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Harris LM, Kerr JC, Skidmore BD, Ghare S, Reyes-Vega A, Remenik-Zarauz V, Samanapally H, Anwar RU, Rijal R, Bryant K, Hall MT, Barve S. A conceptual analysis of SBIRT implementation alongside the continuum of PrEP awareness: domains of fit and feasibility. Front Public Health 2024; 11:1310388. [PMID: 38259734 PMCID: PMC10801388 DOI: 10.3389/fpubh.2023.1310388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Screening, Brief Intervention, and Referral to Treatment (SBIRT) is a supplementary intervention that can be incorporated into the Pre-Exposure Prophylaxis (PrEP) Care Continuum, complementing initiatives and endeavors focused on Human Immunodeficiency Virus (HIV) prevention in clinical care and community-based work. Referencing the Transtheoretical Model of Change and the PrEP Awareness Continuum, this conceptual analysis highlights how SBIRT amplifies ongoing HIV prevention initiatives and presents a distinct chance to address identified gaps. SBIRT's mechanisms show promise of fit and feasibility through (a) implementing universal Screening (S), (b) administering a Brief Intervention (BI) grounded in motivational interviewing aimed at assisting individuals in recognizing the significance of PrEP in their lives, (c) providing an affirming and supportive Referral to Treatment (RT) to access clinical PrEP care, and (d) employing client-centered and destigmatized approaches. SBIRT is uniquely positioned to help address the complex challenges facing PrEP awareness and initiation efforts. Adapting the SBIRT model to integrate and amplify HIV prevention efforts merits further examination.
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Affiliation(s)
- Lesley M. Harris
- Kent School of Social Work & Family Science, University of Louisville, Louisville, KY, United States
| | - Jelani C. Kerr
- Department of Health Promotion and Behavioral Sciences, University of Louisville, Louisville, KY, United States
| | - Blake D. Skidmore
- Kent School of Social Work & Family Science, University of Louisville, Louisville, KY, United States
| | - Smita Ghare
- School of Medicine, University of Louisville, Louisville, KY, United States
| | - Andrea Reyes-Vega
- School of Medicine, University of Louisville, Louisville, KY, United States
| | | | | | - Rana Usman Anwar
- School of Medicine, University of Louisville, Louisville, KY, United States
| | - Rishikesh Rijal
- School of Medicine, University of Louisville, Louisville, KY, United States
| | - Kendall Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda, MD, United States
| | - Martin T. Hall
- Kent School of Social Work & Family Science, University of Louisville, Louisville, KY, United States
| | - Shirish Barve
- School of Medicine, University of Louisville, Louisville, KY, United States
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Ayangeakaa SD, Kerr J, Combs RM, Harris LM, Sears JS, Parker K, Sterrett-Hong E. Sociocultural and structural influences on HIV Pre-Exposure Prophylaxis (PrEP) Engagement and Uptake among African American Young adults. BMC Public Health 2023; 23:1427. [PMID: 37495954 PMCID: PMC10369814 DOI: 10.1186/s12889-023-16273-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/09/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) demonstrates effectiveness in decreasing new cases of HIV. However, few African Americans use PrEP, despite being disproportionately impacted by HIV. Understanding the influence of sociocultural and structural factors on PrEP use among multiple priority groups of African Americans, including but not limited to men who have sex with men, may improve PrEP engagement and uptake. The social ecological model (SEM) as a framework guided the understanding of how these factors operate on multiple levels to influence PrEP use among this population. METHODS This study derived data from the Afya PrEP study consisting of eleven focus groups (N = 63) with 18-29-year-old African American sexual and gender minority and heterosexual individuals at heightened behavioral vulnerability to HIV. We employed constructivist grounded theory processes to inductively analyze the data. A pooled kappa score of 0.90 indicated excellent inter-rater agreement. RESULTS Factors impacting PrEP engagement among African American young adults included: (1) Community/social network influences; (2) medical mistrust; (3) stigma; (4) PrEP availability and accessibility, which had two sub-categories: (a) cost and (b) where to obtain PrEP; and (5) PrEP engagement strategies, which had two sub-categories: (a) current AIDS service organizations' PrEP engagement practices and (b) recommended future PrEP engagement strategies. Categories one through three represent sociocultural factors, and categories four and five represent structural factors that influence perceptions and attitudes of African American young adults regarding PrEP. CONCLUSION Our study highlights sociocultural and structural factors that act as barriers and facilitators to PrEP engagement. The SEM guided the understanding of how these factors operated on multiple levels. One of the sociocultural factors, community/social network influences operated at the interpersonal level of the SEM; the other two, stigma and medical mistrust, operated at the community level. The structural factors (PrEP availability, accessibility, and engagement strategies) operated at the institutional/organizational level. Thus, multi-level interventions are warranted to improve PrEP engagement among various African American young adult priority groups.
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Affiliation(s)
- Suur D Ayangeakaa
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St. Durham, Durham, NC, 27701, USA.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
| | - Jelani Kerr
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Ryan M Combs
- Department of Health Promotion and Behavioral Sciences, School of Public Health and Information Sciences, University of Louisville, Louisville, KY, USA
| | - Lesley M Harris
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
| | - Jeanelle S Sears
- Department of Human Services, Bowling Green State University, Bowling Green, OH, USA
| | | | - Emma Sterrett-Hong
- Kent School of Social Work, University of Louisville, Louisville, KY, USA
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Khosropour CM, Riley T, Healy E, Backus KV, Gomillia CE, Mena L, Lockwood KR, Gordon FM, Means AR, Ward LM. Persistence in a pharmacist-led, same-day PrEP program in Mississippi: a mixed-methods study. BMC Public Health 2023; 23:1130. [PMID: 37312077 PMCID: PMC10262591 DOI: 10.1186/s12889-023-16072-1] [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] [Received: 10/07/2022] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Mississippi has one of the highest rates of HIV in the United States but low PrEP uptake. Understanding patterns of PrEP use can improve PrEP initiation and persistence. METHODS This is a mixed-method evaluation of a PrEP program in Jackson, Mississippi. Between November 2018-December 2019, clients at high risk for HIV attending a non-clinical testing site were referred to a pharmacist for same-day PrEP initiation. The pharmacist provided a 90-day PrEP prescription and scheduled a follow-up clinical appointment within three months. We linked client records from this visit to electronic health records from the two largest PrEP clinics in Jackson to determine linkage into ongoing clinical care. We identified four distinct PrEP use patterns, which we used for qualitative interview sampling: 1) filled a prescription and linked into care within three months; 2) filled a prescription and linked into care after three months; 3) filled a prescription and never linked into care; and 4) never filled a prescription. In 2021, we purposively sampled patients in these four groups for individual interviews to ascertain barriers and facilitators to PrEP initiation and persistence, using guides informed by the Theory of Planned Behavior. RESULTS There were 121 clients evaluated for PrEP; all were given a prescription. One-third were less than 25 years old, 77% were Black, and 59% were cisgender men who have sex with men. One-quarter (26%) never filled their PrEP prescription, 44% picked up the prescription but never linked into clinical care, 12% linked into care at some point after three months (resulting in a gap in PrEP coverage), and 18% linked into care within 3 months. We interviewed 26 of 121 clients. Qualitative data revealed that cost, stigmas related to sexuality and HIV, misinformation about PrEP, and perceived side effects were barriers to uptake and persistence. Individuals' desire to stay healthy and the support of PrEP clinic staff were facilitators. CONCLUSIONS The majority of individuals given a same-day PrEP prescription either never started PrEP or stopped PrEP within the first three months. Addressing noted barriers of stigma and misinformation and reducing structural barriers may increase PrEP initiation and persistence.
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Affiliation(s)
- Christine M Khosropour
- Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA.
| | - Taylor Riley
- Department of Epidemiology, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Elise Healy
- Department of Medicine, Health Sciences Building, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Kandis V Backus
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Courtney E Gomillia
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Leandro Mena
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Khadijra R Lockwood
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Felicia M Gordon
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
| | - Arianna R Means
- Department of Global Health, Hans Rosling Center for Population Health, University of Washington, 3980 15th Ave NE, Seattle, WA, 98195, USA
| | - Lori M Ward
- Department of Population Health Science, University of Mississippi Medical Center, 2500 N State Street, Jackson, MS39216, USA
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