1
|
Luz PM, Apelian H, Lambert G, Fourmigue A, Dvorakova M, Grace D, Lachowsky N, Hart TA, Moore DM, Skakoon-Sparling S, Cox J. HIV Treatment Optimism Moderates the Relationship between Sexual Risk Behavior and HIV Risk Perception among Urban HIV-negative Gay, Bisexual, and Other Men who have Sex With Men. AIDS Behav 2024; 28:2683-2694. [PMID: 38869761 DOI: 10.1007/s10461-024-04380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/14/2024]
Abstract
Using baseline data of the Engage Cohort Study, a Canadian study of sexually active gay, bisexual and other men who have sex with men (GBM), we evaluated the association between sexual behavior and risk perception among HIV-negative participants and whether HIV treatment optimism moderated this relationship. Participants were recruited by respondent-driven-sampling (RDS). We defined high-risk sexual behavior in the past six months as any condomless anal sex with a casual partner (i.e. not the participant's main partner) with either unknown HIV-status where neither used pre-exposure prophylaxis or with a partner living with HIV having detectable/unknown viral load. We assessed HIV treatment optimism-skepticism using a 12-item scale. RDS-II-weighted adjusted logistic regression models examined associations with risk perception measured by the question "How would you assess your current risk of getting HIV?" (response options were on a 6-point Likert-scale ranging from "very unlikely" to "very likely", dichotomized into "No Perceived Risk" (very unlikely/unlikely) and "Perceived Risk" (somewhat likely/likely/very likely/I think I already have HIV). Of 1961 participants, engagement in high-risk sexual behavior was reported by 155 (17.0%), 62 (12.4%), 128 (17.2%) of participants in Montréal, Toronto, and Vancouver, respectively. High-risk sexual behavior increased the odds of perceived HIV risk (pooled adjusted odds ratio = 2.9, 95%CI = 2.2-3.8). HIV treatment optimism-skepticism scores moderated the relationship: for GBM engaging in high-risk sexual behavior, higher HIV treatment optimism-skepticism scores increased perceived HIV risk. Promoting awareness around advances related to HIV prevention and treatment is important for appropriate risk assessment and for increased engagement in prevention interventions.
Collapse
Affiliation(s)
- Paula M Luz
- National Institute of Infectious Disease Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Herak Apelian
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Gilles Lambert
- Direction régionale de santé publique de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
- Institut national de santé publique du Québec, Montréal, QC, Canada
| | - Alain Fourmigue
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Milada Dvorakova
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Nathan Lachowsky
- School of Public, Health & Social Policy, University of Victoria, Victoria, BC, Canada
| | - Trevor A Hart
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
| | - David M Moore
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Shayna Skakoon-Sparling
- Department of Psychology, Toronto Metropolitan University, Toronto, ON, Canada
- Psychology Department, University of Guelph, Guelph, ON, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montréal, QC, Canada
- Direction régionale de santé publique de Montréal, CIUSSS Centre-Sud-de-l'Ile-de-Montréal, Montréal, QC, Canada
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montréal, QC, Canada
| |
Collapse
|
2
|
She B, Lu F, Zhao R, Lin S, Sun J, He S, Liu Y, Su S, Zhang L. Examining the Effects of PrEP Use on Sexual Behaviors and Sexually Transmitted Infections Among Chinese Men who have Sex with Men: A Cross-Sectional Study. AIDS Behav 2024:10.1007/s10461-024-04398-9. [PMID: 39066859 DOI: 10.1007/s10461-024-04398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2024] [Indexed: 07/30/2024]
Abstract
Men who have sex with men (MSM) is a high-risk population for HIV and sexually transmitted infections (STIs). Pre-exposure prophylaxis (PrEP) is effective in HIV prevention. This study aims to examine the differences in sexual behaviors, STI prevalence and HIV/STI testing across subgroups of MSM with various PrEP use. Data were collected via a cross-sectional survey in an MSM community in Xi'an, Shaanxi, from 2022.01 to 2022.09. Participants were categorized as 'PrEP-naïve and unwilling to use', 'PrEP-naïve but willing to use', and 'current or former PrEP users'. Shannon index was used to assess sexual act diversity and multivariate logistic regression analyzed factors associated with PrEP use. Of the 1,131 MSM participants, 23.52% were PrEP-naïve and unwilling, 64.98% were PrEP-naïve but willing, and 11.49% were current or former PrEP users. The PrEP-naïve but willing group had the highest recent STI testing rates at 73.06% and showed greater sexual act diversity (Shannon index 1.61). This group also had the highest syphilis rates (7.49% vs. 6.47% and2.54%, p < 0.01). Younger age (18-30: OR = 0.39 (0.18-0.85); 31-40: OR = 0.43 (0.20-0.96)) and lower education (high school/vocational: OR = 0.15 (0.04-0.58); associate degree: OR = 0.21 (0.06-0.71)) were factors that negatively influenced PrEP use. Current or former PrEP users had the highest oropharyngeal gonorrhea (14.39% vs. 9.68% and 5.80%, p < 0.01) and overall gonorrhea rates (20.86% vs. 17.17% and 8.37%, p < 0.001). 'PrEP-naïve but willing' participants consistently demonstrated high-risk sexual behavior, increased STI testing, and more diverse sexual acts, whereas PrEP users had the highest STI prevalence.
Collapse
Affiliation(s)
- Bingyang She
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Fang Lu
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Rui Zhao
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Siqi Lin
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Jiajun Sun
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | - Shiyi He
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Yi Liu
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China
| | - Shu Su
- Department of Epidemiology and Biostatistics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Lei Zhang
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, China.
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia.
| |
Collapse
|
3
|
Denson DJ, Stanley A, Randall L, Tesfaye CL, Glusberg D, Cardo J, King AR, Gale B, Betley V, Schoua-Glusberg A, Frew PM. Understanding Preferences for Visualized New and Future HIV Prevention Products Among Gay, Bisexual and Other Men Who Have Sex with Men in the Southern United States: A Mixed-Methods Study. JOURNAL OF HOMOSEXUALITY 2024:1-19. [PMID: 38989968 DOI: 10.1080/00918369.2024.2373803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Abstract
Men who have sex with men (MSM) are vulnerable to HIV infection. Although daily oral pre-exposure prophylaxis (PrEP) prevents HIV among MSM, its usage remains low. We conducted virtual in-depth interviews (IDIs) and focus groups (FGs) with Black, Hispanic/Latino, and White MSM consisting of current PrEP users and those aware of but not currently using PrEP. We delved into their preferences regarding six emerging PrEP products: a weekly oral pill, event-driven oral pills, anal douche/enema, anal suppository, long-acting injection, and a skin implant. Our mixed methods analysis involved inductive content analysis of transcripts for thematic identification and calculations of preferences. Among the sample (n = 98), the weekly oral pill emerged as the favored option among both PrEP Users and PrEP Aware IDI participants. Ranking exercises during FGs also corroborated this preference, with the weekly oral pill being most preferred. However, PrEP Users in FGs leaned toward the long-acting injectable. Conversely, the anal suppository and douche/enema were the least preferred products. Overall, participants were open to emerging PrEP products and valued flexibility but expressed concerns about limited protection for products designed solely for receptive sex. Public health practitioners should tailor recommendations based on individuals' current sexual behaviors and long-term vulnerability to infection.
Collapse
Affiliation(s)
- Damian J Denson
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, USA
| | - Ayana Stanley
- Division of HIV Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, USA
| | | | | | | | | | | | - Bryan Gale
- American Institutes for Research, Inc, Rockville, MD, USA
| | - Valerie Betley
- American Institutes for Research, Inc, Rockville, MD, USA
| | | | - Paula M Frew
- Emory University School of Medicine, Department of Medicine, Division of Infectious Diseases, Atlanta, GA, USA
| |
Collapse
|
4
|
Liu L, Ruan Y, Chen S, Tang H, Liu J, Jiang Y, Pei H, Huang T, Lan G, Xie Y. Willingness to Use Long-Acting Injectable Cabotegravir and Associated Factors Among Men Who Have Sex with Men in Guangxi, China. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:2795-2806. [PMID: 38849704 DOI: 10.1007/s10508-024-02886-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 04/10/2024] [Accepted: 04/30/2024] [Indexed: 06/09/2024]
Abstract
Cabotegravir (CAB-LA), the first long-acting injectable pre-exposure prophylaxis (PrEP), has been approved for use in the USA and is not currently on the market in China. However, willingness to use CAB-LA and associated factors among men who have sex with men (MSM) have not yet been evaluated in China. A cross-sectional study was conducted in Guangxi, China, in 2022 recruiting 1,006 MSM. Their mean age was 30.2 years, 74.2% had college or above education, and 48.6% had a monthly income between 3,000 and 5,999 Chinese yuan (CNY). Most (73.4%) had previously heard of PrEP while few (8.3%) had ever used this type of preventative medication. Willingness to use CAB-LA was 79.8% and was positively associated with eight variables: younger age, being married to a woman, having a low monthly income, having six or more male partners in the past six months, having only regular male partners in the past month, having a high perceived risk of HIV infection, and history of using PrEP. Ten other variables were not significantly associated with willingness to use CAB-LA. Among 894 participants who were willing to use or did not definitely reject using CAB-LA, the main concerns about CAB-LA were its side effects (90.2%), efficacy (63.6%), and high cost (58.2%). Only 14.7% were willing to pay more than 1,200 CNY (~US$180) every two months to use CAB-LA. The preferred injection places were centers for disease control facilities, hospitals, and social organizations. Many (89.0%) said that they would recommend CAB-LA to their male sexual partners. We conclude that willingness to use CAB-LA was high among MSM in Guangxi. However, implementation of CAB-LA faces tough challenges due to its high cost and the low use of PrEP. Peer education may play a large role in the implementation of CAB-LA in China.
Collapse
Affiliation(s)
- Lu Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, 22, Shuangyong Road, Nanning, 530021, China
| | - Yuhua Ruan
- State Key Laboratory of Infectious Disease Prevention and Control, National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Beijing, China
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Shiwen Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, 22, Shuangyong Road, Nanning, 530021, China
| | - Hongyang Tang
- Division of AIDS Control and Prevention, Nanning Center for Disease Control and Prevention, Nanning, China
| | - Junhui Liu
- Division of AIDS Control and Prevention, Nanning Center for Disease Control and Prevention, Nanning, China
| | - Yu Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, 22, Shuangyong Road, Nanning, 530021, China
| | - Hengyan Pei
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, 22, Shuangyong Road, Nanning, 530021, China
| | - Tengda Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, 22, Shuangyong Road, Nanning, 530021, China
| | - Guanghua Lan
- Guangxi Key Laboratory of Major Infectious Disease Prevention Control and Biosafety Emergency Response, Guangxi Center for Disease Control and Prevention, Nanning, China
- Division of AIDS Control and Prevention, Guangxi Center for Disease Control and Prevention, Nanning, China
| | - Yihong Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Guangxi Medical University, 22, Shuangyong Road, Nanning, 530021, China.
| |
Collapse
|
5
|
Goswami S, Gannon T, Nasruddin S, Mancuso B, Kang M, Bentley JP, Bhattacharya K, Barnard M. Willingness to use PrEP among PrEP naïve men who have sex with men: a meta-analysis. AIDS Care 2024:1-14. [PMID: 38771970 DOI: 10.1080/09540121.2024.2354207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/07/2024] [Indexed: 05/23/2024]
Abstract
This study aimed to measure the pooled estimate of willingness to use HIV pre-exposure prophylaxis (PrEP) (WTUP) among PrEP-naïve United States (U.S.)-based men who have sex with men (MSM). PubMed, Embase, Web of Science, CINAHL, and PsycINFO were searched. The search strategy contained the keyword willingness and interest and the MeSH terms for HIV and PrEP. Articles were included if they were published between January 2005 and May 2022, reported quantitative data on WTUP among PrEP-naïve US-based MSM, and were available as full text in English. Meta-analysis was conducted to assess the pooled effect size of WTUP prevalence using a random-effects model, heterogeneity in the pooled estimate was assessed, and subgroup analyzes were conducted. Fifteen studies were included based on the inclusion and exclusion criteria. Meta-analysis revealed a pooled prevalence proportion for WTUP of 0.58 (95% CI 0.54-0.61) (or 58 out of 100) among PrEP-naïve MSM. High inter-study heterogeneity (Q = 548.10, df = 19, p < 0.01, I2 = 96.53, τ2 = 0.09) was observed. Age of the study sample and region where the data were collected significantly moderated the pooled WTUP estimate. Age-appropriate PrEP related messaging and a focus on HIV priority areas of the U.S. would be important strategies to improve WTUP among MSM in the U.S. moving forward.
Collapse
Affiliation(s)
- Swarnali Goswami
- Complete HEOR Solutions (CHEORS), Chalfont, PA, USA (At the time this study was conducted, Dr. Goswami was a graduate student in the Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS, USA)
| | - Taylor Gannon
- School of Pharmacy, University of Mississippi, University, MS, USA
| | - Saara Nasruddin
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Blake Mancuso
- School of Pharmacy, University of Mississippi, University, MS, USA
| | - Minsoo Kang
- Department of Health, Exercise Science, and Recreation Management, School of Applied Sciences, University of Mississippi, University, MS, USA
| | - John P Bentley
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
- Center for Pharmaceutical Marketing and Management, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Kaustuv Bhattacharya
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
- Center for Pharmaceutical Marketing and Management, School of Pharmacy, University of Mississippi, University, MS, USA
| | - Marie Barnard
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, University, MS, USA
- Center for Pharmaceutical Marketing and Management, School of Pharmacy, University of Mississippi, University, MS, USA
| |
Collapse
|
6
|
Yu YJ, Schieber E, Janamnuaysook R, Wang B, Gunasekar A, MacDonell K, Getwongsa P, Kim D, Wongharn P, Phanuphak N. Barriers and facilitators to pre-exposure prophylaxis (PrEP) uptake and adherence among men who have sex with men (MSM) in Thailand: a qualitative study. AIDS Care 2024:1-9. [PMID: 38574278 DOI: 10.1080/09540121.2024.2332443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 03/12/2024] [Indexed: 04/06/2024]
Abstract
Young MSM (YMSM), aged 15-24, account for nearly half of new HIV infections in Thailand. Pre-exposure prophylaxis (PrEP) is an effective prevention medicine for populations at substantial HIV risk, yet YMSM frequently have suboptimal uptake of and adherence to PrEP. We conducted 35 in-depth interviews with YMSM to explore barriers and facilitators of both PrEP initiation and adherence. Interviews also elicited the perceptions and experiences of healthcare providers (HCPs) working with YMSM at three clinics in Bangkok. Primary barriers to PrEP initiation were limited accessibility, insufficient knowledge, and efficacy concerns; HCPs identified no-to-low self-perception of HIV risk, pre-existing health problems, fears of side effects, and living in distant provinces as barriers to PrEP initiation. YMSM primarily reported PrEP information and self-perceptions of elevated HIV risk as facilitators to PrEP initiation. Additionally, forgetfulness and low HIV risk awareness were common barriers to PrEP adherence. Reminders were a prominent facilitator of PrEP adherence alongside disclosure to close relationships, the routinization of regimens, and convenient facilities. HCPs regarded counseling as the leading facilitator of PrEP adherence. By understanding the barriers/facilitators of PrEP use, the current study seeks to help develop evidence-informed PrEP intervention programs among YMSM while considering cultural sensitivity.
Collapse
Affiliation(s)
- Yeon Jung Yu
- Department of Anthropology, Western Washington University, Bellingham, WA, USA
| | - Elizabeth Schieber
- Department of Population and Quantitative Health Sciences, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
- Amsterdam UMC, location University of Amsterdam, Department of Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Infectious Diseases, Amsterdam, the Netherlands
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Abhinaya Gunasekar
- Department of Population and Quantitative Health Sciences, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Karen MacDonell
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | | | - Deogwoon Kim
- Department of Population and Quantitative Health Sciences, The University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Prissana Wongharn
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation (IHRI), Bangkok, Thailand
- Center of Excellence in Transgender Health, Chulalongkorn University, Bangkok, Thailand
| |
Collapse
|
7
|
Lewis J, Melendez-Torres GJ. Prep-Tok: a queer critical discourse analysis of TikToks regarding HIV-related pre-exposure prophylaxis. CULTURE, HEALTH & SEXUALITY 2024; 26:449-465. [PMID: 37435990 DOI: 10.1080/13691058.2023.2224414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/08/2023] [Indexed: 07/13/2023]
Abstract
Human immunodeficiency virus (HIV) continues to present a public health problem, and pre-exposure prophylaxis (PrEP) offers a promising preventative intervention; however, its uptake remains low, so investigating determinants of use is essential. This article applies queer critical discourse analysis to a corpus of 121 TikToks sampled via the TikTok algorithm, coded and refined into three overarching content categories: 'what makes a PrEP user?', 'what is PrEP as a drug?', and 'sexual health and HIV'. Examples from within these categories reveal four underlying discursive themes: (1) stigmatisation of HIV as a 'gay disease' with a poor prognosis; (2) stigmatisation of gay men as unsafe, high-risk and untrustworthy; (3) stigmatisation of PrEP as increasing 'unsafe' sexual practices; (4) poor healthcare and education gay men and other beneficiaries of PrEP. These themes are influenced by a broad spectrum of homophobic and heteronormative discourses available with specific examples reflecting parts of this spectrum from predominantly perpetuating to occasionally challenging. The findings report complementary evidence obtained from other media platforms yet offer a unique take while suggesting useful avenues for future public health messaging relating to PrEP which may be used to inform the next steps against HIV.
Collapse
Affiliation(s)
- Joseph Lewis
- Faculty of Health and Life Sciences, University of Exeter, Exeter, UK
| | | |
Collapse
|
8
|
Gupta AK, Lyons B, Hunter I, Arnold B, Gilbert M, Hoang L, Malleson S, Ryan V, Romney MG, Severini A, Wong J, Grennan T. The Resurgence of Lymphogranuloma Venereum: Changing Presentation of Lymphogranuloma Venereum in the Era of HIV Preexposure Prophylaxis, 2004 to 2022. Sex Transm Dis 2024; 51:233-238. [PMID: 38299874 DOI: 10.1097/olq.0000000000001944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Before the early 2000s, the sexually transmitted infection lymphogranuloma venereum (LGV) was rare in high-income countries. Initially, most cases in these countries were among symptomatic men who have sex with men (MSM) living with HIV. In the context of widespread HIV preexposure prophylaxis (PrEP), LGV's epidemiology may be changing. We aimed to characterize the epidemiology and clinical presentation of LGV in the PrEP era. METHODS A retrospective chart review was performed on all LGV cases occurring between November 2004 to October 2022 in British Columbia (BC), Canada. Cases were stratified by having occurred before (2004-2017) or after widespread PrEP availability in BC (2018-2022). Annual rates and test positivity percentages were calculated. Bivariate logistic regression was performed to identify drivers of asymptomatic infection in the PrEP era. RESULTS Among 545 cases identified, 205 (37.6%) occurred pre-PrEP and 340 (62.4%) occurred during the PrEP era. Most cases were among MSM (97.2%). The estimated rate of LGV has doubled from 2018 to 2022, reaching 1535.2 cases per 100,000 PrEP users. Most PrEP-era cases were among HIV-negative individuals (65.3%), particularly those on PrEP (72.6%). Cases in the PrEP era were often asymptomatic compared with pre-PrEP (38.6% vs. 19.3%; P < 0.001). Users of PrEP were more likely to experience asymptomatic infection compared with HIV-negative PrEP nonusers (odds ratio, 2.07; 95% confidence interval, 1.07-3.99). CONCLUSIONS In the context of increased asymptomatic testing, LGV may be increasing in BC. Most infections now occur among HIV-negative MSM. A high proportion of infections are asymptomatic.
Collapse
Affiliation(s)
| | | | - Ian Hunter
- British Columbia Centre for Disease Control
| | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Kamitani E, Mizuno Y, Koenig LJ. Strategies to Eliminate Inequity in PrEP Services in the US South and Rural Communities. J Assoc Nurses AIDS Care 2024; 35:153-160. [PMID: 37963267 PMCID: PMC11090982 DOI: 10.1097/jnc.0000000000000437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
ABSTRACT Inequity in preexposure prophylaxis (PrEP) care in the US South and rural communities is likely attributed to Social Determinants of Health and structural issues beyond individuals' control. We describe three approaches to modify PrEP care practice models to make access easier-"normalizing," "digitalizing," and "simplifying." "Normalizing" approaches are defined as practice models where medical providers who have access to PrEP candidates prescribe PrEP routinely (e.g., primary care providers, community pharmacists); these approaches are found to be highly applicable in real-world settings. Telehealth and other dHealth tools are examples of "digitalizing" PrEP, and their use has been increasing rapidly since the COVID-19 pandemic. "Simplifying" PrEP care (e.g., with HIV self-testing, on-demand PrEP) is highlighted in the most recent World Health Organization PrEP guideline. Identifying, implementing, and scaling up these new strategies can allow PrEP candidates to access it, potentially addressing inequities and promoting HIV risk reduction in the US South and rural communities.
Collapse
Affiliation(s)
- Emiko Kamitani
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S. 30329-4027
| | - Yuko Mizuno
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S. 30329-4027
| | - Linda J. Koenig
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, U.S. 30329-4027
| |
Collapse
|
10
|
Nagai H, Ankomah A, Fuseini K, Adiibokah E, Semahegn A, Tagoe H. HIV Pre-Exposure Prophylaxis Uptake Among High-Risk Population in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. AIDS Patient Care STDS 2024; 38:70-81. [PMID: 38381951 DOI: 10.1089/apc.2023.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Globally, 38.4 million people are affected by the human immunodeficiency virus (HIV) pandemic, and more than 2.5 million new HIV infections occur yearly. HIV pre-exposure prophylaxis (PrEP) has been widely recognized as a potential way to prevent new infections among risk population. There is a paucity of abridged evidence on the level and barriers to PrEP service uptake in sub-Saharan Africa (SSA). Therefore, we conducted a systematic review to synthesize existing evidence on PrEP uptake in SSA. Relevant studies were searched from major databases (PubMed and PsychInfo) and direct Google Scholar. Data were extracted and recorded using a pilot-tested template. Methodological rigor, heterogeneity and publication bias of studies were assessed to minimize the inclusion of erroneous findings. A random effect model was used for the meta-analysis followed by narrative metasynthesis. The protocol of this systematic review has been by registered PROSPERO (ID: CRD42022308855). A total of 1830 studies were retrieved, and 30 studies met inclusion criteria of the systematic review. People who heard about PrEP ranged from 23% to 98%. The pooled prevalence of willingness to use PrEP was 64.2% (95% confidence interval: 55.5-72.0). Fear of side effect, stigma, nonreceptive attitude, cost of pills, low awareness about PrEP, perceived reason about the effectiveness of PrEP, and lack of friendly services were the common barriers to PrEP uptake in Africa. In conclusion, comprehensive knowledge and willingness to use PrEP were low in SSA. The barriers to low PrEP service uptake are avoidable through comprehensive awareness creation and availing essential services to key population in Africa. Expanding educational messages to key population using friendly approaches and more accessible platforms, engaging stakeholders, and integrating PrEP service with routine health care are important to foster HIV prevention and control in the future.
Collapse
Affiliation(s)
- Henry Nagai
- John Snow Research and Training Institute, Inc., Accra, Ghana
| | - Augustine Ankomah
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | - Agumasie Semahegn
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Henry Tagoe
- John Snow Research and Training Institute, Inc., Accra, Ghana
| |
Collapse
|
11
|
Bonner CP, Minnis AM, Ndirangu JW, Browne FA, Speizer I, Nyblade L, Ahmed K, Wechsberg WM. The Importance of the Individual in PrEP Uptake: Multilevel Correlates of PrEP Uptake Among Adolescent Girls and Young Women in Tshwane, South Africa. AIDS Behav 2023; 27:4124-4130. [PMID: 37439915 DOI: 10.1007/s10461-023-04126-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
Adolescent girls and young women (AGYW) account for 25% of new HIV infections in South Africa. Pre-exposure prophylaxis (PrEP) is approved by the South African Government, but the factors that promote PrEP uptake among AGYW are not well understood. This study examines multilevel factors associated with PrEP uptake among AGYW in six clinic catchment areas in Tshwane (Pretoria), South Africa. After consent/assent, PrEP-eligible AGYW (n = 448) completed a questionnaire assessing factors at the individual, network/interpersonal, and community levels and were prescribed PrEP in study clinics, if interested. A multivariable model, adjusting for clustering, assessed factors associated with PrEP uptake over a 9-month period. At the individual level, multiple partners in the past 3 months (OR = 0.47), perceived risk of HIV (OR = 0.71), and PrEP-related shame (OR = 0.63) were correlated with lower odds of PrEP uptake (ps ≤ 0.05). The findings highlight modifiable factors that should be addressed to support PrEP uptake efforts.
Collapse
Affiliation(s)
- Courtney Peasant Bonner
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | | | - Jacqueline W Ndirangu
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Felicia A Browne
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| | - Ilene Speizer
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Laura Nyblade
- Women's Global Health Imperative, RTI International, NC, USA
| | - Khatija Ahmed
- Setshaba Research Centre, Soshanguve, South Africa
- Faculty of Health Sciences, Dept of Medical Microbilogy, University of Pretoria, Pretoria, South Africa
| | - Wendee M Wechsberg
- Substance Use, Gender, and Applied Research Program, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
| |
Collapse
|
12
|
Jin G, Shi H, Du J, Guo H, Yuan G, Yang H, Zhu Z, Zhang J, Zhang K, Zhang X, Lu X, Xu W, Wang S, Hao J, Sun Y, Su P, Zhang Z. Pre-Exposure Prophylaxis Care Continuum for HIV Risk Populations: An Umbrella Review of Systematic Reviews and Meta-Analyses. AIDS Patient Care STDS 2023; 37:583-615. [PMID: 38011347 DOI: 10.1089/apc.2023.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is an effective biomedical strategy for HIV prevention. This umbrella review is aimed at providing a comprehensive summary of the current status of each stage of the PrEP care cascade. A systematic literature search was conducted in PubMed, Embase, and Cochrane. Additionally, a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) tool and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist were used to evaluate their methodological and reporting quality, respectively. A total of 30 systematic reviews met the inclusion criteria. According to the results of methodological quality assessment, 3 reviews were rated as low, while 27 as critically low. Furthermore, the results of the reporting quality evaluation revealed a mean score of 23.03 for the included reviews. Across all the reviews, awareness of PrEP was generally moderate in all populations, and the acceptability was even higher compared with awareness. Unfortunately, the PrEP uptake among different groups was even less optimal, although the adherence was almost above moderate, and several barriers that hindered the utilization of PrEP were identified, and the most common are as follows: cost, stigma, lack of knowledge, mistrust, low risk perception, and more. Although PrEP has proven to be an effective prevention method to date, the promotion of PrEP failed to achieve the anticipated outcome. To reinforce the generalization of and use of PrEP, and effectively control HIV transmission, it is urgent to identify the underlying causes of low uptake rates so that efficient interventions can be implemented.
Collapse
Affiliation(s)
- Guifang Jin
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Haiyan Shi
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jun Du
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Haiyun Guo
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Guojing Yuan
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Huayu Yang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihui Zhu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jianghui Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Kexin Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Xueqing Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Xiaoyan Lu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Wenzhuo Xu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Sainan Wang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jiahu Hao
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Ying Sun
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Puyu Su
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihua Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| |
Collapse
|
13
|
Chebet JJ, McMahon SA, Chase RP, Tarumbiswa T, Maponga C, Mandara E, Bärnighausen T, Geldsetzer P. Stakeholder perspectives on interventions to improve HIV pre-exposure prophylaxis uptake and continuation in Lesotho: A participant-ranked preferences study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001423. [PMID: 37756319 PMCID: PMC10529554 DOI: 10.1371/journal.pgph.0001423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Low uptake and high discontinuation remain major obstacles to realizing the potential of Pre-Exposure Prophylaxis (PrEP) in changing the trajectory of the HIV epidemic. We conducted a card sorting and ranking exercise with 155 local stakeholders to determine their views on the most important barriers and most promising interventions to achieving high PrEP coverage. Stakeholders were a purposive sample of PrEP policymakers and implementing partners (n = 7), healthcare providers (n = 51), and end-users (n = 97). End-users included adults who were currently using PrEP (n = 55), formerly using PrEP (n = 36), and those who were offered PrEP but declined (n = 6). Participants sorted pre-selected interventions and barriers to PrEP coverage into three piles-most, somewhat, and least important. Participants then ranked interventions and barriers in the "most important" piles in ascending order of significance. Ranked preferences were analyzed as voting data to identify the smallest set of candidates for which each candidate in the set would win in a two-candidate election against any candidate outside the set. Participants viewed a lack of PrEP awareness as the most important barrier to PrEP uptake for women, and a fear of HIV testing for men. Community-based HIV testing was ranked as the most promising intervention to improve PrEP uptake for both men and women. Perceived or experienced stigma was seen as an important barrier for PrEP continuation for both men and women, with an additional important barrier for men being daily activities that compete with the time needed to take a daily pill. Adherence counseling and multi-month PrEP prescriptions were seen as the most promising interventions to improve PrEP continuation. Our findings suggest community-based activities that generate PrEP demand (community-based HIV testing and mass media campaigns), reinforced with facility-based follow-up (counseling and multi-month prescription) could be promising interventions for PrEP programs that are aimed at the general adult population.
Collapse
Affiliation(s)
- Joy J. Chebet
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States of America
| | - Shannon A. McMahon
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Social and Behavioral Interventions, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Rachel P. Chase
- Wexner Medical Center, Ohio State University, Columbus, OH, United States of America
| | - Tapiwa Tarumbiswa
- Disease Control Department, Ministry of Health Lesotho, Maseru, Lesotho
| | - Chivimbiso Maponga
- Clinton Health Access Initiative–Lesotho Country Office, Maseru, Lesotho
| | - Esther Mandara
- Clinton Health Access Initiative–Lesotho Country Office, Maseru, Lesotho
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Germany
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Africa Health Research Institute (AHRI), Durban, South Africa
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, CA, United States of America
- Chan Zuckerberg Biohub–San Francisco, San Francisco, CA, United States of America
| |
Collapse
|
14
|
Zimmermann HML, Davidovich U, van Bilsen WPH, Coyer L, Matser A, Prins M, van Harreveld F. A psychosocial network approach studying biomedical HIV prevention uptake between 2017 and 2019. Sci Rep 2023; 13:16168. [PMID: 37758796 PMCID: PMC10533833 DOI: 10.1038/s41598-023-42762-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
Biomedical HIV-prevention strategies (BmPS) among men who have sex with men (MSM), such as pre-exposure prophylaxis (PrEP) and viral load sorting (VLS), are essential but relatively new and their uptake gradual. Using an extension of the causal attitude network approach, we investigated which beliefs are related to uptake of PrEP and VLS at each time-point. We included 632 HIV-negative MSM from the Amsterdam Cohort Studies from four data-waves between 2017 and 2019. We estimated weighted, undirected networks for each time-point, where we included pairwise interactions of PrEP and VLS uptake and related beliefs. PrEP use increased from 10 to 31% (p < 0.001), while VLS was reported by 7-10% at each time-point. Uptake of both BmPS was directly related to the perceived positive impact of the strategy on one's quality of sex life and perceived supportive social norms. Overall network structure differed between time points, specifically in regard to PrEP. At earlier time points, perceptions of efficacy and affordability played an important role for PrEP uptake, while more recently social and health-related concerns became increasingly important.The network structure differed across data-waves, suggesting specific time changes in uptake motives. These findings may be used in communication to increase prevention uptake.
Collapse
Affiliation(s)
- Hanne M L Zimmermann
- Department of Infectious Diseases, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands.
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands.
| | - Udi Davidovich
- Department of Infectious Diseases, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Ward P H van Bilsen
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity Institute (AII), Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Liza Coyer
- Department of Infectious Diseases, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
| | - Amy Matser
- Department of Infectious Diseases, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity Institute (AII), Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Maria Prins
- Department of Infectious Diseases, Public Health Service of Amsterdam, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam Institute for Infection and Immunity Institute (AII), Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Frenk van Harreveld
- Department of Social Psychology, University of Amsterdam, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| |
Collapse
|
15
|
Zhang Y, Shi L, Fu G, Yang C, Zaller ND, Wei C, Yan H. Willingness to use and intention to adhere to pre-exposure prophylaxis (PrEP) among men who have sex with men in Jiangsu Province, China. AIDS Care 2023; 35:1386-1394. [PMID: 37075742 PMCID: PMC10523904 DOI: 10.1080/09540121.2023.2200992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/28/2023] [Indexed: 04/21/2023]
Abstract
ABSTRACTPre-exposure prophylaxis (PrEP) is a biomedical prevention approach that significantly reduces HIV acquisition. Our study aimed to explore factors associated with PrEP willingness and intention to adhere to PrEP among MSM through a cross-sectional survey in Nanjing, Jiangsu province, China. Location sampling (TLS) and online recruitment were used to recruit participants to gauge their PrEP willingness and intention to adhere. Of 309 HIV-negative/unknown serostatus MSM, 75.7% were willing to use PrEP and 55.3% had high intention to take PrEP daily. Willingness to use PrEP was positively associated with having a college degree or higher (AOR = 1.90, 95%CI: 1.11-3.26) and higher anticipated HIV stigma (AOR = 2.74, 95%CI: 1.13-6.61). Facilitators of intention to adhere included higher education levels (AOR = 2.12, 95%CI: 1.33-3.39) and higher anticipated HIV stigma (AOR = 3.65, 95%CI: 1.36-9.80), whereas a primary barrier was community homophobia (AOR = 0.43, 95%CI: 0.20-0.92). This study documented high willingness to use PrEP, yet lower intention to adhere to PrEP in a sample of MSM in China. Public interventions and programs to promote adherence of PrEP for MSM is urgently needed in China. Psychosocial factors should be addressed and taken into consideration for PrEP implementation and adherence programs.
Collapse
Affiliation(s)
- Ying Zhang
- Xuzhou Center for Disease Control and Prevention, Xuzhou, China
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Lingen Shi
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Gengfeng Fu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Cui Yang
- Johns Hopkins Bloomberg School of Public Health
| | - Nickolas D Zaller
- College of Public Health, University of Arkansas for Medical Sciences
| | | | - Hongjing Yan
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| |
Collapse
|
16
|
Moyo PL, Nunu WN. Oral Pre-exposure Prophylaxis Uptake and Acceptability Among Men Who Have Sex With Men: A Scoping Review of the Literature. Am J Mens Health 2023; 17:15579883231201729. [PMID: 37776162 PMCID: PMC10541771 DOI: 10.1177/15579883231201729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/18/2023] [Accepted: 08/31/2023] [Indexed: 10/01/2023] Open
Abstract
Despite the global effort to end the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) epidemic as a global threat by 2030, the rate of new HIV infections worldwide remains unacceptably high among men who have sex with men, hence the need to use pre-exposure prophylaxis (PrEP) to reduce the risk of HIV infection. This population has an increased risk of getting HIV; thus, it is imperative to assess the uptake and acceptability of PrEP. This study investigated the willingness, availability, accessibility, and knowledge and identified barriers and facilitators to using PrEP among this population. A scoping literature review search was conducted on research papers published in English and focused on men who have sex with men and their use of PrEP. These were independently screened and coded. Of about 1,202 literature sources, 55 were included in the study. Findings reported that the uptake and acceptability of PrEP were influenced by knowledge and perception of being high-risk. Generally, PrEP uptake and understanding were high in North America, Latin America, and Europe and low in Asia and Africa. Low uptake and acceptability have been largely attributed to fear of side effects, societal stigma, cost, and perception of not being at risk. Noted facilitators to PrEP use include education, availability of free pills, support groups, and friendly health care facilities. Health intervention programs to increase the use of PrEP must be backed by appropriate legal and regulatory frameworks.
Collapse
Affiliation(s)
- Perez Livias Moyo
- Department of Environmental Health, Faculty of Environmental Science, National University of Science & Technology, Bulawayo, Zimbabwe
| | - Wilfred Njabulo Nunu
- Office of the Executive Dean, Faculty of Environmental Science, National University of Science & Technology, Bulawayo, Zimbabwe
| |
Collapse
|
17
|
Kamitani E, Mizuno Y, DeLuca JB, Collins CB. Systematic review of alternative HIV preexposure prophylaxis care delivery models to improve preexposure prophylaxis services. AIDS 2023; 37:1593-1602. [PMID: 37199602 PMCID: PMC10366650 DOI: 10.1097/qad.0000000000003601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVES To identify types, evidence, and study gaps of alternative HIV preexposure prophylaxis (PrEP) care delivery models in the published literature. DESIGN Systematic review and narrative synthesis. METHODS We searched in the US Centers for Disease Control and Prevention (CDC) Prevention Research Synthesis (PRS) database through December 2022 (PROSPERO CRD42022311747). We included studies published in English that reported implementation of alternative PrEP care delivery models. Two reviewers independently reviewed the full text and extracted data by using standard forms. Risk of bias was assessed using the adapted Newcastle-Ottawa Quality Assessment Scale. Those that met our study criteria were evaluated for efficacy against CDC Evidence-Based Intervention (EBI) or Evidence-Informed Intervention (EI) criteria or Health Resources and Services Administration Emergency Strategy (ES) criteria, or for applicability by using an assessment based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. RESULTS This review identified 16 studies published between 2018 and 2022 that implemented alternative prescriber ( n = 8), alternative setting for care ( n = 4), alternative setting for laboratory screening ( n = 1), or a combination of the above ( n = 3) . The majority of studies were US-based ( n = 12) with low risk of bias ( n = 11). None of the identified studies met EBI, EI, or ES criteria. Promising applicability was found for pharmacists prescribers, telePrEP, and mail-in testing. CONCLUSIONS Delivery of PrEP services outside of the traditional care system by expanding providers of PrEP care (e.g. pharmacist prescribers), as well as the settings of PrEP care (i.e. telePrEP) and laboratory screening (i.e. mail-in testing) may increase PrEP access and care delivery.
Collapse
Affiliation(s)
- Emiko Kamitani
- Division of HIV Prevention, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | |
Collapse
|
18
|
Philpot SP, Prestage G, Holt M, Maher L, Haire B, Bourne A, Hammoud MA. Reasons for not Using HIV Pre-Exposure Prophylaxis (PrEP) among Gay and Bisexual Men in Australia: Mixed-Methods Analyses from a National, Online, Observational Study. Behav Med 2023; 49:271-282. [PMID: 35176964 DOI: 10.1080/08964289.2022.2033159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 11/14/2021] [Accepted: 01/12/2022] [Indexed: 11/02/2022]
Abstract
Although approximately 31,000 Australian gay and bisexual men (GBM) are eligible for HIV pre-exposure prophylaxis (PrEP), only 18,500 people currently use it, indicating a need to investigate why GBM do not use it. This article uses data from a national, online, observational study. It adopts a mixed-methods analysis to responses to survey questions asking about reasons Australian GBM were not using PrEP in 2018, according to their level of HIV risk as delineated by the Australian PrEP prescribing guidelines at the time. Participants responded to check-box questions and had the option to respond to a qualitative free-text question. Results showed that just over one-fifth of men were at higher risk of HIV acquisition. Compared to lower-risk men, higher-risk men were more likely to indicate PrEP was too expensive and more likely to cite embarrassment asking for it. Reasons for not using PrEP included a lack of personal relevance, poor accessibility or knowledge, concerns about PrEP's inability to protect against STIs, potential side effects, and a preference for condoms. We conclude that health promotion more effectively targeting GBM who may benefit the most from PrEP may be valuable.
Collapse
Affiliation(s)
- Steven P Philpot
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Garrett Prestage
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Kensington, New South Wales, Australia
| | - Lisa Maher
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Bridget Haire
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| | - Adam Bourne
- Australian Research Centre in Sex, Health, and Society La Trobe University, Melbourne, Victoria, Australia
| | - Mohamed A Hammoud
- Kirby Institute, UNSW Sydney, Kensington, New South Wales, Australia
| |
Collapse
|
19
|
Pico-Espinosa OJ, Hull M, Gaspar M, Lachowsky N, Grace D, Truong R, Mohammed S, MacPherson P, Woodward K, Tan DHS. Disjuncture between self-perceived and clinically assessed risk of HIV among gay, bisexual, and other men who have sex with men in Ontario and British Columbia, Canada. BMC Public Health 2023; 23:1133. [PMID: 37312073 DOI: 10.1186/s12889-023-16065-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 06/06/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Self-perceived and clinically assessed HIV risk do not always align. We compared self-perceived and clinically assessed risk of HIV and the reasons for self-perceived low risk of HIV among gay, bisexual, and other men who have sex with men (GBM) from large urban centers in Ontario and British Columbia, Canada. METHODS Never PrEP users recruited from sexual health clinics or online, completed a cross-sectional survey between July/2019 and August/2020. We contrasted self-perceived HIV risk against criteria from the Canadian PrEP guidelines and participants were categorized as concordant or discordant. We used content analysis to categorize participants' free-text explanations for perceived low HIV risk. These were compared with answers to quantitative responses about condomless sex acts and number of partners. RESULTS Of 315 GBM who self-perceived low risk of HIV, 146 (46%) were considered at high risk according to the guidelines. Participants with discordant assessment were younger, had less years of formal education, were more often in an open relationship and were more likely to self-identify as gay. Reasons for self-perceived low HIV risk in the discordant group were condom use (27%), being in a committed relationship/having one main partner (15%), having no or infrequent anal sex (12%) and having few partners (10%). CONCLUSIONS There is a disjuncture between self-perceived and clinically assessed risk of HIV. Some GBM may underestimate their HIV risk and clinical criteria may overestimate risk. Bridging these gaps requires efforts to increase HIV risk awareness in the community, and refinement of clinical assessments based on individualized discussions between the provider and the user.
Collapse
Affiliation(s)
| | - Mark Hull
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | | | | | | | - Saira Mohammed
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | | | | |
Collapse
|
20
|
Gyamerah AO, Kinzer E, Aidoo-Frimpong G, Sorensen G, Mensah MD, Taylor KD, Vanderpuye NA, Lippman SA. PrEP knowledge, acceptability, and implementation in Ghana: Perspectives of HIV service providers and MSM, trans women, and gender diverse individuals living with HIV. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001956. [PMID: 37285336 DOI: 10.1371/journal.pgph.0001956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/29/2023] [Indexed: 06/09/2023]
Abstract
Pre-exposure prophylaxis (PrEP) could help reduce HIV incidence among cis men, trans women, and gender diverse individuals assigned male at birth who have sex with men (MSM, trans women, and GDSM) in Ghana, a group that bears a high HIV burden. Our study examined PrEP knowledge and acceptability, and barriers and facilitators to its uptake and implementation through qualitative interviews with 32 MSM, trans women, and GDSM clients living with HIV, 14 service providers (SPs), and four key informants (KIs) in Accra, Ghana. We interviewed participants about their PrEP knowledge, whether MSM would take PrEP, and what factors would make it easy/difficult to uptake or implement PrEP. Interview transcripts were analyzed using thematic analysis. There was high acceptability of PrEP use and implementation among MSM, trans women, GDSM, and SPs/KIs in Ghana. MSM, trans women, and GDSM interest in, access to, and use of PrEP were shaped by intersectional HIV and anti-gay stigma; PrEP affordability, acceptability, and ease of use (e.g., consumption and side effects); sexual preferences (e.g., condomless sex vs. condom use), and HIV risk perception. Concerns raised about barriers and facilitators of PrEP use and implementation ranged from medical concerns (e.g., STIs; drug resistance); social behavioral concerns (e.g., stigma, risk compensation, adherence issues); and structural barriers (e.g., cost/affordability, govern commitment, monitoring systems, policy guidance). Targeted education on PrEP and proper use of it is needed to generate demand and dispel worries of side effects among MSM, trans women, and GDSM. Free, confidential, and easy access to PrEP must be supported by health systems strengthening, clear prescription guidelines, and anti-stigma training for providers.
Collapse
Affiliation(s)
- Akua O Gyamerah
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Ezra Kinzer
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Gloria Aidoo-Frimpong
- Department of Community Health and Health Behavior, The State University of New York at Buffalo, Buffalo, New York, United States of America
| | | | | | - Kelly D Taylor
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | | | - Sheri A Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| |
Collapse
|
21
|
Nagai H, Adiibokah E, Tagoe H, Tun W, Pilgrim NA, Ankomah A, Rahman YAA, Addo SA, Atuahene SK, Essandoh E, Maher S, Kowalski M. Policymakers' and healthcare providers' perspectives on the introduction of oral pre-exposure prophylaxis for key populations in Ghana. BMC Public Health 2023; 23:1065. [PMID: 37277772 DOI: 10.1186/s12889-023-15871-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/11/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Key populations (KPs) such as female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID), and their partners contribute more than a quarter (27.5%) of new HIV infection in Ghana. Oral pre-exposure prophylaxis (PrEP) can substantially reduce HIV acquisition among this group. While the available research indicates KPs willingness to take PrEP in Ghana, little is known about the position of policymakers and healthcare providers on the introduction of PrEP for KPs. METHODS Qualitative data were collected from September to October 2017 in the Greater Accra (GA) and Brong-Ahafo (BA) regions of Ghana. Key informant interviews were conducted with 20 regional and national policymakers and supplemented with In-depth Interviews with 23 healthcare providers to explore their level of support for PrEP and their perspectives on challenges and issues to consider for oral PrEP implementation in Ghana. Thematic content analysis was used to unearth the issues emerging from the interviews. RESULTS Policymakers and healthcare providers in both regions expressed strong support for introducing PrEP for KPs. Key concerns regarding oral PrEP introduction included potential for behavioral disinhibition, non-adherence and side effects of medication, cost and long-term financial implications, and stigma related to HIV and key populations. Participants stressed the need to integrate PrEP into existing services and the provision of PrEP should start with high risk groups like sero-discordant couples, FSWs and MSM. CONCLUSIONS Policymakers and providers recognize the value of PrEP in cubing new HIV infections but have concerns about disinhibition, non-adherence, and cost. Therefore, the Ghana health service should roll-out a range of strategies to address their concerns including: sensitization with providers to mitigate underlying stigma towards KPs, particularly MSM, integration of PrEP into existing services, and innovative strategies to improve continued use of PrEP.
Collapse
Affiliation(s)
- Henry Nagai
- JSI Research & Training Institute, Inc, Accra, Ghana
| | | | - Henry Tagoe
- JSI Research & Training Institute, Inc, Accra, Ghana.
| | | | | | | | | | | | | | | | - Sean Maher
- JSI Research & Training Institute, Inc, Boston, USA
| | | |
Collapse
|
22
|
Gómez W. Assessing PrEP messaging and communication: A review of the qualitative literature. Curr Opin Psychol 2023; 51:101586. [PMID: 37247445 DOI: 10.1016/j.copsyc.2023.101586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/04/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a biomedical HIV prevention intervention approved by the FDA in 2012. Nevertheless, most sexual minority men (SMM) who could benefit from its use are not currently prescribed PrEP. The literature during the first decade of PrEP availability has suggested a diverse set of multi-level barriers and facilitators to PrEP uptake and adherence. Through a scoping review, 16 qualitative studies were surveyed to assess these barriers and facilitators, specifically regarding messaging and communication. Seven main themes were identified: information & misinformation, peer messaging, expansion of sexual experiences, relationships with providers, expectations & stigma, navigation support, and barriers to uptake & adherence. Data suggest that peer support, messaging around empowerment and agency, and PrEP's role in shifting sociosexual norms contributed to uptake and adherence. On the other hand, stigma, provider disconnection, and access issues hindered PrEP uptake and adherence. Findings could inform multi-level, strengths-based, and holistic approaches to designing effective interventions for PrEP engagement among SMM.
Collapse
Affiliation(s)
- Walter Gómez
- Jane Addams College of Social Work, University of Illinois Chicago, Chicago IL 1040 W Harrison St, #4220 Chicago, IL 60607-7134, USA.
| |
Collapse
|
23
|
Pico-Espinosa OJ, Hull M, MacPherson P, Grace D, Lachowsky N, Gaspar M, Mohammed S, Truong R, Tan DHS. Reasons for not using pre-exposure prophylaxis for HIV and strategies that may facilitate uptake in Ontario and British Columbia among gay, bisexual and other men who have sex with men: a cross-sectional survey. CMAJ Open 2023; 11:E560-E568. [PMID: 37369522 PMCID: PMC10310342 DOI: 10.9778/cmajo.20220113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) for HIV is underutilized. We aimed to identify barriers to use of PrEP and strategies that may facilitate its uptake. METHODS Gay, bisexual and other men who have sex with men, aged 19 years or older and living in Ontario and British Columbia, Canada, completed a cross-sectional survey in 2019-2020. Participants who met Canadian PrEP guideline criteria and were not already using PrEP identified relevant barriers and which strategies would make them more likely to start PrEP. We described the barriers and strategies separately for Ontario and BC. RESULTS Of 1527 survey responses, 260 respondents who never used PrEP and met criteria for PrEP were included. In Ontario, the most common barriers were affordability (43%) and concern about adverse effects (42%). In BC, the most common reasons were concern about adverse effects (41%) and not feeling at high enough risk (36%). In Ontario, preferred strategies were short waiting time (63%), the health care provider informing about their HIV risk being higher than perceived (62%), and a written step-by-step guide (60%). In BC, strategies were short waiting time (68%), people speaking publicly about PrEP (68%), and the health care provider counselling about their HIV risk being higher than perceived (64%), adverse effects of PrEP (65%) and how well PrEP works (62%). INTERPRETATION Concern about adverse effects and not self-identifying as having high risk for HIV were common barriers, and shorter waiting times may increase PrEP uptake. In Ontario, the findings suggested lack of affordability, whereas in BC, strategies involving health care providers were valued.
Collapse
Affiliation(s)
- Oscar Javier Pico-Espinosa
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Mark Hull
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Paul MacPherson
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Daniel Grace
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Nathan Lachowsky
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Mark Gaspar
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Saira Mohammed
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Robinson Truong
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| | - Darrell H S Tan
- St Michael's Hospital (Pico-Espinosa, Truong, Tan), Toronto, Ont.; BC Centre for Excellence in HIV/AIDS (Hull, Mohammed); Department of Medicine (Hull), University of British Columbia, Vancouver, BC; Department of Medicine (MacPherson) University of Ottawa, Ottawa, Ont.; Dalla Lana School of Public Health (Grace, Gaspar), University of Toronto, Toronto, Ont.; School of Public Health and Social Policy (Lachowsky), University of Victoria, Victoria, BC
| |
Collapse
|
24
|
Reyniers T, Babo SAY, Ouedraogo M, Kanta I, Ekon Agbégnigan L, Rojas D, Eubanks A, Anoma C, Dah TTE, Mensah E, Dembélé Keita B, Spire B, Vuylsteke B, Laurent C. Strategies to improve PrEP uptake among West African men who have sex with men: a multi-country qualitative study. Front Public Health 2023; 11:1165327. [PMID: 37181706 PMCID: PMC10167043 DOI: 10.3389/fpubh.2023.1165327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 03/27/2023] [Indexed: 05/16/2023] Open
Abstract
Introduction West African men who have sex with men (MSM) remain at substantial risk of contracting HIV. Pre-exposure prophylaxis (PrEP) can be an effective game-changer in reducing the number of HIV infections in MSM communities. To optimize the roll-out of PrEP, we need to better understand how we can increase its uptake. The objective of this study was to explore the perceptions of West African MSM toward PrEP and their proposed strategies to overcome barriers to PrEP uptake within their communities. Methods Between April 2019 and November 2021, we conducted 12 focus group discussions with 97 MSM not taking PrEP, and 64 semi-structured interviews with MSM taking PrEP, in Burkina Faso, Côte d'Ivoire, Mali, and Togo. Data collection and analysis were guided and conducted by local research teams, enabling a community-based participatory approach. A coordinating researcher collaborated with these local teams to analyze the data guided by a grounded theory approach. Results The results show that participants were generally positive toward PrEP and that MSM communities have become more aware of PrEP for the study. We identified three main strategies for increasing PrEP uptake. First, participants proposed to raise awareness and improve knowledge of HIV as they considered the self-perceived risk of MSM in their communities to be low. Second, because of existing misconceptions and false information, participants proposed to improve the dissemination of PrEP to allow for informed choices, e.g., via peers or PrEP users themselves. Third, as oral PrEP also entails a risk of being associated with HIV or homosexuality, strategies to avoid stigmatization (e.g., hiding pills) were deemed important. Discussion These findings indicate that the roll-out of oral PrEP and other future PrEP modalities should be accompanied by raising awareness and improving knowledge on HIV, and wide dissemination of information that focuses on the health-promoting aspect of these tools. Tailored delivery and long-acting PrEP modalities will be important to avoid potential stigmatization. Sustained efforts to prevent discrimination and stigmatization based on HIV status or sexual orientation continue to be highly important strategies to address the HIV epidemic in West Africa.
Collapse
Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | | | | | | | | - Daniela Rojas
- Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
- Coalition Plus, Community-based Research Laboratory, Pantin, France
| | - August Eubanks
- Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso
- UFR Sciences de la Santé, Université de Ouahigouya, Ouahigouya, Burkina Faso
| | | | | | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | | |
Collapse
|
25
|
Cui TS, Lane B, Wu Y, Ma J, Fu R, Hou J, Meng S, Xie L, Gu Y, Huang X, Zheng H, Ma Y, He N, Meyers K. Determinants of Willingness to Use PrEP Among Gay and Bisexual Men in China Before Implementation: A Structural Equation Modeling Assessment. AIDS Behav 2023; 27:823-831. [PMID: 36044125 PMCID: PMC11274899 DOI: 10.1007/s10461-022-03815-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2022] [Indexed: 11/01/2022]
Abstract
With the recent endorsement of PrEP by the Chinese government, research is urgently needed to better understand factors impacting PrEP uptake among gay, bisexual, and other men who have sex with men (GBMSM) in China. This study examined willingness to use PrEP for HIV prevention among GBMSM in China through structural equation modeling. We examined the relationship among PrEP-related attitudes, subjective norms, PrEP-related knowledge and beliefs about medicines and willingness to use PrEP. The analysis showed a good fit between the data and both the measurement model (RMSEA = 0.060) and structural model (RMSEA = 0.054). Knowledge, attitudes, and subjective norms were significantly related to intention to use PrEP, whereas the effect of general beliefs about medicines was insignificant. These effect mechanisms point to the importance of designing interventions to support PrEP uptake that target knowledge, enhance positive attitudes about PrEP within social networks, and build positive social norms around PrEP among sexually active GBMSM.
Collapse
Affiliation(s)
| | - Benjamin Lane
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Yumeng Wu
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Jing Ma
- Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Rong Fu
- City University of Hong Kong, Hong Kong SAR, China
| | - Jianhua Hou
- City University of Hong Kong, Hong Kong SAR, China
| | - Siyan Meng
- The University of North Carolina, Project China, Guangzhou, China
| | - Lu Xie
- University of Macau, Macao, China
| | - Yuzhou Gu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Xiaojie Huang
- Clinical and Research Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | | | - Yanling Ma
- Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China
| | - Na He
- Fudan University, Shanghai, China
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, USA.
| |
Collapse
|
26
|
Owens C, Hubach RD. An Exploratory Study of the Mpox Media Consumption, Attitudes, and Preferences of Sexual and Gender Minority People Assigned Male at Birth in the United States. LGBT Health 2023. [PMID: 36735618 DOI: 10.1089/lgbt.2022.0251] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Purpose: This study examined the consumption of, attitudes toward, and preferences for mpox media among U.S. sexual and gender minority (SGM) people assigned male at birth (AMAB). Methods: A total of 496 SGM people AMAB completed an online cross-sectional survey between August 6 and 15, 2022. Data were analyzed with descriptive statistics and logistic regressions. Results: Approximately two-thirds of participants overall agreed that media-related content about mpox targeted (66.3%) and stigmatized gay, bisexual, and other men who have sex with men (69.2%). The three most preferred mpox content were the destigmatization of SGM people (44.2%), mpox vaccine accessibility (25.2%), and mpox transmission and prevention (19.2%). Rural participants had a lower likelihood of consuming mpox-related media than urban participants. Conclusion: SGM people AMAB prefer mpox messaging campaigns to be grounded in stigma-reduction to ensure that messages do not perpetrate stigma against them. Stigmatizing content might foster SGM people AMAB to distrust mpox interventions.
Collapse
Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, Texas, USA
| | - Randolph D Hubach
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, Indiana, USA
| |
Collapse
|
27
|
Soares F, Magno L, da Silva LAV, Guimarães MDC, Leal AF, Knauth D, Veras MA, de Brito AM, Kendall C, Kerr LRFS, Dourado I. Perceived Risk of HIV Infection and Acceptability of PrEP among Men Who Have Sex with Men in Brazil. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:773-782. [PMID: 36169773 PMCID: PMC9517975 DOI: 10.1007/s10508-022-02342-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 06/16/2023]
Abstract
The HIV epidemic affects men who have sex with men (MSM) disproportionally in Brazil, and pre-exposure prophylaxis (PrEP) is effective for preventing HIV in this population. However, low perceived risk of HIV may influence the acceptability and decision to use PrEP. This study estimated the association between self-perception of HIV risk and acceptability of daily oral PrEP among Brazilian MSM. Respondent-driven sampling (RDS) was used for behavioral and biological surveillance to recruit 4,176 MSM 18 years or over in 12 Brazilian cities in 2016. Results were weighted using Gile's estimator in RDS Analyst software. Adjusted odds rations (OR) with 95% confidence intervals were calculated using multivariate logistic regression. Acceptability of daily oral PrEP was high (69.7%) among the 3,544 MSM available for analysis. Most participants self-reported low or moderate risk of HIV infection (67.2%) and a small proportion (9.3%) reported high risk. A dose-response relationship was observed between acceptability of PrEP and self-reported risk: PrEP acceptability was 1.88 times higher (OR 1.8; 95% CI: 1.24-2.85) among MSM whose perceived risk of HIV infection was low or moderate, and 5 times higher (OR 5.68; 95% CI: 2.54-12.73) among those who self-reported high risk compared to MSM reporting no HIV risk. MSM with the highest risk perception of HIV reported higher rates of PrEP acceptability. Given the availability of daily oral PrEP in the public health care system in Brazil, we suggest emphasizing counseling about self-perception of HIV risk as part of routine HIV prevention services.
Collapse
Affiliation(s)
- Fabiane Soares
- Institute of Collective Health, Federal University of Bahia, Basílio da Gama, s/n, Campos Universitário Do Canela, Salvador, Bahia, CEP: 4.0110-040, Brazil.
| | - Laio Magno
- Department of Life Sciences, State University of Bahia, Salvador, Bahia, Brazil
| | | | | | - Andrea Fachel Leal
- Sociology Department, Institute of Philosophy and Human Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniela Knauth
- Department of Social Medicine, Faculty of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Amélia Veras
- School of Medical Sciences, Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Carl Kendall
- Department of Community Health, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Basílio da Gama, s/n, Campos Universitário Do Canela, Salvador, Bahia, CEP: 4.0110-040, Brazil
| |
Collapse
|
28
|
Gillespie D, Williams A, Wood F, Couzens Z, Jones A, Ma R, de Bruin M, Hughes DA, Hood K. Psychometric Properties of an Adapted Stigma Scale and Experiences of Stigma Associated with HIV Pre-exposure Prophylaxis Use Among Men Who have Sex with Men: A Mixed Methods Study. AIDS Behav 2023; 27:2397-2410. [PMID: 36622489 DOI: 10.1007/s10461-022-03967-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 01/10/2023]
Abstract
Stigma may influence the use of HIV pre-exposure prophylaxis (PrEP). However, there is an absence of robust measures for PrEP-related stigma. We describe an adaptation of a HIV stigma scale for use in PrEP users and experiences of PrEP users in Wales (UK) with regards to PrEP-related stigma. A mixed methods study was conducted where PrEP users completed questionnaire items about PrEP-related stigma and a subset were interviewed about their experiences of taking PrEP. We adapted items from the HIV stigma scale and assessed construct validity and internal consistency. We analysed interview data using a framework approach, with themes focussing on enacted and anticipated stigma in order to identify areas for scale refinement. Our measure had good psychometric properties but additional items may be useful (e.g. specific instances of enacted stigma, concerns around homonegativity). Further work is needed to develop this scale and validate it in a larger sample.
Collapse
Affiliation(s)
- David Gillespie
- Centre for Trials Research, College of Biomedical & Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK.
| | - Adam Williams
- Centre for Trials Research, College of Biomedical & Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Fiona Wood
- Division of Population Medicine and PRIME Centre Wales, College of Biomedical & Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Zoë Couzens
- Public Health Wales NHS Trust, Cardiff, Wales, UK
| | - Adam Jones
- Policy, Research and International Development, Public Health Wales, Cardiff, Wales, UK
| | - Richard Ma
- Imperial College London, London, England, UK
| | - Marijn de Bruin
- Radboud University Medical Center, Institute of Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Wales, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical & Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
| |
Collapse
|
29
|
Bhatta DN, Hecht J, Facente SN. Factors associated with stigma related to HIV pre-exposure prophylaxis (PrEP) use among men who have sex with men (MSM). Sex Transm Infect 2022; 98:592-594. [PMID: 35121674 DOI: 10.1136/sextrans-2021-055296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 01/22/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is a noteworthy scientific development that increases the opportunities for men who have sex with men (MSM) to prevent HIV infection, but stigma is a major barrier to its uptake. This study aims to determine the associations between PrEP-related stigma and individual characteristics among MSM. METHODS Self-reported cross-sectional data were collected from routine-collected electronic healthcare record data from 4084 MSM receiving PrEP in San Francisco, California, between July 2018 and June 2020. Multivariable logistic regression was performed to determine the associations between individual characteristics and PrEP-related stigma, adjusting for age, race, gender identity, injection history, housing status and mental health status. RESULTS PrEP-related stigma was experienced by 9.0% of the participants in our study. PrEP-related stigma was significantly associated with being transgender or gender non-conforming (adjusted OR (AOR): 1.81, 95% CI 1.21 to 2.72), having a history of injection drug use (AOR: 2.02, 95% CI 1.18 to 3.46), being unstably housed (AOR: 1.58, 95% CI 1.11 to 2.26) and having mental health concerns (AOR: 1.99, 95% CI 1.35 to 2.92), after controlling for age, race, gender, injection history, housing status and mental health status. CONCLUSION Participants who reported being transgender or gender non-conforming, having a history of injection drug use, or having mental health concerns were more likely to report experiencing PrEP-related stigma. It is crucial to develop culturally appropriate interventions to reduce PrEP-related stigma among populations who are at high risk of HIV infection and may benefit strongly from improved PrEP uptake.
Collapse
Affiliation(s)
- Dharma N Bhatta
- San Francisco AIDS Foundation, San Francisco, California, USA
| | - Jennifer Hecht
- San Francisco AIDS Foundation, San Francisco, California, USA.,Springboard HealthLab, Berkeley, California, USA
| | - Shelley N Facente
- School of Public Health, University of California Berkeley, Berkeley, California, USA .,Facente Consulting, Richmond, California, USA
| |
Collapse
|
30
|
Sosnowy C, Predmore Z, Dean LT, Raifman J, Chu C, Galipeau D, Nocka K, Napoleon S, Chan P. Paying for PrEP: A qualitative study of cost factors that impact pre-exposure prophylaxis uptake in the US. Int J STD AIDS 2022; 33:1199-1205. [PMID: 36271632 PMCID: PMC9912748 DOI: 10.1177/09564624221132406] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Concerns about the actual and perceived costs of pre-exposure prophylaxis (PrEP) continue to be a major barrier to uptake among gay, bisexual and men who have sex with men (GBMSM) in the United States. METHODS We conducted semi-structured interviews with 25 GBMSM who presented for routine health care at a STD clinic in the northeastern United States. The cohort included GBMSM who were or were not currently taking PrEP and represented varied health care coverage and financial resources. We used a structured coding scheme to analyze transcripts and identify themes relevant to cost factors. RESULTS Participants shared their perspectives about PrEP and their experiences with accessing and paying for PrEP. Our findings suggest that health care coverage or financial assistance were essential to PrEP access but were not easily accessible to all people and did not always cover all costs. Therefore, paying for PrEP had to be balanced with other life expenses. Participants had multiple sources for information about PrEP cost and assistance from clinic and pharmacy staff helped reduce burden and resolve difficulties. CONCLUSION Addressing gaps in health care coverage, providing financial support, and improving the enrollment process in a financial assistance program may improve PrEP uptake.
Collapse
Affiliation(s)
| | - Zachary Predmore
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- The RAND Corporation, Boston, MA, USA
| | - Lorraine T Dean
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Julia Raifman
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Christina Chu
- Department of Medicine, Brown University, Providence, RI, USA
| | - Drew Galipeau
- Department of Medicine, Brown University, Providence, RI, USA
| | - Kristen Nocka
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - Siena Napoleon
- Department of Medicine, Brown University, Providence, RI, USA
| | - Philip Chan
- Department of Medicine, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
31
|
Suen YT, Chan RCH, Wong EMY. Sex Conservatism, Internalized Homonegativity, PrEP Stigma, and Intention to Use PrEP: A Study of Chinese-Speaking Gay and Bisexual Male Youth in Hong Kong. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:467-480. [PMID: 36454136 DOI: 10.1521/aeap.2022.34.6.467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Pre-exposure prophylaxis (PrEP) stigma has been found to be a major barrier to PrEP acceptability and uptake. Research has found that different ethnic/cultural groups display varying levels of PrEP stigma. This article studies sex conservatism and internalized homonegativity as two sexuality- and culture-related aspects that influence PrEP stigma and intention to use PrEP. An online survey of 279 young gay and bisexual men in Hong Kong found that internalized homonegativity was positively associated with PrEP stigma. Respondents who were more conservative about sex showed lower intention to use PrEP, whereas those who had higher income and more positive attitudes about PrEP were more likely to express intention to use PrEP. This study provides novel empirical evidence for understanding PrEP stigma and uptake from a sexuality and cultural perspective. The influence of sexuality- and culture-related factors on PrEP stigma and uptake warrants greater attention, especially in the Asia-Pacific region.
Collapse
Affiliation(s)
- Yiu Tung Suen
- Gender Studies Programme, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Randolph C H Chan
- Department of Special Education and Counselling, The Education University of Hong Kong, Tai Po, Hong Kong
| | - Eliz Miu Yin Wong
- Department of Social Policy, London School of Economics and Political Science, London, UK
| |
Collapse
|
32
|
Wray TB, Chan PA, Klausner JD, Ward LM, Ocean EMS. Gay, Bisexual, and Other Men Who Have Sex With Men Who Are Not on Oral PrEP may be Less Interested in Available Injectable Products than in Oral PrEP: Examining Individual-Level Determinants of Interest and Barriers Across Products. AIDS Behav 2022; 26:3794-3805. [PMID: 35583574 PMCID: PMC9912751 DOI: 10.1007/s10461-022-03708-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/24/2022]
Abstract
Approval of the first injectable PrEP product (cabotegravir) provides an exciting addition to oral PrEP that could encourage those not currently on PrEP to use it. However, few studies have explored interest in injectable cabotegravir among those at increased risk who are not currently on PrEP. We conducted an online survey with 327 gay, bisexual, and other men who have sex with men (GBM) with limited PrEP history to explore their interest and intentions to use oral and injectable PrEP (cabotegravir), and examine barriers and individual-level predictors of both product types. Results showed that 17% of participants who reported being uninterested/neutral about oral PrEP expressed interest in injectable PrEP. Slightly more racial/ethnic minority GBM who were uninterested/neutral for oral PrEP expressed interest in injectable PrEP than White GBM (23% vs. 14%). Determinants were similar across PrEP types. Findings can directly inform interventions encouraging use of both PrEP products.
Collapse
Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, United States.
| | - Philip A Chan
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lori M Ward
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Erik M S Ocean
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, United States
| |
Collapse
|
33
|
Sang JM, McAllister K, Wang L, Barath J, Lal A, Parlette A, Noor SW, Apelian H, Skakoon‐Sparling S, Hull M, Moore DM, Cox J, Hart TA, Lambert G, Grace D, Jollimore J, Hogg RS, Lachowsky NJ. Examining provincial PrEP coverage and characterizing PrEP awareness and use among gay, bisexual and other men who have sex with men in Vancouver, Toronto and Montreal, 2017-2020. J Int AIDS Soc 2022; 25:e26017. [PMID: 36306245 PMCID: PMC9616170 DOI: 10.1002/jia2.26017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Accessibility of pre-exposure prophylaxis (PrEP) in Canada remains complex as publicly funded coverage and delivery differs by province. In January 2018, PrEP became publicly funded and free of charge in British Columbia (BC), whereas PrEP coverage in Ontario and Montreal is more limited and may require out-of-pocket costs. We examined differences over time in PrEP uptake and assessed factors associated with PrEP awareness and use. METHODS Gay, bisexual and other men who have sex with men (GBM) were recruited through respondent-driven sampling (RDS) in Toronto, Vancouver and Montreal, Canada, in a prospective biobehavioural cohort study. We applied generalized estimating equations with hierarchical data (RDS chain, participant, visit) to examine temporal trends of PrEP use and correlates of PrEP awareness and use from 2017 to 2020 among self-reported HIV-negative/unknown GBM. RESULTS Of 2008 self-identified HIV-negative/unknown GBM at baseline, 5093 study visits were completed from February 2017 to March 2020. At baseline, overall PrEP awareness was 88% and overall PrEP use was 22.5%. During our study period, we found PrEP use increased in all cities (all p<0.001): Montreal 14.2% during the first time period to 39.3% during the last time period (p<0.001), Toronto 21.4-31.4% (p<0.001) and Vancouver 21.7-59.5% (p<0.001). Across the study period, more Vancouver GBM used PrEP than Montreal GBM (aOR = 2.05, 95% CI = 1.60-2.63), with no significant difference between Toronto and Montreal GBM (aOR = 0.90, 95% CI = 0.68-1.18). CONCLUSIONS Full free-of-charge public funding for PrEP in BC likely contributed to differences in PrEP awareness and use. Increasing public funding for PrEP will improve accessibility and uptake among GBM most at risk of HIV.
Collapse
Affiliation(s)
- Jordan M. Sang
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Kate McAllister
- School of Public Health and Social PolicyUniversity of VictoriaVictoriaBritish ColumbiaCanada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | | | - Syed W. Noor
- Ryerson UniversityTorontoOntarioCanada,School of Human SciencesLouisiana State University ShreveportShreveportLouisianaUSA
| | - Herak Apelian
- McGill UniversityMontréalQuebecCanada,Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada
| | | | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,University of British ColumbiaVancouverBritish ColumbiaCanada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Joseph Cox
- McGill UniversityMontréalQuebecCanada,Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada
| | - Trevor A. Hart
- Ryerson UniversityTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
| | - Gilles Lambert
- Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada,Institut national de santé publique du QuébecMontréalQuebecCanada
| | | | - Jody Jollimore
- Community Based Research CentreVancouverBritish ColumbiaCanada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,Simon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,School of Public Health and Social PolicyUniversity of VictoriaVictoriaBritish ColumbiaCanada,Community Based Research CentreVancouverBritish ColumbiaCanada
| |
Collapse
|
34
|
Pico-Espinosa OJ, Hull M, MacPherson P, Grace D, Gaspar M, Lachowsky N, Mohammed S, Demers J, Kilduff M, Truong R, Tan DHS. PrEP-related stigma and PrEP use among gay, bisexual and other men who have sex with men in Ontario and British Columbia, Canada. AIDS Res Ther 2022; 19:49. [PMID: 36303191 PMCID: PMC9615170 DOI: 10.1186/s12981-022-00473-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 10/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background We aimed to explore the association between PrEP-related stereotypes and perceived disapproval (hereafter PrEP-related stigma), and PrEP use. Methods We used data from a cross-sectional online survey among adult gay, bisexual, other men who have sex with men in Ontario and British Columbia, Canada. Participants were recruited 2019–2020 in-person from sexual health clinics and outreach programs, and online through dating mobile applications and websites. We used logistic regression models to explore the relationship between PrEP-related stigma and: 1-being a ‘never’ versus ‘current’ PrEP user, and 2-being a ‘former’ versus ‘current’ user. Results The median age of the sample was 32 (Q1-Q3 = 27–40), most were white born in Canada (48%), 45% had never used PrEP, 16% were former PrEP users and 39% were current PrEP users. Of 1527 individuals who started the survey, 1190 participants answered questions about PrEP-related stigma: 254 (21.3%) were classified as having low level of PrEP-related stigma, 776 (65.2%) intermediate, and 160 (13.5%) high. No significant association was found when never PrEP users and current PrEP users were compared: adjusted OR = 1.44 (95%-CI: 0.8–2.5). High PrEP-related stigma was positively associated with being a former PrEP user compared to being a current PrEP user: adjusted OR = 2.5 (95%-CI: 1.3–4.9). Conclusion PrEP-related stigma is associated with not using PrEP, particularly with PrEP discontinuation. Our findings indicate that stigma persists as a barrier to PrEP use. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-022-00473-0.
Collapse
Affiliation(s)
| | - Mark Hull
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | | | | | | | - Saira Mohammed
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | | | | | | | | |
Collapse
|
35
|
Eubanks A, Coulibaly B, Dembélé Keita B, Anoma C, Dah TTE, Mensah E, Kaba S, Lokrou KJ, Ouedraogo FR, Badjassim AMF, Maradan G, Bourrelly M, Mora M, Riegel L, Rojas Castro D, Yaya I, Spire B, Laurent C, Sagaon-Teyssier L. Socio-behavioral correlates of pre-exposure prophylaxis use and correct adherence in men who have sex with men in West Africa. BMC Public Health 2022; 22:1832. [PMID: 36175860 PMCID: PMC9520809 DOI: 10.1186/s12889-022-14211-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 09/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple barriers compromise pre-exposure prophylaxis (PrEP) engagement (i.e., use and adherence) in men who have sex with men (MSM). In low/middle-income countries, little is known about PrEP engagement in this population. In West Africa, the CohMSM-PrEP study was one of the rare interventions providing PrEP to MSM. We estimated PrEP use and correct adherence rates in CohMSM-PrEP, together with associated factors over time. METHODS: CohMSM-PrEP recruited MSM in four community-based clinics in Mali, Côte d'Ivoire, Burkina Faso, and Togo. Quarterly follow-up included collecting socio-behavioral data, and providing a comprehensive HIV prevention package, PrEP (daily or event-driven), and peer educator (PE)-led counselling. Using repeated measures, multivariate generalized estimating equations models were used to identify factors associated with self-reported i) PrEP use and ii) correct PrEP adherence during participants' most recent anal intercourse (defined as four pills/week for daily users and 2 + 1 + 1 for event-driven users). RESULTS Five hundred twenty participants were included with a median follow-up time of 12 months (IQR 6-21). Of the 2839 intercourses declared over the follow-up period, PrEP use was self-reported for 1996 (70%), and correct PrEP adherence for 1461 (73%) of the latter. PrEP use was higher in participants who also attended participating clinics outside of scheduled visits (adjusted odds ratio (aOR) [95% Confidence Interval, CI], p-value; 1.32[1.01-1.71], 0.040), and in those who practiced condomless anal sex (1.86[1.54-2.24], < 0.001). Correct adherence was higher in those who often contacted PE outside of scheduled visits (2.16[1.01-4.64], 0.047) and in participants who adopted receptive/versatile sexual positions with stable partners (1.36[1.03-1.81], 0.030). Instead, after an interaction effect between financial situation and regimen was tested, it was lower in event-driven users with a difficult/very difficult financial situation (comfortable/just making ends meet & daily, 4.19[2.56-6.86], < 0.001; difficult/very difficult & daily, 6.47[4.05-10.30], < 0.001; comfortable/just making ends meet & event-driven, 1.63[1.22-2.17], 0.001), and in participants who felt alone (0.76[0.58-0.99], 0.042). CONCLUSIONS Community-based clinic attendance and PE contact outside of scheduled visits were both associated with higher PrEP engagement, but some socially and economically marginalized participants struggled with adherence. As scale-up continues in West Africa, we recommend implementing community-based interventions and providing extra support for vulnerable users to ensure adequate PrEP engagement.
Collapse
Affiliation(s)
- August Eubanks
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.
| | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso.,Centre Muraz, Centre Muraz, Institut National de Santé Publique, Bobo-Dioulasso, Burkina Faso
| | | | | | | | | | | | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,ORS PACA, Observatoire Régional de La Santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | - Lucas Riegel
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Daniela Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Issifou Yaya
- TransVIHMI, Univ Montpellier, INSERM, Montpellier, IRD, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | | | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques and Sociales de La Santé and Traitement de L'Information Médicale, ISSPAM, Marseille, France.,ARCAD Santé PLUS, Bamako, Mali
| | | |
Collapse
|
36
|
Curley CM, Rosen AO, Mistler CB, Eaton LA. Pleasure and PrEP: A Systematic Review of Studies Examining Pleasure, Sexual Satisfaction, and PrEP. JOURNAL OF SEX RESEARCH 2022; 59:848-861. [PMID: 35089110 PMCID: PMC9329484 DOI: 10.1080/00224499.2021.2012638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective form of Human Immunodeficiency Virus (HIV) prevention for people at potential risk for exposure. Despite its demonstrated efficacy, PrEP uptake and adherence have been discouraging, especially among groups most vulnerable to HIV transmission. A primary message to persons who are at elevated risk for HIV has been to focus on risk reduction, sexual risk behaviors, and continued condom use, rarely capitalizing on the positive impact on sexuality, intimacy, and relationships that PrEP affords. This systematic review synthesizes the findings and themes from 16 quantitative, qualitative, and mixed methods studies examining PrEP motivations and outcomes focused on sexual satisfaction, sexual pleasure, sexual quality, and sexual intimacy. Significant themes emerged around PrEP as increasing emotional intimacy, closeness, and connectedness; PrEP as increasing sexual options and opportunities; PrEP as removing barriers to physical closeness and physical pleasure; and PrEP as reducing sexual anxiety and fears. It is argued that positive sexual pleasure motivations should be integrated into messaging to encourage PrEP uptake and adherence, as well as to destigmatize sexual pleasure and sexual activities of MSM.
Collapse
Affiliation(s)
- Christine M. Curley
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- The first two authors are co-authors on this manuscript, as they contributed equally to design and analyses
| | - Aviana O. Rosen
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
- The first two authors are co-authors on this manuscript, as they contributed equally to design and analyses
| | - Colleen B. Mistler
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA
| | - Lisa A. Eaton
- Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs, CT, USA
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
37
|
Atkins K, Kan L, Musau A, Reed J, Were D, Mohan D. Adaptation and psychometric evaluation of a scale to measure oral pre-exposure prophylaxis-related stigma among key and vulnerable populations in Kenya. J Int AIDS Soc 2022; 25 Suppl 1:e25929. [PMID: 35818870 PMCID: PMC9274213 DOI: 10.1002/jia2.25929] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 05/04/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION As oral pre-exposure prophylaxis (PrEP) services scale up throughout sub-Saharan Africa (SSA), clients continue to face challenges with sustained PrEP use. PrEP-related stigma has been shown to influence engagement throughout the HIV PrEP care continuum throughout SSA. Validated quantitative measures of PrEP-related stigma in SSA are of critical importance to better understand its impacts at each stage of the HIV PrEP care continuum. This study aimed to psychometrically evaluate a PrEP-related stigma scale for use among key and vulnerable populations in the context of a Kenya national PrEP programme. METHODS As part of a larger prospective cohort study nested within Kenya's Jilinde programme, this study used baseline data collected from 1135 participants between September 2018 and April 2020. We used exploratory factor analysis to evaluate the factor structure of a PrEP-related stigma scale. We also assessed convergent construct validity of the PrEP-Related Stigma Scale by testing for expected correlations with depression and uptake of HIV services. Finally, we examined the relationship between PrEP-related stigma and key demographic, psychosocial and behavioural characteristics. RESULTS We identified four dimensions of PrEP-related stigma: (1) interpersonal stigma, (2) PrEP norms, (3) negative self-image and (4) disclosure concerns. The scale demonstrated strong internal consistency (α = 0.84), was positively correlated with depressive symptoms and negatively correlated with uptake of HIV services. Multivariable regression analysis demonstrated associations between PrEP-related stigma and sex worker identity. CONCLUSIONS The adapted and validated PrEP-Related Stigma Scale can enable programmes to quantify how PrEP-related stigma and its dimensions may differentially impact outcomes on the HIV PrEP care continuum, evaluate stigma interventions and tailor programmes accordingly. Opportunities exist to validate the scale in other populations and explore further dimensions of PrEP-related stigma.
Collapse
Affiliation(s)
- Kaitlyn Atkins
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lena Kan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Jason Reed
- Jhpiego Corporation, Baltimore, Maryland, USA
| | | | - Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
38
|
Mi Y, Zeng Y, Wang P, Zhou M, Cheng F. Cost-Effectiveness of Pre-exposure Prophylaxis Among Men Who Have Sex With Men in China: A Systematic Review. Front Public Health 2022; 10:809268. [PMID: 35801237 PMCID: PMC9253462 DOI: 10.3389/fpubh.2022.809268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/20/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Men who have sex with men in China meet the definition of the population at “substantial risk” of contracting human immunodeficiency virus (HIV) according to the World Health Organization; therefore, initiating pre-exposure prophylaxis (PrEP) is recommended for this population. Lack of convincing evidence on cost-effectiveness has resulted in the lack of large-scale PrEP implementation at a national level. The objective of this review is to assess the cost-effectiveness of pre-exposure prophylaxis implementation among men who have sex with men in China. Methods The following databases were used to search studies of pre-exposure prophylaxis in China in both English and Chinese: PubMed, Embase, the China National Knowledge Infrastructure (CNKI), and the Wanfang Database. Inclusion criteria included pre-exposure intervention, year for publication (2007–2021), setting (China), and cost-effectiveness estimation. Results Seven studies were identified. We found that pre-exposure prophylaxis is only cost-effective among men who have sex with men without prioritization with at least a 5.5% reduction in the market price in the models. Pre-exposure prophylaxis is potentially cost-effective when using the latest market price, combined with other preventive programs or delivered to the population with a high risk of HIV exposure. Conclusion Our study identifies key considerations in cost-effectiveness evaluation: cost assumptions, implementation coverage, and targeted population. The scarce evidence available is not comparable to some extent. However, combined with the latest market and policy reform, the cost-effectiveness of PrEP could be achieved as estimated by the underlying model of the included studies. Consequently, it calls for more standard and transparent modeling studies that include the latest drug types and market prices.
Collapse
Affiliation(s)
- Yuanqi Mi
- School of Nursing, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yuhong Zeng
- Department of Epidemiology, College of Preventive Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Peicheng Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
| | - Mengge Zhou
- Vanke School of Public Health, Tsinghua University, Beijing, China
- School of Medicine, Tsinghua University, Beijing, China
- *Correspondence: Mengge Zhou
| | - Feng Cheng
- Vanke School of Public Health, Tsinghua University, Beijing, China
- Feng Cheng
| |
Collapse
|
39
|
Philpot SP, Murphy D, Chan C, Haire B, Fraser D, Grulich AE, Bavinton BR. Switching to Non-daily Pre-exposure Prophylaxis Among Gay and Bisexual Men in Australia: Implications for Improving Knowledge, Safety, and Uptake. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1979-1988. [PMID: 35730059 DOI: 10.1007/s13178-021-00669-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Preexposure prophylaxis (PrEP) dosing options such as event-driven PrEP hold promise to increase PrEP uptake among gay, bisexual, and queer men (GBQM), but their impacts have not yet been realized and uptake by GBQM suitable for PrEP remains slow in countries where it is only considered an alternative option to daily PrEP. METHODS We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBQM in Australia to understand PrEP dosing behaviors, knowledge, and preferences. RESULTS All participants commenced PrEP daily; 35% had ever switched to non-daily PrEP, mostly taking it event-driven. GBQM who preferred non-daily PrEP had infrequent or predictable sex, were concerned about cost given infrequency of sex, and/or wanted to minimize unnecessary drug exposure. Accurate knowledge of event-driven PrEP was poor. However, reflecting concepts underpinning critical pedagogy, having accurate knowledge was supported by access to consistent messaging across clinical, social, community, and public settings. Several participants who switched to event-driven PrEP had condomless sex events in which they were unable to adhere to pills due to unanticipated sex. CONCLUSIONS AND POLICY IMPLICATIONS Implementation of comprehensive and consistent education about correct dosing for event-driven PrEP across multiple settings is needed to ensure increased uptake and safe use. GBQM require messaging about non-condom based HIV prevention strategies when they cannot access daily or event-driven PrEP.
Collapse
Affiliation(s)
| | - Dean Murphy
- The Kirby Institute, UNSW, Sydney, Australia
| | - Curtis Chan
- The Kirby Institute, UNSW, Sydney, Australia
| | | | - Doug Fraser
- The Kirby Institute, UNSW, Sydney, Australia
| | | | | |
Collapse
|
40
|
Jin X, Shi L, Wang C, Qiu T, Yin Y, Shen M, Fu G, Peng Z. Cost-effectiveness of oral pre-exposure prophylaxis and expanded antiretroviral therapy for preventing HIV infections in the presence of drug resistance among men who have sex with men in China: A mathematical modelling study. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 23:100462. [PMID: 35542892 PMCID: PMC9079770 DOI: 10.1016/j.lanwpc.2022.100462] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Oral pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) can effectively prevent HIV infections among men who have sex with men (MSM), but the emergence and transmission of HIV drug-resistance (HIVDR) may compromise their benefits. The costs and benefits of expanding PrEP and ART coverage in the presence of HIVDR in China remain unknown. Methods We developed a comprehensive dynamic transmission model incorporating the transmitted (TDR) and acquired (ADR) HIV drug resistance. The model was calibrated by the HIV surveillance data from 2009 to 2019 among MSM in Jiangsu Province, China, and validated by the dynamic prevalence of ADR and TDR. We aimed to investigate the impact of eight intervention scenarios (no PrEP, 20%, 50% or 80% of PrEP, without (77% coverage) or with (90% coverage) expanded ART) on the HIV epidemic trend and cost-effectiveness of PrEP over the next 30 years. Findings 20% or 50% PrEP + 90% ART would be cost-effective, with an incremental cost-effectiveness ratio (ICER) of 25,417 (95% confidence interval [CI]: 12,390–38,445) or 47,243 (23,756–70,729), and would yield 154,949 (89,662–220,237) or 179,456 (102,570–256,342) incremental quality-adjusted life-years (QALYs) over the next 30 years. No PrEP + 90% ART would yield 125,211 (73,448–176,974) incremental QALYs and be cost-saving. However, 20–80% PrEP + 77% ART and 80% PrEP + 90% ART with ICER of $77,862–$98,338 and $63,332, respectively, and were not cost-effective. A reduction of 64% in the annual cost of oral PrEP would make it highly cost-effective for 50% PrEP + 90% ART. Interpretation 20% or 50% PrEP + 90% ART is cost-effective for HIV control in the presence of HIVDR. Expanded ART alone may be the optimal policy under the current limited budgets. Funding National Natural Science Foundation of China, the National S&T Major Project Foundation of China.
Collapse
|
41
|
Eubanks A, Coulibaly B, Dembélé Keita B, Anoma C, Dah TTE, Mensah E, Maradan G, Bourrelly M, Mora M, Riegel L, Rojas Castro D, Yaya I, Spire B, Laurent C, Sagaon-Teyssier L. Rate and Predictors of Ineffective HIV Protection in African Men Who Have Sex with Men Taking Pre-Exposure Prophylaxis. AIDS Behav 2022; 26:3524-3537. [PMID: 35469111 DOI: 10.1007/s10461-022-03692-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/30/2022]
Abstract
We investigated the rate and predictors of ineffective HIV protection in men who have sex with men (MSM) taking pre-exposure prophylaxis (PrEP) in a prospective cohort study from November 2017 to November 2020 in Mali, Côte d'Ivoire, Burkina Faso, and Togo. MSM had to be 18 years or older and at high risk of HIV infection to participate. They also received a comprehensive sexual health prevention package, including PrEP, in community-based clinics as part of the cohort study. Using socio-behavioral/clinical data, HIV protection during their most recent anal intercourse with a male partner was categorized as effective or ineffective (i.e., incorrect PrEP adherence and no condom use). Seventeen percent (500/2839) of intercourses were ineffectively protected for the 520 study participants. Predictors of ineffective HIV protection included being an event-driven user with financial difficulties, having a high alcohol misuse score, and not being a member of a community association. PrEP programs in West Africa must be tailored to socially vulnerable MSM who struggle to adopt PrEP.
Collapse
Affiliation(s)
- August Eubanks
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France.
| | | | | | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso
- Institut National de Santé Publique, Centre Muraz, Bobo-Dioulasso, Burkina Faso
| | | | - Gwenaëlle Maradan
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- ORS PACA, Observatoire Régional de la santé Provence-Alpes-Côte d'Azur, Marseille, France
| | - Michel Bourrelly
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | - Lucas Riegel
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Daniela Rojas Castro
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | - Issifou Yaya
- TransVIHMI, Univ Montpellier, INSERM, Montpellier, IRD, France
| | - Bruno Spire
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
| | | | - Luis Sagaon-Teyssier
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de L'Information Médicale, ISSPAM, Marseille, France
- ARCAD Santé PLUS, Bamako, Mali
| |
Collapse
|
42
|
Zhou L, Assanangkornchai S, Shi Z, Jiang F, Yang D, Shi W. Acceptability of Pre-Exposure Prophylaxis and Non-Occupational Post-Exposure Prophylaxis among Men Who Have Sex with Men in Guilin, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063579. [PMID: 35329266 PMCID: PMC8951311 DOI: 10.3390/ijerph19063579] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/15/2022]
Abstract
Pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) are both effective strategies for preventing HIV. There is limited information about the acceptability of these prevention measures in undeveloped areas of China. We aimed to examine the acceptability of PrEP and nPEP and their determinants among men who have sex with men (MSM). 219 MSM were recruited in Guilin, China. In total, 28.6% (95% CI: 20.0–41.0) and 35.9% (95% CI: 27.3–49.5) of the participants had heard of PrEP and nPEP, respectively, while 57.0% (95% CI: 43.1–68.2) and 58.6 (95% CI:44.8–68.8) reported they would be willing to use PrEP and nPEP after the methods were explained. A higher acceptability of PrEP was seen among participants who were previously married (aOR = 3.30; 95% CI: 1.22–9.19), working as a laborer (aOR = 5.13; 95% CI: 1.64–17.59), migrant workers/farmers (aOR = 2.56; 95% CI: 1.15–5.79), government employees (aOR = 4.76; 95%CI: 1.80–13.02), had higher social support (aOR = 1.05; 95% CI: 1.03–1.08), and had been previously tested for HIV (aOR = 2.79; 95% CI: 1.36–5.94). A higher acceptability of nPEP was associated with those having higher social support (aOR = 1.06; 95% CI: 1.04–1.09), not knowing their sexual partner’s HIV status (aOR = 2.72; 95% CI: 1.23–6.12), and having a prior HIV test (aOR = 5.53; 95% CI: 2.58–12.51). PrEP and nPEP are acceptable, especially among MSM with higher social support and had received a previous HIV test. Effective education and different dissemination strategies to promote the acceptance of PrEP and nPEP among MSM are needed.
Collapse
Affiliation(s)
- Lingmi Zhou
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand;
- Department of AIDS Control and Prevention, Guilin Center for Disease Control and Prevention, Guilin 541000, China; (Z.S.); (F.J.); (D.Y.)
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand;
- Correspondence: (S.A.); (W.S.)
| | - Zhaohui Shi
- Department of AIDS Control and Prevention, Guilin Center for Disease Control and Prevention, Guilin 541000, China; (Z.S.); (F.J.); (D.Y.)
| | - Fusheng Jiang
- Department of AIDS Control and Prevention, Guilin Center for Disease Control and Prevention, Guilin 541000, China; (Z.S.); (F.J.); (D.Y.)
| | - Dong Yang
- Department of AIDS Control and Prevention, Guilin Center for Disease Control and Prevention, Guilin 541000, China; (Z.S.); (F.J.); (D.Y.)
| | - Wuxiang Shi
- Health Management Unit, Faculty of Humanities and Management, Guilin Medical University, Guilin 541004, China
- Correspondence: (S.A.); (W.S.)
| |
Collapse
|
43
|
Lin B, Liu J, He W, Pan H, Ma Y, Zhong X. Effect of Reminder System on Pre-exposure Prophylaxis Adherence in Men Who Have Sex with Men: A Prospective Cohort Study Based on WeChat Intervention (Preprint). J Med Internet Res 2022; 24:e37936. [PMID: 35969436 PMCID: PMC9412721 DOI: 10.2196/37936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 06/16/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions Trial Registration
Collapse
Affiliation(s)
- Bing Lin
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
| | - Jiaxiu Liu
- School of Medical Informatics, Chongqing Medical University, Chongqing, China
| | - Wei He
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
| | - Haiying Pan
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
| | - Yingjie Ma
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
| | - Xiaoni Zhong
- School of Public Health and Management, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
| |
Collapse
|
44
|
Sun Z, Gu Q, Dai Y, Zou H, Agins B, Chen Q, Li P, Shen J, Yang Y, Jiang H. Increasing awareness of HIV pre-exposure prophylaxis (PrEP) and willingness to use HIV PrEP among men who have sex with men: a systematic review and meta-analysis of global data. J Int AIDS Soc 2022; 25:e25883. [PMID: 35255193 PMCID: PMC8901150 DOI: 10.1002/jia2.25883] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 01/17/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Integrated knowledge regarding pre‐exposure prophylaxis (PrEP) awareness and willingness to use PrEP can be useful for HIV prevention in high incidence groups. This review summarizes the awareness of PrEP and willingness to use PrEP among men who have sex with men (MSM). Methods Online electronic databases were searched before 31 August 2021. A meta‐analysis was conducted to pool studies analysing PrEP awareness and willingness to use PrEP. LOESS regression and linear regression were applied to fit the trends over time for the proportion of MSM aware of PrEP and willing to use PrEP. Dose–response meta‐analysis (DRMA) was conducted by a restricted cubic spline model to explore the relationship between willingness to use PrEP and selected factors. Results and Discussion A total of 156 articles involving 228,403 MSM were included. The pooled proportions of MSM aware of PrEP and willing to use PrEP were 50.0 (95% CI: 44.8–55.2) and 58.6% (95% CI: 54.8–62.4), respectively. PrEP awareness varied among countries with different economic status and different WHO regions, among different publication and research years, PrEP types and support policies. PrEP willingness differed among countries with different economic status and groups with different risks of HIV. The awareness of PrEP increased from 2007 to 2019 with a slope of 0.040260 (p<0.0001), while the proportion of MSM willing to use PrEP decreased from 2007 to 2014 (slope = –0.03647, p = 0.00390) but increased after 2014 (slope = 0.04187, p = 0.03895). The main facilitators of willingness to use PrEP were PrEP awareness, condomless sexual behaviours, high perceived risk of HIV infection and influence of social network. The main barriers were doubts about the efficacy and side effects of PrEP. DRMA results indicated that MSM with more sexual partners and lower level of education were more willing to use PrEP. No publication bias was observed. Conclusions The proportions of PrEP awareness and willingness to use PrEP among MSM have increased since 2014, although the awareness was low and the willingness was moderate. Improving awareness of PrEP through increasing access to PrEP‐related health education and enhancing risk perceptions of HIV infection could have positive effects on the willingness to use PrEP among MSM.
Collapse
Affiliation(s)
- Zhishan Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, PR China
| | - Qianfei Gu
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, PR China
| | - Yifan Dai
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, PR China
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China.,Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.,School of Public Health, Shanghai Jiao Tong University, Shanghai, PR China
| | - Bruce Agins
- HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, California, USA
| | - Qiaosen Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, PR China
| | - Peiyang Li
- School of Public Health, Sun Yat-sen University, Guangzhou, PR China
| | - Junchun Shen
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, PR China
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, PR China
| | - Hongbo Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, PR China.,Guangdong Provincial Engineering Research Center of Public Health Detection and Assessment, Guangdong Pharmaceutical University, Guangzhou, PR China
| |
Collapse
|
45
|
Orser L, O'Byrne P, Holmes D. Perceptions, motivations, and beliefs about HIV risk and pre-exposure prophylaxis (PrEP) among participants in a nurse-led PrEP service (PrEP-RN). BMC Infect Dis 2022; 22:196. [PMID: 35227202 PMCID: PMC8883450 DOI: 10.1186/s12879-022-07146-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 02/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background While HIV pre-exposure prophylaxis (PrEP) has become more readily available in Canada, its uptake among HIV priority populations continues to be affected by system-level and individual factors. Such impediments relate to challenges by healthcare providers in assessing HIV-related risk and variability in patients’ motivations for PrEP initiation and continued engagement in care. Methods In Ottawa, Canada, a group of researchers implemented Canada’s first nurse-led HIV prevention program, known as PrEP-RN. As part of this pilot, qualitative interviews were completed with fourteen patients who had accessed PrEP-RN. The purpose of these interviews was to understand participants’ perspectives related to HIV prevention and experiences accessing care through a nurse-led service. Interviews were analyzed using thematic analysis, which were organized into the two major themes of (1) motivations for PrEP initiation and (2) beliefs about the benefits of PrEP. Results Findings revealed participants’ motivations for PrEP differed from healthcare provider’s views of risk, which were influenced by external life factors and personal perceptions of risk. In addition, participants discussed the benefits of PrEP in terms of its ability to manage their potential mistrust of sexual partners, control their sexual health, and liberate fears and anxieties related to HIV. Conclusions Based on these findings, health and allied providers should consider incorporating individual motivations and beliefs into patient education and counselling about PrEP to better target HIV prevention care at persons are at elevated risk of HIV. These perspectives could also be used to re-structure web and social media campaigns to increase PrEP uptake among HIV priority populations.
Collapse
Affiliation(s)
- Lauren Orser
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada. .,Sexual Health and Harm Reduction Services, Ottawa Public Health, Ottawa, ON, Canada.
| | - Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada.,Sexual Health and Harm Reduction Services, Ottawa Public Health, Ottawa, ON, Canada
| | - Dave Holmes
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
46
|
Gómez W, Holloway IW, Pantalone DW, Grov C. PrEP uptake as a social movement among gay and bisexual men. CULTURE, HEALTH & SEXUALITY 2022; 24:241-253. [PMID: 33118858 PMCID: PMC8081761 DOI: 10.1080/13691058.2020.1831075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 09/28/2020] [Indexed: 05/31/2023]
Abstract
Despite PrEP's effectiveness as an HIV prevention intervention, uptake among gay and bisexual men remains low. Historical involvement in AIDS activism may reveal important ways of mobilising gay and bisexual men to increase PrEP uptake. Data come from a qualitative study to understand New York City gay and bisexual men's experiences with PrEP. Informed by a constructivist grounded theory approach, we assessed ways in which gay and bisexual men's relational experiences concerning PrEP were congruent with features of past AIDS activism. Participants' mean age was 32.5 years, half were men of colour, and over half had been taking PrEP for less than one year. Analysis revealed three primary themes related to AIDS activism strategies: (1) framing, which referenced how participants referred to PrEP as an empowering, liberatory and community-building intervention (2) reactions, which encompassed positive to negative expressions about PrEP and sex; and (3) innovation, which conveyed ways that participants engaged in processes of transferring lay knowledge about PrEP through leadership roles across social and digital encounters. Findings suggest that the ways in which gay and bisexual men communicate about PrEP with peers are consistent with features of AIDS activism. Deploying lay knowledge using framing strategies through peer-based intervention could expand PrEP uptake. However, elements of PrEP stigma must be addressed to engage with the wide-ranging HIV prevention needs of gay and bisexual men.
Collapse
Affiliation(s)
- Walter Gómez
- School of Social Welfare, University of California, Berkeley, CA, USA
| | - Ian W. Holloway
- Luskin School of Public Affairs, University of California, Los Angeles, CA, USA
| | - David W. Pantalone
- College of Liberal Arts, University of Massachusetts, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Christian Grov
- City University of New York, Graduate School of Public Health and Health Policy, New York, NY, USA
- City University of New York, Institute for Implementation Science in Population Health, New York, NY, USA
| |
Collapse
|
47
|
Wang H, Wang Z, Huang X, Chen Y, Wang H, Cui S, Zhang J, Chu Z, Hu Q, Ding H, Qian H, Zou H, Tang W, Gao Y, Jin X, Liu Z, Zhang L, Zhao J, He X, Jiang Y, Geng W, Xu J, Shang H. Association of HIV Preexposure Prophylaxis Use With HIV Incidence Among Men Who Have Sex With Men in China: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e2148782. [PMID: 35171258 PMCID: PMC8851305 DOI: 10.1001/jamanetworkopen.2021.48782] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE Evidence on HIV preexposure prophylaxis (PrEP) among Chinese men who have sex with men (MSM) is critical to guide its large-scale implementation in low- and middle-income countries. OBJECTIVE To evaluate incident HIV infection, adherence, safety, and changes in sexual behaviors among MSM using daily PrEP (D-PrEP) and event-driven PrEP (ED-PrEP) in 4 cities in China. DESIGN, SETTING, AND PARTICIPANTS This nonrandomized controlled trial was conducted among HIV-seronegative MSM from December 11, 2018, to November 30, 2020, in Beijing, Shenyang, Chongqing, and Shenzhen. Participants self-chose D-PrEP or ED-PrEP regimens at baseline and could switch regimens during the 12-month study period. HIV-negative MSM who declined to initiate PrEP (nonusers) in the same cities joined a separate parallel prospective cohort and served as control individuals. INTERVENTIONS PrEP consisted of coformulated tenofovir disoproxil fumarate, 300 mg, and emtricitabine, 200 mg. MAIN OUTCOMES AND MEASURES The main outcome was incident HIV infection. Poisson regression was used to obtain the HIV incidence rate ratio (IRR). RESULTS A total of 1530 MSM were included in the analysis (median age, 30 [IQR, 25-37] years). At baseline, 520 MSM chose D-PrEP (median age, 29 [IQR, 25-35] years) and 503 chose ED-PrEP (median age, 29 [IQR, 25-36] years). The median HIV Risk Index score was 18 (IQR, 12-22) among D-PrEP users and 18 (IQR, 11-22) among ED-PrEP users. Among 507 PrEP nonusers, the median age was 33 (IQR, 27-43) years, and the median HIV Risk Index score was 12 (IQR, 7-18). Although PrEP users had more baseline behaviors associated with HIV risk, the HIV incidence was lower among all PrEP users (adjusted IRR, 0.09 [95% CI, 0.04-0.21]), ED-PrEP users (adjusted IRR, 0.05 [95% CI, 0.01-0.22]), and D-PrEP users (adjusted IRR, 0.12 [95% CI, 0.04-0.33]) compared with PrEP nonusers. There was no difference in HIV incidence between D-PrEP users and ED-PrEP users (IRR, 0.33 [95% CI, 0.06-2.04]). Event-driven PrEP users consumed 40% fewer tablets than D-PrEP users during the study period. Adherence, defined as the proportion of self-reported days with sexual intercourse in which PrEP was taken according to prescription of at least 90%, increased over time among ED-PrEP users (from 57.4% to 77.8%; P < .001 for trend) and decreased over time among D-PrEP users (from 75.1% to 72.1%; P = .02 for trend). Daily PrEP users reported fewer adverse events than ED-PrEP users (193 of 520 [37.1%] vs 241 of 503 [47.9%]). CONCLUSIONS AND RELEVANCE The findings of this study suggest that D-PrEP and ED-PrEP regimens are associated with lower incidence of HIV and a good safety profile among high-risk MSM in China. TRIAL REGISTRATION Chinese Clinical Trial Registry number: ChiCTR-IIN-17013762.
Collapse
Affiliation(s)
- Hongyi Wang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zixin Wang
- JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiaojie Huang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yaokai Chen
- Chongqing Public Health Medical Center, Chongqing, China
| | - Hui Wang
- Department of Infectious Diseases, National Clinical Center for Infectious Diseases, Third People’s Hospital of Shenzhen (Second Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Sitong Cui
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Jing Zhang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhenxing Chu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Qinghai Hu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Haibo Ding
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hanzhu Qian
- School of Public Health, Yale University, New Haven, Connecticut
| | - Huachun Zou
- School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China
| | - Weiming Tang
- University of North Carolina at Chapel Hill Project–China, Guangzhou, China
| | - Yangyang Gao
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Xia Jin
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Zhaozhen Liu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Lukun Zhang
- Department of Infectious Diseases, National Clinical Center for Infectious Diseases, Third People’s Hospital of Shenzhen (Second Affiliated Hospital of Southern University of Science and Technology), Shenzhen, China
| | - Jin Zhao
- Shenzhen Center for Disease Control and Prevention Shenzhen, Guangdong, China
| | - Xiaoqing He
- Chongqing Public Health Medical Center, Chongqing, China
| | - Yongjun Jiang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Wenqing Geng
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Junjie Xu
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Hong Shang
- NHC Key Laboratory of AIDS Immunology (China Medical University), National Clinical Research Center for Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang
- Key Laboratory of AIDS Immunology, Chinese Academy of Medical Sciences, Shenyang
- Key Laboratory of AIDS Immunology of Liaoning Province, Shenyang, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| |
Collapse
|
48
|
Wray TB, Chan PA, Guigayoma JP, Kahler CW. Game Plan-a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis. JMIR Form Res 2022; 6:e30408. [PMID: 34989679 PMCID: PMC8771347 DOI: 10.2196/30408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/18/2021] [Accepted: 11/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background HIV pre-exposure prophylaxis (PrEP) has considerable potential for reducing incidence among high-risk groups, such as gay, bisexual, and other men who have sex with men (GBM). However, PrEP’s effectiveness is closely linked with consistent use, and a variety of individual-level barriers, including alcohol use, could impede optimal uptake and use. Web-based interventions can encourage medication adherence, HIV prevention behaviors, and responsible drinking and may help support PrEP care, particularly in resource-limited settings. Objective We previously developed a web application called Game Plan that was designed to encourage heavy drinking GBM to use HIV prevention methods and reduce their alcohol use and was inspired by brief motivational interventions. This paper aims to describe the web-based content we designed for integration into Game Plan to help encourage PrEP uptake and consistent use among GBM. In this paper, we also aim to describe this content and its rationale. Methods Similar to the original site, these components were developed iteratively, guided by a thorough user-centered design process involving consultation with subject-matter experts, usability interviews and surveys, and user experience surveys. Results In addition to Game Plan’s pre-existing content, the additional PrEP components provide specific, personal, and digestible feedback to users about their level of risk for HIV without PrEP and illustrate how much consistent PrEP use could reduce it; personal feedback about their risk for common sexually transmitted infections to address low-risk perceptions; content challenging common beliefs and misconceptions about PrEP to reduce stigma; content confronting familiar PrEP and alcohol beliefs; and a change planning module that allows users to select specific goals for starting and strategies for consistent PrEP use. Users can opt into a weekly 2-way SMS text messaging program that provides similar feedback over a 12-week period after using Game Plan and follows up on the goals they set. Conclusions Research preliminarily testing the efficacy of these components in improving PrEP outcomes, including uptake, adherence, sexually transmitted infection rates, and alcohol use, is currently ongoing. If supported, these components could provide a scalable tool that can be used in resource-limited settings in which face-to-face intervention is difficult.
Collapse
Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Philip A Chan
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - John P Guigayoma
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, RI, United States
| |
Collapse
|
49
|
Philpot SP, Murphy D, Chan C, Haire B, Fraser D, Grulich AE, Bavinton BR. Switching to Non-daily Pre-exposure Prophylaxis Among Gay and Bisexual Men in Australia: Implications for Improving Knowledge, Safety, and Uptake. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1979-1988. [PMID: 35730059 PMCID: PMC9203261 DOI: 10.1007/s13178-022-00736-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Preexposure prophylaxis (PrEP) dosing options such as event-driven PrEP hold promise to increase PrEP uptake among gay, bisexual, and queer men (GBQM), but their impacts have not yet been realized and uptake by GBQM suitable for PrEP remains slow in countries where it is only considered an alternative option to daily PrEP. METHODS We conducted semi-structured interviews between June 2020 and February 2021 with 40 GBQM in Australia to understand PrEP dosing behaviors, knowledge, and preferences. RESULTS All participants commenced PrEP daily; 35% had ever switched to non-daily PrEP, mostly taking it event-driven. GBQM who preferred non-daily PrEP had infrequent or predictable sex, were concerned about cost given infrequency of sex, and/or wanted to minimize unnecessary drug exposure. Accurate knowledge of event-driven PrEP was poor. However, reflecting concepts underpinning critical pedagogy, having accurate knowledge was supported by access to consistent messaging across clinical, social, community, and public settings. Several participants who switched to event-driven PrEP had condomless sex events in which they were unable to adhere to pills due to unanticipated sex. CONCLUSIONS AND POLICY IMPLICATIONS Implementation of comprehensive and consistent education about correct dosing for event-driven PrEP across multiple settings is needed to ensure increased uptake and safe use. GBQM require messaging about non-condom based HIV prevention strategies when they cannot access daily or event-driven PrEP.
Collapse
Affiliation(s)
| | - Dean Murphy
- The Kirby Institute, UNSW, Sydney, Australia
| | - Curtis Chan
- The Kirby Institute, UNSW, Sydney, Australia
| | | | - Doug Fraser
- The Kirby Institute, UNSW, Sydney, Australia
| | | | | |
Collapse
|
50
|
Chan C, Vaccher S, Fraser D, Grulich AE, Holt M, Zablotska-Manos I, Prestage GP, Bavinton BR. Preferences for Current and Future PrEP Modalities Among PrEP-Experienced Gay and Bisexual Men in Australia. AIDS Behav 2022; 26:88-95. [PMID: 34142274 DOI: 10.1007/s10461-021-03344-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 01/02/2023]
Abstract
Alternatives to daily dosing of HIV pre-exposure prophylaxis (PrEP) are continuing to emerge. From October 2019 to March 2020, we conducted an online survey of PrEP-experienced gay and bisexual men in Australia about interest in and preference for four different PrEP modalities: daily dosing, event-driven dosing, long-acting injectable (LAI)-PrEP and subdermal PrEP implants. Using data from 1477 participants, we measured interest and preference of different modalities using multivariate logistic regression. High proportions of participants were interested in LAI-PrEP (59.7%), daily PrEP (52.0%), PrEP implants (45.3%) and event-driven PrEP (42.8%). LAI-PrEP was the most frequently selected preference (30.5%), followed by PrEP implants (26.3%), daily PrEP (21.4%) and event-driven PrEP (21.2%). Higher interest and preference for non-daily PrEP modalities were associated with being concerned about side effects and perceived difficulties with daily adherence. As novel modalities emerge, attitudes to them should be considered in public health messaging to facilitate informed decision-making.
Collapse
Affiliation(s)
- Curtis Chan
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia.
| | | | - Doug Fraser
- The Kirby Institute, UNSW Sydney, Sydney, NSW, 2052, Australia
| | | | - Martin Holt
- The Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, Australia
| | - Iryna Zablotska-Manos
- Sydney Medical School - Westmead and Western Sydney Sexual Health Centre, University of Sydney, Sydney, Australia
| | | | | |
Collapse
|