A programmatic approach to address increasing HIV diagnoses among Hispanic/Latino MSM, 2010-2014

PrEPárate: Evaluation of a Community-Driven PrEP Social Marketing Intervention Tailored to Latino/a/x Individuals

Latino/a/x sexual minority men (SMM) and transgender women remain disproportionately impacted by HIV, with higher HIV incidence and lower uptake of pre-exposure prophylaxis (PrEP) than their non-Hispanic White peers. Disparities in PrEP uptake among Latino/a/x populations have been found to be due to structural, social, and personal barriers. Social marketing interventions have been shown to effectively address barriers and increase PrEP uptake in other populations, and thus offer potential as a tool to increase PrEP uptake for Latino/a/x populations. The PrEPárate campaign was developed through community based participatory research and ran from April to September 2022 in Cook County, Illinois. We conducted a mixed methods evaluation through surveys (N = 515) and semi-structured interviews with survey participants and community partners (N = 14). We examined cross-sectional associations of campaign exposure with PrEP awareness and uptake in adjusted multivariable regression models. We used rapid qualitative methods to analyze interviews and assess implementation outcomes following the RE-AIM framework. The campaign reached over 118,000 people on social media, with additional reach over public transit and local events. PrEPárate exposure was associated with increased PrEP awareness (aOR = 5.23; 95% CI [2.58, 10.63]) and PrEP uptake (aOR = 1.69; 95% CI [1.09, 2.62]). Survey respondents expressed that the campaign name, visuals, ambassadors, and distribution were effective in engaging the target audience. Community partners felt the campaign was implemented with fidelity to the original vision and identified future directions for PrEPárate. Social marketing campaigns, anchored in community engagement, may be an effective strategy to increase PrEP awareness and uptake among underserved Latino/a/x populations.

"Honesty, Communication and Trust Are What Bring Peace of Mind": Narratives of HIV Risk Among Hispanic/Latino Men Who Have Sex with Men in the Southern United States

For Hispanic/Latino MSM (HLMSM) in the South, HIV burden remains high, and HIV elimination is a national priority. Between July and September 2016, using a strengths-based approach informed by resilience theory, we conducted qualitative interviews with HIV-negative HLMSM in five southern cities in the United States with elevated HIV prevalence. We analyzed data using a qualitative content analysis approach, assessing for interrater reliability. A brief behavioral survey was also conducted. We enrolled 51 HLMSM (mean age = 33 years, range = 15-63). HLMSM discussed the climate of fear about HIV and homosexuality impeding HIV prevention, including the impact of stigma and taboo. Three main strengths-based strategies emerged for preventing HIV: assessing partner risk, establishing boundaries for sexual interactions, and self-education. Future HIV prevention efforts may benefit from balancing risk-based approaches with those that emphasize resilience, address partner trustworthiness and safety, and focus on providing novel outlets for HIV prevention education.

Adaptation and Reach of a Pre-Exposure Prophylaxis Social Marketing Campaign for Latino, Latina, and Latinx Populations: Development Study

BACKGROUND

Latino, Latina, and Latinx (Latino/a/x) individuals remain disproportionately impacted by HIV, particularly sexual minority men and transgender women. Pre-exposure prophylaxis (PrEP) is an effective means of biomedical HIV prevention, but awareness and uptake remain low among marginalized Latino/a/x populations. Social marketing campaigns have demonstrated promise in promoting PrEP in other populations but are poorly studied in Latino/a/x sexual minority men and transgender women.

OBJECTIVE

This study aims to (1) adapt and pilot a PrEP social marketing campaign tailored to Latino/a/x populations with a focus on sexual minority men and transgender women through community-based participatory research (CBPR) and (2) evaluate the reach and ad performance of the adapted PrEP social marketing campaign.

METHODS

We used the ADAPT-ITT (assessment, decision, adaptation, production, topical experts-integration, training, and testing) framework for adapting evidence-based interventions for new settings or populations. This paper presents how each phase of the ADAPT-ITT framework was applied via CBPR to create the PrEPárate ("Be PrEPared") campaign. Key community engagement strategies included shared ownership with community partners, focus groups to guide content, crowdsourcing to name the campaign, design by local Latino/a/x artists, and featuring local influencers as the faces of PrEPárate. We evaluated campaign reach and advertisement performance using social media platform metrics (paid and organic reach, impressions, unique clicks, and click-through rates [CTR]) and website use statistics from Google Analytics.

RESULTS

The PrEPárate campaign ran in Cook County, Illinois, from April to September 2022. The campaign reached over 118,750 people on social media (55,750 on Facebook and Instagram [Meta Platforms Inc] and 63,000 on TikTok [ByteDance Ltd]). The Meta ads performed over the industry benchmark with ads featuring local transgender women (2% CTR) and cisgender sexual minority men (1.4% CTR). Of the different Grindr (Grindr Inc) ad formats piloted, the interstitial Grindr ads were the highest performing (1183/55,479, 2.13% CTR). YouTube (Google) ads were low performing at 0.11% (153/138,337) CTR and were stopped prematurely, given limits on sexual education-related content. In the first year, there were 5006 visitors to the website.

CONCLUSIONS

Adaptation of an existing evidence-based intervention served as an effective method for developing a PrEP social marketing campaign for Latino/a/x audiences. CBPR and strong community partnerships were essential to tailor materials and provide avenues to systematically address barriers to PrEP access. Social marketing is a promising strategy to promote PrEP among underserved Latino/a/x populations.

Perspectives on long-acting formulations of pre-exposure prophylaxis (PrEP) among men who have sex with men who are non-adherent to daily oral PrEP in the United States

INTRODUCTION

Pre-exposure prophylaxis (PrEP) persistence among men who have sex with men (MSM) in real world clinical settings for HIV prevention is suboptimal. New longer-acting formulations of PrEP are becoming available, including injectables, subdermal implants, and other oral medications. These longer-acting formulations have the potential to improve retention among those who have challenges remaining adherent to daily oral PrEP.

METHODS

We interviewed 49 MSM who had initiated but discontinued oral PrEP at three diverse clinics across the United States. We examined participants' perspectives about long-acting PrEP formulations and how long-acting options could affect PrEP use using thematic analysis.

RESULTS

Participants were not very knowledgeable about long-acting formulations of PrEP but were open to learning about them and considering use. Participants were concerned about safety and efficacy of products given that they were still newer and/or in development. Finally, participants had clear preferences for oral pills, injectables, and then subdermal implants and were most interested in options that reduced the number of visits to the clinic.

CONCLUSION

Long-acting formulations of PrEP are acceptable to MSM with suboptimal PrEP persistence and have the potential to improve PrEP persistence. However, many felt they needed more information on safety, efficacy, and use to consider these options. As these long-acting formulations are implemented, public health campaigns and clinical interventions to encourage may maximize uptake particularly among those who are not currently adherent to daily oral PrEP.

The Pre-exposure Prophylaxis (PrEP) Care Continuum Among English-Speaking Latino Sexual Minority Men in the United States (2014-2020)

BACKGROUND

There is limited understanding of the pre-exposure prophylaxis (PrEP) care continuum specific to Latino/x gay, bisexual, and other sexual minority men (SMM) that encompasses the population residing outside of large metropolitan or urban areas.

SETTING

We examined trends and characteristics associated with the PrEP care continuum with data from the 2014-2020 cycles of the American Men's Internet Survey, an annual online cross-sectional behavioral survey of cisgender SMM in the United States.

METHODS

We calculated PrEP continuum outcomes overall and by year among Hispanic/Latino SMM (n = 9010). We used generalized estimating equations with Poisson links to examine (1) temporal trends (2014-2020) in each step of the PrEP continuum and PrEP use in the past year stratified by PrEP eligibility and (2) correlates of each step of the PrEP continuum in 2020 using multivariable models.

RESULTS

Among 2283 Latino SMM in 2020, 84% reported PrEP awareness, 30% discussed PrEP with a provider, 15% used PrEP in the past year, and 12% were currently using PrEP. PrEP awareness increased from 52% in 2014 to 84% in 2020; and PrEP use in the past year increased from 4% in 2014 to 15% in 2020. In the multivariable models, age and PrEP eligibility were associated with PrEP use in the past year, and urban-rural classification was associated with current PrEP use.

CONCLUSIONS

While most of the Latino SMM are aware of PrEP, significant gaps remain in this population in discussing PrEP with a provider and using PrEP that require tailored strategies to enhance access to HIV prevention services.

Adherence to Pre-Exposure Prophylaxis in Adolescents and Young Adults: A Systematic Review and Meta-Analysis

This meta-analysis synthesized the proportion of adolescents and young adults (AYAs) who are adherent to pre-exposure prophylaxis (PrEP) and factors moderating adherence. A systematic search was conducted of studies published through May 2020 using PubMed, PsycInfo, Cochrane, EMBASE, and CINAHL. Included studies reported the proportion of AYAs (mean age ≤ 29 years) who were PrEP adherent. PrEP adherence was meta-analyzed using random-effects models. Secondary analyses evaluated potential moderating variables. A total of 41 individual samples, from 29 studies, of 8,679 AYA (weighted average age = 23.8 years) were synthesized. The proportion of AYA who met study-defined thresholds for PrEP adherence was .64 (95% confidence interval .57-.71) across studies. Subgroup analyses revealed that adherence was lower in young cisgender women (.46) than young men who have sex with men (.65) and serodiscordant heterosexual couples (.98). Adherence was higher in studies initiated after 2012 (.70) than earlier studies (.47). No differences based on participant age, country, or strategies to promote adherence were found. Across published studies to date, 64% of AYA demonstrate adequate PrEP adherence. Findings can be used to guide PrEP adherence interventions and also provide directions for future research on PrEP among AYA.

Projecting the age-distribution of men who have sex with men receiving HIV treatment in the United States

BACKGROUND

The age-distribution of men who have sex with men (MSM) continues to change in the 'Treat-All' era as effective test-and-treat programs target key-populations. However, the nature of these changes and potential racial heterogeneities remain uncertain.

METHODS

The PEARL model is an agent-based simulation of MSM in HIV care in the US, calibrated to data from the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

RESULTS

PEARL projects a gradual decrease in median age of MSM at ART initiation from 36 to 31 years during 2010-2030, accompanied by changes in mortality among Black, White, and Hispanic MSM on ART by -8.4%, 42.4% and -19.6%. The median age of all MSM on ART is projected to increase from 45 to 47 years from 2010-2030, with the proportion of ART-users age ≥60y increasing from 6.7% to 28.0%. Almost half (49.7%) of White MSM ART-users are projected to age ≥60y by 2030, compared to 19.5% of Black and 17.2% of Hispanic MSM.

CONCLUSIONS

The overall age of US MSM in HIV care is expected to increase over the next decade, and differentially by race/ethnicity. As this population age, HIV programs should expand care for age-related causes of morbidity and mortality.

Vital Voices: HIV Prevention and Care Interventions Developed for Disproportionately Affected Communities by Historically Underrepresented, Early-Career Scientists

BACKGROUND

HIV prevention interventions which support engagement in care and increased awareness of biomedical options, including pre-exposure prophylaxis (PrEP), are highly desired for disproportionately affected Black/African American, Hispanic/Latinx and gay, bisexual, and other men who have sex with men (GBMSM) populations in the United States (US). However, in almost 40 years of HIV research, few interventions have been developed directly by and for these priority populations in domestic counties most at risk. We submit that interventions developed by early-career scientists who identify with and work directly with affected subgroups, and which include social and structural determinants of health, are vital as culturally tailored HIV prevention and care tools.

METHODS

We reviewed and summarized interventions developed from 2007 to 2020 by historically underrepresented early-career HIV prevention scientists in a federally funded research mentoring program. We mapped these interventions to determine which were in jurisdictions deemed as high priority (based on HIV burden) by national prevention strategies.

RESULTS

We summarized 11 HIV interventions; 10 (91%) of the 11 interventions are in geographic areas where HIV disparities are most concentrated and where new HIV prevention and care activities are focused. Each intervention addresses critical social and structural determinants of health disparities, and successfully reaches priority populations.

CONCLUSION

Focused funding that supports historically underrepresented scientists and their HIV prevention and care intervention research can help facilitate reaching national goals to reduce HIV-related disparities and end the HIV epidemic. Maintaining these funding streams should remain a priority as one of the tools for national HIV prevention.

Harnessing "Scale-Up and Spread" to Support Community Uptake of the HoMBReS por un Cambio Intervention for Spanish-Speaking Men: Implementation Science Lessons Learned by a CBPR Partnership

Latinx men in the southern United States are affected disproportionately by HIV and other sexually transmitted infections (STIs). However, few evidence-based prevention interventions exist to promote health equity within this population. Developed by a well-established community-based participatory research partnership, the HoMBReS por un Cambio intervention decreases sexual risk among Spanish-speaking, predominately heterosexual Latinx men who are members of recreational soccer teams in the United States. Scale-up and spread, an implementation science framework, was used to study the implementation of this evidence-based community-level intervention within three community organizations that represent typical community-based providers of HIV and STI prevention interventions (i.e., an AIDS service organization, a Latinx-serving organization, and a county public health department). Archival and interview data were analyzed, and 24 themes emerged that mapped onto the 12 scale-up and spread constructs. Themes included the importance of strong and attentive leadership, problem-solving challenges early, an established relationship between innovation developers and implementers, organizational capacity able to effectively work with men, trust building, timelines and incremental deadlines, clear and simple guidance regarding all aspects of implementation, appreciating the context (e.g., immigration-related rhetoric, policies, and actions), recognizing men’s competing priorities, and delineated supervision responsibilities. Scale-up and spread was a useful framework to understand multisite implementation of a sexual risk reduction intervention for Spanish-speaking, predominately heterosexual Latinx men. Further research is needed to identify how constructs, like those within scale-up and spread, affect the process across the implementation continuum, given that the uptake and implementation of an innovation is a process, not an event.

Enlaces Por La Salud: A Personal Health Navigator Intervention Grounded in the Transnational Framework

Despite the disproportionate burden of HIV among Latinxs, there is a paucity of culturally appropriate interventions that have shown efficacy at increasing their engagement and retention in HIV care. We describe the development and implementation of Enlaces, a six-session, individual-level intervention, guided by the transnational framework, to improve HIV care outcomes for newly diagnosed and out-of-care Mexican men and transgender women (TW). Descriptive statistics summarizing baseline data and implementation outcomes are provided. 91 participants enrolled between October 2014 and August 2017. Intervention engagement and satisfaction was high; 81.3% completed all six sessions and 100% were very satisfied/satisfied with their experience. Successful implementation of the ENLACES intervention was the result of establishing client trust and maintaining a flexible, supportive approach to intervention delivery. Use of the transnational framework provided a contextualized approach to engaging with Mexican men and TW living with HIV that can be adapted to other Latino populations.

The persistent and evolving HIV epidemic in American men who have sex with men

Men who have sex with men (MSM) in the USA were the first population to be identified with AIDS and continue to be at very high risk of HIV acquisition. We did a systematic literature search to identify the factors that explain the reasons for the ongoing epidemic in this population, using a social-ecological perspective. Common features of the HIV epidemic in American MSM include role versatility and biological, individual, and social and structural factors. The high-prevalence networks of some racial and ethnic minority men are further concentrated because of assortative mixing, adverse life experiences (including high rates of incarceration), and avoidant behaviour because of negative interactions with the health-care system. Young MSM have additional risks for HIV because their impulse control is less developed and they are less familiar with serostatus and other risk mitigation discussions. They might benefit from prevention efforts that use digital technologies, which they often use to meet partners and obtain health-related information. Older MSM remain at risk of HIV and are the largest population of US residents with chronic HIV, requiring culturally responsive programmes that address longer-term comorbidities. Transgender MSM are an understudied population, but emerging data suggest that some are at great risk of HIV and require specifically tailored information on HIV prevention. In the current era of pre-exposure prophylaxis and the undetectable equals untransmittable campaign, training of health-care providers to create culturally competent programmes for all MSM is crucial, since the use of antiretrovirals is foundational to optimising HIV care and prevention. Effective control of the HIV epidemic among all American MSM will require scaling up programmes that address their common vulnerabilities, but are sufficiently nuanced to address the specific sociocultural, structural, and behavioural issues of diverse subgroups.

HIV Pre-exposure Prophylaxis Education for Clinicians Caring for Spanish-Speaking Men Who Have Sex With Men (MSM)

INTRODUCTION

A growing number of Liaison Committee on Medical Education-accredited allopathic medical schools offer formal bilingual (English and Spanish) medical education, and numerous other schools offer medical Spanish through elective workshops as part of their curricula. One significant health disparity in the Hispanic community is the incidence of HIV among Spanish-speaking men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) has emerged as an effective strategy to reduce the risk of HIV transmission.

METHODS

We developed an education module to train clinicians to discuss PrEP with Spanish-speaking MSM. Our module is adapted from an English module on PrEP education. It includes a Spanish-language PowerPoint slide deck with information about PrEP as well as a Spanish-language videotaped scripted clinical encounter.

RESULTS

The module was implemented on three occasions with 18 participants, and learners reported increased comfort in discussing and confidence in prescribing PrEP with Spanish-speaking patients.

DISCUSSION

This workshop can be incorporated within medical Spanish curriculums offered at health professional schools and community-based organizations dedicated to reducing the HIV burden in the Spanish-speaking Hispanic community.

Providing Unique Support for Health Study Among Young Black and Latinx Men Who Have Sex With Men and Young Black and Latinx Transgender Women Living in 3 Urban Cities in the United States: Protocol for a Coach-Based Mobile-Enhanced Randomized Control Trial

BACKGROUND

The US National HIV/AIDS Strategy 2020 calls for increasing access to care, improving outcomes of people living with HIV, and targeting biomedical prevention efforts, including access to pre-exposure prophylaxis (PrEP) in communities where HIV is most heavily concentrated. The cities of Baltimore, Maryland (MD); Washington, DC; and Philadelphia, Pennsylvania (PA) are disproportionately burdened by high rates of new cases of HIV infection, with high prevalence among young Black and Latinx men who have sex with men (YBLMSM) and young Black and Latinx transgender women (YBLTW) aged 15-24 years.

OBJECTIVE

This study aims (1) to identify and recruit YBLMSM and YBLTW who are at risk or living with HIV in Baltimore, MD; Philadelphia, PA; and Washington, DC, using respondent-driven sampling (RDS) with targeted seed selection, and (2) to assess the efficacy of a coach-based mobile-enhanced intervention (MEI) compared with standard of care (SOC) to increase successful engagement and retention into HIV, PrEP, and substance use treatment care across the HIV care and prevention continua in 3 Mid-Atlantic cities. This paper describes the protocol and progress as of October 20, 2019.

METHODS

This study uses a multiphase mixed methods design. The first phase is a formative, qualitative research with focus group discussions and key informant interviews. The second phase consists of evaluating the ability of RDS with targeted seed selection. The third phase includes 2 embedded randomized controlled trials (RCTs), where participants complete a baseline sociobehavioral survey, rapid HIV testing, and eligible youth enroll in parallel status-dependent RCTs that randomize the participant to 1 of 2 study arms: MEI with coach or SOC. Participants are asked to complete a web-based survey and provide biologic specimens-HIV-1 RNA (viral load) or HIV-1 antibody test and urine drug screen-at baseline and at 3, 6, and 12 months, and an exit interview at 18 months.

RESULTS

A formative qualitative research was conducted in February 2017 and May 2018, and this led to further refinement of recruitment and study methods. Aim 1 recruitment began in September 2017 with subsequent enrollment into the RCTs. Recruitment is ongoing with 520 participants screened and 402 (77.3%) enrolled in aim 1 by October 2020. Of these, 159 are enrolled in the 2 randomized trials: 36 (22.6%) HIV-positive not virally suppressed (aim 2) and 123 (77.4%) high-risk HIV-negative (aim 3).

CONCLUSIONS

This study has the potential to significantly impact the medical and substance use services provided to YBLMSM and YBLTW in the United States by providing rigorous scientific evidence outlining approaches and strategies that improve the uptake and engagement of YBLMSM and YBLTW in the HIV treatment and prevention continuum.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03194477; https://clinicaltrials.gov/ct2/show/NCT03194477.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/17269.

The Invisible US Hispanic/Latino HIV Crisis: Addressing Gaps in the National Response

The federal government has proposed an end to HIV transmission in the United States by 2030. Although the United States has made substantial overall progress in the fight against HIV/AIDS, data released by the Centers for Disease Control and Prevention have raised concerns about widening, yet largely unrecognized, HIV infection disparities among Hispanic and Latino populations.This commentary identifies underlying drivers of increasing new HIV infections among Hispanics/Latinos, discusses existing national efforts to fight HIV in Hispanic/Latino communities, and points to gaps in the federal response. Consideration of the underlying drivers of increased HIV incidence among Hispanics/Latinos is warranted to achieve the administration's 2030 HIV/AIDS goals.Specifically, the proposed reinforcement of national efforts to end the US HIV epidemic must include focused investment in four priority areas: (1) HIV stigma reduction in Hispanic/Latino communities, (2) the availability and accessibility of HIV treatment of HIV-positive Hispanics/Latinos, (3) the development of behavioral interventions tailored to Hispanic/Latino populations, and (4) the engagement of Hispanic/Latino community leaders.

Changes in Disparities in Estimated HIV Incidence Rates Among Black, Hispanic/Latino, and White Men Who Have Sex With Men (MSM) in the United States, 2010-2015

BACKGROUND

During 2008-2015, the estimated annual HIV incidence rate in the United States decreased for each transmission risk category, except for men who have sex with men (MSM). Racial/ethnic disparities exist, with higher incidence rates for Black and Hispanic/Latino MSM.

SETTING

This analysis examines changes, 2010-2015, in disparities of HIV incidence among Black, Hispanic/Latino and White MSM.

METHODS

We compared results from the rate ratio, rate difference, weighted and unweighted index of disparity, and population attributable proportion. We calculated incidence rates for MSM using HIV surveillance data and published estimates of the MSM population in the United States. We generated 95% confidence intervals for each measure and used the Z statistic and associated P values to assess statistical significance.

FINDINGS

Results from all but one measure, Black-to-White rate difference, indicate that racial/ethnic disparities increased during 2010-2015; not all results were statistically significant. There were statistically significant increases in the Hispanic/Latino-to-White MSM incidence rate ratio (29%, P < 0.05), weighted index of disparity with the rate for White MSM as the referent group (9%, P < 0.05), and the population attributable proportion index (10%, P < 0.05). If racial/ethnic disparities among MSM had been eliminated, a range of 55%-61% decrease in overall MSM HIV incidence would have been achieved during 2010-2015.

CONCLUSIONS

A large reduction in overall annual HIV incidence among MSM can be achieved by eliminating racial/ethnic disparities among MSM. Removing social and structural causes of racial/ethnic disparities among MSM can be effective in reducing overall annual HIV incidence among MSM.

Social Support and Other Factors Associated with HIV Testing by Hispanic/Latino Gay, Bisexual, and Other Men Who Have Sex with Men in the U.S. South

Cognitive-psychosocial and other factors may affect participation in HIV testing, particularly by Hispanic/Latino gay, bisexual, and other men who have sex with men (MSM) in the U.S. South, a region hard-hit by HIV. We used univariate and multivariable logistic regression analyses to examine the association between social support and other cognitive-psychosocial factors; sociodemographic characteristics; risk behaviors; and self-reported HIV testing in a sample of 304 Hispanic/Latino MSM in North Carolina. In the multivariable logistic regression analysis, general and HIV-related social support and HIV-related knowledge were associated with greater odds of testing; speaking only Spanish was associated with reduced odds of testing. Social support and aspects of social connectedness may constitute community-based resources for use in HIV prevention efforts with Hispanic/Latino MSM. However, harnessing these resources for HIV prevention will require a better understanding of how social support relationships and processes shape HIV risks and protective actions by these vulnerable MSM.