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Abstract
Tenofovir disoproxil fumarate coformulated with emtricitabine (TDF/FTC) was shown to be effective in preventing HIV acquisition when used for pre-exposure prophylaxis (PrEP), but questions have arisen regarding optimal PrEP implementation strategies.
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Fisher CB, Bragard E, Bloom R. Ethical Considerations in HIV eHealth Intervention Research: Implications for Informational Risk in Recruitment, Data Maintenance, and Consent Procedures. Curr HIV/AIDS Rep 2020; 17:180-189. [PMID: 32358768 PMCID: PMC7263316 DOI: 10.1007/s11904-020-00489-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Along with the benefits of eHealth HIV interventions are challenges to participant privacy and confidentiality inherent in the use of online strategies. This paper reviews current guidelines and recent publications to identify ethical issues and suggested solutions in recruitment, data management, and informed consent. RECENT FINDINGS Across eHealth HIV research, recruitment, data collection, and storage efforts to protect informational risk highlight the tension between the investigators' ability to protect participant confidentiality and the evolving informational risk posed by the online platforms on which they are operating. Adequately addressing these challenges requires updating technical competencies and educating participants on their own responsibilities to guard against privacy violations. Additional protections are required when interventions involve peer or community support, especially with minors. The rapid progression of technology presents challenges in solidifying best practices for future interventions. This article draws on published works describing investigator experiences to contribute to the ongoing development of guidance in this area.
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Affiliation(s)
- Celia B Fisher
- Center for Ethics Education and Department of Psychology, Fordham University, 117 Dealy Hall, Rose Hill Campus, 441 E. Fordham Road, Bronx, NY, 10458, USA.
| | - Elise Bragard
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Rachel Bloom
- Department of Psychology, Fordham University, Bronx, NY, USA
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53
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Sun CJ, Anderson KM, Kuhn T, Mayer L, Klein CH. A Sexual Health Promotion App for Transgender Women (Trans Women Connected): Development and Usability Study. JMIR Mhealth Uhealth 2020; 8:e15888. [PMID: 32396131 PMCID: PMC7251477 DOI: 10.2196/15888] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/22/2019] [Accepted: 12/15/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women. OBJECTIVE This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app. METHODS We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions. RESULTS Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer-friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively. CONCLUSIONS This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway.
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Affiliation(s)
- Christina J Sun
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, United States
| | - Kirsten M Anderson
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, OR, United States
| | | | - Liat Mayer
- Department of Anthropology, Portland State University, Portland, OR, United States
| | - Charles H Klein
- Department of Anthropology, Portland State University, Portland, OR, United States
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Owens C, Hubach RD, Lester JN, Williams D, Voorheis E, Reece M, Dodge B. Assessing determinants of pre-exposure prophylaxis (PrEP) adherence among a sample of rural Midwestern men who have sex with men (MSM). AIDS Care 2020; 32:1581-1588. [PMID: 32338061 DOI: 10.1080/09540121.2020.1757021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Pre-exposure prophylaxis (PrEP) efficacy in preventing HIV among gay, bisexual, and other men who have sex with men (MSM) is dependent upon adherence. Little is known about the PrEP adherence experiences among MSM who live in rural areas of the US. This qualitative study was informed by a modified version of Straussian Grounded Theory. Thirty-four 34 rural Midwestern MSM participated in telephone interviews that assessed their PrEP adherence factors. Overall, participants adhered to the PrEP regimen, ranging from missing none to a couple of doses per month. Participants had high self-efficacy (competence) and self-reliance (autonomy) in taking PrEP daily. Participants incorporated PrEP into their already existing routines. Participants were motivated to adhere to prevent HIV acquisition and be financially responsible. All participants mentioned their PrEP provider discussed the importance of adherence with PrEP's effectiveness, but future patient-provider PrEP adherence communication varied among participants. Future PrEP adherence interventions should address counseling strategies that leverage these constructs to support pill taking. Future research should explore patient-provider conversations surrounding PrEP adherence to inform provider- and patient-level interventions.
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Affiliation(s)
- Christopher Owens
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Randolph D Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, OK, USA
| | - Jessica Nina Lester
- Deparmtent of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Deana Williams
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Eva Voorheis
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
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55
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Chan PA, Goedel WC, Nunn AS, Sowemimo-Coker G, Galárraga O, Prosperi M, Patel R, Mena L, Montgomery MC, Marshall BD. Potential Impact of Interventions to Enhance Retention in Care During Real-World HIV Pre-Exposure Prophylaxis Implementation. AIDS Patient Care STDS 2019; 33:434-439. [PMID: 31584857 DOI: 10.1089/apc.2019.0064] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) has the potential to significantly reduce HIV incidence among men who have sex with men (MSM) in the United States. However, the extent to which suboptimal PrEP adherence and retention in care may limit successful implementation is unknown. An agent-based model was used to represent the entire population of MSM in Rhode Island from 2013 to 2017. The impact of potential interventions to improve PrEP adherence and retention in care on HIV transmission was evaluated. Demographics, behaviors, and PrEP adherence and retention in care rates were based on local clinical data. We assumed that 20% of HIV-negative MSM had ever taken PrEP. The primary outcome was HIV incidence over the 5-year period. The model included 23,815 MSM with an estimated 4.1% HIV prevalence based on local surveillance data. An estimated 173.1 new infections occurred over 5 years [95% simulation interval (SI): 171.5-174.7], including 29.1 new infections among individuals who had ever initiated PrEP (95% SI: 28.6-29.7). Interventions that improved retention in PrEP care by an odds of 5.0 compared with the base case maximized reductions in HIV incidence among MSM who had ever initiated PrEP by 37.5%. Interventions focusing on improving PrEP adherence had little to no effect on HIV incidence, regardless of intervention efficacy. Retention in care is a critical component of the PrEP care continuum. Interventions that improve retention in PrEP care may lead to greater reductions in population-level HIV incidence compared with interventions focused exclusively on adherence.
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Affiliation(s)
- Philip A. Chan
- Department of Medicine, Brown University, Providence, Rhode Island
- Department of Behavioral and Social Sciences, Policy and Practice, Brown University, Providence, Rhode Island
| | - William C. Goedel
- Department of Epidemiology, and Policy and Practice, Brown University, Providence, Rhode Island
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, Policy and Practice, Brown University, Providence, Rhode Island
| | | | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island
| | - Mattia Prosperi
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Rupa Patel
- Department of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - Leandro Mena
- Department of Population Health Science, University of Mississippi, Jackson, Mississippi
| | | | - Brandon D.L. Marshall
- Department of Epidemiology, and Policy and Practice, Brown University, Providence, Rhode Island
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56
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Nguyen LH, Tran BX, Rocha LEC, Nguyen HLT, Yang C, Latkin CA, Thorson A, Strömdahl S. A Systematic Review of eHealth Interventions Addressing HIV/STI Prevention Among Men Who Have Sex With Men. AIDS Behav 2019; 23:2253-2272. [PMID: 31401741 DOI: 10.1007/s10461-019-02626-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A systematic review was conducted to summarize and appraise the eHealth interventions addressing HIV/STI prevention among men who have sex with men (MSM), and characterize features of successful eHealth interventions. Fifty-five articles (17 pilots and 38 full efficacy trials) were included with the predominance of web-based interventions in the United States-based settings. Intervention modalities include web-based, short message service (SMS)/text messges/email reminder, online video-based, computer-assisted, multimedia-based, social network, live chat and chat room, virtual simulation intervention, and smartphone applications. Forty-nine eHealth interventions achieved a short-term behaviour change among participants. Four studies were conducted with 12-month follow-ups; and only one of them could maintain the behaviour change over this longer time period which could be due to the lack of booster interventions. Our study suggests that eHealth interventions can achieve short term behaviour change among MSM, however limited interventions could maintain behaviour change over 12 months. Further eHealth intervention strategies to promote HIV prevention among MSM should be conducted and rigorously evaluated.
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57
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Clement ME, Johnston BE, Eagle C, Taylor D, Rosengren AL, Goldstein BA, Seña AC. Advancing the HIV Pre-Exposure Prophylaxis Continuum: A Collaboration Between a Public Health Department and a Federally Qualified Health Center in the Southern United States. AIDS Patient Care STDS 2019; 33:366-371. [PMID: 31233329 DOI: 10.1089/apc.2019.0054] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Uptake of pre-exposure prophylaxis (PrEP) has been limited among black and Latino men who have sex with men (MSM), especially in the southern United States. Public health departments and federally qualified health centers (FQHCs) serving predominantly uninsured populations are uniquely positioned to improve access. We evaluated a novel PrEP collaboration between a public health department and an FQHC in North Carolina (NC). In May 2015, a PrEP program was initiated that included no-cost HIV/sexually transmitted infection screening at a public health department, followed by referral to a colocated FQHC for PrEP services. We profiled the PrEP continuum for patients entering the program until February 2018. PrEP initiators and noninitiators were compared using Wilcoxon rank-sum test for continuous variables and chi-square or Fisher's exact tests for categorical variables. Of 196 patients referred to the FQHC, 60% attended an initial appointment, 43% filled a prescription, 38% persisted in care for >3 months, and 30% reported >90% adherence at follow-up. Among those presenting for initial appointments (n = 117), most were MSM (n = 95, 81%) and black (n = 62, 53%); 21 (18%) were Latinx and 9 (8%) were trans persons. Almost half (n = 55) were uninsured. We found statistically significant differences between PrEP initiators versus noninitiators based on race/ethnicity (p = 0.02), insurance status (p = 0.05), and history of sex work (p = 0.05). In conclusion, this collaborative model of PrEP care was able to reach predominantly black and Latino MSM in the southern United States. Although sustainable, program strategies to improve steps along the PrEP care continuum are vital in this population.
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Affiliation(s)
- Meredith E Clement
- 1Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Barbara E Johnston
- 2Lincoln Community Health Center, Durham, North Carolina
- 3Duke University Medical Center, Durham, North Carolina
| | - Cedar Eagle
- 4Durham County Department of Public Health, Durham, North Carolina
| | - Destry Taylor
- 2Lincoln Community Health Center, Durham, North Carolina
| | - Anna Lina Rosengren
- 5Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Benjamin A Goldstein
- 6Department of Biostatistics and Bioinformatics, Duke University, Durham, North C1arolina
| | - Arlene C Seña
- 4Durham County Department of Public Health, Durham, North Carolina
- 7Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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58
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Lankowski AJ, Bien-Gund CH, Patel VV, Felsen UR, Silvera R, Blackstock OJ. PrEP in the Real World: Predictors of 6-Month Retention in a Diverse Urban Cohort. AIDS Behav 2019; 23:1797-1802. [PMID: 30341556 DOI: 10.1007/s10461-018-2296-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The effectiveness of HIV pre-exposure prophylaxis (PrEP) depends on adherence, which requires retention in PrEP care. We sought to examine factors associated with six-month retention in PrEP care among individuals prescribed PrEP between 2011 and 2015 in a large, academic health system in the Bronx, New York. We used multivariable logistic regression to identify factors independently associated with six-month retention. Among 107 patients, retention at 6 months was 42%. In the multivariable analysis, heterosexual individuals were less likely to be retained in PrEP care at 6 months, but individuals who received prescriptions from attending physicians were more likely to be retained in care. Larger prospective studies are needed to better evaluate the individual and health system factors associated with long-term engagement in PrEP care.
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59
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Carnevale C, Zucker J, Womack JA, Dixon J, Cohall A, Sobieszczyk ME, Gordon P. Adolescent Preexposure Prophylaxis Administration: An Education Curriculum for Health Care Providers. J Pediatr Health Care 2019; 33:288-295. [PMID: 30594441 PMCID: PMC8459443 DOI: 10.1016/j.pedhc.2018.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Accepted: 09/19/2018] [Indexed: 11/27/2022]
Abstract
On May 15, 2018, the Federal Drug Administration amended the approval of preexposure prophylaxis (PrEP) to include minors (>35 kgs). Adolescent providers are now in need of access to a comprehensive education curriculum on the administration of PrEP to adolescents. This paper outlines such a curriculum with the goal of reaching adolescent providers unfamiliar with PrEP assessment, administration, and monitoring. A comprehensive adolescent PrEP curriculum was designed using a literature review. An expert panel of seven reviewed the curriculum for content validity. A pilot implementation of the curriculum was conducted with staff from eight school-based health clinics located in Upper Manhattan and the Bronx. A formal content-validated curriculum was established providing adolescent health care providers with the tools needed to administer PrEP in their clinical setting. Clinical providers can access our curriculum to aid in their administration of PrEP to an adolescent population.
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60
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Barry CM, Sabhlok A, Saba VC, Majors AD, Schechter JC, Levine EL, Streicher M, Bennett GG, Kollins SH, Fuemmeler BF. An Automated Text-Messaging Platform for Enhanced Retention and Data Collection in a Longitudinal Birth Cohort: Cohort Management Platform Analysis. JMIR Public Health Surveill 2019; 5:e11666. [PMID: 30938689 PMCID: PMC6465978 DOI: 10.2196/11666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/05/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
Background Traditional methods for recruiting and maintaining contact with participants in cohort studies include print-based correspondence, which can be unidirectional, labor intensive, and slow. Leveraging technology can substantially enhance communication, maintain engagement of study participants in cohort studies, and facilitate data collection on a range of outcomes. Objective This paper provides an overview of the development process and design of a cohort management platform (CMP) used in the Newborn Epigenetic STudy (NEST), a large longitudinal birth cohort study. Methods The platform uses short message service (SMS) text messaging to facilitate interactive communication with participants; it also semiautomatically performs many recruitment and retention procedures typically completed by research assistants over the course of multiple study follow-up visits. Results Since February 2016, 302 participants have consented to enrollment in the platform and 162 have enrolled with active engagement in the system. Daily reminders are being used to help improve adherence to the study’s accelerometer wear protocol. At the time of this report, 213 participants in our follow-up study who were also registered to use the CMP were eligible for the accelerometer protocol. Preliminary data show that texters (138/213, 64.8%), when compared to nontexters (75/213, 35.2%), had significantly longer average accelerometer-wearing hours (165.6 hours, SD 56.5, vs 145.3 hours, SD 58.5, P=.01) when instructed to wear the devices for 1 full week. Conclusions This platform can serve as a model for enhancing communication and engagement with longitudinal study cohorts, especially those involved in studies assessing environmental exposures.
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Affiliation(s)
- Caroline M Barry
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Aditi Sabhlok
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Victoria C Saba
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Alesha D Majors
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Julia C Schechter
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Erica L Levine
- Global Digital Health Science Center, Global Health Institute, Duke University, Durham, NC, United States
| | - Martin Streicher
- Global Digital Health Science Center, Global Health Institute, Duke University, Durham, NC, United States
| | - Gary G Bennett
- Global Digital Health Science Center, Global Health Institute, Duke University, Durham, NC, United States
| | - Scott H Kollins
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Duke University, Durham, NC, United States
| | - Bernard F Fuemmeler
- Cancer Prevention and Control, Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States
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61
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Campbell BR, Ingersoll KS, Flickinger TE, Dillingham R. Bridging the digital health divide: toward equitable global access to mobile health interventions for people living with HIV. Expert Rev Anti Infect Ther 2019; 17:141-144. [PMID: 30721103 PMCID: PMC6693863 DOI: 10.1080/14787210.2019.1578649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/01/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Breanna R Campbell
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, USA
| | - Karen S Ingersoll
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, USA
| | - Tabor E Flickinger
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, USA
| | - Rebecca Dillingham
- Department of Medicine, University of Virginia School of Medicine, Charlottesville, USA
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Spinelli MA, Scott HM, Vittinghoff E, Liu AY, Gonzalez R, Morehead-Gee A, Gandhi M, Buchbinder SP. Missed Visits Associated With Future Preexposure Prophylaxis (PrEP) Discontinuation Among PrEP Users in a Municipal Primary Care Health Network. Open Forum Infect Dis 2019; 6:ofz101. [PMID: 30949540 PMCID: PMC6441570 DOI: 10.1093/ofid/ofz101] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 02/25/2019] [Indexed: 01/08/2023] Open
Abstract
Background Maintaining retention in preexposure prophylaxis (PrEP) care among diverse patient populations will be needed to support PrEP's efficacy. We characterized patterns of PrEP care retention in a US municipal primary care health network and examined whether missed visits, a metric of care retention that is easy to evaluate in clinic, are associated with subsequent discontinuation. Methods We included individuals on PrEP from July 2012 until August 2017 in the San Francisco Primary Care Clinics, a 15-clinic municipal health network. We categorized PrEP usage patterns as follows: early discontinuation (<90 days), later discontinuation (after ≥90 days), and continuing use at the end of follow-up. We first examined early discontinuation using adjusted Poisson regression. In patients who continued PrEP for ≥90 days, we examined factors associated with late discontinuation. Results Of the 364 individuals who started PrEP, 16% discontinued PrEP before 90 days, 46% discontinued later, and 38% were retained in care over a median 12 months of observation. Transgender women were more likely to discontinue PrEP early (adjusted risk ratio; 2.16; 95% confidence interval, 1.36-3.49), and younger users were more likely to discontinue late (0.82 per 10-year increase in age; .70-.96), as were persons who use illicit drugs (1.59; 1.02-2.47). Missed visits during use of PrEP were associated with future discontinuation (adjusted risk ratio, 1.52; 95% confidence interval, 1.14-2.03). Later year of current PrEP use was associated with both early and late discontinuation. Conclusion Diverse populations may require differentiated care to continue PrEP. Missed visits should trigger tailored interventions to maximize the impact of PrEP.
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Affiliation(s)
- Matthew A Spinelli
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Hyman M Scott
- Bridge HIV, San Francisco Department of Public Health, University of California, Los Angeles
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, University of California, Los Angeles
| | - Rafael Gonzalez
- Bridge HIV, San Francisco Department of Public Health, University of California, Los Angeles
| | | | - Monica Gandhi
- Division of HIV, ID, and Global Medicine, University of California, San Francisco
| | - Susan P Buchbinder
- Bridge HIV, San Francisco Department of Public Health, University of California, Los Angeles
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63
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Chhoun P, Kaplan KC, Wieten C, Jelveh I, Lienemann M, Tuot S, Yi S, Brody C. Using participatory methods to build an mHealth intervention for female entertainment workers in Cambodia: the development of the Mobile Link project. Mhealth 2019; 5:24. [PMID: 31559269 PMCID: PMC6737450 DOI: 10.21037/mhealth.2019.07.02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/27/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The HIV epidemic in Cambodia is strongly and disproportionately concentrated among key populations. One important hard-to-reach key population is the expanding community of female entertainment workers (FEWs). HIV as well as other sexual and reproductive health (SRH) outcomes including sexually transmitted infections (STIs), contraception, and gynecologic health are also substandard among FEWs. To address these concerns, a mobile health intervention (mHealth) using short message service (SMS) and voice message (VM) services-the Mobile Link project-was constructed. This paper aims to describe the development of this mHealth intervention that used participatory methodologies and to illustrate how these findings can be useful in future mHealth projects. METHODS This intervention development process used an iterative, participatory approach. Twenty-seven focus group discussions (FGDs) covering SRH topics were designed and conducted and implemented across four provinces in Cambodia. Additionally, six in-depth interviews (IDIs) were conducted with FEWs living with HIV in Siem Reap and Phnom Penh. Data from the FGDs and IDIs were analyzed using content and matrix analysis methods to identify prioritized themes for messages. Two data validation workshops were organized to present the prioritized themes to FEWs and outreach workers (outreach workers) for validation. The workshops included activities stimulating participation such as listening to sample messages in order to determine health priorities as well as message tone and style. RESULTS The findings from the qualitative research provided guidance on how to tailor the intervention to the FEW community in terms of the tone, timing, content and delivery mode of the messages. Participants preferred a friendly, professional female voice for VM. Participants revealed that health priorities such as gynecologic issues (vaginal infections/irritation) and cervical and breast cancer, were emphasized more than HIV and family planning. Participants also reported a number of misconceptions about contraception, particularly around oral contraceptives and intrauterine devices, and STI transmission. Participants expressed the need to build trust in outreach workers and linkages, affirming the emphasis on the link within the Mobile Link project. Lastly, from the IDIs, FEWs living with HIV highlighted wanting supportive/messages to address depressive feelings that may stem from their perceived stigma. CONCLUSIONS Utilizing participatory methodologies was demonstrated to be useful in intervention content creation and program implementation. As a result of this intervention development process, the research team gleaned lessons that may be applicable to future mHealth projects including the idea of adding some layers of choice to mHealth interventions for further tailoring at the individual level and the importance of human contact and trusting relationship.
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Affiliation(s)
- Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | | | - Carlijn Wieten
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Ida Jelveh
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA
| | - Mitchell Lienemann
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA
| | - Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Carinne Brody
- Public Health Program, College of Education and Health Sciences, Touro University California, Vallejo, CA, USA
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Gama LN, Tavares CMDM. DEVELOPMENT AND EVALUATION OF MOBILE APPLICATION FOR THE PREVENTION OF MUSCULOSKELETAL RISKS IN NURSING WORK. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to develop a multi-platform mobile application for the prevention of musculoskeletal risk factors related to nursing work in a hospital unit and to evaluate the usability criteria with nurses and computer professionals. Method: technological production study for the development of a mobile application, following the phases of software engineering: analysis of requirements, design and specification, construction, internal tests, maintenance and external evaluation. The product was evaluated for usability by nurses from public hospital units in the city of Rio de Janeiro (Brazil). The System Usability Scale instrument was used for the evaluation of the nurses and the instrument of heuristics of compliance of digital interfaces was used with the informational technology professionals. The application development period lasted from November 2017 to March 2018 and the usability assessment from March to May 2018. Results: the evaluation data showed that the application shows agreement and compliance with the principles of usability in the criteria of effectiveness, efficiency and user satisfaction, however, the evaluators suggest that the application's functionalities should be simplified. Conclusion: the application was designed as a care strategy for the nursing professional, considering the musculoskeletal risks which they are exposed to in their professional activities. The development and evaluation methods were satisfactory and the proposed objectives were achieved.
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Affiliation(s)
- Linda Nice Gama
- Universidade Federal Fluminense, Brasil; Universidade Federal Fluminense, Brazil
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Biello KB, Bazzi AR, Mimiaga MJ, Biancarelli DL, Edeza A, Salhaney P, Childs E, Drainoni ML. Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs. Harm Reduct J 2018; 15:55. [PMID: 30419926 PMCID: PMC6233595 DOI: 10.1186/s12954-018-0263-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/30/2018] [Indexed: 12/21/2022] Open
Abstract
Background Antiretroviral pre-exposure prophylaxis (PrEP) is clinically efficacious and recommended for HIV prevention among people who inject drugs (PWID), but uptake remains low and intervention needs are understudied. To inform the development of PrEP interventions for PWID, we conducted a qualitative study in the Northeastern USA, a region where recent clusters of new HIV infections have been attributed to injection drug use. Methods We conducted qualitative interviews with 33 HIV-uninfected PWID (hereafter, “participants”) and 12 clinical and social service providers (professional “key informants”) in Boston, MA, and Providence, RI, in 2017. Trained interviewers used semi-structured interviews to explore PrEP acceptability and perceived barriers to use. Thematic analysis of coded data identified multilevel barriers to PrEP use among PWID and related intervention strategies. Results Among PWID participants (n = 33, 55% male), interest in PrEP was high, but both participants and professional key informants (n = 12) described barriers to PrEP utilization that occurred at one or more socioecological levels. Individual-level barriers included low PrEP knowledge and limited HIV risk perception, concerns about PrEP side effects, and competing health priorities and needs due to drug use and dependence. Interpersonal-level barriers included negative experiences with healthcare providers and HIV-related stigma within social networks. Clinical barriers included poor infrastructure and capacity for PrEP delivery to PWID, and structural barriers related to homelessness, criminal justice system involvement, and lack of money or identification to get prescriptions. Participants and key informants provided some suggestions for strategies to address these multilevel barriers and better facilitate PrEP delivery to PWID. Conclusions In addition to some of the facilitators of PrEP use identified by participants and key informants, we drew on our key findings and behavioral change theory to propose additional intervention targets. In particular, to help address the multilevel barriers to PrEP uptake and adherence, we discuss ways that interventions could target information, self-regulation and self-efficacy, social support, and environmental change. PrEP is clinically efficacious and has been recommended for PWID; thus, development and testing of strategies to improve PrEP delivery to this high-risk and socially marginalized population are needed.
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Affiliation(s)
- K B Biello
- Departments of Behavioral and Social Sciences and Epidemiology, Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA. .,Center for Health Equity Research, Brown University, Providence, RI, USA. .,The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - A R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - M J Mimiaga
- Departments of Behavioral and Social Sciences and Epidemiology, Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Center for Health Equity Research, Brown University, Providence, RI, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - D L Biancarelli
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - A Edeza
- Center for Health Equity Research, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - P Salhaney
- Center for Health Equity Research, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - E Childs
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - M L Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
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Stekler JD, Scanlan JM, Simoni JM, Crane HM, Fredericksen RJ, Marquard J, Saver BG. Predictors of Art and PrEP Adherence and Medication-Taking Practices and Preferences to Inform Development of a Wrist-Worn Adherence System. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:357-368. [PMID: 30332308 DOI: 10.1521/aeap.2018.30.5.357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We examined adherence, medication-taking practices, and preferences to inform development of a wrist-worn adherence system. Two convenience samples of persons taking antiretroviral therapy and HIV pre-exposure prophylaxis completed a survey. Additional online questions asked about willingness to use a wrist-worn device and reminder and feedback preferences. Among 225 participants, 13% reported adherence < 90%; this was associated with younger age and clinic sample. Compared to pill bottle-using participants, mediset users less commonly reported adherence < 90% (aOR = 0.16, p = .02), and blister pack users (aOR = 6.3, p = .02) and pill roll users (aOR = 3.3, p = .04) more commonly reported adherence < 90%. Sixty-two percent of the online participants reporting adherence (< 100%) had some interest in receiving adherence reminders, including 42% with interest in receiving reminders by smartwatch notifications. Although confounders are likely, formative work identified potential users and interest in using a wrist-worn adherence system. Future work will determine its acceptability and efficacy.
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Affiliation(s)
| | | | | | | | | | | | - Barry G Saver
- Swedish Center for Research and Innovation, Seattle
- University of Massachusetts, Amherst, Massachusetts
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Zucchi EM, Grangeiro A, Ferraz D, Pinheiro TF, Alencar T, Ferguson L, Estevam DL, Munhoz R. [From evidence to action: challenges for the Brazilian Unified National Health System in offering pre-exposure prophylaxis (PrEP) for HIV to persons with the greatest vulnerability]. CAD SAUDE PUBLICA 2018; 34:e00206617. [PMID: 30043853 DOI: 10.1590/0102-311x00206617] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 05/02/2018] [Indexed: 12/12/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) has been considered a promising strategy for controlling the global HIV epidemic. However, it is necessary to translate the knowledge accumulated from clinical trials and demosntration studies to the reality of health services and the groups most vulnerable to infection in order to achieve broad coverage with PrEP. The article proposes a reflection on this challenge, focusing on three dimensions: users of prophylaxis, with an emphasis on the contexts of sexual practices and the potential exposures to HIV; the advantages of prophylaxis as compared to other methods and the challenges for protective and safe use; and health services, considering the organizational principles to ensure greater success in the supply and incorporation of PrEP as part of combination prevention strategies. The following principles were analyzed: uniqueness of care, freedom of choice and non-hierarchization of prevention methods, sexual risk management, scheduling flexibility, and complementary and multidisciplinary care. These principles can foster organization of the health service and care, facilitating linkage and retention in care. Some comments were offered on the relative incompatibility between the existing structure of services and the Brazilian Ministry of Health guidelines for offering PrEP. The conclusion was that the success of PrEP as a public health policy depends on two essential factors: ensuring that health services are culturally diverse settings, free of discrimination, and the intensification of community-based interventions, including social networks, in order to reduce inequalities in access to PrEP and health services as a whole.
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Affiliation(s)
- Eliana Miura Zucchi
- Programa de Pós-graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brasil
| | | | - Dulce Ferraz
- Escola Fiocruz de Governo, Fundação Oswaldo Cruz, Brasília, Brasil
| | | | - Tatianna Alencar
- Departamento de Vigilância, Prevenção e Controle das Infecções Sexualmente Transmissíveis, do HIV/Aids e das Hepatites Virais, Ministério da Saúde, Brasília, Brasil
| | - Laura Ferguson
- Keck School of Medicine, University of Southern California, Los Angeles, U.S.A
| | - Denize Lotufo Estevam
- Centro de Referência e Treinamento em DST/AIDS-SP, Secretaria de Estado de Saúde de São Paulo, São Paulo, Brasil
| | - Rosemeire Munhoz
- Centro de Referência e Treinamento em DST/AIDS-SP, Secretaria de Estado de Saúde de São Paulo, São Paulo, Brasil
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