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Kennedy CE, Feng X, Ssekubugu R, Rosen JG, Ssekasanvu J, Kigozi G, Serwadda D, Yeh PT, Kagaayi J, Quinn TC, Tobian AAR, Wawer MJ, Reynolds SJ, Chang LW, Grabowski MK, Nalugoda F. Population prevalence of antiretroviral therapy sharing and its association with HIV viremia in rural Uganda: a cross-sectional population-based study. J Int AIDS Soc 2023; 26:e26135. [PMID: 37705364 PMCID: PMC10500261 DOI: 10.1002/jia2.26135] [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: 11/29/2022] [Accepted: 06/07/2023] [Indexed: 09/15/2023] Open
Abstract
INTRODUCTION Antiretroviral treatment (ART) sharing has been reported among fishermen and sex workers in Uganda and South Africa. However, no population-based studies have documented ART diversion prevalence (including sharing [giving/receiving], buying and selling) or its relationship with viremia among men and women living with HIV in Africa. METHODS In 2018-2020, we surveyed people living with HIV aged 15-49 years in 41 communities in the Rakai Community Cohort Study, a population-based cohort in south-central Uganda. We assessed the prevalence and correlates of self-reported lifetime and past-year ART diversion, stratifying by age and gender and documenting sources of diverted drugs. We used log-binomial regression to quantify the relationship between diversion patterns and viremia (viral load >40 copies/ml), reported as unadjusted and adjusted prevalence ratios (aPR) with 95% confidence intervals (CI). RESULTS Of 2852 people living with HIV and self-reporting current ART use, 266 (9.3%) reported lifetime ART diversion. Giving/receiving drugs were most common; few participants reported buying, and none reported selling. Men (12.9%) were more likely to report lifetime diversion than women (7.4%), with men aged 25-34 reporting high levels of sharing (18.9%). Friends were the most common sources of shared drugs, followed by spouses/sexual partners. Patterns of lifetime and past-year diversion were similar. Among participants with viral load results, 8.6% were viraemic. In adjusted analyses, people who reported only giving ART were nearly twice as likely to be viraemic than those who reported no diversion (aPR: 1.94, 95% CI: 1.10-3.44), and those reporting only receiving ART were less likely to exhibit viremia (aPR: 0.46, 95% CI: 0.12-1.79), although the latter was not statistically significant. Reporting both giving and receiving ART was not associated with viremia (aPR: 0.79, 95% CI: 0.43-1.46). Reporting buying ART, though rare, was also correlated with higher rates of viremia, but this relationship was not statistically significant (aPR: 1.98, 95% CI: 0.72-5.45). CONCLUSIONS ART sharing is common among persons reporting ART use in rural Uganda, particularly among men. Sharing ART was associated with viremia, and receiving ART may facilitate viral suppression. HIV programmes may benefit from considering ART sharing in counselling messages.
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Affiliation(s)
- Caitlin E. Kennedy
- Social and Behavioral Interventions ProgramDepartment of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Xinyi Feng
- Department of PathologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | - Joseph G. Rosen
- Social and Behavioral Interventions ProgramDepartment of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Joseph Ssekasanvu
- Department of EpidemiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | | | | | - Ping Teresa Yeh
- Social and Behavioral Interventions ProgramDepartment of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | | | - Thomas C. Quinn
- Division of Intramural ResearchNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Aaron A. R. Tobian
- Department of PathologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Rakai Health Sciences ProgramKalisizoUganda
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Maria J. Wawer
- Rakai Health Sciences ProgramKalisizoUganda
- Department of EpidemiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Steven J. Reynolds
- Division of Intramural ResearchNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthBethesdaMarylandUSA
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Larry W. Chang
- Social and Behavioral Interventions ProgramDepartment of International HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
- Rakai Health Sciences ProgramKalisizoUganda
- Department of EpidemiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Division of Infectious DiseasesDepartment of MedicineJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - M. Kate Grabowski
- Department of PathologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Rakai Health Sciences ProgramKalisizoUganda
- Department of EpidemiologyJohns Hopkins School of MedicineBaltimoreMarylandUSA
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Rock A, Comins C, Mulumba N, Young K, Mcingana M, Guddera V, Hausler H, Phetlhu R, Baral S, Schwartz S. Antiretroviral Treatment Sharing among Female sex Workers Living with HIV in eThekwini (Durban), South Africa: Drivers and Implications for Treatment Success. J Int Assoc Provid AIDS Care 2022; 21:23259582221110820. [PMID: 35786210 PMCID: PMC9263844 DOI: 10.1177/23259582221110820] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In South Africa, 62% of female sex workers (FSW) are estimated to be living with HIV. Qualitative research indicates that FSW share antiretroviral therapy (ART) with peers to surmount treatment barriers. We quantitatively described ART sharing, its correlates, and its relationship with viral suppression (VS) among FSW living with HIV in eThekwini, South Africa. Among FSW on ART (n = 890), 30% ever shared (gave and/or received) ART. Sharing ART was more likely among those with higher levels of alcohol use, illicit drug use, depression severity, and physical/sexual violence in the adjusted model. There was a positive, dose-response relationship between number of pills given to peers in the last 30 days and VS likelihood (aPR: 1.05, 95% CI: 1.02, 1.08; p < 0.01). Giving pills may strengthen peer relationships, which may facilitate ART adherence. ART distribution through peer networks holds promise as a context-appropriate intervention for improving ART adherence among FSW in this setting.
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Affiliation(s)
- Amelia Rock
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Carly Comins
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ntambue Mulumba
- Key Populations Programme, TB HIV Care, Durban, South Africa
| | | | | | | | | | - Rene Phetlhu
- TB HIV Care, Cape Town, South Africa.,School of Nursing, 108325University of the Western Cape, Cape Town, South Africa
| | - Stefan Baral
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sheree Schwartz
- Department of Epidemiology, 25802Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Recreational Use of HIV Antiretroviral Medication and Implications for HIV Pre-exposure Prophylaxis and Treatment. AIDS Behav 2020; 24:2650-2655. [PMID: 32140876 DOI: 10.1007/s10461-020-02821-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Diversion of antiretroviral therapy (ART) for recreational use is concerning for countries with high HIV prevalence. This paper presents reports of recreational use of ART among adolescents from two HIV prevention studies in South Africa: (1) a cross-sectional survey of N = 200 adolescents and (2) a qualitative study of pre-exposure prophylaxis with N = 57 adolescents and N = 25 clinicians. Among adolescents, 3% used and 14% knew someone who used non-prescribed ART for recreational purposes. Administration included smoking (71%), snorting (15%), injecting (15%), ingesting (15%), and inserting (3%). Participants predicted increased crime as recreational use of ART increased. Future studies should investigate prevalence, composition, and diversion of ART from HIV prevention and treatment.
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Escudero DJ, Bennett B, Suarez S, Darrow WW, Mayer KH, Seage GR. Progress and Challenges in "Getting to Zero" New HIV Infections in Miami, Florida. J Int Assoc Provid AIDS Care 2020; 18:2325958219852122. [PMID: 31131664 PMCID: PMC6573019 DOI: 10.1177/2325958219852122] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objectives: Miami has the highest rate of new HIV diagnoses in the United States. We examined the
early successes and challenges in fulfilling recommendations made by the Miami-Dade
County HIV/AIDS Getting to Zero Task Force, formed by local experts in 2016. Methods: We used a host of surveillance data, published empirical studies, public reports, and
unpublished data from partners of the Task Force to evaluate progress and challenges in
meeting the recommendations. Results: Improvements in prevention and care included routinized HIV testing in emergency
departments, moving the linkage-to-care benchmark from 90 to 30 days, increased viral
suppression, and awareness of pre-exposure prophylaxis. However, treatment enrollment,
viral suppression, and pre-exposure prophylaxis uptake remained low. Conclusions: Recommendations from the Task Force provide excellent guidance for implementing
evidence-based HIV prevention in Miami, yet success in achieving the recommendations
will require continued or increased support in many public health sectors in South
Florida.
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Affiliation(s)
- Daniel Javier Escudero
- Department of Epidemiology, Harvard T.H. Chan School of Public Health,
Boston, MA, USA
- Daniel J. Escudero, Department of Epidemiology,
Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
| | - Brady Bennett
- The Health Council of South Florida, Miami, FL, USAs
| | - Sarah Suarez
- Florida Department of Health in Miami-Dade County, Miami, FL, USA
| | - William Ward Darrow
- Department of Health Promotion and Disease Prevention, Robert Stempel
College of Public Health and Social Work, Florida International University, Miami, FL,
USA
| | - Kenneth Hugh Mayer
- The Fenway Institute, Boston, MA, USA
- Department of Global Health and Population, Harvard T.H. Chan School of
Public Health, Boston, MA, USA
| | - George Richard Seage
- Department of Epidemiology, Harvard T.H. Chan School of Public Health,
Boston, MA, USA
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Rosen JG, Nakyanjo N, Isabirye D, Wawer MJ, Nalugoda F, Reynolds SJ, Nakigozi G, Grabowski MK, Kennedy CE. Antiretroviral treatment sharing among highly mobile Ugandan fisherfolk living with HIV: a qualitative study. AIDS Care 2019; 32:912-915. [PMID: 31533449 DOI: 10.1080/09540121.2019.1668528] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Antiretroviral treatment (ART) diversion from prescribed to non-prescribed users (i.e., sharing or selling) is an understudied dimension of HIV treatment adherence. We sought to explore ART diversion patterns in high-prevalence fishing communities on Lake Victoria, Uganda. We implemented a qualitative study in two fishing communities on Lake Victoria in south-central Uganda to identify facilitators of and pathways to ART diversion. We conducted 25 semi-structured interviews with HIV-positive fishermen (n = 25) and female sex workers (n = 10) covering personal and community experiences with ART selling/sharing, reasons for medication diversion, and potential solutions to reduce diversion. Data were analyzed using an adapted framework analysis approach. Participants reported frequent ART sharing within occupational networks, but no selling. Mobility was the principal driver of ART sharing and was associated with other barriers to treatment access including stigma, fear of negative health provider interactions, and transportation. ART sharing appears to emerge in response to short-term treatment interruptions in this setting. Future studies should explore characteristics and drivers of ART diversion in other high-burden settings and identify how these practices are correlated with key health outcomes like virologic failure and drug resistance.
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Affiliation(s)
- Joseph G Rosen
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Neema Nakyanjo
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Dauda Isabirye
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Maria J Wawer
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Fred Nalugoda
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda
| | - Steven J Reynolds
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Gertrude Nakigozi
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda
| | - M Kathryn Grabowski
- Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Social and Behavioral Sciences, Rakai Health Sciences Program, Kalisizo, Uganda
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Representations of Pre-exposure Prophylaxis, Informal Antiretroviral Medication Use for HIV Prevention, and Diversion on Geosocial Networking Apps among Men Who Have Sex with Men. AIDS Behav 2019; 23:1790-1796. [PMID: 30255385 DOI: 10.1007/s10461-018-2281-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The use of geosocial networking applications (e.g., Grindr) among men who have sex with men (MSM) is common. Yet scant research has examined how antiretroviral medications (ARVs)-including informal use-diversion and pre-exposure prophylaxis (PrEP) are presented inside of the applications. The present study examines this phenomenon. Data are drawn from a qualitative study (N = 39) of the scope and magnitude of the informal market of ARV use for HIV prevention among MSM. Twenty-five participants reported seeing references to ARVs inside the applications. Men described geosocial networking application users' presentations of ARVs as being related to: PrEP use among HIV-negative MSM, the sale and/or use of illicit drugs (e.g., methamphetamine), informal trade/sale for HIV-prevention, and PrEP use among HIV-positive men. Findings suggest continued desire for and acceptability of PrEP as HIV prevention tool and that geosocial networking apps are being used to facilitate the exchange and informal use of ARVs for HIV-prevention. Geosocial networking applications represent a promising and important platform to educate MSM about safe and effective use of PrEP and the risks related to diversion and informal ARV use.
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Wu Y, Xie L, Meng S, Hou J, Fu R, Zheng H, He N, Meyers K. Mapping Potential Pre-Exposure Prophylaxis Users onto a Motivational Cascade: Identifying Targets to Prepare for Implementation in China. LGBT Health 2019; 6:250-260. [PMID: 31170020 DOI: 10.1089/lgbt.2018.0256] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose: China recently commenced several pre-exposure prophylaxis (PrEP) projects, but little work has characterized potential users. This study describes awareness of, intention to use, and uptake of PrEP in a sample of men who have sex with men (MSM), a key population experiencing high rates of HIV in China. Methods: Through a cross-sectional survey administered to 708 MSM in four cities, we mapped respondents onto a Motivational PrEP Cascade. We conducted bivariable and multivariable analysis to examine factors associated with progression through the Cascade. Results: Among 45.6% of MSM who were PrEP eligible, 36% were in Contemplation, 9% were in PrEParation, 2% were in PrEP Action and Initiation, and none reached Maintenance and Adherence. We found no association between individual risk factors and progression through the Cascade. In multivariable analysis, friends' positive attitudes toward PrEP, more frequent sexually transmitted infection testing, and higher scores on the perceived PrEP benefits scale were positively associated with entering PrEP Contemplation. Having higher condom use self-efficacy was associated with decreased odds of entering PrEP Contemplation. Having sex with men and women in the past 6 months, having heard of PrEP from medical providers, and knowing a PrEP user were positively associated with entering PrEParation. Conclusion: We found a high proportion of MSM who were PrEP eligible and identified several intervention targets to prepare for PrEP introduction in China: community education to increase accurate knowledge, gain-framed messaging for PrEP and sexual health, and provider trainings to build MSM-competent services that can support shared decision-making for PrEP initiation.
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Affiliation(s)
- Yumeng Wu
- 1 Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York
| | - Lu Xie
- 2 Institute of HIV/AIDS, The First Hospital of Changsha, Changsha, China
| | - Siyan Meng
- 3 School of Public Health, Fudan University, Shanghai, China
| | - Jianhua Hou
- 4 Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Rong Fu
- 5 Guangzhou Center for Disease Control and Prevention, Guangzhou, China
| | - Huang Zheng
- 6 Shanghai CSW & MSM Center, Shanghai, China
| | - Na He
- 3 School of Public Health, Fudan University, Shanghai, China
| | - Kathrine Meyers
- 1 Aaron Diamond AIDS Research Center, The Rockefeller University, New York, New York
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Informal PrEP: an emerging need for nomenclature. LANCET PUBLIC HEALTH 2018; 4:e83. [PMID: 30578132 DOI: 10.1016/s2468-2667(18)30254-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/26/2018] [Indexed: 11/24/2022]
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Palummieri A, De Carli G, Rosenthal É, Cacoub P, Mussini C, Puro V. Awareness, discussion and non-prescribed use of HIV pre-exposure prophylaxis among persons living with HIV/AIDS in Italy: a Nationwide, cross-sectional study among patients on antiretrovirals and their treating HIV physicians. BMC Infect Dis 2017; 17:734. [PMID: 29179700 PMCID: PMC5704632 DOI: 10.1186/s12879-017-2819-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 11/06/2017] [Indexed: 11/30/2022] Open
Abstract
Background Before Pre-Exposure Prophylaxis (PrEP) was officially recommended and made available, a few surveys among gay and bisexual men, and persons living with HIV/AIDS (PLWHA), identified an informal use of antiretrovirals (ARVs) for PrEP among HIV-negative individuals. Before PrEP availability in Italy, we aimed to assess whether PLWHA in Italy shared their ARVs with HIV-negative individuals, whether they knew people who were on PrEP, and describe the level of awareness and discussion on this preventive measure among them and people in their close circle. Methods Two anonymous questionnaires investigating personal characteristics and PrEP awareness, knowledge, and experience were proposed to HIV specialists and their patients on ARVs in a one-week, cross-sectional survey (December 2013–January 2014). Among PLWHA, a Multivariable Logistic Regression analysis was conducted to identify factors associated with PrEP discussion with peers (close circle and/or HIV associations), and experience (use in close circle and/or personal ARV sharing). Results Eighty-seven specialists in 31 representative Infectious Diseases departments administered the questionnaire to 1405 PLWHA. Among specialists, 98% reported awareness, 65% knew the dosage schedule, and 14% had previously suggested or prescribed PrEP. Among PLWHA, 45.6% were somehow aware, discussed or had direct or indirect experience of PrEP: 38% “had heard” of PrEP, 24% were aware of studies in HIV-negative individuals demonstrating a risk reduction through the use of ARVs, 22% had discussed PrEP, 12% with peers; 9% reported PrEP use in close circle and 1% personal ARV sharing. Factors predictive of either PrEP discussion with peers or experience differed between men and women, but across all genders were mainly related to having access to information, with HIV association membership being the strongest predictor. Conclusions At a time and place where there were neither official information nor proposals or interventions to guide public policies on PrEP in Italy, a significant number of PLWHA were aware of it, and approximately 10% reported PrEP use in their close circle, although they rarely shared their ARVs with uninfected people for this purpose. Official policies and PrEP availability, along with implementation programs, could avoid risks from uncontrolled PrEP procurement and self-administration practices. Electronic supplementary material The online version of this article (10.1186/s12879-017-2819-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Antonio Palummieri
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Department of Epidemiology, Pre-clinical Research and Advanced Diagnostics, via Portuense, 292, 00149, Roma, Italy
| | - Gabriella De Carli
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Department of Epidemiology, Pre-clinical Research and Advanced Diagnostics, via Portuense, 292, 00149, Roma, Italy.
| | - Éric Rosenthal
- Centre Hospitalier Universitaire de Nice, Service de Médecine Interne, F-06200, Nice, France
| | - Patrice Cacoub
- Sorbonne Universités, UPMC Univ Paris 06, UMR 7211, and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), F-75005, Paris, France.,INSERM, UMR_S 959, F-75013, Paris, France.,CNRS, FRE3632, F-75005, Paris, France.,AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Internal Medicine and Clinical Immunology, F-75013, Paris, France
| | - Cristina Mussini
- Università degli Studi di Modena e Reggio Emilia, Infectious Diseases Clinics, Modena, Italy
| | - Vincenzo Puro
- National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Department of Epidemiology, Pre-clinical Research and Advanced Diagnostics, via Portuense, 292, 00149, Roma, Italy
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