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A shot at equity? Addressing disparities among Black MSM in the coming era of long-acting injectable preexposure prophylaxis. AIDS 2019; 33:2110-2112. [PMID: 31577579 DOI: 10.1097/qad.0000000000002341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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102
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Ellison J, van den Berg JJ, Montgomery MC, Tao J, Pashankar R, Mimiaga MJ, Chan PA. Next-Generation HIV Pre-Exposure Prophylaxis Preferences Among Men Who Have Sex with Men Taking Daily Oral Pre-Exposure Prophylaxis. AIDS Patient Care STDS 2019; 33:482-491. [PMID: 31603712 DOI: 10.1089/apc.2019.0093] [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: 12/21/2022] Open
Abstract
Next-generation forms of HIV pre-exposure prophylaxis (PrEP) currently in development, including long-acting injectables (LAIs), rectal microbicides (RMs), antibody infusions (AIs), and subdermal implants (SIs), may address barriers to daily oral PrEP uptake and adherence. The purpose of this study was to evaluate barriers to oral PrEP, preferences for next-generation PrEP modalities, sociodemographic characteristics and sexual behaviors associated with preferences, and reasons for wanting or not wanting each formulation among a sample of men who have sex with men (MSM). We administered a cross-sectional survey to a diverse sample of MSM currently taking oral PrEP (n = 108) at two sexually transmitted disease clinics. We used logistic multivariate analyses to explore preferences, relative to oral PrEP, for each formulation across sociodemographic and sexual behaviors. The most commonly endorsed barriers were finding a PrEP provider and making appointments to get PrEP. Participants were most likely to prefer the SI (45%), followed by the LAI (31%), pill (21%), RM (1%), and AI (1%). Black/African American and Hispanic/Latino MSM were more likely to prefer the LAI over daily oral PrEP (odds ratio: 2.45, 95% confidence interval: 0.86-6.89), and sexual behaviors were most commonly associated with preference for the SI. Top reasons for wanting or not wanting each formulation were most commonly related to perceived ease of use. These findings demonstrate variations in preferences for next-generation PrEP modalities, highlighting a need to ensure comprehensive access to all formulations once they become available.
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Affiliation(s)
- Jacqueline Ellison
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, Massachusetts
| | - Jacob J. van den Berg
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Madeline C. Montgomery
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jun Tao
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Rashmi Pashankar
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Matthew J. Mimiaga
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
| | - Philip A. Chan
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island
- Department of Medicine, Alpert Medical School of Brown University, Providence, Rhode Island
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103
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Rice WS, Stringer KL, Sohail M, Crockett KB, Atkins GC, Kudroff K, Batey DS, Hicks J, Turan JM, Mugavero MJ, Turan B. Accessing Pre-exposure Prophylaxis (PrEP): Perceptions of Current and Potential PrEP Users in Birmingham, Alabama. AIDS Behav 2019; 23:2966-2979. [PMID: 31297683 DOI: 10.1007/s10461-019-02591-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Limited studies to date assess barriers to and facilitators of PrEP uptake and utilization using a patient-centered access to care framework, among diverse socio-demographic groups, or in the U.S. Deep South, an area with disproportionate HIV burden. We examine perceptions of PrEP access in qualitative interviews with 44 current and potential PrEP users in Birmingham, Alabama. Participants were 32 years old on average, 66% Black, 66% gay or lesbian, 70% male, and 66% single. Perceived barriers to PrEP access included: lack of PrEP awareness and advertisement; sexuality-related stigma; time and resource constraints; and concerns about the adequacy and technical quality of PrEP services. Perceived facilitators to PrEP access were: PrEP-related information gathering and sharing; increased dialogue and visibility around PrEP; social, programmatic, and clinical support; and, lastly, self-preservation; personal motivation; and treatment self-efficacy. Results point to opportunities to address complex barriers to equitable PrEP access using multilevel and multimodal solutions.
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Affiliation(s)
- Whitney S Rice
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, GCR 538, Atlanta, GA, 30322, USA.
| | - Kristi L Stringer
- Social Intervention Group, School of Social Work, Columbia University, New York, NY, USA
| | - Maira Sohail
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kaylee B Crockett
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Ghislaine C Atkins
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kachina Kudroff
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - D Scott Batey
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Janet M Turan
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bulent Turan
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL, USA
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104
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Brief Report: Role of Sociobehavioral Factors in Subprotective TFV-DP Levels Among YMSM Enrolled in 2 PrEP Trials. J Acquir Immune Defic Syndr 2019; 80:160-165. [PMID: 30640203 DOI: 10.1097/qai.0000000000001901] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Young men who have sex with men (YMSM) experience disparities in HIV acquisition more than any other group. Daily oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine has been shown to effectively prevent HIV transmission in YMSM; however, recent studies suggest that young Black men who have sex with men experience subprotective levels of tenofovir diphosphate more frequently than other groups. SETTING Combined data from Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) 110/113, 2 open-label PrEP studies that provided PrEP and evidence-based behavioral interventions to YMSM aged 15-22 years. METHODS Bivariate and logistic regression analyses were used to examine sociodemographic and behavioral factors associated with protective tenofovir diphosphate levels (defined as ≥700 fmol/punch) in ATN 110/113 data. RESULTS In bivariate analysis, self-identified Black participants, residential displacement due to sexual orientation, low perceived risk, and stigma with the medication were associated with subprotective levels. Hispanic ethnicity was associated with protective levels. In the final models, Black males were less likely to have subprotective levels than non-Black males at 4, 8, and 12 weeks. Self-reported displacement due to sexual orientation was associated with subprotective levels, whereas older age was as associated with protective levels. CONCLUSIONS These findings highlight how future behavioral research and biomedical prevention efforts in YMSM will need to address PrEP disparities that may occur in young Black men who have sex with men, perception of risk, and lack of key supportive housing during this period that may be critical factors that contribute to HIV acquisition.
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105
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Patterns and Correlates of Participant Retention in a Multi-City Pre-Exposure Prophylaxis Demonstration Project. J Acquir Immune Defic Syndr 2019; 79:62-69. [PMID: 29771790 DOI: 10.1097/qai.0000000000001724] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Safe and effective use of pre-exposure prophylaxis (PrEP) depends on retention in care after initial engagement. SETTING The United States PrEP Demonstration Project offered daily oral tenofovir/emtricitabine to participants in San Francisco, Miami, and Washington, D.C. for 48 weeks from 2012 to 2014. METHODS The Demo Project participants' patterns of retention were assigned to 1 of 3 categories: early loss to follow-up (ELTF) within the first 12 weeks of the study, retention throughout the study, or intermittent retention in which missed or delayed visits resulted in gaps in medication availability. For each group, baseline characteristics were tabulated. A two-step multivariable analysis was performed. RESULTS Overall, 366/554 (66.1%) of enrolled participants were retained for all study visits, 127/554 (22.9%) had intermittent retention, and 61/554 (11.0%) ELTF. In multivariable analysis, Miami compared with San Francisco site was associated with ELTF rather than full retention [aOR 2.84; confidence interval (CI): 1.24 to 6.47] and also with intermittent rather than full retention (aOR 2.70; CI: 1.43 to 5.11). Younger age was associated with ELTF (aOR 1.80 for each 10-year decrement in age; CI: 1.26 to 2.57) and intermittent retention (aOR 1.47; CI: 1.17 to 1.84) compared with full retention. Factors associated with ELTF (but not intermittent retention) compared with full retention were black compared with white (aOR 3.32; CI: 1.09 to 10.16), reporting sex work (aOR 4.67; CI: 1.49 to 14.58), lack of regular employment (aOR 2.53; CI: 1.27 to 5.05), and lack of previous PrEP awareness (aOR 2.01; CI: 1.01 to 3.96). CONCLUSIONS Tailored interventions addressing causes and risk factors for loss from PrEP care may improve retention and consistency of PrEP use.
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106
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HIV Pre-Exposure Prophylaxis Stigma as a Multidimensional Barrier to Uptake Among Women Who Attend Planned Parenthood. J Acquir Immune Defic Syndr 2019; 79:46-53. [PMID: 29847480 DOI: 10.1097/qai.0000000000001762] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) uptake has lagged among US women. PrEP stigma is a recognized barrier to uptake among men who have sex with men but remains largely unexplored among women. This study examined the pervasiveness of PrEP stigma among US women and its implications for uptake. SETTING/METHODS In a 2017 online survey of Planned Parenthood patients drawn from the 3 cities with the highest numbers of new HIV infections in Connecticut, 597 heterosexually active, HIV-negative, PrEP-inexperienced women reported background characteristics, 2 dimensions of anticipated PrEP stigma (PrEP-user stereotypes and PrEP disapproval by others), and 3 indicators of potential PrEP uptake (interest in learning more about PrEP, intention to use PrEP, and comfort discussing PrEP with a provider). RESULTS Participants commonly perceived PrEP-user stereotypes, with many believing that others would regard them as promiscuous (37%), HIV-positive (32%), bad (14%), or gay (11%) if they used PrEP. Thirty percent would feel ashamed to disclose PrEP use. Many participants expected disapproval by family (36%), sex partners (34%), and friends (25%). In adjusted analyses, perception of PrEP-user stereotypes was uniquely associated with less comfort discussing PrEP with a provider. Expected PrEP disapproval by others was uniquely associated with less PrEP interest, less intention to use PrEP, and less comfort discussing PrEP with a provider. Exploratory moderation analyses suggested that intention to use PrEP was greatest when participants anticipated low levels of both PrEP-user stereotypes and PrEP disapproval by others. CONCLUSIONS Findings highlight the need for positive messaging targeting potential PrEP users and their social networks to increase PrEP acceptance and uptake.
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107
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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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108
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Brantley ML, Rebeiro PF, Pettit AC, Sanders A, Cooper L, McGoy S, Morrison M. Temporal Trends and Sociodemographic Correlates of PrEP Uptake in Tennessee, 2017. AIDS Behav 2019; 23:304-312. [PMID: 31456198 DOI: 10.1007/s10461-019-02657-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Client-level data from two Tennessee-based PrEP navigation demonstration projects reported to the Tennessee Department of Health from January to December 2017 were evaluated to determine the proportion of clients who accepted, were linked to, and were prescribed PrEP. Disparities by age, race, transmission risk, and geographic region as well as trends over time were examined via bivariate and multivariable modified Poisson regression models accounting for potential confounders. Among 1385 PrEP-eligible individuals, 50.5% accepted, 33.4% were linked, and 27.3% were prescribed PrEP. PrEP uptake varied by age, race, and HIV transmission risk, and most disparities persisted across Tennessee throughout evaluation period. Multivariable regression models revealed significant independent associations between age, race/ethnicity, transmission risk, and region and PrEP acceptance and linkage. While differences in PrEP acceptance by race narrowed over time, success among black MSM was limited, underscoring a significant need to improve upstream PrEP continuum outcomes for this important population.
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109
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Mind the gaps: prescription coverage and HIV incidence among patients receiving pre-exposure prophylaxis from a large federally qualified health center in Los Angeles, California : Mind the Gaps: Cobertura de recetas e incidencia de VIH entre pacientes recibiendo profilaxis pre-exposición de un centro de salud grande y federalmente calificado en Los Ángeles, CA. AIDS Behav 2019; 23:2730-2740. [PMID: 30953305 PMCID: PMC6863609 DOI: 10.1007/s10461-019-02493-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We conducted a records-based cohort study of patients who initiated pre-exposure prophylaxis (PrEP) at a large federally qualified health center in Los Angeles, CA to characterize patterns of PrEP use, identify correlates of PrEP discontinuation, and calculate HIV incidence. Of 3121 individuals initiating PrEP between 2014 and 2017, 42% (n = 1314) were active (i.e., had a current PrEP prescription) in April 2018. HIV incidence was 0.1/100 person-years among active PrEP patients, compared to 2.1/100 person-years among patients who discontinued. Compared to patients accessing PrEP through government programs with no prescription copay, risk of discontinuation was higher among those with private insurance (ARR = 1.4, 95% CI 1.2, 1.7), or no insurance (ARR = 4.5, 95% CI 3.2, 6.4). Sixty-three percent of active PrEP patients had gaps between PrEP prescriptions, averaging one gap per year (median length = 65 days). Increasing access to free or low-cost PrEP can improve PrEP continuity.
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110
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Abstract
We aimed to discover barriers and facilitators of HIV pre-exposure prophylaxis (PrEP) adherence in young men and transgender women of color who have sex with men (YMSM/TW). Short-term and sustained adherence were measured by urine tenofovir concentration and pharmacy refills, respectively. Optimal adherence was defined as having both urine tenofovir concentration consistent with dose ingestion within 48 h and pharmacy refills consistent with ≥ 4 doses per week use. Participants completed semi-structured interviews exploring adherence barriers and facilitators. Participants (n = 31) were primarily African-American (68%), mean age 22 years (SD: 1.8), and 48% had optimal adherence. Adherence barriers included stigma, health systems inaccessibility, side effects, competing stressors, and low HIV risk perception. Facilitators included social support, health system accessibility, reminders/routines, high HIV risk perception, and personal agency. Our findings identify targets for intervention to improve PrEP adherence in these populations, including augmenting health activation and improving accuracy of HIV risk perception.
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111
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Nunn A, Jeffries WL, Foster P, McCoy K, Sutten-Coats C, Willie TC, Ransome Y, Lanzi RG, Jackson E, Berkley-Patton J, Keefer M, Coleman JD. Reducing the African American HIV Disease Burden in the Deep South: Addressing the Role of Faith and Spirituality. AIDS Behav 2019; 23:319-330. [PMID: 31444712 DOI: 10.1007/s10461-019-02631-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Nearly half of HIV infections in the United States are concentrated among African Americans, and over half of new HIV infections occur in the South. African Americans have poorer outcomes in the entire continua of HIV and PrEP care. Complex social, structural, and behavioral factors contribute to our nation's alarming racial disparities in HIV infection, particularly in the Deep South. Despite the importance of faith, spirituality and religious practice in the lives of many African Americans, there has been little scientific investment exploring how African Americans' religious participation, faith and spirituality may impact our nation's HIV epidemic. This article summarizes the state of the science on this critical issue. We also identify opportunities for new scholarship on how faith, spirituality and religious participation may impact HIV care continuum outcomes in the South and call for greater federal research investment on these issues.
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Affiliation(s)
- Amy Nunn
- Center for Health Equity Research, Brown University, 121 S. Main St, G-810, Providence, RI, 02903, USA.
- Rhode Island Public Health Institute, Providence, USA.
| | - William L Jeffries
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Antlanta, USA
| | - Pamela Foster
- Department of Community Medicine/Population Health, University of Alabama School of Medicine, Tuscaloosa Regional Campus, Tuscaloosa, USA
| | - Katryna McCoy
- School of Nursing & Health Studies, University of Washington - Bothell, Bothell, USA
| | - Cassandra Sutten-Coats
- Center for Health Equity Research, Brown University, 121 S. Main St, G-810, Providence, RI, 02903, USA
- Rhode Island Public Health Institute, Providence, USA
| | - Tiara C Willie
- Rhode Island Public Health Institute, Providence, USA
- Warren Alpert School of Medicine, Brown University, Providence, USA
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA
| | - Robin Gaines Lanzi
- Department of Health Behavior, University of Alabama at Birmingham, Birmingham, USA
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
| | - Edward Jackson
- Center for AIDS Research, University of Alabama at Birmingham, Birmingham, USA
| | | | - Michael Keefer
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, USA
| | - Jason D Coleman
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, USA
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112
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Rolle CP, Onwubiko U, Jo J, Sheth AN, Kelley CF, Holland DP. PrEP Implementation and Persistence in a County Health Department Setting in Atlanta, GA. AIDS Behav 2019; 23:296-303. [PMID: 31468296 DOI: 10.1007/s10461-019-02654-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
For marginalized populations, county health departments may be important PrEP access points; however, there are little data on successful PrEP programs at these venues outside of incentivized demonstration projects. Therefore, we implemented an open-access, free PrEP clinic at a county health department in Atlanta, GA to promote PrEP uptake among high-risk clients. The Fulton County Board of Health PrEP clinic launched in October 2015, and eligible clients who expressed interest initiated PrEP and attended follow-up visits per CDC guidelines. Clients engaged in quarterly follow-up and seen within the last 6 months were defined as "persistent", whereas clients with a lapse in follow-up of > 6 months were defined as "not persistent." Factors associated with PrEP persistence were assessed with unadjusted odds ratios. Between October 2015 and June 2017, 399 clients were screened for PrEP, almost all were eligible [392/399 (98%)]; however, 158/392 (40%) did not return to start PrEP after screening. Of 234 patients, 216 (92%) received a prescription for PrEP. As of June 2017, only 69/216 (32%) clients remained persistent in PrEP care, and the only evaluated factor significantly associated with PrEP persistence was age ≥ 30 years (OR 1.86, 95% CI 1.02, 3.42). Implementation of PrEP in the county health department setting is feasible; however, we have identified significant challenges with PrEP uptake and persistence in our setting. Further research is needed to fully understand mediators of PrEP persistence and inform interventions to optimize health department-based PrEP services.
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113
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"You Never Know What Could Happen": Women's Perspectives of Pre-Exposure Prophylaxis in the Context of Recent Intimate Partner Violence. Womens Health Issues 2019; 30:41-48. [PMID: 31537431 DOI: 10.1016/j.whi.2019.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 07/15/2019] [Accepted: 08/02/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Vulnerability to human immunodeficiency virus (HIV) infection is a significant public health issue for women experiencing intimate partner violence (IPV). Despite the increased risk of human immunodeficiency virus infection, women only represent 4.6% of pre-exposure prophylaxis (PrEP) users in the United States. IPV may present additional difficulties to PrEP access. In this qualitative study, we examined how IPV and the relational context shaped women's decisions, attitudes, and engagement in the PrEP care continuum. METHODS We conducted semistructured interviews with 19 women residing in Connecticut who participated in a prospective cohort study. We purposively recruited our sample to include women who reported physical and/or sexual IPV in the past 6 months, and used a grounded theory approach to analyze the qualitative data. RESULTS Our findings suggest multiple ways that the relational context can affect women's decisions, attitudes, and engagement in the PrEP care continuum. We identified five aspects of women's relationships that can shape women's interest, intentions, and access to PrEP: 1) relationship power struggles, 2) infidelity, 3) trust and monogamy, 4) male partner's reactions, and 5) "season of risk" (i.e., PrEP use only during times of perceived human immunodeficiency virus risk). Collectively, these findings suggest that women experiencing IPV might face additional relational challenges that need to be adequately addressed in settings administering PrEP. CONCLUSIONS Communication on sexual risk reduction strategies should address relational factors and promote women's autonomy. Future research on long-acting and invisible forms of PrEP may help to circumvent some of the relational barriers women experiencing IPV may face when considering PrEP care.
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114
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Chan PA, Patel RR, Mena L, Marshall BDL, Rose J, Sutten Coats C, Montgomery MC, Tao J, Sosnowy C, Mayer KH, Nunn A. Long-term retention in pre-exposure prophylaxis care among men who have sex with men and transgender women in the United States. J Int AIDS Soc 2019; 22:e25385. [PMID: 31423756 PMCID: PMC6698689 DOI: 10.1002/jia2.25385] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 07/31/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Retention in HIV pre-exposure prophylaxis (PrEP) care in real-world settings, outside of controlled trials or demonstration projects, remains poorly understood. METHODS We evaluated retention in PrEP care outcomes among men who have sex with men (MSM) and transgender women prescribed PrEP through March 2017 at three clinical sites in the United States (US): Jackson, Mississippi; Providence, Rhode Island; and St. Louis, Missouri. We determined retention rates by attendance of clinical visits every three months, per US Centers for Disease Control and Prevention (CDC) guidelines, as well as by the timing of patients' actual clinical visits. Multivariable analyses examined demographic and behavioural factors associated with retention. RESULTS From 2013 to 2015, 282 MSM and transgender women were prescribed PrEP; 82% attended a follow-up visit. Based on CDC recommendations, 56% of patients were retained in PrEP care at the first follow-up visit, having attended a visit three months after initiation. However, 76% had a follow-up visit within eight months. Thirty-percent were retained at 12 months by CDC criteria, but 62% were retained when using a 16-month endpoint. Self-reported adherence was strongly correlated with retention. In multivariable analyses, younger age was associated with decreased odds of retention at initial follow-up, and completing college was associated with increased odds of retention at 16 months. Eight participants were newly diagnosed with HIV; six were African American, and seven were under 30 years of age. CONCLUSIONS Measuring retention in PrEP care using three-month follow-up intervals may underestimate true retention. Nevertheless, retention in PrEP care is suboptimal in real-world settings and should be the focus of future interventions.
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Affiliation(s)
- Philip A Chan
- Department of MedicineBrown UniversityProvidenceRIUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Rupa R Patel
- Department of MedicineWashington University in St. LouisSt. LouisMOUSA
| | - Leandro Mena
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMSUSA
| | - Brandon DL Marshall
- Department of EpidemiologyBrown University School of Public HealthProvidenceRIUSA
| | | | - Cassandra Sutten Coats
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Madeline C Montgomery
- Department of MedicineBrown UniversityProvidenceRIUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
| | - Jun Tao
- Department of MedicineBrown UniversityProvidenceRIUSA
| | | | - Kenneth H Mayer
- The Fenway InstituteBostonMAUSA
- Division of Infectious DiseasesBeth Israel Deaconess Medical CenterBostonMAUSA
- Department of MedicineHarvard Medical SchoolBostonMAUSA
| | - Amy Nunn
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRIUSA
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115
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Chan PA, Patel RR, Mena L, Marshall BD, Rose J, Sutten Coats C, Montgomery MC, Tao J, Sosnowy C, Mayer KH, Nunn A. Long-term retention in pre-exposure prophylaxis care among men who have sex with men and transgender women in the United States. J Int AIDS Soc 2019. [PMID: 31423756 DOI: 10.1002/jia] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Retention in HIV pre-exposure prophylaxis (PrEP) care in real-world settings, outside of controlled trials or demonstration projects, remains poorly understood. METHODS We evaluated retention in PrEP care outcomes among men who have sex with men (MSM) and transgender women prescribed PrEP through March 2017 at three clinical sites in the United States (US): Jackson, Mississippi; Providence, Rhode Island; and St. Louis, Missouri. We determined retention rates by attendance of clinical visits every three months, per US Centers for Disease Control and Prevention (CDC) guidelines, as well as by the timing of patients' actual clinical visits. Multivariable analyses examined demographic and behavioural factors associated with retention. RESULTS From 2013 to 2015, 282 MSM and transgender women were prescribed PrEP; 82% attended a follow-up visit. Based on CDC recommendations, 56% of patients were retained in PrEP care at the first follow-up visit, having attended a visit three months after initiation. However, 76% had a follow-up visit within eight months. Thirty-percent were retained at 12 months by CDC criteria, but 62% were retained when using a 16-month endpoint. Self-reported adherence was strongly correlated with retention. In multivariable analyses, younger age was associated with decreased odds of retention at initial follow-up, and completing college was associated with increased odds of retention at 16 months. Eight participants were newly diagnosed with HIV; six were African American, and seven were under 30 years of age. CONCLUSIONS Measuring retention in PrEP care using three-month follow-up intervals may underestimate true retention. Nevertheless, retention in PrEP care is suboptimal in real-world settings and should be the focus of future interventions.
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Affiliation(s)
- Philip A Chan
- Department of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Rupa R Patel
- Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Leandro Mena
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Brandon Dl Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | | | - Cassandra Sutten Coats
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Madeline C Montgomery
- Department of Medicine, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Jun Tao
- Department of Medicine, Brown University, Providence, RI, USA
| | | | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, USA.,Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Amy Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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116
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Sullivan PS, Mena L, Elopre L, Siegler AJ. Implementation Strategies to Increase PrEP Uptake in the South. Curr HIV/AIDS Rep 2019; 16:259-269. [PMID: 31177363 PMCID: PMC7117066 DOI: 10.1007/s11904-019-00447-4] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Seven years after TDF/FTC was approved for pre-exposure prophylaxis to reduce risks of HIV infection, there have been large increases in the number of persons using PrEP in the USA. However, recent data on pre-exposure prophylaxis (PrEP) use at the state level indicate that people living in the Southern United States are underserved by PrEP relative to their epidemic need. We sought to review possible reasons for inequitable uptake of PrEP in the South and identify implementation approaches to increase PrEP uptake in the South. RECENT FINDINGS Published literature, data on the locations of PrEP service providers, recent data on PrEP utilization from pharmacy prescription databases, HIV surveillance data and government data on healthcare providers, and health literacy indicate a confluence of factors in the South that are likely limiting PrEP uptake. A variety of approaches are needed to address the complex challenges to PrEP implementation in the South. These include considering alternative PrEP provision strategies (e.g., pharmacy-based PrEP, telemedicine-delivered PrEP), conducting gain-based stigma-reduction campaigns, increasing capacity for reimbursement for PrEP medications and services through policy change to expand Medicaid and to preserve access to Affordable Care Act-compliant health plans, expanding STI screening programs and improving integration of PrEP offering with delivery of positive STI results, using mHealth tools to screen groups at highest risk for HIV (e.g., men who have sex with men) periodically to increase correct perception of risk, and streamlining clinical procedures to allow same-day PrEP starts for patients without obvious medical contraindications. Overcoming the structural, capacity, and policy challenges to increasing PrEP uptake in the South will require innovations in clinical approaches, leveraging technologies, and policy changes. The South has unique challenges to achieving equitable PrEP uptake, and addressing key barriers to expanded PrEP use will require multisectoral responses.
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Affiliation(s)
- Patrick S Sullivan
- Rollins School of Public Health, Department of Epidemiology, Emory University, 1518 Clifton Road NE, Room 464, Atlanta, GA, 30322, USA.
| | - Leandro Mena
- John D. Bower School of Population Health, Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Latesha Elopre
- School of Medicine, University of Alabama, Birmingham, AL, USA
| | - Aaron J Siegler
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
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117
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Kamis KF, Marx GE, Scott KA, Gardner EM, Wendel KA, Scott ML, Montgomery AE, Rowan SE. Same-Day HIV Pre-Exposure Prophylaxis (PrEP) Initiation During Drop-in Sexually Transmitted Diseases Clinic Appointments Is a Highly Acceptable, Feasible, and Safe Model that Engages Individuals at Risk for HIV into PrEP Care. Open Forum Infect Dis 2019; 6:ofz310. [PMID: 31341933 PMCID: PMC6641790 DOI: 10.1093/ofid/ofz310] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/26/2019] [Indexed: 11/18/2022] Open
Abstract
Objective Strategies to increase pre-exposure prophylaxis (PrEP) uptake are needed. We hypothesized that same-day PrEP initiation in a sexually transmitted diseases (STD) clinic would be acceptable, feasible, and safe, and that individuals would engage in ongoing PrEP care. Method Individuals aged ≥ 18 years were evaluated for PrEP. Exclusion criteria were HIV, history of renal dysfunction or chronic hepatitis B infection, pregnancy, indications for HIV post-exposure prophylaxis, or positive screen for acute HIV symptoms. One hundred individuals received a free 30-day PrEP starter pack and met with a patient navigator to establish ongoing care. Bivariate analysis and multivariable logistic regression were used to compare individuals who did and did not attend at least 1 PrEP follow-up appointment within 180 days of enrollment. Client satisfaction surveys were given 3 months after enrollment. Results The majority (78%) of participants completed at least 1 PrEP follow-up appointment, and 57% attended at least 2 follow-up appointments. After adjusting for race and ethnicity, age, health insurance status, and annual income, only income was associated with follow-up appointment attendance. Each additional $10,000 increase in income was associated with a 1.7-fold increase in the odds of attending a PrEP follow-up appointment (95% confidence interval, 1.07–2.66, P = .02). The majority (54%) of individuals completed the satisfaction survey and all respondents liked the option of same-day PrEP initiation. Conclusions Our study suggests STD clinic-based, same-day PrEP initiation is acceptable, feasible, safe, and links a high proportion of individuals into ongoing PrEP care. Additional resources may be needed to support low-income individuals’ retention in care.
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Affiliation(s)
- Kevin F Kamis
- Denver Public Health, Denver Health and Hospital Authority, Colorado
| | - Grace E Marx
- University of Colorado, Department of Medicine, Division of Infectious Diseases, Aurora.,Colorado School of Public Health, Department of Epidemiology, Aurora
| | - Kenneth A Scott
- Denver Public Health, Denver Health and Hospital Authority, Colorado
| | - Edward M Gardner
- Denver Public Health, Denver Health and Hospital Authority, Colorado.,University of Colorado, Department of Medicine, Division of Infectious Diseases, Aurora
| | - Karen A Wendel
- Denver Public Health, Denver Health and Hospital Authority, Colorado.,University of Colorado, Department of Medicine, Division of Infectious Diseases, Aurora
| | | | | | - Sarah E Rowan
- Denver Public Health, Denver Health and Hospital Authority, Colorado.,University of Colorado, Department of Medicine, Division of Infectious Diseases, Aurora
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118
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Freeborn K, Portillo C, Boyer CB, Santos GM. Misclassification of sexual health risks in a self-identified low risk cohort of men who have sex with men (MSM) enrolled in a community based PrEP program. AIDS Care 2019; 32:230-237. [PMID: 31129982 DOI: 10.1080/09540121.2019.1620167] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The CDC recommends PrEP for MSM at substantial risk of HIV acquisition, leaving clinicians unsure whether to prescribe PrEP to MSM who do not disclose HIV risk factors. A longitudinal cohort of MSM requesting PrEP despite reporting during a clinical visit either 100% condom use or participation in oral sex only and no other risk factors was followed over 13 months at a community clinic in San Francisco to assess the accuracy of their HIV risk perception. Participants completed a sexual and substance use behavior questionnaire at baseline, outside of the clinical visit and were followed by quarterly HIV/STI testing and condom use change questionnaires. Condomless sex increased from 0% at baseline to 12% at month 1, peaked at 34% at month 7, and then decreased again to 8% at month 13. Rates of pharyngeal GC/CT varied from 7% at baseline to 12% at month 13, while rectal GC/CT decreased from 6% at baseline to 0% at month 13. The rate of syphilis was 1% both at baseline and at month 13, however, 11% and 15% of clients tested positive for syphilis at months 1 and 7 respectively.
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Affiliation(s)
- Kellie Freeborn
- Division of Global Women's Health, Department of Obstetrics and Gynecology, The University of North Carolina, Chapel Hill, NC, USA
| | | | - Cherie B Boyer
- San Francisco Division of Adolescent and Young Adult Medicine, Department of Pediatrics UCSF Benioff Children's Hospital San Francisco, University of California, San Francisco, CA, USA
| | - Glen Milo Santos
- School of Nursing, Department of Community Health Systems, University of California San Francisco, San Francisco, CA, USA
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119
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Jaiswal J, Griffin M, Singer SN, Greene RE, Acosta ILZ, Kaudeyr SK, Kapadia F, Halkitis PN. Structural Barriers to Pre-exposure Prophylaxis Use Among Young Sexual Minority Men: The P18 Cohort Study. Curr HIV Res 2019; 16:237-249. [PMID: 30062970 DOI: 10.2174/1570162x16666180730144455] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 07/11/2018] [Accepted: 07/15/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Despite decreasing rates of HIV among many populations, HIV-related health disparities among gay, bisexual and other men who have sex with men persist, with disproportional percentages of new HIV diagnoses among racial and ethnic minority men. Despite increasing awareness of HIV pre-exposure prophylaxis (PrEP), PrEP use remains low. In addition to exploring individual-level factors for this slow uptake, structural drivers of PrEP use must also be identified in order to maximize the effectiveness of biomedical HIV prevention strategies. METHOD Using cross-sectional data from an ongoing cohort study of young sexual minority men (N=492), we examine the extent to which structural-level barriers, including access to health care, medication logistics, counseling support, and stigma are related to PrEP use. RESULTS While almost all participants indicated awareness of PrEP, only 14% had ever used PrEP. PrEP use was associated with lower concerns about health care access, particularly paying for PrEP. Those with greater concerns talking with their provider about their sexual behaviors were less likely to use PrEP. CONCLUSION Paying for PrEP and talking to one's provider about sexual behaviors are concerns for young sexual minority men. In particular, stigma from healthcare providers poses a significant barrier to PrEP use in this population. Providers need not only to increase their own awareness of and advocacy for PrEP as an effective risk-management strategy for HIV prevention, but also must work to create open and non-judgmental spaces in which patients can discuss sexual behaviors without the fear of stigma.
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Affiliation(s)
- Jessica Jaiswal
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Social and Behavioral Sciences, College of Global Public Health, New York University, 715 Broadway, New York, NY 10012, United States.,Center for Interdisciplinary Research on AIDS, Yale University, 135 College St., Ste. 200, New Haven, CT 06510, United States
| | - Marybec Griffin
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Social and Behavioral Sciences, College of Global Public Health, New York University, 715 Broadway, New York, NY 10012, United States
| | - Stuart N Singer
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ 08854, United States
| | - Richard E Greene
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,School of Medicine, New York University, 550 1st Avenue, New York, NY 10016, United States
| | - Ingrid Lizette Zambrano Acosta
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States
| | - Saara K Kaudeyr
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States
| | - Farzana Kapadia
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Department of Epidemiology, College of Global Public Health, New York University, 719 Broadway, 10th floor, New York NY 10003, United States.,Department of Population Health, School of Medicine, New York University, 227 East 30th Street, New York, NY 10016, United States
| | - Perry N Halkitis
- Center for Health, Identity, Behavior & Prevention Studies, New York University, 715 Broadway, New York, NY 10012, United States.,Graduate School of Applied & Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Busch Campus, Piscataway, NJ 08854, United States.,Department of Social and Behavioral Health Sciences, Rutgers University, 683 Hoes Lane West Piscataway, NJ 08854, United States.,Robert Wood Johnson School of Medicine, Rutgers University, 675 Hoes Ln W, Piscataway Township, NJ 08854, United States.,School of Public Policy and Administration, Rutgers University, 401 Cooper Street, Camden, NJ 08102, United States
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120
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Mannheimer S, Hirsch-Moverman Y, Franks J, Loquere A, Hughes JP, Li M, Amico KR, Grant RM. Factors Associated With Sex-Related Pre-exposure Prophylaxis Adherence Among Men Who Have Sex With Men in New York City in HPTN 067. J Acquir Immune Defic Syndr 2019; 80:551-558. [PMID: 30865051 PMCID: PMC6417801 DOI: 10.1097/qai.0000000000001965] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/20/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND HPTN 067 assessed the feasibility of daily and non-daily dosing of open-label emtricitabine/tenofovir disoproxil fumarate (FTC/TDF)-based pre-exposure prophylaxis (PrEP). METHODS Factors associated with sex-related PrEP adherence were assessed among men who have sex with men (MSM) randomized to one of 3 PrEP dosing arms in HPTN 067 in New York City. Sex-related PrEP adherence was defined per protocol as at least 1 PrEP tablet taken within 4 days pre-sex and at least 1 additional PrEP tablet taken within 24 hours post-sex, assessed via electronic drug monitoring and weekly interviews. Demographic data and behavioral measures were evaluated for association with sex-related PrEP adherence. Logistic regression for clustered data was used to estimate the unadjusted and adjusted odds ratios. RESULTS Of 176 randomized MSM participants, 59% were Black, 10% White, 25% Hispanic, and 6% other; median age was 31 years. In the multivariable analyses, higher sex-related PrEP adherence was significantly associated with daily dosing arm, older age, employment, and higher PrEP adherence behavioral skills. Lower sex-related PrEP adherence was significantly associated with identifying as Black or Hispanic (compared with White), opiate use, and reporting "I forgot" as an adherence barrier. CONCLUSIONS This analysis identified populations of MSM who might benefit from additional support to optimize PrEP adherence, including those who are younger, unemployed, or opiate users. MSM with lower PrEP behavioral skills may benefit from targeted interventions. Further study is needed to assess racial and ethnic disparities in PrEP adherence, which may reflect broader social and economic inequalities not captured in this study.
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Affiliation(s)
- Sharon Mannheimer
- Department of Epidemiology, ICAP, Mailman School of Public Health, Columbia University, New York City Health + Hospitals/Harlem, New York, NY
| | | | - Julie Franks
- ICAP, Mailman School of Public Health, Columbia University, New York, NY
| | - Avelino Loquere
- ICAP, Mailman School of Public Health, Columbia University, New York, NY
| | | | - Maoji Li
- Fred Hutchinson Cancer Research Center, Seattle, WA
| | - K. Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI; and
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121
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Sun CJ, Anderson KM, Bangsberg D, Toevs K, Morrison D, Wells C, Clark P, Nicolaidis C. Access to HIV Pre-exposure Prophylaxis in Practice Settings: a Qualitative Study of Sexual and Gender Minority Adults' Perspectives. J Gen Intern Med 2019; 34:535-543. [PMID: 30719647 PMCID: PMC6445896 DOI: 10.1007/s11606-019-04850-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 10/25/2018] [Accepted: 12/27/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Sexual and gender minority (SGM) populations remain at disproportionate risk of HIV infection. Despite the effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV, PrEP uptake has been slow. OBJECTIVE To identify barriers and facilitators of PrEP access by examining SGM patients' experiences with accessing health care systems and engaging with providers about PrEP in a variety of practice settings. DESIGN Semi-structured, individual, qualitative interviews. PARTICIPANTS Twenty-seven sexual and gender minority adults residing in Oregon. APPROACH Interviews were audio-recorded, transcribed, and analyzed using thematic analysis. KEY RESULTS We identified three main themes. Participants described the centrality of patient-provider relationships to positive experiences around PrEP, the necessity of personally advocating to access PrEP, and the experience of system-level barriers to PrEP access. Participants also made several suggestions to improve PrEP access including improving provider engagement with SGM patients, encouraging providers to initiate conversations about PrEP, and increasing awareness of medication financial support. CONCLUSIONS In order to reduce HIV disparities, improving PrEP access will require additional efforts by providers and resources across health care settings to reduce barriers. Interventions to improve provider education about PrEP and provider communication skills for discussing sexual health are needed. Additionally, there should be system-level improvements to increase coordination between patients, providers, pharmacies, and payers to facilitate PrEP access and uptake.
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Affiliation(s)
- Christina J Sun
- Oregon Health & Science University-Portland State University School of Public Health, 506 SW Mill St, Suite 450H, Portland, OR, 97201, USA.
| | - Kirsten M Anderson
- Oregon Health & Science University-Portland State University School of Public Health, 506 SW Mill St, Suite 450H, Portland, OR, 97201, USA
| | - David Bangsberg
- Oregon Health & Science University-Portland State University School of Public Health, 506 SW Mill St, Suite 450H, Portland, OR, 97201, USA
| | - Kim Toevs
- Multnomah County Health Department, Portland, OR, USA
| | - Dayna Morrison
- Oregon AIDS Education and Training Center at Portland Veterans Affairs Research Foundation, Portland, OR, USA
| | | | - Pete Clark
- Multnomah County Health Department, Portland, OR, USA
| | - Christina Nicolaidis
- Oregon Health & Science University-Portland State University School of Public Health, 506 SW Mill St, Suite 450H, Portland, OR, 97201, USA.,Portland State University School of Social Work, Portland, OR, USA.,Oregon Health & Science University School of Medicine, Portland, OR, USA
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122
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Jenness SM, Maloney KM, Smith DK, Hoover KW, Goodreau SM, Rosenberg ES, Weiss KM, Liu AY, Rao DW, Sullivan PS. Addressing Gaps in HIV Preexposure Prophylaxis Care to Reduce Racial Disparities in HIV Incidence in the United States. Am J Epidemiol 2019; 188:743-752. [PMID: 30312365 DOI: 10.1093/aje/kwy230] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 09/18/2018] [Accepted: 10/02/2018] [Indexed: 12/15/2022] Open
Abstract
The potential for human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) to reduce the racial disparities in HIV incidence in the United States might be limited by racial gaps in PrEP care. We used a network-based mathematical model of HIV transmission for younger black and white men who have sex with men (BMSM and WMSM) in the Atlanta, Georgia, area to evaluate how race-stratified transitions through the PrEP care continuum from initiation to adherence and retention could affect HIV incidence overall and disparities in incidence between races, using current empirical estimates of BMSM continuum parameters. Relative to a no-PrEP scenario, implementing PrEP according to observed BMSM parameters was projected to yield a 23% decline in HIV incidence (hazard ratio = 0.77) among BMSM at year 10. The racial disparity in incidence in this observed scenario was 4.95 per 100 person-years at risk (PYAR), a 19% decline from the 6.08 per 100 PYAR disparity in the no-PrEP scenario. If BMSM parameters were increased to WMSM values, incidence would decline by 47% (hazard ratio = 0.53), with an associated disparity of 3.30 per 100 PYAR (a 46% decline in the disparity). PrEP could simultaneously lower HIV incidence overall and reduce racial disparities despite current gaps in PrEP care. Interventions addressing these gaps will be needed to substantially decrease disparities.
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Affiliation(s)
- Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Kevin M Maloney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Dawn K Smith
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Karen W Hoover
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven M Goodreau
- Department of Anthropology, University of Washington, Seattle, Washington
| | - Eli S Rosenberg
- Department of Epidemiology and Biostatistics, School of Public Health, University of Albany, Albany, New York
| | - Kevin M Weiss
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Albert Y Liu
- Bridge HIV, Population Health Division, San Francisco Department of Public Health, San Francisco, California
| | - Darcy W Rao
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington
| | - Patrick S Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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123
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Whiteley L, Mena L, Craker LK, Healy MG, Brown LK. Creating a Theoretically Grounded Gaming App to Increase Adherence to Pre-Exposure Prophylaxis: Lessons From the Development of the Viral Combat Mobile Phone Game. JMIR Serious Games 2019; 7:e11861. [PMID: 30916652 PMCID: PMC6456850 DOI: 10.2196/11861] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/05/2018] [Accepted: 12/09/2018] [Indexed: 12/20/2022] Open
Abstract
Background In the United States, young minority men who have sex with men (MSM) are most likely to become infected with HIV. The use of antiretroviral medications to reduce the risk of acquiring HIV infection (pre-exposure prophylaxis, PrEP) is an efficacious and promising prevention strategy. There have been significant advances regarding PrEP, including the definitive demonstration that PrEP reduces HIV acquisition and the development of clinical prescribing guidelines. Despite these promising events, the practical implementation of PrEP can be challenging. Data show that PrEP’s safety and effectiveness could be greatly compromised by suboptimal adherence to treatment, and there is concern about the potential for an increase in HIV risk behavior among PrEP users. Due to these challenges, the prescribing of PrEP should be accompanied by behavioral interventions to promote adherence. Objective This study aimed to develop an immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. Methods Game development was guided by social learning theory, taking into consideration the perspectives of young adult MSM who are taking PrEP. A total of 20 young men who have sex with men (YMSM; aged 18-35 years) were recruited from a sexually transmitted infection (STI), HIV testing, and PrEP care clinic in Jackson, Mississippi, between October 2016 and June 2017. They participated in qualitative interviews guided by the information-motivation-behavioral skills (IMB) model of behavior change. The mean age of participants was 26 years, and all the participants identified as male. Acceptability of the game was assessed with the Client Service Questionnaire and session evaluation form. Results A number of themes emerged that informed game development. YMSM taking PrEP desired informational game content that included new and comprehensive details about the effectiveness of PrEP, details about PrEP as it relates to doctors’ visits, and general information about STIs other than HIV. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and a focus on personal relevance of PrEP-related medical care. Behavioral skills themes centered around self-efficacy and strategies for adherence to PrEP and self-care. Conclusions We utilized youth feedback, IMB, and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. There is a dearth of gaming interventions for persons on PrEP. This study is a significant step in working toward the development and testing of an iPhone gaming intervention to decrease HIV risk and promote adherence to PrEP for YMSM.
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Affiliation(s)
- Laura Whiteley
- Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Leandro Mena
- University of Mississippi Medical Center, University of Mississippi, Jackson, MS, United States
| | - Lacey K Craker
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
| | - Meredith Garver Healy
- Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
| | - Larry K Brown
- Department of Psychiatry, Warren Alpert Medical School, Brown University, Providence, RI, United States.,Young Adult Behavioral Health, Department of Psychiatry and Human Behavior, Rhode Island Hospital, Providence, RI, United States
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124
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Lockard A, Rosenberg ES, Sullivan PS, Kelley CF, Serota DP, Rolle CPM, Luisi N, Pingel E, Siegler AJ. Contrasting Self-Perceived Need and Guideline-Based Indication for HIV Pre-Exposure Prophylaxis Among Young, Black Men Who Have Sex with Men Offered Pre-Exposure Prophylaxis in Atlanta, Georgia. AIDS Patient Care STDS 2019; 33:112-119. [PMID: 30844305 PMCID: PMC6442270 DOI: 10.1089/apc.2018.0135] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite high HIV incidence among young black men who have sex with men (YBMSM), pre-exposure prophylaxis (PrEP) uptake in this group is low. In a cohort of HIV-negative YBMSM in Atlanta, GA, all participants were offered PrEP as standard of care with free clinician visits and laboratory testing. We explored self-perceived need for PrEP among 29 in-depth interview participants by asking about reasons for PrEP uptake or refusal and factors that may lead to future reconsideration. Self-perceived need was compared to US Center for Disease Control and Prevention guidance for clinical PrEP indication using behavioral data and laboratory testing data. Self-perceived need for PrEP consistently underestimated clinical indication, primarily due to optimism for choosing other HIV prevention strategies, such as condom use, abstinence, or monogamy. Many participants cited consistent condom use and lack of sexual activity as reasons for not starting PrEP; however, follow-up survey data frequently demonstrated low condom use and high levels of sexual activity in the period after the interview. Study participants endorsed perceptions that PrEP is only for people with very high levels of sexual activity. Only one participant perceived incident sexually transmitted infection (STI) to be an indication for PrEP, despite the fact that several of the participants had a history of an STI diagnosis. These findings point to an opportunity for clinician intervention at diagnosis. Disconnect between self-perceived and guidance-based PrEP indications, as well as other factors such as medical mistrust or difficulty with access, may contribute to low PrEP uptake among YBMSM. A better understanding of the ways in which these issues manifest may be one tool for clinicians to support PrEP uptake.
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Affiliation(s)
- Annie Lockard
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Eli S. Rosenberg
- Department of Epidemiology and Biostatistics, University of Albany School of Public Health, SUNY, Albany, New York
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Colleen F. Kelley
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - David P. Serota
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | | | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Emily Pingel
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aaron J. Siegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia
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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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126
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Implementation of a Socio-structural Demonstration Project to Improve HIV Outcomes Among Young Black Men in the Deep South. J Racial Ethn Health Disparities 2019; 6:775-789. [PMID: 30793253 DOI: 10.1007/s40615-019-00576-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/31/2019] [Accepted: 02/12/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND We describe the background, rationale, intervention components, and formative results of a demonstration project aimed to ameliorate five socio-structural barriers to HIV services for young Black men aged 18-29 living with and at risk for HIV in Louisiana. METHODS The interventions and activities consisted of (1) five person-centered approaches to enhance linkage to HIV services and improve socio-economic outcomes; (2) the implementation of systematic mystery shopping tests to document instances of housing discrimination; (3) the development and implementation of a multi-prong communications campaign to increase knowledge about the signs of housing discrimination and community resources among young Black men who have sex with men (YBMSM); (4) the integration of HIV/STI services and lesbian, gay, bisexual, and trans (LGBT)-inclusive events on Historically Black Colleges and Universities (HBCUs); and (5) the development of a safe space for YBMSM. A multi-method approach was used to evaluate the outcomes of the different interventions. RESULTS The majority (62%) of participants living with HIV were linked to HIV care and 49% had achieved viral suppression. More than 40% of participants were employed during the project. Thirty-seven percent (37%) of the mystery shopping tests showed definite or possible signs of housing discrimination. The housing campaign's duration was limited with unknown long-term impact among YBMSM. Fifteen cases of syphilis were identified during two HBCU events. A safe space was specifically created for YBMSM at a community-based organization. CONCLUSION Multi-component holistic health interventions are needed to improve HIV outcomes and curb the high HIV rates among young Black men, particularly YBMSM in the United States and the Deep South.
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127
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Sun CJ, Anderson KM, Toevs K, Morrison D, Wells C, Nicolaidis C. "Little Tablets of Gold": An Examination of the Psychological and Social Dimensions of PrEP Among LGBTQ Communities. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2019; 31:51-62. [PMID: 30742478 DOI: 10.1521/aeap.2019.31.1.51] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
There are significant psychological, social, and cultural dimensions to the HIV epidemic in the United States, especially among lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities. Biomedical HIV treatment has been shown to impact these dimensions. However, there is little understanding of the real-world psychosocial and sociocultural effects of the latest biomedical HIV prevention strategy, HIV pre-exposure prophylaxis (PrEP). This study explored the psychosocial and sociocultural dimensions of PrEP use among LGBTQ adults. We interviewed 23 LGBTQ adults who were current or former users of PrEP. Results included that PrEP users' experiences were shaped by multiple forms of stigma. Participants were highly motivated to challenge PrEP stigma and to support PrEP use among other community members. Lastly, participants described positive impacts on their individual well-being and their sexual partnerships. Findings suggest that PrEP has significant impacts beyond biomedical outcomes for both the individuals who use PrEP and their communities.
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Affiliation(s)
- Christina J Sun
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Kirsten M Anderson
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Kim Toevs
- Multnomah County Health Department, Portland, Oregon
| | - Dayna Morrison
- Oregon AIDS Education and Training Center at Portland Veterans Affairs Research Foundation, Portland, Oregon
| | | | - Christina Nicolaidis
- School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, and the School of Social Work, Portland State University, Portland, Oregon
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128
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Gamarel KE, Golub SA. Closeness Discrepancies and Intimacy Interference: Motivations for HIV Prevention Behavior in Primary Romantic Relationships. PERSONALITY AND SOCIAL PSYCHOLOGY BULLETIN 2019; 45:270-283. [PMID: 29984632 PMCID: PMC6377335 DOI: 10.1177/0146167218783196] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Relational closeness has been positively associated with relationship quality and mental health; however, desire for closeness and intimacy in a relationship may also motivate sexual risk-taking, that is, forgoing condom use. This study examined the impact of desiring more closeness with a primary partner (i.e., motivation for reducing closeness discrepancies) on HIV prevention behavior. Using pre-exposure prophylaxis (PrEP) as a case study, we examined the extent to which closeness discrepancies motivate behavioral intentions (Study 1) and actual behavior (Study 2). In both studies, desiring more closeness and believing that condoms interfere with intimacy were independently positively associated with PrEP adoption. Understanding the relational needs for closeness and intimacy in motivating prevention behavior is critical for social psychology, relationship science, and public health efforts to improve sexual health.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Sarit A. Golub
- Hunter College and the Graduate Center of the City University of New York, New York, NY USA
- Hunter HIV/AIDS Research Team, New York, NY USA
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129
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Calabrese SK, Tekeste M, Mayer KH, Magnus M, Krakower DS, Kershaw TS, Eldahan AI, Gaston Hawkins LA, Underhill K, Hansen NB, Betancourt JR, Dovidio JF. Considering Stigma in the Provision of HIV Pre-Exposure Prophylaxis: Reflections from Current Prescribers. AIDS Patient Care STDS 2019; 33:79-88. [PMID: 30715918 DOI: 10.1089/apc.2018.0166] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Efforts to identify and address social inequities in HIV pre-exposure prophylaxis (PrEP) access are urgently needed. We investigated early-adopting PrEP prescribers' beliefs about how stigma contributes to PrEP access disparities in health care and explored potential intervention strategies within the context of PrEP service delivery. US-based PrEP prescribers were recruited through professional networks and participant referrals. Qualitative interviews were conducted, transcribed, and thematically analyzed. Participants (n = 18) were primarily male (72%); white (39%) or Asian (33%); and heterosexual (56%). Most practiced in the Northeastern (67%) or Southern (22%) United States; were physicians (94%); and specialized in HIV/infectious disease (89%). Participants described multiple forms of structural and interpersonal stigma impeding PrEP access. The requirement that PrEP be prescribed was a perceived deterrent for populations with medical mistrust and/or low health literacy. Practice norms such as discussing PrEP only in response to patient requests were seen as favoring more privileged groups. When probed about personally held biases, age-related stereotypes were the most readily acknowledged, including assumptions about older adults being sexually inactive and uncomfortable discussing sex. Participants criticized providers who chose not to prescribe PrEP within their clinical practice, particularly those whose decision reflected personal values related to condomless sex or discomfort communicating about sex with their patients. Suggested solutions included standardizing PrEP service delivery across patients and increasing cultural competence training. These early insights from a select sample of early-adopting providers illuminate mechanisms through which stigma could compromise PrEP access for key populations and corresponding points of intervention within the health care system.
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Affiliation(s)
- Sarah K. Calabrese
- Department of Psychology, George Washington University, Washington, District of Columbia
| | - Mehrit Tekeste
- Department of Psychology, George Washington University, Washington, District of Columbia
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Manya Magnus
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia
| | - Douglas S. Krakower
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Population Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Trace S. Kershaw
- Social and Behavioral Sciences Department, Yale School of Public Health, Yale University, New Haven, Connecticut
| | | | | | - Kristen Underhill
- Columbia Law School, Columbia University, New York, New York
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, New York
| | - Nathan B. Hansen
- Department of Health Promotion and Behavior, College of Public Health, University of Georgia, Athens, Georgia
| | - Joseph R. Betancourt
- Disparities Solutions Center, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - John F. Dovidio
- Department of Psychology, Yale University, New Haven, Connecticut
- Chronic Disease Epidemiology Department, Yale School of Public Health, Yale University, New Haven, Connecticut
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130
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Ward LM, Bruce MA, Thorpe RJ, Mena L, Nunn A, Crosby R. Correlates Associated With Willingness to Start Pre-exposure Prophylaxis Among Young Black Men Who Have Sex With Men (MSM) in Jackson, Mississippi. FAMILY & COMMUNITY HEALTH 2019; 42:189-196. [PMID: 31107729 DOI: 10.1097/fch.0000000000000225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Black men who have sex with men have the greatest risk for human immunodeficiency virus infection. Pre-exposure prophylaxis (PrEP) is a highly effective prevention method. However, uptake in this group is extremely low. Data from a sample of 225 human immunodeficiency virus-negative young black men who have sex with men residing in Jackson, Mississippi, were analyzed to examine correlates associated with willingness to start PrEP. Consistent condom users for both insertive and receptive sex were more likely to be willing to start PrEP than inconsistent condom users. Heterogeneity among this high-risk population is an important consideration for future studies assessing PrEP uptake and evaluating prevention efforts.
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Affiliation(s)
- Lori M Ward
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson (Drs Ward, Bruce, Thorpe, and Mena); Program for Research on Faith and Health, Center for Research on Men's Health, and Center for Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee (Dr Bruce); Program for Research on Men's Health, Hopkins Center for Health Disparities Solutions, and Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Thorpe); Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson (Dr Mena); Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island (Dr Nunn); and Department of Health Behavior, College of Public Health, University of Kentucky, Lexington (Dr Crosby)
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131
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Gamarel KE, Chakravarty D, Neilands TB, Hoff CC, Lykens J, Darbes LA. Composite Risk for HIV: A New Approach Towards Integrating Biomedical and Behavioral Strategies in Couples-Based HIV Prevention Research. AIDS Behav 2019; 23:283-288. [PMID: 30003506 PMCID: PMC6368473 DOI: 10.1007/s10461-018-2229-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
A substantial number of new HIV infections among gay, bisexual, and other men who have sex with men and transgender women occurs in the context of primary partnerships. Given the diversity of risk reduction needs and various approaches available for reducing risk within couples, condomless sex is no longer the gold standard HIV outcome. We present a novel, comprehensive, and flexible Composite Risk for HIV (CR-HIV) approach for integrating evolving biomedical and behavioral HIV prevention strategies into couples-based HIV prevention intervention and survey research. We provide illustrative examples of the utility of the CR-HIV approach based on couples' HIV status.
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Affiliation(s)
- Kristi E Gamarel
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA.
| | - Deepalika Chakravarty
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Torsten B Neilands
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Colleen C Hoff
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - James Lykens
- Center for Research and Education on Gender and Sexuality, San Francisco State University, San Francisco, CA, USA
| | - Lynae A Darbes
- Center for Sexuality & Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
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132
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Brinkley-Rubinstein L, Peterson M, Arnold T, Nunn AS, Beckwith CG, Castonguay B, Junious E, Lewis C, Chan PA. Knowledge, interest, and anticipated barriers of pre-exposure prophylaxis uptake and adherence among gay, bisexual, and men who have sex with men who are incarcerated. PLoS One 2018; 13:e0205593. [PMID: 30532275 PMCID: PMC6286000 DOI: 10.1371/journal.pone.0205593] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022] Open
Abstract
Criminal justice (CJ) settings disproportionately include populations at high risk for acquiring HIV, and CJ-involved individuals are often at the intersection of multiple overlapping risk factors. However, few studies have examined attitudes about pre-exposure prophylaxis (PrEP) among incarcerated men who have sex with men (MSM). This study explored interest in, knowledge of, and barriers to PrEP uptake among gay, bisexual, and other men who have sex with men at the Rhode Island Department of Corrections. Using semi-structured interviews, 26 MSM were interviewed about PrEP knowledge, interest, timing preferences for provision (e.g. before or after release), and barriers to uptake and adherence during community re-entry. Interviews were coded and analyzed using a general inductive approach. Participants demonstrated low initial knowledge of PrEP but high interest after being told more about it. Participants self-identified risk factors for HIV acquisition, including condomless sex and substance use. In addition, participants preferred provision of PrEP prior to release. Post-release barriers to PrEP uptake and adherence included 1) concerns about costs of PrEP medications; 2) anticipated partner or family disapproval; 3) lack of access to transportation; 4) unstable housing; 5) compounding impacts of multiple hardships leading to a de-prioritization of PrEP and 6) fears of future re-incarceration. These results point to the need for future PrEP interventions among incarcerated populations that address incarceration and PrEP related barriers during community re-entry via wraparound services that address PrEP and incarceration-related barriers.
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Affiliation(s)
- Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Center for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Meghan Peterson
- Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, Rhode Island, United States of America
| | - Trisha Arnold
- Department of Psychology, Jackson State University, Jackson, Missouri, United States of America
- Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
| | - Curt G. Beckwith
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
| | - Breana Castonguay
- Center for AIDS Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Eric Junious
- College of Health and Human Services, University of North Carolina, Charlotte, North Carolina, United States of America
| | - Chantal Lewis
- Center for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Philip A. Chan
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, United States of America
- Department of Medicine, Brown University, Providence, Rhode Island, United States of America
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133
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Vaccher SJ, Kaldor JM, Callander D, Zablotska IB, Haire BG. Qualitative Insights Into Adherence to HIV Pre-Exposure Prophylaxis (PrEP) Among Australian Gay and Bisexual Men. AIDS Patient Care STDS 2018. [DOI: 10.1089/apc.2018.0106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
| | | | - Denton Callander
- Kirby Institute, UNSW Sydney, Sydney, Australia
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Iryna B. Zablotska
- Westmead Clinical School, University of Sydney Medical School, Sydney, Australia
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134
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The Role of Social Relationships in PrEP Uptake and Use Among Transgender Women and Men Who Have Sex with Men. AIDS Behav 2018; 22:3673-3680. [PMID: 29754268 DOI: 10.1007/s10461-018-2151-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Qualitative studies suggest that social relationships play an important role in HIV pre-exposure prophylaxis (PrEP) use, but there have been few quantitative assessments of the role of social relationships in PrEP uptake or adherence. We examined the association between disclosure of study participation or LGBT identity and PrEP use in the 1603 HIV-negative participants enrolled in the iPrEx OLE study. We also evaluated the association between LGBT social group involvement and PrEP use. Study participation disclosure to parents and LGBT identity disclosure to anyone in a participant's social network were associated with greater PrEP uptake. Study participation disclosure to partners was associated with higher probability of having protective PrEP drug concentrations compared [risk difference 0.15 95% CI (0.01, 0.30)]. For each additional type of LGBT organization a participant was involved in, the probability of PrEP uptake and having protective drug concentrations increased by 0.04 [95% CI (0.03, 0.06)] and 0.04 (95% CI (0.02, 0.07)] respectively. Overall, social context was associated with PrEP use in iPrEx OLE, and should be taken into consideration when designing future PrEP implementation programs.
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135
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Dubov A, Altice FL, Fraenkel L. An Information-Motivation-Behavioral Skills Model of PrEP Uptake. AIDS Behav 2018; 22:3603-3616. [PMID: 29557540 DOI: 10.1007/s10461-018-2095-4] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite documented effectiveness of pre-exposure prophylaxis (PrEP), PrEP uptake remains low among at-risk populations. The 2015 CDC report estimates that about 1.2 million people in the US have indications for PrEP. However, only 49,158 or 4% of the targeted population are currently using PrEP. Efforts to optimize uptake of PrEP may be facilitated by the development of a comprehensive theoretical framework which can be used to understand reasons for poor uptake and to develop interventions to maximize PrEP uptake and adherence. This article reviews research on correlates of PrEP uptake and presents findings organized within an Information-Motivation-Behavioral Skills (IMB) model framework. In the context of PrEP uptake, the IMB model asserts that to the extent that at-risk groups are well-informed about PrEP, motivated to act on their knowledge, and have necessary behavioral skills to seek out and initiate PrEP regimen, they will successfully overcome obstacles to initiate and adhere to PrEP. The article proposes an adaptation the IMB model for PrEP uptake, provides empirical support for the adapted IMB model extracted from related research, and discusses its application in PrEP uptake interventions.
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136
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Marcus JL, Hurley LB, Dentoni-Lasofsky D, Ellis CG, Silverberg MJ, Slome S, Snowden JM, Volk JE. Barriers to preexposure prophylaxis use among individuals with recently acquired HIV infection in Northern California. AIDS Care 2018; 31:536-544. [PMID: 30304942 DOI: 10.1080/09540121.2018.1533238] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Barriers to HIV preexposure prophylaxis (PrEP) use have not been well-characterized in people who became HIV-infected, all of whom could have benefited from PrEP. We invited Kaiser Permanente Northern California members diagnosed with HIV during 2014-2016, following a negative HIV test in the prior year, to complete a survey assessing barriers to PrEP use before HIV diagnosis. Of 268 patients surveyed, 122 (46%) responded. Median age was 36, most (84%) were men who have sex with men, and 64% were of minority racial/ethnic background. Thirty-six (30%) had discussed PrEP with a provider, of whom 10 were diagnosed with HIV at PrEP intake. Overall, only 5 (4.1%) had used PrEP, and all 5 discontinued before diagnosis. Among all respondents, the most common barrier to PrEP use was lack of PrEP awareness (51%). Among those aware of PrEP, the most common barriers were cost/insurance concerns (36%) and perceived low risk for HIV (24%). Lack of PrEP awareness ranged from 39% among those aged 25-34 to 88% among those aged <25 (P = 0.011), and from 33% among Hispanics to 69% among Blacks (P = 0.055). Increasing awareness and affordability of PrEP, and facilitating accurate assessment of HIV risk, are critical to reducing missed opportunities for PrEP.
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Affiliation(s)
- Julia L Marcus
- a Harvard Medical School and Harvard Pilgrim Health Care Institute , Boston , MA , USA
| | - Leo B Hurley
- b Kaiser Permanente Division of Research , Oakland , CA , USA
| | | | | | | | - Sally Slome
- c Kaiser Permanente Oakland Medical Center , Oakland , CA , USA
| | - Jonathan M Snowden
- d Oregon Health & Science University-Portland State University , Portland , OR , USA
| | - Jonathan E Volk
- e Kaiser Permanente San Francisco Medical Center , San Francisco , CA , USA
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Pilkington V, Hill A, Hughes S, Nwokolo N, Pozniak A. How safe is TDF/FTC as PrEP? A systematic review and meta-analysis of the risk of adverse events in 13 randomised trials of PrEP. J Virus Erad 2018; 4:215-224. [PMID: 30515300 PMCID: PMC6248833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Tenofovir/emtricitabine (TDF/FTC) used as pre-exposure prophylaxis (PrEP) has proven benefits in preventing HIV infection. Widespread use of TDF/FTC can only be justified if the preventative benefits outweigh potential risks of adverse events. A previous meta-analysis of TDF/FTC compared to alternative tenofovir alafenamide (TAF)/FTC for treatment found no significant difference in safety endpoints when used without ritonavir or cobicistat, but more evidence around the safety of TDF/FTC is needed to address concerns and inform widespread use. METHODS A systematic review identified 13 randomised trials of PrEP, using either TDF/FTC or TDF, versus placebo or no treatment: VOICE, PROUD, IPERGAY, FEM-PrEP, TDF-2, iPrEX, IAVI Kenya, IAVI Uganda, PrEPare, PARTNERS, US Safety study, Bangkok TDF study, W African TDF study. The number of participants with grade 3/4 adverse events or serious adverse events (SAEs) was compared between treatment and control in the meta-analysis. Further analyses of specific renal and bone markers were also undertaken, with fractures as a marker of bone effects and creatinine elevations as a surrogate marker for renal impairment. Analyses were stratified by study duration (</>1 year of follow up). RESULTS The 13 randomised trials included 15,678 participants in relevant treatment and control arms. Three studies assessed TDF use only. The number of participants with grade 3/4 adverse events was 1306/7504 (17.4%) on treatment versus 1259/7502 (16.8%) on control (difference=0%, 95% confidence interval [CI] -1% to +2%). The number of participants with SAEs was 740/7843 (9.4%) on treatment versus 795/7835 (10.1%) on no treatment (difference=0%, 95% CI -1% to +1%). The number of participants with creatinine elevations was 8/7843 on treatment versus 4/7835 on control (difference=0%, 95% CI 0%-0%). The number of participants with bone fractures was 217/5789 on treatment versus 189/5795 on control (difference=0%, 95% CI 0% to 1%). There was no difference in outcome between studies with <1 versus >1 year of randomised treatment. CONCLUSIONS In this meta-analysis of 13 randomised clinical trials of PrEP in 15,678 participants, there was no significant difference in risk of grade 3/4 clinical adverse events or SAEs between TDF/FTC (or TDF) and control. Furthermore, there was no significant difference in risk of specific renal or bone adverse outcomes. The favourable safety profile of TDF/FTC would support more widespread use PrEP in populations with a lower risk of HIV infection.
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Affiliation(s)
| | - Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool,
UK,Corresponding author: Andrew M Hill,
Department of
Translational Medicine,
University of Liverpool,
70 Pembroke Place,
LiverpoolL69 3GF,
UK.
| | | | - Nneka Nwokolo
- Chelsea and Westminster Hospital, 56 Dean Street,
LondonUK
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Felsher M, Szep Z, Krakower D, Martinez-Donate A, Tran N, Roth AM. "I Don't Need PrEP Right Now": A Qualitative Exploration of the Barriers to PrEP Care Engagement Through the Application of the Health Belief Model. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:369-381. [PMID: 30332306 PMCID: PMC8558876 DOI: 10.1521/aeap.2018.30.5.369] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
The Health Belief Model has been useful for studying uptake of HIV prevention behaviors and has had limited application to understanding utilization of pre-exposure prophylaxis (PrEP), a biomedical strategy to reduce HIV acquisition. We recruited 90 persons undergoing HIV screening and educated them about PrEP. We followed up with 35 participants approximately 3 weeks later and quantitatively assessed PrEP uptake. No participant had initiated PrEP. We conducted in-depth interviews with 15 participants to explore situational factors impacting this decision. In this paper we provide an overview of PrEP-related engagement using qualitative data to contextualize (in)action. While participants perceived PrEP as beneficial, perceived benefits did not outweigh real- and perceived barriers, such as financial and time-related constraints. In order to promote PrEP uptake, cues to action that increase the benefits of PrEP during seasons of risk, and interventions that reduce real and perceived barriers are needed.
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Affiliation(s)
- Marisa Felsher
- Drexel University, Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Zsofia Szep
- Drexel University College of Medicine, Division of Infectious Diseases and HIV Medicine, Philadelphia
| | - Douglas Krakower
- Beth Israel Deaconess Medical Center, Infectious Diseases/Department of Medicine, Boston, Massachusetts
| | - Ana Martinez-Donate
- Drexel University, Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Nguyen Tran
- Drexel University, Dornsife School of Public Health, Philadelphia, Pennsylvania
| | - Alexis M Roth
- Drexel University, Dornsife School of Public Health, Philadelphia, Pennsylvania
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139
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Pilkington V, Hill A, Hughes S, Nwokolo N, Pozniak A. How safe is TDF/FTC as PrEP? A systematic review and meta-analysis of the risk of adverse events in 13 randomised trials of PrEP. J Virus Erad 2018. [DOI: 10.1016/s2055-6640(20)30312-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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140
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Peterson M, Nowotny K, Dauria E, Arnold T, Brinkley-Rubinstein L. Institutional distrust among gay, bisexual, and other men who have sex with men as a barrier to accessing pre-exposure prophylaxis (PrEP). AIDS Care 2018; 31:364-369. [PMID: 30227719 DOI: 10.1080/09540121.2018.1524114] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Populations at highest risk for acquiring HIV are more likely to pass through criminal justice (CJ) settings, and CJ-involved individuals are often at the intersection of multiple overlapping risk factors. The present study explored interest in, knowledge of, and barriers to PrEP uptake among gay, bisexual, and other men who have sex with men involved in the criminal justice system. Using semi-structured interviews, 26 participants who identified as MSM were asked about PrEP knowledge and interest, HIV risk, and incarceration experience. One theme that emerged across interviews was how institutional distrust in CJ settings may instill lack of trust in medical care after perceived mistreatment. Participants explained how lack of privacy fostered feelings that medical care was not confidential, care received was tied to status as an incarcerated person, and feelings of dehumanization led to distrust. Findings explore how distrust may hinder PrEP uptake and other HIV prevention efforts in CJ settings as well as after release. They highlight the need for greater privacy efforts and cultural humility, and explore how medical settings may function as spaces for people who are incarcerated to disclose HIV risk status. Few studies to our knowledge have examined the role of institutional distrust on men who have sex with men (MSM) in the context of pre-exposure prophylaxis (PrEP) interventions. The present study has implications for creating best practices to structure HIV prevention interventions in CJ settings.
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Affiliation(s)
- Meghan Peterson
- a School of Public Health , Brown University , Providence , RI , USA.,b Center for Prisoner Health and Human Rights , Miriam Hospital , Providence , RI , USA
| | - Kathryn Nowotny
- c Department of Sociology , University of Miami , Miami , FL , USA
| | - Emily Dauria
- d Department of Psychiatry , University of California , San Francisco , CA , USA
| | - Trisha Arnold
- e Department of Psychology , Rhode Island Hospital , Providence , RI , USA
| | - Lauren Brinkley-Rubinstein
- f Department of Social Medicine , University of North Carolina , Chapel Hill , NC , USA.,g Center for Health Equity Research , University of North Carolina , Chapel Hill , NC , USA
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Werner RN, Gaskins M, Ahrens J, Jessen H, Kutscha F, Mosdzen R, Osswald W, Sander D, Schellberg S, Schwabe K, Wünsche T, Dressler C, Sammons M, Nast A. Knowledge and use of HIV pre-exposure prophylaxis among men who have sex with men in Berlin - A multicentre, cross-sectional survey. PLoS One 2018; 13:e0204067. [PMID: 30212547 PMCID: PMC6136827 DOI: 10.1371/journal.pone.0204067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 08/31/2018] [Indexed: 12/22/2022] Open
Abstract
Background HIV pre-exposure prophylaxis (PrEP) has likely contributed to large decreases in HIV incidence among men who have sex with men (MSM) in several major cities. Berlin has seen a smaller decline, and affordable PrEP has been accessible through formal channels in Germany only since autumn 2017. We aimed to investigate knowledge and use of PrEP among MSM in Berlin, and factors predictive of a desire to use PrEP and history of PrEP use. Methods Multicentre, paper-based, self-administered survey of adult MSM whose HIV status was negative or unknown at time of participation. Data were collected from 1 October 2017 to 2 April 2018. Results 473 of 875 questionnaires were returned (response rate 54.1%; mean age 37.4 years, range 18–79). 90.0% of participants were aware of PrEP and, of these, 48.2% felt well informed about it. Among the 17.2% of participants reporting PrEP use, 59.3% indicated obtaining some or all of it from informal sources. 23.7% of those with no history of PrEP use reported having condomless anal intercourse (CAI) with two or more partners over the past six months. Worries about side effects, cost, not having a doctor who prescribes it, and a lack of information were the most frequently reported barriers to PrEP use. A desire to use PrEP and history of PrEP use were associated in our multivariable model with having multiple CAI partners. A history of PrEP use was associated with having a university degree, one or two parents born outside Germany, or friends living with HIV. Conclusions We found high awareness of PrEP among MSM in Berlin, but also a strong need for more education on its pros, cons and proper use. The frequency of informal PrEP use was also high, raising urgent individual and public health concerns. Policy makers need to consider recent calls to improve access to PrEP and PrEP education through regular health services.
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Affiliation(s)
- Ricardo Niklas Werner
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venereology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
- * E-mail:
| | - Matthew Gaskins
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venereology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
| | | | - Heiko Jessen
- Praxis Jessen + Kollegen, SHC–Sexual Health Center Berlin, Berlin, Germany
| | | | | | | | | | | | - Kai Schwabe
- Schwulenberatung Berlin gGmbH, Berlin, Germany
| | | | - Corinna Dressler
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venereology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
| | - Mary Sammons
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venereology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
| | - Alexander Nast
- Charité–Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health; Department of Dermatology, Venereology and Allergy; Division of Evidence-Based Medicine (dEBM), Berlin, Germany
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142
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Qu D, Zhong X, Xiao G, Dai J, Liang H, Huang A. Adherence to pre-exposure prophylaxis among men who have sex with men: A prospective cohort study. Int J Infect Dis 2018; 75:52-59. [PMID: 30125688 DOI: 10.1016/j.ijid.2018.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/05/2018] [Accepted: 08/08/2018] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To evaluate adherence to pre-exposure prophylaxis (PrEP) in a clinical trial of a population of men who have sex with men (MSM), to explore the influence of social psychology and objective factors (e.g., forgetting, too busy) on adherence, and to provide evidence for subsequent PrEP research. METHODS This study analyzed the data from the daily medication group within a PrEP study (a randomized placebo-controlled trial of oral tenofovir among MSM in Western China from April 2013 to March 2015). A total of 331 participants were analyzed. PrEP adherence was self-reported by the subjects at every 3-month follow-up visit for 24 months. AIDS-related information including HIV prevention, transmission, and treatment knowledge, as well as PrEP-related motivation (including personal and social motivation) and behavior skills, i.e., self-efficacy, were collected using questionnaires. The objective reasons for non-adherence were collected during face-to-face follow-up visits every 3 months. A theoretical model of information motivation behavior skills (IMB) was constructed. Then confirmatory factor analysis was performed to test the fit of each IMB construct. Finally, the structure equation model was used to evaluate the IMB model. RESULTS The median adherence rate was 64.29%. During the follow-up period, the percentage of high adherence (adherence ≥80%) was 32.33%, intermediate adherence (adherence 40-80%) was 38.97%, and low adherence (adherence ≤40%) was 28.70%. The final IMB model showed that there was no significant correlation between adherence to PrEP and the psychological constructs: information, motivation, and behavior skills. The main objective reasons for non-adherence were 'forgetting to take medicine' (70.21%), 'too busy' (29.08%), 'worrying about side effects' (28.01%), and 'too much trouble' (18.44%). CONCLUSIONS This study found no association between PrEP adherence and social psychological factors, and the main objective factor in non-adherence was forgetting to take the medicine. In the future, the MSM population could be reminded to take their medicine regularly using electronic devices, which may improve PrEP adherence to some extent and may further reduce the incidence of HIV. The strategy to improve PrEP adherence requires further study.
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Affiliation(s)
- Dou Qu
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China; Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China; Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Xiaoni Zhong
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China; Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China; Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China.
| | - Guiyuan Xiao
- Department of Epidemiology and Health Statistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China; Research Center for Medicine and Social Development, Chongqing Medical University, Chongqing, China; Innovation Center for Social Risk Governance in Health, Chongqing Medical University, Chongqing, China
| | - Jianghong Dai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Xinjiang, China
| | - Hao Liang
- Department of Epidemiology and Health Statistics, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Ailong Huang
- Key Laboratory of Molecular Biology, Ministry of Molecular Biology, Infectious Diseases, Chongqing Medical University, Chongqing, China
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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: 11] [Impact Index Per Article: 1.8] [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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Mayer KH, Chan PA, R Patel R, Flash CA, Krakower DS. Evolving Models and Ongoing Challenges for HIV Preexposure Prophylaxis Implementation in the United States. J Acquir Immune Defic Syndr 2018; 77:119-127. [PMID: 29084044 PMCID: PMC5762416 DOI: 10.1097/qai.0000000000001579] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The use of preexposure prophylaxis (PrEP) for HIV prevention was approved by the Food and Drug Administration in 2012, but delivery to at-risk persons has lagged. This critical review analyzes the current state of PrEP implementation in the United States, by reviewing barriers and innovative solutions to enhance PrEP access and uptake. SETTING Clinical care settings, public health programs, and community-based organizations (CBOs). METHODS Critical review of recent peer-reviewed literature. RESULTS More than 100 papers were reviewed. PrEP is currently provided in diverse settings. Care models include sexually transmitted disease clinics, community health centers, CBOs, pharmacies, and private primary care providers (PCPs). Sexually transmitted disease clinics have staff trained in sexual health counseling and are linked to public health programs (eg, partner notification services), whereas PCPs and community health centers may be less comfortable counseling and feel time-constrained in managing PrEP. However, PCPs may be ideal PrEP providers, given their long-term relationships with patients, integrating PrEP into routine care. Collaborations with CBOs can expand PrEP care through adherence support and insurance navigation. Pharmacies can deliver PrEP, given their experience with medication dispensing and counseling, and may be more accessible for some patients, but to address other health concerns, liaisons with PCPs may be needed. CONCLUSIONS PrEP implementation in the United States is moving forward with the development of diverse models of delivery. Optimal scale-up will require learning about the best features of each model and providing choices to consumers that enhance engagement and uptake.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
| | - Philip A Chan
- Department of Medicine, Brown University, Providence, RI
| | - Rupa R Patel
- Department of Internal Medicine, Washington University in St. Louis, St. Louis, MO
| | - Charlene A Flash
- Section of Infectious Diseases, Division of Internal Medicine, Baylor College of Medicine, Houston, TX
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA
- Department of Medicine, Harvard Medical School, Boston, MA
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145
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Kahle EM, Sullivan S, Stephenson R. Functional Knowledge of Pre-Exposure Prophylaxis for HIV Prevention Among Participants in a Web-Based Survey of Sexually Active Gay, Bisexual, and Other Men Who Have Sex With Men: Cross-Sectional Study. JMIR Public Health Surveill 2018; 4:e13. [PMID: 29362213 PMCID: PMC5801519 DOI: 10.2196/publichealth.8089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 10/09/2017] [Accepted: 11/08/2017] [Indexed: 01/24/2023] Open
Abstract
Background Awareness of pre-exposure prophylaxis (PrEP) for HIV prevention is increasing, but little is known about the functional knowledge of PrEP and its impact on willingness to use PrEP. Objective The objective of this study was to assess the functional knowledge of PrEP among a sample of gay, bisexual, and other men who have sex with men (MSM) participating in a Web-based survey of sexually active MSM. Methods Men at least 18 years old, residing in the United States, and reporting sex with a man in the previous 6 months were recruited through social networking websites. PrEP functional knowledge included the following 4 questions (1) efficacy of consistent PrEP use, (2) inconsistent PrEP use and effectiveness, (3) PrEP and condom use, and (4) effectiveness at reducing sexually transmitted infections (STIs). Ordinal logistic regression was used to identify respondent characteristics associated with PrEP functional knowledge. In a subsample of participants responding to HIV prevention questions, we compared willingness to use PrEP by response to PrEP functional knowledge using logistic regression analysis adjusted for age, race and ethnicity, and education level. Results Among 573 respondents, PrEP knowledge was high regarding adherence (488/573, 85.2%), condom use (532/573, 92.8%), and STIs (480/573, 83.8%), but only 252/573 (44.0%) identified the correct efficacy. Lower functional PrEP knowledge was associated with minority race/ethnicity (P=.005), lower education (P=.01), and not having an HIV test in the past year (P=.02). Higher PrEP knowledge was associated with willingness to use PrEP (P=.009). Younger age was not associated with higher PrEP functional knowledge or willingness to use PrEP. Conclusions PrEP knowledge was generally high in our study, including condom use and consistent use but may be lacking in higher risk MSM. The majority of respondents did not correctly identify PrEP efficacy with consistent use, which could impact motivation to seek out PrEP for HIV prevention. Targeted messaging to increase PrEP knowledge may increase PrEP use.
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Affiliation(s)
- Erin M Kahle
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Stephen Sullivan
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, School of Nursing, University of Michigan, Ann Arbor, MI, United States
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146
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Smith DK, Van Handel M, Huggins R. Estimated Coverage to Address Financial Barriers to HIV Preexposure Prophylaxis Among Persons With Indications for Its Use, United States, 2015. J Acquir Immune Defic Syndr 2017; 76:465-472. [PMID: 28834798 PMCID: PMC5821499 DOI: 10.1097/qai.0000000000001532] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An estimated 1.2 million American adults engage in sexual and drug use behaviors that place them at significant risk of acquiring HIV infection. Engagement in health care for the provision of daily oral antiretroviral medication as preexposure prophylaxis (PrEP), when clinically indicated, could substantially reduce the number of new HIV infections in these persons. However, resources to cover the financial cost of PrEP care are anticipated barriers for many of the populations with high numbers of new HIV infections. METHODS Using nationally representative data, we estimated the current national met and unmet need for financial assistance with covering the cost of PrEP medication, clinical visits, and laboratory tests among adults with indications for its use, overall and by transmission risk population. RESULTS This study found that of the 1.2 million adults estimated to have indications for PrEP use, <1% (∼7300) are in need of financial assistance for both PrEP medication and clinical care, at an estimated annual cost of $89 million. An additional 7% (∼86,300) are in need of financial assistance only for PrEP clinical care at an estimated annual cost of $119 million. CONCLUSIONS This information on PrEP care costs, insurance coverage, and unmet financial need among persons in key HIV transmission risk subpopulations can inform policy makers at all levels as they consider how to address remaining financial barriers to the use of PrEP and accommodate any changes in eligibility for various insurance and financial assistance programs that may occur in coming years.
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Affiliation(s)
- Dawn K. Smith
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Michelle Van Handel
- Program and Performance Improvement Office, National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Rebecca Huggins
- Division of HIV/AIDS Prevention (DHAP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA
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147
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Abstract
Although pre-exposure prophylaxis (PrEP)-the use of antiretroviral drugs by non-infected people to prevent the acquisition of HIV-is a promising preventive option, important public health questions remain. Daily oral emtricitabine (FTC)-tenofovir disoproxil fumarate (TDF) is highly efficacious in preventing the acquisition of HIV in people at risk as a result of a range of different types of sexual exposure. There is good evidence of efficacy in women and men, and when men who have sex with men use event based dosing. Studies have been conducted in several countries and epidemics. Because adherence to this treatment varies greatly there are questions about its public health benefit. Oral FTC-TDF is extremely safe, with minimal impact on kidney, bone, or pregnancy outcomes, and there is no evidence that its effectiveness has been reduced by risk compensation during open label and programmatic follow-up. It is too early to assess the impact of this treatment on the incidence of sexually transmitted infections (STIs) at a population level. Many challenges remain. Access to pre-exposure prophylaxis is limited and disparities exist, including those governed by race and sex. Different pricing and access models need to be explored to avoid further widening inequalities. The optimal combination prevention program needs to be defined, and this will depend on local epidemiology, service provision, and cost effectiveness. This review updates the evidence base for pre-exposure prophylaxis regarding its effectiveness, safety, and risk compensation.
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Affiliation(s)
- Monica Desai
- HIV and STI Department, Public Health England, London NW9 5EQ, UK
| | - Nigel Field
- Centre for Molecular Epidemiology and Translational Research, University College London, London WC1E 6BT, UK
| | - Robert Grant
- University of California School of Medicine; Gladstone Institutes; San Francisco AIDS Foundation, San Francisco, CA 94115, USA
| | - Sheena McCormack
- MRC Clinical Trials Unit, University College London, London
- Chelsea and Westminster Hospital, London SW10 9BH
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148
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Marks SJ, Merchant RC, Clark MA, Liu T, Rosenberger JG, Bauermeister J, Mayer KH. Potential Healthcare Insurance and Provider Barriers to Pre-Exposure Prophylaxis Utilization Among Young Men Who Have Sex with Men. AIDS Patient Care STDS 2017; 31:470-478. [PMID: 29087744 DOI: 10.1089/apc.2017.0171] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Young adult men-who-have-sex-with-men (YMSM) continue to have among the highest incidence of HIV infection in the United States. Pre-exposure prophylaxis (PrEP) is an effective and safe method of preventing HIV infection; however, despite US Food and Drug Administration approval, utilization remains low, in part, due to structural barriers, particularly access to healthcare. In this study, we used social media to recruit black, Hispanic, and white HIV-uninfected 18- to 24-year-old YMSM. Participants completed an online survey about their sexual behavior, healthcare access, and previous use of PrEP. Of the 2297 YMSM surveyed, only 3.4% had used PrEP. PrEP use was associated with higher levels of education, living alone, older age, higher levels of sexual activity, and greater healthcare access, specifically having healthcare insurance and a clinic or primary care provider (PCP) from whom they received care. Among PrEP nonusers, 65% met at least one of the US Centers for Disease Control and Prevention recommended indications for PrEP use, and of these, 59% had healthcare insurance and received care in a clinic and/or had a PCP. Multi-variable multi-nomial logistic regression modeling identified disparities in access to healthcare by age, race/ethnicity, education, and region. Specifically, older YMSM, blacks and Hispanics, those with fewer years of formal education, and residents of the southern and the western United States were more likely to lack healthcare access. These results demonstrate both potential opportunities and barriers to the scale-up of PrEP among YMSM.
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Affiliation(s)
- Sarah J. Marks
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
| | - Roland C. Merchant
- Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, Rhode Island
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island
| | - Melissa A. Clark
- Department of Quantitative Health Sciences, Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tao Liu
- Department of Biostatistics, Center for Statistical Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Joshua G. Rosenberger
- Department of Biobehavioral Health, Pennsylvania State University, State College, Pennsylvania
| | - Jose Bauermeister
- Department of Family and Community Health, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth H. Mayer
- Fenway Health, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts
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Correlates of Preexposure Prophylaxis (PrEP) Use among Men Who Have Sex with Men (MSM) in Los Angeles, California. J Urban Health 2017; 94:710-715. [PMID: 28600749 PMCID: PMC5610125 DOI: 10.1007/s11524-017-0172-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We assessed socio-structural and behavioral correlates of preexposure prophylaxis (PrEP) for HIV infection among a sample of high-risk HIV-negative men who have sex with men (MSM) in Los Angeles, California. Participants from an ongoing 5-year prospective cohort study investigating the direct impacts of substance use on HIV transmission dynamics were enrolled between February 2015 and January 2017. All men completed a computer-assisted self-interview every 6 months that assessed recent (past 6 months) PrEP use and socio-structural and behavioral factors. Of the total 185 MSM (mean age = 29 years) included in the study, majority were African American (40%) or Hispanic (41%) and reported current health insurance coverage (80%). In multivariable analysis using log-binomial regression, having health insurance coverage [adjusted prevalence ratio (aPR) 2.02; 95% confidence interval (CI) 1.01 to 4.01, p = 0.04] was associated with recent PrEP use. Unstable housing (aPR = 0.44, 95% CI 0.22 to 0.90, p = 0.02) was associated with lower PrEP use. Behavioral factors associated with recent PrEP use include sex with a HIV-positive partner (aPR = 3.63, 95% CI 1.45 to 9.10, p = 0.01), having six or more sex partners (aPR = 2.20, 95% CI 1.26 to 3.82, p = <0.01), and popper use (aPR = 2.76, 95% CI 1.58 to 4.84, p = <0.01). In this sample of predominantly racial/ethnic minority MSM, socio-structural and behavioral factors were important factors associated with recent PrEP use. These findings provide considerations for intervention development to promote PrEP use among key groups of MSM.
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PrEP awareness and decision-making for Latino MSM in San Antonio, Texas. PLoS One 2017; 12:e0184014. [PMID: 28953905 PMCID: PMC5617149 DOI: 10.1371/journal.pone.0184014] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 08/16/2017] [Indexed: 01/10/2023] Open
Abstract
Pre-Exposure Prophylaxis (PrEP) has been promoted among high-risk populations as an effective HIV biomedical intervention. However, limited research is available on the significance of culturally informed biomedical interventions for Latino MSM. A total of 159 self-administered Internet surveys were completed by Latino MSM ages 21–30 in San Antonio, Texas. The purpose of this research was to develop an instrument that measured Latino MSM attitudes and beliefs towards PrEP, identify associations between demographic factors and PrEP related factors and to suggest culturally appropriate strategies for the promotion of PrEP among the Latino MSM population. Research findings revealed implications for PrEP at the structural and individual level for Latino MSM. Structural level indicators emphasized the importance for raising PrEP awareness among Latino MSM in regards to PrEP related expenses, ameliorating stigmatization of high-risk populations, enhancing access to PrEP informed medical providers, and address mistrust of the government and medical providers role on addressing health disparities among Latino MSM. Overall, the findings for individual factors emphasize the need for patient-centered interventions for Latino MSM. Latino MSM currently on PrEP require supplemental resources to enhance PrEP adherence. Latino MSM not on PrEP require alternate options for PrEP delivery and/or cognitive behavioral approaches minimizing HIV risk behavior for Latino MSM concerned with PrEP toxicity, which may require non-biomedical interventions. Integration of Latino MSM currently on PrEP as peer educators provides a valuable resource for developing culturally informed PrEP interventions for Latino MSM. Peer educators are able to share their experiential knowledge of PrEP contextualized through cultural norms, beliefs, and values.
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