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Mussini C, Cazanave C, Adachi E, Eu B, Alonso MM, Crofoot G, Chounta V, Kolobova I, Sutton K, Sutherland-Phillips D, Urbaityte R, Ehmann A, Scherzer J, de Los Rios P, D'Amico R, Spreen W, van Wyk J. Improvements in Patient-Reported Outcomes After 12 Months of Maintenance Therapy With Cabotegravir + Rilpivirine Long-Acting Compared With Bictegravir/Emtricitabine/Tenofovir Alafenamide in the Phase 3b SOLAR Study. AIDS Behav 2024:10.1007/s10461-024-04490-0. [PMID: 39375290 DOI: 10.1007/s10461-024-04490-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2024] [Indexed: 10/09/2024]
Abstract
SOLAR (NCT04542070; registered 2020-09-09) is a Phase 3b study that demonstrated the noninferior virological efficacy of switching to cabotegravir + rilpivirine long-acting (CAB + RPV LA) dosed every 2 months vs. continuing daily oral bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) over 12 months. Participants were randomised (2:1) to switch to CAB + RPV LA or to continue BIC/FTC/TAF. Patient-reported endpoints included treatment preference, treatment satisfaction (12-item HIV Treatment Satisfaction Questionnaire status version), acceptability of injections (Perception of Injection questionnaire [acceptability domain]) and three single-item questions exploring psychological challenges related to HIV treatment (fear of disclosure, adherence-related anxiety and reminder of HIV status). Of 670 participants, 447 participants switched to CAB + RPV LA and 223 continued BIC/FTC/TAF. Overall, 18% were female, median age was 37 years and 31% were non-White. At Month 12, CAB + RPV LA significantly improved treatment satisfaction vs. BIC/FTC/TAF (mean [95% confidence interval (CI)] change: + 3.36 [2.59, 4.13] vs. -1.59 [-2.71, -0.47]; p < 0.001). At Month 12, a higher proportion of CAB + RPV LA arm participants reported improvements across the psychological challenges related to HIV treatment questions compared with BIC/FTC/TAF participants. Participants indicating ≥ 1 psychological challenge at baseline experienced a statistically significant and clinically meaningful improvement in treatment satisfaction after 12 months of CAB + RPV LA vs. continuing BIC/FTC/TAF (adjusted difference [95% CI]: 7.96 [5.65, 10.26]; p < 0.001). Most (90%, 382/425) questionnaire respondents preferred CAB + RPV LA vs. BIC/FTC/TAF (5%, 21/425). Switching to CAB + RPV LA was associated with significantly improved treatment satisfaction and relief from the fear of disclosure, anxiety surrounding adherence and reminder of HIV status.
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Affiliation(s)
| | - Charles Cazanave
- Department of Infectious Diseases, Pellegrin Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Eisuke Adachi
- The Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Beng Eu
- Prahran Market Clinic, Melbourne, VIC, Australia
- Department of General Practice, University of Melbourne, Melbourne, VIC, Australia
| | - Marta Montero Alonso
- Unit of Infectious Diseases, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | | | - Irina Kolobova
- ViiV Healthcare, 410 Blackwell Street, Durham, NC, 27701, USA.
| | - Kenneth Sutton
- ViiV Healthcare, 410 Blackwell Street, Durham, NC, 27701, USA
| | | | | | | | | | | | - Ronald D'Amico
- ViiV Healthcare, 410 Blackwell Street, Durham, NC, 27701, USA
| | - William Spreen
- ViiV Healthcare, 410 Blackwell Street, Durham, NC, 27701, USA
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Agovi AMA, Thompson CT, Craten KJ, Fasanmi E, Pan M, Ojha RP, Thompson EL. Patient and clinic staff perspectives on the implementation of a long-acting injectable antiretroviral therapy program in an urban safety-net health system. Implement Sci Commun 2024; 5:93. [PMID: 39210473 PMCID: PMC11363636 DOI: 10.1186/s43058-024-00631-7] [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: 05/06/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Long-acting injectable cabotegravir plus rilpivirine (LAI CAB/RPV) has several potential benefits over daily oral formulations for HIV treatment, including the potential to facilitate long-term adherence and reduce pill fatigue. We aimed to assess facilitators of and barriers to LAI CAB/RPV implementation and delivery through the perspectives of physicians and clinical staff, and the experiences of LAI CAB/RPV use among people living with HIV (PLWH) at a Ryan-White supported safety-net clinic in North Texas. METHODS We conducted semi-structured interviews with recruited clinic staff (physicians, nurses, and support staff) involved with LAI CAB/RPV implementation and PLWH who switched to LAI CAB/RPV and consented to participate in individual interviews. Data were collected from July to October 2023. Our interview guide was informed by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM), and Proctor Implementation Outcomes frameworks. Qualitative data were analyzed using a rapid qualitative analysis approach to summarize key themes. RESULTS We recruited and interviewed 15 PLWH who transitioned to LAI CAB/RPV and 11 clinic staff serving these patients. PLWH conveyed that emotional and informational support from family or a trusted clinician influenced their decision to switch to LAI CAB/RPV. PLWH also reported that injectable treatment was more effective, convenient, and acceptable than oral antiretroviral therapy. Clinic staff and physicians reported that staff training, pharmacist-led medication switches, flexible appointments, refrigeration space and designated room for injection delivery facilitated implementation. Clinic staff cited medication costs, understaffing, insurance prior authorization requirements, and lack of medication access through state drug assistance programs as critical barriers. CONCLUSIONS Our study offers insights into real-world experiences with LAI usage from the patient perspective and identifies potential strategies to promote LAI CAB/RPV uptake. The barriers to and facilitators of LAI CAB/RPV program implementation reported by clinic staff in our study may be useful for informing strategies to optimize LAI CAB/RPV programs.
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Affiliation(s)
- Afiba Manza-A Agovi
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA.
| | - Caitlin T Thompson
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Kevin J Craten
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Esther Fasanmi
- Pharmacy Clinical Services Outpatient, JPS Health Network, Fort Worth, TX, USA
| | - Meng Pan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Rohit P Ojha
- Center for Epidemiology & Healthcare Delivery Research, JPS Health Network, 1500 South Main Street, Fort Worth, TX, 76104, USA
| | - Erika L Thompson
- Department of Quantitative and Qualitative Health Sciences, The University of Texas School of Public Health San Antonio, San Antonio, TX, USA
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3
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McCrimmon T, Collins LF, Pereyra M, Platamone C, Perez-Brumer A, Shaffer VA, Kerrigan D, Sheth AN, Cohen MH, Hanna DB, Ramirez C, Gange SJ, Rana A, Tamraz B, Goparaju L, Wilson TE, Alcaide M, Philbin MM. Likelihood of Trying Long-Acting Injectable Antiretroviral Therapy Among Women With HIV in Nine Sites Across the United States. J Acquir Immune Defic Syndr 2024; 96:e23-e27. [PMID: 38905479 PMCID: PMC11250912 DOI: 10.1097/qai.0000000000003422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2024]
Affiliation(s)
- Tara McCrimmon
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Lauren F. Collins
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Margaret Pereyra
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY
| | - Corbin Platamone
- Benioff Homelessness and Housing Initiative, Department of Medicine, University of California San Francisco, San Francisco, CA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Anandi N Sheth
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Mardge H Cohen
- Department of Medicine, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - David B. Hanna
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Catalina Ramirez
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Stephen J. Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Aadia Rana
- Department of Medicine, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Bani Tamraz
- School of Pharmacy, University of California San Francisco, San Francisco, CA, USA
| | - Lakshmi Goparaju
- School of Medicine, Georgetown University Medical Center, Washington, D.C., USA
| | - Tracey E Wilson
- Department of Community Health Sciences, School of Public Health, State University of New York, Downstate Health Sciences University, Brooklyn, NY, USA
| | - Maria Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Morgan M. Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, CA
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4
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Collins LF, Sheth AN, Tisdale T, Mehta CC, Daniel G, Westreich D, Kassaye S, Topper EF, Konkle-Parker D, Rana A, Alcaide ML, Philbin MM. Interest in and Preference for Long-acting Injectable Antiretroviral Therapy in the Era of Approved Cabotegravir/Rilpivirine among Reproductive-aged Women in the U.S. South. Clin Infect Dis 2024:ciae331. [PMID: 38943370 DOI: 10.1093/cid/ciae331] [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: 03/30/2024] [Revised: 05/26/2024] [Accepted: 06/14/2024] [Indexed: 07/01/2024] Open
Abstract
Among 103 reproductive-aged women with HIV in the U.S. South surveyed post-approval of long-acting injectable (LAI) cabotegravir/rilpivirine, nearly two-thirds reported willingness to try LAI antiretroviral therapy (ART). Most expressed preference for LAI over daily oral ART and had minimal concerns over potential LAI-ART use impacting reproductive health.
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Affiliation(s)
- Lauren F Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Ponce de Leon Center, Grady Health System, Atlanta, GA, USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Ponce de Leon Center, Grady Health System, Atlanta, GA, USA
| | - Tina Tisdale
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Ponce de Leon Center, Grady Health System, Atlanta, GA, USA
| | - C Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Gaea Daniel
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Daniel Westreich
- Department of Epidemiology, University of North Carolina-Chapel Hill, NC, USA
| | - Seble Kassaye
- Department of Medicine, Georgetown University, Washington, D.C., USA
| | - Elizabeth F Topper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Deborah Konkle-Parker
- Schools of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, MS, USA
| | - Aadia Rana
- Division of Infectious Diseases, Department of Medicine, University of Alabama-Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Morgan M Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Harris MT, Weinberger E, O'Brien C, Althoff M, Paltrow-Krulwich S, Taylor JL, Judge A, Samet JH, Walley AY, Gunn CM. PrEP facilitators and barriers in substance use bridge clinics for women who engage in sex work and who use drugs. Addict Sci Clin Pract 2024; 19:47. [PMID: 38831359 PMCID: PMC11145858 DOI: 10.1186/s13722-024-00476-4] [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: 09/04/2023] [Accepted: 05/24/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Women who engage in sex work and use drugs (WSWUD) experience disproportionate HIV risks. Substance use treatment bridge clinics offer an opportunity to increase HIV pre-exposure prophylaxis (PrEP) delivery to WSWUD, but research on best practices is lacking. Therefore, we explored facilitators and barriers to PrEP across the PrEP care continuum in these settings. METHODS Bridge clinic and affiliated harm reduction health service providers and WSWUD from Boston were recruited using passive and active outreach between December 2021 and August 2022. Participants were invited to take part in semi-structured phone or in-person interviews to explore HIV prevention and PrEP care experiences overall and within bridge clinic settings. Deductive codes were developed based on HIV risk environment frameworks and the Information-Motivation-Behavioral Skills model and inductive codes were added based on transcript review. Grounded content analysis was used to generate themes organized around the PrEP care continuum. RESULTS The sample included 14 providers and 25 WSWUD. Most WSWUD were aware of PrEP and more than half had initiated PrEP at some point. However, most who initiated PrEP did not report success with daily oral adherence. Providers and WSWUD described facilitators and barriers to PrEP across the steps of the care continuum: Awareness, uptake, adherence, and retention. Facilitators for WSWUD included non-stigmatizing communication with providers, rapid wraparound substance use treatment and HIV services, having a PrEP routine, and service structures to support PrEP adherence. Barriers included low HIV risk perceptions and competing drug use and survival priorities. Provider facilitators included clinical note templates prompting HIV risk assessments and training. Barriers included discomfort discussing sex work risks, competing clinical priorities, and a lack of PrEP adherence infrastructure. CONCLUSION WSWUD and bridge clinic providers favored integrated HIV prevention and substance use services in harm reduction and bridge clinic settings. Harm reduction and bridge clinic programs played a key role in HIV prevention and PrEP education for WSWUD. Effective behavioral and structural interventions are still needed to improve PrEP adherence for WSWUD.
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Affiliation(s)
- Miriam Th Harris
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA.
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA.
| | - Emma Weinberger
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
| | - Christine O'Brien
- Project Trust Boston Area Substance Abuse and Harm Reduction, Boston Medical Center, Boston, MA, 02118, USA
| | - Mary Althoff
- AIDS Action Committee, Cambridge, MA, 02119, USA
| | - Samantha Paltrow-Krulwich
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Jessica L Taylor
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Abigail Judge
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Jeffrey H Samet
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Alexander Y Walley
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine and Boston Medical Center, Boston, MA, 02118, USA
- Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, 03756, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, 02118, USA
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6
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Manghani P, Monroe A, Castel A, Kumar P, Phunmongkol J, Denyer R, O’Connor L. Low Uptake of Long-Acting Injectables in the First 2.5 Years Following Approval Among a Cohort of People Living With HIV. Open Forum Infect Dis 2024; 11:ofae087. [PMID: 38756764 PMCID: PMC11097117 DOI: 10.1093/ofid/ofae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Indexed: 05/18/2024] Open
Affiliation(s)
- Priyanka Manghani
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Anne Monroe
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Amanda Castel
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Princy Kumar
- Division of Infectious Diseases, Georgetown University School of Medicine, Washington, DC, USA
| | - Jennifer Phunmongkol
- Division of Infectious Diseases, Georgetown University School of Medicine, Washington, DC, USA
| | - Rachel Denyer
- Infectious Disease Division, Veterans Affairs Medical Center, Washington, DC, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - Lauren O’Connor
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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Barr E, Marshall LJ, Collins LF, Godfrey C, St Vil N, Stockman JK, Davey DLJ, Dong K, Temkin SM, Glenshaw MT, Byrd C, Clayton JA, Goodenow MM. Centring the health of women across the HIV research continuum. Lancet HIV 2024; 11:e186-e194. [PMID: 38417977 PMCID: PMC11301651 DOI: 10.1016/s2352-3018(24)00004-3] [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: 09/07/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 03/01/2024]
Abstract
Despite tremendous advances in HIV research, women and gender diverse people-particularly women from racial and ethnic groups under-represented in research, transgender women, and young women-remain disproportionately affected by HIV. Women and gender diverse people face unique challenges and have been under-represented in HIV research. The National Institutes of Health (NIH) is tasked to apply fundamental knowledge about the nature and behaviour of living systems to enhance health, lengthen life, and reduce disability. Rigorous exploration of-and interventions for-the individual, social, biological, structural, and environmental factors that influence HIV prevention, transmission, treatment, and cure is crucial to advance research for women, girls, and gender diverse people across the lifespan. In this Position Paper, we introduce a framework for an intersectional, equity-informed, data-driven approach to research on HIV and women and highlight selected issues for women and gender diverse people, including HIV prevention, HIV cure, ageing with HIV, substance use and misuse, violence, pregnancy, and breastfeeding or chestfeeding. This framework underlines a new HIV and Women Signature Programme from the NIH Office of AIDS Research and Office of Research on Women's Health that advances the NIH vision for women's health, in which all women receive evidence-based HIV prevention, treatment, and care across their lifespan tailored to their unique needs, circumstances, and goals. The time is now to centre the health of women, girls, and gender diverse people across the HIV research continuum.
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Affiliation(s)
- Elizabeth Barr
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA.
| | - Leslie J Marshall
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, USA
| | - Lauren F Collins
- Emory University School of Medicine and the Grady Ponce de Leon Center, Atlanta, GA, USA
| | - Catherine Godfrey
- Office of the Global AIDS Coordinator, Department of State, Washington, DC, USA
| | - Noelle St Vil
- University at Buffalo School of Social Work, Buffalo, NY, USA
| | - Jamila K Stockman
- University of California San Diego School of Medicine, San Diego, CA, USA
| | - Dvora L Joseph Davey
- Division of Infectious Diseases, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Department of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Krista Dong
- Ragon Institute of Mass General, MIT and Harvard, Cambridge, MA, USA; Infectious Diseases Division, Massachusetts General Hospital, Boston, MA, USA
| | - Sarah M Temkin
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Mary T Glenshaw
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, USA
| | - Corette Byrd
- Office of AIDS Research, National Institutes of Health, Bethesda, MD, USA
| | - Janine A Clayton
- Office of Research on Women's Health, National Institutes of Health, Bethesda, MD, USA
| | - Maureen M Goodenow
- Office of the Director, National Institutes of Health, Bethesda, MD, USA
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8
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Kerr J, Combs R, Sterrett-Hong E, Harris L, Northington T, Krigger K, Parker K. Evaluation of a community-informed multimedia intervention to increase PrEP awareness and intention among African American young adults. AIDS Care 2024:1-7. [PMID: 38301133 DOI: 10.1080/09540121.2023.2297739] [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: 01/20/2023] [Accepted: 12/14/2023] [Indexed: 02/03/2024]
Abstract
Despite the benefits of pre-exposure prophylaxis (PrEP) in preventing HIV and its potential for reducing racial/ethnic HIV inequities, PrEP remains underutilized among African Americans who may benefit from it. Factors of PrEP uptake include awareness and acceptability of this prevention strategy among this group, yet few community-informed interventions have been developed and evaluated to address these challenges. Thus, this study evaluates the effectiveness of a community-informed, six-month multimedia campaign (print, digital media, internet radio, social media) for African American young adults (age 18-29) in Louisville, Kentucky to increase PrEP awareness and PrEP use intentions. Pretest surveys, posttest surveys, and digital analytic metrics were used to determine campaign effectiveness. Logistic regressions indicate increased PrEP awareness over time (p ≤ 0.0001) and greater PrEP intention among participants reporting greater campaign affinity (p ≤ 0.05). Campaign digital analytic performance was similar to or exceeded that of industry competitors (e.g., healthcare organizations). Findings indicate that a community-informed multimedia campaign increased PrEP use intentions among those exhibiting greater campaign affinity (the extent to which participants report a favorable view of the campaign) and demonstrated similar or greater effectiveness in digital elements as industry competitors at a cost-effective price. Future studies should incorporate community-engaged approaches in developing health communication products for greater PrEP acceptability and efficiency.Trial registration: ClinicalTrials.gov identifier: NCT0355959.
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Affiliation(s)
- Jelani Kerr
- Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Ryan Combs
- Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Emma Sterrett-Hong
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
| | - Lesley Harris
- Kent School of Social Work and Family Science, University of Louisville, Louisville, KY, USA
| | | | - Karen Krigger
- Department of Family and Geriatric Medicine, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Kim Parker
- Parker-Owens Research Group, Frisco, TX, USA
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9
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McCrimmon T, Collins LF, Perez-Brumer A, Bazzi AR, Shaffer VA, Kerrigan D, Alcaide ML, Philbin MM. Long-Acting Injectable Antiretrovirals for HIV Treatment: A Multi-Site Qualitative Study of Clinic-Level Barriers to Implementation in the United States. AIDS Patient Care STDS 2024; 38:61-69. [PMID: 38381949 PMCID: PMC11250840 DOI: 10.1089/apc.2023.0248] [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: 02/23/2024] Open
Abstract
Long-acting injectable antiretroviral therapy (LAI ART) has the potential to address adherence obstacles associated with daily oral ART, leading to enhanced treatment uptake, adherence, and viral suppression among people living with HIV (PLWH). Yet, its potential may be limited due to ongoing disparities in availability and accessibility. We need a better understanding of the organizational context surrounding the implementation of LAI ART, and to inform its widespread rollout, we conducted 38 in-depth interviews with medical and social service providers who offer HIV care at private and hospital-based clinics across six US cities. Our findings highlight real-world implementation barriers outside of clinical trial settings. Providers described ongoing and anticipated barriers across three stages of LAI ART implementation: (1) Patient enrollment (challenges registering patients and limited insurance coverage), (2) medication delivery (insufficient personnel and resources), and (3) leadership and management (lack of interprofessional coordination and a lack of programming guidelines). Providers described how these barriers would have a disproportionate impact on under-resourced clinics, potentially exacerbating existing disparities in LAI ART access and adherence. Our findings suggest strategies that clinic leadership, policymakers, and other stakeholders can pursue to promote rapid and equitable LAI ART implementation in clinics across the United States. Resource and staffing investments could support clinics to begin, sustain, and scale up LAI ART delivery; additionally, the establishment of guidelines and tools could facilitate wider adoption of LAI ART across clinical settings. These efforts are crucial to promote resourced, standardized, and equitable implementation of LAI ART and maximize its potential to help end the HIV epidemic.
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Affiliation(s)
- Tara McCrimmon
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Lauren F. Collins
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Amaya Perez-Brumer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Angela R. Bazzi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Victoria A. Shaffer
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Maria L. Alcaide
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Morgan M. Philbin
- Division of Vulnerable Populations, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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10
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O’Shea JG, Cholli P, Heil EL, Buchacz K. Considerations for long-acting antiretroviral therapy in older persons with HIV. AIDS 2023; 37:2271-2286. [PMID: 37965737 PMCID: PMC10993170 DOI: 10.1097/qad.0000000000003704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
People with HIV (PWH) can now enjoy longer, healthier lives due to safe and highly effective antiretroviral therapy (ART), and improved care and prevention strategies. New drug formulations such as long-acting injectables (LAI) may overcome some limitations and issues with oral antiretroviral therapy and strengthen medication adherence. However, challenges and questions remain regarding their use in aging populations. Here, we review unique considerations for LAI-ART for the treatment of HIV in older PWH, including benefits, risks, pharmacological considerations, implementation challenges, knowledge gaps, and identify factors that may facilitate uptake of LA-ART in this population.
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Affiliation(s)
- Jesse G. O’Shea
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Preetam Cholli
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily L. Heil
- Department of Practice, Sciences, and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
| | - Kate Buchacz
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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11
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Rodriguez Gonzalez H, Volcan AI, Castonguay BJU, Carda-Auten J, Ruiz C, Peretti M, Suarez A, Kerrigan D, Wohl DA, Barrington C. "What Is the Benefit?": Perceptions and Preferences for Long-Acting Injectable Antiretroviral Therapy Among People Living With HIV. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:467-483. [PMID: 38096455 PMCID: PMC10785827 DOI: 10.1521/aeap.2023.35.6.467] [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: 12/18/2023]
Abstract
Long-acting injectable antiretroviral therapy (LA-ART) expands treatment options for people living with HIV (PLWH). This qualitative study characterizes LA-ART awareness, perceptions, and preferences among PLWH engaged in HIV care. From 2019 through 2021, we conducted semistructured in-depth interviews with 71 PLWH sampled from three clinics in three U.S. settings (North Carolina, Washington, DC, Massachusetts). Transcripts were analyzed using narrative and thematic techniques. Participant mean age was 46 years (range 24-72); most were cisgender men (55%) and virally suppressed (73%). Most participants had not heard of LA-ART and reacted with a mix of excitement and cautiousness. Potential LA-ART benefits included easier adherence, privacy, and effectiveness; concerns included effectiveness, side effects, costs, and increased clinic visits. Participants appreciated that LA-ART could support achieving and sustaining viral suppression. To inform their decision, participants wanted more information and convenient access and administration. Findings indicated that a shared decision-making approach and economic and logistical support for PLWH could facilitate LA-ART uptake.
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Affiliation(s)
- Humberto Rodriguez Gonzalez
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina
| | - Andrea Isabel Volcan
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Breana Jae Uhrig Castonguay
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Jessica Carda-Auten
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Carolina Ruiz
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina
| | - Matteo Peretti
- Fenway Institute at Fenway Health, Boston, Massachusetts
| | - Angela Suarez
- Program Integration and Evaluation, La Clinica Del Pueblo, Washington, D.C
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, D.C
| | - David Alain Wohl
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, North Carolina
| | - Clare Barrington
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina
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12
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Tarfa A, Sayles H, Bares SH, Havens JP, Fadul N. Acceptability, Feasibility, and Appropriateness of Implementation of Long-acting Injectable Antiretrovirals: A National Survey of Ryan White Clinics in the United States. Open Forum Infect Dis 2023; 10:ofad341. [PMID: 37520423 PMCID: PMC10386882 DOI: 10.1093/ofid/ofad341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 07/05/2023] [Indexed: 08/01/2023] Open
Abstract
Background The approval of long-acting injectable cabotegravir/rilpivirine (LAI CAB/RPV) heightened the urgency of ensuring effective implementation. Our study assesses readiness and barriers to implement LAI CAB/RPV across Ryan White-funded clinics in the United States. Methods We conducted a cross-sectional survey between December 2020 and January 2021 using validated 4-item measures: acceptability of intervention measure (AIM), intervention appropriateness measure (IAM), and feasibility of intervention measure (FIM). Associations between measures and clinic characteristics were evaluated via Spearman rank correlations. A 5-point Likert scale ranked potential barriers of implementation responses. Open-ended questions were analyzed through a thematic approach. Results Of 270 clinics, 44 (16%) completed the survey: 38% federally qualified health centers, 36% academic, 20% community-based organizations, 14% hospital outpatient, and 9% nonprofit. Means (SD; range) were as follows: AIM, 17.6 (2.4; 12-20); IAM, 17.6 (2.4; 13-20); and FIM, 16.8 (2.9; 7-20). Twenty percent were not at all ready to implement LAI CAB/RPV, and 52% were slightly or somewhat ready. There was a significant association between AIM and the proportion of Medicaid patients (AIM, rho = 0.312, P = .050). Community-based organizations scored the highest readiness measures (mean [SD]: AIM, 19.50 [1.41]; IAM, 19.25 [1.49]; FIM, 19.13 [1.36]) as compared with other clinics. Implementation barriers were cost and patients' nonadherence to visits. Conclusions There is variability of readiness yet high levels of perceived acceptability and appropriateness of implementing LAI CAB/RPV among Ryan White clinics, necessitating tailored interventions for successful implementation. A special focus on addressing the barriers of adherence and the cost of implementation is needed.
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Affiliation(s)
- Adati Tarfa
- School of Pharmacy, University of Wisconsin–Madison, Madison, Wisconsin, USA
| | - Harlan Sayles
- College of Public Health, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska, USA
| | - Sara H Bares
- College of Medicine, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska, USA
| | - Joshua P Havens
- College of Medicine, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska, USA
- College of Pharmacy, University of Nebraska Medical Center, University of Nebraska, Omaha, Nebraska, USA
| | - Nada Fadul
- Correspondence: Nada Fadul, MD, FIDSA, Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE 68198-8106 ()
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13
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Collins LF, Corbin-Johnson D, Asrat M, Morton ZP, Dance K, Condra A, Jenkins K, Todd-Turner M, Sumitani J, Smith BL, Armstrong WS, Colasanti JA. Early Experience Implementing Long-acting Injectable Cabotegravir/Rilpivirine for HIV-1 Treatment at a Ryan White-funded Clinic in the U.S. South. Open Forum Infect Dis 2022; 9:ofac455. [PMID: 36147599 PMCID: PMC9487705 DOI: 10.1093/ofid/ofac455] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/29/2022] [Indexed: 11/14/2022] Open
Abstract
Background Long-acting injectable (LAI) antiretroviral therapy (ART) has the potential to improve medication adherence, reduce human immunodeficiency virus (HIV) stigma, and promote equity in care outcomes among people with HIV (PWH). We describe our early experience implementing LAI-cabotegravir/rilpivirine (CAB/RPV) for maintenance HIV-1 treatment. Methods We launched a pilot LAI-ART program at a large Ryan White-funded clinic in the Southeast, which accept provider-initiated referrals from April 14, 2021 to December 1, 2021. Our interdisciplinary program team (Clinician-Pharmacy-Nursing) verified clinical eligibility and pursued medication access for eligible patients. We describe (1) demographic and clinical variables of PWH referred and enrolled and (2) early outcomes among those accessing LAI-CAB/RPV. Results Among 58 referrals, characteristics were median age 39 (Q1–Q3, 30.25–50) years, 74% male, and 81% Black, and payor source distribution was 26% Private, 21% Medicare, 19% Medicaid, and 34% AIDS Drugs Assistance Program. Forty-five patients (78%) met clinical eligibility for LAI-CAB/RPV; ineligibility concerns included evidence of confirmed or possible RPV resistance (n = 8), HIV nonsuppression (n = 3), possible RPV hypersensitivity (n = 1), and pregnancy (n = 1). Among 45 eligible PWH, 39 (87%) enrolled and 15 (38%) initiated LAI-CAB/RPV after a median of 47 (Q1–Q3, 31–95) days since enrollment. Conclusions Implementing LAI-ART at a Southern US Ryan White-funded clinic has been challenged by the following: substantial human resource capital to attain drug, administer injections, and support enrolled patients; delayed therapy initiation due to insurance denials; patient ineligibility primarily due to possible RPV resistance; and inability to provide drug regardless of payor source. These barriers may perpetuate disparities in ART access and outcomes among PWH and should be urgently addressed so that LAI-ART can be offered equitably.
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Affiliation(s)
- Lauren F Collins
- Divison of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | | | - Meron Asrat
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Zoey P Morton
- Divison of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
| | - Kaylin Dance
- Divison of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
| | - Alton Condra
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Kimberly Jenkins
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Marie Todd-Turner
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Jeri Sumitani
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Bradley L Smith
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Wendy S Armstrong
- Divison of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
| | - Jonathan A Colasanti
- Divison of Infectious Diseases, Department of Medicine, Emory University School of Medicine , Atlanta, Georgia , USA
- Grady Healthcare System, Infectious Diseases Program , Atlanta, Georgia , USA
- Hubert Department of Global Health, Emory University Rollins School of Public Health , Atlanta, GA , USA
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14
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Bazzi AR, Valasek CJ, Streuli SA, Vera CF, Harvey-Vera A, Philbin MM, Biello KB, Roth AM, Strathdee SA, Pines HA. Long-Acting Injectable Human Immunodeficiency Virus Pre-Exposure Prophylaxis Preferred Over Other Modalities Among People Who Inject Drugs: Findings from a Qualitative Study in California. AIDS Patient Care STDS 2022; 36:254-262. [PMID: 35727647 PMCID: PMC9464050 DOI: 10.1089/apc.2022.0068] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
People who inject drugs (PWID) have extraordinarily low uptake of human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) despite high levels of need. Long-acting PrEP modalities hold promise for HIV prevention among PWID, but product preferences remain poorly understood. From September to November 2021, we conducted qualitative interviews with 28 HIV-negative, adult (≥18 years) PWID in San Diego County, CA, to explore their perspectives on daily oral PrEP pills and long-acting PrEP modalities (i.e., injections, implants, intravaginal rings, and broadly neutralizing antibodies), which we explained using standard scripts. Thematic analysis identified variations in PrEP modality interest and acceptability. We identified three key factors across the 28 interviews that appeared to influence PrEP modality preferences: perceived convenience of use, invasiveness, and familiarity (based on past experience). Overall, most participants preferred injectable PrEP over other modalities because they viewed injectable medications as convenient, noninvasive, and familiar. While injectable PrEP was recently approved for use in the United States and was most the acceptable PrEP modality in this sample, our findings suggest that intervention and implementation research is urgently needed to improve our understanding of strategies that could support access, uptake, and sustained adherence to longer-acting PrEP for PWID.
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Affiliation(s)
- Angela R. Bazzi
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Chad J. Valasek
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
| | - Samantha A. Streuli
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
| | - Carlos F. Vera
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Alicia Harvey-Vera
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Morgan M. Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Katie B. Biello
- Departments of Behavioral & Social Sciences and Epidemiology, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Alexis M. Roth
- Department of Community Health and Prevention, Drexel University School of Public Health, Philadelphia, Pennsylvania, USA
| | - Steffanie A. Strathdee
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, California, USA
| | - Heather A. Pines
- Herbert Wertheim School of Public Health, University of California, San Diego, La Jolla, California, USA
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
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15
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Key population perceptions and opinions about long-acting antiretrovirals for prevention and treatment: a scoping review. Curr Opin HIV AIDS 2022; 17:145-161. [PMID: 35439789 DOI: 10.1097/coh.0000000000000734] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE OF REVIEW Key populations are disproportionately affected by human immunodeficiency virus (HIV). Access, retention, and adherence are important barriers for the efficacy of preexposure prophylaxis (PrEP) and HIV treatment among these populations. Long-acting (LA) antiretrovirals hold the promise to solve some of these backdrops. The objective of the current review is to update the perceptions of key populations and PLWH about LA, based on their opinion, acceptability, and willingness to use it. RECENT FINDINGS According to the review preferences for LA vary with the population studied. Regarding people living with HIV (PLWH), male having sex with men are interested in having different options, adolescents are interested in LA (strong preference for implants), yet also perceive substantial obstacles to using biomedical prevention; transgender women aimed to nonvisible small implants, with long-lasting effects or LA injections that can be applied in other areas than buttocks, and women who experienced history of medical injections might increase preference for LA (except for history of people who inject drugs [IDU]). Female sex workers and IDU both showed interest in LA-PrEP. Regarding antiretroviral therapy, LA increased treatment satisfaction and acceptance, mainly among those receiving injections every 2 months. LA helped overcome pill fatigue, stigma, and adherence issues. SUMMARY Knowing preferences for biomedical interventions will contribute to better understanding and developing effective strategies for these populations.
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16
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Rodriguez-Diaz CE, Davis W, Ellis MV, Cameron MS, Donastorg Y, Bowleg L, Greenberg A, Kerrigan D. Disrupting the Systems: Opportunities to Enhance Methodological Approaches to Address Socio-Structural Determinants of HIV and End the Epidemic Through Effective Community Engagement. AIDS Behav 2021; 25:225-231. [PMID: 34618266 PMCID: PMC8494756 DOI: 10.1007/s10461-021-03475-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 12/12/2022]
Abstract
A world without HIV is only possible by addressing the socio-structural determinants of health. Our understanding of socio-structural determinants is constantly changing, and parallel changes must occur with the methodologies used to explain the drivers of the HIV epidemic. We argue for the need to engage communities in the planning, implementation, and dissemination of research on the socio-structural determinants of HIV. Community engagement should cross-cut various types of research including rigorous measurement development of socio-structural determinants and novel analytic techniques to model their role in the trajectory of the epidemic and the impact of interventions. Considering the role of place, we recommend collaboration between scientists and communities in the interpretation of results from studies that map HIV-related behaviors and movement. As we collectively delve into historically oppressive systems with colonial antecedents, we must be ready to challenge these systems and replace them with collaborative models. The success of research-driven HIV policy and programming will best be evaluated with methodologies derived from the insights of the very individuals that these policies and programs aim to serve.
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Affiliation(s)
- Carlos E Rodriguez-Diaz
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washigton University, 950 New Hampshire Ave NW, Suite 300, Washington, DC, 20052, USA.
- DC Center for AIDS Research, Washington, USA.
| | - Wendy Davis
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washigton University, 950 New Hampshire Ave NW, Suite 300, Washington, DC, 20052, USA
- DC Center for AIDS Research, Washington, USA
| | | | | | - Yeycy Donastorg
- Instituto Dermatológico y Cirugia de Piel, Santo Domingo, Dominican Republic
| | - Lisa Bowleg
- DC Center for AIDS Research, Washington, USA
- Department of Psychology and Brain Sciences, George Washington University, Washington, USA
| | - Alan Greenberg
- DC Center for AIDS Research, Washington, USA
- Department of Epidemiology, George Washington University-Milken Institute School of Public Health, Washington, USA
| | - Deanna Kerrigan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washigton University, 950 New Hampshire Ave NW, Suite 300, Washington, DC, 20052, USA
- DC Center for AIDS Research, Washington, USA
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