Following rabies virus (RABV) exposure, a combination of thorough wound washing, multiple-dose vaccine administration and the local infiltration of rabies immune globulin (RIG) are essential components of modern post-exposure prophylaxis (PEP). Although modern cell-culture-based rabies vaccines are increasingly used in many countries, RIG is much less available. The prohibitive cost of polyclonal serum RIG products has prompted a search for alternatives and design of anti-RABV monoclonal antibodies (MAbs) that can be manufactured on a large scale with a consistent potency and lower production costs. Robust in vitro neutralization activity has been demonstrated for the CL184 MAb cocktail, a 1:1 protein mixture of two human anti-RABV MAbs (CR57/CR4098), against a large panel of RABV isolates. In this study, we used a hamster model to evaluate the efficacy of experimental PEP against a lethal challenge. Various doses of CL184 and commercial rabies vaccine were assessed for the ability to protect against lethal infection with representatives of four distinct bat RABV lineages of public health relevance: silver-haired bat (Ln RABV); western canyon bat (Ph RABV); big brown bat (Ef-w1 RABV) and Mexican free-tailed bat RABV (Tb RABV). 42–100% of animals survived bat RABV infection when CL184 (in combination with the vaccine) was administered. A dose-response relationship was observed with decreasing doses of CL184 resulting in increasing mortality. Importantly, CL184 was highly effective in neutralizing and clearing Ph RABV in vivo, even though CR4098 does not neutralize this virus in vitro. By comparison, 19–95% survivorship was observed if human RIG (20 IU/kg) and vaccine were used following challenge with different bat viruses. Based on our results, CL184 represents an efficacious alternative for RIG. Both large-scale and lower cost production could ensure better availability and affordability of this critical life-saving biologic in rabies enzootic countries and as such, significantly contribute to the reduction of human rabies deaths globally.

No description available.

Pre-exposure prophylaxis (PrEP) is an effective tool for preventing human immunodeficiency virus (HIV) acquisition in sexually active at-risk individuals such as men who have sex with men (MSM). The purpose of this study is to examine factors associated with intent to engage in risky sexual behavior among HIV-negative college aged (18-24) MSM who are currently adherent to PrEP or who have expressed interest in the future adoption of PrEP. A multiracial/ethnic sample of 31 men expressing interest in the adoption of PrEP and 6 men currently taking PrEP completed a quantitative survey identifying key themes regarding attitudes towards PrEP and potential behaviors associated with adherence. Themes associated with current adherence to PrEP included protection from HIV infection, the opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Themes associated with potential adoption of PrEP included protection from HIV infection, opportunity to engage in sexual activity with known HIV-positive partners, opportunity to engage in sexual activities with a non-condom HIV prevention method, and perceived protection from sexually transmitted infections. Review found that decreased condom use and increased sexual partners are key themes related to initiation of PrEP, and a decrease in frequency of condom use was indicated among the adherent sample. Other key themes identified include barriers to PrEP implementation and misinformation regarding sexually transmitted infections among the population.

A Profilaxia Pré-exposição ao HIV (PrEP) é uma nova estratégia de prevenção na qual os indivíduos consomem uma combinação de antirretrovirais diariamente para evitar a aquisição do vírus da AIDS. O objetivo deste estudo foi compreender, a partir da experiência dos usuários de PrEP, a produção do processo de individualização e saúde. Analisou-se o conteúdo de discussões de um grupo de usuários de PrEP, e de pessoas interessadas no assunto, numa rede social virtual com predominância de gays, bissexuais e outros homens que fazem sexo com homens. Os resultados e discussão foram distribuídos em três artigos científicos: o primeiro, discute os conflitos da experiência dos usuários no contexto da sociedade do risco e da individualização. O segundo explora a produção das dimensões do desejo e do prazer sexual - mediados pela PrEP - na vida dos indivíduos. O terceiro, aproxima e discute a experiência dos usuários de PrEP com processos identitários autoproduzidos na individualização contemporânea. As considerações finais, por fim, refletem sobre as implicações às repostas sociais e políticas à epidemia de HIV/AIDS no atual contexto de quimioprofilaxias. / HIV Pre-exposure Prophylaxis (PrEP) is a new prevention strategy in which individuals take a daily combination of antiretrovirals in order to prevent acquiring HIV. This study aimed to understand, grounded in PrEP users\' experiences, the production of the individualization process and health. We conducted a discussion-content-analysis of PrEP users, and of interested persons on the subject, in a digital social network. Gays, bisexuals and other Men who have sex with Men accounted for the majority of the group members. Results and discussion were presented in three scientific articles: the first discusses conflicts from the experience of PrEP users in the context of risk society and individualization. The second explores productions of sexual desire and sexual pleasure - mediated by PrEP - on individuals\' lives. The third approaches and discusses PrEP users experiences and self-produced identity processes in contemporary individualization. Final remarks reflects on the implications for social and political responses to the HIV / AIDS epidemic given the current context of chemoprophylaxis.

Introdução: As representações coletivas que alicerçam os ideais de masculinidade hegemônica distanciaram os homens heterossexualmente ativos das respostas à epidemia de HIV ao longo das últimas décadas, o que resultou no aumento da vulnerabilidade desses indivíduos em diversos países do mundo, inclusive no Brasil. Entretanto, a partir do paradigma da prevenção combinada, a Profilaxia Pós-exposição Sexual (PEPsexual), bem como outros métodos baseados no uso de antirretrovirais, torna possível novas formas de gerir os riscos de infecção pelo HIV, ao mesmo tempo em que traz novas questões a serem enfrentadas. Objetivos: O objetivo desta pesquisa é caracterizar os homens heterossexualmente ativos e seus comportamentos sexuais, considerando risco e prevenção à infecção pelo HIV, e explorar os significados atribuídos ao risco de contrair HIV e às formas de gerenciamento de risco entre homens heterossexualmente ativos que buscaram a PEPsexual em serviços em cinco cidades brasileiras. Metodologia: O perfil e o comportamento dos homens foram descritos utilizando a abordagem quantitativa, com dados obtidos das consultas iniciais de PEPsexual registradas em prontuários clínicos. Foram analisados todos os homens atendidos nos serviços nos anos de 2014 e 2015, sendo realizada análise descritiva. O significado do risco e o gerenciamento das vivências foram analisados utilizando a abordagem qualitativa, por meio de entrevistas em profundidade (16) com usuários dos serviços, com foco na situação que levou ao uso do método, bem como as experiências com o uso da PEPsexual. Para a análise dos dados empíricos empregou-se o método de interpretação de sentidos, de acordo com os princípios hermenêuticos-dialéticos. Resultados: Com base nas características descritas no eixo quantitativo, os participantes são, em sua maioria, adultos jovens, com idade média de 31 anos, altamente escolarizados, brancos e sem uso prévio da PEPsexual. A maioria das exposições aconteceu com parceria casual. O uso da camisinha foi mencionado pela maioria dos participantes, no entanto, a falha do preservativo foi o principal motivo pela busca da profilaxia. A maioria dos usuários relatou não conhecer a sorologia da parceria envolvida na exposição sexual, além disso as frequências de testagem sorológica para HIV, Hepatites B e C, Sífilis e Anti-HBs anteriores ao episódio da exposição sexual foram baixas. A análise dos dados qualitativos mostra que a camisinha é o principal e mais acessado método de prevenção à infecção pelo HIV, mas sua efetiva utilização foi condicionada a diversos fatores subjetivos e contextuais. As relações sexuais com parceria estável oferecem maior sensação de proteção, enquanto que a percepção de risco aumenta quando as relações são com parcerias casuais ou em ambientes associados às populações mais vulneráveis à infecção, como profissionais do sexo ou casas de swing. Evitar ou reduzir, ao máximo, o número de relacionamentos extraconjugais, utilizar mais consistentemente o preservativo e buscar informações especializadas emergiram como estratégias amplamente utilizadas pelos participantes. A PEPsexual consistiu numa oportunidade de reflexão acerca da forma de pensar e fazer prevenção não só ao HIV, mas também às outras ISTs. O estigma relacionado ao uso de antirretrovirais e a necessidade de esconder a medicação dos amigos e familiares foram elementos disparadores de autorreflexão acerca das vulnerabilidades pessoais frente à epidemia. Os participantes que planejaram ações concretas e detalhadas de prevenção após uso da PEPsexual foram também aqueles que relataram maior autopercepção do risco individual. Conclusão: As características dos usuários PEPsexual nos cinco serviços investigados revelam que os homens heterossexualmente ativos brancos, altamente escolarizados e jovens são maioria entre aqueles que buscam a profilaxia. No entanto, grande esforço deve ser direcionado às ações de prevenção à infecção pelo HIV entre diferentes segmentos dos homens heterossexualmente ativos, considerando os marcadores sociais de classe, cor, raça e geração. Os ideais de masculinidade hegemônica permearam os discursos de percepção e gerenciamento de risco à infecção pelo vírus. Ações de sensibilização devem ser direcionadas para que tais padrões de masculinidade sejam ressignificados a fim de diminuir a vulnerabilidade dos homens em geral e, mais especificamente, entre os segmentos dos heterossexuais / Introduction: The collective representations that support the ideals of hegemonic masculinity have distanced the heterosexually active men from the responses to the HIV epidemic over the last decades, which has resulted in the increased vulnerability of these individuals in several countries around the world, including Brazil. However, from the new prevention paradigm, Sexual Post-exposure Prophylaxis (PEPsexual), as well as other methods based on the use of antiretrovirals, make possible new ways of managing the risks of HIV infection, while bringing new issues to be addressed. Objectives: The objective of this research is to characterise heterosexually active men and their sexual behaviours, regarding risk and prevention of HIV infection, and to explore the meanings attributed to the risk of contracting HIV and the forms of risk management among heterosexually active men who sought PEPsexual in services in five Brazilian cities. Methodology: The profile and behaviour of the men were described using the quantitative procedure, with data obtained from the initial consultations of sexual PEPs documented in clinical reports. All the records from the men who have searched the services in the years 2014 and 2015 were analysed, and a descriptive analysis was performed. The meaning of risk and the management of the experiences were interpreted using the qualitative approach, through in-depth interviews (16) with users of the services, focusing on the situation that led to the use of the method, as well as the experiences with the use of PEPsexual. For the analysis of the empirical data, the sense interpretation approach was used, according to the hermeneutic-dialectic principles. Results: Based on the characteristics described in the quantitative component, the participants are mostly young adults, with a mean age of 31 years, highly educated, white and without previous use of PEPsexual. Most of the sexual HIV risk behaviours happened with a casual partnership. The use of condoms was mentioned by most of the participants; however, condom failure was the main reason for searching the PEPsexual prophylaxis. Most participants reported not knowing the serology of the partner involved in the sexual encounter and the frequency of serological testing for HIV, Hepatitis B and C, Syphilis and Anti-HBs before the episode of sexual exposure was low. The analysis of qualitative data shows that condoms are the main and most widely used method of HIV prevention, but their effective use has been conditioned by diverse subjective and contextual factors. Stable sexual relations offer a greater sense of protection, while the perception of risk increases when the relationships are with casual partnerships or in environments associated with populations most vulnerable to HIV infection, such as sex workers or swing houses. Avoiding or minimizing the number of extramarital relationships, using condoms more consistently, and seeking specialized information emerged as strategies widely used by participants. PEPsexual consisted of an opportunity for thinking on how to prevent not only HIV but also other STIs. The stigma related to the use of antiretrovirals and the need to hide medication from friends and relatives were self-reflexive triggers about personal vulnerability to the epidemic. Participants who planned concrete and detailed prevention actions after using PEPsexual were also those who reported greater self-perception of individual risk. Conclusion: The characteristics of PEPsexual users in the five services studied reveal that heterosexually active white man, highly educated and young are the majority among those who seek PEPsexual prophylaxis; however, great effort should be focused on actions to prevent HIV infection among different segments of heterosexually active men, regarding the social markers of class, colour, race and generation. The ideals of hegemonic masculinity permeated perceptions and risk management discourses to HIV infection. Preventive actions should be undertaken to replace such masculinity patterns in order to reduce the vulnerability of men in general and, more specifically, among heterosexual segments

A Profilaxia Pré-exposição ao HIV (PrEP) é uma nova estratégia de prevenção na qual os indivíduos consomem uma combinação de antirretrovirais diariamente para evitar a aquisição do vírus da AIDS. O objetivo deste estudo foi compreender, a partir da experiência dos usuários de PrEP, a produção do processo de individualização e saúde. Analisou-se o conteúdo de discussões de um grupo de usuários de PrEP, e de pessoas interessadas no assunto, numa rede social virtual com predominância de gays, bissexuais e outros homens que fazem sexo com homens. Os resultados e discussão foram distribuídos em três artigos científicos: o primeiro, discute os conflitos da experiência dos usuários no contexto da sociedade do risco e da individualização. O segundo explora a produção das dimensões do desejo e do prazer sexual - mediados pela PrEP - na vida dos indivíduos. O terceiro, aproxima e discute a experiência dos usuários de PrEP com processos identitários autoproduzidos na individualização contemporânea. As considerações finais, por fim, refletem sobre as implicações às repostas sociais e políticas à epidemia de HIV/AIDS no atual contexto de quimioprofilaxias. / HIV Pre-exposure Prophylaxis (PrEP) is a new prevention strategy in which individuals take a daily combination of antiretrovirals in order to prevent acquiring HIV. This study aimed to understand, grounded in PrEP users\' experiences, the production of the individualization process and health. We conducted a discussion-content-analysis of PrEP users, and of interested persons on the subject, in a digital social network. Gays, bisexuals and other Men who have sex with Men accounted for the majority of the group members. Results and discussion were presented in three scientific articles: the first discusses conflicts from the experience of PrEP users in the context of risk society and individualization. The second explores productions of sexual desire and sexual pleasure - mediated by PrEP - on individuals\' lives. The third approaches and discusses PrEP users experiences and self-produced identity processes in contemporary individualization. Final remarks reflects on the implications for social and political responses to the HIV / AIDS epidemic given the current context of chemoprophylaxis.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2017-02-22T19:39:50Z No. of bitstreams: 1 Maria M¿nica Paulino do Nascimento.pdf: 1616200 bytes, checksum: 24df1c4dc5ed8f29f91052acd0d438e0 (MD5) / Made available in DSpace on 2017-02-22T19:39:50Z (GMT). No. of bitstreams: 1 Maria M¿nica Paulino do Nascimento.pdf: 1616200 bytes, checksum: 24df1c4dc5ed8f29f91052acd0d438e0 (MD5) Previous issue date: 2016-12-15 / The use of post-exposure prophylaxis after sexual intercourse for women is one of the challenges for the HIV prevention policies, because sociocultural aspects and gender inequalities hamper the appropriation of preventive measures for this population segment. Thus, this study aimed to describe the use of this type of post-exposure prophylaxis for HIV in consensual sexual intercourse between women assisted by public health services in Brazil. This is a cross cutout of a larger study that was conducted from the data of 365 women assisted by four health services from May 2012 to May 2016. Were described characterization variables of women, of the partner in sexual exposure that caused the use of prophylaxis, of the sexual exposure, of the use and the clinical follow-up, being the use categorized as complete or partial. The average age of women was 30.7 years (SD = 9, 5), 32.6% attended complete high school, 28.3% were sex workers, 16.1% owned serodiscordance partnership and 61.4% had not held test anti-HIV before. Sexual exposure occurred for vaginal sexual intercourse with casual partner (68.3%), with serological status unknown (60.1%) and rupture of condom (51.7%). A total of 49.0% of women held only one return query and 72.1% presented adverse effects. Specifically, among those who returned to the service in the period of 29 to 60 days, only 22.2% attended one or two return visits, 15.7% underwent anti-HIV testing and 81.8% underwent complete antiretroviral use. We can affirm that women use post-exposure prophylaxis after sexual exposure completely, but the health services can not retain these women during the period of clinical and serological follow-up, damaging the evaluation of the effectiveness of prophylaxis, pointing out the need for the organization of services and expansion of strategies that may provide greater autonomy for women to use preventive measures. / O uso da profilaxia pós-exposição sexual por mulheres é um dos desafios para as políticas de prevenção da infecção pelo HIV, pois aspectos socioculturais e as desigualdades de gênero dificultam a apropriação de medidas preventivas por este segmento populacional. Assim, este estudo objetivou descrever o uso da profilaxia pós-exposição sexual ao HIV em relações sexuais consentidas entre mulheres atendidas em serviços públicos de saúde no Brasil. Trata-se de um recorte transversal de um estudo maior que foi realizado a partir dos dados de 365 mulheres atendidas em quatro serviços de saúde no período de maio de 2012 a maio de 2016. Foram descritas variáveis de caracterização das mulheres, do parceiro na exposição sexual que ocasionou o uso da profilaxia, da exposição sexual, do uso e do seguimento clínico, sendo o uso categorizado em completo e parcial. A idade média das mulheres foi 30,7 anos (DP=9,5), 32,6 cursaram ensino médio completo, 28,3% eram profissionais do sexo, 16,1% possuíam parceria sorodiscordante e 61,4% não haviam realizado teste anti-HIV anterior. A exposição sexual se deu por relação sexual vaginal com parceiro ocasional (68,3%), com status sorológico desconhecido (60,1%) e rompimento de preservativo (51,7%). Um total de 49,0% das mulheres realizaram apenas uma consulta de retorno e 72,1% apresentaram efeitos adversos. Especificamente entre as que retornaram ao serviço no período de 29 a 60 dias, somente 22,2% compareceram a uma ou duas consultas de retorno, 15,7% realizaram teste anti-HIV e 81,8% realizaram uso completo dos antirretrovirais. Podemos afirmar que mulheres usam de forma completa a profilaxia pós-exposição sexual, porém os serviços de saúde não conseguem reter essas mulheres durante o período de seguimento clínico e sorológico, prejudicando a avaliação da efetividade da profilaxia, apontando a necessidade de organização dos serviços e de ampliação de estratégias que possam proporcionar maior autonomia das mulheres para o uso de medidas preventivas.

Prevention is key to keeping men who have sex with men (MSM) protected from Human Immunodeficiency Virus (HIV). Despite new and innovative HIV prevention resources such as pre-exposure prophylaxis (PrEP), factors such as education level, employment status, number of sexual partners, and access to health resources may inhibit certain populations from using PrEP. The purpose of this cross-sectional study was to examine the association between education level, employment status, number of sexual partners, and access to health resources and the use of PrEP among MSM. The fundamental cause theory was used to examine how socioeconomic barriers are associated with the use of PrEP among MSM in the United States. Secondary data from 217 surveys were collected from the Public Library of Science. Findings from multiple regression analyses indicated that employment status, access to health resources, and number of sexual partners were not associated with use of PrEP among MSM. Those who had at least some high school or a high school diploma were 3.98 times more likely to be likely to extremely likely to use PrEP, compared to those who had less than a high school education (OR = 3.98, p = .048). Those who had some college were 6.91 more likely to be likely to extremely likely to use PrEP, compared to those who had less than a high school education (OR = 6.91, p = .028). Findings may be used to assist public health professionals in identifying factors that prevent the use of PrEP. By addressing these health threats, and social barriers, specialists could have the ability to increase HIV prevention activity in populations that are more susceptible to being infected with HIV and may decrease HIV infections not only within the MSM population but also in other populations.

Exposições acidentais de trabalhadores da saúde a material biológico potencialmente contaminado ocorrem com frequência nas instituições de saúde e em virtude do risco de contaminação pelo HIV, a profilaxia com antirretrovirais pode ser indicada e a adesão ao tratamento é fundamental para a eficácia da prevenção do adoecimento do trabalhador. O objetivo foi construir e validar uma ferramenta educativa visando a adesão à profilaxia antirretroviral após exposição ocupacional de trabalhadores da saúde a material biológico. Este estudo foi realizado em duas fases. A primeira fase trata-se de estudo descritivo com abordagem quantitativa dos dados e a segunda de estudo metodológico. A população foi composta por 32 trabalhadores da saúde, vítimas de acidente de trabalho com material biológico, atendidos em um serviço especializado em exposições ocupacionais de Ribeirão Preto, SP, que receberam indicação de profilaxia com antirretrovirais, no período de agosto/2015 a janeiro/2016. O projeto da pesquisa foi aprovado por Comitê de Ética em Pesquisa sob Protocolo 22342813.9.00005393. Dentre os resultados destaca-se o predomínio do sexo feminino (84,4%), exposições ocupacionais envolvendo sangue (96,9%) e o conhecimento insuficiente dos trabalhadores sobre a exposição ao risco e suas consequências. Constatou-se que 68,8% dos participantes aderiram aos 28 dias de quimioprofilaxia com antirretrovirais e que há relação estatística entre a capacidade de autocuidado com a adesão ao tratamento. A partir dos resultados da primeira fase deste estudo, das evidências científicas, do referencial teórico de autocuidado e de técnicas educativas foi construído o aplicativo denominado Exposição Ocupacional ao HIV, o qual foi validado por 11 especialistas pela técnica Delphi e que julgaram que a ferramenta educativa (aplicativo para celular) tem índices satisfatórios em seus itens informativos e dinâmicos, considerando, assim, o aplicativo válido para ser utilizado com a finalidade de estimular trabalhadores da saúde para realizar autocuidado e aderir ao tratamento com antirretrovirais, quando indicado, após exposição acidental a material biológico potencialmente contaminado / Accidental exposure of healthcare workers to the potentially contaminated biological material often occurs in health institutions. Due the contamination risk by HIV, the antiretroviral prophylaxis can be indicated and the compliance to the treatment is crucial to the prevention effectiveness of the worker\'s falling ill. The objective was to construct and validate an educative tool aiming for the compliance to the antiretroviral prophylaxis after the occupational exposure by the healthcare workers to the biological material. The study conducted in two phases. The first is about a descriptive study with the data quantitative approach, and the second is a methodological study. The population of 32 healthcare workers, victim of an occupational accident with biologic material assisted by a specialized service in occupational exposures from Ribeirao Preto, SP, that received prophylaxis indication with antiretroviral in the period of 2015, August to 2016, January. The research project was approved by the Ethics Committee in researches under the protocol 22342813.9.00005393. Among the results is detached the predominance of the female gender (84,4%), occupational exposure involving blood (96,9%) and the insufficient knowledge of the workers about the biological risk and their consequences. It was found that 68,8% of the participants adhered to the 28 days of chemoprophylaxis with antiretroviral and that there is an statistic relation between self-care capacity with the treatment compliance. From the results of the first phase of this study, from the scientific evidences, the self-care theoretical referential and the educative techniques it was build an app called HIV Occupational Exposure; which was validated by 11 specialists by the Delphi technique, judging the educative tool (cell phone app) with satisfactory indexes in their informative and dynamic items, thus considering the app valid to be used for the purpose of stimulating healthcare workers to perform self-care and compliance to treatment with antiretrovirals when indicated, after accidental exposure to potentially contaminated biological material

La rage entraîne plus de 60,000 décès par an dans le Monde, dont 800 au Cambodge, pays fortement endémique pour la rage canine.La mort survient dans près de 100% des cas de rage, maladie évitable dans presque 100% des cas par l’accès à une prophylaxie post-exposition (PPE) antirabique adéquate et en temps utile. L’amélioration de l’accès à une PPE dans les zones rurales des pays endémiques permettra d’épargner des vies humaines à court terme. Cette thèse en épidémiologie a tiré parti des données collectées auprès des patients consultant au centre antirabique et les chiens testés à l’Institut Pasteur du Cambodge (IPC), Phnom Penh. Suite à un bilan épidémiologique de la situation et des obstacles auxquels sont confrontés les patients cherchant à accéder à la PPE adéquate et en temps utile, elle vise à contribuer à améliorer 1/ l’accès géographique et 2/ l’accès financier à une PPE pour les populations rurales du Cambodge. Nous avons développé une stratégie originale d’identification des poches de populations à haut risque d’incomplétude vaccinale après une exposition potentielle à la rage. Ceci devrait permettre d’améliorer l’accès géographique à la PPE et se concrétiser par l’ouverture en Juillet 2018 d’un centre périphérique de prévention de la rage dans l’Ouest du Cambodge. Cette stratégie d’identification de difficultés d’accès aux soins est applicable à d’autres thématiques de santé, sous certaines conditions. Notre rappel des patients et l’analyse des décès par rage parmi les patients n’ayant pas complété de leur propre chef le protocole PPE de 4 sessions intradermales sur 1 mois ne permettent pas de mettre en évidence une différence de mortalité par rage parmi les patients n’ayant reçu que 3 sessions sur 1 semaine, par rapport à au moins 4 sessions/1mois. Le raccourcissement du protocole à 1 semaine permet de réduire les coûts directs et indirects et l’absence de revenus pendant la durée du traitement en capitale. La mise en place de ce protocole doit s’accompagner d’un suivi d’au moins 6 mois des patients après leur prise en charge initiale. L’ensemble de ces travaux a des implications qui dépassent le cadre du Cambodge: Dans ses recommandations d’Avril 2018, l’OMS recommande désormais ce nouveau protocole IPC– le premier protocole PPE antirabique abrégé à 1 semaine. / Rabies causes more than 60,000 deaths worldwide each year, including 800 in Cambodia, where canine-mediated rabies virus circulates. Death occurs in nearly 100% of rabies cases, a disease which is nearly 100% avoidable by timely and adequate rabies post-exposure prophylaxis (PEP). Improving access to PEP in rural areas of endemic countries will spare human lives in the short term. This epidemiology PhD used the data collected in patients referred to the rabies prevention clinic and tested dogs at Institut Pasteur du Cambodge (IPC), Phnom Penh. After a baseline assessment of access to and obstacles to access timely and adequate PEP in Cambodia, this PhD aims to contribute to improving: 1/ geographical access and 2/ financial access to PEP for rural populations in Cambodia. We developed an original strategy to identify populations with a high risk of PEP noncompletion after a bite by a potentially rabid dog. This should help improve geographical access to PEP following the implementation in July 2018 of a peripheral rabies prevention center in Western Cambodia. This strategy can be applied to identify difficulties in accessing health services relevant to other health issues, under certain conditions. After patient callback and analysis of rabies deaths among those who did and did not complete the 4-sessions/1-month intradermal PEP regimen of their own accord, we were unable to demonstrate a difference in rabies mortality among patients who only received 3 vaccine sessions over the first week compared to those receiving at least 4 sessions/one month. Abridging the protocol to one week would reduce direct and indirect costs and the loss of income during PEP in the Capital. The adoption of this abridged regimen must be associated with a strengthened clinical monitoring system for at least 6 months following patients’ initial PEP.The work presented in this PhD has implications which reach beyond Cambodia: WHO recommends this new IPC regimen – the first approved one-week, abridged rabies PEP regimen – in its April 2018 guidelines.