Frontiers in reproductive health最新文献

{"title":"Identification of deleterious variants associated with male infertility genes in a cohort of idiopathic hypospermatogenesis patients.","authors":"Nisha Sharma, Ashutosh Halder, Seema Kaushal, Manoj Kumar, Manish Jain","doi":"10.3389/frph.2024.1494585","DOIUrl":"10.3389/frph.2024.1494585","url":null,"abstract":"<p><strong>Introduction: </strong>Hypospermatogenesis is a common histopathological subtype of non-obstructive azoospermia and is characterized by a decrease in the total number of germ cells within the seminiferous tubule as a result of spermatogenic failure. Determination of genetic factors before intracytoplasmic sperm injection can prevent the inheritance of these factors, as hypospermatogenesis patients gives high successful sperm retrieval rate. This study aimed to identify the structural variants associated with idiopathic hypospermatogenesis (iHS) by analyzing patient cohorts diagnosed with azoospermia using whole exome sequencing.</p><p><strong>Methods: </strong>It is a hospital-based observational study in which patients reporting with azoospermia due to spermatogenic failure were recruited prospectively. Comprehensive clinical history, blood samples, semen analysis parameters, and reproductive endocrine evaluation reports of 51 hypospermatogenesis patients were collected. The known genetic causes were investigated using XY fluorescent <i>in situ</i> hybridization and Yq microdeletion for exclusion. Whole exome sequencing was performed, and the data of 42 iHS patients was analyzed to identify single nucleotide variants associated with diagnostically important male infertility genes.</p><p><strong>Results: </strong>Genomic analysis of SNVs identified rare deleterious candidate variants in <i>CFTR</i> (c.1265C>T; p.Ser422Phe), <i>CYP21A2</i> (c.955C>T; p.Gln319Glu), <i>SRD5A2</i> (c.737G>A; p.Arg245Gln), <i>LHCGR</i> (c.378A>C; p.Lys126Asn) and <i>AR</i> (c.2179C>A; p.Arg727Ser) genes associated with 7/42 idiopathic hypospermatogenesis patients. In silico analysis of variants shows deleterious and probably damaging effects on canonical transcripts of the genes.</p><p><strong>Discussion: </strong>This exploratory genomic analysis conducted on idiopathic hypospermatogenesis patients shows prevalence of rare deleterious candidate variants in genes associated with human male infertility. The candidate variants in idiopathic hypospermatogenesis patients are heterozygous and genotypically associated with syndromic male infertility. The symptomatic heterozygosity leading to mild spermatogenic failure resulting in hypospermatogenesis points towards a multifactorial etiology of the disease. This study justifies the importance of genetic screening of idiopathic hypospermatogenesis patients for the presence of structural variants in known human male infertility genes.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1494585"},"PeriodicalIF":2.3,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739308/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143017577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Critical appraisal and narrative review of the literature in IVF/ICSI patients with adenomyosis and endometriosis.","authors":"Ramazan Mercan, Can Benlioglu, Gulumser Ece Aksakal","doi":"10.3389/frph.2024.1525705","DOIUrl":"https://doi.org/10.3389/frph.2024.1525705","url":null,"abstract":"<p><p>Endometriosis and adenomyosis are prevalent causes of infertility, often coexisting in a significant proportion of patients. Although endometriosis typically does not negatively impact assisted reproductive technology (ART) outcomes, the presence of coexisting adenomyosis, mainly non-severe external forms, may slightly influence IVF/ICSI success rates. However, this impact is often minimal and may result in insignificant changes in statistical analyses. Recent studies underscore the critical role of accurate diagnostic techniques, such as ultrasound or MRI, in identifying severe adenomyosis characteristics, including diffuse involvement with junctional zone participation. This precise delineation is reassuring, as it is essential for tailoring assisted reproductive technology (ART) strategies to enhance success rates and reduce the confounding effects of adenomyosis, particularly when it coexists with endometriosis. Strategic approaches, such as ultralong GnRH agonist protocols or freeze-all strategies, may provide advantages in these scenarios. However, the need for extensive research is vital to understanding the complex interactions between endometriosis, adenomyosis, and ART outcomes. This ongoing exploration is particularly important in cases where coexisting adenomyosis might not significantly influence statistical results.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1525705"},"PeriodicalIF":2.3,"publicationDate":"2024-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11703904/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: Participant characteristics and biological markers for endometriosis diagnosis or prediction of treatment response.","authors":"Amy L Shafrir, Philippa T K Saunders","doi":"10.3389/frph.2024.1487745","DOIUrl":"10.3389/frph.2024.1487745","url":null,"abstract":"","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1487745"},"PeriodicalIF":2.3,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693682/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The magnitude of casual sex and associated factors among students at Debre Berhan University.","authors":"Tsega Mathewos, Esubalew Tesfahun, Muluken Tessema Aemiro, Tadesse Mamo Dejene","doi":"10.3389/frph.2024.1491617","DOIUrl":"10.3389/frph.2024.1491617","url":null,"abstract":"<p><strong>Background: </strong>Today's youth are adopting a new trend: casual sex. College students are expected to engage in a range of potentially harmful sexual activities, such as casual sex. Numerous factors can lead students to engage in casual sexual encounters. However, there has been limited research on the prevalence of casual sex and related issues in higher education institutions in Ethiopia.</p><p><strong>Objective: </strong>To assess the prevalence of casual sex and its associated factors among regular undergraduate students at Debre Berhan University in 2023.</p><p><strong>Methods: </strong>From 15 May 2023, to 30 May 2023, regular undergraduate students from Debre Berhan University participated in a cross-sectional study. A total of 512 samples were collected using a multistage sampling technique. Subsequently, a simple random sampling technique was employed to select the students, with a proportionate allocation of samples distributed to randomly selected colleges, departments, and academic years. The data were collected using a structured, pretested, and self-administered questionnaire. Once the data were imported into Epi-data version 4.6 and exported to SPSS version 20 for analysis, frequencies, percentages, and tables were generated. Bivariate and multivariate logistic regression models were used to identify characteristics associated with casual sex.</p><p><strong>Results: </strong>The prevalence of casual sex among regular undergraduate students at Debre Berhan University was 31.0% 95% CI (27.2-34.6). Several factors were significantly associated with casual sex. These included students from urban areas [AOR: 2.95; 95% CI (1.66-5.24)], students with poor academic performance [AOR: 2.81; 95% CI (1.51-5.22)], alcohol consumption [AOR: 4.59; 95% CI (2.60-8.12)], attending nightclubs [AOR: 2.75; 95% CI (1.47-5.16)], watching pornography [AOR: 2.59; 95% CI (1.47-5.16)], and peer pressure [AOR: 2.24; 95% CI (1.38-3.65)].</p><p><strong>Conclusion: </strong>The prevalence of casual sex was high among Debre Berhan University students. In order to lessen the negative effects of casual sex practices, this study found predictors that can be avoided through various interventions. Key preventative measures include improving student academic performance, providing engaging and free entertainment, restricting access to pornographic websites on university Wi-Fi, and employing peer educators.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1491617"},"PeriodicalIF":2.3,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attitudes and practices regarding contraception among male students in a Nigerian tertiary educational institution: a cross-sectional study.","authors":"Awawu G Nmadu, Jeremiah Musa, Istifanus A Joshua, Adegboyega M Oyefabi, Nafisat O Usman, Bilkisu Nwankwo, Tukur Dahiru","doi":"10.3389/frph.2024.1439900","DOIUrl":"10.3389/frph.2024.1439900","url":null,"abstract":"<p><strong>Objectives: </strong>Limited data exists on attitudes and practices of young men in tertiary institutions towards contraception. This study assesses attitudes and practices regarding contraception among male students in a tertiary educational institution in northwestern Nigeria, identifying factors influencing these attitudes.</p><p><strong>Methods: </strong>This cross-sectional study conducted from July to August 2021 at Kaduna Polytechnic, Nigeria, involved 160 male students chosen via multistage sampling. Structured questionnaires gathered information on socio-demographic characteristics, awareness, attitudes, and contraceptive practices. Analysis utilized SPSS version 23.0, employing descriptive statistics, bivariate, and multivariable logistic regression analyses to determine significant factors influencing contraception attitudes.</p><p><strong>Results: </strong>Findings revealed a mean respondent age of 25.4 ± 3.5 years, with most being single (71.3%) and 51.2% sexually active. While awareness of contraceptives was high (85.6%), almost half (46.7%) exhibited negative attitudes towards contraception. Common concerns included reliability, impact on sexual pleasure, and traditional gender norms. Only 35.8% had ever used contraception, primarily using withdrawal and male condoms. Significant factors influencing positive attitudes included being aged 18-24 years compared to 26-35 years (AOR = 2.66, 95% CI: 1.22-5.82).</p><p><strong>Conclusion: </strong>Culturally sensitive interventions are vital for improving negative attitudes and low contraceptive use among male Nigerian youth.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1439900"},"PeriodicalIF":2.3,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11693658/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Provider views on vasectomy: cultural, gender, and political elements of Men's decisions to seek publicly funded services.","authors":"Michelle Teti, Denise Raybon, Stephanie Spitz, Shelby Webb, Jacki Witt, Kristin Metcalf-Wilson","doi":"10.3389/frph.2024.1386244","DOIUrl":"10.3389/frph.2024.1386244","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence suggests a new demand for vasectomies following the Supreme Court's Dobbs v. Jackson Women's Health Organization [597 U.S. 215 (2022), (Dobbs)]. Vasectomies are safer and more cost-effective than tubal sterilization. Understanding how to support men's use of this procedure is important to improving sexual and reproductive health and wellbeing (SRHW). This study is an exploration of health care providers' perspectives on the gender, cultural and political influences on vasectomies at Title X-funded clinics across all regions of the US.</p><p><strong>Methods: </strong>Providers or health services staff (<i>N</i> = 21) at Title X-funded settings currently offering vasectomy services in their own clinics or via referral were recruited using list serve and email outreach. Participants took part in one-on-one or small group interviews about vasectomy procedures, patient experiences, and trends. A thematic analysis of interview transcripts through an iterative process of reviewing, note-taking, and discussing data assessed provider views on patient cultural, gender, and political vasectomy influences.</p><p><strong>Results: </strong>Qualitative interviews yielded four themes related to participant access to services, including income challenges, language barriers, medical distrust, and societal gender roles that stressed women's responsibility for contraception. Two additional themes focused on men's fear of losing reproductive health options and desire to \"step up\" to do their part to prevent unplanned pregnancies.</p><p><strong>Discussion: </strong>Interviewees stressed that vasectomy was for everyone but identified sub-groups of men who still faced logistical and social access challenges to the procedure. Providers also believed that men were concerned over reproductive justice in the US and wanted to do their part to help prevent unplanned pregnancies. They thought that the Dobbs decision may mark a turning point in reproductive care that could ultimately better public health initiatives and overall SRHW by including men in the conversation. Vasectomy education, marketing-along with policy changes that ease access, can support this goal.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1386244"},"PeriodicalIF":2.3,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11688344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916055","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proposals for integrated public management of the menopausal transition and postmenopause through Spanish women's experiences: a qualitative study.","authors":"Clara Selva","doi":"10.3389/frph.2024.1483267","DOIUrl":"10.3389/frph.2024.1483267","url":null,"abstract":"<p><strong>Introduction: </strong>In Spain, legislation protecting women during the menopausal transition and postmenopause is still in its early stages. For public policies to be effective, it is essential that their design, implementation, and evaluation actively involve women going through this stage. Only from their experience and perspective can the impact of measures be maximized and ensure that they truly respond to their needs and realities. The goal of this article is to identify and analyze proposals for action that public organizations in Spain could undertake to improve the management of and transition through menopause. On the basis of the initiatives identified through women's narratives, this study aims to establish a solid basis for the inclusion of future governmental policies and practices in Spain. Adapting to the economic conditions and sociocultural aspects specific to each region can stimulate reflection and debate on their policies regarding menopause.</p><p><strong>Methods: </strong>This qualitative study, which was conducted in Spain, was based on 20 semistructured interviews with women who had experienced physiological and symptomatic menopause in the last five years, were postmenopausal, and were actively employed. The interviews were audio-recorded, transcribed, and analyzed following an inductive thematic analysis.</p><p><strong>Results: </strong>The stories of the interviewees indicate three categories of government action comprising a set of specific measures. More specifically, the categories relate to: (a) proposals for accompaniment and social awareness, (b) educational and training proposals, and (c) political and regulatory proposals.</p><p><strong>Conclusions: </strong>This study identifies governmental proposals and specific actions to improve support for the menopausal transition and postmenopause in Spain. While its findings may be applicable to other countries, further research is needed to explore how they could be adapted to the different socioeconomic and cultural realities of those contexts. Ultimately, the proposals presented lay the groundwork for developing public policies and laws that respond to the needs of women, improving their well-being and promoting gender equity in public health.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1483267"},"PeriodicalIF":2.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683108/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142907997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and projections of the burden of disease for male infertility in China from 1990 to 2021: an analysis from the Global Burden of Disease 2021 study.","authors":"Ran Xu, Xin-Jun Wang, Qing-Cheng Lin, Yan-Ting Zhuang, Qing-Ying Zhou, Nai-Fen Xu, Ding-Qin Zheng","doi":"10.3389/frph.2024.1501675","DOIUrl":"10.3389/frph.2024.1501675","url":null,"abstract":"<p><strong>Background: </strong>Currently, male infertility represents a serious disease burden worldwide, and China is one of the most affected countries. The aim of this study was to examine the evolution of the disease burden of male infertility in China during the period 1990-2021 and to project the trend for 2022-2036.</p><p><strong>Methods: </strong>By screening and processing data from the Global Burden of Disease 2021, this study obtained data on the prevalence, disability-adjusted life years and corresponding rates and age-standardised rates of male infertility between 1990 and 2021. To assess the trend in the burden of male infertility over the past 30 years, the annual percentage change and the average annual percentage change were calculated from the above data using Joinpoint regression models. In addition, age-period-cohort models were used to estimate the independent effects of age, period and cohort factors on male infertility, and Bayesian projection models were used to predict the trend in the disease over the next 15 years.</p><p><strong>Result: </strong>In both 1990 and 2021, the burden of male infertility tended to increase and then decrease with age, with the heaviest burden in the 35-39 age group. Meanwhile, the Joinpoint model found statistically significant average annual percentage changes in age-standardised prevalence and age-standardised disability-adjusted life years of 0.14% and 0.19%, respectively. In addition, the trend for both was a gradual increase over time until 1994 and a gradual decrease over time after 1994. In the age-period-cohort analysis model, age, period and cohort effects indicated that 35-39 years, 1997-2001 and 1945-1949 were the years with the highest risk of male infertility. Finally, the Bayesian projection model suggested that the disease burden of male infertility in China would show a decreasing trend over the next 15 years.</p><p><strong>Conclusion: </strong>From 1990 to 2021, the disease burden of male infertility in China generally increased. However, thanks to a number of factors, including China's proactive health policies and effective management, the burden of disease has continued to decrease in the last decade and is projected to continue declining from 2022 to 2036. To sustain this positive trend, it remains essential for China to maintain and strengthen effective management and control of male infertility.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1501675"},"PeriodicalIF":2.3,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11683063/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142908067","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The factors associated with teenage pregnancy among young women aged between 15 and 19 years in Rwanda: a retrospective cross-sectional study on the Rwanda Demographic Health Survey 2019-2020.","authors":"Felix Nduhuye, Emmanuel Kubana, Stella Matutina, David Mwesigye, Athanase Munyaneza, Laetitia Nyirazinyoye","doi":"10.3389/frph.2024.1453933","DOIUrl":"10.3389/frph.2024.1453933","url":null,"abstract":"<p><strong>Background: </strong>Teenage pregnancy is a significant public health issue and is strongly associated with risky sexual behaviors such as early sexual initiation, unprotected sex, and multiple sexual partners. According to the 2014 World Health Organization report, 11% of all births worldwide were to teenagers aged 15-19 years, with more than 95% of these pregnancies occurring in low- and middle-income countries, particularly in sub-Saharan Africa, which bears much of this burden. In Rwanda, the prevalence of teenage pregnancy has risen from 4.1% in 2005 to 7.3% in 2014, indicating a growing concern. However, there is limited and inconsistent evidence on the factors contributing to teenage pregnancy. Hence, our study aimed to investigate the factors associated with teenage pregnancy. This research seeks to provide valuable insights for targeted interventions, which are urgently needed in light of the increasing rates.</p><p><strong>Methods: </strong>We employed a cross-sectional study design, utilizing data from the 2019/2020 Rwanda Demographic Health Survey of 3,258 eligible participants aged 15-19 years. To identify factors associated with teenage pregnancy, we performed a bivariate logistic regression analysis. The significant variables from the bivariate analysis were then exported into multivariate logistic regression models, with the results presented as odds ratios (ORs) along with 95% confidence intervals (CIs) and a significance threshold set at 5%.</p><p><strong>Results: </strong>Our findings indicated that teenagers aged 18-19 years were more likely to experience pregnancy compared to those younger than 17 (OR = 4.2; 95% CI: 2.16-8.37). Adolescents who had engaged in sexual activity 95 times or more had a significantly higher likelihood of becoming pregnant than those with less frequent sexual activity (OR = 13.53; 95% CI: 5.21-35.12). Furthermore, adolescents with parents with a secondary education were 80% less likely to become pregnant compared to those with parents with a primary or no education (OR = 0.2; 95% CI: 0.07-0.63).</p><p><strong>Conclusion: </strong>Our study revealed that teenage pregnancy is shaped by several individual factors including age and sexual behavior, along with parental education levels. These findings underscore the critical need for targeted sexual education and enhanced family support systems to mitigate teenage pregnancies. Further, longitudinal studies are essential for establishing causality and guiding effective policy development.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1453933"},"PeriodicalIF":2.3,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671394/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Disparities in PrEP use and unmet need across PEPFAR-supported programs: doubling down on prevention to put people first and end AIDS as a public health threat by 2030.","authors":"Trena I Mukherjee, Mitchell Yep, Megan Koluch, Sisay Alemayehu Abayneh, Gizachew Eyassu, Elizabeth Manfredini, Sara Herbst","doi":"10.3389/frph.2024.1488970","DOIUrl":"10.3389/frph.2024.1488970","url":null,"abstract":"<p><strong>Background: </strong>In 2023, an estimated 1.3 million people newly acquired HIV. In the same year, 3.5 million individuals received pre-exposure prophylaxis (PrEP), falling short of the UNAIDS target of 21.2 million by 2025. With over 90% of global PrEP programming supported by PEPFAR, a better understanding of disparities in PrEP provision is needed to inform PEPFAR's approach to reach and deliver prevention services and achieve UNAIDS 95-95-95 goals in all populations by 2025. The objective of this paper is to assess unmet PrEP need in PEPFAR-supported countries.</p><p><strong>Methods: </strong>We analyzed FY2023 Monitoring, Evaluation, and Reporting (MER) results from 48 PEPFAR-supported countries to calculate PrEP-to-need ratios (PnR) by geography and population. PnR offers an ecological measure to identify disparities and missed opportunities for PrEP programming. PnR was calculated as the ratio of PrEP users to the number of positive HIV tests. PrEP users are defined through new initiations (PrEP_NEW) and re-initiations or continuation (PrEP_CT). HTS_TST_POS measures the number of positive HIV tests and was used as a proxy for new diagnoses. PnR was also calculated using Naomi-estimated 2023 HIV incidence, where available. A higher PnR indicates more PrEP users relative to PrEP need in a population.</p><p><strong>Results: </strong>In FY23, 1,760,888 people initiated PrEP, and 1,736,144 people tested positive for HIV. PnR ranged from 0.12 (India) to 6.46 (Brazil), and 19 (40%) countries had fewer PrEP users than positive HIV tests (PnR <1.0). By population, people 15-24 years old, people who inject drugs, and transgender populations had the highest median PnR. When examining estimated HIV incidence, Mozambique and South Africa reported lower than average PnR and higher than average HIV incidence.</p><p><strong>Conclusion: </strong>PrEP use relative to population need varied greatly by country and subpopulation across PEPFAR programs, suggesting a need for greater advocacy, inclusivity, accessibility, and integrated prevention programming. PnR may be a useful indicator of population PrEP coverage and unmet need, and can inform effective, data-driven, and person-centered PEPFAR prevention programming and policies. Tailoring PrEP scale-up strategies by age, sex, key population, and geography is crucial to achieving UNAIDS targets and ending the AIDS epidemic as a public health threat for all by 2030.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"6 ","pages":"1488970"},"PeriodicalIF":2.3,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11671492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142904148","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}