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Ribas Rietti Souto A, Aikhuele E, Esposito M, Rainer C, Budhwani H, Hightow-Weidman L, Tolley B, Maragh-Bass A. Patient and Provider Perceptions of Barriers and Facilitators to Pre-exposure Prophylaxis Access and Adherence in Black and Latinx Young Men Who Have Sex with Men. AIDS Patient Care STDS 2024; 38:315-323. [PMID: 38916119 DOI: 10.1089/apc.2024.0083] [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: 06/26/2024] Open
Abstract
In the United States, the use of pre-exposure prophylaxis (PrEP) has led to a substantial decrease in HIV prevalence and incidence. However, some populations, including young men who have sex with men (YMSM) of color, continue to be disproportionately impacted, highlighting the need for tailored interventions addressing barriers to adequate PrEP access. In collaboration with partner clinics, we recruited 19 PrEP clients and 19 PrEP providers (n = 35) to participate in hour-long in-depth interviews. Although client interviews explored personal experiences with stigma, barriers, and motivators to PrEP and information preferences, provider interviews explored providers' perceived stigma in their clinic, perceived barriers and motivators to meeting clients' PrEP needs, and rapport building with clients. Most participants were affiliated with one of the southern partner clinics. Clients and providers noted similar determinants to PrEP access, uptake, and adherence. Both recognized the impact of personal barriers such as routine adjustments and perception of need, as well as institutional barriers such as transportation and financial difficulties. Clients emphasized the role of the client-provider relationship as part of contributing to willingness to disclose information such as HIV status and sexual practices. Providers noted the importance of sexual health and LGBTQ+ topics in their training. Despite limited geographical scope and the sensitive nature of HIV-related topics, this study has several implications. PrEP clinics may benefit from hiring providers who share identities and experiences with YMSM clients of color and operating with a flexible schedule. Medical provider training should include comprehensive sexual health and LGBTQ+ competencies to reduce bias in care.
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Affiliation(s)
- Amanda Ribas Rietti Souto
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences (BECS) Division, Durham, North Carolina, USA
| | - Ese Aikhuele
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences (BECS) Division, Durham, North Carolina, USA
| | - Maria Esposito
- The University of North Carolina at Chapel Hill (NC), Center for Health Equity Research, Chapel Hill, North Carolina, USA
| | - Crissi Rainer
- Florida State University College of Nursing, Tallahassee, Florida, USA
| | - Henna Budhwani
- Florida State University College of Nursing, Tallahassee, Florida, USA
| | | | - Betsy Tolley
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences (BECS) Division, Durham, North Carolina, USA
| | - Allysha Maragh-Bass
- FHI 360, Behavioral, Epidemiological, and Clinical Sciences (BECS) Division, Durham, North Carolina, USA
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Ferguson L, Grangeiro A, Natividad AA, Massa P, Rodrigues A, Ferraz D, Zucchi EM. Are Rights-Based Services Important? An Adolescent PrEP Demonstration Project in Brazil. Health Hum Rights 2024; 26:71-86. [PMID: 38933221 PMCID: PMC11197856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
In this study, we systematically examined the importance of human rights standards and principles for rights-based pre-exposure prophylaxis (PrEP) provision for marginalized adolescents. Nested within a demonstration study of PrEP provision to adolescent men who have sex with men, travestis, and transgender women, we carried out interviews in São Paulo, Brazil with 25 adolescents, eight health providers, and six workers involved in community-based demand creation. Analysis focused on participants' narratives about aspects of human rights within service delivery, including the availability, accessibility, acceptability, and quality of services; informed decision-making; nondiscrimination; and privacy and confidentiality. Clients and service providers highlighted the importance of availing a range of services beyond PrEP and described how community outreach and social media helped promote accessibility. Acceptability centered around clients feeling heard and respected. Health workers appreciated having time to build trusting relationships with clients to ensure quality of care and support informed decision-making. Nondiscrimination was valued by all, including using clients' chosen pronouns. Privacy and confidentiality were primary concerns for clients who were not "out" about their sexuality or PrEP use; to mitigate this, health workers sought to accommodate clients' preferred channels of communication. Rights-based PrEP services can help promote engagement and retention in PrEP services, particularly for marginalized populations.
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Affiliation(s)
- Laura Ferguson
- Associate professor of population and public health sciences at the University of Southern California (USC) and director of research at the USC Institute on Inequalities in Global Health, Los Angeles, United States
| | - Alexandre Grangeiro
- Scientific researcher in the Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Paula Massa
- Researcher in the Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ayra Rodrigues
- Researcher in the Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brazil
| | - Dulce Ferraz
- Postdoctoral fellow at the University of Lyon, France, and a public health analyst at Fundação Oswaldo Cruz, Brasília, Brazil
| | - Eliana Miura Zucchi
- Assistant professor in the Programa de Pós-Graduação em Saúde Coletiva, Universidade Católica de Santos, Santos, Brazil
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Goodreau SM, Barry MP, Hamilton DT, Williams AM, Wang LY, Sanchez TH, Katz DA, Delaney KP. Behavior Change Among HIV-Negative Men Who Have Sex with Men Not Using PrEP in the United States. AIDS Behav 2024; 28:1766-1780. [PMID: 38411799 DOI: 10.1007/s10461-024-04281-7] [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: 01/25/2024] [Indexed: 02/28/2024]
Abstract
This study measures changes in condomless anal sex (CAS) among HIV-negative men who have sex with men (MSM) who are not taking pre-exposure prophylaxis (PrEP). It considers the 2014-2019 cycles of the American Men's Internet Survey, a serial, cross-sectional web-based survey of US cisgender MSM aged ≥ 15 years, in which ~ 10% of each year's sample is drawn from the previous year. Among those surveyed for 2 years who remained HIV-negative and off PrEP, reports of having any CAS and of CAS partner number were compared across years. We disaggregated by partner HIV status, and considered demographic predictors. The overall population saw a significant 2.2 percentage-point (pp) increase in reports of any CAS year-over-year. Sub-populations with the largest year-on-year increases were 15-24-year-olds (5.0-pp) and Hispanic respondents (5.1-pp), with interaction (young Hispanic respondents = 12.8-pp). On the relative scale, these numbers correspond to 3.2%, 7.2%, 7.3% and 18.7%, respectively. Absolute increases were concentrated among partners reported as HIV-negative. Multivariable analyses for CAS initiation found effects concentrated among Hispanic and White youth and residents of fringe counties of large metropolitan areas. CAS partner number increases were similarly predicted by Hispanic identity and young age. Although condom use remains more common than PrEP use, increasing CAS among MSM not on PrEP suggests potential new HIV transmission pathways. Concentration of increases among 18-24-year-old MSM portends future increases in the proportion of newly diagnosed HIV that occur among youth. Concentration among young Hispanic MSM will likely expand existing disparities. Although reducing barriers to PrEP remains vital, condom promotion for MSM remains a key public health practice and appears to be missing key audiences. LGBTQ+-inclusive sex education is one avenue for enhancing these efforts.
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Affiliation(s)
- Steven M Goodreau
- Department of Anthropology, University of Washington, Campus Box 353100, Seattle, WA, 98122, USA.
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA.
| | - Michael P Barry
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Center for AIDS & STD, University of Washington, Seattle, WA, USA
| | - Deven T Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, USA
| | - Austin M Williams
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Li Yan Wang
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - David A Katz
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kevin P Delaney
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Rosen JG, Beckham SW, Glick JL, White RH, Park JN, Footer KH, Sherman SG. Acceptability of Event-Driven and Long-Acting HIV Pre-Exposure Prophylaxis Formulations Among Transgender Women Engaged in Street-Based Sex Work in Baltimore, Maryland. Transgend Health 2024; 9:185-191. [PMID: 38585249 PMCID: PMC10998007 DOI: 10.1089/trgh.2022.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We assessed acceptability of nonoral HIV pre-exposure prophylaxis (PrEP) formulations among transgender women (TW) engaged in street-based sex work in Baltimore, Maryland. In a K-means cluster analysis, TW (N=36) were partitioned into groups characterized by high interest in long-acting injectable PrEP only (Injectable Enthusiasts, 36%), high interest in injectables and subdermal implants (Long-Acting Acceptors, 36%), and low interest across PrEP formulations (Non-Acceptors, 28%). TW's interest in novel PrEP agents varied widely across formulations (range: 22-66%) and clustered around numerous relational, occupational, and structural factors, highlighting the importance of availing multiple PrEP formulations for this impacted population.
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Affiliation(s)
- Joseph G. Rosen
- Department of International Health and Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - S. Wilson Beckham
- Department of International Health and Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jennifer L. Glick
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Rebecca Hamilton White
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ju Nyeong Park
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine H.A. Footer
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Susan G. Sherman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Keddem S, Thatipelli S, Caceres O, Roder N, Momplaisir F, Cronholm P. Barriers and Facilitators to Long-Acting Injectable HIV Pre-Exposure Prophylaxis Implementation in Primary Care Since Its Approval in the United States. J Acquir Immune Defic Syndr 2024; 95:370-376. [PMID: 38133586 PMCID: PMC10932839 DOI: 10.1097/qai.0000000000003370] [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: 08/21/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) is a highly effective method to mitigate the HIV epidemic, but uptake of PrEP has been slow and is associated with racial and gender disparities. Oral PrEP requires high levels of adherence to be effective, which may disadvantage certain high-risk groups. The first injectable HIV PrEP, a drug given every 2 months rather than as a daily pill, was approved by the US Food & Drug Administration in December 2021. SETTING A Family Medicine practice in a single health organization in the United States (November 2022 to February 2023). METHODS We conducted interviews with patients and key stakeholders to characterize factors affecting long-acting injectable (LAI) PrEP implementation. Data collection and analysis were guided by the Consolidated Framework for Implementation Research. Interviews were transcribed and analyzed using guided content analysis. RESULTS Twenty-five patients (n = 13) and practice stakeholders (n = 12) were interviewed. Overall, stakeholders described a very low uptake of LAI PrEP. Barriers to LAI PrEP included a lack of awareness, insurance and access issues, a lack of streamlined workflow, and a trust in pills over injectables. Facilitators to LAI PrEP implementation included the absence of a pill burden, a culture of shared decision making, and pharmacy support. CONCLUSIONS Although uptake has been slow, we have identified several promising strategies for improving rollout and implementation of LAI PrEP. Approaches that can bolster rollout of LAI PrEP include having an interdisciplinary care team that is supported by PrEP navigators and pharmacists and are informed by a patient-centered model of care to increase patient engagement and trust.
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Affiliation(s)
- Shimrit Keddem
- Center for Health Equity, Research and Promotion (CHERP), Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Center for Public Health, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sneha Thatipelli
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Omaris Caceres
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Navid Roder
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Florence Momplaisir
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Peter Cronholm
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Center for Public Health, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Herrera MC, Johnson J, Lim S, Morales KH, Wilson JD, Hadland SE, Metzger D, Wood S, Dowshen N. Co-delivery of HIV pre-exposure prophylaxis (PrEP) and HIV testing among publicly insured adolescents and young adults (AYA) receiving medication for opioid use disorder (MOUD). Drug Alcohol Depend 2024; 257:111132. [PMID: 38387256 PMCID: PMC11031309 DOI: 10.1016/j.drugalcdep.2024.111132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Low rates of HIV pre-exposure prophylaxis (PrEP) prescribing contribute to the disproportionate burden of HIV in the United States. Among adolescent and young adults (AYA) with opioid use disorder, HIV testing and PrEP co-prescription rates are poorly characterized. METHODS We performed a retrospective analysis involving deidentified data from Philadelphia's Medicaid beneficiaries ages 16-29 years who were prescribed medication for opioid use disorder (MOUD) from 2015 to 2020 and continuously Medicaid-enrolled for ≥6 months prior to that prescription. After identifying the presence of a qualifying diagnosis signifying a PrEP indication, we examined the outcome of appropriate PrEP co-prescriptions and HIV testing using generalized estimating equations (GEE) modeling. RESULTS We identified 795 AYA Medicaid beneficiaries with 1269 qualified treatment episodes. We calculated a PrEP prescribing rate of 29.47 per 1000 person-years among AYA receiving MOUD. The HIV testing rate was 63.47 per 1000 person-years among AYA receiving MOUD. GEE modeling revealed that individuals receiving methadone were more likely (aOR=2.62, 95% CI=1.06-6.49) to receive HIV testing within 6 months after a PrEP-qualifying diagnosis compared to those receiving other MOUD medications. Those who only saw outpatient behavioral health providers were less likely (aOR=0.48, 95% CI=0.24-0.99) to have received an HIV test within 6 months after the PrEP-qualifying diagnosis compared to those receiving inpatient behavioral health services. CONCLUSIONS Co-prescription of PrEP and HIV testing among AYA receiving MOUD was rare in this large urban publicly insured population. Interventions are needed to increase HIV prevention services for this key population of AYA at risk for HIV infection.
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Affiliation(s)
- M C Herrera
- Division of Adolescent Medicine, Department of General Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - J Johnson
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - S Lim
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - K H Morales
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - J Deanna Wilson
- Department of Family Medicine and Community Health, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - S E Hadland
- Division of Adolescent and Young Adult Medicine, MassGeneral for Children / Harvard Medical School, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - D Metzger
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - S Wood
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - N Dowshen
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Cespedes MS, Das M, Yager J, Prins M, Krznaric I, de Jong J, Xiao D, Shao Y, Wong P, Kintu A, Carter C, Hoornenborg E, Ruane P, Phoenix J, Younis I, Halperin J. Gender Affirming Hormones Do Not Affect the Exposure and Efficacy of F/TDF or F/TAF for HIV Preexposure Prophylaxis: A Subgroup Analysis from the DISCOVER Trial. Transgend Health 2024; 9:46-52. [PMID: 38312459 PMCID: PMC10835152 DOI: 10.1089/trgh.2022.0048] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose Transgender women are disproportionately affected by HIV and are underutilizing preexposure prophylaxis (PrEP). The lower uptake of PrEP by transgender women may be, in part, owing to the perception that taking PrEP may lower the efficacy of gender-affirming hormone therapy (GAHT) or to provider concerns that GAHT may lower the efficacy of PrEP. Methods DISCOVER was a randomized, double-blind, noninferiority trial comparing emtricitabine (FTC, F) and tenofovir alafenamide (F/TAF) versus emtricitabine and tenofovir disoproxil fumarate (F/TDF) as PrEP among transgender women and cisgender men who have sex with men (MSM). This nested substudy of the DISCOVER trial compared the exposure of the active intracellular metabolites of FTC and tenofovir (TFV), FTC triphosphate (FTC-TP) and TFV diphosphate (TFV-DP), in peripheral blood mononuclear cells (PBMC) among transgender women receiving GAHT versus MSM within the F/TAF and F/TDF groups. Results Our results demonstrate that TFV-DP and FTC-TP levels in PBMC were comparable between transgender women on GAHT and MSM receiving F/TAF, and between transgender women on GAHT and MSM receiving F/TDF. TFV-DP concentrations remained above the EC90 of 40 fmol/106 cells across all groups. No clinically significant drug-drug interactions of GAHT were observed with either F/TAF or F/TDF in this subanalysis. Conclusions These findings are consistent with the clinical pharmacology of GAHT, FTC, TDF, and TAF reported in previous studies, and support the continued use of F/TAF and F/TDF for PrEP in transgender women. Clinicaltrials.gov registration number: NCT02842086.
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Affiliation(s)
- Michelle S Cespedes
- Division of Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Moupali Das
- Gilead Sciences, Foster City, California, USA
| | - Jenna Yager
- Gilead Sciences, Foster City, California, USA
| | - Maria Prins
- Department of Infectious Diseases, Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers (UMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Ivanka Krznaric
- Zentrum für Infektiologie Berlin Prenzlauer Berg, Berlin, Germany
| | - Jan de Jong
- Gilead Sciences, Foster City, California, USA
| | - Deqing Xiao
- Gilead Sciences, Foster City, California, USA
| | - Yongwu Shao
- Gilead Sciences, Foster City, California, USA
| | - Pamela Wong
- Gilead Sciences, Foster City, California, USA
| | | | | | - Elske Hoornenborg
- Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands
| | - Peter Ruane
- Ruane Clinical Research Group, Inc., Los Angeles, California, USA
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Gordon J, Wongsomboon V, Alvarado Avila A, Lorenzo J, Mustanski B, Macapagal K. Experiences of Successful PrEP Uptake Among Adolescent Sexual Minority Men in the United States: A Qualitative Exploration. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2024; 36:1-15. [PMID: 38349349 DOI: 10.1521/aeap.2024.36.1.1] [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] [Indexed: 02/15/2024]
Abstract
Male adolescent sexual minorities are at elevated risk of HIV acquisition yet demonstrate low rates of PrEP uptake. Understanding the experiences of adolescents who have successfully accessed PrEP may inform ways to best support adolescents seeking PrEP. Adolescent sexual minorities (N = 100) who reported utilizing PrEP responded to open-ended items asking about their initial PrEP experiences and advice for others. Qualitative analysis suggested that adolescents' ability to access PrEP is influenced by managing parental involvement and seeking culturally competent health care providers. Additionally, they reported how the benefits and drawbacks of taking PrEP played a role in their PrEP use. Findings suggest that educational PrEP interventions targeted at this population could improve uptake by incorporating discussions on side effects and mental health benefits associated with PrEP use. Structural interventions are warranted that improve adolescents' ability to seek sexual health care independently and make room for parental involvement when adolescents could benefit from their support.
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Affiliation(s)
- Jacob Gordon
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Val Wongsomboon
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Julianna Lorenzo
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brian Mustanski
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kathryn Macapagal
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Quinn KG, Walsh JL, DiFranceisco W, Edwards T, Takahashi L, Johnson A, Dakin A, Bouacha N, Voisin DR. The Inherent Violence of Anti-Black Racism and its Effects on HIV Care for Black Sexually Minoritized Men. J Urban Health 2024; 101:23-30. [PMID: 38158546 PMCID: PMC10897081 DOI: 10.1007/s11524-023-00823-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/03/2024]
Abstract
The goal of this study was to examine the effects of racial discrimination, depression, and Black LGBTQ community support on HIV care outcomes among a sample of Black sexually minoritized men living with HIV. We conducted a cross-sectional survey with 107 Black sexually minoritized men living with HIV in Chicago. A path model was used to test associations between racial discrimination, Black LGBTQ community support, depressive symptoms, and missed antiretroviral medication doses and HIV care appointments. Results of the path model showed that men who had experienced more racism had more depressive symptoms and subsequently, missed more doses of HIV antiretroviral medication and had missed more HIV care appointments. Greater Black LGBTQ community support was associated with fewer missed HIV care appointments in the past year. This research shows that anti-Black racism may be a pervasive and harmful determinant of HIV inequities and a critical driver of racial disparities in ART adherence and HIV care engagement experienced by Black SMM. Black LGBTQ community support may buffer against the effects of racial discrimination on HIV care outcomes by providing safe, inclusive, supportive spaces for Black SMM.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Jennifer L Walsh
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wayne DiFranceisco
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Travonne Edwards
- School of Child and Youth Care, Toronto Metropolitan University, Toronto, Canada
| | - Lois Takahashi
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Anthony Johnson
- School of Social Work, Loyola University Chicago, Chicago, IL, USA
| | | | | | - Dexter R Voisin
- School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA
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10
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Watson DL, Listerud L, Drab RA, Lin WY, Momplaisir FM, Bauermeister JA. HIV pre-exposure prophylaxis programme preferences among sexually active HIV-negative transgender and gender diverse adults in the United States: a conjoint analysis. J Int AIDS Soc 2024; 27:e26211. [PMID: 38332521 PMCID: PMC10853582 DOI: 10.1002/jia2.26211] [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: 08/18/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Current implementation efforts have failed to achieve equitable HIV pre-exposure prophylaxis (PrEP) provision for transgender and gender-diverse (trans) populations. We conducted a choice-based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States. METHODS Between April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out-of-pocket cost; dispensing venue; frequency of visits for PrEP-related care; travel time to PrEP provider; and ability to bundle PrEP-related care with gender-affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt-out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part-worth utility scores for the total sample and by respondents' PrEP status. RESULTS The median age was 24 years (range 18-56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out-of-pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender-affirming hormone therapy services (18.7%). Minimal cost-sharing ($0 out-of-pocket cost) most positively influenced the attribute importance of cost (average conjoint part-worth utility coefficient of 2.5 [95% CI 2.4-2.6]). PrEP-experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP-naïve respondents preferred pharmacies (relative utility score 5.1). CONCLUSIONS Participants preferred programmes that offered PrEP services without cost-sharing and bundled with gender-affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low-barrier PrEP provision are critical to achieving equitable PrEP provision. Community-engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient-centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients.
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Affiliation(s)
- Dovie L. Watson
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Louis Listerud
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ryan A. Drab
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Willey Y. Lin
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Florence Marie Momplaisir
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - José A. Bauermeister
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Rodriguez A, Horvath KJ, Dowshen N, Voss R, Warus J, Jacobs M, Kidd KM, Inwards-Breland DJ, Blumenthal J. Awareness and utilization of pre-exposure prophylaxis and HIV prevention services among transgender and non-binary adolescent and young adults. FRONTIERS IN REPRODUCTIVE HEALTH 2024; 5:1150370. [PMID: 38318604 PMCID: PMC10839107 DOI: 10.3389/frph.2023.1150370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 12/29/2023] [Indexed: 02/07/2024] Open
Abstract
Introduction Transgender and gender non-binary (TGNB) individuals are disproportionally affected by HIV and face high rates of discrimination and stigmatization, resulting in limited access to HIV prevention services. Pre-exposure prophylaxis (PrEP) is highly efficacious for reducing the risk of HIV transmission. However, little research is available regarding PrEP awareness and utilization among TGNB adolescents and young adults (AYA). Methods TGNB AYA ages 15-24 years old were recruited between December 2021 and November 2022 for participation in a one-time, anonymous online survey study to assess PrEP awareness and perceptions, as well as barriers to its use. Participants were recruited from seven academic centers offering gender-affirming care to TGNB AYA across the United States. Results Of the 156 TGNB AYA individuals who completed the survey, most (67%) were aware of PrEP; however, few (7%) had been prescribed PrEP. Many (60%) had not spoken to a medical provider and, even if the medication was free and obtained confidentially, most participants did not plan to take PrEP due to low perceived HIV risk, lack of PrEP knowledge, and concern about interactions between their hormone therapy and PrEP. Discussion These findings underscore the need for broad PrEP educational efforts for both TGNB AYA and their providers to improve knowledge, identify potential PrEP candidates among TGNB AYA and improve access by addressing identified barriers.
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Affiliation(s)
- Arianna Rodriguez
- Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Nadia Dowshen
- Craig-Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Raina Voss
- Division of Adolescent Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
| | - Jonathan Warus
- Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Megan Jacobs
- Department of Pediatrics, Oregon Health and Science University, Portland, OR, United States
| | - Kacie M. Kidd
- Division of Adolescent Medicine, WVU Medicine Children’s, Morgantown, WV, United States
| | | | - Jill Blumenthal
- Department of Medicine, University of California San Diego, La Jolla, CA, United States
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12
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Harris LM, Kerr JC, Skidmore BD, Ghare S, Reyes-Vega A, Remenik-Zarauz V, Samanapally H, Anwar RU, Rijal R, Bryant K, Hall MT, Barve S. A conceptual analysis of SBIRT implementation alongside the continuum of PrEP awareness: domains of fit and feasibility. Front Public Health 2024; 11:1310388. [PMID: 38259734 PMCID: PMC10801388 DOI: 10.3389/fpubh.2023.1310388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a supplementary intervention that can be incorporated into the Pre-Exposure Prophylaxis (PrEP) Care Continuum, complementing initiatives and endeavors focused on Human Immunodeficiency Virus (HIV) prevention in clinical care and community-based work. Referencing the Transtheoretical Model of Change and the PrEP Awareness Continuum, this conceptual analysis highlights how SBIRT amplifies ongoing HIV prevention initiatives and presents a distinct chance to address identified gaps. SBIRT's mechanisms show promise of fit and feasibility through (a) implementing universal Screening (S), (b) administering a Brief Intervention (BI) grounded in motivational interviewing aimed at assisting individuals in recognizing the significance of PrEP in their lives, (c) providing an affirming and supportive Referral to Treatment (RT) to access clinical PrEP care, and (d) employing client-centered and destigmatized approaches. SBIRT is uniquely positioned to help address the complex challenges facing PrEP awareness and initiation efforts. Adapting the SBIRT model to integrate and amplify HIV prevention efforts merits further examination.
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Affiliation(s)
- Lesley M. Harris
- Kent School of Social Work & Family Science, University of Louisville, Louisville, KY, United States
| | - Jelani C. Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, United States
| | - Blake D. Skidmore
- Kent School of Social Work & Family Science, University of Louisville, Louisville, KY, United States
| | - Smita Ghare
- School of Medicine, University of Louisville, Louisville, KY, United States
| | - Andrea Reyes-Vega
- School of Medicine, University of Louisville, Louisville, KY, United States
| | | | | | - Rana Usman Anwar
- School of Medicine, University of Louisville, Louisville, KY, United States
| | - Rishikesh Rijal
- School of Medicine, University of Louisville, Louisville, KY, United States
| | - Kendall Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD, United States
| | - Martin T. Hall
- Kent School of Social Work & Family Science, University of Louisville, Louisville, KY, United States
| | - Shirish Barve
- School of Medicine, University of Louisville, Louisville, KY, United States
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13
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Bonett S, Mahajan A, da Silva DT, Williams J, Brady K, Bauermeister J, Wood SM. Advancing the community plan to end the HIV Epidemic in Philadelphia: a qualitative descriptive evaluation of low-threshold PrEP services in sexual health clinics. Implement Sci Commun 2024; 5:4. [PMID: 38183133 PMCID: PMC10768374 DOI: 10.1186/s43058-023-00543-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 12/21/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method and a key component of Philadelphia's Community Plan to End the HIV Epidemic (EHE). However, significant barriers to accessing PrEP exist among people at risk for HIV. Low-threshold models for PrEP services that minimize barriers to entry and service engagement could help bolster access to PrEP through community-based clinics. This study aimed to describe the initial implementation of low-threshold PrEP services in three sexual health clinics funded by the Philadelphia Department of Public Health and explore strategies for delivering low-threshold PrEP services. METHODS We conducted three focus groups with staff (i.e., providers, prevention navigators, and administrative staff, N = 21) at each of three participating PDPH-funded sexual health clinics from November 2021 to January 2022. Discussion topics included details about the PrEP delivery process, clinic strengths and assets, resource gaps, and PrEP implementation goals. Follow-up interviews with staff members (N = 8) between March 2022 and May 2022 focused on identifying successful strategies for PrEP delivery and adaptations needed to optimize low-threshold PrEP service delivery. Rapid qualitative methods and the Consolidated Framework for Implementation Science were used to analyze data from focus groups and interviews. RESULTS Participants collaborated to create process maps that visualized the steps involved in delivering PrEP services within their respective settings. These maps highlighted several stages in PrEP service delivery, such as connecting individuals to services, providing prevention navigation, conducting clinical encounters, and ensuring follow-up care. Participants described effective strategies for implementing PrEP, which included integrating and co-locating services on-site, strengthening staffing resources and capacity, and addressing barriers experienced by clients. CONCLUSIONS Lessons from the implementation of low-threshold PrEP service delivery in Philadelphia can guide ongoing local adaptations and future scale-up of these models to improve access to PrEP and advance the goals of the EHE initiative.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
| | | | | | | | - Kathleen Brady
- Philadelphia Department of Public Health, Philadelphia, PA, USA
| | - José Bauermeister
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah M Wood
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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14
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Mthimkhulu N, Chidumwa G, Kutywayo A, Mataboge P, Martin CE, Kwatsha K, Makalela N, Mazibuko M, Butler V, Mullick S. Factors influencing the uptake of a mono-PrEP implant for the prevention of HIV: Males' perspectives from three South African provinces. PLoS One 2024; 19:e0296341. [PMID: 38166044 PMCID: PMC10760848 DOI: 10.1371/journal.pone.0296341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 12/11/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Oral pre-exposure prophylaxis (PrEP) is an effective HIV prevention method; however, males over 15 years face challenges with its effective use. Long-acting prevention products could address barriers to effective PrEP use. This study aimed to estimate the potential uptake of a mono-PrEP implant and the factors influencing uptake among males in South Africa. The study also examined messaging and demand creation tactics that males perceive will improve HIV prevention uptake. METHODS We conducted a mixed methods study comprising participatory workshops and a self-administered survey among 142 PrEP-eligible males (18-40 years) in three provinces (Gauteng, Eastern Cape, and Kwa-Zulu Natal) in South Africa from July to November 2022. Logistic regression was used to assess the relationship between the potential uptake of a hypothetical, non-biodegradable mono-PrEP implant and socioeconomic and behavioural factors. Workshop data were analysed using content analysis. RESULTS The top three HIV prevention products that males would consider using were the monthly pill (74.6%), the mono-PrEP implant (62.7%), and event-driven oral PrEP (59.2%). If one prevention option was available, 31.7% of participants stated that they would use the monthly oral pill, 28.2% would use the six-monthly injection, and 19.7% the mono-PrEP implant. Four key themes were noted as influential to potential mono-PrEP uptake: "Health Over Everything", "Mono-PrEP Implant Concerns", "Potential Disclosure of Mono-PrEP Use", and "Information Distribution Channels". Participants preferred social and mainstream media as information distribution channels to receive information on HIV prevention services, including the mono-PrEP implant. CONCLUSION In this study among predominantly heterosexual men in South Africa, there was interest in long-acting HIV prevention methods but concerns about the mono-PrEP implant. A comprehensive and participatory introduction will be needed for the implant, to improve acceptability and address potential concerns. Demand-creation strategies utilising social media and health campaigns should be considered to engage and reach males.
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Affiliation(s)
- Nqaba Mthimkhulu
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Glory Chidumwa
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Alison Kutywayo
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Paballo Mataboge
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Khanyiswa Kwatsha
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Mbali Mazibuko
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Vusile Butler
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | - Saiqa Mullick
- Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
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15
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Storholm ED, Ogunbajo A, Nacht CL, Opalo C, Horvath KJ, Lyman P, Flynn R, Reback CJ, Blumenthal J, Moore DJ, Bolan R, Morris S. Facilitators of PrEP Persistence among Black and Latinx Transgender Women in a PrEP Demonstration Project in Southern California. Behav Med 2024; 50:63-74. [PMID: 35993278 PMCID: PMC9943802 DOI: 10.1080/08964289.2022.2105794] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/28/2022] [Accepted: 07/19/2022] [Indexed: 11/02/2022]
Abstract
Black and Latinx transgender women in the United States (U.S.) are at disproportionately high risk for HIV. Although HIV pre-exposure prophylaxis (PrEP) reduces the risk of HIV infection, uptake and persistence (i.e., ability to continue taking PrEP over time) can be a challenge for Black and Latinx transgender women due to myriad social and structural forces. In this qualitative study, we present unique data on the facilitators of PrEP persistence from Black and Latinx transgender women who initiated PrEP and exhibited varying levels of persistence during a demonstration project in Southern California. PrEP persistence was assessed by collecting quantitative intracellular tenofovir-diphosphate (TFV-DP) levels on dried blood spot (DBS) samples collected at weeks 12 and 48. Informed by the socioecological framework, we conducted and analyzed interviews using qualitative content analysis to determine themes on the facilitators of PrEP persistence. Individual-level facilitators included the use of reminders, having high individual-level HIV risk perception, feeling empowered to take PrEP, and reporting having improved peace of mind and mental health because of taking PrEP. Interpersonal/Community-level facilitators included feeling motivation to prevent HIV in the community, motivation to prevent HIV in the context of sex work, and having high community-level risk perception. Structural-level facilitators included having positive experiences in affirming healthcare settings and having PrEP visits combined with other gender-related healthcare visits. Interventions aiming to increase PrEP uptake and persistence among Black and Latinx transgender women in the U.S. should harness the multiple levels of support exhibited by those who were able to start and persist on PrEP in the face of the myriad social and structural barriers.
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Affiliation(s)
- Erik D. Storholm
- School of Public Health, San Diego State University
- RAND Corporation
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles
| | - Adedotun Ogunbajo
- RAND Corporation
- Department of Behavioral and Social Sciences, Brown University School of Public Health
| | | | | | | | | | | | - Cathy J. Reback
- Center for HIV Identification, Prevention and Treatment Services, Department of Family Medicine, University of California Los Angeles
- Friends Research Institute
| | - Jill Blumenthal
- AntiViral Research Center, University of California, San Diego School of Medicine
| | - David J. Moore
- AntiViral Research Center, University of California, San Diego School of Medicine
| | | | - Sheldon Morris
- AntiViral Research Center, University of California, San Diego School of Medicine
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16
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Pereira M, Castro CTD, Magno L, Oliveira TDA, Gomes FS, Neves FMF, Nascimento PRDSD, Dourado I. Adverse effects of daily oral pre-exposure prophylaxis in men who have sex with men and transgender women: a systematic review and meta-analysis. CAD SAUDE PUBLICA 2023; 39Suppl 1:e00089522. [PMID: 38088646 PMCID: PMC10712916 DOI: 10.1590/0102-311xen089522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 12/18/2023] Open
Abstract
The adverse effects of oral pre-exposure prophylaxis (PrEP) using tenofovir disoproxil fumarate are barriers to PrEP initiation and continuation. Although serious effects are rare and predictable, evidence for this assessment among men who have sex with men (MSM) and transgender women (TGW) is still limited. This study assesses the adverse effects of daily oral PrEP in MSM and TGW. This is a systematic review and meta-analysis of clinical trials and cohort studies on the use of daily oral PrEP selected from the PubMed/MEDLINE, Embase, LILACS, and Cochrane CENTRAL databases. Data extraction included adverse effects and changes in renal and hepatic markers. Random effects models were used to summarize the risk of adverse effects throughout the study. Heterogeneity was assessed using the Cochran's Q test and the inconsistency test (I2). The risk of bias and the certainty of the evidence were assessed using the Cochrane Collaboration recommendations. The search identified 653 references. Of these, 10 were selected. All studies assessed the eligibility of renal and hepatic markers. The use of daily oral PrEP was not associated with grade 3 or 4 adverse events (RR = 0.99; 95%CI: 0.83-1.18; I2 = 26.1%), any serious adverse event (RR = 1.04; 95%CI: 0.58-1.87; I2 = 88.4%), grade 3+4 creatinine level (RR = 0.66; 95%CI: 0.24-1.84; I2 = 79.9%), and grade 3 or 4 hypophosphatemia (RR = 0.56; 95%CI: 0.15-2.10). The certainty of the evidence ranged from high to moderate for the outcomes analyzed. Daily oral PrEP is safe and well tolerated by MSM and TGW. Adverse effects were minimal and evenly distributed between intervention and control.
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Affiliation(s)
- Marcos Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Laio Magno
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Brasil
| | | | | | | | | | - Ines Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
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17
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Rusley JC, Valente PK, Chan PA. Making a Choice With Your Adolescent: Next-Generation HIV Pre-Exposure Prophylaxis and Parents of Sexual and Gender Minority Adolescents in the United States. J Adolesc Health 2023; 73:611-613. [PMID: 37716712 DOI: 10.1016/j.jadohealth.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/05/2023] [Indexed: 09/18/2023]
Affiliation(s)
- Jack C Rusley
- Division of Adolescent Medicine, Department of Pediatrics, Brown University, Providence, Rhode Island
| | - Pablo K Valente
- Department of Allied Health Sciences, University of Connecticut, Waterbury, Connecticut
| | - Philip A Chan
- Division of Infectious Diseases, Department of Medicine, Brown University, Providence, Rhode Island
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18
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Braun RA, Erenrich RK, Coyle KK, Doan THP, Klausner JD. Effectiveness, Acceptability, and Feasibility of a Telehealth HIV Pre-Exposure Prophylaxis Care Intervention Among Young Cisgender Men and Transgender Women Who Have Sex With Men: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e47932. [PMID: 37713244 PMCID: PMC10541640 DOI: 10.2196/47932] [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: 04/05/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Despite its promise for HIV prevention, the uptake of pre-exposure prophylaxis (PrEP) has been slow, and there have been substantial inequities in PrEP access. Young men who have sex with men and transgender women of color are most in need of PrEP and least likely to have that need fulfilled. PrEP telehealth care, which provides remote PrEP care via electronic communication, seems well suited to address several of the challenges of PrEP provision, including discomfort with stigmatizing and difficult-to-access health care systems, transportation challenges, and privacy concerns, and address disparities in PrEP access. Research suggests that PrEP telehealth care has promise and is a favored option for many prospective recipients of PrEP. However, despite growing attention to telehealth approaches as an avenue for increasing access to PrEP amidst the COVID-19 pandemic, there have been no published randomized controlled trials (RCTs) on PrEP telehealth care to date, making it difficult to draw strong conclusions about the advantages or disadvantages of telehealth compared with usual PrEP care. We developed PrEPTECH, a telehealth intervention that focuses specifically on alleviating issues of stigma, access, cost, and confidentiality for young people with risk factors for HIV infection who are seeking PrEP care. Leveraging data from the 2017 observational pilot study, we redesigned and enhanced PrEPTECH. OBJECTIVE This study aims to assess the effectiveness, acceptability, and feasibility of a telehealth HIV PrEP care intervention, PrEPTECH, in increasing PrEP uptake. METHODS This is the protocol for an RCT of young cisgender men and transgender women who have sex with men in 4 regions within the United States: the San Francisco Bay Area, California; Los Angeles County, California; Miami-Dade County, Florida; and Broward County, Florida. Participants in the intervention arm received access to a web-based telehealth program, PrEPTECH, which offers a fully web-based pathway to PrEP, whereas those in the control arm received access to a dynamic web page containing publicly available informational resources about PrEP. Follow-up data collection occurred at 3 and 6 months. An analysis will be conducted on outcomes, including PrEP initiation, persistence, adherence, coverage, and medication prescription, as well as PrEPTECH acceptability and feasibility. RESULTS The study was funded in 2019 and received institutional review board approval in 2020. The PrEPTECH intervention was developed over the next 1.5 years. Study recruitment was launched in February 2022 and completed in September 2022, with 229 participants recruited in total. Data collection was completed in April 2023. CONCLUSIONS The results of this RCT will offer valuable evidence regarding the effectiveness, acceptability, and feasibility of telehealth HIV PrEP care interventions among young cisgender men and transgender women who have sex with men. TRIAL REGISTRATION ClinicalTrials.gov NCT04902820; https://clinicaltrials.gov/ct2/show/NCT04902820. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/47932.
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Affiliation(s)
| | | | | | | | - Jeffrey D Klausner
- Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
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19
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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.
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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
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20
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Sánchez-Mendoza V, Soriano-Ayala E, Vallejo-Medina P, Martínez O. A Scoping Review of Biobehavioural Interventions to Improve PrEP Continuum of Care in Latin America. ACTA COLOMBIANA DE PSICOLOGIA 2023; 26:141-154. [PMID: 38130977 PMCID: PMC10733975 DOI: 10.14718/acp.2023.26.2.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
According to the literature, biobehavioural interventions or combined strategies would reduce the risk of HIV infection by more than 7,000 new cases each day, which would contribute to the battle facing Latin America, where despite the high incidence and prevalence of HIV in the region, access to PrEP (pre-exposure prophylaxis) is very limited. The objective of this research was, consistent with the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), to conduct a scoping review to assess the evidence of available outcome data on biobehavioural interventions and programs to address gaps in the PrEP continuum of care in Latin America. The search was conducted in the databases EBSCOhost, WoS, Scopus, and ProQuest, and include all studies published from 2010 to 2021. One hundred eighty-six studies were identified and evaluated according to the eligibility criteria in six stages starting with the elimination of duplicates until the selection of studies that met the previously mentioned criteria; at the end five studies were chosen which were submitted to the methodological quality assessment including compliance with ethical guidelines. Results show that biobehavioural interventions promoting PrEP in Latin America are effective in increasing condom use, decreasing HIV risk, and increasing PrEP awareness, uptake, adherence, and retention. The limited number of interventions in the PrEP continuum of care indicates a need for the uptake of dissemination and implementation science (D&I) frameworks. D&I could help facilitate the translation of evidence-based practices, interventions, and policies to address the HIV crisis in Latin America.
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Affiliation(s)
- Vanessa Sánchez-Mendoza
- Universidad de Almería, Almería, Spain, Fundación Universitaria Konrad Lorenz, Bogotá, Colombia
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21
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Biello KB, Valente PK, da Silva DT, Lin W, Drab R, Hightow‐Weidman L, Mayer KH, Bauermeister JA. Who prefers what? Correlates of preferences for next-generation HIV prevention products among a national U.S. sample of young men who have sex with men. J Int AIDS Soc 2023; 26 Suppl 2:e26096. [PMID: 37439061 PMCID: PMC10339006 DOI: 10.1002/jia2.26096] [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: 10/14/2022] [Accepted: 04/27/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) has been available for young people for over a decade, yet only ∼15% of young people in the United States with indications for PrEP have a prescription for it. Next-generation PrEP modalities may address some of the challenges of daily oral PrEP. However, preferences for these products are unknown. METHODS From October 2020 to June 2021, we conducted an online survey of 737 cisgender, young men who have sex with men (age 15-24 years) without HIV across the United States who reported same-sex attraction or consensual sex with another man in the past 6 months. Participants completed a conjoint experiment comparing daily oral pills, event-driven oral pills, event-driven rectal douches, intramuscular injections, intravenous broadly neutralizing antibody (bnAb) infusions and subcutaneous implants. Participants ranked the products from most to least preferred. Exploded logit models examined the association between ranked preferences of PrEP modalities and socio-demographic and behavioural characteristics. RESULTS Participants' mean age was 21 years (SD = 2.3), and 56% identified as White. Nineteen percent were currently taking daily oral PrEP, and another 9% had previously taken it. Participants prioritized efficacy, absence of side effects and costs in the conjoint analyses. Daily oral PrEP had the highest preference ranking, followed by event-driven oral (OR = 0.89, p = 0.058), injectable (OR = 0.83, p = 0.005), implant (OR = 0.48, p < 0.0001), bnAb infusions (OR = 0.38, p < 0.0001) and rectal douches (OR = 0.24, p < 0.0001). There were differences in PrEP preferences across age, insurance status, sexual behaviour, PrEP use history, HIV and sexually transmitted infection (STI) testing history, and STI diagnoses (omnibus tests: p < 0.05). Participants also provided reasons for selecting their top product choice: ease of use for those who chose daily oral (99%) and daily event-driven (98.5%); feel more protected against HIV for those who chose injectable (95.4%) and implants (100%); not worrying about forgetting to take it for those who chose bnAbs (93.8%); and being able to stop taking it when they want for those who chose rectal douche (90.9%). CONCLUSIONS Next-generation modalities were less likely to be preferred over daily oral PrEP, with differences in the magnitude by socio-demographic and behavioural characteristics. Given the low uptake of daily oral PrEP, end-users' preferences for and concerns about PrEP products must be understood to ensure high acceptability and penetration.
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Affiliation(s)
- Katie B. Biello
- Departments of Behavioral & Social Sciences and Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
- Center for Health Promotion and Health EquityBrown UniversityProvidenceRhode IslandUSA
- The Fenway InstituteFenway HealthBostonMassachusettsUSA
| | - Pablo K. Valente
- Departments of Behavioral & Social Sciences and Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
- Department of Allied Health SciencesUniversity of ConnecticutWaterburyConnecticutUSA
| | - Daniel Teixeira da Silva
- Department of Family & Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaPennsylvaniaUSA
| | - Willey Lin
- Department of Family & Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaPennsylvaniaUSA
| | - Ryan Drab
- Department of Family & Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaPennsylvaniaUSA
| | | | | | - José A. Bauermeister
- Department of Family & Community HealthUniversity of Pennsylvania School of NursingPhiladelphiaPennsylvaniaUSA
| | - the iTech Team
- Departments of Behavioral & Social Sciences and Epidemiology, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
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22
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McKetchnie SM, White B, Fontenot H, Dormitzer J, Psaros C, Fitch C, O'Cleirigh C, Mayer KH, Krakower DS. Perspectives of Young Men Who Have Sex with Men on PrEP Adherence and Peer Navigation: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2037-2049. [PMID: 36940046 PMCID: PMC10330054 DOI: 10.1007/s10508-023-02579-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
HIV incidence is disproportionately high among young cisgender men who have sex with men (YMSM), but YMSM are less likely than adults to use HIV pre-exposure prophylaxis (PrEP). Among YMSM living with HIV, peer navigation programs have been effective in linkage to care and increasing medication adherence; such programs may aid HIV-uninfected YMSM in overcoming barriers to engagement in PrEP care. We conducted 32 semi-structured qualitative interviews at a community health center in Massachusetts, USA, specializing in sexual and gender minority health with four sub-groups of YMSM who: (1) had never discussed PrEP with a medical provider, (2) had discussed PrEP with a medical provider but declined a prescription, (3) were prescribed PrEP and have sub-optimal adherence (taking fewer than 4 pills per week), and (4) were prescribed PrEP and were optimally adherent. Domains addressed in the interviews included knowledge of PrEP and HIV prevention, barriers and facilitators to PrEP adherence, and attitudes toward peer navigation for PrEP. Interviews were transcribed and coded using thematic analysis methodology. Multiple themes emerged from the interviews, including finding that perceived costs, anticipated stigma, sexual activity, and relationship status influence PrEP uptake and adherence; establishing pill-taking routines is an important adherence facilitator; and peer navigators could offer benefits for PrEP adherence.
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Affiliation(s)
- Samantha M McKetchnie
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA.
- School of Social Work, Boston College, Newton, MA, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Bradley White
- Department of Nursing, MGH Institute of Health Professionals, Boston, MA, USA
| | - Holly Fontenot
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, HI, USA
| | | | - Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Calvin Fitch
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Conall O'Cleirigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
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23
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Camp CE, Chan CT, Saberi P. Young Adult Perspectives on Sex, Dating, and PrEP Use During the Pandemic and Improving the Future of PrEP Care. AIDS Behav 2023; 27:2430-2438. [PMID: 36629971 PMCID: PMC9832408 DOI: 10.1007/s10461-022-03970-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 01/12/2023]
Abstract
Few studies have researched young adults' experiences taking HIV pre-exposure prophylaxis (PrEP) after the start of California's COVID-19 shelter-in-place (SIP) orders. The purpose of this study was to examine the experiences of young adults with sex, dating, and PrEP use during SIP and their perceptions on how to improve PrEP care in this age group. In this mixed-methods study, PrEP users ages 18-29 living in California between April 2020 and June 2021 completed a quantitative survey (N = 37) and one-on-one qualitative interviews (N = 18). Over half of survey participants reported trouble accessing PrEP care during SIP, citing difficulty obtaining medication refills, clinic appointments, and access to completing lab work. In qualitative interviews, participants expressed their preferences for more accessible PrEP service delivery across the PrEP care continuum. Despite pandemic SIP orders and trouble accessing PrEP services, young adults continued to engage in sexual behaviors.
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Affiliation(s)
- Christina E Camp
- Department of Community Health Systems, School of Nursing, University of California San Francisco, 2 Koret Way, N405K, San Francisco, CA, 94143, USA.
| | - Carrie T Chan
- Department of Family Health Care Nursing, University of California San Francisco, San Francisco, CA, USA
- Stanford Children's Health, Palo Alto, CA, USA
| | - Parya Saberi
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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24
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Antonini M, Silva IED, Elias HC, Gerin L, Oliveira AC, Reis RK. Barriers to Pre-Exposure Prophylaxis (PrEP) use for HIV: an integrative review. Rev Bras Enferm 2023; 76:e20210963. [PMID: 37377313 DOI: 10.1590/0034-7167-2021-0963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/07/2022] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES to identify and synthesize scientific evidence on the barriers and difficulties for Pre-exposure Prophylaxis (PrEP) use and compliance for HIV. METHODS an integrative literature review, using the MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier and Scopus (Elsevier) databases. RESULTS all (100%) the articles included identified that PrEP users experience some type of structural barrier related to health services such as long distance from the units, suboptimal logistics for taking pills and professional resistance to prescribing PrEP. Furthermore, 63.21% identified social barriers, such as stigma about sexuality and HIV, in addition to individual barriers such as alcohol use, adverse effects, and concerns about long-term toxicity. CONCLUSIONS the barriers to PrEP use are multifactorial. Effective interventions are needed to support PrEP users in accessing, complying with, and retaining health services.
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Affiliation(s)
| | | | | | - Larissa Gerin
- Universidade de São Paulo. Ribeirão Preto, São Paulo, Brasil
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25
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Simon KA, Hanna-Walker V, Clark AN, Driver R, Kalinowski J, Watson RJ, Eaton LA. "This Is To Help Me Move Forward": The Role of PrEp in Harnessing Sex Positivity and Empowerment Among Black Sexual Minority Men in the Southern United States. JOURNAL OF SEX RESEARCH 2023; 60:741-751. [PMID: 36239604 PMCID: PMC10102248 DOI: 10.1080/00224499.2022.2131704] [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] [Indexed: 05/12/2023]
Abstract
In the United States (U.S.), Black sexual minority men (BSMM) are disproportionately burdened by HIV. Prevention advances, such as HIV pre-exposure prophylaxis (PrEP), play a key role in reducing HIV transmission and improving our understanding of sexual expression and health. Despite these advances, little is known regarding the potential link between PrEP use and positive sexuality, including the benefits that BSMM see in accessing PrEP. We conducted a thematic analysis of 32 interviews with BSMM in the Southern U.S. regarding their PrEP beliefs. We developed five themes: (1) Sexual freedom, (2) Agency and empowerment, (3) Making PrEP normative, (4) Behavioral health practices, and (5) Committed relationship tensions. Our findings suggest that BSMM are increasingly concerned about freedom of choice and invested in sexual empowerment as related to their PrEP use. Further, unanticipated benefits, community support, and relationship tensions are salient factors in considerations of PrEP use among BSMM. These findings have implications for how we might understand a broader movement toward sexual empowerment and positivity, and the pivotal role that PrEP serves in this movement.
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Affiliation(s)
- Kay A. Simon
- Department of Family Social Science, University of Minnesota, St. Paul, MN, USA
| | - Veronica Hanna-Walker
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Alyssa N. Clark
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Jolaade Kalinowski
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Ryan J. Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
| | - Lisa A. Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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26
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Hill SV, Sohail M, Bhagat D, Ball A, Smith TV, Coyne-Beasley T, Simpson TY, Elopre L, Matthews LT. "Sex. Maybe We Should Do Things to be Healthy About It." Adolescent-Caregiver Discussions About Sex. J Adolesc Health 2023; 72:746-753. [PMID: 36781324 DOI: 10.1016/j.jadohealth.2022.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/09/2022] [Accepted: 12/15/2022] [Indexed: 02/13/2023]
Abstract
PURPOSE Adolescents are disproportionately burdened with HIV. Numerous barriers limit adolescent pre-exposure prophylaxis (PrEP) use for HIV prevention. We explored adolescent-caregiver perspectives on discussing sexual health and PrEP to inform future caregiver interventions as a possible strategy to promote PrEP use. METHODS We conducted separate in-depth interviews with adolescents aged 14-18 living in Alabama and their parent/guardian (caregiver). Interviews explored attitudes about sex, knowledge and attitudes about HIV prevention and PrEP, and attitudes about PrEP communication within adolescent-caregiver groups. Thematic analysis of adolescent and caregiver interviews was conducted independently and then triangulated to compare shared themes. RESULTS Nine adolescents and seven caregivers contributed to five dyads and two triads. Adolescents had a median age of 16 years (range 14-18); five were girls (55%), and five were non-Hispanic Black (55%). Most caregivers were mothers (5, 71%), non-Hispanic Black (5, 71%), with a median age of 41 (36-56) years. All adolescents expressed willingness to involve their caregiver around PrEP use. Major themes included as follows: 1) caregiver efforts to overcome cultural taboos about sex and sexuality foster adolescents' willingness to talk with caregivers about sex; 2) evolving societal norms and reflections on their own upbringings motivate caregivers to discuss and support adolescents with sexual health; and 3) caregivers desire to engage in sexual health discussions with providers and support their teens with PrEP. DISCUSSION As socio-cultural norms around sex evolve, adolescent-caregiver discussions about sexual health and PrEP may be an opportunity to increase PrEP use and reduce HIV infections among select adolescent sub-populations.
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Affiliation(s)
- Samantha V Hill
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama.
| | - Maira Sohail
- Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Delima Bhagat
- The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Amy Ball
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Theolishia V Smith
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Tamera Coyne-Beasley
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama; Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Tina Y Simpson
- Department of Pediatrics, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Latesha Elopre
- Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
| | - Lynn T Matthews
- Department of Medicine, The University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama
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27
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Bauermeister JA, Dominguez Islas C, Jiao Y, Tingler R, Brown E, Zemanek J, Giguere R, Balan I, Johnson S, Macagna N, Lucas J, Rose M, Jacobson C, Collins C, Livant E, Singh D, Ho K, Hoesley C, Liu A, Kayange N, Palanee-Phillips T, Chariyalertsak S, Gonzales P, Piper J. A randomized trial of safety, acceptability and adherence of three rectal microbicide placebo formulations among young sexual and gender minorities who engage in receptive anal intercourse (MTN-035). PLoS One 2023; 18:e0284339. [PMID: 37043527 PMCID: PMC10096248 DOI: 10.1371/journal.pone.0284339] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/20/2023] [Indexed: 04/13/2023] Open
Abstract
Efforts to develop a range of HIV prevention products that can serve as behaviorally congruent viable alternatives to consistent condom use and oral pre-exposure prophylaxis (PrEP) remain crucial. MTN-035 was a randomized crossover trial seeking to evaluate the safety, acceptability, and adherence to three placebo modalities (insert, suppository, enema) prior to receptive anal intercourse (RAI). If participants had no RAI in a week, they were asked to use their assigned product without sex. We hypothesized that the modalities would be acceptable and safe for use prior to RAI, and that participants would report high adherence given their behavioral congruence with cleansing practices (e.g., douches and/or enemas) and their existing use to deliver medications (e.g., suppositories; fast-dissolving inserts) via the rectum. Participants (N = 217) were sexual and gender minorities enrolled in five different countries (Malawi, Peru, South Africa, Thailand, and the United States of America). Mean age was 24.9 years (range 18-35 years). 204 adverse events were reported by 98 participants (45.2%); 37 (18.1%) were deemed related to the study products. The proportion of participants reporting "high acceptability" was 72% (95%CI: 65% - 78%) for inserts, 66% (95%CI: 59% - 73%) for suppositories, and 73% (95%CI: 66% - 79%) for enemas. The proportion of participants reporting fully adherent per protocol (i.e., at least one use per week) was 75% (95%CI: 69% - 81%) for inserts, 74% (95%CI: 68% - 80%) for suppositories, and 83% (95%CI: 77% - 88%) for enemas. Participants fully adherent per RAI-act was similar among the three products: insert (n = 99; 58.9%), suppository (n = 101; 58.0%) and enema (n = 107; 58.8%). The efficacy and effectiveness of emerging HIV prevention drug depends on safe and acceptable delivery modalities that are easy to use consistently. Our findings demonstrate the safety and acceptability of, and adherence to, enemas, inserts, and suppositories as potential modalities through which to deliver a rectal microbicide.
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Affiliation(s)
- Jose A. Bauermeister
- Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
| | - Clara Dominguez Islas
- Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Yuqing Jiao
- Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Ryan Tingler
- Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States of America
| | - Elizabeth Brown
- Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Jillian Zemanek
- Statistical Center for HIV/AIDS Research & Prevention, Fred Hutchinson Cancer Center, Seattle, Washington, United States of America
| | - Rebecca Giguere
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida, United States of America
| | - Ivan Balan
- Center for Translational Behavioral Science, Florida State University College of Medicine, Tallahassee, Florida, United States of America
| | - Sherri Johnson
- FHI 360, Durham, North Carolina, United States of America
| | - Nicole Macagna
- FHI 360, Durham, North Carolina, United States of America
| | - Jonathan Lucas
- FHI 360, Durham, North Carolina, United States of America
| | - Matthew Rose
- FHI 360, Durham, North Carolina, United States of America
| | - Cindy Jacobson
- Magee-Women’s Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Clare Collins
- Magee-Women’s Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Edward Livant
- Magee-Women’s Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Devika Singh
- Magee-Women’s Research Institute, Pittsburgh, Pennsylvania, United States of America
| | - Ken Ho
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Craig Hoesley
- University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Albert Liu
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Noel Kayange
- Johns Hopkins University Research Project, Blantyre, Malawi
| | - Thesla Palanee-Phillips
- Wits Reproductive Health and HIV Institute, University of the Witwatersrand, School of Public Health, Johannesburg, South Africa
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Suwat Chariyalertsak
- Research Institute for Health Sciences, Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jeanna Piper
- Division of AIDS/NIAID/NIH, Bethesda, Maryland, United States of America
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28
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Christodoulou J, Vincent E, Shaw E, Jones ASK, Rotheram-Borus MJ. Not as Clear Online? Active Visualization of How PrEP Works in the Body Improves Knowledge But Doesn't Change Behavior. AIDS Behav 2023; 27:1116-1122. [PMID: 36112258 PMCID: PMC9483425 DOI: 10.1007/s10461-022-03848-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
Abstract
Active visualization, the use of dynamic representation of internal processes, is associated with increased knowledge and adherence to ART among people living with HIV. The current pilot intervention study tested the effectiveness of an online visualization for HIV prevention among 146 at-risk youth. Youth were randomized to a standard PrEP briefing or an online visualization. PrEP knowledge, attitudes, and uptake were self-reported at baseline and 3-months. Knowledge of PrEP increased, but there were no changes in preferences or uptake. Active visualization delivered online may be a useful educational tool for PrEP but not for shifting youth's uptake.
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Affiliation(s)
| | - Eleanor Vincent
- Department of Psychology, Palo Alto University, Palo Alto, CA USA
| | - Elizabeth Shaw
- Department of Psychology, Palo Alto University, Palo Alto, CA USA
| | - Annie S. K. Jones
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mary Jane Rotheram-Borus
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute, University of California, Los Angeles, 10920 Wilshire Blvd., Suite 350, Los Angeles, CA 90024 USA
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29
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Budhwani H, Yiğit İ, Maragh-Bass AC, Rainer CB, Claude K, Muessig KE, Hightow-Weidman LB. Development and Validation of the Youth Pre-Exposure Prophylaxis (PrEP) Stigma Scale. AIDS Behav 2023; 27:929-938. [PMID: 36029425 PMCID: PMC9968821 DOI: 10.1007/s10461-022-03829-9] [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: 08/21/2022] [Indexed: 01/05/2023]
Abstract
To date, there are no established scales to assess PrEP stigma among youth. We validated the Youth PrEP Stigma Scale within the Adolescent Trials Network P3 study (2019-2021). Data from sexual and gender minority youth (16-24 years) who were prescribed PrEP across nine domestic sites were evaluated (N = 235). Descriptive statistics, exploratory factor analysis, and correlation coefficients are reported. Results yielded a three-factor solution (PrEP Disapproval by Others, Enacted PrEP Stigma, and PrEP User Stereotypes) with strong factor loadings and Cronbach's alphas ranging from 0.83 to 0.90, suggesting excellent internal consistency. Correlations between this Scale, anticipated HIV stigma, perceived HIV risk, and disclosure of sexual identity were significant, indicating potential for robust application. Given the persistence of HIV infections among youth, stigma as a barrier to prevention, and expansion of PrEP modalities, the Youth PrEP Stigma Scale could enhance intervention and mechanistic research among youth at elevated risk for HIV acquisition.
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Affiliation(s)
- Henna Budhwani
- Center of Population Sciences for Health Equity, College of Nursing, Florida State University, 32306, Tallahassee, FL, USA.
| | - İbrahim Yiğit
- Department of Psychology, Faculty of Arts and Sciences, TED University, Ankara, Turkey
| | - Allysha C Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Crissi B Rainer
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Kristina Claude
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Kathryn E Muessig
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
| | - Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill (UNC), Chapel Hill, NC, USA
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30
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Phillips G, Davoudpour S, Floresca YB, Felt D, Curry CW, Wang X, Choi J, Kelsey SW, Beach LB. Disparities in HIV Testing, Condom Use, and HIV Education Between Transgender and Not Transgender High School-Aged Youth: Findings From the 2019 Youth Risk Behavior Survey. HEALTH EDUCATION & BEHAVIOR 2023; 50:29-40. [PMID: 36540958 DOI: 10.1177/10901981221142238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Transgender individuals are disproportionately affected by HIV in the United States. Given increased risk of HIV among youth, there is a need to understand HIV risk and protective factors among transgender individuals who are 18 years and younger. Patterns of HIV testing, HIV education, and condom use have known associations with HIV outcomes among youth in general, but are understudied among transgender youth. This study assessed these outcomes by developing a series of sex-stratified multivariable logistic regression models using pooled Youth Risk Behavior Survey data. Results indicate female and male transgender youth as well as males who were not sure they were transgender were more likely have tested for HIV compared with their not transgender peers. Male transgender youth were significantly less likely to have received HIV education compared with not transgender males. Females not sure if they were transgender and male transgender youth were significantly less likely to have used condoms compared with, respectively, not transgender female and not transgender male counterparts. In sum, condom use and HIV education both remain lower among transgender individuals relative to their not-transgender peers. This highlights the need for the promotion of culturally appropriate HIV education and HIV prevention supports among transgender youth.
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Affiliation(s)
| | | | | | - Dylan Felt
- Northwestern University, Chicago IL, USA
| | - Caleb W Curry
- Northwestern University, Chicago IL, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Xinzi Wang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Santos LAD, Unsain RF, Brasil SA, Silva LAVD, Duarte FM, Couto MT. PrEP perception and experiences of adolescent and young gay and bisexual men: an intersectional analysis. CAD SAUDE PUBLICA 2023; 39Suppl 1:e00134421. [PMID: 36995863 DOI: 10.1590/0102-311xen134421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 11/11/2021] [Indexed: 03/29/2023] Open
Abstract
Studies indicate gaps in knowledge about the barriers to access and adhere to HIV pre-exposure prophylaxis (PrEP) in adolescents. In this article, we explore the perceptions and experiences of young gay, bisexual, and other men who have sex with men (YGBMSM) of the search, use and adherence to PrEP, considering their positions according to social markers of difference such as race/skin color, gender, sexuality, and social status. Intersectionality provides theoretical and methodological tools to interpret how the interlinking of these social markers of difference constitutes barriers and facilitators in the PrEP care continuum. The analyzed material is part of the PrEP1519 study and is comprised of 35 semi-structured interviews with YGBMSM from two Brazilian capitals (Salvador and São Paulo). The analyses suggest connections between social markers of difference, sexual cultures, and the social meanings of PrEP. Subjective, relational and symbolic aspects permeate the awareness of PrEP in the range of prevention tools. Willingness to use and adhere to PrEP is part of a learning process, production of meaning, and negotiation in the face of getting HIV and other sexually transmittable infections and the possibilities of pleasure. Thus, accessing and using PrEP makes several adolescents more informed about their vulnerabilities, leading to more informed decision-making. Interlinking the PrEP continuum of care among YGBMSM with the intersections of the social markers of difference may provide a conceptual framework to problematize the conditions and effects of implementing this prevention strategy, which could bring advantages to HIV prevention programs.
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Nacht CL, Felner JK, Muthuramalingam S, Towner W, Ling Grant D, Martos A, Chang JM, Hechter R, Storholm ED. Barriers and Opportunities to Improve the Implementation of Patient Screening and Linkage to Pre-Exposure Prophylaxis in Primary Care. JOURNAL OF CLINICAL RESEARCH IN HIV AIDS AND PREVENTION 2022; 4:15-31. [PMID: 37841674 PMCID: PMC10572105 DOI: 10.14302/issn.2324-7339.jcrhap-22-4371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
Although pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV infection, only around 25% of at-risk individuals in the United States have accessed a prescription. One way to increase PrEP uptake is through the sexual health screening of patients and linkage to PrEP in primary care settings. The objective of this analysis was to assess the barriers and implementation strategies during a screening and linkage to PrEP pilot intervention. Primary care patients were screened for PrEP indication during routine primary care visits. Of the 1,225 individuals screened, 1.8% (n=22) were eligible for PrEP and from those, 77.3% (n=17) attended the specialist appointment and were prescribed PrEP. Primary care patients (n=30) and providers (n=8) then participated in semi-structured interviews assessing their experience with the pilot intervention. Using an applied thematic analytic approach, patients and providers identified barriers and related improvement strategies that could be classified into four main categories: 1) Financial Barriers: Individual- vs. Clinic-level Considerations 2) The Role of Stigma, Discomfort, and Cultural Factors 3) Logistical Hurdles and Streamlining the Intervention, and 4) The Lack of PrEP Knowledge and the Need for Education. Findings support the accepatability and feasibility of screening for PrEP in primary care along with appropriate implementation strategies. This study suggests that because of the high volume of patients seen in primary care, sexual health screenings and linkage to PrEP interventions have the potential to reduce new incident HIV infections among diverse sexual minority men.
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Affiliation(s)
- Carrie L Nacht
- San Diego State University, School of Public Health, San Diego, CA
| | - Jennifer K Felner
- San Diego State University, School of Public Health, San Diego, CA
- San Diego State University Research Foundation, Institute for Behavioral and Community Health, San Diego, CA
| | | | - William Towner
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Deborah Ling Grant
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Alexander Martos
- Southern California Permanente Medical Group, Los Angeles Medical Center Department of Consulting Services, Los Angeles, CA
| | - John M Chang
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Rulin Hechter
- Kaiser Permanente Southern California, Research & Evaluation, Department of Research & Evaluation, Pasadena, CA
| | - Erik D Storholm
- San Diego State University, School of Public Health, San Diego, CA
- RAND Corporation, Behavioral and Policy Sciences, Santa Monica, CA
- University of California Los Angeles, Department of Family Medicine, Center for HIV Identification, Prevention and Treatment Services, Los Angeles, CA
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Shrestha R, Wickersham JA, Khati A, Azwa I, Ni Z, Kamarulzaman A, Sullivan PS, Jadkarim L, Eger WH, Gautam K, Altice FL. Clinic-Integrated Mobile Health Intervention ("JomPrEP" App) to Improve Uptake of HIV Testing and Pre-exposure Prophylaxis Among Men Who Have Sex With Men in Malaysia: Protocol for an Intervention Development and Multiphase Trial. JMIR Res Protoc 2022; 11:e43318. [PMID: 36542425 PMCID: PMC9813821 DOI: 10.2196/43318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/16/2022] [Accepted: 11/17/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Men who have sex with men (MSM) are disproportionately affected by the HIV epidemic in Malaysia and globally. Cross-cutting prevention strategies such as mobile health (mHealth), particularly smartphone apps, hold great promise for HIV prevention efforts among Malaysian MSM, especially when linked to HIV testing and pre-exposure prophylaxis (PrEP). OBJECTIVE This study aims to adapt an existing app to create and test a clinic-integrated app (JomPrEP), a virtual platform to deliver HIV testing and PrEP services for MSM in Malaysia. METHODS The JomPrEP project involves developing and testing an app-based platform for HIV prevention among Malaysian MSM and will be conducted in 2 phases. In phase I (development phase), we will adapt an existing mHealth app (HealthMindr) to create a new clinic-integrated app called "JomPrEP" to deliver holistic HIV prevention services (eg, HIV testing, PrEP, support services for mental health and substance use) among MSM in Malaysia. During phase II (testing phase), we will use a type I hybrid implementation science trial design to test the efficacy of JomPrEP while gathering information on implementation factors to guide future scale-up in real-world settings. RESULTS As of September 2022, we have completed phase I of the proposed study. Based on a series of formative work completed during phase I, we developed a fully functional, clinic-integrated JomPrEP app, which provides a virtual platform for MSM in Malaysia to facilitate their engagement in HIV prevention in a fast and convenient manner. Based on participant feedback provided during phase I, we are currently optimizing JomPrEP and the research protocols for a large-scale efficacy trial (phase II), which will commence in January 2023. CONCLUSIONS Scant HIV prevention resources coupled with entrenched stigma, discrimination, and criminalization of same-sex sexual behavior and substance use hamper access to HIV prevention services in Malaysia. If found efficacious, JomPrEP can be easily adapted for a range of health outcomes and health care delivery services for MSM, including adaptation to other low- and middle-income countries. TRIAL REGISTRATION ClinicalTrials.gov NCT05325476; https://clinicaltrials.gov/ct2/show/NCT05325476. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/43318.
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Affiliation(s)
- Roman Shrestha
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | | | - Antoine Khati
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
| | - Iskandar Azwa
- Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Zhao Ni
- School of Nursing, Yale University, West Haven, CT, United States
| | | | | | - Luzan Jadkarim
- AIDS Program, Yale School of Medicine, New Haven, CT, United States
| | - William H Eger
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla, CA, United States.,College of Health and Human Services, San Diego State University, San Diego, CA, United States
| | - Kamal Gautam
- Department of Allied Health Sciences, University of Connecticut, Storrs, CT, United States
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34
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Tagliaferri Rael C, Giguere R, Sutton S, Horn E, Schieffer RJ, Greene GJ, D'Aquila R, Bryndza Tfaily E, Kiser PF, Hope TJ. Preferences Among Physicians and Men Who Have Sex with Men (MSM) for a Long-Acting, Removable Implant for HIV Prevention: A Discrete Choice Study. AIDS Res Hum Retroviruses 2022; 38:898-908. [PMID: 36178358 PMCID: PMC9805877 DOI: 10.1089/aid.2022.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
A longer acting, removable implant for HIV prevention has the potential to improve uptake of HIV pre-exposure prophylaxis (PrEP) by removing the need for daily adherence to an oral tablet, reducing potential side effects, and eliminating concerns about residual drug following injections. To end the HIV epidemic, we must understand the needs and preferences of groups most affected by HIV (e.g., men who have sex with men; MSM), and the physicians who prescribe PrEP to them. This article describes a discrete choice experiment to estimate the preference share for the implant within a competitive context of other PrEP products (including the oral tablet, dissolvable implant, and injection) and evaluate the impact of potential implant attributes. Physicians who had prescribed oral PrEP (n = 75) and MSM at risk for HIV (n = 175) completed a web-based survey that prompted decision-making about PrEP product preferences. The findings from both physicians and MSM demonstrated that the removable implant could capture a meaningful portion of the preference share, making it feasible to advance in the development pipeline as an important addition to the biomedical HIV prevention toolkit. Among MSM, specifically, the cost of treatment was the most important attribute impacting product preference. Our findings inform implant developers and future payers (e.g., commercial manufacturers, insurance companies) about specific device attributes that will likely affect MSM's willingness to use and physicians' willingness to prescribe this HIV prevention strategy.
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Affiliation(s)
| | - Rebecca Giguere
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, New York, USA
| | | | | | - Robert J. Schieffer
- Northwestern University, Kellogg School of Management, Evanston, Illinois, USA
| | - George J. Greene
- Department of Medical Social Sciences and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Richard D'Aquila
- Division of Infectious Diseases, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ewa Bryndza Tfaily
- Department of Cell and Molecular Biology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Patrick F. Kiser
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, USA
| | - Thomas J. Hope
- Department of Cell and Molecular Biology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Address correspondence to: Thomas J. Hope, Department of Cell and Molecular Biology, Northwestern University Feinberg School of Medicine, Simpson Querrey, 6th Floor, 303 East Superior Street, Chicago, Illinois 60611, USA
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35
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Wilson K, Przybyla S, Bleasdale J, Gabriel S, Leblanc N, St Vil N. Factors correlated with pre-exposure prophylaxis (PrEP) awareness and use among black adults in the United States: implications for improving HIV prevention. AIDS Care 2022; 34:1481-1488. [PMID: 35981242 DOI: 10.1080/09540121.2022.2113027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
HIV remains a significant public health concern for Black adults (BA) in the United States. Pre-exposure prophylaxis (PrEP) is a highly effective prevention tool prescribed to protect the health of HIV-uninfected individuals. Yet, low rates of PrEP awareness and utilization persist among BA. Less is understood about the pathways that may promote PrEP uptake. The present study explored factors associated with PrEP awareness and use among BA. Using a cross-sectional sample of 666 BA, we employed multivariable logistic regression models to examine the relationship between PrEP and several covariates. Most participants were unaware of PrEP (71%). Reporting history of incarceration and lifetime sexually transmitted infection testing [aOR 1.76 (1.19, 2.59), p < 0.05] had greater odds of PrEP awareness. Only 6% of respondents had ever taken PrEP. Reports of incarceration history [aOR 9.96 (2.82, 35.14), p < 0.05], concurrent sexual partners [aOR 1.09 (1.00, 1.18), p < 0.05], and substance use during sex [aOR 4.23 (1.02, 17.48), p < 0.05] had greater odds of PrEP use. Interventions aiming to improve PrEP uptake among BA must consider the individual, social, and structural contexts associated with its awareness and use. Enhanced efforts by healthcare providers and institutions may better facilitate access to PrEP for HIV prevention and control transmission.
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Affiliation(s)
- Kennethea Wilson
- Department of Community Health and Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Sarahmona Przybyla
- Department of Community Health and Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Jacob Bleasdale
- Department of Community Health and Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Steven Gabriel
- Department of Community Health and Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY, USA
| | - Natalie Leblanc
- School of Nursing, University of Rochester, Rochester, NY, USA
| | - Noelle St Vil
- School of Social Work, University at Buffalo, Buffalo, NY, USA
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36
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Barnett AP, Brown LK, Crosby R, Craker L, Washington R, Burns PA, Mena LA. Family-Related Factors and HIV-Related Outcomes Among Black Young Men Who Have Sex with Men in Mississippi. AIDS Behav 2022; 27:1548-1563. [PMID: 36318432 PMCID: PMC9628553 DOI: 10.1007/s10461-022-03889-x] [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: 10/01/2022] [Indexed: 11/05/2022]
Abstract
Given their disproportionate HIV incidence, there is a critical need to identify factors related to HIV risk among Black young men who have sex with men (YMSM) in the southeastern United States. This study investigated the association of family factors and HIV-related outcomes among Black YMSM in Mississippi ages 14-20 (n = 72). Multivariable regression models evaluated associations of family factors and outcomes. Greater parent/child communication about sex was associated with fewer lifetime male sex partners and lower odds of lifetime anal sex. Greater parental monitoring was associated with greater likelihood of future condom use. Sexual orientation disclosure was associated with more lifetime male sex partners. Parental monitoring and parent/child communication about sex were protective, suggesting that family-based interventions are promising for HIV prevention among Black YMSM in Mississippi. Results also indicated that YMSM who are "out" to family are important to reach, and families could be useful in encouraging healthy behaviors.
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Affiliation(s)
- Andrew P. Barnett
- Bradley/Hasbro Children’s Research Center, Rhode Island Hospital, 1 Hoppin Street, Suite 204, Providence, RI 02903 USA ,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Larry K. Brown
- Bradley/Hasbro Children’s Research Center, Rhode Island Hospital, 1 Hoppin Street, Suite 204, Providence, RI 02903 USA ,Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Richard Crosby
- Department of Health, Behavior, and Society, University of Kentucky, Lexington, KY USA
| | - Lacey Craker
- Bradley/Hasbro Children’s Research Center, Rhode Island Hospital, 1 Hoppin Street, Suite 204, Providence, RI 02903 USA ,Present Address: Division of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL USA
| | - Rodney Washington
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Paul A. Burns
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Leandro A. Mena
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, USA ,Present Address: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA USA
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37
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Tran NK, Martinez O, Scheim AI, Goldstein ND, Welles SL. Perceived Barriers to and Facilitators of Long-Acting Injectable HIV PrEP Use Among Black, Hispanic/Latino, and White Gay, Bisexual, and Other Men Who Have Sex With Men. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:365-378. [PMID: 36181495 DOI: 10.1521/aeap.2022.34.5.365] [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: 06/16/2023]
Abstract
Long-acting injectable pre-exposure prophylaxis (LAI-PrEP) was recently approved for HIV prevention as an alternative to daily oral PrEP. We explored preferences and attitudes toward LAI-PrEP among Black, Hispanic/Latino, and White gay, bisexual, and other men who have sex with men (GBM) using focus groups (n = 13) and in-depth interviews (n = 17). Participants expressed differing levels of interest in LAI-PrEP. While important benefits of LAI-PrEP included convenience, provider-facilitated PrEP discussion, and expansion of PrEP options, participants raised concerns about treatment efficacy and side effects, discomfort with needles/injections, cost, and frequency of clinic visits. Our findings highlight ongoing challenges with accessing HIV-prevention tools and provide guidance for developing strategies to enhance LAI-PrEP uptake among GBM.
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Affiliation(s)
- Nguyen K Tran
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Omar Martinez
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, Florida
| | - Ayden I Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Neal D Goldstein
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Seth L Welles
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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38
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Valente PK, Bauermeister JA, Lin WY, Operario D, Rusley J, Hightow-Weidman L, Mayer KH, Biello KB. Next Generation Pre-Exposure Prophylaxis for Young Men who have Sex with Men: Lessons from System and Provider-level barriers to oral PrEP. AIDS Behav 2022; 26:3422-3435. [PMID: 35445994 PMCID: PMC9474568 DOI: 10.1007/s10461-022-03665-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
Next generation pre-exposure prophylaxis (PrEP) modalities that do not require daily regimens may address some of the barriers to daily oral PrEP among young men who have sex with men (YMSM). We conducted online semi-structured interviews with 30 YMSM to examine experiences and preferences related to HIV prevention care that may inform implementation of next generation PrEP. Barriers to PrEP care included initiating conversations about sexuality with providers; confidentiality concerns regarding disclosure of sexual practices and PrEP use to family; gaps in access to healthcare; and limited availability of affordable health services. Future implementation of next generation PrEP may benefit from providers addressing confidentiality concerns when discussing PrEP with YMSM; PrEP programs accounting for discontinuities in healthcare access among YMSM while strengthening access to affordable services; and collaborations between generalist providers and specialized clinics and providers to address providers' education needs, which may increase as next generation PrEP becomes available. We have linked affiliation 9 to author name "Katie B. Biello". Please check and confirm. Okay!
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, U.S
| | - Jose A Bauermeister
- Program for Sexuality, Technology, and Action Research, University of Pennsylvania, Philadelphia, PA, U.S
- Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, U.S
| | - Willey Y Lin
- Program for Sexuality, Technology, and Action Research, University of Pennsylvania, Philadelphia, PA, U.S
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, U.S
| | - Jack Rusley
- Division of Adolescent Medicine, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, U.S
- Department of Health Services, Policy, and Practice, Brown University School of Public, Providence, RI, U.S
| | - Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, U.S
| | | | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, U.S..
- The Fenway Institute, Fenway Health, Boston, MA, U.S..
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, U.S..
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, U.S..
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39
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Eiduson R, Murchison GR, Agénor M, Suarez L, Gordon AR. Sexual healthcare experiences of nonbinary young adults. CULTURE, HEALTH & SEXUALITY 2022; 24:1319-1335. [PMID: 34657546 DOI: 10.1080/13691058.2021.1946595] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 06/18/2021] [Indexed: 06/13/2023]
Abstract
Nonbinary young adults (who do not identify with a binary male or female identity and may hold diverse gender identities, including genderqueer, nonbinary and agender) may have unique and unmet sexual healthcare needs compared to binary transgender and cisgender people. However, there is limited knowledge about the sexual health and healthcare needs of nonbinary young adults. We conducted 19 semi-structured, in-depth interviews between August and November 2018 with nonbinary people aged 18-30 years in New England. Interview topics included experiences accessing sexual healthcare and engaging in sexual activity. Interviews were transcribed and transcripts were analysed using inductive and deductive thematic analysis. Three main themes were identified. First, participants described barriers to accessing high-quality sexual healthcare at both the interpersonal and institutional level. Second, participants employed strategies to meet their sexual healthcare needs despite encountering barriers. Third, participants articulated the ways nonbinary gender identities affect sexual relationships, with implications for sexual health. These findings underscore the need for research and advocacy - in collaboration with nonbinary persons themselves - to develop best practices to meet the sexual healthcare needs and advance the sexual health of nonbinary young people.
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Affiliation(s)
| | | | - Madina Agénor
- Department of Community Health, Tufts University, Medford, MA, USA
- Department of Obstetrics and Gynecology, Tufts University School of Medicine, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Allegra R Gordon
- Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
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40
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Miller TA, Halza K, Hovis Z. Implementation of
pharmacist‐led HIV pre‐exposure
prophylaxis management to increase access to care at an academic internal medicine practice. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Trisha A. Miller
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
| | - Katherine Halza
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
- Department of Pharmacy Kingman Regional Medical Center Kingman Arizona USA
| | - Zachary Hovis
- Department of Pharmacy University of Pittsburgh Medical Center Presbyterian Shadyside Pittsburgh Pennsylvania USA
- Clinical Sciences Department Medical College of Wisconsin Pharmacy School Milwaukee Wisconsin USA
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41
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Burgess R, Feliciano JT, Lizbinski L, Ransome Y. Trends and Characteristics of #HIVPrevention Tweets Posted Between 2014 and 2019: Retrospective Infodemiology Study. JMIR Public Health Surveill 2022; 8:e35937. [PMID: 35969453 PMCID: PMC9412898 DOI: 10.2196/35937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 06/24/2022] [Accepted: 07/11/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Twitter is becoming an increasingly important avenue for people to seek information about HIV prevention. Tweets about HIV prevention may reflect or influence current norms about the acceptability of different HIV prevention methods. Therefore, it may be useful to empirically investigate trends in the level of attention paid to different HIV prevention topics on Twitter over time. OBJECTIVE The primary objective of this study was to investigate temporal trends in the frequency of tweets about different HIV prevention topics on Twitter between 2014 and 2019. METHODS We used the Twitter application programming interface to obtain English-language tweets employing #HIVPrevention between January 1, 2014, and December 31, 2019 (n=69,197, globally). Using iterative qualitative content analysis on samples of tweets, we developed a keyword list to categorize the tweets into 10 prevention topics (eg, condom use, preexposure prophylaxis [PrEP]) and compared the frequency of tweets mentioning each topic over time. We assessed the overall change in the proportions of #HIVPrevention tweets mentioning each prevention topic in 2019 as compared with 2014 using chi-square and Fisher exact tests. We also conducted descriptive analyses to identify the accounts posting the most original tweets, the accounts retweeted most frequently, the most frequently used word pairings, and the spatial distribution of tweets in the United States compared with the number of state-level HIV cases. RESULTS PrEP (13,895 tweets; 20.08% of all included tweets) and HIV testing (7688, 11.11%) were the most frequently mentioned topics, whereas condom use (2941, 4.25%) and postexposure prophylaxis (PEP; 823, 1.19%) were mentioned relatively less frequently. The proportions of tweets mentioning PrEP (327/2251, 14.53%, in 2014, 5067/12,971, 39.1%, in 2019; P≤.001), HIV testing (208/2251, 9.24%, in 2014, 2193/12,971, 16.91% in 2019; P≤.001), and PEP (25/2251, 1.11%, in 2014, 342/12,971, 2.64%, in 2019; P≤.001) were higher in 2019 compared with 2014, whereas the proportions of tweets mentioning abstinence, condom use, circumcision, harm reduction, and gender inequity were lower in 2019 compared with 2014. The top retweeted accounts were mostly UN-affiliated entities; celebrities and HIV advocates were also represented. Geotagged #HIVPrevention tweets in the United States between 2014 and 2019 (n=514) were positively correlated with the number of state-level HIV cases in 2019 (r=0.81, P≤.01). CONCLUSIONS Twitter may be a useful source for identifying HIV prevention trends. During our evaluation period (2014-2019), the most frequently mentioned prevention topics were PrEP and HIV testing in tweets using #HIVPrevention. Strategic responses to these tweets that provide information about where to get tested or how to obtain PrEP may be potential approaches to reduce HIV incidence.
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Affiliation(s)
- Raquel Burgess
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Josemari T Feliciano
- Department of Biostatistics, Yale School of Public Health, Yale University, New Haven, CT, United States
| | - Leonardo Lizbinski
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
- The Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Yusuf Ransome
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, United States
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42
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Rogers BG, Sosnowy C, Zanowick-Marr A, Chan PA, Mena LA, Patel RR, Goedel WC, Arnold T, Chu C, Galipeau D, Montgomery MC, Curoe K, Underwood A, Villalobos J, Gomillia C, Nunn AS. Facilitators for retaining men who have sex with men in pre-exposure prophylaxis care in real world clinic settings within the United States. BMC Infect Dis 2022; 22:673. [PMID: 35931953 PMCID: PMC9354303 DOI: 10.1186/s12879-022-07658-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) can significantly reduce HIV acquisition especially among communities with high HIV prevalence, including men who have sex with men (MSM). Much research has been finding suboptimal PrEP persistence; however, few studies examine factors that enhance PrEP persistence in real-world settings. METHODS We interviewed 33 patients who identified as MSM at three different PrEP clinics in three regions of the U.S. (Northeast, South, Midwest). Participants were eligible if they took PrEP and had been retained in care for a minimum of 6 months. Interviews explored social, structural, clinic-level and behavioral factors that influencing PrEP persistence. RESULTS Through thematic analysis we identified the following factors as promoting PrEP persistence: (1) navigation to reduce out-of-pocket costs of PrEP (structural), (2) social norms that support PrEP use (social), (3) access to LGBTQ + affirming medical providers (clinical), (4) medication as part of a daily routine (behavioral), and (5) facilitation of sexual health agency (belief). DISCUSSION In this sample, persistence in PrEP care was associated with structural and social supports as well as a high level of perceived internal control over protecting their health by taking PrEP. Patients might benefit from increased access, LGBTQ + affirming medical providers, and communications that emphasize PrEP can promote sexual health.
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Affiliation(s)
- Brooke G. Rogers
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA ,grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02903 USA
| | - C. Sosnowy
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA
| | - A. Zanowick-Marr
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA
| | - P. A. Chan
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA ,grid.40263.330000 0004 1936 9094Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, RI 02903 USA
| | - L. A. Mena
- grid.410721.10000 0004 1937 0407Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS 39216 USA ,grid.410721.10000 0004 1937 0407Department of Medicine, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | - R. R. Patel
- grid.4367.60000 0001 2355 7002Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - W. C. Goedel
- grid.40263.330000 0004 1936 9094Department of Epidemiology, Brown University School of Public Health, Providence, RI 02903 USA
| | - T. Arnold
- grid.40263.330000 0004 1936 9094Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI 02903 USA
| | - C. Chu
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA
| | - D. Galipeau
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA
| | - M. C. Montgomery
- grid.40263.330000 0004 1936 9094Department of Medicine, Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, RI 02903 USA
| | - K. Curoe
- grid.4367.60000 0001 2355 7002Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - A. Underwood
- grid.4367.60000 0001 2355 7002Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - J. Villalobos
- grid.4367.60000 0001 2355 7002Department of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110 USA
| | - C. Gomillia
- grid.410721.10000 0004 1937 0407Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS 39216 USA
| | - A. S. Nunn
- grid.40263.330000 0004 1936 9094Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, RI 02903 USA
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43
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Chai PR, Goodman GR, Bronzi O, Gonzales G, Baez A, Bustamante MJ, Najarro J, Mohamed Y, Sullivan MC, Mayer KH, Boyer EW, O'Cleirigh C, Rosen RK. Real-World User Experiences with a Digital Pill System to Measure PrEP Adherence: Perspectives from MSM with Substance Use. AIDS Behav 2022; 26:2459-2468. [PMID: 35089449 PMCID: PMC8795732 DOI: 10.1007/s10461-022-03594-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2022] [Indexed: 12/30/2022]
Abstract
Once-daily oral pre-exposure prophylaxis (PrEP) is highly effective for preventing HIV transmission, but adherence can be challenging for men who have sex with men (MSM) who use substances. A novel method for directly measuring ingestion events is a digital pill system (DPS), which comprises an ingestible radiofrequency emitter that signals a wearable Reader device upon PrEP ingestion, relaying ingestion data to a wearable Reader device and then to a smartphone application. Qualitative interviews were conducted with 15 MSM with non-alcohol substance use following an open-label pilot demonstration trial involving use of the DPS to measure PrEP adherence for 90 days. The purpose of this qualitative investigation was to understand overall user experiences and potential barriers and facilitators to using the DPS to measure PrEP adherence among MSM. The DPS was largely perceived as acceptable, novel, and valuable, with most participants reporting that the system was easily integrated into their daily routines. Technological and design factors, especially related to the wearable Reader, impacted participants’ interest in using the technology long-term; several suggested improvements were discussed. Trial Registration ClinicalTrials.gov: NCT03842436.
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Affiliation(s)
- Peter R Chai
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02411, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, MA, USA.
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA.
| | - Georgia R Goodman
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02411, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Olivia Bronzi
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | | | | | - Jesse Najarro
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | - Matthew C Sullivan
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Infectious Diseases, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Edward W Boyer
- Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis St., Boston, MA, 02411, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Rochelle K Rosen
- Center for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
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44
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Dang M, Scheim AI, Teti M, Quinn KG, Zarwell M, Petroll AE, Horvath KJ, John SA. Barriers and Facilitators to HIV Pre-Exposure Prophylaxis Uptake, Adherence, and Persistence Among Transgender Populations in the United States: A Systematic Review. AIDS Patient Care STDS 2022; 36:236-248. [PMID: 35687813 PMCID: PMC9242706 DOI: 10.1089/apc.2021.0236] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
HIV pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV; however, PrEP use among transgender individuals remains low. We conducted a systematic review to identify barriers and facilitators to PrEP uptake, adherence, and persistence among transgender individuals in the United States. We conducted a literature search in PubMed and CINAHL databases in March 2021 and followed PRISMA guidelines. Studies were eligible if they were published in a peer-reviewed journal and reported interest, uptake, adherence, and/or persistence of PrEP use among transgender individuals. Articles that did not disaggregate results for transgender participants were excluded. Data from included articles were coded using content analysis and narratively synthesized using a framework matrix. We screened 254 unique articles published after US Food and Drug Administration approval of PrEP, and 33 articles were included in the review. Five themes were identified in the literature, including (1) PrEP concentrations were lower among individuals taking feminizing hormones, but the difference did not appear clinically significant; (2) concerns regarding interactions between gender-affirming hormone therapy and PrEP remain a large barrier; (3) PrEP initiation may facilitate increased self-advocacy and self-acceptance; (4) lack of trust in medical institutions impacts PrEP uptake; and (5) social networks have a significant influence on PrEP knowledge, interest, and adherence. Additional research is needed involving transgender men and nonbinary persons, and efforts to improve PrEP persistence among the transgender community are needed. Training health care providers to provide inclusive and affirming care is perhaps one of the strongest areas for intervention to increase PrEP uptake and persistence.
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Affiliation(s)
- Madeline Dang
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michelle Teti
- Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, Missouri, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Address correspondence to: Steven A. John, PhD, MPH, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI 53202, USA
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45
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Biello KB, Valente PK, Lin WY, Lodge Ii W, Drab R, Hightow-Weidman L, da Silva DT, Mayer K, Bauermeister JA. PrEParing for NextGen: Cognitive Interviews to Improve Next Generation PrEP Modality Descriptions for Young Men Who have Sex with Men. AIDS Behav 2022; 26:1956-1965. [PMID: 34860304 PMCID: PMC9050851 DOI: 10.1007/s10461-021-03545-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
Next generation PrEP formulations may circumvent factors that impede daily oral pre-exposure prophylaxis (PrEP) use among young men who have sex with men (YMSM). We conducted video-based cognitive interviews with 20 YMSM (age 16-24) recruited in the US Northeast to assess participants' attitudes and comprehension of written descriptions of next generation PrEP modalities. Participants were predominately racial/ethnic minorities and half used daily oral PrEP. We identified four main areas for improvement of descriptions: defining scientific terms and balancing medical jargon and casual language; referencing more established products to contextualize PrEP formulations (e.g., hormonal implants); ensuring clarity and reducing redundancy; and including imagery (e.g., rectal douche applicator). The refined descriptions serve as exemplar text that may be used in future studies examining YMSM's preferences across next generation PrEP modalities. Accurate descriptions of next generation PrEP products strengthen measurement accuracy and can help roll-out products that become approved for clinical use.
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Affiliation(s)
- Katie B Biello
- School of Public Health, Brown University, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA.
- Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Pablo K Valente
- School of Public Health, Brown University, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA
| | - Willey Y Lin
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - William Lodge Ii
- School of Public Health, Brown University, 121 South Main Street, Box G-S121-8, Providence, RI, 02912, USA
| | - Ryan Drab
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Daniel Teixeira da Silva
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, USA
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46
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MacDonell KK, Wang B, Phanuphak N, Janamnuaysook R, Srimanus P, Rongkavilit C, Naar S. Optimizing an mHealth Intervention to Improve Uptake and Adherence to HIV Pre-exposure Prophylaxis in Young Transgender Women: Protocol for a Multi-Phase Trial. JMIR Res Protoc 2022; 11:e37659. [PMID: 35587370 PMCID: PMC9164094 DOI: 10.2196/37659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/08/2022] [Accepted: 03/22/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Vulnerable adolescents and emerging adults (aged 18-29 years), particularly young transgender women, are among the fastest-growing HIV positive populations worldwide. Thailand has the highest adult HIV seroprevalence in Asia, with a rate of infection among this population of 18%. Widespread technology offers opportunities for innovative mobile health (mHealth) interventions. Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention strategy recommended for at-risk individuals. PrEP is highly effective when taken as prescribed, but uptake and adherence have been low, with high discontinuation rates among youth. OBJECTIVE We propose to develop and pilot a multi-component, technology-based intervention to promote PrEP usage. We will adapt an existing 2-session, technology-delivered, motivational interviewing-based intervention to focus on PrEP use in transgender women in Thailand. We call this the Motivational Enhancement System for PrEP Uptake and Adherence (MES-PrEP). We will also refine and enhance YaCool, a mobile app with integrated text messaging developed and used clinically by our Thai team. The new version of the app is called Enhanced YaCool, and it enables self-management of gender and sexual health (including PrEP). Our primary aim is to develop and assess the preliminary efficacy of this mHealth intervention. METHODS We will utilize a multiphase optimization strategy (MOST) to identify the most effective intervention component or combination of components to improve PrEP usage in Thai transgender women. The study includes two phases: phase I (R21) includes qualitative interviews with key stakeholders to explore barriers and facilitators of PrEP usage through thematic analysis to inform intervention adaptation. Following this, we will adapt and beta-test MES-PrEP and Enhanced YaCool for functionality and feasibility using a community advisory board of HIV-negative Thai transgender women. In phase II (R33), we will conduct a MOST design-based trial to evaluate the feasibility, acceptability, and preliminary efficacy of MES-PrEP and Enhanced YaCool. Eighty HIV-negative participants who are currently taking PrEP and 80 participants who are not will be randomized to four conditions: (1) standard PrEP counseling (the control condition); (2) MES-PrEP and standard PrEP counseling; (3) Enhanced YaCool and standard PrEP counseling; and (4) MES-PrEP, Enhanced YaCool, and standard PrEP counseling. Feasibility and acceptability of the intervention will be assessed through usage patterns and the System Usability Scale. Preliminary impact will be assessed by evaluating the proportion of participants who initiate PrEP and their level of adherence to PrEP. Assessments will be at baseline and 1, 3, 6, 9, and 12 months postintervention. Biomarkers of adherence to PrEP, HIV, and other sexually transmitted infections will be collected. RESULTS Upon project completion, we will have an optimized mHealth intervention to support the use of PrEP by transgender women that will be ready for testing in a larger efficacy trial. CONCLUSIONS Even though transgender women in Thailand face increasing risks of HIV, few interventions have targeted them. Effective developmentally and culturally tailored interventions are needed to prevent HIV transmission in this high-risk population. TRIAL REGISTRATION ClinicalTrials.gov NCT05262426; https://clinicaltrials.gov/ct2/show/NCT05262426. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/37659.
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Affiliation(s)
- Karen Kolmodin MacDonell
- Department of Family Medicine and Public Health Sciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand
- Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | | | - Chokechai Rongkavilit
- Department of Pediatrics, University of California San Francisco-Fresno Branch Campus, Fresno, CA, United States
| | - Sylvie Naar
- Center for Translational Behavioral Research, Florida State University, Tallahassee, FL, United States
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47
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Shorrock F, Alvarenga A, Hailey-Fair K, Vickroy W, Cos T, Kwait J, Trexler C, Wirtz AL, Galai N, Beyrer C, Celentano D, Arrington-Sanders R. Dismantling Barriers and Transforming the Future of Pre-Exposure Prophylaxis Uptake in Young Black and Latinx Sexual Minority Men and Transgender Women. AIDS Patient Care STDS 2022; 36:194-203. [PMID: 35507322 PMCID: PMC9125574 DOI: 10.1089/apc.2021.0222] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) has the potential to transform HIV in young Black and Latinx sexual minority men (SMM) and transgender women (TW). Addressing low PrEP uptake in this population depends on the better understanding of barriers to PrEP use. This article uses an ecological framework to explore barriers to daily oral PrEP in a sample of young Black and Latinx SMM and TW in three geographically prioritized cities in the United States. In-depth interviews were completed with 33 young Black and Latinx SMM and TW (22 at risk for and 11 recently diagnosed with HIV), aged 17-24, participating in a randomized trial aimed at increasing PrEP and antiretroviral therapy (ART) uptake and adherence. Interviews were recorded and transcribed, and then analyzed using inductive and deductive coding. Coded transcripts were organized into individual, interpersonal, community, and structural categories, by PrEP use and HIV status. Among participants, nine reported having been prescribed PrEP, with five actively or recently taking PrEP, whereas only one participant diagnosed with HIV had been prescribed PrEP. Major themes related to barriers emerged across the individual, family, community, and structural level. Limited barriers related to partners, instead partners with HIV encouraged PrEP use. Participants commonly reported low perceived HIV risk, fear of disclosure, barriers relating to insurance/cost, and medication use as reasons for nonuse of PrEP. For youth to remain on a healthy life course, HIV preventative measures will need to be adopted early in adolescence for those at risk of HIV acquisition. Interventions need to simultaneously address multilevel barriers that contribute to nonuse in adolescents. Clinical trials registry site and number: ClinicalTrials.gov Identifier: NCT03194477.
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Affiliation(s)
- Fiona Shorrock
- Johns Hopkins School of Nursing, Baltimore, Maryland, USA.,Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aubrey Alvarenga
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kimberly Hailey-Fair
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Wil Vickroy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Travis Cos
- Public Health Management Corporation, Philadelphia, Pennsylvania, USA
| | - Jennafer Kwait
- Whitman Walker Health, Washington, District of Columbia, USA
| | | | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Chris Beyrer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - David Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Renata Arrington-Sanders
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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48
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Bonett S, Dowshen N, Bauermeister J, Meanley S, Wirtz AL, Celentano DD, Galai N, Arrington-Sanders R. Characterizing the PrEP Continuum for Black and Latinx Sexual and Gender Minority Youth. AIDS Behav 2022; 26:1211-1221. [PMID: 34546472 DOI: 10.1007/s10461-021-03476-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 11/25/2022]
Abstract
Pre-exposure prophylaxis (PrEP) rollout efforts thus far have inadequately reached young people from underrepresented backgrounds. This study explores PrEP engagement among young Black and Latinx men who have sex with men, transgender women, and gender diverse individuals in three U.S. cities using an adapted PrEP continuum measure. We analyze data from the recruitment phase of an ongoing PrEP engagement intervention (n = 319) using partial proportional odds logistic regression. Participants reported high willingness and intention to use PrEP, yet most (82%) were not currently taking PrEP. Being insured (aOR = 2.95, 95%-CI = 1.60-5.49), having one or more PrEP users in one's sexual network (aOR = 4.19, 95%-CI = 2.61-6.79), and higher individual HIV risk scores (aOR = 1.62, 95%-CI = 1.34-1.97) were each associated with being further along the PrEP continuum. Strategies are needed to address barriers to healthcare access and leverage connections within social and sexual networks in order to bolster PrEP engagement among marginalized young people from diverse backgrounds.
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Affiliation(s)
- Stephen Bonett
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - Nadia Dowshen
- Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, 3550 Market St, Philadelphia, PA, 19104, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
| | - José Bauermeister
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Steven Meanley
- School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Andrea L Wirtz
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - David D Celentano
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
| | - Noya Galai
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
- Department of Statistics, University of Haifa, Mt Carmel, Haifa, Israel
| | - Renata Arrington-Sanders
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St, Baltimore, MD, 21205, USA
- Division of Adolescent and Young Adult Medicine, Johns Hopkins School of Medicine, 200 N. Wolfe Street, Baltimore, MD, 21287, USA
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49
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Rowe K, Theodore DA, Zucker J, Cohensedgh O, LaSota E, Carnevale C, Cohall A, Olender S, Gordon P, Sobieszczyk ME. Lost2PrEP: Understanding Reasons for Pre-Exposure Prophylaxis and Sexual Health Care Disengagement Among Men Who Have Sex with Men Attending a Sexual Health Clinic at a Large Urban Academic Medical Center in New York City. AIDS Patient Care STDS 2022; 36:153-158. [PMID: 35438522 PMCID: PMC9057871 DOI: 10.1089/apc.2022.0004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) prevents HIV, but low rates of retention in care limit its effectiveness. We conducted a prospective survey-based study to investigate reasons for PrEP disengagement among men who have sex with men attending a sexual health clinic at a large urban academic medical center in New York City who were lost to follow up; surveys asked about current PrEP status, reasons for disengagement, attitudes toward PrEP, substance use, sexual practices, and behavioral/social determinants of health. Outreach attempts were made to 634 patients; majority of eligible participants were unable to be contacted (59%). Among those who agreed to participate (n = 175), 21% asked to re-establish care. Among those who completed the questionnaire (n = 86), 36% were taking PrEP. The most common reasons for PrEP discontinuation were cost/lack of insurance coverage (31%), decreased HIV risk perception (29%), and side effects (16%). Among those with decreased perception of risk, 62% were less sexually active, 38% were no longer engaging in anal sex, and 31% were using condoms for prevention. Participants reported that free medication (60%), having a sexual partner recommend PrEP (13%), and being able to receive PrEP from a primary care provider (13%) would encourage restarting PrEP. Findings were limited by low response rate (12% of eligible subjects completed the survey) and lack of Spanish-language questionnaires. Understanding reasons for loss-to-PrEP follow-up is essential for HIV prevention. Many people lost to follow up still desired PrEP, underscoring the importance of outreach, benefits navigators, and expansion of PrEP into primary care settings.
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Affiliation(s)
- Kelly Rowe
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Deborah A. Theodore
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Jason Zucker
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Omid Cohensedgh
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Elijah LaSota
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Caroline Carnevale
- NYP HIV Prevention Program, New York-Presbyterian Hospital, New York, New York, USA
| | - Alwyn Cohall
- Mailman School of Public Health and Columbia University Irving Medical Center, New York, New York, USA
| | - Susan Olender
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Peter Gordon
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Magdalena E. Sobieszczyk
- Division of Infectious Diseases, Department of Internal Medicine, Columbia University Irving Medical Center, New York, New York, USA
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50
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Abstract
This cross-sectional study used 2012 to 2019 Oregon Medicaid claims to estimate the prevalence of PrEP use and identify determinants of high adherence across transgender and cisgender men and women. Gender identity (cisgender woman/man; transgender, assigned female sex at birth [AFAB]; transgender, assigned male sex at birth [AMAB]) was based on medical history and enrollment records. Proportion of days covered ≥ 0.80 was considered high adherence to PrEP. The association between gender identity and PrEP uptake or high adherence was estimated using multivariable logistic regression. 1555 PrEP users, including 171 (11.0%) cis women, 1171 (75.3%) cis men, 67 (4.3%) AFAB, and 146 (9.4%) AMAB individuals, were included. The probability of PrEP use per 10,000 people was highest in transgender groups (AMAB 546.8, 95% CI 462.4-631.3; AFAB 226.5, 95% CI 173.4-279.6), followed by cisgender men (20.6, 95% CI 19.4, 21.8) and women (2.6, 95% CI 2.2, 3.0). High adherence was significantly lower in AMAB recipients (72.6%) than cisgender women (86.0%) and cisgender men (82.2%). Among the 279 PrEP users with female on their enrollment record, 76 (27.2%) were AMAB, while among the 1276 PrEP users with male on their enrollment record, 35 (2.7%) were AFAB. This demonstrates the importance of surveillance methods that take gender identity into account in addition to sex assigned at birth. There were significant differences in PrEP use and adherence by gender identity. PrEP surveillance, outreach, and prescribing practices must consider gender identity-unique risk factors.
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Affiliation(s)
- Jae Downing
- Department of Health Policy and Management, OHSU-PSU School of Public Health, Portland, OR, USA
| | - Kimberly Yee
- Department of Health Policy and Management, OHSU-PSU School of Public Health, Portland, OR, USA.
- OHSU-PSU School of Public Health, 840 SW Gaines St, Gaines Hall, Room 230, Portland, OR, 97239, USA.
| | - Jae M Sevelius
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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