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Wyatt GE, Norwood-Scott E, Cooley-Strickland M, Zhang M, Smith-Clapham A, Jordan W, Liu H, Hamilton AB. Increasing Urban African American Women's Readiness for Pre-exposure Prophylaxis: A Pilot Study of the Women Prepping for PrEp Plus Program (WP3+). Womens Health Issues 2024; 34:241-249. [PMID: 38267337 DOI: 10.1016/j.whi.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND African American women are disproportionately at risk for HIV infection. To increase women's readiness to consider taking pre-exposure prophylaxis (PrEP), we conducted a pilot study of Women Prepping for PrEP Plus (WP3+). Adapted from an evidence-based HIV risk reduction intervention for African American couples who are HIV-serodiscordant, WP3+ is a group-based culturally congruent program designed for African American women without HIV. METHODS Women were screened for eligibility; if eligible, they were invited to participate in the four-session WP3+ group. Participants completed surveys at baseline (n = 47) and post-implementation (n = 28); surveys assessed demographics, HIV and PrEP knowledge, depression and posttraumatic stress (PTS) symptoms, substance use, sexual risk behaviors, health care-related discrimination, and social support. In a process evaluation, a subset of women completed qualitative interviews at baseline (n = 35) and post-implementation (n = 18); the interviews were designed to converge with (e.g., on HIV and PrEP knowledge) and expand upon (e.g., unmeasured perceived impacts of WP3+) quantitative measures. To triangulate with the quantitative data, deductive qualitative analysis concentrated on women's knowledge and awareness of PrEP and HIV, their relationship dynamics and challenges, and their considerations (e.g., barriers, facilitators) related to taking PrEP; inductive analysis focused on women's experiences in the intervention. RESULTS Participants in the WP3+ intervention reported: improved proportion of condom use in the past 90 days (p < .01) and in a typical week (p < .05); reduced PTS symptoms (p < .05); increased HIV knowledge (p < .0001) and awareness of PrEP (p < .001); and greater consideration of using PrEP (p < .001). In interviews, participants expressed not only increased knowledge but also appreciation for learning how to protect themselves against HIV, communicate with their partners, and take charge of their health, and they expressed greater receptiveness to using PrEP as a result of the knowledge and skills they gained. CONCLUSIONS The WP3+ pilot study demonstrated preliminary efficacy and acceptability as an HIV-prevention program for African American women. A controlled trial is needed to confirm its efficacy for increasing PrEP use among African American women.
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Affiliation(s)
- Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California.
| | - Enricka Norwood-Scott
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Michele Cooley-Strickland
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Muyu Zhang
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Amber Smith-Clapham
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Wilbert Jordan
- Charles R. Drew University/OASIS Clinic, Los Angeles, California
| | - Honghu Liu
- Section of Public and Population Health, School of Dentistry, University of California Los Angeles, Los Angeles, California; Departments of Biostatistics and Medicine, University of California Los Angeles, Los Angeles, California
| | - Alison B Hamilton
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California; Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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Irie WC, Calabrese SK, Mayer KH, Geng EH, Blackstock O, Marcus JL. Social and structural factors associated with interest in HIV preexposure prophylaxis among Black women in the United States. AIDS Care 2024; 36:672-681. [PMID: 38176016 PMCID: PMC10994725 DOI: 10.1080/09540121.2023.2299338] [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: 03/08/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
In a nationwide sample of cisgender Black women in the US, we assessed the associations between social and structural factors and interest in using HIV preexposure prophylaxis (PrEP). Among 315 respondents, 62.2% were interested in PrEP if it were provided for free. Positive social norms surrounding PrEP, including injunctive norms (perceived social acceptability of PrEP use) and descriptive norms (perceived commonality of PrEP use), were positively associated with interest in using PrEP. Concerns about HIV infection, recently visiting a health care provider, and comfort discussing PrEP with a provider were also positively associated with interest in using PrEP. Anticipating PrEP disapproval from others was negatively associated with interest in PrEP. Although PrEP can promote autonomy and personal discretion, Black women's PrEP-related decisions occur in a complex social environment. Black women may benefit from interventions to promote positive norms and attitudes surrounding PrEP at the community level and empower them in discussions with their providers about PrEP.
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Affiliation(s)
- Whitney C Irie
- Boston College School of Social Work, Chestnut Hill, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sarah K Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, DC, USA
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA, USA
| | - Elvin H Geng
- Division of Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA
| | | | - Julia L Marcus
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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3
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Waldron EM, Goodman GR, Rivas AM, Ott C, Blyler A, McDonald VW, Campbell M, Underwood E, Bonner A, Wise JM, Elopre L, Kudroff K, Krakower D, Sherr K, Kempf MC, Psaros C. Perceptions of and preferences for PrEP use among African American women and providers in the U.S. South: a qualitative study. Psychol Health 2024:1-20. [PMID: 38441003 DOI: 10.1080/08870446.2024.2322079] [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: 08/12/2023] [Accepted: 02/17/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE African American (AA) women in the U.S. South experience significant HIV incidence, and efforts to support antiretroviral pre-exposure prophylaxis (PrEP) uptake and maintenance among this group have been insufficient. This study aimed to explore perceptions, attitudes, and implementation preferences surrounding PrEP use for AA women in the U.S. South. METHODS AND MEASURES The study team conducted qualitative interviews with AA cisgender women clients (n = 21) and their providers (n = 20) in Federally Qualified Health Centers and HIV clinics in Alabama. The research team employed directed qualitative content analysis to analyze interview data. RESULTS Five themes emerged: a) inconsistent access to PrEP and PrEP knowledge, b) need for improving low PrEP awareness, c) managing hesitancy to prescribe or use PrEP, d) perceived HIV vulnerability and inherent stigma, and e) normalizing PrEP as part of routine sexual healthcare to increase uptake and maintenance. Interviews revealed an openness towards PrEP as an HIV prevention strategy for AA, cisgender women in Alabama. CONCLUSION Improving PrEP uptake and maintenance among AA women in the U.S. South must go beyond increasing awareness to improving PrEP access and trust through visibility of AA women's PrEP use and incorporating PrEP education and services into routine sexual healthcare.
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Affiliation(s)
- Elizabeth M Waldron
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Georgia R Goodman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
- The Fenway Institute at Fenway Health, Boston, MA, USA
| | - Alexa M Rivas
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Corilyn Ott
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Abigail Blyler
- Positive Psychology Center, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria W McDonald
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marquetta Campbell
- Maude L. Whatley Health Center, Whatley Health Services, Inc, Tuscaloosa, AL, USA
| | - Eric Underwood
- Maude L. Whatley Health Center, Whatley Health Services, Inc, Tuscaloosa, AL, USA
| | - Aharisi Bonner
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jenni M Wise
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Latesha Elopre
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kachina Kudroff
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Douglas Krakower
- The Fenway Institute at Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Mirjam-Colette Kempf
- School of Nursing, The University of Alabama at Birmingham, Birmingham, AL, USA
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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4
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Pitchford K, Shangani S, Dawson C, Masa R, Heron K. Community Health Care Providers' Perspectives on Human Immunodeficiency Virus Pre-Exposure Prophylaxis Use Among Black Women in Eastern Virginia. AIDS Patient Care STDS 2024; 38:123-133. [PMID: 38471092 DOI: 10.1089/apc.2023.0199] [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: 03/14/2024] Open
Abstract
The most at-risk population among women for human immunodeficiency virus (HIV) diagnosis in the United States are Black women, accounting for 61% of all new HIV cases. Pre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention method for people at risk of HIV acquisition. Although disproportionately affected by HIV, Black women's knowledge, perceived benefits, and uptake of PrEP remain low. The socioecological model (SEM) may be useful for understanding why there is a low uptake of PrEP among Black women. The current study used the SEM to explore provider perspectives on the barriers and facilitators of PrEP uptake among Black women in Eastern Virginia. Semistructured interviews were conducted with a total sample of 15 community health care providers. Barriers of PrEP uptake at the societal (e.g., PrEP advertisements focus on gay men), community/organizational (e.g., time constraints in the workplace), interpersonal (e.g., perceived monogamy), and individual (e.g., unmet basic needs) levels were identified. Providers also identified facilitators of PrEP uptake at the societal (e.g., PrEP advertisements that target women), community/organizational (e.g., PrEP education), interpersonal (e.g., HIV-positive partner), and individual (e.g., PrEP awareness and perceived susceptibility to HIV) levels. These findings highlight unique barriers to accessing and taking PrEP for Black women in the United States, and potential factors that could facilitate PrEP use. Both barriers and facilitators may be important targets for interventions to improve PrEP uptake. Future research focused on improving PrEP uptake among Black women in the United States should consider multi-level interventions that target barriers and facilitators to reduce rates of HIV infections.
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Affiliation(s)
- Kayla Pitchford
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Sylvia Shangani
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts, USA
- Social and Behavioral Sciences Department, Yale School of Public Health, New Haven, Connecticut, USA
| | - Charlotte Dawson
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Rainier Masa
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristin Heron
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
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5
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Hazra A, McNulty MC, Pyra M, Pagkas-Bather J, Gutierrez JI, Pickett J, Stewart J, Bolan RK, Molina JM, Celum C, Luetkemeyer AF, Klausner JD. Filling in the Gaps: Updates on Doxycycline Prophylaxis for Bacterial Sexually Transmitted Infections. Clin Infect Dis 2024:ciae062. [PMID: 38332660 DOI: 10.1093/cid/ciae062] [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: 11/09/2023] [Revised: 01/19/2024] [Accepted: 02/02/2024] [Indexed: 02/10/2024] Open
Abstract
Over the past two decades, cases of sexually transmitted infections (STIs) due to syphilis, gonorrhea, and chlamydia have been rising in the United States, disproportionately among gay, bisexual, and other men who have sex with men (MSM), as well as racial and ethnic minorities of all genders. In this review, we address updates about the evidence on doxycycline post-exposure prophylaxis (doxy-PEP) for prevention of bacterial STIs, including efficacy, safety, antimicrobial resistance (AMR), acceptability, modeling population impact, and evolving guidelines for use. Equitable implementation of doxy-PEP will require evaluation of who is offered and initiates it, understanding patterns of use and longer-term STI incidence and AMR, provider training, and tailored community education.
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Affiliation(s)
- Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
- Howard Brown Health, Chicago, IL, USA
| | - Moira C McNulty
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - Maria Pyra
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jade Pagkas-Bather
- Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, IL, USA
| | - Jose I Gutierrez
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Robert K Bolan
- Los Angeles LGBT Center (The Center), Los Angeles, CA, USA
| | - Jean-Michel Molina
- University of Paris Cité, Saint-Louis and Lariboisière Hospitals, Assistance Publique Hopitaux de Paris, France
| | - Connie Celum
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA, USA
| | - Anne F Luetkemeyer
- Division of HIV, Infectious Diseases and Global Medicine, University of California, San Francisco, CA, USA
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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6
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Zarwell M, Witt B, Marin-Cespedes S, Gorman B, Kumtap MU, Hoff R, Rysbayeva A, Jha P, Boehm EL, Harihar S, Issel LM, Robinson P. Uptake and Discontinuation of Pre-Exposure Prophylaxis Among Uninsured Transgender and Cisgender Women: A Public-Private Partnership Model in North Carolina. AIDS Patient Care STDS 2023; 37:525-534. [PMID: 37956243 DOI: 10.1089/apc.2023.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
HIV pre-exposure prophylaxis (PrEP) remains underutilized among cis and trans women. The PrEP Initiative Program (PIP) is a novel public-private partnership implemented at 12 local clinics in North Carolina. PIP provides HIV/sexually transmitted infection (STI) testing and clinical and laboratory monitoring for PrEP to uninsured/underinsured clients. We sought to understand service-related differences among both cis and trans women enrolled in PIP, including STIs diagnoses, clinic type, sources of referral, services needed, and reasons for PrEP discontinuation. The Kaplan-Meier curves display retention on PrEP over the duration of the program. Since 2018, 142 women (cis n = 113; trans n = 29) enrolled, and 136 started PrEP. The majority were ages 25-34 years (31.7%) or 18-24 years (29.6%), Black (57.8%) or Latinx (24.7%). Approximately 20.6% of recipients reported at least one STI while enrolled. Overall, trans women requested fewer services than cis women. After accounting for the amount of time each patient was taking PrEP, there were higher rates of trans women diagnosed with syphilis than cis women. Rates of persons with other STIs were not notably different between trans and cis women. Clinic access varied by gender: 69% of trans women were enrolled at only one site. Trans women were retained significantly longer: The Kaplan-Meier adjusted median time to discontinuation was 560 and 238 days for trans and cis women, respectively. PIP successfully reached historically marginalized and uninsured cis and trans women who may benefit from PrEP. Further investigations into factors contributing to recruitment and retention of women in HIV prevention programs are needed.
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Affiliation(s)
- Meagan Zarwell
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
- Academy for Population Health Innovation, UNC Charlotte, Charlotte, North Carolina, USA
| | - Brian Witt
- Academy for Population Health Innovation, UNC Charlotte, Charlotte, North Carolina, USA
- HIV/STI Division, Mecklenburg County Public Health Department, Charlotte, North Carolina, USA
| | - Sebastian Marin-Cespedes
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
- Academy for Population Health Innovation, UNC Charlotte, Charlotte, North Carolina, USA
| | - Brianna Gorman
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
| | - Makshwar U Kumtap
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
| | - Rhoen Hoff
- Department of Psychology, UNC Charlotte, College of Liberal Arts and Sciences, Charlotte, North Carolina, USA
| | - Ainella Rysbayeva
- Department of Biology, UNC Charlotte, College of Liberal Arts and Sciences, Charlotte, North Carolina, USA
| | - Prashant Jha
- Department of Biology, UNC Charlotte, College of Liberal Arts and Sciences, Charlotte, North Carolina, USA
| | - Elsa L Boehm
- BASIS DC High School, Washington, District of Columbia, USA
| | - Sweta Harihar
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
- Academy for Population Health Innovation, UNC Charlotte, Charlotte, North Carolina, USA
| | - L Michele Issel
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
| | - Patrick Robinson
- Department of Public Health Sciences, UNC Charlotte, College of Health and Human Services, Charlotte, North Carolina, USA
- Academy for Population Health Innovation, UNC Charlotte, Charlotte, North Carolina, USA
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7
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Irie W, Mahone A, Nakka R, Ghebremichael M. Confidence in Ability to Communicate With Sexual Partners About PrEP Among Black Cisgender Women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:333-346. [PMID: 37843905 DOI: 10.1521/aeap.2023.35.5.333] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
This study explored the factors associated with Black women's confidence in their ability to engage male sexual partners in discussions about PrEP. Communication about PrEP with male partners is an important, yet minimally explored, outcome in PrEP research among Black women in heterosexual partnerships. Among 315 respondents, results show significant differences in anticipated stigma and interest in PrEP between a binary outcome variable being confident and not-confident discussing PrEP with sexual partners. Further, factors such as employment, worrying about HIV infection, interest in taking oral PrEP, subjective norms, injunctive norms, and descriptive norms were associated with Black women's higher odds of confidence in their ability to engage sexual partners about PrEP. Conversely, PrEP disapproval and stigma resulted in lower odds of Black women's confidence in their ability to engage sexual partners about PrEP. Results indicate the need for continued investigation of confidence and, relatedly, communication about PrEP among heterosexual couples and communitylevel interventions normalizing PrEP discussions and uptake.
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Affiliation(s)
- Whitney Irie
- Boston College School of Social Work, Chestnut Hill, Massachusetts, and The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Anais Mahone
- School of Social Work, Rutgers University, New Brunswick, New Jersey
| | - Raja Nakka
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts
| | - Musie Ghebremichael
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts
- Department of Medicine, Harvard Medical School, Cambridge, Massachusetts
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Miley KL, Tran NK, Elopre L, Groves A, Stockman JK, Bazzi AR, Carrico A, Mazzella S, Roth AM. A Note on Preexposure Prophylaxis Preferences Among Women Who Inject Drugs. Sex Transm Dis 2023; 50:671-674. [PMID: 36728264 DOI: 10.1097/olq.0000000000001768] [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] [Indexed: 02/03/2023]
Abstract
ABSTRACT We informed women who inject drugs about different preexposure prophylaxis (PrEP) formulations; they then ranked their preferences. Daily oral PrEP was most preferred, followed by injectable PrEP and vaginal rings/gels, especially among women of color. Multiple PrEP options should be discussed with women who inject drugs to increase uptake.
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Affiliation(s)
- Kerry L Miley
- From the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Nguyen K Tran
- Department of Medicine, Stanford University, Palo Alto, CA
| | - Latesha Elopre
- Division of Infectious Diseases, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Allison Groves
- From the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Jamila K Stockman
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Angela R Bazzi
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami, Miami, FL
| | | | - Alexis M Roth
- From the Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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9
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Irie WC, Mahone A, Nakka R, Ghebremichael M. Factors Associated with Comfort Discussing PrEP with Healthcare Providers among Black Cisgender Women. Trop Med Infect Dis 2023; 8:436. [PMID: 37755897 PMCID: PMC10534734 DOI: 10.3390/tropicalmed8090436] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/17/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
Preexposure prophylaxis (PrEP) for HIV prevention uptake remains low among Black cisgender women in the United States, despite their disproportionate HIV burden. This study aimed to examine factors associated with Black women's comfort discussing PrEP with healthcare providers and its link to their interest in PrEP use. A cross-sectional survey was conducted with a national sample of 315 Black cisgender women. Descriptive statistics and logistic regression models were utilized for data analysis. The results showed that 79% of Black women felt comfortable discussing PrEP with their healthcare provider. Age, recent healthcare provider visit, interest in PrEP, and positive social norms were associated with increased odds of comfort in discussing PrEP, while anticipated PrEP disapproval and stigma were associated with decreased odds. Older age was related to greater comfort, potentially due to increased familiarity and self-efficacy in discussing sexual health. Recent healthcare utilization indicated positive provider relationships, facilitating discussions about sexual health. Anticipating support from social networks positively influenced comfort levels. Conversely, PrEP-related stigma and anticipated disapproval were barriers to comfort. These findings highlight the importance of provider-patient communication and social support in facilitating PrEP engagement among Black cisgender women. Interventions should consider age-appropriate strategies and address structural and provider biases to improve PrEP discussions and promote HIV prevention.
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Affiliation(s)
- Whitney C. Irie
- Boston College School of Social Work, Chestnut Hill, MA 02467, USA
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA
| | - Anais Mahone
- School of Social Work, Rutgers University, New Brunswick, NJ 08901, USA
| | - Raja Nakka
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA (M.G.)
| | - Musie Ghebremichael
- The Ragon Institute of MGH, MIT, and Harvard, Cambridge, MA 02139, USA (M.G.)
- Department of Medicine, Harvard Medical School, Cambridge, MA 02215, USA
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10
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Durham SH, Milam A, Waer D, Chahine EB. Cabotegravir: The First Long-Acting Injectable for HIV Preexposure Prophylaxis. Ann Pharmacother 2023; 57:306-316. [PMID: 35778802 DOI: 10.1177/10600280221102532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Review the pharmacology, pharmacokinetics, efficacy, safety, and role of long-acting injectable cabotegravir (CAB-LA) in HIV preexposure prophylaxis (PrEP). DATA SOURCES A literature search was performed using PubMed and Google Scholar (2012 to April 2022) with the search terms cabotegravir, preexposure prophylaxis, and PrEP. Other resources included abstracts presented at recent conferences, the manufacturer's Web site, prescribing information, and review articles. STUDY SELECTION AND DATA EXTRACTION All English-language articles of studies assessing the efficacy and safety of CAB-LA for PrEP were included. DATA SYNTHESIS CAB-LA is the first long-acting injectable therapy approved for HIV-1 PrEP in both men and women. It is a suspension given intramuscularly every other month. CAB-LA has been shown to be more effective than daily oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) in preventing HIV-1 infection among high-risk individuals. Two phase 3 trials were stopped early on the basis of superior efficacy of CAB-LA. The most common adverse effects were injection site reactions (ISRs), although they tended to decrease over time, and few participants in clinical trials discontinued use due to ISRs. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE CAB-LA may be particularly useful for individuals with known adherence problems to oral therapy, those with renal impairment, and those with decreased bone mineral density. However, CAB-LA is more expensive than generic TDF/FTC and may be associated with weight gain. CONCLUSIONS CAB-LA is the first long-acting injectable agent for HIV PrEP. It is more effective than oral TDF/FTC, is well-tolerated aside from ISRs, and has few clinically significant drug-drug interactions.
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Affiliation(s)
- Spencer H Durham
- Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, Auburn, AL, USA
| | - Ashlee Milam
- Auburn University Harrison College of Pharmacy, Auburn, AL, USA
| | - Dylan Waer
- Auburn University Harrison College of Pharmacy, Auburn, AL, USA
| | - Elias B Chahine
- Lloyd L. Gregory School of Pharmacy, Palm Beach Atlantic University, West Palm Beach, FL, USA
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11
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Ramakrishnan A, Sales JM, McCumber M, Powell L, Sheth AN. Human Immunodeficiency Virus Pre-Exposure Prophylaxis Knowledge, Attitudes, and Self-Efficacy Among Family Planning Providers in the Southern United States: Bridging the Gap in Provider Training. Open Forum Infect Dis 2022; 9:ofac536. [PMID: 36349276 PMCID: PMC9636854 DOI: 10.1093/ofid/ofac536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is an effective human immunodeficiency virus (HIV) prevention intervention, but its access and use are suboptimal, especially for women. Healthcare providers provision of PrEP is a key component of the Ending the HIV Epidemic initiative. Although training gaps are an identified barrier, evidence is lacking regarding how to tailor trainings for successful implementation. Title X family planning clinics deliver safety net care for women and are potential PrEP delivery sites. To inform provider training, we assessed PrEP knowledge, attitudes, and self-efficacy in the steps of PrEP care among Title X providers in the Southern United States. Methods We used data from providers in clinics that did not currently provide PrEP from a web-based survey administered to Title X clinic staff in 18 Southern states from February to June 2018. We developed generalized linear mixed models to evaluate associations between provider-, clinic-, and county-level variables with provider knowledge, attitudes, and self-efficacy in PrEP care, guided by the Consolidated Framework for Implementation Research. Results Among 351 providers from 193 clinics, 194 (55%) were nonprescribing and 157 (45%) were prescribing providers. Provider ability to prescribe medications was significantly associated PrEP knowledge, attitudes, and self-efficacy. Self-efficacy was lowest in the PrEP initiation step of PrEP care and was positively associated with PrEP attitudes, PrEP knowledge, and contraception self-efficacy. Conclusions Our findings suggest that PrEP training gaps for family planning providers may be bridged by addressing unfavorable PrEP attitudes, integrating PrEP and contraception training, tailoring training by prescribing ability, and focusing on the initiation steps of PrEP care.
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Affiliation(s)
- Aditi Ramakrishnan
- Division of Infectious Diseases, Washington University School of Medicine , St. Louis, Missouri , USA
| | - Jessica M Sales
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
| | - Micah McCumber
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina , USA
| | - Leah Powell
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Emory University School of Medicine , Atlanta, Georgia , USA
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Gollub EL, Vaughan R. U.S. Women Need the Dapivirine Ring, Too: FDA as Structural Barrier to HIV Prevention for Women. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2022; 34:311-324. [PMID: 35994576 DOI: 10.1521/aeap.2022.34.4.311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The dapivirine monthly vaginal ring-a discreet, anti-HIV microbicide created specifically for women-has received a positive scientific opinion by the European Medicines Agency and is included in the WHO HIV prevention guidelines. It has received regulatory approvals in several countries in southern and eastern Africa. During the review of the New Drug Application that was submitted in December 2020, FDA advised the developer, International Partnership for Microbicides, that it was unlikely to be approved in the United States; the application has since been withdrawn. This commentary will present the case for FDA approval for the dapivirine ring. Advocacy is urgently needed to protect U.S. women's access to user-controlled HIV prevention technologies, consistent with both global regulatory decisions to date and with a reproductive justice framework. Women continue to need the fullest range of HIV prevention methods to integrate into their lives in the most practical and effective way possible.
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Affiliation(s)
- Erica L Gollub
- Health Science Program, College of Health Professions, Pace University, Pleasantville, New York
| | - Raven Vaughan
- Health Science Program, College of Health Professions, Pace University, Pleasantville, New York
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13
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Sexually Transmitted Infection Testing, Prevalence, and Treatment among Individuals Receiving HIV Pre-Exposure Prophylaxis within an Integrated Healthcare Delivery System. Sex Transm Dis 2022; 49:616-621. [PMID: 35724111 DOI: 10.1097/olq.0000000000001665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Initial and follow-up sexually transmitted infection (STI) and HIV testing is recommended when taking HIV preexposure prophylaxis (PrEP). We assessed STI services before and after PrEP initiation among persons aged ≥18 years. METHODS We conducted this retrospective cohort study at an US integrated healthcare delivery system. We measured HIV/STI testing rates, STI prevalence and treatment at 3 time points: (1) at PrEP initiation, (2) at 120 days, and (3) at 210 days. RESULTS Of 685 PrEP initiators, 67.2% continued PrEP use at 120 days and 49.5% at 210 days. Of PrEP users, HIV and STI testing were > 85% and > 80%, respectively, at all 3 time points. Prevalence for any chlamydia, rectal chlamydia, and any gonorrhea, rectal gonorrhea, or pharyngeal gonorrhea was always high at the 120 days and 210 days (e.g, 6.9%, 10.5%, 6.7%, 5.0%, and 5.2%, respectively, at the 120-days for continuous PrEP users). Over 90% of all individuals who tested positive for chlamydia and/or gonorrhea received antibiotic pharmacy fills within seven days at 120 days and 210 days. Monthly PrEP-related pharmacy cost was about $2259-$2659. The proportion of the total medical cost that was PrEP-related pharmacy was about 82% for PrEP continuous users. CONCLUSIONS Although HIV/STI testing rates were high, they can still be improved during HIV PrEP management. High STI prevalence after PrEP initiation in this study suggests that patients taking PrEP are at risk of acquiring an STI. Interventions to improve STI services during PrEP management are continuously needed.
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14
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Elopre L, Boutwell A, Gordon B, Johnson B, Marrazzo J, Van Der Pol B, Mugavero MJ. PrEP service delivery preferences of black Cis-gender women living in the Southern United States. AIDS Behav 2022; 26:3469-3479. [PMID: 35445992 PMCID: PMC9022049 DOI: 10.1007/s10461-022-03691-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
To assess PrEP service delivery preferences among Black cis-gender women living in urban and rural settings in Alabama, we conducted a cross-sectional discrete choice experiment survey. Discrete choice experiments included five attributes. Hierarchical Bayes (HB) modeling and latent class analyses (LCA) were used to evaluate attribute preferences. Among 795 Black cis-gender HIV-negative women, almost two-thirds lived in urban settings and reported having at least some college; about a third reported a household income less than $25,000 annually; and reported willingness to use PrEP. Respondents placed the greatest importance on PrEP medication formulation and healthcare facility. LCA showed the group with the highest rural proportion preferred for on-line visits. Black women in the Deep South had distinct preferences regarding PrEP service delivery. These findings can inform tailored interventions to improve PrEP uptake among Black cis-gender women across diverse settings in the South.
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Affiliation(s)
- Latesha Elopre
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States.
| | - Alexander Boutwell
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States
| | - Bretia Gordon
- Medical Advocacy and Outreach, Birmingham, AL, United States
| | - Bernadette Johnson
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States
| | - Jeanne Marrazzo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States
| | - Barbara Van Der Pol
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, United States
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Pratt MC, Jeffcoat S, Hill SV, Gill E, Elopre L, Simpson T, Lanzi R, Matthews LT. "We Feel Like Everybody's Going to Judge us": Black Adolescent Girls' and Young Women's Perspectives on Barriers to and Opportunities for Improving Sexual Health Care, Including PrEP, in the Southern U.S. J Int Assoc Provid AIDS Care 2022; 21:23259582221107327. [PMID: 35699978 PMCID: PMC9201301 DOI: 10.1177/23259582221107327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Black adolescent girls and young women (AGYW) are disproportionately affected by
HIV in the southern U.S.; however, PrEP prescriptions to Black AGYW remain
scarce. We conducted in-depth interviews (IDIs) with Black AGYW ages 14-24 in
Alabama to explore opportunities for and barriers to sexual health care
including PrEP prescription. Twelve AGYW participated in IDIs with median age 20
(range 19-24). All reported condomless sex, 1-3 sexual partners in the past 3
months, and 6 reported prior STI. Themes included: 1) Stigma related to sex
contributes to inadequate discussions with educators, healthcare providers, and
parents about sexual health; 2) Intersecting stigmas around race and gender
impact Black women's care-seeking behavior; 3) Many AGYW are aware of PrEP but
don't perceive it as an option for them. Multifaceted interventions utilizing
the perspectives, voices, and experiences of Black cisgender AGYW are needed to
curb the HIV epidemic in Alabama and the U.S. South.
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Affiliation(s)
- Madeline C Pratt
- Division of Infectious Diseases, Department of Medicine, School of Medicine, 9968University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | | | - Samantha V Hill
- Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Elizabeth Gill
- School of Medicine, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Latesha Elopre
- Division of Infectious Diseases, Department of Medicine, School of Medicine, 9968University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Tina Simpson
- Division of Adolescent Medicine, Department of Pediatrics, School of Medicine, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Robin Lanzi
- Department of Health Behavior, School of Public Health, 9968University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lynn T Matthews
- Division of Infectious Diseases, Department of Medicine, School of Medicine, 9968University of Alabama at Birmingham (UAB), Birmingham, AL, USA
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