Facilitators for retaining men who have sex with men in pre-exposure prophylaxis care in real world clinic settings within the United States.

BACKGROUND: Pre-exposure prophylaxis (PrEP) can significantly reduce HIV acquisition especially among communities with high HIV prevalence, including men who have sex with men (MSM). Much research has been finding suboptimal PrEP persistence; however, few studies examine factors that enhance PrEP persistence in real-world settings. METHODS: We interviewed 33 patients who identified as MSM at three different PrEP clinics in three regions of the U.S. (Northeast, South, Midwest). Participants were eligible if they took PrEP and had been retained in care for a minimum of 6 months. Interviews explored social, structural, clinic-level and behavioral factors that influencing PrEP persistence. RESULTS: Through thematic analysis we identified the following factors as promoting PrEP persistence: (1) navigation to reduce out-of-pocket costs of PrEP (structural), (2) social norms that support PrEP use (social), (3) access to LGBTQ + affirming medical providers (clinical), (4) medication as part of a daily routine (behavioral), and (5) facilitation of sexual health agency (belief). DISCUSSION: In this sample, persistence in PrEP care was associated with structural and social supports as well as a high level of perceived internal control over protecting their health by taking PrEP. Patients might benefit from increased access, LGBTQ + affirming medical providers, and communications that emphasize PrEP can promote sexual health.

In utero partial liver resection in the rabbit model: a study on fetal tissue regeneration.

In this study we developed a model of in vivo intrauterine partial liver resection in the fetal rabbit to analyze fetal liver regeneration. After intravenous anesthesia, 12 time-dated pregnant, California rabbits underwent a midline laparotomy and minimal hysterotomy at 24-25 days of gestational age. One fetus was exposed from each pregnant doe and the fetal liver was partially resected. Cesarean sections were performed 24, 48 and 72 h and 4 days after surgery. Three fetuses operated at 24 days of gestational age and 3 fetuses operated at 25 days were alive at retrieval. The fetuses and the sampled livers were weighed at retrieval and fetal liver weight showed a well-maintained value in all cases. Fetal livers were processed for the common histologic stains. Lymphocytes, polymorphonuclear leukocytes and phagocytes were counted from sections obtained in areas close to the edge of resection. Inflammatory cells showed a peculiar pattern of infiltration at different stages of repair, with a constantly increased number of phagocytes peaking 48 h after resection. Fetal liver seems to present a specific pattern of repair that differs from both the adult liver and other fetal tissues healing after injury.