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Owczarzak J, Martin E, Weicker N, Evans I, Morris M, Sherman SG. A qualitative exploration of harm reduction in practice by street-based peer outreach workers. Harm Reduct J 2024; 21:161. [PMID: 39210459 PMCID: PMC11363392 DOI: 10.1186/s12954-024-01076-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/14/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Despite the widespread use of the phrase "harm reduction" and the proliferation of programs based on its principles during the current opioid epidemic, what it means in practice is not universally agreed upon. Harm reduction strategies have expanded from syringe and needle exchange programs that emerged in the mid-1980s primarily in response to the HIV epidemic, to include medication for opioid use disorder, supervised consumption rooms, naloxone distribution, and drug checking technologies such as fentanyl test strips. Harm reduction can often be in tension with abstinence and recovery models to address substance use, and people who use drugs may also hold competing views of what harm reduction means in practice. Street-based outreach workers are increasingly incorporated into harm reduction programs as part of efforts to engage with people more fully in various stages of drug use and nonuse. METHOD This paper explores how peer outreach workers, called "members," in a street-based naloxone distribution program define and practice harm reduction. We interviewed 15 members of a street-based harm reduction organization in an urban center characterized by an enduring opioid epidemic. Inductive data analysis explored harm reduction as both a set of principles and a set of practices to understand how frontline providers define and enact them. RESULTS Analysis revealed that when members talked about their work, they often conceptualized harm reduction as a collection of ways members and others can "save lives" and support people who use drugs. They also framed harm reduction as part of a "path toward recovery." This path was complicated and nonlinear but pursued a common goal of life without drug use and its residual effects. These findings suggest the need to develop harm reduction programs that incorporate both harm reduction and recovery to best meet the needs of people who use drugs and align with the value systems of implementers.
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Affiliation(s)
- Jill Owczarzak
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Room 739, Baltimore, MD, 21205, USA.
| | - Emily Martin
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Room 163, Baltimore, MD, 21205, USA
| | - Noelle Weicker
- Tufts Clinical and Translational Science Institute, 35 Kneeland Street, 7th - 11th Floor, Boston, MA, USA
| | - Imogen Evans
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Room 163, Baltimore, MD, 21205, USA
| | - Miles Morris
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Room 163, Baltimore, MD, 21205, USA
| | - Susan G Sherman
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway Ave, Room 749, Baltimore, MD, 21205, USA
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Wu E, Lee YG, Vinogradov V, Zhakupova G, Mergenova G, Davis A, Paine EA, Hunt T, Reeder K, Primbetova S, Terlikbayeva A, Laughney C, Chang M, Baiserkin B, Abishev A, Tukeyev M, Abdraimov S, Denebayeva A, Kasymbekova S, Tazhibayeva G, Kozhakhmet M. Increasing HIV Testing Among Sexual and Gender Expansive Men in Kazakhstan: A Stepped-Wedge Randomized Trial of a Community-Level Intervention. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.08.01.24311235. [PMID: 39132483 PMCID: PMC11312675 DOI: 10.1101/2024.08.01.24311235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
Importance HIV transmission in Kazakhstan has increased among men who have sex with men (MSM) and transgender and nonbinary people who have sex with men (TSM), driven by low HIV testing rates. Objective To determine if the PRIDE in HIV Care intervention had a community effect of increasing HIV testing among MSM and TSM in Kazakhstan. Design We employed a stepped-wedge, cluster-randomized controlled trial with MSM and TSM community members recruited from three cities in Kazakhstan: Almaty, Astana, and Shymkent. We collected serial cross-sectional data where community members completed one assessment between 21 August 2018, and 30 March 2022. Setting We collected data from 629 MSM and TSM among the study cities. Community respondents were recruited from real-world (e.g., NGOs, bars, clubs) or virtual sites (e.g., social media, apps) where MSM and TSM in each of the three cities were known to frequent. Participants Eligibility criteria for community respondents were: (1) ≥18 years old; (2) identifying as male at any point in life or being assigned male at birth; (3) having consensual sex with another man in the past 12 months; (4) engaging in binge drinking (i.e., ≥5 drinks in a 2 hour period), illicit use of drugs, or both in the past 90 days; and (5) residing in one of the three study cities. Intervention The PRIDE in HIV Care intervention is a theory-driven "crowdsourcing and peer-actuated network intervention" designed to amplify community members' successes and resilience via "influencers" who can strengthen and impart benefit to their networks and community. Main outcome measures Received an HIV test in the prior six months. Results There was a statistically significant increase in odds of recent HIV testing for every additional month the intervention was implemented in a respondent's city (AOR=1.08, 95% CI=1.05-1.12; p<.001). Conclusions The PRIDE in HIV Care intervention appears to be efficacious in enacting a community wide increase-i.e., promoted HIV testing among those who did not go through the intervention itself-in HIV testing among MSM and TSM. Trial Registration This trial is registered with clinicaltrials.gov (NCT02786615). Funding National Institute on Drug Abuse (NIDA), grant number R01DA040513.
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Affiliation(s)
- Elwin Wu
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Yong Gun Lee
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | | | | | | | - Alissa Davis
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Emily A. Paine
- Department of Psychiatry, Columbia University, New York, NY USA; HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY, USA
| | - Timothy Hunt
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
- Global Health Research Center of Central Asia, Almaty, Kazakhstan
| | - Kelsey Reeder
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
| | | | | | - Caitlin Laughney
- Department of Psychiatry, Columbia University, New York, NY USA; HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, NY, USA
| | - Mingway Chang
- Social Intervention Group, Columbia School of Social Work, New York, NY, USA
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Jaramillo J, Reyes N, Atuluru P, Payen N, Taylor K, Safren SA, Saber R, Harkness A. Peer ambassador stories: formative qualitative research to enhance the reach of PrEP, HIV testing, and behavioral health treatments to LMSM in South Florida. AIDS Care 2024; 36:569-579. [PMID: 38157344 PMCID: PMC10932813 DOI: 10.1080/09540121.2023.2287736] [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: 03/31/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024]
Abstract
Existing HIV prevention interventions, such as pre-exposure prophylaxis (PrEP), and behavioral health treatments inadequately reach Latino men who have sex with men (LMSM) in the US. This study involved formative research to inform the content, design, and implementation of a scalable, low resource implementation strategy - peer ambassador stories - stories from peers to normalize using PrEP, HIV testing, and behavioral health treatment. We conducted semi-structured interviews with 20 LMSM to elucidate their content, design, and implementation preferences for peer ambassador stories. Men were asked about story prompts, story contributor characteristics, story platform features, design preferences, and recommendations for enhancing the adoption and use of the peer ambassador technology platform among LMSM. Interviews were transcribed and analyzed via rapid qualitative analysis. Qualitative analyses identified 14 themes within 4 pre-specified domains. Collectively, the themes unified around the central concept that technology-delivered peer ambassador stories require a personalized, relational, culturally relevant touch to be acceptable and appropriate for LMSM. This study suggests that disseminating peer ambassador stories using electronic platforms and audio/video formats may enhance the reach of services and if they are personalized, relational, and culturally relevant. Findings have broad implications for informing other peer-based strategies to mitigate HIV disparities among LMSM.
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Affiliation(s)
- Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nequiel Reyes
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pranusha Atuluru
- Department of Medicine, University of Miami, Miller School of Medicine, FL, USA
| | - Naomie Payen
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
| | - Kayla Taylor
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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Verinumbe T, Katomski AS, Turpin G, Syarif O, Looze P, Lalak K, Anoubissi J, Brion S, Dunaway K, Sprague L, Matyushina D, De Leon Moreno CG, Baral SD, Rucinski K, Lyons C. Characterizing the Relationship between HIV Peer Support Groups and Internalized Stigma Among People Living with HIV in Nigeria. AIDS Behav 2024; 28:1068-1076. [PMID: 37889362 PMCID: PMC11234473 DOI: 10.1007/s10461-023-04217-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 10/28/2023]
Abstract
HIV-related stigma remains a significant barrier to implementing effective HIV treatment and prevention strategies in Nigeria. Despite the high uptake of peer support groups among people living with HIV (PLHIV) in Nigeria, the potential role of such peer support on the burden of internalized stigma remains understudied. To address this gap, we conducted a secondary analysis of the PLHIV Stigma Index 2.0, a socio-behavioral survey implemented by PLHIV led-organizations to assess the relationship between group membership and internalized stigma. Internalized stigma was measured using the Internalized AIDS-related Stigma Scale. Multinomial logistic regression was used to measure the association between self-reported engagement in peer support groups and internalized stigma adjusting for age, education, duration since HIV diagnosis, employment, disclosure status, and sex-work engagement. Of the 1,244 respondents in this study, 75.1% were engaged in HIV peer support groups. Over half (55.5%) and about one-fourth (27.3%) demonstrated low/moderate and high levels of internalized stigma, respectively. PLHIV engaged in HIV peer support groups were less likely to report both low/moderate (versus no) (adjusted odds ratio (aOR): 0.47 [95% CI: 0.27 to 0.81]; p = 0.006) and high (versus no) (aOR: 0.30 [95% CI: 0.17 to 0.53]; p < 0.001) levels of internalized stigma compared to those not engaged. In this study, the burden of internalized stigma is high among PLHIV in Nigeria. However, engagement in peer support groups appears to mitigate these stigmas. Stigma mitigation strategies to increase peer support may represent a critical tool in decreasing sustained HIV treatment gaps among PLHIV in Nigeria.
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Affiliation(s)
- Tarfa Verinumbe
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1717 East Monument St., Baltimore, MD, 21205, USA.
| | - Anna-Sophia Katomski
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Gnilane Turpin
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Omar Syarif
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Pim Looze
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Katarzyna Lalak
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Jean Anoubissi
- Global Network of People Living with HIV (GNP+), Amsterdam, The Netherlands
| | - Sophie Brion
- The International Community of Women Living with HIV (ICW), London, UK
| | - Keren Dunaway
- The International Community of Women Living with HIV (ICW), London, UK
| | - Laurel Sprague
- The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | - Daria Matyushina
- The Joint United Nations Programme on HIV/AIDS (UNAIDS), Geneva, Switzerland
| | | | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Katherine Rucinski
- Department of International Health, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
| | - Carrie Lyons
- Department of Epidemiology, Johns Hopkins University School of Public Health, 615 N. Wolfe St., Baltimore, MD, 21205, USA
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Palis H, Young P, Korchinski M, Wood S, Xavier J, Luk N, Mahil S, Bartlett S, Brown H, Salmon A, Nicholls T, Slaunwhite A. "Shared experience makes this all possible": documenting the guiding principles of peer-led services for people released from prison. BMC Public Health 2024; 24:84. [PMID: 38172781 PMCID: PMC10765918 DOI: 10.1186/s12889-023-17524-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There is a growing body of evidence demonstrating the effectiveness of peer-led services in supporting community reintegration for people released from prison. This study aims to document the guiding principle of a peer-led service for people released from prison, from the perspective of peer mentors. METHODS Data were collected using focus groups (N = 10; 2 groups with 5 participants each) and one-on-one interviews (N = 5) including a total of 13 people, representing all UTGSS staff at the time of the study. An inductive thematic analysis was used to identify patterns in the data. Initial coding was done by using "in-vivo" codes (i.e. applying codes to terms used by participants). This informed the direction of the next stage of analysis, which focused on identifying categories that synthesized the codes and data across transcripts. In this stage, broad themes and sub-themes were developed. FINDINGS Six themes were constructed to reflect the guiding principles of UTGSS staff. This includes four central themes: 1) Offering hope; 2) Building respectful relationships; 3) Providing consistent support; 4) Meeting people where they are at. Two connected themes are also reported: 1) Relying on shared experience, which participants reported serves as the foundation for practicing these guiding principles and 2) Bridging connections to services, which reflects the outcome of practicing these guiding principles. CONCLUSION The principles identified in this study can be used by UTGSS staff as a guide for checking-in on progress with clients and may be considered as a model for reflection on practice by staff providing similar peer-led services. These principles should not be applied in a prescriptive way, as relationship building is at the centre of peer support, and different applications will be required depending on clients' goals and the range of supports available within their community.
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Affiliation(s)
- Heather Palis
- Department of Psychiatry, University of British Columbia, 255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada.
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada.
- Department of Psychiatry, University of British Columbia, BC Centre for Disease Control, 655 W 12th Avenue, Vancouver, BC, V5Z 4R4, Canada.
| | - Pam Young
- Unlocking the Gates Services Society, 22838 Lougheed Hwy. Unit 104, Maple Ridge, BC, V2X 2V6, Canada
| | - Mo Korchinski
- Unlocking the Gates Services Society, 22838 Lougheed Hwy. Unit 104, Maple Ridge, BC, V2X 2V6, Canada
| | - Shawn Wood
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Jessica Xavier
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Nelson Luk
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
| | - Simrat Mahil
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Sofia Bartlett
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Helen Brown
- School of Nursing, University of British Columbia, 2211 Wesbrook Mall T201, Vancouver, BC, V6T 2B5, Canada
| | - Amy Salmon
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, 70-1081 Burrard Street, Vancouver, BC, V6Z IY6, Canada
| | - Tonia Nicholls
- Department of Psychiatry, University of British Columbia, 255 Wesbrook Mall, Vancouver, BC, V6T 2A1, Canada
- BC Mental Health and Substance Use Services, 4949 Heather St, Vancouver, BC, V5Z 3L7, Canada
| | - Amanda Slaunwhite
- British Columbia Centre for Disease Control, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
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Mabuto T, Woznica DM, Ndini P, Moyo D, Abraham M, Hanrahan C, Charalambous S, Zack B, Baral S, Owczarzak J, Hoffmann CJ. Transitional community adherence support for people leaving incarceration in South Africa: a pragmatic, open-label, randomised controlled trial. Lancet HIV 2024; 11:e11-e19. [PMID: 38071994 PMCID: PMC10894448 DOI: 10.1016/s2352-3018(23)00235-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/15/2023] [Accepted: 09/11/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND People released from correctional facilities face multifactorial barriers to continuing HIV treatment. We hypothesised that barriers faced in the first 6 months of community re-entry would be decreased by a multilevel group-based and peer-led intervention, the Transitional Community Adherence Club (TCAC). METHODS We did a pragmatic, open-label, individually randomised controlled trial in five correctional facilities in Gauteng, South Africa. Participants aged 18 years and older and receiving antiretroviral therapy (ART) in correctional facilities were enrolled before release and randomly assigned (1:2) to either passive referral (usual care) or TCACs. TCACs followed a 12-session curriculum over 6 months and were facilitated by trained peer and social workers. Participants were followed up by telephone and in person to assess the primary outcome: post-release enrolment in HIV treatment services at 6 months from the date of release. We did an intention-to-treat analysis to determine the effectiveness of TCACs compared with usual care. The trial was registered with the South African National Clinical Trials Register (DOH-27-0419-605) and ClinicalTrials.gov (NCT03340428). This study is completed and is listed as such on ClinicalTrials.gov. FINDINGS From March 1, to Dec 13, 2019, we screened 222 individuals and enrolled 176 participants who were randomly assigned 1:2 to the usual care group (n=59) or TCACs (n=117). 175 participants were included in the final analysis. In the usual care group, 21 (36%) of 59 participants had enrolled in HIV treatment services at 6 months, compared with 71 (61%) of 116 in the TCAC group (risk ratio 1·7, 95% CI 1·2-2·5; p=0·0010). No adverse events were reported. INTERPRETATION We found strong evidence that a differentiated service delivery model with curriculum and peer support designed specifically to address the needs of people with HIV returning from incarceration improved the primary outcome of enrolment in HIV treatment services. Our approach is a reasonable model to build further HIV treatment continuity interventions for individuals in the criminal justice system in South Africa and elsewhere. FUNDING National Institute of Mental Health.
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Affiliation(s)
- Tonderai Mabuto
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa.
| | | | - Pretty Ndini
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa
| | - Derrick Moyo
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa
| | - Munazza Abraham
- Department of Psychology, University of Maryland, College Park, MD, USA
| | - Colleen Hanrahan
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Salome Charalambous
- Department of Implementation Research, The Aurum Institute, Johannesburg, South Africa; The University of the Witwatersrand School of Public Health, Johannesburg, South Africa
| | | | - Stefan Baral
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jill Owczarzak
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Christopher J Hoffmann
- The University of the Witwatersrand School of Public Health, Johannesburg, South Africa; Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Jaramillo J, Harkness A. Supporting the helpers: what do peer deliverers of HIV interventions need to sustain their implementation efforts? Transl Behav Med 2023; 13:826-832. [PMID: 37368359 PMCID: PMC10631879 DOI: 10.1093/tbm/ibad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Peer-led HIV interventions are an increasingly common and low-cost strategy to address shortages of professionally trained health workers for implementing evidence-based HIV prevention and treatment interventions to populations who experience health disparities. There is a need to understand the experiences and unmet needs of this essential workforce responsible for implementing and delivering HIV interventions to ensure their implementation efforts are sustainable. This commentary provides a brief overview of barriers to peer deliverers' sustained engagement in the HIV workforce and potential implementation strategies to promote the sustainment of peer deliverers' implementation efforts.
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Affiliation(s)
- Jahn Jaramillo
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Audrey Harkness
- School of Nursing and Health Studies, University of Miami, Miami, FL 33146, USA
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Tobin K, Heidari O, Volpi C, Sodder S, Duncan D. Use of geofencing interventions in population health research: a scoping review. BMJ Open 2023; 13:e069374. [PMID: 37536963 PMCID: PMC10401224 DOI: 10.1136/bmjopen-2022-069374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 07/17/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVES Technological advancements that use global positioning system (GPS), such as geofencing, provide the opportunity to examine place-based context in population health research. This review aimed to systematically identify, assess and synthesise the existing evidence on geofencing intervention design, acceptability, feasibility and/or impact. DESIGN Scoping review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidance for reporting. DATA SOURCES PubMed, CINAHL, EMBASE, Web of Science, Cochrane and PsycINFO for articles in English published up to 31 December 2021. ELIGIBILITY CRITERIA Articles were included if geofencing was used as a mechanism for intervention delivery. EXCLUSION CRITERIA (1) a component or combination of GPS, geographical information system or ecological momentary assessment was used without delivery of an intervention; (2) did not include a health or health-related outcome from the geofencing intervention; or (3) was not a peer-reviewed study. DATA EXTRACTION AND SYNTHESIS Several researchers independently reviewed all abstracts and full-text articles for final inclusion. RESULTS A total of 2171 articles were found; after exclusions, nine studies were included in the review. The majority were published in 5 years preceding the search (89%). Geofences in most studies (n=5) were fixed and programmed in the mobile application carried by participants without their input. Mechanisms of geofencing interventions were classified as direct or indirect, with five studies (56%) using direct interventions. There were several different health outcomes (from smoking to problematic alcohol use) across the five studies that used a direct geofencing intervention. CONCLUSIONS This scoping review found geofencing to be an emerging technology that is an acceptable and feasible intervention applied to several different populations and health outcomes. Future studies should specify the rationale for the locations that are geofenced and user input. Moreover, attention to mechanisms of actions will enable scientists to understand not only whether geofencing is an appropriate and effective intervention but why it works to achieve the outcomes observed.
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Affiliation(s)
- Karin Tobin
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Omeid Heidari
- Child, Family and Population Health Nursing, University of Washington School of Nursing, Seattle, Washington, USA
| | - Connor Volpi
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Shereen Sodder
- Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Dustin Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
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