1
|
Üsküp DK, Nieto O, Rosenberg-Carlson E, Brooks RA. Acceptability and appropriateness of information sessions to increase knowledge and awareness of PrEP and TelePrEP among Latina Women. AIDS Care 2024; 36:1162-1171. [PMID: 38943675 PMCID: PMC11288768 DOI: 10.1080/09540121.2024.2354223] [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: 10/27/2023] [Accepted: 05/07/2024] [Indexed: 07/01/2024]
Abstract
Women of color are disproportionately impacted by HIV. Although PrEP effectively prevents HIV infection, PrEP coverage and knowledge remain low in this population. To address barriers to PrEP, we implemented women-centered and culturally appropriate Information Sessions (IS) delivered by staff from the population they serve to increase knowledge, awareness, and use of PrEP through telemedicine (e.g., PlushCare). Our analysis focuses on Latina women (LW) participants, given the dearth of literature dedicated to the needs of LW. We partnered with a woman-led community-based organization (CBO) to implement the strategy with LW clients. Health educators conducted 26 IS with 94 LW (20 in Spanish and 6 in English). Participants who completed the IS were invited for interviews to assess the acceptability and appropriateness of the IS to increase knowledge and awareness of PrEP and PlushCare. Four themes emerged from the thematic analysis: (1) IS increased knowledge and awareness of PrEP and PlushCare; (2) perceived acceptability and appropriateness of IS; (3) insufficient reasons to warrant use of PrEP; and (4) positive attitudes about PlushCare. Our findings suggest that a women-centered and culturally appropriate IS implemented through a trusted, woman-led CBO is an acceptable and appropriate implementation strategy to inform LW about PrEP.
Collapse
Affiliation(s)
- Dilara K. Üsküp
- Department of Family Medicine, University of California, Los Angeles
- Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), University of California, Los Angeles
- Department of Internal Medicine, Charles R. Drew University of Medicine and Science
- UCLA-CDU Center for AIDS Research (CFAR)
| | - Omar Nieto
- Department of Family Medicine, University of California, Los Angeles
| | - Elena Rosenberg-Carlson
- Department of Family Medicine, University of California, Los Angeles
- Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), University of California, Los Angeles
| | - Ronald A. Brooks
- Department of Family Medicine, University of California, Los Angeles
- Center for HIV Identification, Prevention, and Treatment Services (CHIPTS), University of California, Los Angeles
| |
Collapse
|
2
|
Heads AM, de Dios C, An K, Yoon JH, Suchting R, Gilmore-Thomas A, Schmitz JM. Interest in and Willingness to Use PrEP: A Cross-Sectional Study of Individuals with Problematic Substance Use Residing in a High HIV Prevalence Jurisdiction. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02936-z. [PMID: 39020242 DOI: 10.1007/s10508-024-02936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 05/23/2024] [Accepted: 06/08/2024] [Indexed: 07/19/2024]
Abstract
Although it is an effective HIV prevention method, pre-exposure prophylaxis (PrEP) is underutilized in the Southern US. Many people who use drugs (PWUD) have increased susceptibility to HIV which could be lessened by using PrEP. Potential barriers to PrEP use include lack of awareness of PrEP, low knowledge about HIV prevention, low self-efficacy for HIV prevention, inaccurate risk perceptions, and anticipated stigma. The current study examined predisposing, enabling, and reinforcing factors that may predict interest in PrEP. The purpose of the current study was to explore factors associated with interest in and willingness to use daily oral and long acting injectable PrEP among sexually active adult PWUD. The data were collected from adult participants (n = 270) residing in Harris County, TX, who self-reported problematic substance use and who reported oral, anal, or vaginal sex in the six months prior to completing the survey. The survey was distributed and completed online via Qualtrics Panels in March of 2022 and included measures of PrEP and HIV knowledge, PrEP stigma, sexual health self-efficacy, experiences of discrimination, health literacy, and medical mistrust. The majority of participants reported circumstances or behaviors that increased their susceptibility to HIV. Findings indicated that PrEP user stereotypes and PrEP anticipated disapproval by others were associated with interest in using daily oral PrEP and willingness to use long acting injectable PrEP. These results provide insight into reasons for low PrEP uptake among PWUD who live in a high HIV prevalence jurisdiction. Implications for HIV prevention intervention are discussed.
Collapse
Affiliation(s)
- Angela M Heads
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA.
| | - Constanza de Dios
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
| | - Kaixuan An
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
| | - Jin H Yoon
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
| | - Robert Suchting
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
| | - Adrienne Gilmore-Thomas
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
| | - Joy M Schmitz
- Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Rd., BBSB Suite 1316, Houston, TX, 77054, USA
| |
Collapse
|
3
|
Eaton LA, Huedo-Medina T, Earnshaw VA, Kalichman M, Watson RJ, Driver R, Chandler CJ, Kalinowski J, Kalichman SC. Randomized Clinical Trial of Stigma Counseling and HIV Testing Access Interventions to Increase HIV Testing Among Black Sexual Minority Men and Transwomen. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:650-660. [PMID: 37898978 DOI: 10.1007/s11121-023-01603-4] [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: 10/17/2023] [Indexed: 10/31/2023]
Abstract
Advances in HIV prevention tools have outpaced our ability to ensure equitable access to these tools. Novel approaches to reducing known barriers to accessing HIV prevention, such as stigma and logistical-related factors, are urgently needed. To evaluate the efficacy of a randomized controlled trial with four intervention arms to address barriers to HIV/STI testing uptake (primary outcome) and PrEP use, depression, and HIV test results (secondary outcomes). We tested a 2 × 2 research design: main effect 1-stigma-focused vs. health information evaluation-focused counseling, main effect 2-offering HIV/STI testing appointments in person vs. at home with a counselor via video chat, and the interaction of the main effects. Participants (N = 474) residing in the southeastern USA were screened and enrolled in a longitudinal trial. Intervention efficacy was established using generalized linear modeling with binomial or Poisson distributions. Intervention efficacy demonstrated an increase in HIV/STI testing uptake when testing was made available at home with a counselor via video chat vs. in person (83% vs. 75% uptake, p < .05), and participants were also more likely to test positive for HIV over the course of the study in the at-home condition (14.5% vs. 9.4%, p < .05). Stigma-focused counseling resulted in lower depression scores and greater uptake of PrEP among participants < 30 years of age when compared with health information counseling (15.4% vs. 9.6%, p < .05). In order to prevent further disparities between HIV prevention advances and access to HIV prevention tools, we must prioritize improvements in linking people to care. Novel interventions, such as those proposed here, offer a practical, evidence-based path to addressing long-standing barriers to HIV prevention strategies. Trial registration: NCT03107910.
Collapse
Affiliation(s)
- Lisa A Eaton
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA.
| | | | - Valerie A Earnshaw
- Human Development and Family Sciences, University of Delaware, Newark, DE, USA
| | | | - Ryan J Watson
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Redd Driver
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Cristian J Chandler
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jolaade Kalinowski
- Human Development and Family Sciences, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06279-1248, USA
| | - Seth C Kalichman
- Psychological Sciences, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
4
|
Mullis CE, Goldberg AJ, Avila K, Hall B, Golub SA, Keller MJ. Understanding Attitudes of Postpartum Cisgender Women Toward Integration of HIV Prevention Services into Routine Prenatal and Postpartum Sexual Health Discussions. AIDS Patient Care STDS 2024; 38:185-193. [PMID: 38656218 PMCID: PMC11236281 DOI: 10.1089/apc.2023.0307] [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: 04/26/2024] Open
Abstract
Oral pre-exposure prophylaxis (PrEP) is an effective, user-controlled method for HIV prevention. However, awareness, uptake, and adherence to PrEP remain low among cisgender women (CGW). The prenatal and postpartum periods present an opportunity for delivery of comprehensive sexual health services that include HIV prevention education and services. However, little is known about postpartum CGW's attitudes toward integration of HIV prevention education and services into obstetric care in the US. We conducted semistructured interviews with 20 postpartum CGW in the Bronx, NY from July to November 2022 to explore their experiences with prenatal and postpartum sexual health care, examine their attitudes toward integration of HIV prevention services into obstetric sexual health care, and identify components of future implementation strategies. Transcripts were analyzed thematically using a framework approach. Among CGW interviewed, fewer than half reported prior knowledge of PrEP. Ten participants preferred long-acting injectable PrEP relative to six who preferred daily oral PrEP. Most participants reported no discussion of sex with their provider during pregnancy, and when discussions occurred, they focused on permission or prohibition of sexual activity. Participants described a reliance on providers to lead prenatal sexual health discussions. Even when not perceived as personally relevant, most respondents valued education on HIV prevention and PrEP services. In the postpartum period, sexual health discussions were similarly limited despite participants describing complex experiential sexual health concerns. This study supports the potential for integration of HIV prevention education and services into routine prenatal and postpartum sexual health discussions in an area of high HIV prevalence in the US.
Collapse
Affiliation(s)
- Caroline E. Mullis
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Alison J. Goldberg
- Department of Psychology, Hunter College of the City University of New York, New York, New York, USA
| | - Karina Avila
- Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| | - Bianca Hall
- Division of General Obstetrics and Gynecology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, New York, New York, USA
- PhD Program in Basic and Applied Social Psychology, Graduate Center of the City University of New York, New York, New York, USA
| | - Marla J. Keller
- Division of Infectious Diseases, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA
| |
Collapse
|
5
|
Townes A, Tanner MR, Yu L, Johnson WD, Zhu W, Iqbal K, Dominguez KL, Henny KD, Drezner K, Schumacher C, Bickham J, Elopre L, Edelstein ZR, Hoover KW. Inequities Along the Human Immunodeficiency Virus (HIV) Pre-exposure Prophylaxis Services Continuum for Black Women in the United States, 2015-2020. Obstet Gynecol 2024; 143:294-301. [PMID: 37963384 PMCID: PMC11325841 DOI: 10.1097/aog.0000000000005451] [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: 07/03/2023] [Accepted: 09/14/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE To estimate the number of women who received human immunodeficiency virus (HIV) and sexually transmitted infection (STI) testing and HIV pre-exposure prophylaxis (PrEP) services by race and ethnicity in seven THRIVE (Targeted Highly Effective Interventions to Reverse the HIV Epidemic)-funded jurisdictions and to estimate associations of age and syphilis and gonorrhea diagnoses with receipt of HIV PrEP services. METHODS We analyzed data collected from 2015 to 2020 in Birmingham, Alabama; Baltimore City, Maryland; Washington, DC, New Orleans, Louisiana; Brooklyn, New York; Philadelphia, Pennsylvania; and Hampton Roads, Virginia. We compared Black women and women of additional racial and ethnic groups by age, HIV status at enrollment, receipt of STI testing and test positivity, and steps in the PrEP continuum (screened, eligible, referred, linked, and prescribed). We also examined the association of age, syphilis, or gonorrhea with the following steps in the PrEP continuum: screened, referred, linked, and prescribed. RESULTS Black women made up 69.2% (8,758/12,647) of women served in THRIVE. Compared with non-Black women, Black women were more likely to have a positive test result for syphilis (3.3% vs 2.1%), gonorrhea (4.9% vs 3.5%), chlamydia (5.1% vs 1.9%), or more than one STI (1.4% vs 0.3%). Among women with negative HIV test results or unknown HIV status, Black women were more likely to be screened for PrEP eligibility (88.4% vs 64.9%). Among Black women, the proportion screened for PrEP was higher among those diagnosed with syphilis (97.3%) or gonorrhea (100%) than among those without an STI (88.1% and 87.8%, respectively). Among 219 Black women who presented with syphilis, only 10 (4.6%) were prescribed PrEP; among 407 with gonorrhea, only 11 (2.7%) were prescribed PrEP. CONCLUSION Although most Black women seeking services received STI testing, the proportion of Black women who were eligible for PrEP and prescribed PrEP was low. To achieve national HIV-prevention goals, it is imperative that Black women have access to PrEP information and services.
Collapse
Affiliation(s)
- Ashley Townes
- Division of HIV Prevention, Centers for Disease Control and Prevention, and DLH Corporation, Atlanta, Georgia; the District of Columbia Department of Health, Washington, DC; the Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; the Louisiana Office of Public Health, New Orleans, Louisiana; the University of Alabama at Birmingham, Birmingham, Alabama; and the New York City Department of Health and Mental Hygiene, New York, New York
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Johnson R, Conley C, Jeter E, Randolph SD. PrEP-aring stylists: Development of a stylist educational workshop to increase PrEP awareness and knowledge among Black women in the US south . Public Health Nurs 2024; 41:57-66. [PMID: 37720933 DOI: 10.1111/phn.13253] [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: 05/19/2023] [Revised: 07/20/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Black cis-gender women are disparately affected by HIV and require prioritization in prevention efforts, including pre-exposure prophylaxis (PrEP). Preparing trusted community leaders such as salon stylists as health-based opinion leaders may be promising to increasing awareness, knowledge, and uptake of PrEP among Black women. We sought to develop training and better understand stylists who may participate in a salon-based PrEP intervention for Black women. METHODS A community-research partnership designed a stylist training workshop for stylists with a majority Black women clientele. A two-session workshop focused on HIV knowledge, HIV prevention including PrEP, and the role of an opinion leader to influence community social and health norms. An exploratory research design and analysis was conducted to examine stylists and provide training feedback. CONCLUSIONS Stylists showed a high level of knowledge and willingness to serve as an opinion leader in their salons and with their communities. Stylists also verified medical mistrust in the healthcare system that makes community-based interventions attractive. This article discusses how the training was piloted and accepted by stylists.
Collapse
Affiliation(s)
- Ragan Johnson
- Division of Health in Adult Populations, Duke University School of Nursing, Durham, North Carolina, USA
| | - Cherie Conley
- Department of Systems, Population, and Leadership, University of Michigan, Ann Arbor, Michigan, USA
| | - Elizabeth Jeter
- Division of Health in Adult Populations, Duke University School of Nursing, Durham, North Carolina, USA
| | - Schenita D Randolph
- Division of Health in Adult Populations, Duke University School of Nursing, Durham, North Carolina, USA
| |
Collapse
|
7
|
Zack JL, Hull SJ, Coleman ME, Ye PP, Lotke PS, Visconti A, Beverley J, Brant A, Moriarty P, Scott RK. Age-related factors associated with intention to initiate pre-exposure prophylaxis among cisgender women in Washington D.C. Ther Adv Infect Dis 2024; 11:20499361241252351. [PMID: 38751758 PMCID: PMC11095193 DOI: 10.1177/20499361241252351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) utilization among cisgender women (subsequently 'women') is low across age groups, relative to their risk of HIV acquisition. We hypothesize that age-related differences in psychosocial factors also influence women's intention to initiate oral PrEP in Washington, D.C. Methods A secondary analysis of a cross-sectional survey data was performed to evaluate factors influencing intention to initiate oral PrEP among women seen at a family planning and a sexual health clinic. A bivariate analysis was performed to identify differences by age group in demographic characteristics, indications for PrEP, and attitudes toward PrEP; we then performed additional bivariate analysis to assess these variables in relation to PrEP intention. Results Across age groups, perceived risk of HIV acquisition was not significantly different and was not associated with intention to initiate PrEP. Awareness of and attitude toward PrEP, injunctive norms, descriptive norms, and self-efficacy were not different across age, however there were significant age-associated differences in relation to PrEP intention. Specifically, among 18-24-year-olds, intention to start PrEP was associated with support from provider (p = 0.03), main sexual partner (p < 0.01), and peers (p < 0.01). For women 25-34 years old, having multiple sexual partners (p = 0.03) and support from casual sexual partners (p = 0.03) was also important. Among women 35-44 years old, prior awareness of PrEP (p = 0.02) and their children's support of PrEP uptake (p < 0.01) were associated with intention to initiate PrEP. Among 45-55 year-old women intention to initiate PrEP was positively associated with engaging in casual sex (p = 0.03) and negatively associated with stigma (p < 0.01). Conclusion Overall, there were more similarities than differences in factors influencing intention to initiate PrEP across age groups. Observed differences offer an opportunity to tailor PrEP delivery and HIV prevention interventions to increase awareness and uptake for cisgender women.
Collapse
Affiliation(s)
- Jennifer L. Zack
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007, USA
| | - Shawnika J. Hull
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Megan E. Coleman
- Whitman-Walker Health, Department of Clinical Investigations, Washington, DC, USA
| | - Peggy Peng Ye
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
| | - Pamela S. Lotke
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
| | - Adam Visconti
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Georgetown University Hospital, Department of Family Medicine, Washington, DC, USA
| | - Jason Beverley
- DC Health, DC Department of Health: HIV/AIDS, Hepatitis, STD & TB Administration (HAHSTA), Washington, DC, USA
| | - Ashley Brant
- Cleveland Clinic Foundation, Women’s Health Institute, Cleveland, OH, USA
| | - Patricia Moriarty
- MedStar Health Research Institute, Clinical Research, Hyattsville, MD, USA
| | - Rachel K. Scott
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
| |
Collapse
|
8
|
Sophus AI, Mitchell JW, Barroso J, Sales JM. Factors Associated with Planned Future Use of PrEP in the Next 3 Months and Likelihood to Use PrEP Among Black Cisgender HIV-negative Women in Texas. AIDS Behav 2024; 28:72-92. [PMID: 37768428 DOI: 10.1007/s10461-023-04188-9] [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] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Identifying and then addressing barriers and leveraging facilitators is important to help increase pre-exposure prophylaxis (PrEP) use among Black women vulnerable to HIV acquisition. The present cross-sectional study examined what factors were associated with future plans to use PrEP, and general likelihood to use it among a convenience sample of 152 adult, Black cisgender women from three metropolitan areas in Texas. The final multivariable logistic regression model revealed that relationship status (aOR = 0.20, 95% CI: 0.05-0.73, p < 0.05), PrEP anticipated stigma (aOR = 0.29, 95% CI: 0.10-0.78, p < 0.05), perceived discrimination (aOR = 0.40, 95% CI: 0.21-0.78, p < 0.01) and interest in learning more about PrEP (aOR = 5.32, 95% CI: 2.60-10.9, p < 0.001) were associated with future plans to use PrEP. The final multivariable linear regression model with maximum likelihood estimation identified that perceived discrimination (β=-0.24, SE: -0.38 - -0.10, p < 0.01), perceived HIV risk (β = 0.33, SE: 0.18-0.49, p < 0.001), willingness to use PrEP with condoms (β = 1.26, SE: 0.94-1.60, p < 0.001), and comfort communicating about PrEP with a provider (β = 0.23, SE: 0.06-0.41, p < 0.01) were associated with general likelihood to use PrEP. Findings reveal key factors that warrant further attention and examination toward improving PrEP use within this population.
Collapse
Affiliation(s)
- Amber I Sophus
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA.
| | - Jason W Mitchell
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, 11200 S.W. 8th Street, AHC5, Miami, FL, 33199, USA
| | - Julie Barroso
- School of Nursing, Vanderbilt University, Nashville, TN, USA
| | - Jessica McDermott Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
9
|
Marks LR, Hayes LR, Amos ATM, Moore KL, Dark T. 'Don't judge me 'til you walk through my shoes': A qualitative investigation of the experiences of women living with HIV. ETHNICITY & HEALTH 2023; 28:1128-1144. [PMID: 37439581 DOI: 10.1080/13557858.2023.2231667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 06/26/2023] [Indexed: 07/14/2023]
Abstract
OBJECTIVE Women living with the human immunodeficiency virus (HIV) are less of a focus in the HIV literature, which tends to focus on the HIV experiences of men who have sex with men (MSMs). Hence, we conducted a qualitative study that examined: (a) the type of stigma and discrimination that women living with HIV experience related to their HIV status, (b) the source of this stigma and discrimination, (c) their responses related to this stigma and discrimination, and (d) the ways in which women living with HIV cope with these experiences of stigma and discrimination. DESIGN Participants consisted of 14 self-identified women living with HIV that were recruited at a community organization in the Southern United States that provides services to individuals living with HIV. The participants ranged in age from 27 to 65 (M = 47.92, SD = 13.08). The sample primarily identified as Black (N = 12), followed by White (N = 1) and Multiracial (N = 1). Most women were cisgender (N = 13) with one woman identifying as transgender (N = 1). RESULTS Fourteen women participated in one of two focus groups (seven in each focus group), which were audio recorded and transcribed. We identified 24 categories across five domains (Stigma and Discrimination, Source of Stigma and Discrimination, Response to Stigma and Discrimination, Coping with Stigma and Discrimination, and Support). CONCLUSIONS This study identified that women living with HIV experience stigma and discrimination in a multitude of ways from different sources. Moreover, women with HIV responded to and coped in negative and positive ways. Multidimensional approaches including personal and community education may help alleviate the stigma and discrimination faced by women living with HIV.
Collapse
Affiliation(s)
- Laura Reid Marks
- Department of Educational Psychology and Leaning Systems, College of Education, Florida State University, Tallahassee, FL, USA
| | - Lauren R Hayes
- Department of Counseling, Educational Psychology, and Research, College of Education, University of Memphis, Memphis, TN, USA
| | - Asia T M Amos
- Department of Counseling, Educational Psychology, and Research, College of Education, University of Memphis, Memphis, TN, USA
| | - Kanesha L Moore
- Department of Counseling, Educational Psychology, and Research, College of Education, University of Memphis, Memphis, TN, USA
| | - Tyra Dark
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, FL, USA
| |
Collapse
|
10
|
Khumalo PN, Mkhonta SS, Kindandi K, Matse S, Dlamini PB, Tukei V, Machekano R, Woelk G. Uptake of and intention to use oral pre-exposure prophylaxis for HIV among pregnant and post-natal women in Eswatini: a cross-sectional survey. FRONTIERS IN REPRODUCTIVE HEALTH 2023; 5:1253384. [PMID: 37965589 PMCID: PMC10641516 DOI: 10.3389/frph.2023.1253384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/11/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction In Eswatini, HIV incidence among women of childbearing age is 1.45%. Eswatini introduced oral pre-exposure prophylaxis (PrEP) for HIV prevention in 2016 and requires that all HIV-negative pregnant and post-natal women (PPW) visiting health care facilities be offered PrEP. Methods Between September-November 2021, we conducted a survey among HIV-negative PPW from 16 purposively selected healthcare facilities in the Hhohho and Shiselweni regions in Eswatini. We interviewed consenting HIV-negative PPW using a structured questionnaire to collect data on PrEP knowledge, attitudes, intentions, and practices, as well as information on partner HIV status and stigma. Multivariate logistic regression was used to determine predictors of PrEP use and intention, adjusted for significant covariates. Results Of 1,484 PPW women approached, 1,149 consented and were interviewed, of whom 704 (61.3%) were post-partum and 445 (38.7%) pregnant. The median age was 25 years [Interquartile Range (IQR) = 21-30 years], with 533 (46.4%) 18-24 years old. Among the 1,149 women, 930 (80.7%) had ever heard about PrEP; 635 (55.3%) had knowledge about PrEP; 183 (15.9%) were currently using PrEP; and 285 (24.8%) had ever used PrEP. Increased odds of PrEP use were associated having HIV-positive male partner (aOR:7.76, 95%CI 3.53- 17.04); positive attitudes to PrEP (aOR:1.56, 95%CI: 1.02-2.40); and high self-efficacy (aOR:1.49, 95%CI:1.13-1.98). Among 864 women who never used PrEP, 569 (65.3%) intended to use PrEP in the future. Odds of intention to use PrEP were higher among women with low levels of education (aOR:2.23, 95% CI: 1.32-3.77); who ever heard about PrEP (aOR:1.69, 95%CI: 1.12-2.56); and had high self-efficacy (aOR:1.57, 95%CI: 1.31-1.87). Regarding stigma, among all women, 759 (66%) either agreed or strongly agreed that people would think they have HIV if they were to use PrEP; 658 (57.3%) reported they would be labelled as having multiple sex partners; 468 (40.7%) reported that their partner would think they are having risky sex with other people. Of 102 women who had discontinued PrEP, a majority stopped due to side effects 32 (35.2%). Conclusion Only about 50% of women had knowledge of PrEP, and PrEP uptake among PPW was low, though intention to use appeared high. More efforts to reduce stigma and promote PrEP use, including adequate information on side effects, are needed.
Collapse
Affiliation(s)
- Philisiwe Ntombenhle Khumalo
- Strategic Information and Evaluation/Clinical Services Delivery Department, Elizabeth Glaser Pediatric AIDS Foundation, Mbabane, Eswatini
| | - Siphiwesihle Sibonisiwe Mkhonta
- Strategic Information and Evaluation/Clinical Services Delivery Department, Elizabeth Glaser Pediatric AIDS Foundation, Mbabane, Eswatini
| | - Kikanda Kindandi
- Strategic Information and Evaluation/Clinical Services Delivery Department, Elizabeth Glaser Pediatric AIDS Foundation, Mbabane, Eswatini
| | - Sindy Matse
- Eswatini National AIDS Program, Ministry of Health, Mbabane, Eswatini
| | - Phinda Brian Dlamini
- Strategic Information and Evaluation/Clinical Services Delivery Department, Elizabeth Glaser Pediatric AIDS Foundation, Mbabane, Eswatini
| | - Vincent Tukei
- Strategic Information and Evaluation/Clinical Services Delivery Department, Elizabeth Glaser Pediatric AIDS Foundation, Mbabane, Eswatini
| | - Rhoderick Machekano
- Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States
| | - Godfrey Woelk
- Research, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, United States
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Scott RK, Hull SJ, Huang JC, Ye PP, Lotke P, Beverley J, Moriarty P, Balaji D, Ward A, Holiday J, Brant AR, Elion R, Visconti AJ, Coleman M. Intention to Initiate HIV Pre-exposure Prophylaxis Among Cisgender Women in a High HIV Prevalence U.S. City. Womens Health Issues 2023; 33:541-550. [PMID: 37479630 PMCID: PMC10552685 DOI: 10.1016/j.whi.2023.05.009] [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: 10/27/2022] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Our objective was to identify the individual, interpersonal, community, health-system, and structural factors that influence HIV pre-exposure prophylaxis (PrEP) initiation among cisgender women seeking sexual and reproductive health care in a high HIV prevalence community to inform future clinic-based PrEP interventions. METHODS We collected anonymous, tablet-based questionnaires from a convenience sample of cisgender women in family planning and sexual health clinics in the District of Columbia. The survey used the lens of the socio-ecological model to measure individual, interpersonal, community, institutional, and structural factors surrounding intention to initiate PrEP. The survey queried demographics, behavioral exposure to HIV, perceived risk of HIV acquisition, a priori awareness of PrEP, intention to initiate PrEP, and factors influencing intention to initiate PrEP. RESULTS A total of 1437 cisgender women completed the survey. By socio-ecological level, intention to initiate PrEP was associated with positive attitudes toward PrEP (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.13-2.15) and higher self-efficacy (OR, 1.32; 95% CI, 1.02-1.72) on the individual level, perceived future utilization of PrEP among peers and low fear of shame/stigma (OR, 1.65; 95% CI, 1.33-2.04) on the community level, and having discussed PrEP with a provider (OR. 2.39; 95% CI, 1.20-4.75) on the institutional level. CONCLUSION Our findings highlight the importance of multilevel, clinic-based interventions for cisgender women, which promote sex-positive and preventive PrEP messaging, peer navigation to destigmatize PrEP, and education and support for women's health medical providers in the provision of PrEP services for cisgender women.
Collapse
Affiliation(s)
- Rachel K Scott
- MedStar Health Research Institute, Hyattsville, Maryland; MedStar Washington Hospital Center, Washington, District of Columbia.
| | - Shawnika J Hull
- Rutgers University, Department of Communications, New Brunswick, New Jersey
| | - Jim C Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Peggy P Ye
- MedStar Washington Hospital Center, Washington, District of Columbia
| | - Pamela Lotke
- MedStar Washington Hospital Center, Washington, District of Columbia
| | | | | | | | - Allison Ward
- MedStar Health Research Institute, Hyattsville, Maryland; MedStar Washington Hospital Center, Washington, District of Columbia
| | | | - Ashley R Brant
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Rick Elion
- DC Health, Washington, District of Columbia
| | | | | |
Collapse
|
13
|
Teitelman AM, Tieu HV, Chittamuru D, Shaw PA, Nandi V, Davis A, Lipsky RK, Darlington CK, Fiore D, Koblin BA. A Randomized Controlled Pilot Study of Just4Us, a Counseling and Navigation Intervention to Promote Oral HIV Prophylaxis Uptake Among PrEP-Eligible Cisgender Women. AIDS Behav 2023; 27:2944-2958. [PMID: 36869921 PMCID: PMC10475488 DOI: 10.1007/s10461-023-04017-z] [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: 02/01/2023] [Indexed: 03/05/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) uptake among cisgender women in the United States is low. Just4Us, a theory-based counseling and navigation intervention, was evaluated in a pilot randomized controlled trial among PrEP-eligible women (n = 83). The comparison arm was a brief information session. Women completed surveys at baseline, post-intervention, and at three months. In this sample, 79% were Black, and 26% were Latina. This report presents results on preliminary efficacy. At 3 months follow-up, 45% made an appointment to see a provider about PrEP; only 13% received a PrEP prescription. There were no differences in PrEP initiation by study arm (9% Info vs. 11% Just4Us). PrEP knowledge was significantly higher in the Just4Us group at post-intervention. Analysis revealed high PrEP interest with many personal and structural barriers along the PrEP continuum. Just4Us is a promising PrEP uptake intervention for cisgender women. Further research is needed to tailor intervention strategies to multilevel barriers.Clinicaltrials.gov registration NCT03699722: A Women-Focused PrEP Intervention (Just4Us).
Collapse
Affiliation(s)
- Anne M Teitelman
- Department of Family and Community Health, School of Nursing, Fagin Hall, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA, 19104-4217, USA.
| | - Hong-Van Tieu
- New York Blood Center, New York, NY, USA
- Columbia University Irving Medical Center, New York, NY, USA
| | - Deepti Chittamuru
- Department of Family and Community Health, School of Nursing, Fagin Hall, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA, 19104-4217, USA
| | - Pamela A Shaw
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | | | - Annet Davis
- Department of Family and Community Health, School of Nursing, Fagin Hall, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA, 19104-4217, USA
| | - Rachele K Lipsky
- Department of Family and Community Health, School of Nursing, Fagin Hall, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA, 19104-4217, USA
| | - Caroline K Darlington
- Department of Family and Community Health, School of Nursing, Fagin Hall, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA, 19104-4217, USA
| | - Danielle Fiore
- Department of Family and Community Health, School of Nursing, Fagin Hall, University of Pennsylvania, 418 Curie Blvd., Philadelphia, PA, 19104-4217, USA
| | | |
Collapse
|
14
|
Troutman J, Robillard A, Ingram LA, Qiao S, Gaddist B, Segosebe K. Individual, Social, and Structural Vulnerability for Black Women in the South: Implications for PrEP. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:290-308. [PMID: 37535327 DOI: 10.1521/aeap.2023.35.4.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, yet adoption among Black women, who are disproportionately impacted by HIV, is low. A nuanced understanding of the multi-level factors that contribute to elevated risk is necessary to better contextualize PrEP uptake. Qualitative data from Black women residing in the Southern U.S. who self-screened as HIV-negative, were collected via four focus groups (N = 27) to understand influences on HIV vulnerability and the potential role of PrEP in mitigating risk. Content analysis of transcribed data yielded multiple themes addressing: the pervasiveness of sexual partner sharing; lack of transparency regarding HIV status, disclosure, and testing; and social/cultural influences on HIV risk. Experiences with the health care system and providers were of particular concern. Findings demonstrate support for PrEP in this population and contribute to our understanding of individual, social, and structural factors to better inform PrEP promotion.
Collapse
Affiliation(s)
- Jamie Troutman
- Quality Comprehensive Health Center, Charlotte, North Carolina
| | - Alyssa Robillard
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Lucy Annang Ingram
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Shan Qiao
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Kebafe Segosebe
- Edson College of Nursing and Health Innovation, Arizona State University
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
O'Malley TL, Krier SE, Bainbridge M, Hawk ME, Egan JE, Burke JG. Women's perspectives on barriers to potential PrEP uptake for HIV prevention: HIV risk assessment, relationship dynamics and stigma. CULTURE, HEALTH & SEXUALITY 2023; 25:776-790. [PMID: 35839305 DOI: 10.1080/13691058.2022.2099016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 07/04/2022] [Indexed: 06/02/2023]
Abstract
HIV remains a significant health issue for women, and multiple overlapping factors shape women's HIV-related risk. Pre-exposure prophylaxis (PrEP) offers critical advantages over other existing options, yet it remains significantly underused among women in the USA where limited work has explored women's opinions on barriers to potential PrEP use. Using open-ended text responses from a sample of women seeking care at a US urban family planning health centre, this study aimed to understand perceptions of factors affecting potential PrEP use. Three themes concerning key factors impacting potential PrEP use emerged: HIV risk assessment, relationship dynamics, and anticipated stigma. Women's assessment of HIV risk suggests that identifying women in clinical settings as having low self-perceived risk may overlook the complexity of how women determine HIV-related risk and prevention needs. Women frequently referenced relationship dynamics when considering PrEP and discussed anticipated partner reactions about use contributing to non-use. Fear or worry of stigma were expressed as motivations to not use PrEP. Study results highlight the importance of public health and health care professionals normalising PrEP as a strategy in women's HIV prevention and sexual health decision-making. Woman-centred PrEP education, screening and communication strategies reflective of their unique HIV-related risk context are needed.
Collapse
Affiliation(s)
- Teagen L O'Malley
- Department of Infectious Diseases and Microbiology, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sarah E Krier
- Department of Infectious Diseases and Microbiology, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Maura Bainbridge
- Department of Infectious Diseases and Microbiology, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mary E Hawk
- Department of Behavioral and Community Health Sciences, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - James E Egan
- Department of Behavioral and Community Health Sciences, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jessica G Burke
- Department of Behavioral and Community Health Sciences, School of Public Heath, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
17
|
Fonner VA, Ridgeway K, van der Straten A, Lorenzetti L, Dinh N, Rodolph M, Schaefer R, Schmidt HMA, Nguyen VTT, Radebe M, Peralta H, Baggaley R. Safety and efficacy of long-acting injectable cabotegravir as preexposure prophylaxis to prevent HIV acquisition. AIDS 2023; 37:957-966. [PMID: 36723489 PMCID: PMC10090368 DOI: 10.1097/qad.0000000000003494] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/02/2023]
Abstract
OBJECTIVE HIV remains a significant burden, despite expanding HIV prevention tools. Long-acting injectable cabotegravir (CAB-LA) is a new preexposure prophylaxis (PrEP) product. We reviewed existing evidence to determine the efficacy and safety of CAB-LA as PrEP to inform global guidelines. DESIGN Systematic review and meta-analysis. METHODS We systematically reviewed electronic databases and conference abstracts for citations on CAB-LA from January 2010 to September 2021. Outcomes included HIV infection, adverse events, drug resistance, pregnancy-related adverse events, and sexual behavior. We calculated pooled effect estimates using random-effects meta-analysis and summarized other results narratively. RESULTS We identified 12 articles/abstracts representing four multisite randomized controlled trials. Study populations included cisgender men, cisgender women, and transgender women. The pooled relative risk of HIV acquisition comparing CAB-LA to oral PrEP within efficacy studies was 0.21 (95% confidence interval: 0.07-0.61), resulting in a 79% reduction in HIV risk. Rates of adverse events were similar across study groups. Of 19 HIV infections among those randomized to CAB-LA with results available, seven had integrase strand transfer inhibitor (INSTI) resistance. Data on pregnancy-related adverse events were sparse. No studies reported on sexual behavior. CONCLUSIONS CAB-LA is highly efficacious for HIV prevention with few safety concerns. CAB-LA may lead to an increased risk of INSTI resistance among those who have acute HIV infection at initiation or become infected while taking CAB-LA. However, results are limited to controlled studies; more research is needed on real-world implementation. Additional data are needed on the safety of CAB-LA during pregnancy (for mothers and infants) and among populations not included in the trials.
Collapse
Affiliation(s)
| | - Kathleen Ridgeway
- FHI 360 Global Health and Population Research, Durham, North Carolina
| | - Ariane van der Straten
- ASTRA Consulting and Center for AIDS prevention Studies (CAPS), Department of Medicine, San Francisco, California, USA
| | - Lara Lorenzetti
- FHI 360 Global Health and Population Research, Durham, North Carolina
| | - Nhi Dinh
- FHI 360 Global Health and Population Research, Durham, North Carolina
| | - Michelle Rodolph
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
| | - Robin Schaefer
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
| | - Heather-Marie A. Schmidt
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
- UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand
| | | | - Mopo Radebe
- World Health Organization, Country Office, Pretoria, South Africa
| | | | - Rachel Baggaley
- World Health Organization, Global HIV, Hepatitis and STIs Programmes, Geneva, Switzerland
| |
Collapse
|
18
|
Experiences of Black Women in the United States Along the PrEP Care Continuum: A Scoping Review. AIDS Behav 2023; 27:2298-2316. [PMID: 36622485 DOI: 10.1007/s10461-022-03960-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 01/10/2023]
Abstract
Black women are disproportionately affected by HIV in the U.S. PrEP could decrease the risk of acquiring HIV. This scoping review seeks to understand the experiences of Black women along the PrEP Care Continuum. We searched PubMed, Embase, PsycInfo, and Google Scholar to identify peer-reviewed studies published between July 16, 2012, and December 15, 2021. Articles were included if they discussed PrEP among Black women in the U.S. Two authors screened titles/abstracts and full-text articles. One author extracted and thematically summarized findings (n = 33). Black women reported low levels of PrEP awareness and knowledge, and negative experiences with providers. Women also experienced negative perceptions of PrEP from their social networks, stigma, and mistrust. Future research should focus on helping Black women to overcome PrEP-related barriers. Additionally, future research should further examine barriers to PrEP initiation, adherence, and retention for Black women, as only three studies discussed these aspects of the Continuum.
Collapse
|
19
|
Chautrakarn S, Rayanakorn A, Intawong K, Chariyalertsak C, Khemngern P, Stonington S, Chariyalertsak S. PrEP stigma among current and non-current PrEP users in Thailand: A comparison between hospital and key population-led health service settings. Front Public Health 2022; 10:1019553. [PMID: 36530709 PMCID: PMC9755171 DOI: 10.3389/fpubh.2022.1019553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/17/2022] [Indexed: 12/04/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) has demonstrated effectiveness in high-risk populations. PrEP service in Thailand became free of charge under the Universal Health Coverage (UHC) in 2021. The National Health Security Office launched a pilot project in 2020 to ensure sustainable service delivery, and the national monitoring and evaluation (M&E) framework was adopted to evaluate early phase implementation. We carried out a cross-sectional survey as part of the M&E process to investigate PrEP stigma among current and non-current PrEP users from both hospital and Key Population Led Health Services (KPLHS) settings in Thailand. Methods Between August and October 2020, an online cross-sectional survey was conducted. A link for a self-administered questionnaire was distributed to all active PrEP centers and PrEP clients were then recruited by PrEP providers. Descriptive and univariate analysis using Chi-square were applied in the analyses. Attitudes toward PrEP were ranked from the most negative to the most positive. The negative attitude can be interpreted as PrEP stigma. Results This study included 513 PrEP clients (355 from hospitals and 158 from KPLHS). In both settings, respondents' attitudes toward PrEP were generally positive, but some potential stigma was observed. 31.8% of hospital PrEP clients and 9.5% of KPLHS clients agreed that PrEP users should keep their pills hidden from others. Almost half (44.5%) of hospital clients and 18.4% of KPLHS clients agreed that PrEP users are often viewed negatively by society. More than 20% of hospital clients and 12% of KPLHS agreed that PrEP users frequently experience difficulties when their partner/lover/family find out that he or she is on PrEP. Respondents from the hospitals had slightly higher PrEP stigma than those from KPLHS. Conclusions According to our findings, at the policy level, the campaign to provide PrEP education to all groups of people should be continued in order to promote a positive view of PrEP and reduce PrEP-related stigma among the general population, which is critical for successful PrEP implementation.
Collapse
Affiliation(s)
| | - Ajaree Rayanakorn
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | - Kannikar Intawong
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand
| | | | - Porntip Khemngern
- Division of AIDS and STIs, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Scott Stonington
- Departments of Internal Medicine and Anthropology, University of Michigan, Ann Arbor, MI, United States
| | - Suwat Chariyalertsak
- Faculty of Public Health, Chiang Mai University, Chiang Mai, Thailand,*Correspondence: Suwat Chariyalertsak
| |
Collapse
|
20
|
Scott RK, Hull SJ, Huang JC, Coleman M, Ye P, Lotke P, Beverley J, Moriarty P, Balaji D, Ward A, Holiday J, Brant AR, Cameron M, Elion R, Visconti A. Factors Associated with Intention to Initiate Pre-exposure Prophylaxis in Cisgender Women at High Behavioral Risk for HIV in Washington, D.C. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2613-2624. [PMID: 35622077 PMCID: PMC9308717 DOI: 10.1007/s10508-021-02274-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
Pre-exposure prophylaxis (PrEP) for HIV prevention is underutilized by cisgender women at risk for HIV in the USA. Published research on PrEP initiation among cisgender women at risk for HIV focuses on identifying barriers and facilitators associated with intention to initiate, but few apply a behavioral theoretical lens to understand the relative importance of these diverse factors. This study provides a theoretically grounded view of the relative importance of factors associated with intention to initiate PrEP. We conducted an anonymous, cross-sectional survey of 1437 cisgender women seeking care at family planning and sexual health clinics to evaluate hypothesized barriers and facilitators of PrEP initiation. We categorized cisgender women with ≥ 3 behavioral risk-factors as "high-risk" for HIV acquisition; 26.9% (N = 387) met high-risk criterion. Among cisgender women in the high-risk sample, the majority were Black and single. Perceived risk of HIV acquisition was low and 13.7% reported intention to initiate PrEP. Positive attitudes toward PrEP, self-efficacy, perceived support from medical providers and social networks, and prior discussion about PrEP with medical providers were associated with intention to initiate PrEP; stigma was negatively associated. Background characteristics (other than age), risk factors for HIV acquisition, prior awareness of PrEP, and perceived risk of HIV were not associated with uptake intention. These findings support interventions that center on the role of providers in the provision of PrEP and on social networks in destigmatization of PrEP use.
Collapse
Affiliation(s)
- Rachel K Scott
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA.
- MedStar Washington Hospital Center, Washington, DC, USA.
| | - Shawnika J Hull
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Jim C Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | | | - Peggy Ye
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Pam Lotke
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Patricia Moriarty
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Dhikshitha Balaji
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Allison Ward
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Jennifer Holiday
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Ashley R Brant
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Martha Cameron
- International Community of Women Living with HIV, Washington, DC, USA
| | | | - Adam Visconti
- MedStar Georgetown University, NW Washington, DC, USA
| |
Collapse
|
21
|
Sonalkar S, McAllister A, Kete C, Fishman J, Frarey A, Short WR, Schreiber CA, Teitelman AM. Implementation of an HIV Pre-exposure Prophylaxis Strategy Into Abortion and Early Pregnancy Loss Care. J Acquir Immune Defic Syndr 2022; 90:S129-S133. [PMID: 35703764 PMCID: PMC9204783 DOI: 10.1097/qai.0000000000002972] [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: 11/26/2022]
Abstract
BACKGROUND Family planning and abortion clinics routinely address sexual health. We sought to evaluate implementation outcomes of an HIV pre-exposure prophylaxis (PrEP) care strategy for patients seeking management of induced abortion and pregnancy loss. SETTING Single-center, urban, academic, hospital-based family planning service. METHODS We used a multifaceted implementation strategy directed toward family planning providers comprised of educational sessions, an electronic medical record-prompted verbal assessment of HIV risk, electronic medical record shortcuts for PrEP prescription, and support of a PrEP navigator. We assessed penetration of the intervention by calculating the penetration of a PrEP offer, measured as the proportion of encounters in which PrEP was offered to PrEP-eligible individuals. We evaluated feasibility, acceptability, and appropriateness of the intervention using belief elicitation interviews with providers. RESULTS From November 2018 to April 2019, the proportion of PrEP eligible patients who were offered PrEP, was 87.9% (29/33). Providers found the intervention acceptable and appropriate, but reported barriers including time constraints, and disappointment if patients did not adhere to PrEP. Providers liked that PrEP provision in abortion care settings felt innovative, and that they could contribute to HIV prevention. CONCLUSION Family planning providers in an academic center found HIV risk assessment and PrEP provision to be feasible, acceptable, and appropriate. Further research should evaluate implementation outcomes of PrEP care strategies in additional abortion care contexts, including clinics offering reproductive health care outside of academia.
Collapse
Affiliation(s)
- Sarita Sonalkar
- Division of Family Planning, Perelman School of Medicine at the University of Pennsylvania, 3737 Market St, 12 Floor, Philadelphia, PA 19119, USA, 215-615-5234
| | - Arden McAllister
- Division of Family Planning, Perelman School of Medicine at the University of Pennsylvania, 3737 Market St, 12 Floor, Philadelphia, PA 19119, USA, 215-615-5234
| | - Corinne Kete
- Division of Family Planning, Perelman School of Medicine at the University of Pennsylvania, 3737 Market St, 12 Floor, Philadelphia, PA 19119, USA, 215-615-5234
| | - Jessica Fishman
- Department of Psychiatry, Perelman School of Medicine; Annenberg School for Communication, 3620 Walnut Street, Philadelphia, PA 19104; Leonard Davis Institute, University of Pennsylvania
| | - Alhambra Frarey
- Division of Family Planning, Perelman School of Medicine at the University of Pennsylvania, 3737 Market St, 12 Floor, Philadelphia, PA 19119, USA, 215-615-5234
| | - William R. Short
- Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, 3801 Filbert Street, Suite 103, Philadelphia, PA 19104, 215-662-9908
| | - Courtney A. Schreiber
- Division of Family Planning, Perelman School of Medicine at the University of Pennsylvania, 3737 Market St, 12 Floor, Philadelphia, PA 19119, USA, 215-615-5234
| | - Anne M. Teitelman
- School of Nursing, University of Pennsylvania, Claire M. Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19104
| |
Collapse
|
22
|
Prevalence and Risk Factors of PrEP Use Stigma Among Adolescent Girls and Young Women in Johannesburg, South Africa and Mwanza, Tanzania Participating in the EMPOWER Trial. AIDS Behav 2022; 26:3950-3962. [PMID: 35776254 PMCID: PMC9640431 DOI: 10.1007/s10461-022-03721-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/01/2022]
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa may benefit from pre-exposure prophylaxis (PrEP), yet stigma may limit PrEP acceptance and continuation. We examined factors associated with PrEP use stigma among 307 participants of the EMPOWER trial (2016-2018), an unblinded randomized controlled trial among HIV-negative, AGYW, aged 16-24, in South Africa and Tanzania. The 6-item, brief-PrEP use stigma scale (B-PSS) had high internal reliability. At the end of the trial, 34.2% of study participants reported any PrEP use stigma. Three latent classes were observed, reflecting low (46.9%), medium (31.9%), and high (21.2%) reported PrEP use stigma. Disclosure of PrEP use to sexual partner and belief that PrEP prevents HIV were associated with less reported PrEP use stigma. Conversely, participants who reported fear and shame about people living with HIV were more likely to report PrEP use stigma. Our validated tool and findings will enable practitioners to identify AGYW at high risk of PrEP use stigma who may benefit from additional support.Pan African clinical trials registry PACTR202006754762723, 5 April 2020, retrospectively registered.
Collapse
|
23
|
Jackson GY, Darlington CK, Tieu HV, Brawner BM, Flores DD, Bannon JA, Davis A, Frye V, Chittamuru D, Gugerty P, Koblin BA, Teitelman AM. Women's views on communication with health care providers about pre-exposure prophylaxis (PrEP) for HIV prevention. CULTURE, HEALTH & SEXUALITY 2022; 24:642-656. [PMID: 33535887 PMCID: PMC8567214 DOI: 10.1080/13691058.2021.1877824] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Since the beginning of the HIV epidemic in the USA, effective interventions to reduce HIV risk among cisgender women have been lacking. Although oral HIV pre-exposure prophylaxis (PrEP) is effective in pharmacologically preventing HIV infection, there is a gap between the recommended use of PrEP and PrEP uptake among eligible women. This study aimed to identify the role of patient-provider communication in PrEP decision-making among women considering PrEP. Semi-structured in-depth interviews were conducted with 41 PrEP-eligible women in Philadelphia and New York City. A thematic analysis of the responses was conducted, and a conceptual model developed and confirmed as analysis continued. Of the women interviewed, 53.6% were African American and 29.3% were Latina. Women noted that having a trusting relationship with their health care provider, receiving a tailored recommendation for PrEP based upon their specific needs and using their health care provider as support were crucial facilitators of PrEP decision-making. Lack of provider knowledge about PrEP, perceived health care provider stigma about their drug use and sexual activity, and lack of care continuity were all identified as barriers to effective communication. Study findings can inform future interventions to enhance patient-provider communication about PrEP and increase PrEP uptake among women.
Collapse
Affiliation(s)
| | - Caroline K. Darlington
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Corresponding Author: Caroline K. Darlington
| | - Hong-Van Tieu
- Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY, USA
| | | | | | | | - Annet Davis
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Victoria Frye
- School of Medicine, The City University of New York, New York, NY, USA
| | - Deepti Chittamuru
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - Paige Gugerty
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Anne M. Teitelman
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
24
|
Teitelman AM, Tieu HV, Flores D, Bannon J, Brawner BM, Davis A, Gugerty P, Koblin B. Individual, social and structural factors influencing PrEP uptake among cisgender women: a theory-informed elicitation study. AIDS Care 2022; 34:273-283. [PMID: 33719816 PMCID: PMC8426410 DOI: 10.1080/09540121.2021.1894319] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The underutilization of pre-exposure prophylaxis (PrEP) among cisgender women in the U.S. limits this population's ability to reduce their risk for HIV infection, especially within the unique individual, social and structural systems they navigate. There is a need to identify the relevant multi-level barriers and facilitators to PrEP use among cisgender women to inform theory-guided efforts that address HIV disparities by race/ethnicity among cisgender women. Guided by the Integrated Behavioral Model and the Behavioral Model of Vulnerble Populations we conducted 41 interviews with PrEP eligible cisgender women in New York City and Philadelphia. Directed content analysis identified 11 modal behavioral beliefs crucial to PrEP uptake, including anticipated negative social consequences, 5 normative beliefs centered on available social supports, and 9 control beliefs such as anticipated barriers such as cost. Awareness and knowledge of PrEP as a biobehavioral HIV prevention method is limited for this sample. Through conventional content analysis we identified interpersonal and structural barriers to PrEP uptake including lack of partner support, transportation, mental health challenges, and challenges in accessing PrEP care. Potential solutions to structural barriers were enumerated along with implications for future intervention work and public health programming.
Collapse
Affiliation(s)
- Anne M. Teitelman
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Hong-Van Tieu
- Lab of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center; Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center
| | - Dalmacio Flores
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Jacqueline Bannon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bridgette M. Brawner
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Annet Davis
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Paige Gugerty
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Beryl Koblin
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA,Independent Consultant, Metuchen, NJ
| |
Collapse
|
25
|
Chandler R, Guillaume D, Wells J, Hernandez N. Let Me Prep You to PREP Me: Amplifying the Voices of Black Women and Their Providers to Consider PrEP as an HIV Prevention Option. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031414. [PMID: 35162438 PMCID: PMC8835000 DOI: 10.3390/ijerph19031414] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023]
Abstract
Despite the high efficacy of pre-exposure prophylaxis (PrEP) in preventing HIV acquisition, PrEP uptake among Black cisgender women remains low. Our qualitative study assessed Black cisgender women's perspectives, attitudes, and acceptability towards PrEP, in addition to exploring PrEP-related attitudes, facilitators, and barriers to PrEP access among health care staff. This study was conducted to ascertain data to inform the development of our HIV prevention app-Savvy HER-which is being designed for Black cisgender women. Our findings indicated that Black women had low levels of PrEP acceptability and high levels of misconceptions, inaccurate knowledge, and stigma towards PrEP. Health care providers in our sample confirmed barriers of stigma, misconceptions, and knowledge among their patients coupled with difficulty accessing PrEP due to structural barriers. Our study indicated that there is a critical need to heighten Black cisgender women's PrEP knowledge and HIV risk perception in order to increase PrEP acceptability and uptake.
Collapse
Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
| | - Dominique Guillaume
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
- School of Nursing, Johns Hopkins University, Baltimore, MD 21224, USA
- Correspondence:
| | - Jessica Wells
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA 30322, USA; (R.C.); (J.W.)
| | - Natalie Hernandez
- Community Health and Preventative Medicine, Morehouse School of Medicine, Atlanta, GA 30310, USA;
| |
Collapse
|
26
|
Sonalkar S, Short WR, McAllister A, Kete C, Ingeno L, Fishman J, Koenig HC, Schreiber CA, Teitelman AM. Incorporating HIV Pre-Exposure Prophylaxis Care for Patients Seeking Induced Abortion and Pregnancy Loss Management. Womens Health Issues 2022; 32:388-394. [PMID: 34998653 DOI: 10.1016/j.whi.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/03/2021] [Accepted: 12/13/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Family planning clinical encounters are important opportunities for HIV prevention. Our objectives were to 1) estimate the proportion of patients seeking induced abortion and early pregnancy loss management eligible for HIV pre-exposure prophylaxis (PrEP) and 2) compare PrEP eligibility and uptake between patients with unintended and intended pregnancy. METHODS We conducted a cross-sectional survey and a nested prospective cohort study of patients seeking an induced abortion or early pregnancy loss management. We assessed pregnancy intendedness, PrEP awareness, HIV risk and risk perception, desire for same-day PrEP start, and PrEP continuation at 30 days. We used the χ2 and Fisher's exact tests to assess differences between the participants with intended and unintended pregnancy. We had 80% power to detect a 14% difference in PrEP eligibility between the groups. RESULTS We enrolled 250 women. Fifty-six percent (139) had an unintended pregnancy and 44% (110) had an intended pregnancy. PrEP eligibility did not differ significantly between the patients with intended and unintended pregnancy (16% vs. 10%; p = .18). More than one-half (54%, 135/250) were unaware of PrEP before their study visit, and 93% (232/250) considered themselves unlikely to acquire HIV. Of 33 women who were PrEP eligible, 11 accepted same-day start and 1 continued PrEP at 30 days. CONCLUSIONS Intendedness of pregnancy was unrelated to PrEP eligibility in women seeking induced abortion and early pregnancy loss management. Most patients seeking these services are unaware of PrEP. Integrating PrEP into family planning care is likely to increase awareness and uptake of PrEP in women.
Collapse
Affiliation(s)
- Sarita Sonalkar
- Division of Family Planning, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - William R Short
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Arden McAllister
- Division of Family Planning, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Corinne Kete
- Division of Family Planning, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Leah Ingeno
- Division of Family Planning, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica Fishman
- Department of Psychiatry, Perelman School of Medicine, Philadelphia, Pennsylvania; Annenberg School for Communication, Philadelphia, Pennsylvania; Leonard Davis Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Helen C Koenig
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
| | - Courtney A Schreiber
- Division of Family Planning, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne M Teitelman
- School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
27
|
Flössner C, Avetisyan M, Frese T. Basic knowledge among GP trainees regarding HIV pre- and post-exposition-prophylaxis. J Family Med Prim Care 2021; 10:3283-3287. [PMID: 34760745 PMCID: PMC8565146 DOI: 10.4103/jfmpc.jfmpc_414_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Preventing human immunodeficiency virus (HIV) infection is central to containing the HIV pandemic. For pre- and post-exposure prophylaxis (PrEP and PEP), drugs approved in Germany are available. Basic information on this should be obtained from physicians in further training to become specialists in General Practice (GP) since they may have to deal with this topic of high relevance for the health of patients at risk and also the physicians' health after a possible exposure in the professional context. Methodology A multiple-choice questionnaire was handed out to doctors in further training in General Practice on seminar days of the Competence Centre for General Practice Saxony-Anhalt for an immediate answer. Results Of the 109 doctors, 73 completed the questionnaire. A general high relevance of the topic HIV was stated by 95%. In contrast, 71% said it was relevant for family doctor activities. The knowledge questions on the prevalence were answered correctly for all questions with less than 40%; 21% stated that they knew the indication prerequisite for a PEP; 49% answered the question about the period of the highest efficacy of PEP correctly. PrEP as a drug option for prophylaxis is known to a part of the respondents, 79% would prescribe PrEP, 69% were in favour of a health insurance benefit. Discussion The results show that the necessary basic knowledge about HIV is partly available. Basic knowledge on structured action in the fields of HIV testing, PEP and PrEP should be taught in a manner appropriate to the relevance of the topic in the context of the German general practice setting. Even a basic knowledge about PEP may help to ensure that the general practice teams receive proper measures after a possible exposition.
Collapse
Affiliation(s)
- Christian Flössner
- Institute of General Medicine, Medical Faculty, University of Halle-Wittenberg, Universitätsplatz, Germany
| | - Meri Avetisyan
- Institute of General Medicine, Medical Faculty, University of Halle-Wittenberg, Universitätsplatz, Germany
| | - Thomas Frese
- Institute of General Medicine, Medical Faculty, University of Halle-Wittenberg, Universitätsplatz, Germany
| |
Collapse
|
28
|
Ramsey SE, Ames EG, Uber J, Habib S, Hunt L, Brinkley-Rubinstein L, Teitelman AM, Clarke J, Kaplan C, Phillips NJ, Murphy M. Linking Women Experiencing Incarceration to Community-Based HIV Pre-Exposure Prophylaxis Care: A Qualitative Study. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:216-233. [PMID: 34014108 PMCID: PMC8189628 DOI: 10.1521/aeap.2021.33.3.216] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Women experiencing incarceration (WEI) in the United States are disproportionately impacted by HIV, yet HIV pre-exposure prophylaxis (PrEP) is underutilized by women in the United States. In order to inform an intervention to promote PrEP initiation during incarceration and facilitate linkage to PrEP care following release from incarceration, we conducted individual, semistructured qualitative interviews with WEI (N = 21) and key stakeholders (N = 14). While WEI had little or no previous knowledge about PrEP, they viewed it as something that would benefit women involved in the criminal justice system. Participants stated that HIV-related stigma and underestimation of HIV risk might serve as barriers to PrEP initiation during incarceration. Participants reported that competing priorities, difficulty scheduling an appointment, and lack of motivation could interfere with linkage to PrEP care in the community. Further, cost, substance use, and difficulty remembering to take the medication were cited most commonly as likely barriers to adherence.
Collapse
Affiliation(s)
- Susan E Ramsey
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| | - Evan G Ames
- Rhode Island Hospital, Providence, Rhode Island
| | - Julia Uber
- Rhode Island Hospital, Providence, Rhode Island
| | - Samia Habib
- Rhode Island Hospital, Providence, Rhode Island
| | - Laura Hunt
- Rhode Island Hospital, Providence, Rhode Island
| | | | - Anne M Teitelman
- University of Pennsylvania School of Nursing, Philadelphia, Pennnsylvania
| | - Jennifer Clarke
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Rhode Island Department of Corrections, Cranston, Rhode Island
| | - Clair Kaplan
- University of Pennsylvania School of Nursing, Philadelphia, Pennnsylvania
| | - Nicole J Phillips
- University of Pennsylvania School of Nursing, Philadelphia, Pennnsylvania
| | - Matthew Murphy
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- Rhode Island Department of Corrections, Cranston, Rhode Island
- Rhode Island Hospital, Providence, Rhode Island
| |
Collapse
|
29
|
Teitelman AM, Koblin BA, Brawner BM, Davis A, Darlington C, Lipsky RK, Iwu E, Bond KT, Westover J, Fiore D, Tieu HV. Just4Us: Development of a Counselor-Navigator and Text Message Intervention to Promote PrEP Uptake Among Cisgender Women at Elevated Risk for HIV. J Assoc Nurses AIDS Care 2021; 32:188-204. [PMID: 33427767 PMCID: PMC10375596 DOI: 10.1097/jnc.0000000000000233] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT In the United States, pre-exposure prophylaxis (PrEP) uptake among eligible cisgender women has been slow, despite the availability of oral PrEP since 2012. Although women make up nearly 20% of those living with HIV, there are currently few PrEP uptake interventions for cisgender women at elevated risk for acquiring HIV. Here we describe the process used to design and pre-pilot test Just4Us, a theory-based behavioral intervention to promote PrEP initiation and adherence among PrEP-eligible cisgender women. This work was part of a multiphase study conducted in New York City and Philadelphia, two locations with HIV rates higher than the national average. The counselor-navigator component of the intervention was designed to be delivered in a 60- to 90-min in-person session in the community, followed by several phone calls to support linkage to care. An automated text messaging program was also designed for adherence support. Just4Us addressed personal and structural barriers to PrEP uptake using an empowerment framework by building on women's insights and resources to overcome barriers along the PrEP cascade. Usability pre-pilot testing results were favorable and provided valuable feedback used to refine the intervention.
Collapse
Affiliation(s)
- Anne M Teitelman
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Beryl A Koblin
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Bridgette M Brawner
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Annet Davis
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Caroline Darlington
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Rachele K Lipsky
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Emilia Iwu
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Keosha T Bond
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Julie Westover
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Danielle Fiore
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Hong-Van Tieu
- Anne M. Teitelman, PhD, FNP-BC, FAAN, FAANP, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Beryl A. Koblin, PhD, is an Independent Consultant, Metuchen, New Jersey, USA. Bridgette M. Brawner, PhD, MDiv, APRN, is an Associate Professor, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Annet Davis, RN, MSW, CCRC, is a Coordinator of Community Engagement & Project Director for the Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Caroline Darlington, MSN, WHNP-BC, is a PhD Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Rachele K. Lipsky, PhD, CRNP, PMHNP-BC, is a Postdoctoral Scholar, National Clinical Scholars Program, Duke University, Durham, North Carolina, USA, and a Former Doctoral Student, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA. Emilia Iwu, PhD, RN, APNC, FWACN, is an Assistant Professor, Rutgers University School of Nursing, Division of Nursing Science and Center for Global Health, Newark, New Jersey, USA. Keosha T. Bond, EdD, MPH, CHES, is an Assistant Medical Professor, Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, New York, USA. Julie Westover, BS, is a Medical Student, University of California San Diego, School of Medicine, San Diego, California, USA, and a Former Innovation Technology Fellow, Penn Medicine Center for Health Care Innovation, Philadelphia, Pennsylvania, USA. Danielle Fiore, BS, is a Data Manager, Just4Us Study, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Hong-Van Tieu, MD, MS, is Head of the Laboratory of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| |
Collapse
|