) strategies.Try to formulate your answers to the questions:</p>\n<ul>\n  <li>What is PrEP?</li>\n  <li>What is the risk of HIV transmission?</li>\n  <li>What is the undetectable viral load in a person living with HIV?</li>\n  <li>If a person has HIV and undetectable viral load in the blood — what are the risks of an HIV-negative person getting HIV in a case of one-time unprotected sexual intercourse with him or her?</li>\n  <li>How does PrEP work in the human body?</li>\n  <li>Is PrEP an experiment or an already proven and approved practice?</li>\n  <li>Are pregnant women allowed take PrEP?</li>\n  <li>Is PrEP an obstacle for the birth planning?</li>\n  <li>re there any particularities of taking PrEP pills?</li>\n  <li>How quickly does PrEP create a barrier against HIV in the tissues of the anal canal and rectum?</li>\n  <li>How quickly does PrEP create a barrier against HIV in the tissues of the vagina?</li>\n  <li>How much does PrEP cost? What are the options?— How to get informed about the ways how PrEP is provided in your country?</li>\n  <li>What highlights of PrEP admission revealed scientists in the study of transgender men and women?</li>\n  <li>Who is considered to be in risk groups?</li>\n  <li>If you cover by PrEP all the people at risk in some community — what changes could be expected in the epidemiological situation? What would happen to the rate of HIV spread in such a community?</li>\n  <li>What is better to use — PrEP or condom?</li>\n  <li>Can I use PrEP and a condom together?</li>\n  <li>Can an HIV-negative person live with an HIV-positive person and regularly engage in unprotected sex in such a couple without a condom and no risk of HIV transmission? When is this possible?</li>\n</ul>\n<p>Try to answer these questions yourself, and we will publish our opinion on the 14th day of the PrEParing course review, so stay tuned!</p>\n<p>Tomorrow we are waiting for the first day of the second module of the online course. If you have not already signed up for the PrEParing course on the Coursera platform, it’s never too late to do it, just follow the link <a href=\"https://www.coursera.org/learn/prep\">https://www.coursera.org/learn/prep</a>.</p>\n<p>Stay with us and stay healthy!</p>\n<p><em>P. S. The original article was posted on the</em> <a href=\"https://life4me.plus/en/blog/\"><em>Life4me+ mobile app for HIV-positive persons blog</em></a><em>.</em></p>\n</html>",
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      "body": "![](https://steemitimages.com/DQmXrvwpGjMrdmL7tfEViPXWRfyLCxEpFKbMPeiHUM8hnmK/image.png)\n\nOn the sixth day of the first week of the PrEParing online course, teachers suggest recalling the lectures of the first module and preparing for a test on HIV pre-exposure prophylaxis.\n\nThe review of the first week of the course was the same as the last lecture, in the form of a dialogue between Shima, the guy we the already know, and Cedric - another man who takes the Truvada as PrEP.\n\nAfter the greetings, the guys go on to discuss the lectures.\n\n> “So what makes PrEP right for someone?” Shima asks.\n\n> “PrEP, in short, is a decision that a person takes for self-defense. A person embraces a personal life view to understanding what risks of getting HIV he or she has. Therefore, if a person is having sex without a condom, injecting drugs or,”— says Cedric.\n\n> “[CROSSTALK] has several sexual partners,” — supports his Shima.\n\n> “That’s why people start to chat with friends, peer consultants, and even PrEP providers, discussing complex details of their lives that potentially putting them at risk of getting HIV. These questions are about how to get PrEP, where to get and how to pay for it. So answering to such questions at the right time and place makes providing PrEP in risk groups more successful.”\n\n> “Yes, I think that it is paramount that you have the opportunity to talk with all possible parties at the time when you make a decision, whether to start PrEP or not. And the central question for all in this circumstances is whether PrEP is effective, does it work? Right?”\n\n> “Right,” laughs Cedric.\n\n> “Yes, people are interested — what’s the evidence behind PrEP? Or is it just an experiment,” says Shima\n\n>  “Exactly.”\n\n>  “People do not understand that PrEP was approved by the FDA five years ago. Scientists have proved that if you take tablets prescribed within the PrEP course every day, if you have adherence to it, then you are protected from HIV with the effectiveness of about 90-99% even in a case of direct contact with an HIV-positive person.”\n\n>  “Yes, it is necessary to educate, telling people how effective the PrEP programs are for HIV prevention.”\n\n>  “Look, taking PrEP for seven days creates a reliable barrier against HIV in the anal tissue, and 21 days builds up that protection in the vaginal tissue. Therefore, it is so important to tell women about PrEP and the peculiarities of its application, in particular for women. It is important for women to understand how PrEP is fit with or without birth control.”\n\n>  “It’s funny when people always mention PrEP as the birth control for HIV. ”\n\n>  “Yes,” laughs Cedric\n\n>  “Because PrEP is much more effective than contraception.”\n\n> “Yes, especially if you take the pill every day, as prescribed by the doctor. For women who already take one tablet a day for birth control, adding another pill for PrEP is not a challenge but will significantly reduce the risk of getting HIV. In this case, a woman is to be protected from both unwanted pregnancy and HIV.”\n\n> “And again we return to the science. Studies show that people of any sex can take PrEP if they feel themselves at a high risk of exposure to HIV in their lives and if they want to protect themselves in such circumstances. It’s not a single study — there have been a lot of such research in the world, and all of them show that the key to the PrEP effectiveness is adherence to the daily intake of pills. Variations in countries are only in the way to obtain PrEP, by what channels, for money or for free. I noticed an interesting thing that in some states, Truvada exists in the form of generics, non-original drugs. In such countries, people buy PrEP for money, and it costs about $0.25.”\n\n> “I heard that there is a website where the availability of PrEP in the world presented,” says Cedric.\n\n>  “Yes, PrePWatch,” — helps Shima.\n\n> “You showed me it earlier, prepwatch.org, there is an interactive map on the site where you can click on the particular country you are interested in and find out how it is handling PrEP.”\n\n> “And see how access to PrEP is regulated in different countries.”\n\n>  “Yes, such information is relevant all over the world, so be sure to check the [PrEPWatch.org](PrEPWatch.org) website.”\n\n“I agree, this is a cool resource. So we finish the first week of the PrEParing course, thank you!” says Shima.\n\nThis is the first module of the PrEParing online course is over, and tomorrow we are about passing the test. Feel free to ask questions and sign up for a PrEParing course at [https://www.coursera.org/learn/prep](https://www.coursera.org/learn/prep).\n\n \nStay with us and stay healthy!\n\nP. S. The original article was posted on the [Life4me+ mobile app for HIV-positive persons blog](https://life4me.plus/en/blog).",
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      "author": "franchb",
      "permlink": "hiv-pre-exposure-prophylaxis-prep-online-course-at-coursera-review-day-5-of-42",
      "title": "HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 5 of 42.",
      "body": "<html>\n<p><img src=\"https://s3.eu-central-1.amazonaws.com/life4me.plus/wlarge/photos/1496140805_592d4c05a85f6.jpeg\" width=\"1000\" height=\"720\"/></p>\n<p>On&nbsp;this day, the lecture was held in&nbsp;the form of&nbsp;a&nbsp;dialogue on&nbsp;the topic “Why did&nbsp;I decide to&nbsp;take PrEP?” between two guys&nbsp;— Shima and Yusuf. Below is&nbsp;the translation of&nbsp;the dialogue with a&nbsp;few abbreviations.</p>\n<blockquote>“How did you first heard about PrEP?”, Shima asks.</blockquote>\n<blockquote>“I&nbsp;was first introduced to&nbsp;the word PrEP through Jack’d,&nbsp;— a&nbsp;mobile online dating application for gays. I&nbsp;noticed that many people with whom&nbsp;I communicated through the application wrote that they were on&nbsp;PrEP and even were putting on&nbsp;their profile that they were PrEP users. It&nbsp;was about three or&nbsp;four years ago. Then I&nbsp;roughly realized that PrEP, it’s something about HIV&nbsp;care, but that was my&nbsp;first introduction to&nbsp;it. ”</blockquote>\n<blockquote>“Cool,”&nbsp;— answers Shima,&nbsp;— “so&nbsp;at&nbsp;one point did you think, maybe this is&nbsp;something&nbsp;I would be&nbsp;interested&nbsp;in?”</blockquote>\n<blockquote>“Let me&nbsp;say&nbsp;I was 19&nbsp;or 20; going onto my&nbsp;sophomore year in&nbsp;college. And so&nbsp;far in&nbsp;the United States, PrEP was seen as&nbsp;something new for LGBT people, for men who have sex with men (MSM). A&nbsp;few years ago PrEP perceived as&nbsp;a&nbsp;peculiar originality. At&nbsp;that time&nbsp;I had a&nbsp;boyfriend, he&nbsp;was my&nbsp;first boyfriend and was a&nbsp;little older than&nbsp;me. The beginning of&nbsp;our relationship was magnificent, but over time, I&nbsp;began to&nbsp;notice that his health was not perfect. He&nbsp;was kind of&nbsp;always in&nbsp;and out of&nbsp;the hospital. But he&nbsp;wasn’t always kind of&nbsp;truthful about&nbsp;it, which was no&nbsp;issue. But I&nbsp;did not consider this a&nbsp;problem because at&nbsp;this age you do&nbsp;not think about HIV. ”</blockquote>\n<blockquote>“Exactly!”</blockquote>\n<blockquote>“But you know that this is&nbsp;not&nbsp;so,” Yusuf complained.</blockquote>\n<blockquote>“You think that you are invincible. That you will not be&nbsp;affected by&nbsp;HIV.”</blockquote>\n<blockquote>“True.”</blockquote>\n<blockquote>“Towards the end of&nbsp;our relationship, one story happened. He&nbsp;again got to&nbsp;the hospital, I&nbsp;ran into one of&nbsp;his friends, and they told&nbsp;me. I&nbsp;was waiting for him at&nbsp;the club, and my&nbsp;friends told me&nbsp;that my&nbsp;friend was in&nbsp;the hospital. From the club, I&nbsp;immediately went to&nbsp;him, got to&nbsp;the nurse department, and accidentally saw his medical history. I&nbsp;should not have done this, but&nbsp;I looked it&nbsp;— there was a&nbsp;diagnosis.”</blockquote>\n<blockquote>“AIDS?”</blockquote>\n<blockquote>“Yes, AIDS. Just imagine, I&nbsp;was still very young and did not fully realize what I&nbsp;see. I&nbsp;knew that something appalling was happening. As&nbsp;for&nbsp;me, too. My&nbsp;boyfriend slept, and&nbsp;I did not want to&nbsp;wake him up&nbsp;to&nbsp;ask questions. Friends who came to&nbsp;the hospital with me&nbsp;urged me&nbsp;to&nbsp;go&nbsp;to&nbsp;the emergency and take an&nbsp;HIV&nbsp;test. I&nbsp;did not do&nbsp;the test that night and did not try to&nbsp;talk to&nbsp;my&nbsp;boyfriend about what&nbsp;I saw because&nbsp;I saw something that&nbsp;I should not have seen. ”</blockquote>\n<blockquote>“Oh&nbsp;yeah.”</blockquote>\n<blockquote>“Yes, but this experience has given me&nbsp;an&nbsp;understanding that I’m vulnerable and that HIV and AIDS can hit everyone. From the outside, you can never understand this; my&nbsp;boyfriend looked healthy. It&nbsp;took me&nbsp;a&nbsp;while to&nbsp;decide, but in&nbsp;the end, I&nbsp;still passed the HIV&nbsp;test, despite the fact that&nbsp;I was frightened, as&nbsp;most of&nbsp;us are afraid. Before the test, I&nbsp;prepared for a&nbsp;long time; it&nbsp;took a&nbsp;lot of&nbsp;mental preparation for me&nbsp;to&nbsp;get tested. And even the providers that&nbsp;I got tested at&nbsp;my&nbsp;college, the University that&nbsp;I was going to&nbsp;at&nbsp;that time. And I&nbsp;feel that they understood and they knew my&nbsp;anxiousness, and they gave me&nbsp;all the information that&nbsp;I needed before the testing, which was great. It&nbsp;made me&nbsp;feel a&nbsp;lot more comfortable. The test result was negative. The medical specialist was an&nbsp;outreach worker, and she noticed that there is&nbsp;a&nbsp;PrEP. My&nbsp;mind works so&nbsp;that as&nbsp;soon as&nbsp;I hear something new, I&nbsp;start to&nbsp;study the question. So&nbsp;I&nbsp;learned what PrEP is&nbsp;and even learned that my&nbsp;insurance company has programs for PrEP and prevention of&nbsp;sexually transmitted infections (STIs). At&nbsp;that time, PrEP was still a&nbsp;whole new practice, and the program was provided by&nbsp;the Kaiser Foundation, offering free STI treatment if&nbsp;you perform PrEP. So&nbsp;I&nbsp;started PrEP, and this continues until now, I’m doing a&nbsp;lot of&nbsp;PrEP advocacy and outreach. Recently, many new programs have appeared in&nbsp;various&nbsp;US medical institutions, and all of&nbsp;them offer PrEP programs that support people’s adherence to&nbsp;taking drugs during PrEP, to&nbsp;visit the therapist once every three months. The incentives for participants in&nbsp;such programs are always different.And so&nbsp;that right there was one. I&nbsp;don’t have to&nbsp;pay copays for my&nbsp;insurance because I&nbsp;am on&nbsp;PrEP with them.”</blockquote>\n<blockquote>“Wow!”</blockquote>\n<blockquote>“Yes, but it&nbsp;does not always happen. Incentives are different everywhere. But the main impetus that moved me&nbsp;— the understanding that many of&nbsp;my&nbsp;friends died of&nbsp;AIDS, I&nbsp;have a&nbsp;lot of&nbsp;friends and a&nbsp;lot of&nbsp;people that are close to&nbsp;me&nbsp;that are HIV&nbsp;infected. Therefore, this is&nbsp;a&nbsp;serious thing, people do&nbsp;lose their lives, and it’s unfortunate because it’s unnecessary for especially youth. So&nbsp;if&nbsp;you do&nbsp;not have HIV, taking one tablet a&nbsp;day can protect you from HIV. ”</blockquote>\n<blockquote>“Yes, for sure,” Shima assists.</blockquote>\n<blockquote>“Or&nbsp;I&nbsp;can choose the path of&nbsp;risky behavior, get HIV and be&nbsp;forced to&nbsp;take all the same pills throughout my&nbsp;life, and if&nbsp;I don’t, it&nbsp;could lead to&nbsp;untimely death. Therefore, my&nbsp;decision is&nbsp;to&nbsp;take PrEP. I&nbsp;accept PrEP for about two years, during this time&nbsp;I took a&nbsp;short break. And the practice of&nbsp;pre-exposure HIV prophylaxis has become part of&nbsp;my&nbsp;life; it’s part of&nbsp;me. ”</blockquote>\n<blockquote>“It&nbsp;is&nbsp;precious that you share your story! Probably, many people have a&nbsp;similar experience,” Shim summed&nbsp;up.</blockquote>\n<blockquote>\"This was a&nbsp;Yusuf’ personal experience of&nbsp;starting pre-exposure HIV&nbsp;prophylaxis. If&nbsp;you have any questions, ask them in&nbsp;the course forum. Thank you for your participation and thank you, Yusuf!\"</blockquote>\n<blockquote>“Thank you!”&nbsp;</blockquote>\n<p>We&nbsp;will join the recommendation of&nbsp;Shima to&nbsp;ask questions&nbsp;— if&nbsp;you have any, feel free to&nbsp;sign up&nbsp;for an&nbsp;online course PrEParing at&nbsp;<a href=\"https://www.coursera.org/learn/prep\">https://www.coursera.org/learn/prep</a> and ask questions on&nbsp;the forum!Stay with&nbsp;us, tomorrow we&nbsp;will sum up&nbsp;the results of&nbsp;the first week and will prepare for the test of&nbsp;the first week.</p>\n<p><em>P. S. The original article was posted on the</em> <a href=\"https://life4me.plus/en/blog/\"><em>Life4me+ mobile app for HIV-positive persons blog</em></a><em>.</em></p>\n</html>",
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      "body": "Thank you. I love London so much and remember the best days I was there.",
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      "permlink": "hiv-pre-exposure-prophylaxis-prep-online-course-at-coursera-review-day-4-of-42",
      "title": "HIV Pre-Exposure Prophylaxis (PrEP) Online Course at Coursera Review. Day 4 of 42.",
      "body": "<html>\n<p><img src=\"https://s3.eu-central-1.amazonaws.com/life4me.plus/wlarge/photos/1494831142_59195026927c1.jpeg\" width=\"1000\" height=\"720\"/></p>\n<p>Today we&nbsp;will talk about the lecture «PrEP Demonstration Projects» read by&nbsp;Chris Beyrer, professor of&nbsp;epidemiology at&nbsp;Bloomberg School of&nbsp;Public Health at&nbsp;Johns Hopkins University.</p>\n<p>Professor Beyrer started the lecture with the question</p>\n<blockquote><em>«Is&nbsp;it&nbsp;possible to&nbsp;achieve a&nbsp;complete control of&nbsp;the HIV&nbsp;epidemic?»</em></blockquote>\n<p>He&nbsp;considered options for answering this question on&nbsp;the graph where HIV incidence with different approaches to&nbsp;control the outbreak was analyzed. Next, the lecturer explained the work of&nbsp;Cremlin and the authors in&nbsp;the AIDS Journal (2013), we&nbsp;he&nbsp;looked at&nbsp;the predictions of&nbsp;HIV incidence per 100 person-years based on&nbsp;mathematical modeling without intervention and with such interventions&nbsp;as:</p>\n<ul>\n  <li>assignment to&nbsp;100% of&nbsp;patients with ART at&nbsp;a&nbsp;CD4 count of&nbsp;200&nbsp;cells;</li>\n  <li>circumcision;</li>\n  <li>early administration of&nbsp;ART immediately after diagnosis;</li>\n  <li>PrEP and behavioral strategies;</li>\n</ul>\n<p>It&nbsp;is&nbsp;worth explaining the meaning of&nbsp;the wording «the occurrence of&nbsp;HIV in&nbsp;the calculation for 100 person-years.» It’s a&nbsp;kind of&nbsp;mathematical generalization to&nbsp;simplify the comparison of&nbsp;data that is&nbsp;obtained from different studies&nbsp;— they observe subjects of&nbsp;different ages, the duration of&nbsp;the studies is&nbsp;also different. It&nbsp;is&nbsp;necessary to&nbsp;bring the data to&nbsp;a&nbsp;single scale for an&nbsp;adequate comparison.</p>\n<p>So, if&nbsp;the HIV incidence was 4&nbsp;per 100 person-years, then in&nbsp;the next year four people out of&nbsp;100 will become HIV-positive.Dr. Beyrer showed that such HIV incidence fell in&nbsp;the «without intervention» series&nbsp;— «PrEP and behavioral strategies,» confirming the hypothesis that providing of&nbsp;PrEP in&nbsp;the risk groups leads to&nbsp;a&nbsp;decrease in&nbsp;HIV transmission and slows down the epidemic.</p>\n<p>Next, the lecturer drew attention to&nbsp;the adherence to&nbsp;taking tablets during PrEP in&nbsp;participants. Often, adherence was low, particularly in&nbsp;transgender women.Another EPIC-NSW study began in&nbsp;March 2016 in&nbsp;the United States.&nbsp;3,700 volunteers from high-risk groups suggested taking PrEP. Of&nbsp;these, 900 people agreed to&nbsp;the study in&nbsp;the first nine weeks.</p>\n<p>A&nbsp;series of&nbsp;studies of&nbsp;PrEP in&nbsp;Thailand in&nbsp;2015-2016 showed levels of&nbsp;voluntary involvement of&nbsp;participants in&nbsp;the PrEP research programs, at&nbsp;the level of&nbsp;44%&nbsp;— 60%. Also, since early 2016, Thailand has a&nbsp;Princess program in&nbsp;Thailand that provides PrEP free of&nbsp;charge to&nbsp;at-risk groups such as&nbsp;MSM and transgender men and women. The involvement in&nbsp;the program in&nbsp;the first months was&nbsp;10%, whereas the three-year program is&nbsp;designed to&nbsp;involve 3,000&nbsp;participants.Another exciting program is&nbsp;a&nbsp;joint project of&nbsp;the Johns Hopkins University, Emory University and the Ministry of&nbsp;Health of&nbsp;Thailand COPE4YMSM, which studies the combined tactics of&nbsp;preventing the spread of&nbsp;HIV among young MSM aged 18-26. It’s not a&nbsp;clinical efficacy study, but an&nbsp;example of&nbsp;a&nbsp;PrEP demonstration project, which became a&nbsp;model of&nbsp;providing PrEP into risk groups. Before the beginning of&nbsp;the research, scientists developed a&nbsp;diagnostic method and rules for including participants in&nbsp;a&nbsp;demonstration project that would allow such a&nbsp;project to&nbsp;be&nbsp;carried out with practical results.</p>\n<p>In&nbsp;the COPE4YMSM study, the investigators analyzed the effectiveness of&nbsp;PrEP along with the cost-effectiveness of&nbsp;interventions. They designed to&nbsp;recruit two groups of&nbsp;tested young MSM without HIV, for 620 people in&nbsp;each. In&nbsp;the one group, PrEP planned to&nbsp;be&nbsp;assigned, and the other group is&nbsp;monitored without the provision of&nbsp;PrEP. The recruitment of&nbsp;the participants took place at&nbsp;the rapid HIV testing and sexually transmitted infection testing centers. A&nbsp;method of&nbsp;attracting subjects&nbsp;— outreach programs and activities in&nbsp;institutions for MSM (gay clubs and others). The inclusion criterion was the absence of&nbsp;HIV and other infections in&nbsp;MSM aged 18-26. The participant, if&nbsp;approached by&nbsp;criteria and signed an&nbsp;informed consent to&nbsp;the study, was included in&nbsp;a&nbsp;random group&nbsp;— with PrEP or&nbsp;without PrEP. The consultants also distributed free condoms and talked about risk reduction programs with all people involved in&nbsp;the program activity. Professor Beyrer was the scientific leader of&nbsp;this study.</p>\n<p>Feedback to&nbsp;monitor adherence to&nbsp;PrEP and informational support was designed in&nbsp;the form of&nbsp;SMS chats. An&nbsp;additional goal of&nbsp;the project was to&nbsp;analyze and describe the connection between the participation of&nbsp;young MSM as&nbsp;sex workers with the risk of&nbsp;getting HIV. As&nbsp;a&nbsp;result, the researchers desired to&nbsp;understand the cumulative cost of&nbsp;the PrEP programs and to&nbsp;calculate the economic effect on&nbsp;savings on&nbsp;future costs of&nbsp;HIV&nbsp;treatment. The fewer people with HIV will be&nbsp;in&nbsp;the country, the lower the future costs of&nbsp;treatment will be&nbsp;expected by&nbsp;the budget of&nbsp;this country.The study is&nbsp;still ongoing, but Chris is&nbsp;ready to&nbsp;share his observations:</p>\n<ul>\n  <li>Among MSM, the maximum risk of&nbsp;getting HIV in&nbsp;small intervals of&nbsp;life;</li>\n  <li>Some men use PrEP for a&nbsp;limited time;</li>\n  <li>40% of&nbsp;young MSM (18-26 years old) in&nbsp;Thailand periodically provide sex services and do&nbsp;not identify themselves as&nbsp;sex workers.</li>\n</ul>\n<p>Are you interested in&nbsp;learning more about the results of&nbsp;the program? Remember the name, COPE4YMSM, and follow the news.</p>\n<p>See you next tomorrow and don’t forget to&nbsp;enroll for the course at&nbsp;<a href=\"https://www.coursera.org/learn/prep\">https://www.coursera.org/learn/prep</a> if&nbsp;you interested in&nbsp;it!</p>\n<p>Stay with&nbsp;us!<br>\n</p>\n<p><em>P. S. The original article was posted on the</em> <a href=\"https://life4me.plus/en/blog/\"><em>Life4me+ mobile app for HIV-positive persons blog</em></a><em>.</em></p>\n</html>",
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