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Hill-Rorie J, Biello KB, Quint M, Johnson B, Elopre L, Johnson K, Lillis R, Burgan K, Krakower D, Whiteside Y, Mayer KH. Weighing the Options: Which PrEP (Pre-exposure Prophylaxis) Modality Attributes Influence Choice for Young Gay and Bisexual Men in the United States? AIDS Behav 2024; 28:2970-2978. [PMID: 39126557 DOI: 10.1007/s10461-024-04384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 08/12/2024]
Abstract
Pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, but uptake and adherence among young men who have sex with men (YMSM) remains suboptimal. New PrEP formulations may enhance PrEP use, but little is known about their acceptability. We enrolled 39 cis- and transgender YMSM (age 18-34) from Boston, MA; Jackson, MS; Birmingham, AL; and New Orleans, LA, who participated in video-based focus groups (n = 30) or in-depth interviews (n = 9) to examine how new PrEP products (e.g., injections, monthly pills, implants) are perceived and might be improved for YMSM. Focus groups were transcribed, coded, and analyzed using grounded theory and content analysis. Nearly half (46%) of participants were Black; 11% identified as Hispanic. Seventy-nine percent were PrEP experienced. Product preference was driven by the desire for flexible, safe, effective, and affordable PrEP options. A majority of participants preferred subcutaneous injections every 6 months or monthly pills dispersed in 3 or 4 doses. Subcutaneous injections and batched monthly pills were favored by those with demanding schedules and those who desired fewer provider visits; monthly pills were more appealing for those who feared needles. Despite broad preferences for longer-acting products for convenience, participants raised concerns regarding side effects and waning protection after missed doses. Participants felt that more education about safety and efficacy profiles of new products could influence their attitudes. These findings suggest that it is important to prioritize YMSM's dynamic lifestyles during product development, and that product safety and efficacy information should be accessible in youth-friendly language.
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Affiliation(s)
| | - Katie B Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
| | - Meg Quint
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | | | - Kendra Johnson
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Rebecca Lillis
- Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Kaylee Burgan
- University of Alabama, Birmingham, Birmingham, AL, USA
| | - Douglas Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Medical Center/Harvard Medical School, Boston, MA, USA
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Calabrese SK, Kalwicz DA, Zaheer MA, Dovidio JF, Garner A, Zea MC, Treloar C, Holt M, Smith AKJ, MacGibbon J, Modrakovic DX, Rao S, Eaton LA. The Potential Role of Undetectable = Untransmittable (U = U) in Reducing HIV Stigma among Sexual Minority Men in the US. AIDS Behav 2024; 28:741-757. [PMID: 38285293 PMCID: PMC11043859 DOI: 10.1007/s10461-023-04263-1] [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: 12/26/2023] [Indexed: 01/30/2024]
Abstract
The Undetectable = Untransmittable (U = U) message and its scientific underpinnings have been widely suggested to reduce HIV stigma. However, misunderstanding and skepticism about U = U may prevent this destigmatizing potential from being fully realized. This cross-sectional study examined associations between U = U belief (belief that someone with a sustained undetectable viral load has zero risk of sexually transmitting HIV) and HIV stigma among US sexual minority men. Differences by serostatus and effects of brief informational messaging were also explored. The survey was completed online by 106 men living with HIV and 351 HIV-negative/status-unknown men (2019-2020). Participants were 18-83 years old (M[SD] = 41[13.0]). Most were non-Hispanic White (70.0%) and gay (82.9%). Although nearly all participants (95.6%) were aware of U = U, only 41.1% believed U = U. A greater percentage of participants living with HIV (66.0%) believed U = U compared with HIV-negative/status-unknown participants (33.6%). Among participants living with HIV, U = U belief was not significantly associated with perceived, internalized, or experienced HIV stigma or with viral load prejudice (prejudice against people who have a detectable HIV viral load). Among HIV-negative/status-unknown participants, U = U belief was associated with less frequently enacted HIV discrimination, more positive feelings toward people with an undetectable viral load, and lower personal endorsement of stigmatizing beliefs. Brief informational messaging about U = U did not affect most stigma dimensions and did not favorably affect any. Interventions are needed to correct commonly held, outdated misconceptions about HIV transmission risk. Such initiatives must not only engage people living with HIV but also engage HIV-negative/status-unknown people to maximize the destigmatizing potential of U = U.
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Affiliation(s)
- Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA.
- Department of Prevention and Community Health, George Washington University, Washington, DC, USA.
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia.
| | - David A Kalwicz
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Myra A Zaheer
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
- School of Medicine and Health Sciences, George Washington University, Washington, DC, USA
| | - John F Dovidio
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Alex Garner
- Hornet Gay Social Network, Los Angeles, CA, USA
- MPact Global Action for Gay Men's Health and Rights, West Hollywood, CA, USA
| | - Maria Cecilia Zea
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Carla Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - James MacGibbon
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Djordje X Modrakovic
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Sharanya Rao
- Department of Psychological and Brain Sciences, George Washington University, 2013 H Street NW, Washington, DC, 20006, USA
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT, USA
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Maragh-Bass AC, Williams T, Agarwal H, Dulin AK, Sales J, Mayer KH, Siegler AJ. Exploring Stigma, Resilience, and Alternative HIV Preventive Service Delivery Among Young Men who Have Sex with Men of Color. Clin Nurs Res 2023; 32:1046-1056. [PMID: 37401801 DOI: 10.1177/10547738231184295] [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: 07/05/2023]
Abstract
Stigmatization on the basis of race, sexuality, gender identity, and/or use of pre-exposure prophylaxis (PrEP) exacerbates HIV disparities for young men who have sex with men of color (YMSM). We explored resilience, healthcare experiences, stigma, and impact of coronavirus disease 2019 (COVID-19) on PrEP care needs among YMSM of color through virtual in-depth interviews. Analyses used adapted grounded theory/constant comparison. Regarding healthcare-based stigma, participants enacted multilevel resilience which was critical to their care retention during COVID-19 (Themes 1 and 2). Some participants noted that remote care could minimize healthcare stigma and promote retention in care and/or on PrEP (Theme 3). Participants were interested in long-acting injectable (LAI) PrEP but expressed concerns about cost, effectiveness, and side effects (Theme 4). Community-based venues like pharmacies were preferred spaces for getting LAI PrEP injections (Theme 4). Although expansion of telehealth that helped mitigate care retention challenges during COVID-19 was temporary, continued telehealth use may reduce stigmatization and promote long-term retention and PrEP persistence.
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Affiliation(s)
- Allysha C Maragh-Bass
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, USA
- Global Health Institute, Duke University, Durham, NC, USA
| | - Tia Williams
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Harsh Agarwal
- Behavioral, Epidemiological, Clinical Sciences Division, FHI 360, Durham, NC, USA
| | - Akilah K Dulin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Jessica Sales
- Department of Behavioral, Social, and Health Education Sciences (BSHES), Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Aaron J Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Zarwell M, Patton A, Gunn LH, Benziger A, Witt B, Robinson PA, Terrell DF. PrEP awareness, willingness, and likelihood to use future HIV prevention methods among undergraduate college students in an ending the HIV epidemic jurisdiction. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-10. [PMID: 37463522 DOI: 10.1080/07448481.2023.2232885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/15/2023] [Accepted: 06/26/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Identify factors associated with PrEP awareness, willingness, and future prevention modalities among undergraduate college students. PARTICIPANTS Undergraduates (N = 701) were recruited from a private university, a public research university, and a private historically Black college and university for an online survey. METHODS Upon multiple imputations, a multivariate logistic model, a multivariate multinomial model, and independent multivariate ordinal logistic models were used to calculate Rubin's rules-pooled adjusted odds ratios for PrEP awareness, willingness, and future HIV prevention methods. RESULTS Only 33.4% of students had heard of and 32.4% were willing to take PrEP. PrEP willingness was higher among sexual minority students compared to heterosexual/straight students (OR = 1.65; 95% CI: 1.03-2.63); p = .036). The likelihood to take a future vaccine or antibody prophylaxis treatment was higher than the likelihood to take injectable PrEP or implants. CONCLUSIONS Interventions to increase PrEP uptake and willingness among undergraduates should emphasize equity in HIV education and include future prevention modalities.
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Affiliation(s)
- Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- Academy for Population Health Innovation, Department of Public Health Sciences, University of North Carolina at Charlotte and Mecklenburg County Public Health, Charlotte, NC, USA
| | - Alexandra Patton
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- Academy for Population Health Innovation, Department of Public Health Sciences, University of North Carolina at Charlotte and Mecklenburg County Public Health, Charlotte, NC, USA
| | - Laura H Gunn
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- School of Data Science, University of North Carolina at Charlotte, Charlotte, NC, USA
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Alyssa Benziger
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- Academy for Population Health Innovation, Department of Public Health Sciences, University of North Carolina at Charlotte and Mecklenburg County Public Health, Charlotte, NC, USA
| | - Brian Witt
- Academy for Population Health Innovation, Department of Public Health Sciences, University of North Carolina at Charlotte and Mecklenburg County Public Health, Charlotte, NC, USA
- Department of HIV/STD Community Services, Mecklenburg County Public Health, Charlotte, NC, USA
| | - Patrick A Robinson
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, NC, USA
- Academy for Population Health Innovation, Department of Public Health Sciences, University of North Carolina at Charlotte and Mecklenburg County Public Health, Charlotte, NC, USA
| | - Debra F Terrell
- Department of Natural and Behavioral Sciences, Johnson C. Smith University, Charlotte, NC, USA
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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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Valente PK, Bauermeister JA, Lin WY, Silva DTD, Hightow-Weidman L, Drab R, Mayer KH, Operario D, Rusley J, Biello KB. Preferences Across Pre-Exposure Prophylaxis Modalities Among Young Men Who Have Sex with Men in the United States: A Latent Class Analysis Study. AIDS Patient Care STDS 2022; 36:431-442. [PMID: 36367995 PMCID: PMC9910107 DOI: 10.1089/apc.2022.0111] [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] [Indexed: 11/13/2022] Open
Abstract
Access to daily oral pre-exposure prophylaxis (PrEP) is suboptimal among young cisgender men who have sex with men (YMSM) in the United States. Next-generation modalities that do not involve daily oral regimens may mitigate some of the barriers to PrEP use. We identified latent classes of YMSM based on health care decision-making patterns and examined associations between latent classes and access to health care and PrEP modality preferences (i.e., daily and event-driven oral, rectal douches, broadly neutralizing antibodies, subcutaneous implants, and an injectable). Between October 2020 and June 2021, we administered an online survey to 737 YMSM. Latent class analysis (LCA) identified groups of YMSM based on communication with providers, stigma and mistrust in health care, and autonomy in sexual health decisions. Logistic regression examined associations between class membership and health care access, and exploded logit regression examined associations between class membership and ranked PrEP modality preferences. LCA identified three classes: shared decision-making (high communication with providers and high autonomy); provider-led decision-making (high communication and low autonomy); and patient-driven decision-making (low communication and high autonomy). Shared decision-making was associated with higher access to health care in comparison with the other classes. Across all classes, YMSM preferred daily oral PrEP over all next-generation PrEP modalities. Preferences for daily oral PrEP over next-generation PrEP modalities were particularly marked among the patient-driven decision-making class. Shared decision-making is associated with access to health care and HIV prevention and higher acceptability of next-generation PrEP modalities, and should be considered as part of future interventions to promote use of daily oral and next-generation PrEP.
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Affiliation(s)
- Pablo K. Valente
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | | | - Willey Y. Lin
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Daniel Teixeira Da Silva
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Lisa Hightow-Weidman
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ryan Drab
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Don Operario
- School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Jack Rusley
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Katie B. Biello
- School of Public Health, Brown University, Providence, Rhode Island, USA
- Fenway Institute, Fenway Health, Boston, Massachusetts, USA
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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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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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