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Saberi P, Mehtani NJ, Sayegh A, Camp CE, Chu C. Understanding HIV Pre-Exposure Prophylaxis Questions of U.S. Health Care Providers: Unique Perspectives from the PrEPline Clinical Teleconsultation Service. Telemed J E Health 2023; 29:376-383. [PMID: 35802493 PMCID: PMC10024264 DOI: 10.1089/tmj.2022.0145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/18/2022] [Accepted: 05/31/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction: Fewer than a quarter of people considered to have factors associated with HIV acquisition are prescribed pre-exposure prophylaxis (PrEP) in the United States. Prior studies demonstrate disparities in provider comfort and knowledge regarding PrEP, suggesting a need for provider capacity building to support widespread PrEP availability. This study examined real-world PrEP clinical questions/cases from providers to a teleconsultation service to identify knowledge gaps and improve PrEP-related training materials and clinical guidelines. Methods: The National Clinician Consultation Center (NCCC) PrEPline provides educational teleconsultation services on clinical decision-making related to PrEP for U.S. health care providers. The NCCC PrEP consultation data collected between 2017 and 2020 were reviewed and systematically categorized by clinical topics, subtopics, and complexity levels (low, moderate, and high). Results: Within the study period, the PrEPline provided 1,754 teleconsultations. More than three quarters came from advanced practice nurses and physicians. The topics of questions commonly focused on medication-based HIV prevention strategies (22.7%), PrEP laboratory ordering/monitoring (17.4%), and side effects and contraindications (14.6%). The majority of teleconsultations (57.9%) involved sharing information that was directly available/addressed in the Centers for Disease Control and Prevention (CDC) 2017 PrEP Guidelines (i.e., low complexity). Discussion: The low frequency of consultations from nonphysician and non-nurse practitioner providers may suggest a need for increased training and collaborative opportunities for other types of providers. The high percentage of low-complexity inquiries may reveal a desire for capacity-building materials specifically designed for practicing providers (e.g., abridged versions of guidelines). This study may inform future research, best clinical practices, and aid in the development of training materials to increase providers' HIV prevention comfort and knowledge.
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Affiliation(s)
- Parya Saberi
- Department of Medicine and University of California, San Francisco, San Francisco, California, USA
| | - Nicky J. Mehtani
- Department of Medicine and University of California, San Francisco, San Francisco, California, USA
| | - Anthony Sayegh
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Christina Elizabeth Camp
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Carolyn Chu
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, California, USA
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52
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Barocas JA, Gai MJ, Nurani A, Bagley SM, Hadland SE. Initiation of HIV pre-exposure prophylaxis among youth in the United States, 2015-2018. AIDS Care 2023; 35:431-436. [PMID: 35468009 PMCID: PMC9592681 DOI: 10.1080/09540121.2022.2067318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 04/13/2022] [Indexed: 10/18/2022]
Abstract
Adolescents and young adults ("youth") account for one-fifth of new HIV diagnoses in the U.S. HIV pre-exposure prophylaxis (PrEP), which became FDA approved in adolescents in May 2018, is highly effective at preventing HIV infection though there are limited data for PrEP initiation in youth. We aimed to quantify PrEP initiation and identify factors associated with PrEP initiation among youth at risk for HIV. We conducted a retrospective cohort study of youth aged 13-26 years who had an indication for PrEP between 1 January 2015, and 31 December 2018. We used data on commercially insured US individuals from the IBM MarketScan Commercial Database. We compared factors among youth who did and did not receive PrEP. We developed a multivariable logistic regression model to identify the association of all study covariates with receipt of PrEP. Among potentially PrEP eligible youth, only 2171 (1.6%) received a PrEP prescription in the year following their PrEP eligible claim. In multivariable models, youth who received PrEP were more likely to be older (adjusted odd ratio [aOR] for 18-20 year olds = 5.11; 95% CI = 3.35-7.77; aOR for 21-26 year olds = 16.90; 95% CI = 11.0-24.7), male (aOR = 92.42; 95% CI = 68.24-125), have sexual activity with elevated risk (aOR = 7.47; 95% CI = 6.50-8.60), or be diagnosed with gonorrhea or syphilis than youth who did not receive PrEP. Our findings highlight an opportunity to improve HIV prevention early in the life course.
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Affiliation(s)
- Joshua A. Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine
| | - Mam Jarra Gai
- Section of Infectious Diseases, Boston Medical Center
| | | | - Sarah M. Bagley
- Department of General Pediatrics, Boston Medical Center
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, BMC, BUSM
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53
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Bunting SR, Hunt B, Boshara A, Jacobs J, Johnson AK, Hazra A, Glick N. Examining the Correlation Between PrEP Use and Black:White Disparities in HIV Incidence in the Ending the HIV Epidemic Priority Jurisdictions. J Gen Intern Med 2023; 38:382-389. [PMID: 35678988 PMCID: PMC9905374 DOI: 10.1007/s11606-022-07687-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION HIV incidence remains high in the U.S. as do disparities in new HIV diagnosis between White and Black populations and access to preventive therapies like pre-exposure prophylaxis (PrEP). The federal Ending the HIV Epidemic (EHE) initiative was developed to prioritize resources to 50 jurisdictions with high HIV incidence. METHODS We conducted secondary analyses of data (2013-2019) from the CDC, Census Bureau, and AIDSVu to evaluate the correlation between PrEP use, HIV incidence, and HIV incidence disparities. We compared the PrEP-to-need ratio (PnR) with the ratio of Black and White HIV incidence rates in 46 EHE counties. Subsequent analyses were performed for the seven states that contained multiple EHE counties. RESULTS These 46 counties represented 25.9% of the U.S. population in 2019. HIV incidence ranged from 10.5 in Sacramento County, CA, to 59.6 in Fulton County, GA (per 100,000). HIV incidence disparity ranged from 1.5 in Orleans Parish, LA, to 12.1 in Montgomery County, MD. PnR ranged from 26.8 in New York County, NY, to 1.46 in Shelby County, TN. Change in HIV incidence disparities and percent change in PnR were not significantly correlated (ρ = 0.06, p = 0.69). Change in overall HIV incidence was significantly correlated with increase in PnR (ρ = -0.42, p = 0.004). CONCLUSIONS PrEP has the potential to significantly decrease HIV incidence; however, this benefit has not been conferred equally. Within EHE priority counties, we found significant HIV incidence disparities between White and Black populations. PrEP has decreased overall HIV incidence, but does not appear to have decreased HIV incidence disparity.
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Affiliation(s)
- Samuel R Bunting
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, IL, USA.
| | - Bijou Hunt
- Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, USA
| | - Arianna Boshara
- Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, USA
| | - Jacquelyn Jacobs
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, USA
| | - Amy K Johnson
- Sinai Urban Health Institute, Sinai Health System, Chicago, IL, USA
- Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, IL, USA
| | - Nancy Glick
- Sinai Infectious Disease Center, Sinai Health System, Chicago, IL, USA
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Johnson MM, Brooks N, Amico KR. Missed Opportunities When We Focus only on Risk: Using the Concerns Based Conversation Starter to Identify Potential PrEP Candidates. AIDS Behav 2023:10.1007/s10461-023-03993-6. [PMID: 36692609 DOI: 10.1007/s10461-023-03993-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 01/25/2023]
Abstract
Collection and use of self-reported HIV sexual risk-behaviors to identify pre-exposure prophylaxis (PrEP) candidates is common practice in PrEP providing and referral services. Critiques of this strategy highlight overreliance on self-report and contribution to ongoing PrEP stigma. As an alternative (or complimentary) approach, we evaluated a 5-item Concerns Based Conversation Starter (CBCS) that could be used to identify individuals who could benefit from PrEP. The CBCS was included in the 2019 cycle of the American Men's Internet Survey. Item responses were characterized overall and in relation to CDC risk-based PrEP indication and reported willingness to use PrEP. In total, 1606 HIV-negative men who have sex with men not on PrEP were evaluated. Of these, 50% were below the age of 25, 11% Black, 16% Latino, and 64% White. Across the sample, 61% (986) met risk-based criteria for PrEP indication, 80% (1278) were identified by the CBCS, and 52% (835) were flagged by both. The CBCS uniquely identified 28% (443) for follow-up PrEP discussions that would have been missed by a risk-based only approach. Only 9% (151) of the sample had risk-based indication but did not report concerns. Over half of those flagged by the CBCS expressed willingness to use PrEP. The CBCS identified more people than a risk-based indication approach, with most also reporting an interest in using PrEP. A small percentage of risk-indicated participants were 'missed' by the CBCS. As PrEP options and access points expand, implementation tools like the CBCS can facilitate more wide-scale, values-focused PrEP implementation.
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Affiliation(s)
| | - Noah Brooks
- School of Public Health, University of Michigan, Ann Arbor Michigan, USA
| | - K Rivet Amico
- School of Public Health, University of Michigan, Ann Arbor Michigan, USA.
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Cernasev A, Melton TC, Jasmin H, Barenie RE. A Qualitative Systematic Literature Review of the Role of U.S. Pharmacists in Prescribing Pre-Exposure Prophylaxis (PrEP). PHARMACY 2023; 11:9. [PMID: 36649019 PMCID: PMC9844378 DOI: 10.3390/pharmacy11010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 12/20/2022] [Accepted: 12/21/2022] [Indexed: 01/06/2023] Open
Abstract
Pre-Exposure Prophylaxis (PrEP) is an effective treatment to combat the human immunodeficiency virus (HIV) endemic, but the uptake of PrEP has been low in the United States (U.S.). While individuals may access PrEP via obtaining a prescription from their prescriber and having it dispensed by their pharmacist, less cumbersome access points may exist. This systematic literature review evaluates qualitative literature to explore the role of pharmacists, pharmacy services, and interprofessional collaborations for persons seeking PrEP in the United States. Four electronic databases (PubMed, Scopus, CINAHL, and Embase) were searched in February 2022 and yielded 3841 results. After excluding duplicates, two researchers reviewed 2461 studies. These results were screened for inclusion and exclusion criteria and yielded 71 studies for full review. Out of these 71 studies, five studies met the pre-selected inclusion criteria. Of the five studies, four were qualitative studies, and one was a mixed-methods study. The studies examined different aspects of initiating PrEP and diverse outcomes, such as screening for PrEP, barriers to access PrEP, feasibility to access PrEP, accessibility via community pharmacy to PrEP, and interdisciplinary collaboration between members of the healthcare team to expand patient access to PrEP. A gap in the qualitative literature focusing on U.S. pharmacists' roles in initiation and provision of PrEP for diverse populations may exist. While PrEP promotion and uptake are largely affected by convenience and accessibility, future interventions and strategies should include training pertaining to PrEP screening, stigma reduction, privacy considerations, and PrEP dispensing.
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Affiliation(s)
- Alina Cernasev
- University of Tennessee Health Science Center, College of Pharmacy, 301 S. Perimeter Park Drive, Suite 220, Nashville, TN 37211, USA
| | - Tyler C. Melton
- University of Tennessee Health Science Center, College of Pharmacy, 1924 Alcoa Hwy, Box 117, Knoxville, TN 37920, USA
| | - Hilary Jasmin
- University of Tennessee Health Science Center, Health Science Library, 877 Madison Avenue, Memphis, TN 38103, USA
| | - Rachel E. Barenie
- University of Tennessee Health Science Center, College of Pharmacy, 881 Madison Avenue, Memphis, TN 38103, USA
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56
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Quinn KG, Dickson-Gomez J, Craig A, John SA, Walsh JL. Intersectional Discrimination and PrEP uSe Among Young Black Sexual Minority Individuals: The Importance of Black LGBTQ Communities and Social Support. AIDS Behav 2023; 27:290-302. [PMID: 35788926 PMCID: PMC9255535 DOI: 10.1007/s10461-022-03763-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 01/24/2023]
Abstract
Intersectional stigma and discrimination have increasingly been recognized as impediments to the health and well-being of young Black sexual minority men (YBSMM) and transgender women (TW). However, little research has examined the relationship between intersectional discrimination and HIV pre-exposure prophylaxis (PrEP) outcomes. This study with 283 YBSMM and TW examines the relationship between intersectional discrimination and current PrEP use and likelihood of future PrEP use. Path models were used to test associations between intersectional discrimination, resilience and social support, and PrEP use and intentions. Individuals with higher levels of anticipated discrimination were less likely to be current PrEP users (OR = 0.59, p = .013), and higher levels of daily discrimination were associated with increased likelihood of using PrEP in the future (B = 0.48 (0.16), p = .002). Greater discrimination was associated with higher levels of resilience, social support, and connection to the Black LGBTQ community. Social support mediated the effect of day-to-day discrimination on likelihood of future PrEP use. Additionally, there was a significant and negative indirect effect of PrEP social concerns on current PrEP use via Black LGBTQ community connectedness. The results of this study highlight the complexity of the relationships between discrimination, resilience, and health outcomes.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
- Department of Psychiatry and Behavioral Medicine, CAIR Medical College of Wisconsin, 2071 N. Summit Ave, 53202, Milwaukee, WI, USA.
| | - Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amber Craig
- Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Steven A John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer L Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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57
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Mulatu MS, Carter JW, Flores SA, Benton S, Galindo CA, Johnson WD, Wilkes AL, Prather C. Expanding PrEP Services for Men Who Have Sex With Men and Transgender Persons Through Health Department Programs: Key Processes and Outcomes From Project PrIDE, 2015-2019. Public Health Rep 2023; 138:31-42. [PMID: 35023401 PMCID: PMC9730169 DOI: 10.1177/00333549211058173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Pre-exposure prophylaxis (PrEP) Implementation, Data to Care, and Evaluation (PrIDE) was a demonstration project implemented by 12 state and local health departments during 2015-2019 to expand PrEP services for men who have sex with men (MSM) and transgender persons at risk for HIV infection. We describe findings from the cross-jurisdictional evaluation of the project. METHODS We analyzed work plans, annual progress reports, and aggregate quantitative program data submitted by funded health departments (n = 12) to identify key activities implemented and summarize key project outcomes. RESULTS PrIDE jurisdictions implemented multiple health equity-focused activities to expand PrEP services to priority populations, including building program capacity, conducting knowledge and awareness campaigns, providing PrEP support services, and addressing barriers to PrEP use. Overall, PrIDE jurisdictions identified 44 813 persons with PrEP indications. Of these, 74.8% (n = 33 500) were referred and 33.1% (n = 14 821) were linked to PrEP providers, and 25.3% (n = 11 356) were prescribed PrEP. Most persons prescribed PrEP were MSM or transgender persons (87.9%) and persons from racial and ethnic minority groups (65.6%). However, among persons with PrEP indications, non-Hispanic Black/African American persons (14.9% of 18 782) were less likely than non-Hispanic White persons (31.0% of 11 633) to be prescribed PrEP (z = -33.57; P < .001). CONCLUSIONS PrIDE jurisdictions successfully expanded PrEP services for MSM, transgender persons, and racial and ethnic minority groups by implementing health equity-focused activities that addressed barriers to PrEP services. However, PrEP prescription was generally low, with significant disparities by demographic characteristics. Additional targeted interventions are needed to expand PrEP services, achieve equity in PrEP use, and contribute to ending the HIV epidemic in the United States.
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Affiliation(s)
- Mesfin S. Mulatu
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jarvis W. Carter
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephen A. Flores
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shaliondel Benton
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carla A. Galindo
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Wayne D. Johnson
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Aisha L. Wilkes
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia Prather
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Nacht CL, Felner JK, Muthuramalingam S, Towner W, Ling Grant D, Martos A, Chang JM, Hechter R, Storholm ED. Barriers and Opportunities to Improve the Implementation of Patient Screening and Linkage to Pre-Exposure Prophylaxis in Primary Care. JOURNAL OF CLINICAL RESEARCH IN HIV AIDS AND PREVENTION 2022; 4:15-31. [PMID: 37841674 PMCID: PMC10572105 DOI: 10.14302/issn.2324-7339.jcrhap-22-4371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Although pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV infection, only around 25% of at-risk individuals in the United States have accessed a prescription. One way to increase PrEP uptake is through the sexual health screening of patients and linkage to PrEP in primary care settings. The objective of this analysis was to assess the barriers and implementation strategies during a screening and linkage to PrEP pilot intervention. Primary care patients were screened for PrEP indication during routine primary care visits. Of the 1,225 individuals screened, 1.8% (n=22) were eligible for PrEP and from those, 77.3% (n=17) attended the specialist appointment and were prescribed PrEP. Primary care patients (n=30) and providers (n=8) then participated in semi-structured interviews assessing their experience with the pilot intervention. Using an applied thematic analytic approach, patients and providers identified barriers and related improvement strategies that could be classified into four main categories: 1) Financial Barriers: Individual- vs. Clinic-level Considerations 2) The Role of Stigma, Discomfort, and Cultural Factors 3) Logistical Hurdles and Streamlining the Intervention, and 4) The Lack of PrEP Knowledge and the Need for Education. Findings support the accepatability and feasibility of screening for PrEP in primary care along with appropriate implementation strategies. This study suggests that because of the high volume of patients seen in primary care, sexual health screenings and linkage to PrEP interventions have the potential to reduce new incident HIV infections among diverse sexual minority men.
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Affiliation(s)
- Carrie L Nacht
- San Diego State University, School of Public Health, San Diego, CA
| | - Jennifer K Felner
- San Diego State University, School of Public Health, San Diego, CA
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, CA
| | | | - William Towner
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Deborah Ling Grant
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Alexander Martos
- Southern California Permanente Medical Group, Los Angeles Medical Center Department of Consulting Services, Los Angeles, CA
| | - John M Chang
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Rulin Hechter
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Erik D Storholm
- San Diego State University, School of Public Health, San Diego, CA
- RAND Corporation, Behavioral and Policy Sciences, Santa Monica, CA
- University of California Los Angeles, Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, Los Angeles, CA
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Xu Q, McMann T, Godinez H, Nali MC, Li J, Cai M, Merenda C, Lee C, Araojo R, Mackey TK. Impact of COVID-19 on HIV Prevention Access: A Multi-platform Social Media Infodemiology Study. AIDS Behav 2022; 27:1886-1896. [PMID: 36471205 PMCID: PMC9734820 DOI: 10.1007/s10461-022-03922-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 12/12/2022]
Abstract
This study seeks to identify and characterize key barriers associated with PrEP therapy as self-reported by users on social media platforms. We used data mining and unsupervised machine learning approaches to collect and analyze COVID-19 and PrEP-related posts from three social media platforms including Twitter, Reddit, and Instagram. Predominant themes detected by unsupervised machine learning and manual annotation included users expressing uncertainty about PrEP treatment adherence due to COVID-19, challenges related to accessibility of clinics, concerns about PrEP costs and insurance coverage, perceived lower HIV risk leading to lack of adherence, and misinformation about PrEP use for COVID-19 prevention.
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Affiliation(s)
- Qing Xu
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA
| | - Tiana McMann
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA ,Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, CA USA
| | | | - Matthew C. Nali
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA ,Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, CA USA
| | | | | | - Christine Merenda
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration, Silver Spring, MD USA
| | - Christine Lee
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration, Silver Spring, MD USA
| | - Richardae Araojo
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration, Silver Spring, MD USA
| | - Tim K. Mackey
- S-3 Research LLC, San Diego, CA USA ,Global Health Policy and Data Institute, Sang Diego, CA USA ,Global Health Program, Department of Anthropology, University of California, San Diego, San Diego, CA USA
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60
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MEREU ALESSANDRA, LIORI ARIANNA, FADDA LUCA, PUDDU MASSIMILIANO, CHESSA LUCHINO, CONTU PAOLO, SARDU CLAUDIA. What do young people know about HIV? Results of a cross sectional study on 18-24-year-old students. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E541-E548. [PMID: 36891004 PMCID: PMC9986992 DOI: 10.15167/2421-4248/jpmh2022.63.4.2555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/09/2022] [Indexed: 03/10/2023]
Abstract
Introduction Increasing people's knowledge of transmission, prevention, early diagnosis, and available treatments is a key step toward HIV control; it means setting the conditions for empowerment and enabling individuals to make aware choices about the prevention strategy best suited to their needs. This study aims to identify unmet needs on HIV knowledge among freshman students. Methods A cross sectional study was carried out at the University of Cagliari, which is an Italian public state university. Data were collected by means of an anonymous questionnaire; the final sample included 801 students. Results Results offer a detailed picture of students' knowledge and perceptions of HIV. Several topics deserve to be better understood by students, but the main gaps relate to the pre-exposure prophylaxis and the decreased likelihood of sexually transmitting HIV due to early treatments. Students' vision of the quality of life of people living with HIV was negatively affected by perceiving as relevant the effects of HIV on physical health or on sexual/affective domains, while conversely, it seemed positively affected by knowing that current treatments are useful for counteracting physical symptoms and decreasing the possibility of transmitting HIV. Conclusion Being aware of the potential benefits of current therapies could favour a less negative view, in line with the current state of the beneficial effects of HIV treatment. Universities are a valuable setting to bridge the HIV knowledge gap and thus also contribute to tackling stigma and actively promoting HIV testing.
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Affiliation(s)
- ALESSANDRA MEREU
- Department of Medical Science and Public Health, University of Cagliari, Italy
| | - ARIANNA LIORI
- Department of Medical Science and Public Health, University of Cagliari, Italy
| | | | | | - LUCHINO CHESSA
- Department of Medical Science and Public Health, University of Cagliari, Italy
| | - PAOLO CONTU
- Department of Medical Science and Public Health, University of Cagliari, Italy
| | - CLAUDIA SARDU
- Department of Medical Science and Public Health, University of Cagliari, Italy
- Correspondence: Claudia Sardu, Department of Medical Science and Public Health, University of Cagliari, Italy. Tel.: +390706753106 - E-mail:
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Mizuno Y, Gelaude DJ, Crepaz N, Kamitani E, DeLuca JB, Leighton CA, Wichser ME, Smith DK. Health Care Providers' Views on Clinic Infrastructure and Practice Models That May Facilitate HIV Preexposure Prophylaxis (PrEP) Prescribing: A Qualitative Meta-Synthesis. Health Promot Pract 2022; 23:999-1014. [PMID: 34549652 PMCID: PMC8938291 DOI: 10.1177/15248399211038364] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
HIV (human immunodeficiency virus) preexposure prophylaxis (PrEP) is an effective biomedical HIV prevention tool. Increasing PrEP use among populations disproportionately affected by HIV is one of the key efforts in the United States' Ending the HIV Epidemic (EHE) initiative and the HIV National Strategic Plan for the United States. Given that PrEP is available only through prescription, it is important to explore structural, organizational, or environmental factors that could facilitate or impede health care provider's PrEP prescribing behavior. The purpose of this systematic review (PROSPERO [CRD: 42019138889]) is to identify qualitative studies that addressed this topic and conduct meta-synthesis using the thematic synthesis method to identify major themes on the characteristics of clinic infrastructure or clinic models that providers consider as facilitators of PrEP prescribing in the United States. Eighteen citations representing 15 studies were included in this review. Five overarching themes were identified: (1) routinized HIV risk assessment; (2) interdisciplinary/coordinated PrEP teams or services; (3) clinic capacity to provide essential PrEP-related services; (4) low out-of-pocket patient costs; and (5) access to the priority populations. Some of these themes are consistent with the recommendations of CDC's PrEP clinical guidelines and the EHE initiative. More recent studies that include perspectives of diverse providers, timely analysis of these studies, and implementation research to assess strategies to address the current practice gaps are needed to further promote PrEP prescribing among providers in the United States.
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Affiliation(s)
- Yuko Mizuno
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Nicole Crepaz
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Emiko Kamitani
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julia B DeLuca
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Dawn K Smith
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Budhwani H, Yigit I, Maragh-Bass AC, Rainer CB, Claude K, Muessig KE, Hightow-Weidman LB. Validation of HIV Pre-Exposure Prophylaxis (PrEP) Medication Scales with Youth on PrEP: PrEP Confidence Scale and PrEP Difficulties Scale. AIDS Patient Care STDS 2022; 36:443-450. [PMID: 36306520 PMCID: PMC9700336 DOI: 10.1089/apc.2022.0072] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is a lifesaving medical intervention that protects against human immunodeficiency virus (HIV), but to date, PrEP uptake has been limited. PrEP utilization and adherence among youth, including stigmatized and highly vulnerable young sexual and gender minorities, have been exceptionally low across all regions, leading to preventable HIV transmission. Considering the scientific value of measuring and understanding predictors or associations of PrEP adherence, our study team validated two scales: a PrEP Difficulties Scale and a PrEP Confidence Scale tested within the Adolescent Trials Network P3 study (2019-2021). Data from sexual and gender minorities who were prescribed PrEP across nine domestic sites were evaluated (N = 235). Descriptive statistics, exploratory factor analysis, and correlation coefficients are reported herein. Results for the PrEP Difficulties Scale yielded a four-factor solution (Disclosure, Health Effects, Logistics, and Cost), and results for the PrEP Confidence Scale produced a three-factor solution (Scheduling, Distraction, and Planning). Factor loadings and Cronbach's alphas suggested good internal consistency for both scales. PrEP Confidence Scale subscales were correlated with PrEP adherence, and subscales of both scales were associated with dimensions of social support and PrEP-related stigma. Given the persistence of preventable HIV infections among key populations, multi-level barriers and facilitators to medication adherence, and expansion of PrEP modalities, the PrEP Difficulties Scale and PrEP Confidence Scale have the potential to enhance intervention, exploratory, and mechanistic HIV prevention research. ClinicalTrials.gov Identifier: NCT03320512.
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Affiliation(s)
- Henna Budhwani
- Center of Population Sciences for Health Equity, College of Nursing, Florida States University (FSU), Tallahassee, Florida, USA
| | - Ibrahim Yigit
- Department of Psychology, Faculty of Arts and Sciences, TED University, Ankara, Turkey
| | - Allysha C. Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Crissi B. Rainer
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Kristina Claude
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Kathryn E. Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
| | - Lisa B. Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, North Carolina, USA
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Fitch C, Haberer JE, Serrano PA, Muñoz A, French AL, Hosek SG. Individual and structural-level Correlates of Pre-exposure Prophylaxis (PrEP) lifetime and current use in a nationwide sample of young sexual and gender minorities. AIDS Behav 2022; 26:3365-3377. [PMID: 35429311 PMCID: PMC9474722 DOI: 10.1007/s10461-022-03656-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 02/03/2023]
Abstract
The objective of this analysis was to describe individual and structural-level factors associated with pre-exposure prophylaxis (PrEP) use among a sample of sexual and gender minorities (SGM) at risk for HIV recruited using limited interaction strategies. SGM (N = 3330), ages 15-34, without HIV enrolled in a nationwide limited interaction cohort study from 2017 to 2020. A baseline cross-sectional single-survey design examined individual and structural-level correlates of PrEP lifetime use and current use using logistic regression. PrEP lifetime use and current use were reported by 31.2% and 23.9%, respectively, of SGM with PrEP data (n = 3077). PrEP use outcomes (lifetime or current use) in cisgender MSM were associated with being over age 18, Black or other race, Hispanic/Latina/x/o ethnicity, being gay, being out to one's healthcare provider, having health insurance, being a college graduate, and having a greater number of PrEP peers. PrEP use outcomes (lifetime use or current use) in transgender/non-binary participants were associated with being over age 24, being Latinx, being transgender vs. non-binary, being assigned male at birth, being out to their healthcare provider, living in the western or northeastern United States, and having more peers on PrEP. More work is needed to address lower PrEP uptake in SGM under 18 and those whose sex risk may be more dynamic (e.g., non-binary, pansexual/queer, and bisexual SGM) and such strategies should consider utilizing peers to provide information and ameliorate structural barriers.
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Affiliation(s)
- Calvin Fitch
- Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, One Bowdoin Square, 7th Floor, 02114, Boston, MA, USA.
- Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Jessica E Haberer
- Harvard Medical School, Harvard University, Boston, MA, USA
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Pedro A Serrano
- Department of Research, CORE Center, Chicago, IL, United States
| | - Alejandro Muñoz
- Department of Research, CORE Center, Chicago, IL, United States
| | - Audrey L French
- Division of Infectious Disease, John Stroger Jr Hospital of Cook County, Chicago, Illinois, USA
| | - Sybil G Hosek
- Division of Infectious Disease, John Stroger Jr Hospital of Cook County, Chicago, Illinois, USA
- Department of Psychiatry, John Stroger Jr Hospital of Cook County, Chicago, Illinois, USA
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Miller TA, Halza K, Hovis Z. Implementation of
pharmacist‐led HIV pre‐exposure
prophylaxis management to increase access to care at an academic internal medicine practice. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Trisha A. Miller
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
| | - Katherine Halza
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
- Department of Pharmacy Kingman Regional Medical Center Kingman Arizona USA
| | - Zachary Hovis
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
- Clinical Sciences Department Medical College of Wisconsin Pharmacy School Milwaukee Wisconsin USA
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Wang H, Shobowale O, den Daas C, Op de Coul E, Bakker B, Radyowijati A, Vermey K, van Bijnen A, Zuilhof W, Jonas KJ. Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8829. [PMID: 35886681 PMCID: PMC9315833 DOI: 10.3390/ijerph19148829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022]
Abstract
PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called "Randstad", entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0-10.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04-4.4). Lower education (aOR = 0.4, 95% CI 0.2-0.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7-2.0) and high education. We showed that regional differences-MSM in non-urban regions-and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.
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Affiliation(s)
- Haoyi Wang
- Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands; (H.W.); (O.S.)
| | - Oladipupo Shobowale
- Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands; (H.W.); (O.S.)
| | - Chantal den Daas
- Health Psychology, University of Aberdeen, Aberdeen AB24 3 FX, UK;
| | - Eline Op de Coul
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands;
| | | | | | - Koenraad Vermey
- Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands; (K.V.); (A.v.B.); (W.Z.)
| | - Arjan van Bijnen
- Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands; (K.V.); (A.v.B.); (W.Z.)
| | - Wim Zuilhof
- Soa Aids Netherlands, 1014 AX Amsterdam, The Netherlands; (K.V.); (A.v.B.); (W.Z.)
| | - Kai J. Jonas
- Department of Work and Social Psychology, Maastricht University, 6200 ER Maastricht, The Netherlands; (H.W.); (O.S.)
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Faro EZ, Mantell JE, Gonzalez-Argoti T, Hoffman S, Edelstein Z, Tsoi B, Bauman LJ. Implementing PrEP Services in Diverse Health Care Settings. J Acquir Immune Defic Syndr 2022; 90:S114-S128. [PMID: 35703763 PMCID: PMC9204802 DOI: 10.1097/qai.0000000000002971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Uptake of pre-exposure prophylaxis (PrEP) in the US has been limited. Evidence for why and how PrEP has been successfully integrated into some clinical settings, but not in others is minimal. To address this gap, we conducted a qualitative study to identify contextual factors that facilitated and challenged the implementation of PrEP services. SETTING In partnership with the NYC Department of Health, we convened a planning committee with expertise with groups highly affected by the HIV epidemic employed in diverse health care settings, to guide the project. Representatives from programs within New York were targeted for participation initially and subsequently expanded nationally to enhance diversity in program type. METHODS Using an interview guide informed by the Consolidated Framework for Implementation Research, we conducted 20 interviews with participants who successfully implemented PrEP programs in different settings (eg, primary care, emergency department, sexual health clinics), using different delivery models. We used template and matrix analysis to identify and characterize contextual determinants and implementation strategies. RESULTS Participants frequently described determinants and strategies fluidly and conceptualized them in context-specific terms. Commonly discussed Consolidated Framework for Implementation Research constructs included implementation climate (tension for change, compatibility, relatively priority), stakeholders' knowledge (or lack thereof) and beliefs about PrEP, and costs associated with PrEP implementation. CONCLUSION Our work identifies patterns in PrEP program implementation, describing how organizations dealt with determinants in their own context. Our research points to the need to connect rigorous implementation research with how frontline implementers conceptualize their work to inform and improve PrEP implementation.
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Affiliation(s)
- Elissa Z Faro
- Department of Internal Medicine, University of Iowa, Iowa City, IA
| | - Joanne E Mantell
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY
| | - Tatiana Gonzalez-Argoti
- Departments of Pediatrics and Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
| | - Susie Hoffman
- Department of Psychiatry, Columbia University Irving Medical Center and the New York State Psychiatric Institute, New York, NY
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY; and
| | - Zoe Edelstein
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Benjamin Tsoi
- New York City Department of Health and Mental Hygiene, Queens, NY
| | - Laurie J Bauman
- Departments of Pediatrics and Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
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Li DH, Benbow N, Keiser B, Mongrella M, Ortiz K, Villamar J, Gallo C, Deskins JS, Hall CX, Miller C, Mustanski B, Smith JD. Determinants of Implementation for HIV Pre-exposure Prophylaxis Based on an Updated Consolidated Framework for Implementation Research: A Systematic Review. J Acquir Immune Defic Syndr 2022; 90:S235-S246. [PMID: 35703776 PMCID: PMC10161203 DOI: 10.1097/qai.0000000000002984] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Delivery and use of HIV pre-exposure prophylaxis (PrEP) are suboptimal in the United States. Previous reviews of barriers and facilitators have not used an implementation science lens, limiting comprehensiveness and the link to implementation strategies. To summarize the state of the science, we systematically reviewed determinants of PrEP implementation using the updated Consolidated Framework for Implementation Research (CFIR 2.0). SETTING PrEP-eligible communities and delivery settings in the United States. METHODS In January 2021, we searched Ovid MEDLINE, PsycINFO, and Web of Science for peer-reviewed articles related to HIV/AIDS, interventions, implementation, and determinants or strategies. We identified 286 primary research articles published after 1999 about US-based PrEP implementation. Team members extracted discrete "mentioned" and "measured" determinants, coding each by setting, population, valence, measurement, and CFIR 2.0 construct. RESULTS We identified 1776 mentioned and 1952 measured determinants from 254 to 239 articles, respectively. Two-thirds of measured determinants were of PrEP use by patients as opposed to delivery by providers. Articles contained few determinants in the inner setting or process domains (ie, related to the delivery context), even among studies of specific settings. Determinants across priority populations also focused on individual patients and providers rather than structural or logistical factors. CONCLUSION Our findings suggest substantial knowledge in the literature about general patient-level barriers to PrEP use and thus limited need for additional universal studies. Instead, future research should prioritize identifying determinants, especially facilitators, unique to understudied populations and focus on structural and logistical features within current and promising settings (eg, pharmacies) that support integration of PrEP into clinical practice.
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Affiliation(s)
- Dennis H. Li
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Center for Prevention Implementation Methodology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Nanette Benbow
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Prevention Implementation Methodology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brennan Keiser
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Melissa Mongrella
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Kasim Ortiz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Juan Villamar
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Prevention Implementation Methodology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carlos Gallo
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
- Center for Prevention Implementation Methodology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jasmine S. Deskins
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
| | - Casey Xavier Hall
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Corinne Miller
- Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Brian Mustanski
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL
- Center for Prevention Implementation Methodology, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Justin D. Smith
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT
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Wood SM, Meanley S, Bonett S, Torres ME, Watson DL, Williams JL, Brady KA, Bauermeister JA. Strengthening HIV Prevention Services Through an Implementation Science Approach: Perspectives From the HIV Testers in Philadelphia. J Acquir Immune Defic Syndr 2022; 90:S90-S97. [PMID: 35703760 PMCID: PMC9204788 DOI: 10.1097/qai.0000000000002969] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/26/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Strengthening HIV prevention services is a key priority of the Ending the HIV Epidemic plan. Informed by the Consolidated Framework for Implementation Research, we examined HIV testers' perceived barriers and facilitators to implementing HIV prevention services, including testers' strengths and weaknesses; enabling factors within the inner and outer settings; and willingness to adopt potential implementation strategies. METHODS In 2019, the Penn Center for AIDS Research (CFAR) partnered with the Philadelphia Department of Public Health (PDPH) to examine system-level challenges and opportunities experienced by PDPH-funded HIV testers (individuals conducting HIV testing) in Philadelphia. We recruited HIV testers to complete 2 web surveys (n ≈ 40 each) and in-depth interviews (n = 11). RESULTS Testers self-reported high HIV testing self-efficacy and competence, despite identifying gaps in their knowledge of STI testing, reporting moderate willingness to recommend pre-exposure prophylaxis, and having insufficient cultural competency when working with priority populations. Testers indicated that educational materials and policies within their agencies might require realignment to affirm sexual and gender minority clients. In qualitative interviews, testers noted challenges to implementing PDPH priorities because limited funding fueled competition between local agencies, deterred interagency partnerships, and limited their ability to serve key populations locally. DISCUSSION HIV testers are critical partners in addressing agency-level barriers to HIV prevention service provision through multilevel implementation strategies. In partnership with PDPH, we will create and implement a train-the-trainers program consisting of skill-building activities, technical assistance, and capacity-building for all agency personnel to address missed opportunities in HIV prevention. These activities will reinforce scalability and sustainability of PDPH-supported HIV prevention programs.
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Affiliation(s)
- Sarah M Wood
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steven Meanley
- School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Mary E Torres
- Philadelphia Department of Public Health, Philadelphia, PA; and
| | - Dovie L Watson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Tsuyuki K, Stockman JK, Stadnick NA, Moore V, Zhu H, Torres V, Cano R, Penninga K, Aldous JL. Proyecto Compadre: Using Implementation Science to Tailor Peer Navigation for Latino Men in the US-Mexico Border Region. J Acquir Immune Defic Syndr 2022; 90:S98-S104. [PMID: 35703761 PMCID: PMC9220980 DOI: 10.1097/qai.0000000000002985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Latino men who have sex with men (MSM) in San Diego have poor HIV testing and prevention outcomes compared with non-Latino White men. Peer navigation (PN) is a promising evidence-based intervention to reduce disparities but needs tailoring for Latino MSM. SETTINGS Health centers near the US-Mexico border. METHODS Using the Exploration, Preparation, Implementation, Sustainment Framework, we conducted mixed-methods implementation science study. In phase I, we conducted interviews with Latino men (n = 15), focus groups with staff (n = 7), and surveys with all to understand the Exploration, Preparation, Implementation, Sustainment factors associated with HIV testing and care linkage. In phase II, we conducted 31 web-based surveys with Latino men and staff to rank intervention and implementation strategies from phase I. Quantitative data were analyzed descriptively, integrated with qualitative data, and reviewed by our community-academic partnership to develop an implementation model. RESULTS Latino men (N = 15) were 94% Spanish speaking, 67% gay identified, 27% US born, and their suggestions were to have navigators use peer referral to address barriers such as stigma; use the Latino social network to expand reach, leverage social media for peer-led intervention, and disseminate HIV information. Staff (N = 26) were 77% Spanish speaking, 35% gay-identified, 96% trained in cultural competency, and suggested including culturally appropriate HIV educational materials in Spanish, status and identity neutral programs, administrative/supervisorial/training structure for PNs, and PN compensation and team integration. Overall, results emphasized a need for a formalized PN model centered on referrals and using existing Latino community social networks. CONCLUSIONS Findings can be packaged for future implementation of PN programs for Latino MSM.
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Affiliation(s)
- Kiyomi Tsuyuki
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (9500 Gilman Drive, La Jolla, CA, 92093-0507, USA)
| | - Jamila K. Stockman
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (9500 Gilman Drive, La Jolla, CA, 92093-0507, USA)
| | | | | | - Helen Zhu
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego (9500 Gilman Drive, La Jolla, CA, 92093-0507, USA)
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Shrestha I, Ming K, Jimenez V, Wendelborn J, Vazquez A, Steward W, Scott H, Saberi P. Lessons Learned from an HIV Pre-Exposure Prophylaxis Coordination Program in San Francisco Primary Care Clinics. AIDS Res Hum Retroviruses 2022; 38:611-614. [PMID: 35592996 PMCID: PMC9419977 DOI: 10.1089/aid.2022.0013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV pre-exposure prophylaxis (PrEP) has shown high efficacy and effectiveness for HIV prevention; however, many individuals with PrEP indications are not receiving PrEP. PrEP Coordinators work closely with patients and health care providers to increase PrEP access, and they provide unique insights into the inner workings of PrEP care and service delivery. In this study, we discuss key challenges and recommendations for improved PrEP service delivery (including training PrEP Coordinators to manage PrEP panels, making PrEP a part of routine care and optimizing electronic health records, designating a PrEP "champion" who can strengthen communication and leadership, using a proactive approach to increase PrEP retention, and training providers and PrEP Coordinators to meet youth-specific needs) from our discussions with the PrEP Coordinators who led PrEP panel management in San Francisco Department of Public Health primary care clinics.
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Affiliation(s)
- Isha Shrestha
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Kristin Ming
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Veronica Jimenez
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - James Wendelborn
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Alexander Vazquez
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Wayne Steward
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, California, USA
| | - Parya Saberi
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Trujillo D, Arayasirikul S, Xie H, Sicro S, Meza J, Bella M, Daza E, Torres F, McFarland W, Wilson EC. Disparities in Sexually Transmitted Infection Testing and the Need to Strengthen Comprehensive Sexual Health Services for Trans Women. Transgend Health 2022; 7:230-236. [PMID: 36643058 PMCID: PMC9829146 DOI: 10.1089/trgh.2020.0133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose Few studies have examined the importance of improving the sexual health delivery system beyond HIV among trans women. We assessed survey data from the National HIV Behavioral Surveillance Transgender Woman (NHBS-Trans) Study in San Francisco to characterize the utilization of sexual health services among HIV-negative trans women and to explore opportunities to improve sexual health services for trans women. Methods Trans women were recruited through respondent-driven sampling from July 2019 to February 2020. The analytic sample was restricted to 116 HIV-negative trans women. We identified trends in data using chi-squared tests to assess significance between sexual risk behavior and the use of preventative sexual health services and built logistic regression models to assess the relationships between sexual risk behaviors and sexually transmitted infection (STI) testing. Results The majority of sample was trans women of color with most identifying as Latinx (42.2%). Over half were low income (56%), and majority had been homeless in past 12 months (62.9%). The prevalence of condomless receptive anal sex was 52.6% with about two-thirds (62.1%) recently having an STI test. Participants who engaged in recent condomless receptive anal sex had more than fivefold greater odds of having a recent STI test compared to their counterparts who did not (adjusted odds ratio [aOR] 5.60, 95% confidence interval [CI] 1.83-17.11; p=0.003). We also found age- and education-related disparities in STI testing. Conclusion This study characterized the utilization of sexual health services among HIV-negative trans women and identified important disparities in STI testing. We discuss opportunities to strengthen sexual health care delivery systems.
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Affiliation(s)
- Dillon Trujillo
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Address correspondence to: Dillon Trujillo, MPH, Trans Research Unit for Equity (TRUE), San Francisco Department of Public Health, Center for Public Health Research, 25 Van Ness Avenue, Suite 500, San Francisco, CA 94102, USA,
| | - Sean Arayasirikul
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.,Department of Psychiatry and University of California San Francisco, San Francisco, California, USA
| | - Hui Xie
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Sofia Sicro
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Joaquin Meza
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Mackie Bella
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Emperatriz Daza
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Francisco Torres
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA
| | - Willi McFarland
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, USA
| | - Erin C. Wilson
- Trans Research Unit for Equity, San Francisco Department of Public Health, Center for Public Health Research, San Francisco, California, USA.,Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, USA
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Harkness A, Weinstein ER, Lozano A, Mayo D, Doblecki-Lewis S, Rodríguez-Díaz CE, Hendricks Brown C, Prado G, Safren SA. Refining an Implementation Strategy to Enhance the Reach of HIV-Prevention and Behavioral Health Treatments to Latino Men Who Have Sex with Men. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221096293. [PMID: 36406189 PMCID: PMC9674182 DOI: 10.1177/26334895221096293] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Latino men who have sex with men (LMSM) experience HIV and behavioral health disparities. Yet, evidence-based interventions, such as pre-exposure prophylaxis (PrEP) and behavioral health treatments, have not been equitably scaled up to meet LMSM needs. To address quality of life and the public health importance of HIV prevention, implementation strategies to equitably scale up these interventions to LMSM need to be developed. This study identifies themes for developing culturally grounded implementation strategies to increase uptake of evidence-based HIV prevention and behavioral health treatments among LMSM. Methods Participants included 13 LMSM and 12 stakeholders in Miami, an HIV epicenter. Feedback regarding the content, design, and format of an implementation strategy to scale up HIV-prevention and behavioral health services to LMSM were collected via focus groups (N=3) and individual interviews (N=3). Themes were inductively identified across the Health Equity Implementation Framework (HEIF) domains. Results Analyses revealed five higher order themes regarding the design, content, and format of the implementation strategy: cultural context, relationships and networks, navigation of health information and systems, resources and models of service delivery, and motivation to engage. Themes were applicable across HEIF domains, meaning that the same theme could have implications for both the development and implementation of the implementation strategy. Conclusions Findings highlight the importance of addressing culturally specific factors, leveraging relational networks, facilitating navigation of health systems, tailoring to available resources, and building consumer and implementer motivation in order to refine an implementation strategy for reducing mental health burden and achieving HIV health equity among LMSM.
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Affiliation(s)
- Audrey Harkness
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | | | - Alyssa Lozano
- Department of Public Health Sciences, University of Miami, Miami, FL, USA
| | - Daniel Mayo
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Susanne Doblecki-Lewis
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of
Medicine, Miami, FL, USA
| | - Carlos E. Rodríguez-Díaz
- Department of Community Health and Prevention, Milken Institute
School of Public Health, The George Washington University, Washington DC, USA
| | - C. Hendricks Brown
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Guillermo Prado
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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73
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Lutete P, Matthews DW, Sabounchi NS, Paige MQ, Lounsbury DW, Rodriguez N, Echevarria N, Usher D, Walker JJ, Dickerson A, Hillesheim J, Frye V. Intersectional Stigma and Prevention Among Gay, Bisexual, and Same Gender-Loving Men in New York City, 2020: System Dynamics Models. Am J Public Health 2022; 112:S444-S451. [PMID: 35763732 PMCID: PMC9241454 DOI: 10.2105/ajph.2022.306725] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2022] [Indexed: 11/04/2022]
Abstract
Objectives. To create causal loop diagrams that characterize intersectional stigma experiences among Black, gay, bisexual, same gender-loving, and other men who have sex with men and to identify intervention targets to reduce stigma and increase testing and prevention access. Methods. Between January and July 2020, we conducted focus groups and in-depth interviews with 80 expert informants in New York City, which were transcribed, coded, and analyzed. These qualitative insights were developed iteratively, visualized, and validated in a causal loop diagram (CLD) using Vensim software. Results. The CLD revealed 3 key feedback loops-medical mistrust and HIV transmission, serosorting and marginalization of Black and gay individuals, and family support and internalized homophobia-that contribute to intersectional HIV and related stigmas, homophobia, and systemic racism. On the basis of these results, we designed 2 novel intervention components to integrate into an existing community-level anti-HIV stigma and homophobia intervention. Conclusions. HIV stigma, systemic racism, and homophobia work via feedback loops to reduce access to and uptake of HIV testing, prevention, and treatment. Public Health Implications. The CLD method yielded unique insights into reciprocal feedback structures that, if broken, could interrupt stigmatization and discrimination cycles that impede testing and prevention uptake. (Am J Public Health. 2022;112(S4):S444-S451. https://doi.org/10.2105/AJPH.2022.306725).
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Affiliation(s)
- Priscila Lutete
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - David W Matthews
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Nasim S Sabounchi
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Mark Q Paige
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - David W Lounsbury
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Noah Rodriguez
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Natalie Echevarria
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - DaShawn Usher
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Julian J Walker
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Alexis Dickerson
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Joseph Hillesheim
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
| | - Victoria Frye
- Priscila Lutete is with the City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Matthews, Mark Q. Paige, Noah Rodriguez, Alexis Dickerson, and Victoria Frye are with the Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY. Nasim S. Sabounchi is with the Department of Health Policy and Management, Center for Systems and Community Design, City University of New York Graduate School of Public Health and Health Policy, New York, NY. David W. Lounsbury is with the Department of Epidemiology & Population Health, Division of Health Behavior Research and Implementation Science, Albert Einstein College of Medicine, Bronx, NY. Natalie Echevarria and Joseph Hillesheim are with the City College of New York, City University of New York, New York, NY. DaShawn Usher and Julian J. Walker are with the Mobilizing Our Brothers Initiative, New York, NY
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Implementing pre-exposure prophylaxis for HIV prevention in women: the role of the obstetrician-gynecologist. Am J Obstet Gynecol 2022; 226:764-772. [PMID: 34973180 DOI: 10.1016/j.ajog.2021.12.263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 11/21/2022]
Abstract
Pre-exposure prophylaxis is a powerful HIV prevention tool that can reduce the risk of acquiring HIV by >90% from unprotected sex and >70% from injection drug use. The peripartum period is a time of heightened HIV risk, which underscores the need for HIV prevention counseling and the provision of biomedical interventions in all stages of a woman's reproductive life. It is important that women receive nonjudgmental care, have access to discussions of HIV risk, and are provided with pre-exposure prophylaxis counseling from their women's health practitioners. Obstetrician-gynecologists and other women's health providers are uniquely positioned to identify women who would benefit from pre-exposure prophylaxis and provide it in trusted clinical settings.
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75
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MacDonell KK, Wang B, Phanuphak N, Janamnuaysook R, Srimanus P, Rongkavilit C, Naar S. Optimizing an mHealth Intervention to Improve Uptake and Adherence to HIV Pre-exposure Prophylaxis in Young Transgender Women: Protocol for a Multi-Phase Trial. JMIR Res Protoc 2022; 11:e37659. [PMID: 35587370 PMCID: PMC9164094 DOI: 10.2196/37659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Vulnerable adolescents and emerging adults (aged 18-29 years), particularly young transgender women, are among the fastest-growing HIV positive populations worldwide. Thailand has the highest adult HIV seroprevalence in Asia, with a rate of infection among this population of 18%. Widespread technology offers opportunities for innovative mobile health (mHealth) interventions. Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention strategy recommended for at-risk individuals. PrEP is highly effective when taken as prescribed, but uptake and adherence have been low, with high discontinuation rates among youth. OBJECTIVE We propose to develop and pilot a multi-component, technology-based intervention to promote PrEP usage. We will adapt an existing 2-session, technology-delivered, motivational interviewing-based intervention to focus on PrEP use in transgender women in Thailand. We call this the Motivational Enhancement System for PrEP Uptake and Adherence (MES-PrEP). We will also refine and enhance YaCool, a mobile app with integrated text messaging developed and used clinically by our Thai team. The new version of the app is called Enhanced YaCool, and it enables self-management of gender and sexual health (including PrEP). Our primary aim is to develop and assess the preliminary efficacy of this mHealth intervention. METHODS We will utilize a multiphase optimization strategy (MOST) to identify the most effective intervention component or combination of components to improve PrEP usage in Thai transgender women. The study includes two phases: phase I (R21) includes qualitative interviews with key stakeholders to explore barriers and facilitators of PrEP usage through thematic analysis to inform intervention adaptation. Following this, we will adapt and beta-test MES-PrEP and Enhanced YaCool for functionality and feasibility using a community advisory board of HIV-negative Thai transgender women. In phase II (R33), we will conduct a MOST design-based trial to evaluate the feasibility, acceptability, and preliminary efficacy of MES-PrEP and Enhanced YaCool. Eighty HIV-negative participants who are currently taking PrEP and 80 participants who are not will be randomized to four conditions: (1) standard PrEP counseling (the control condition); (2) MES-PrEP and standard PrEP counseling; (3) Enhanced YaCool and standard PrEP counseling; and (4) MES-PrEP, Enhanced YaCool, and standard PrEP counseling. Feasibility and acceptability of the intervention will be assessed through usage patterns and the System Usability Scale. Preliminary impact will be assessed by evaluating the proportion of participants who initiate PrEP and their level of adherence to PrEP. Assessments will be at baseline and 1, 3, 6, 9, and 12 months postintervention. Biomarkers of adherence to PrEP, HIV, and other sexually transmitted infections will be collected. RESULTS Upon project completion, we will have an optimized mHealth intervention to support the use of PrEP by transgender women that will be ready for testing in a larger efficacy trial. CONCLUSIONS Even though transgender women in Thailand face increasing risks of HIV, few interventions have targeted them. Effective developmentally and culturally tailored interventions are needed to prevent HIV transmission in this high-risk population. TRIAL REGISTRATION ClinicalTrials.gov NCT05262426; https://clinicaltrials.gov/ct2/show/NCT05262426. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37659.
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Affiliation(s)
- Karen Kolmodin MacDonell
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | | | - Chokechai Rongkavilit
- Department of Pediatrics, University of California San Francisco-Fresno Branch Campus, Fresno, CA, United States
| | - Sylvie Naar
- Center for Translational Behavioral Research, Florida State University, Tallahassee, FL, United States
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76
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Andriano TM, Arnsten J, Patel VV. Social determinants of health and HIV Pre-Exposure Prophylaxis (PrEP) interest and use among young Black and Latinx sexual minority men. PLoS One 2022; 17:e0267031. [PMID: 35427397 PMCID: PMC9012374 DOI: 10.1371/journal.pone.0267031] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 04/01/2022] [Indexed: 12/01/2022] Open
Abstract
Young Black and Latinx sexual minority men (YBLSMM) have low use of HIV pre-exposure prophylaxis (PrEP), despite high rates of new HIV diagnosis. While unmet social determinants of health (SDOH) have been associated with low uptake of preventive health services, this association is unknown for PrEP. To understand the relationship between SDOH and PrEP adoption in this population, we analyzed data from an online survey of HIV-negative YBLSMM aged 18-29 in New York City (n = 143). Participants completed a 17-item SDOH needs scale measuring basic, health/social-services, and economic needs. We used regression models to examine associations of unmet SDOH with outcomes of intention to use PrEP and current PrEP use. Of those not on PrEP (n = 114), 69 (61%) intended to use PrEP. More unmet SDOH needs overall were associated with intention to use PrEP (OR 1.4; 95% CI 1.1, 2.0), as were more unmet basic needs (OR 1.7; 95% CI 1.1, 2.5) and more unmet economic needs (OR 1.3; 95% CI 1.0, 1.7). Unmet SDOH needs were not associated with current PrEP use. Findings suggest that intention to use PrEP among YBLSMM is a likely marker of unmet SDOH needs, as YBLSMM with unmet needs may have limited resources to support moving from intention to actual use. Future research should evaluate programs engaging YBLSMM intending to use PrEP with interventions to screen for and address SDOH.
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Affiliation(s)
- Tyler M Andriano
- Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Julia Arnsten
- Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, United States of America
| | - Viraj V. Patel
- Division of General Internal Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, United States of America
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77
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Falconi‐McCahill A, Lee ASD, Knights JE. Evaluation of a pre‐exposure prophylaxis (PrEP) program for HIV prevention in a federally qualified health center (FQHC). Worldviews Evid Based Nurs 2022; 19:219-226. [DOI: 10.1111/wvn.12577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/19/2021] [Accepted: 01/09/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Amy S. D. Lee
- Capstone College of Nursing The University of Alabama Tuscaloosa Alabama USA
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Martinez-Cajas JL, Torres J, Mueses HF, Plazas PC, Arrivillaga M, Gomez SA, Galindo X, Buitrago EM, Llano BEA. Applying implementation science frameworks to identify factors that influence the intention of healthcare providers to offer PrEP care and advocate for PrEP in HIV clinics in Colombia: a cross-sectional study. Implement Sci Commun 2022; 3:31. [PMID: 35296369 PMCID: PMC8925047 DOI: 10.1186/s43058-022-00278-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/24/2022] [Indexed: 11/23/2022] Open
Abstract
Background Few studies have used implementation science frameworks to identify determinants of PrEP prescription by healthcare providers. In this work, we developed and psychometrically examined a questionnaire using the theoretical domains framework (TDF) and the consolidated framework for implementation research (CFIR). We used this questionnaire to investigate what factors influence the intention of healthcare providers to offer PrEP care and advocate for PrEP. Methods We conducted a cross-sectional study in 16 HIV healthcare organizations in Colombia. A 98-item questionnaire was administered online to 129 healthcare professionals. One hundred had complete data for this analysis. We used exploratory factor analysis to assess the psychometric properties of both frameworks, and multinomial regression analysis to evaluate the associations of the frameworks’ domains with two outcomes: (1) intention to offer PrEP care and (2) intention to advocate for PrEP impmentation. Results We found support for nine indices with good internal consistency, reflecting PrEP characteristics, attitudes towards population needs, concerns about the use of PrEP, concerns about the role of the healthcare systems, knowledge, beliefs about capabilities, professional role, social influence, and beliefs about consequences. Notably, only 57% of the participants were likely to have a plan to care for people in PrEP and 66.7% were likely to advocate for PrEP. The perception of the need for PrEP in populations, the value of PrEP as a practice, the influence of colleagues, and seeing PrEP care as a priority was related to being less likely to be unwilling to provide or advocate for PrEP care. Conclusion Our findings suggested the importance of multilevel strategies to increase the provision of PrEP care by healthcare providers including adquisition of new skills, training of PrEP champions, and strength the capacity of the health system. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-022-00278-2.
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Affiliation(s)
- Jorge Luis Martinez-Cajas
- Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, ON, K7L 3 N6, Canada
| | - Julian Torres
- Montefiore Medical Center, Moses Division, Albert Einstein College of Medicine, The Oval Center at Montefiore, 3230 Bainbridge Ave, Bronx, NY, 10467, USA
| | | | | | - Marcela Arrivillaga
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali, Colombia, Calle, 18 118-250, Cali, Colombia
| | - Sheila Andrea Gomez
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali, Colombia, Calle, 18 118-250, Cali, Colombia
| | - Ximena Galindo
- Corporación de Lucha Contra el Sida, Carrera 56 2- 120, Cali, Colombia
| | - Ernesto Martinez Buitrago
- Departamento de Medicina Interna, Universidad del Valle, Calle 5 36-08 Hospital Universitario del Valle, Cali, Colombia
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Persistence on oral pre-exposure prophylaxis (PrEP) among female sex workers in eThekwini, South Africa, 2016–2020. PLoS One 2022; 17:e0265434. [PMID: 35290421 PMCID: PMC8923438 DOI: 10.1371/journal.pone.0265434] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background Despite the established efficacy of PrEP to prevent HIV and the advantages of a user-controlled method, PrEP uptake and persistence by women in both trials and demonstration projects has been suboptimal. We utilized real-world data from an HIV service provider to describe persistence on oral PrEP among female sex workers (FSW) in eThekwini, South Africa. Methods We examined time from PrEP initiation to discontinuation among all FSW initiating PrEP at TB HIV Care in eThekwini between 2016–2020. We used a discrete time-to-event data setup and stacked cumulative incidence function plots, displaying the competing risks of 1) not returning for PrEP, 2) client discontinuation, and 3) provider discontinuation. We calculated hazard ratios using complementary log-log regression and sub-hazard ratios using competing risks regression. Results The number of initiations increased each year from 155 (9.3%, n = 155/1659) in 2016 to 1224 (27.5%, n = 1224/4446) in 2020. Persistence 1-month after initiation was 53% (95% CI: 51%-55%). Younger women were more likely to discontinue PrEP by not returning compared with those 25 years and older. Risk of discontinuation through non-return declined for those initiating in later years. Despite the COVID-19 pandemic, a greater number of initiations and sustained persistence were observed in 2020. Conclusions Low levels of PrEP persistence were observed, consistent with data among underserved women elsewhere. Encouragingly, the proportion of women persisting increased over time, even as the number of women newly initiating PrEP and staff workload increased. Further research is needed to understand which implementation strategies the program may have enacted to facilitate these improvements and what further changes may be necessary.
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80
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Atukunda EC, Owembabazi M, Pratt MC, Psaros C, Muyindike W, Chitneni P, Bwana MB, Bangsberg D, Haberer JE, Marrazzo J, Matthews LT. A qualitative exploration to understand barriers and facilitators to daily oral PrEP uptake and sustained adherence among HIV-negative women planning for or with pregnancy in rural Southwestern Uganda. J Int AIDS Soc 2022; 25:e25894. [PMID: 35324081 PMCID: PMC8944216 DOI: 10.1002/jia2.25894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 02/08/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Antiretroviral pre-exposure prophylaxis (PrEP) may reduce periconception and pregnancy HIV incidence among women in settings, where gender power imbalances limit HIV testing, engagement in care and HIV viral suppression. We conducted qualitative interviews to understand factors influencing periconception and pregnancy PrEP uptake and use in a cohort of women (Trial registration: NCT03832530) offered safer conception counselling in rural Southwestern Uganda, where PrEP uptake was high. METHODS Between March 2018 and January 2019, in-depth interviews informed by conceptual frameworks for periconception risk reduction and PrEP adherence were conducted with 37 women including those with ≥80% and <80% adherence to PrEP doses measured by electronic pill cap, those who never initiated PrEP, and seven of their male partners. Content and dyadic analyses were conducted to identify emergent challenges and facilitators of PrEP use within individual and couple narratives. RESULTS The median age for women was 33 years (IQR 28, 35), 97% felt likely to acquire HIV and 89% initiated PrEP. Individual-level barriers included unwillingness to take daily pills while healthy, side effects and alcohol use. Women overcame these barriers through personal desires to have control over their HIV serostatus, produce HIV-negative children and prevent HIV transmission within partnerships. Couple-level barriers included nondisclosure, mistrust and gender-based violence; facilitators included shared goals and perceived HIV protection, which improved communication, sexual intimacy and emotional support within partnerships through a self-controlled method. Community-level barriers included multi-level stigma related to HIV, ARVs/PrEP and serodifference; facilitators included active peer, family or healthcare provider support as women aspired to safely meet socio-cultural expectations to conceive and preserve serodifferent relationships. Confidence in PrEP effectiveness was promoted by positive peer experiences with PrEP and ongoing HIV testing. CONCLUSIONS Multi-level forms of HIV-, serodifference- and disclosure-related stigma, side effects, pill burden, alcohol use, relationship dynamics, social, professional and partnership support towards adaptation and HIV risk reduction influence PrEP uptake and adherence among HIV-negative women with plans for pregnancy in rural Southwestern Uganda. Confidence in PrEP, individually controlled HIV prevention and improved partnership communication and intimacy promoted PrEP adherence. Supporting individuals to overcome context-specific barriers to PrEP use may be an important approach to improving uptake and prolonged use.
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Affiliation(s)
| | | | - Madeline Claire Pratt
- Division of Infectious DiseasesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Christina Psaros
- Behavioral Medicine ProgramDepartment of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
- Harvard Medical SchoolBostonMassachusettsUSA
| | | | - Pooja Chitneni
- Division of Infectious Diseases and General Internal MedicineBrigham and Women's HospitalBostonMassachusettsUSA
| | | | - David Bangsberg
- School of Public HealthOregon Health Sciences University – Portland State UniversityPortlandOregonUSA
| | - Jessica Elizabeth Haberer
- Harvard Medical SchoolBostonMassachusettsUSA
- Department of MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Jeanne Marrazzo
- Division of Infectious DiseasesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Lynn Turner Matthews
- Division of Infectious DiseasesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
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81
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Lin C, Li L, Liu J, Fu X, Chen J, Cao W, Li Y. HIV PrEP services for MSM in China: a mixed-methods study. AIDS Care 2022; 34:310-314. [PMID: 33650447 PMCID: PMC8410894 DOI: 10.1080/09540121.2021.1896661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is a promising HIV prevention method. However, the rollout of PrEP among men who have sex with men (MSM) is facing challenges. This study sought to understand PrEP acceptability and service use challenges among MSM in China. The study was conducted in 2018 in Guangdong Province using a mixed-methods approach. Among 489 HIV-negative MSM who completed an online survey, 374 (76.5%) had heard of PrEP before. The most common PrEP information sources were internet/social media (32.1%) and community-based organizations (30.4%). Two-thirds (n=328) of the MSM would accept PrEP even the protective efficacy is less than 100%, 60.1% (n=294) expressed willingness to use PrEP once it is approved in China, and 59.3% (n=290) were willing to pay out of pocket. Employment, disclosure of MSM status, and mental health issues were associated with PrEP acceptability. In-depth interviews with 30 MSM revealed that high cost, low accessibility, and stigma in clinic settings were barriers to PrEP using. Primary care-based PrEP services were acceptable, but patients' confidentiality was a concern. PrEP promotion efforts should address social and mental health challenges among MSM and mobilize primary care systems and community-based organizations to achieve the best result.
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Affiliation(s)
- Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Jun Liu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xiaobing Fu
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Jun Chen
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A.,Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Wei Cao
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A.,Department of Epidemiology, Fielding School of Public Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Yan Li
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
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Murphy M, Sosnowy C, Rogers B, Napoleon S, Galipeau D, Scott T, Tao J, Berk J, Clarke J, Nunn A, Chan PA. Defining the Pre-exposure Prophylaxis Care Continuum Among Recently Incarcerated Men at High Risk for HIV Infection: Protocol for a Prospective Cohort Study. JMIR Res Protoc 2022; 11:e31928. [PMID: 35142633 PMCID: PMC8874820 DOI: 10.2196/31928] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND HIV disproportionately impacts criminal justice-involved individuals, including men who experience incarceration. Men make up the vast majority of those experiencing incarceration as well as those newly diagnosed with HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention that significantly reduces the risk of HIV acquisition. However, implementation in criminal justice systems is limited. Little is known about effective PrEP implementation and use in this unique public health context. OBJECTIVE The aim of this study is to characterize the experience of implementing PrEP clinical care in a criminal justice setting for men vulnerable to HIV acquisition. METHODS This article describes a PrEP care continuum for men experiencing incarceration who are at increased risk of HIV acquisition, which can help conceptualize approaches to evaluating PrEP implementation. RESULTS The outlined study will enroll 100 men experiencing incarceration at high risk for HIV acquisition prior to release into the community. The goal is to initiate PrEP prior to release and link individuals to PrEP providers in the community, capturing barriers and facilitators to PrEP use during this uniquely vulnerable time period for HIV acquisition. CONCLUSIONS Based on the proposed care continuum and what is known about HIV risk and prevention efforts in the criminal justice context, we outline key future research efforts to better understand effective approaches to preventing HIV infection among this vulnerable population. The described approach presents a powerful public health opportunity to help end the HIV epidemic. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/31928.
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Affiliation(s)
| | | | | | | | | | - Ty Scott
- Brown University, Providence, RI, United States
| | - Jun Tao
- Brown University, Providence, RI, United States
| | - Justin Berk
- Brown University, Providence, RI, United States
| | | | - Amy Nunn
- Brown University, Providence, RI, United States
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83
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Greene GJ, Reidy E, Felt D, Marro R, Johnson AK, Phillips G, Green E, Stonehouse P. Implementation and evaluation of patient navigation in Chicago: Insights on addressing the social determinants of health and integrating HIV prevention and care services. EVALUATION AND PROGRAM PLANNING 2022; 90:101977. [PMID: 34373116 DOI: 10.1016/j.evalprogplan.2021.101977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/12/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
Patient navigation is a primary element in linkage to HIV pre-exposure prophylaxis (PrEP) care and linkage to or re-engagement in HIV care, depending on the HIV status of the individual. However, there is a dearth of literature describing navigation services in these areas. In the context of Chicago Project PrIDE, this project conducted process and implementation evaluations with eight agencies leading demonstration projects to address these gaps. The evaluation team conducted semi-structured, individual interviews with agency staff (N = 20) assessing navigation implementation and fit, as well as project successes and challenges. Additionally, agency staff collected patient surveys (N = 300) assessing services provided, service quality, and satisfaction. The interview transcripts were coded and analyzed thematically and descriptive analyses were performed on the survey data. Analyses indicated that screening for social determinants of health, providing healthcare engagement guidance, and providing service referrals were frequently cited navigation activities. Most staff members indicated that navigation fits well within their agencies, and that limited staff and clinic capacity were often barriers to navigation. Patient navigation to support engagement in HIV prevention and care services is critical due to the extensive support provided by navigators to address social determinants of health impacting HIV disparity populations.
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Affiliation(s)
- George J Greene
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA.
| | - Emma Reidy
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Dylan Felt
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Rachel Marro
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Amy K Johnson
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, The Potocsnak Family Division of Adolescent and Young Adult Medicine, 225 E. Chicago Ave., Box 161, Chicago, IL, 60611, USA
| | - Gregory Phillips
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Evelyn Green
- Chicago Department of Public Health, 333 S. State St., Suite 200, Chicago, IL, 60604, USA
| | - Patrick Stonehouse
- Chicago Department of Public Health, 333 S. State St., Suite 200, Chicago, IL, 60604, USA
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84
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Wray TB, Chan PA, Guigayoma JP, Kahler CW. Game Plan-a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis. JMIR Form Res 2022; 6:e30408. [PMID: 34989679 PMCID: PMC8771347 DOI: 10.2196/30408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/18/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background HIV pre-exposure prophylaxis (PrEP) has considerable potential for reducing incidence among high-risk groups, such as gay, bisexual, and other men who have sex with men (GBM). However, PrEP’s effectiveness is closely linked with consistent use, and a variety of individual-level barriers, including alcohol use, could impede optimal uptake and use. Web-based interventions can encourage medication adherence, HIV prevention behaviors, and responsible drinking and may help support PrEP care, particularly in resource-limited settings. Objective We previously developed a web application called Game Plan that was designed to encourage heavy drinking GBM to use HIV prevention methods and reduce their alcohol use and was inspired by brief motivational interventions. This paper aims to describe the web-based content we designed for integration into Game Plan to help encourage PrEP uptake and consistent use among GBM. In this paper, we also aim to describe this content and its rationale. Methods Similar to the original site, these components were developed iteratively, guided by a thorough user-centered design process involving consultation with subject-matter experts, usability interviews and surveys, and user experience surveys. Results In addition to Game Plan’s pre-existing content, the additional PrEP components provide specific, personal, and digestible feedback to users about their level of risk for HIV without PrEP and illustrate how much consistent PrEP use could reduce it; personal feedback about their risk for common sexually transmitted infections to address low-risk perceptions; content challenging common beliefs and misconceptions about PrEP to reduce stigma; content confronting familiar PrEP and alcohol beliefs; and a change planning module that allows users to select specific goals for starting and strategies for consistent PrEP use. Users can opt into a weekly 2-way SMS text messaging program that provides similar feedback over a 12-week period after using Game Plan and follows up on the goals they set. Conclusions Research preliminarily testing the efficacy of these components in improving PrEP outcomes, including uptake, adherence, sexually transmitted infection rates, and alcohol use, is currently ongoing. If supported, these components could provide a scalable tool that can be used in resource-limited settings in which face-to-face intervention is difficult.
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Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Philip A Chan
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - John P Guigayoma
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
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85
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Stanton MC, Ali SB, the SUSTAIN Center Team. A typology of power in implementation: Building on the exploration, preparation, implementation, sustainment (EPIS) framework to advance mental health and HIV health equity. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895211064250. [PMID: 37091105 PMCID: PMC9978699 DOI: 10.1177/26334895211064250] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Persistent inequities in HIV health are due, in part, to barriers to successful HIV-related mental health intervention implementation with marginalized groups. Implementation Science (IS) has begun to examine how the field can promote health equity. Lacking is a clear method to analyze how power is generated and distributed through practical implementation processes and how this power can dismantle and/or reproduce health inequity through intervention implementation. The aims of this paper are to (1) propose a typology of power generated through implementation processes, (2) apply this power typology to expand on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to advance HIV and mental health equity and (3) articulate questions to guide the explicit examination and distribution of power throughout implementation. Methods This paper draws on the work of an Intermediary Purveyor organization implementing trauma-informed care and harm reduction organizational change with HIV service organizations. The expanded framework was developed through analyzing implementation coaching field notes, grant reporting, and evaluation documents, training feedback, partner evaluation interviews, and existing implementation literature. Results The authors identify three types of power working through implementation; (1) discursive power is enacted through defining health-related problems to be targeted by intervention implementation, as well as through health narratives that emerge through implementation; (2) epistemic power influences whose knowledge is valued in decision-making and is recreated through knowledge generation; and (3) material power is created through resource distribution and patterns of access to health resources and acquisition of health benefits provided by the intervention. Decisions across all phases and related to all factors of EPIS influence how these forms of power striate through intervention implementation and ultimately affect health equity outcomes. Conclusions The authors conclude with a set of concrete questions for researchers and practitioners to interrogate power throughout the implementation process. Plain language summary Over the past few years, Implementation Science researchers have committed increased attention to the ways in which the field can more effectively address health inequity. Lacking is a clear method to analyze how implementation processes themselves generate power that has the potential to contribute to health inequity. In this paper, the authors describe and define three types of power that are created and distributed through intervention implementation; discursive power, epistemic power, and material power. The authors then explain how these forms of power shape factors and phases of implementation, using the well-known EPIS (exploration, preparation, implementation, sustainment) framework. The authors draw from their experience working with and Intermediary Purveyor supporting HIV service organizations implementing trauma-informed care and harm reduction organizational change projects. This paper concludes with a set of critical questions that can be used by researchers and practitioners as a concrete tool to analyze the role of power in intervention implementation processes.
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Affiliation(s)
- Megan C. Stanton
- Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, Willimantic, CT, USA
| | - Samira B. Ali
- Graduate College of Social Work, University of Houston, Houston, TX, USA
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86
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Lau JYC, Wong NS, Lee KCK, Kwan TH, Lui GCY, Chan DPC, Lee SS. What makes an optimal delivery for PrEP against HIV: A qualitative study in MSM. Int J STD AIDS 2022; 33:322-329. [PMID: 34978228 DOI: 10.1177/09564624211060824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective means of HIV prevention for men who have sex with men (MSM), a key population whose engagement is crucial for achieving effective public health outcomes. An optimal service model would be important in planning the implementation of PrEP in places where such service has not been established. METHODS A qualitative study was conducted to delineate the attributes of an optimal PrEP service model for MSM in Hong Kong, a city where no formal PrEP programs existed. Twenty purposively sampled MSM who were enrollees of two pilot PrEP projects participated in the semi-structured interviews promoting story-telling. The coded data were thematically analyzed following Grounded Theory approach, focusing on uncovering a typology of the essential attributes of an optimal PrEP service model, and the reasons for such preferences. RESULTS Participating MSM were all ethnic Chinese and aged 26 to 52 years. All had received PrEP from pilot projects in conjunction with periodic screening of sexually transmitted infections (STI), HIV antibody, and plasma creatinine. Four major themes emerged as regards the attributes of a preferred PrEP service: (i) comprehensiveness of HIV/STI and safety monitoring; (ii) convenient unitary service; (iii) stigma-free PrEP access and protecting confidentiality; and (iv) affordable price. Whereas regular provision of PrEP was acceptable to MSM, unaffordability and related stigma were the anticipated challenges for potential service providers. CONCLUSIONS The qualitative assessment of MSM's preference for PrEP service delivery has yielded important information on the many facets of a desirable service model.
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Affiliation(s)
- Janice Y C Lau
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Ngai-Sze Wong
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Krystal C K Lee
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China.,Department of Psychiatry, Queen Mary Hospital, Hong Kong, People's Republic of China
| | - Tsz-Ho Kwan
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Grace C Y Lui
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China.,Department of Medicine and Therapeutics, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Denise P C Chan
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Shui-Shan Lee
- Stanley Ho Centre for Emerging Infectious Diseases, 26451The Chinese University of Hong Kong, Hong Kong, People's Republic of China
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87
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Custer S, Herbert L. Implementing Pre-exposure Prophylactic Therapy in Primary Care. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2021.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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88
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Harkness A, Weinstein ER, Atuluru P, Mayo D, Vidal R, Rodríguez-Díaz CE, Safren SA. Latinx Sexual Minority Men's Access to HIV and Behavioral Health Services in South Florida During COVID-19: A Qualitative Study of Barriers, Facilitators, and Innovations. J Assoc Nurses AIDS Care 2022; 33:9-21. [PMID: 34939984 PMCID: PMC8981513 DOI: 10.1097/jnc.0000000000000280] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Despite the availability of HIV prevention and treatment tools, HIV disparities continue to affect Latinx sexual minority men (LSMM). Behavioral health concerns further exacerbate HIV disparities among LSMM. This study used rapid qualitative analysis to understand factors influencing LSMM's access to HIV and behavioral health services during coronavirus disease 2019 (COVID-19). Participants included LSMM with (n = 10) and without HIV (n = 10). The analysis identified 15 themes. Themes revealed that LSMM's access was disrupted by new and worsening barriers resulting from COVID-19, such as anxiety about COVID-19 exposure, confusion and disruptions to services, and new structural challenges. Other themes highlight positive changes, such as telehealth and relaxed clinic protocols, which enhanced LSMM's access to services during COVID-19. The findings suggest the need for HIV and behavioral health clinics to innovate and ensure LSMM's continued access to services during and beyond COVID-19.
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Affiliation(s)
- Audrey Harkness
- Research Assistant Professor of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Elliott R. Weinstein
- Predoctoral Psychology Trainee, Department of Psychology, University of Miami, Miami, Florida, USA
| | - Pranusha Atuluru
- medical student, Department of Medicine, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Daniel Mayo
- Research Associate, Department of Psychology, University of Miami, Miami, Florida, USA
| | - Ronald Vidal
- graduate student, Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Carlos E. Rodríguez-Díaz
- Associate Professor, The George Washington University, Washington, D.C., USA, and Associate Professor, University of Puerto Rico-Medical Sciences Campus, School of Public Health, San Juan, Puerto Rico
| | - Steven A. Safren
- Professor, Department of Psychology, University of Miami, Miami, Florida
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89
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Xu Q, Nali MC, McMann T, Godinez H, Li J, He Y, Cai M, Lee C, Merenda C, Araojo R, Mackey TK. Unsupervised Machine Learning to Detect and Characterize Barriers to Pre-exposure Prophylaxis Therapy: Multiplatform Social Media Study. JMIR INFODEMIOLOGY 2022; 2:e35446. [PMID: 37113799 PMCID: PMC10014091 DOI: 10.2196/35446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/18/2022] [Accepted: 03/07/2022] [Indexed: 04/29/2023]
Abstract
Background Among racial and ethnic minority groups, the risk of HIV infection is an ongoing public health challenge. Pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV when taken as prescribed. However, there is a need to understand the experiences, attitudes, and barriers of PrEP for racial and ethnic minority populations and sexual minority groups. Objective This infodemiology study aimed to leverage big data and unsupervised machine learning to identify, characterize, and elucidate experiences and attitudes regarding perceived barriers associated with the uptake and adherence to PrEP therapy. This study also specifically examined shared experiences from racial or ethnic populations and sexual minority groups. Methods The study used data mining approaches to collect posts from popular social media platforms such as Twitter, YouTube, Tumblr, Instagram, and Reddit. Posts were selected by filtering for keywords associated with PrEP, HIV, and approved PrEP therapies. We analyzed data using unsupervised machine learning, followed by manual annotation using a deductive coding approach to characterize PrEP and other HIV prevention-related themes discussed by users. Results We collected 522,430 posts over a 60-day period, including 408,637 (78.22%) tweets, 13,768 (2.63%) YouTube comments, 8728 (1.67%) Tumblr posts, 88,177 (16.88%) Instagram posts, and 3120 (0.6%) Reddit posts. After applying unsupervised machine learning and content analysis, 785 posts were identified that specifically related to barriers to PrEP, and they were grouped into three major thematic domains: provider level (13/785, 1.7%), patient level (570/785, 72.6%), and community level (166/785, 21.1%). The main barriers identified in these categories included those associated with knowledge (lack of knowledge about PrEP), access issues (lack of insurance coverage, no prescription, and impact of COVID-19 pandemic), and adherence (subjective reasons for why users terminated PrEP or decided not to start PrEP, such as side effects, alternative HIV prevention measures, and social stigma). Among the 785 PrEP posts, we identified 320 (40.8%) posts where users self-identified as racial or ethnic minority or as a sexual minority group with their specific PrEP barriers and concerns. Conclusions Both objective and subjective reasons were identified as barriers reported by social media users when initiating, accessing, and adhering to PrEP. Though ample evidence supports PrEP as an effective HIV prevention strategy, user-generated posts nevertheless provide insights into what barriers are preventing people from broader adoption of PrEP, including topics that are specific to 2 different groups of sexual minority groups and racial and ethnic minority populations. Results have the potential to inform future health promotion and regulatory science approaches that can reach these HIV and AIDS communities that may benefit from PrEP.
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Affiliation(s)
- Qing Xu
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
| | - Matthew C Nali
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- Global Health Program, Department of Anthropology University of California La Jolla, CA United States
| | - Tiana McMann
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- Global Health Program, Department of Anthropology University of California La Jolla, CA United States
| | | | - Jiawei Li
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
| | - Yifan He
- S-3 Research San Diego, CA United States
| | - Mingxiang Cai
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
| | - Christine Lee
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration Silver Spring, MD United States
| | - Christine Merenda
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration Silver Spring, MD United States
| | - Richardae Araojo
- Office of Minority Health and Health Equity, U.S. Food and Drug Administration Silver Spring, MD United States
| | - Tim Ken Mackey
- S-3 Research San Diego, CA United States
- Global Health Policy and Data Institute San Diego, CA United States
- Global Health Program, Department of Anthropology University of California La Jolla, CA United States
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90
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Irungu EM, Musau M, Nyerere B, Dollah A, Kwach B, Owidi E, Wamoni E, Odoyo J, Mugo N, Bukusi E, Mugwanya K, Baeten JM. Using an on-site modular training approach to amplify prep service delivery in public health facilities in Kenya. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000092. [PMID: 36962311 PMCID: PMC10021257 DOI: 10.1371/journal.pgph.0000092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022]
Abstract
Delivery of oral PrEP, a potent HIV prevention intervention, has begun within public health systems in many countries in Africa. Training as many health providers as possible expeditiously is necessary to efficiently and rapidly scale up PrEP delivery among at risk populations and thereby realize the greatest impact of PrEP. We designed and implemented an innovative on-site modular training approach delivered in five two-hour modules. The modules could be covered in two consecutive days or be broken across several days enabling flexibility to accommodate health provider work schedules. We assessed knowledge gain comparing pre-and post-training test scores and determined monthly PrEP uptake for six months following the training intervention. We also evaluated the cost of this training approach and conducted key informant interviews to explore acceptability among health providers. Between January 2019 and December 2020, 2111 health providers from 104 health facilities were trained on PrEP. Of 1821 (83%) providers who completed both pre- and post-tests, 505 (28%) were nurses, 333 (18%) were HIV counsellors, 276 (15%) were clinical officers and 255 (14%) were lay providers. The mean score prior to and after training was 58% and 82% respectively (p <0.001). On average, health facilities initiated an average of 2.7 (SD 4.7) people on PrEP each month after the training, a number that did not decline over six months post-training (p = 0.62). Assuming Ministry of Health costs, the costs per provider trained was $16.27. Health providers expressed satisfaction with this training approach because it enabled many providers within a facility receive training. On-site modular training is an effective approach for improving PrEP education for health workers in public health facilities, It is also acceptable and low-cost. This method of training can be scaled up to rapidly amplify the number of health workers able to offer PrEP services.
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Affiliation(s)
- Elizabeth M Irungu
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Moses Musau
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Bernard Nyerere
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Anabelle Dollah
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Benn Kwach
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Emmah Owidi
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elizabeth Wamoni
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Josephine Odoyo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nelly Mugo
- Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Elizabeth Bukusi
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
- Obstetrics and Gynecology, University of Washington, Seattle, WA, United States of America
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, Seattle, WA, United States of America
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, WA, United States of America
- Epidemiology, University of Washington, Seattle, WA, United States of America
- Medicine, University of Washington, Seattle, WA, United States of America
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91
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Guy D, Doran J, White TM, van Selm L, Noori T, Lazarus JV. The HIV pre-exposure prophylaxis continuum of care among women who inject drugs: A systematic review. Front Psychiatry 2022; 13:951682. [PMID: 36090369 PMCID: PMC9459118 DOI: 10.3389/fpsyt.2022.951682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/25/2022] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION People who inject drugs have a substantial risk for HIV infection, especially women who inject drugs (WWID). HIV pre-exposure prophylaxis (PrEP), a highly-effective HIV prevention drug, is uncommonly studied among WWID, and we aimed to synthesize existing knowledge across the full PrEP continuum of care in this population. METHODS We systematically searched for peer-reviewed literature in three electronic databases, conference abstracts from three major HIV conferences, and gray literature from relevant sources.Eligibility criteria included quantitative, qualitative or mixed-methods studies with primary data collection reporting a PrEP-related finding among WWID, and published in English or Spanish between 2012 and 2021. The initial search identified 2,809 citations, and 32 were included. Data on study characteristics and PrEP continuum of care were extracted, then data were analyzed in a narrative review. RESULTS Our search identified 2,809 studies; 32 met eligibility requirements. Overall, awareness, knowledge, and use of PrEP was low among WWID, although acceptability was high. Homelessness, sexual violence, unpredictability of drug use, and access to the healthcare system challenged PrEP usage and adherence. WWID were willing to share information on PrEP with other WWID, especially those at high-risk of HIV, such as sex workers. CONCLUSIONS To improve PrEP usage and engagement in care among WWID, PrEP services could be integrated within gender-responsive harm reduction and drug treatment services. Peer-based interventions can be used to improve awareness and knowledge of PrEP within this population. Further studies are needed on transgender WWID as well as PrEP retention and adherence among all WWID.
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Affiliation(s)
- Danielle Guy
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jason Doran
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,National Infection Service, UK Health Security Agency, London, United Kingdom.,London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
| | - Trenton M White
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Lena van Selm
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Teymur Noori
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain.,Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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92
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Pharmacy-Based Interventions to Increase Use of HIV Pre-exposure Prophylaxis in the United States: A Scoping Review. AIDS Behav 2022; 26:1377-1392. [PMID: 34669062 PMCID: PMC8527816 DOI: 10.1007/s10461-021-03494-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 12/15/2022]
Abstract
HIV pre-exposure prophylaxis (PrEP) remains underutilized in the U.S. Since greater than 85% of PrEP prescriptions are filled at commercial pharmacies, pharmacists are uniquely positioned to increase PrEP use. This scoping review explores pharmacy-based initiatives to increase PrEP use. We searched PubMed, PsycINFO, CINAHL, and Scopus for peer-reviewed studies on pharmacist-led interventions to increase PrEP use or pharmacy-based PrEP initiatives. Forty-nine articles were included in this review. Overall, studies demonstrated that patients expressed strong support for pharmacist prescription of PrEP. Three intervention designs compared changes in PrEP initiation or knowledge pre- and post-intervention. Commentary/review studies recommended PrEP training for pharmacists, policy changes to support pharmacist screening for HIV and PrEP prescription, and telemedicine to increase prescriptions. Pharmacists could play key roles in improving PrEP use in the U.S. Studies that assess improvements in PrEP use after interventions such as PrEP prescription, PrEP-specific training, and adherence monitoring by pharmacists are needed.
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93
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Rao S, Reed AE, Parchem B, Edelman EJ, Magnus M, Hansen NB, Kershaw TS, Earnshaw VA, Krakower DS, Dovidio JF, Mayer KH, Underhill K, Rosenberger JG, Ogburn DF, Betancourt JR, Calabrese SK. Optimizing Provider Preexposure Prophylaxis (PrEP) Training: A Cross-Sectional Analysis of Recommendations from Providers Across the PrEP Implementation Cascade. AIDS Behav 2022; 26:218-231. [PMID: 34287754 PMCID: PMC8294250 DOI: 10.1007/s10461-021-03375-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 11/29/2022]
Abstract
Expanding PrEP access necessitates training that supports healthcare providers’ progression along the PrEP implementation cascade, moving from PrEP awareness to prescription. We surveyed 359 USA providers about PrEP training content and format recommendations. We examined the association between cascade location and training recommendations. Most providers were aware of PrEP (100%), willing to prescribe PrEP (97.2%), had discussed PrEP with patients (92.2%), and had prescribed PrEP (79.9%). Latent class regression analysis revealed that cascade location was associated with training recommendations. Although all providers recommended PrEP-specific content (e.g., patient eligibility), providers who were located further along the cascade also recommended more comprehensive content, including sexual history-taking and sexual and gender minority competence training. Providers further along the cascade were also more likely to recommend interactive training formats (e.g., role-playing). These insights from providers furthest along the cascade indicate the importance of including comprehensive content and interactive formats in future PrEP training initiatives.
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Affiliation(s)
- Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA.
| | - Ashley E Reed
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
| | - Benjamin Parchem
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
| | - E Jennifer Edelman
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Manya Magnus
- Department of Epidemiology, Milken School of Public Health, George Washington University, Washington DC, USA
| | - Nathan B Hansen
- Department of Health Promotion and Behavior, University of Georgia, Athens, GA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | - Douglas S Krakower
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | | | - Kenneth H Mayer
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Fenway Health, The Fenway Institute, Boston, MA, USA
| | - Kristen Underhill
- Population and Family Health and Law, Columbia University, New York City, NY, USA
| | - Joshua G Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, University Park, PA, USA
| | - Damon F Ogburn
- National Center for Health Statistics, Hyattsville, MD, USA
| | | | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2125 G St. NW, Washington DC, 20052, USA
- Department of Prevention and Community Health, Milken School of Public Health, George Washington University, Washington, DC, USA
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94
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Ballreich J, Levengood T, Conti RM. Opportunities and Challenges of Generic Pre-Exposure Prophylaxis Drugs for HIV. THE JOURNAL OF LAW, MEDICINE & ETHICS : A JOURNAL OF THE AMERICAN SOCIETY OF LAW, MEDICINE & ETHICS 2022; 50:32-39. [PMID: 35902088 PMCID: PMC9341204 DOI: 10.1017/jme.2022.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Antiretroviral pre-exposure prophylaxis (PrEP) is protective against HIV. Low utilization rates amongst HIV vulnerable populations are due in part to the high cost of PrEP. Generic PrEP offers the potential to improve health at significantly reduced costs. In this study, we examine early utilization patterns and prices for generic PrEP. We discuss the opportunities and challenges for generic PrEP to improve health among HIV vulnerable populations.
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95
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Keddem S, Dichter ME, Hamilton AB, Chhatre S, Sonalkar S. Awareness of HIV Preexposure Prophylaxis Among People at Risk for HIV: Results From the 2017-2019 National Survey of Family Growth. Sex Transm Dis 2021; 48:967-972. [PMID: 34108411 DOI: 10.1097/olq.0000000000001494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although daily preexposure prophylaxis (PrEP) is now widely accepted as a safe and effective method for reducing the risk of HIV in high-risk groups, uptake has been slow. The goal of this analysis was to identify factors associated with PrEP awareness among individuals at risk for HIV. METHODS This investigation analyzed data from the Centers for Disease Control and Prevention nationally representative survey, National Survey of Family Growth, for the years 2017 to 2019. Logistic regression was used to explore the relationship between PrEP awareness and demographics, HIV risk factors, and provider HIV risk screening. RESULTS Only 37% of survey respondents with an increased risk of HIV were aware of PrEP. Several segments of the at-risk population had lower odds of being aware of PrEP, including heterosexual women, heterosexual men, individuals younger than 20 years, and individuals with lower levels of education. Those who participate in sex in exchange for money or drugs had significantly lower odds of being aware of PrEP. In comparison, PrEP awareness was significantly higher among nonheterosexual men and both men and women whose partners were HIV positive. Lastly, those who had been screened by a provider for HIV risk had significantly higher odds of being aware of PrEP. CONCLUSIONS This research supports the need for policies and programs to increase awareness of PrEP, especially among certain segments of the population at increased risk for HIV.
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Affiliation(s)
| | | | | | | | - Sarita Sonalkar
- From the Perelman School of Medicine, University of Pennsylvania
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96
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Considerations for the Design of Pre-exposure Prophylaxis (PrEP) Interventions for Women: Lessons Learned from the Implementation of a Novel PrEP Intervention. AIDS Behav 2021; 25:3987-3999. [PMID: 34138377 PMCID: PMC8210500 DOI: 10.1007/s10461-021-03353-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 01/05/2023]
Abstract
Pre-exposure prophylaxis (PrEP) uptake among women in the United States has been low. To increase uptake, we developed a peer outreach and navigation PrEP intervention. Semi-structured qualitative interviews with 32 cisgender women and 3 transgender women were conducted to assess the intervention. We used a thematic approach to identify barriers to, and facilitators of the intervention. Facilitators included interest in PrEP, offer of health and social services, the intervention’s women-focused approach, and peer outreach and navigation. Barriers were perceived HIV risk, concerns about medication side effects or interactions, housing insecurity and travel, co-occurring health-related conditions, and caregiving responsibilities. We recommend that future interventions consider packaging PrEP in local community settings, such as syringe exchange programs; include services such as food and housing assistance; use peers to recruit and educate women; integrate a culturally appropriate women’s focus; and consider providing same-day PrEP.
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97
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Sharkey T, Wall KM, Parker R, Tichacek A, Pappas-DeLuca KA, Kilembe W, Inambao M, Malama K, Hoagland A, Peeling R, Allen S. A cluster randomized trial to reduce HIV risk from outside partnerships in Zambian HIV-Negative couples using a novel behavioral intervention, "Strengthening Our Vows": Study protocol and baseline data. Contemp Clin Trials Commun 2021; 24:100850. [PMID: 34622087 PMCID: PMC8481973 DOI: 10.1016/j.conctc.2021.100850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 08/02/2021] [Accepted: 09/08/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Heterosexual couples contribute to most new HIV infections in areas of generalized HIV epidemics in sub-Saharan Africa. After Couples' Voluntary HIV Counseling and Testing (CVCT), heterosexual concordant HIV negative couples (CNC) in cohabiting unions contribute to approximately 47% of residual new infections in couples. These infections are attributed to concurrent sexual partners, a key driver of the HIV epidemic in Zambia. METHODS/DESIGN Ten Zambian government clinics in two of the largest cities were randomized in matched pairs to a Strengthening Our Vows (SOV) intervention or a Good Health Package (GHP) comparison arm. SOV addressed preventing HIV infection from concurrent partners and protecting spouses after exposures outside the relationship. GHP focused on handwashing; water chlorination; household deworming; and screening for hypertension, diabetes and schistosomiasis. CNC were referred from CVCT services in government clinics. Follow-up includes post-intervention questionnaires and outcome assessments through 60 months. Longitudinal outcomes of interest include self-report and laboratory markers of condomless sex with outside partners and reported sexual agreements. We present baseline characteristics and factors associated with study arm and reported risk using descriptive statistics. RESULTS The mean age of men was 32 and 26 for women. On average, couples cohabited for 6 years and had 2 children. Baseline analyses demonstrated some failures of randomization by study arm which will be considered in future primary analyses of longitudinal data. An HIV/STI risk factor composite was not different in the two study arms. Almost one-quarter of couples had an HIV risk factor at baseline. DISCUSSION In preparation for future biomedical and behavioral interventions in sub-Saharan Africa, it is critical to understand and decrease HIV risk within CNC.
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Affiliation(s)
- Tyronza Sharkey
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- London School of Hygiene and Tropical Medicine, UK
| | - Kristin M. Wall
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
- Department of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Rachel Parker
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Amanda Tichacek
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Katina A. Pappas-DeLuca
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - William Kilembe
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Mubiana Inambao
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Kalonde Malama
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | - Alexandra Hoagland
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
| | | | - Susan Allen
- Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, GA, 30322, USA
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98
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Kadiamada-Ibarra H, Hawley NL, Sosa-Rubí SG, Wilson-Barthes M, Galárraga O, Franco RR. Barriers and facilitators to pre-exposure prophylaxis uptake among male sex workers in Mexico: an application of the RE-AIM framework. BMC Public Health 2021; 21:2174. [PMID: 34837988 PMCID: PMC8626882 DOI: 10.1186/s12889-021-12167-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 11/03/2021] [Indexed: 11/28/2022] Open
Abstract
Background The ImPrEP México demonstration project is the first to distribute free HIV pre-exposure prophylaxis (PrEP) to men who have sex with men (MSM) and transgender women living in Mexico. In Mexico City, MSM who are also male sex workers (MSWs) face a disproportionately high risk of HIV infection. PrEP is highly effective for HIV prevention, yet “real-life” implementation among MSWs is a challenge due to the unique adherence barriers faced by this population. Methods This study uses the RE-AIM implementation science framework to characterize the unique barriers to and facilitators of PrEP uptake among MSWs in Mexico City. We conducted 9 in-depth key informant interviews and 2 focus group discussions with MSWs across 5 clinic and community sites. Qualitative data were analyzed using inductive, open coding approaches from grounded theory. We supplemented findings from the primary qualitative analysis with quantitative indicators derived from ImPrEP program records to describe the current Reach of the ImPrEP program among MSWs in Mexico City and the potential for wider PrEP Adoption among other high-risk populations in Mexico. Results The Reach of the ImPrEP program was 10% of known HIV-negative MSWs in Mexico City. Program Reach was lowest among MSWs who were street-based sex workers, of lower socioeconomic status, migrants from other states and self-identified as heterosexual. Barriers to program Reach included limited PrEP knowledge, HIV-related stigma, and structural barriers; facilitators included in-person program recruitment, patient-centered care, and spread of information through word of mouth among MSWs. Two out of the four eligible institutions had adopted the ImPrEP protocol. Barriers to wider program Adoption included HIV- and sexual identity– related stigma, protocol limitations, and lack of a national policy for PrEP distribution; facilitators of Adoption included existing healthcare infrastructure, sensitized providers, and community support from non-governmental organizations. Conclusions Increasing the ImPrEP program’s Reach among MSWs will depend on improving PrEP education and addressing HIV-related stigma and access barriers. Future Adoption of the ImPrEP program should build on existing clinical infrastructure and community support. Creation of a national policy for PrEP distribution may improve the Reach and Adoption of PrEP among highest-risk populations in Mexico. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-12167-9.
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Affiliation(s)
| | - Nicola L Hawley
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, 06510, USA
| | - Sandra G Sosa-Rubí
- Division of Health Economics, National Institute of Public Health (INSP), 62100, Cuernavaca, CP, Mexico
| | - Marta Wilson-Barthes
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Omar Galárraga
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, 02912, USA
| | - Roxana Rodríguez Franco
- Center for Demographic, Urban, and Environmental Studies (CEDUA), The College of Mexico, 14110, Mexico City, CP, Mexico.
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99
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Gaskins M, Sammons MK, Kutscha F, Nast A, Werner RN. Factors that motivate men who have sex with men in Berlin, Germany, to use or consider using HIV pre-exposure prophylaxis-A multi-methods analysis of data from a multicentre survey. PLoS One 2021; 16:e0260168. [PMID: 34793575 PMCID: PMC8601504 DOI: 10.1371/journal.pone.0260168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/03/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND While our knowledge of what motivates men who have sex with men (MSM) to use HIV pre-exposure prophylaxis (PrEP) has grown in recent years, quantitative survey-based studies have not asked MSM explicitly to name their motivations. We did so using a qualitative open-ended question and aimed to categorise the responses and explore whether these were related to where MSM were located along a conceptual continuum of PrEP care. METHODS In a multicentre survey examining knowledge and use of PrEP among MSM in Berlin, Germany, we additionally asked an open-ended question about motivations for using or considering PrEP. Data were collected from 10/2017-04/2018. One researcher developed a thematic framework deductively from the literature and another did so inductively from the free-text data, and a merged framework was used to code responses independently. We used Fisher's exact test to assess whether the frequency of motivations differed significantly between respondents using or considering PrEP. RESULTS Of 875 questionnaires, 473 were returned and 228 contained a free-text response. Motivations in the following categories were reported: (1) Safety/protection against HIV (80.2% of participants, including general safety; additional protection to condoms), (2) Mental well-being and quality of life (23.5%, including reduced anxiety; better quality of life), (3) Condom attitudes (18.9% intent not to use condoms), (4) Expectations about sexuality (14.4%, including worry-free sex or more pleasurable sex, with explicit mention of sex or sexuality), (5) Norms/social perspectives (0.8%). The difference in frequencies of motivations between those using or considering PrEP was not statistically significant. CONCLUSIONS Safety and protection against HIV, particularly having additional protection if condoms fail, were the most common motivations for using or considering PrEP, followed by mental well-being and quality of life. Many respondents reported several motivations, and responses overall were heterogeneous. This suggests that approaches to increase PrEP uptake that focus exclusively on its effectiveness in preventing HIV are unlikely to be as successful as a holistic approach that emphasises multiple motivations and how these fit into the broader sexual and psychological health of MSM.
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Affiliation(s)
- Matthew Gaskins
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Mary Katherine Sammons
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Kutscha
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Nast
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ricardo Niklas Werner
- Division of Evidence-Based Medicine (dEBM), Department of Dermatology, Venereology and Allergy, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Kusemererwa S, Kansiime S, Mutonyi G, Namirembe A, Katana S, Kitonsa J, Kakande A, Okello JM, Kaleebu P, Ruzagira E. Predictors of oral pre-exposure prophylaxis (PrEP) uptake among individuals in a HIV vaccine preparedness cohort in Masaka, Uganda. Medicine (Baltimore) 2021; 100:e27719. [PMID: 34871265 PMCID: PMC8568469 DOI: 10.1097/md.0000000000027719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/21/2021] [Indexed: 01/05/2023] Open
Abstract
Oral pre-exposure prophylaxis (PrEP) significantly reduces human immunodeficiency virus (HIV) acquisition risk. However, data on predictors of PrEP uptake in sub-Saharan Africa are limited. We assessed predictors of PrEP uptake among HIV-uninfected high risk individuals enrolled in a HIV vaccine preparedness study in Masaka, Uganda.Between July 2018 and October 2020, we recruited adults (18-40 years) from sex work hotspots along the trans-African highway and Lake Victoria fishing communities. We collected baseline data on socio-demographics and PrEP awareness, and provided HIV counselling and testing, information on PrEP, and PrEP referrals at quarterly visits. Urine pregnancy tests (women) and data collection on sexual risk behaviour and PrEP uptake were performed every 6 months. We analysed PrEP uptake among participants who had completed 6 months of follow-up.Of the 588 cohort participants, 362 (62%) were included in this analysis. Of these, 176 (49%) were female, 181 (50%) were aged ≤24 years, 104 (29%) worked in sex work hotspots, 74 (20%) were fisher folk. Only 75 (21%) participants initiated PrEP. Predictors of PrEP uptake included having ≥6 sex partners (adjusted odds ratio [aOR] = 2.29; 95% confidence interval [CI] 1.26-4.17), engaging in transactional sex (aOR = 2.23; 95% CI 0.95-5.20), and residence in a nonfishing community (aOR = 2.40; 95% CI 1.14-5.08). The commonest reasons for not starting PrEP were pill burden (38%) and needing more time to decide (27%).PrEP uptake was low and associated with HIV risk indicators in this cohort. Interventions are needed to improve access to PrEP especially in fishing communities.
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Affiliation(s)
- Sylvia Kusemererwa
- Department of HIV and Emerging Infections, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Sheila Kansiime
- Department of Statistics, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Gertrude Mutonyi
- Department of Statistics, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Aeron Namirembe
- Department of Statistics, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Safina Katana
- Department of HIV and Emerging Infections, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Jonathan Kitonsa
- Department of HIV and Emerging Infections, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Ayoub Kakande
- Department of Statistics, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Joseph Mugisha Okello
- Department of HIV and Emerging Infections, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Pontiano Kaleebu
- Department of HIV and Emerging Infections, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
| | - Eugene Ruzagira
- Department of HIV and Emerging Infections, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda
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