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Garcia C, Rehman N, Matos-Silva J, Deng J, Ghandour S, Huang Z, Mbuagbaw L. Interventions to Improve Adherence to Oral Pre-exposure Prophylaxis: A Systematic Review and Network Meta-analysis. AIDS Behav 2024; 28:2534-2546. [PMID: 38814406 DOI: 10.1007/s10461-024-04365-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/31/2024]
Abstract
For people at risk of HIV infection, pre-exposure prophylaxis (PrEP) can reduce the risk of infection in anticipation of exposure to HIV. The effectiveness of PrEP relies upon a user's adherence to their PrEP regimen. We sought to assess the effect of PrEP adherence interventions compared to usual care or another intervention for people at risk of HIV. We searched electronic databases from 2010 onwards for randomized controlled trials (RCTs) involving persons at risk of HIV randomized to an adherence promoting intervention vs usual care or another intervention. We used network meta-analyses to compare PrEP adherence for all participant populations. Certainty of evidence was assessed using Confidence in Network Meta-Analysis (CINeMA). 21 trials (N = 4917) were included in qualitative analysis (19 in network meta-analyses (N = 4101)). HIV self-testing interventions with adherence feedback elements improved adherence compared to usual care (risk ratio (RR): 1.83, 95%CI 1.19, 2.82). In contrast, HIV self-testing alone was inferior to HIV self-testing with adherence feedback (RR: 0.58, 95%CI 0.37-0.92). Reminders alone also were inferior to HIV self-testing with adherence feedback on adherence (RR: 0.53, 95%CI 0.34-0.84) and had similar effects on adherence as usual care (RR: 0.98, 95%CI: 0.86-1.11). Interventions with only one component were inferior for adherence than those with two components (RR: 0.74, 95%CI 0.62-0.88) and those with three components (RR: 0.78, 95%CI 0.65-0.93). The certainty of evidence was moderate for HIV self-testing plus adherence feedback and interventions with two or three components. When designing future PrEP adherence interventions, we recommend strategies with more than one but no more than three components.
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Affiliation(s)
- Cristian Garcia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Nadia Rehman
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jéssyca Matos-Silva
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Jiawen Deng
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sara Ghandour
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zhongyu Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Krajewski T, LeMasters KH, Oser CB, Brinkley-Rubinstein L. Perceived versus actual HIV risk among PrEP indicated persons with criminal legal involvement. AIDS Care 2024:1-10. [PMID: 39088545 DOI: 10.1080/09540121.2024.2383873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 07/18/2024] [Indexed: 08/03/2024]
Abstract
Individuals involved with community supervision experience multi-level obstacles impacting health outcomes. This is a high-risk period for HIV acquisition due to potential reengagement in unprotected sex and/or unsafe injection drug practices. This study aimed to assess the congruence between actual and perceived HIV risk and the degree to which individual, social, and behavioral factors impact risk perception among individuals on community supervision. While all participants were clinically indicated for PrEP, most participants (81.5%) did not consider themselves at risk for HIV (69.5%) or were not sure of their risk (12.0%). Among those with no or unsure perceived risk, 94% engaged in sexual behaviors that put them at-risk of HIV. Perceived HIV risk was associated with sharing injection equipment (aPR = 1.8, 95% CI [1.02, 3.3]), identifying as a sexual minority (aPR = 2.3, 95% CI [1.3, 3.9]), and having sex with a partner living with HIV (aPR = 2.4, 95% CI [1.3, 4.3]). Having sex with a partner living with HIV was the only sexual risk behavior associated with a perceived risk of HIV. These findings indicate a substantial discrepancy between actual and perceived HIV risk, highlighting the need for targeted interventions to improve risk perception accuracy and enhance risk prevention among individuals on community supervision.
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Affiliation(s)
- Taylor Krajewski
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Center for AIDS Research, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine H LeMasters
- Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carrie B Oser
- Department of Sociology, Center on Drug & Alcohol Research, Center for Health Equity Transformation, University of Kentucky, Lexington, KY, USA
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Nijhawan AE, Pulitzer Z, Torres B, Noreen N, Schultheis A, Frank C, Colon R, Brooks R, Proffitt R, Pankow J, Bennett A, Salyards M, Kuo I, Knight K, Springer SA. HIV Risk and Interest in Preexposure Prophylaxis in Justice-Involved Persons. Emerg Infect Dis 2024; 30:S68-S74. [PMID: 38561803 PMCID: PMC10986824 DOI: 10.3201/eid3013.230739] [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] [Indexed: 04/04/2024] Open
Abstract
Preexposure prophylaxis (PrEP) is underused in persons who use drugs and justice-involved persons. In an ongoing randomized controlled trial in 4 US locations comparing patient navigation versus mobile health unit on time to initiation of HIV medication or PrEP for justice-involved persons who use stimulants or opioids and who are at risk for or living with HIV, we assessed HIV risk factors, perceived HIV risk, and interest in PrEP. Participants without HIV (n = 195) were 77% men, 65% White, 23% Black, and 26% Hispanic; 73% reported a recent history of condomless sex, mainly with partners of unknown HIV status. Of 34% (67/195) reporting injection drug use, 43% reported sharing equipment. Despite risk factors, many persons reported their risk for acquiring HIV as low (47%) or no (43%) risk, although 51/93 (55%) with PrEP indications reported interest in PrEP. Justice-involved persons who use drugs underestimated their HIV risk and might benefit from increased PrEP education efforts.
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Desai J, Krakower D, Harris BL, Culp S, Nijhawan AE. HIV/Sexually Transmitted Infection Screening and Eligibility for HIV Preexposure Prophylaxis Among Women Incarcerated in an Urban County Jail. Sex Transm Dis 2023; 50:675-679. [PMID: 37699368 PMCID: PMC10503027 DOI: 10.1097/olq.0000000000001852] [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: 09/14/2023]
Abstract
BACKGROUND Incarcerated women experience high rates of HIV and sexually transmitted infections (STIs); few are offered HIV preexposure prophylaxis (PrEP). We aimed to examine HIV/STI screening rates in this population and identify PrEP eligibility. METHODS Results of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) urine and HIV/syphilis screening in cisgender women in the Dallas County Jail were compiled from January to October 2020. An electronic health record review was conducted for a subgroup in March 2020 to identify PrEP eligibility. RESULTS Overall, 4398 of 13,292 women were screened for CT and 4389 of 13,292 for GC, and among them, 479 (11%) screened for HIV and 562 (13%) for syphilis. Furthermore, 462 of 4398 (11%) were positive for CT, 323 of 4389 (7%) were positive for GC, 10 of 479 (2%) had positive HIV test results, of whom 6 (1.3%) were new diagnoses and 75 (13%) had a reactive rapid plasma reagin test. In March 2020, of 541 women screened, 90 tested positive for CT or GC. Of these 90, 70 (78%) did not receive HIV or syphilis screening, including women with these risk factors: 10 (14%) were homeless, 11 (16%) reported heroin use, and 10 (14%) reported methamphetamine use. Based on the presence of an acute bacterial STI, 17% (96 of 541) were PrEP eligible. CONCLUSIONS Incarcerated women had high STI rates and other risk factors for HIV acquisition, although only 1 in 5 with acute STIs (11% overall) was also screened for HIV or syphilis. HIV prevention efforts should include comprehensive STI/HIV screening, linkage to treatment, and identification of PrEP candidates.
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Affiliation(s)
- Jui Desai
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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Yellin H, Levy ME, Magnus M, Kuo I, Siegel M. HIV Risk Perception, Willingness to Use PrEP, and PrEP Uptake Among Young Men who have Sex with Men in Washington, DC. AIDS Behav 2023; 27:2844-2854. [PMID: 36807246 PMCID: PMC10439971 DOI: 10.1007/s10461-023-04008-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
Low HIV risk perception is a barrier to PrEP uptake, but few studies have examined risk perception and PrEP uptake among young men who have sex with men (YMSM). We performed a secondary analysis of data collected in 2016 from YMSM ages 16-25 in the Washington, DC metropolitan area who participated in a cross-sectional online survey that aimed to identify strategies for engaging YMSM in PrEP services. Of 188 participants, 115 (61%) were considered eligible for PrEP. Among PrEP-eligible participants who had never used PrEP, 53%, 71%, and 100% with low, moderate, and high risk perception, respectively, were willing to use PrEP (Fisher's exact test p = 0.01). Odds of PrEP willingness were greater among those with moderate/high versus low risk perception (adjusted odds ratio [OR] = 5.62, 95% CI = 1.73-18.34). HIV risk perception was not significantly associated with self-reported PrEP use. These findings suggest the importance of risk perception as a correlate of willingness to use PrEP, which is a key step in existing frameworks of PrEP uptake.
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Affiliation(s)
- Hannah Yellin
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, 20037, Washington, DC, USA.
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA.
| | - Matthew E Levy
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, 20037, Washington, DC, USA
| | - Manya Magnus
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, 20037, Washington, DC, USA
| | - Irene Kuo
- Department of Epidemiology, George Washington University Milken Institute School of Public Health, 950 New Hampshire Ave NW, 20037, Washington, DC, USA
| | - Marc Siegel
- Division of Infectious Disease, Department of Medicine, Medical Faculty Associates, George Washington University, Washington, DC, USA
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Knittel AK, Jackson JB, Swartzwelder RA, Ferguson EG, Hulshult H, Adimora AA. PrEP and HIV prevention decision-making among social network members of women who have experienced incarceration: a qualitative study. AIDS Care 2023; 35:1375-1385. [PMID: 36912643 PMCID: PMC10363199 DOI: 10.1080/09540121.2023.2182872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/14/2023] [Indexed: 03/14/2023]
Abstract
ABSTRACTIncarceration and HIV are a syndemic for US women, yet very few women who have experienced incarceration use pre-exposure prophylaxis (PrEP) for HIV. We conducted semi-structured interviews with 32 participants recruited by women who have experienced incarceration from their social networks, informed by the modified social ecological model for PrEP. Emergent themes from the interviews included individual-level (low personal HIV risk assessment, personal responsibility for HIV prevention, and decisions in addiction versus recovery), network-level (influential sex partners and the importance of trust, supportive treatment peers, and high-risk but indifferent drug use networks), community-level (stigma, and mitigation of stigma in supportive substance use disorder treatment environments), and public policy-level (incarceration and PrEP cost and access) determinants. PrEP interventions for women who have experienced incarceration and their networks will need to incorporate contingency planning into HIV risk assessment, navigate complex network dynamics, and be situated in trusted contexts to address structural barriers.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Jamie B. Jackson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Rita A. Swartzwelder
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill NC USA
| | - Ella G. Ferguson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Hannah Hulshult
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill NC USA
| | - Ada A. Adimora
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, NC, USA
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Dauria E, Rodriguez C, Bauerle Bass S, Tolou-Shams M, Christopoulos K. Implementation strategies to screen, refer and link women involved in the carceral system to PrEP for HIV prevention. Int J Prison Health 2023; 19:10.1108/IJPH-06-2022-0037. [PMID: 37113046 PMCID: PMC11058187 DOI: 10.1108/ijph-06-2022-0037] [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: 04/29/2023]
Abstract
PURPOSE Women involved in the carceral system (CS) experience several conditions that increase their risk for HIV (e.g. high rates of substance use, psychiatric disorders, histories of victimization). The purpose of this study is to explore perspectives on potential strategies to connect women in the CS to pre-exposure prophylaxis (PrEP) services. DESIGN/METHODOLOGY/APPROACH This study conducted in-depth interviews with 27 women involved in the CS eligible for PrEP. Using vignettes, interviews explored attitudes, barriers and facilitators toward PrEP screening, referral and linkage facilitated via a CS stakeholder, an mHealth application or providing PrEP service referrals during detention via a navigator. FINDINGS Most women were, on average, 41.3 years, from racial and ethnic minority groups (56% black/African American; 19% Latinx). Inductive thematic analysis revealed CS involved women expressed mostly positive attitudes toward CS-based PrEP implementation. Younger women were more accepting of and interested in mHealth interventions. Implementation facilitators included leveraging relationships with trusted allies (e.g. "peers") and existing systems collaborations. Recommended implementation strategies included providing HIV and PrEP-specific education and training for system stakeholders and addressing issues related to privacy, system mistrust and stigma. ORIGINALITY/VALUE Results provide a critical foundation for the implementation of interventions to improve PrEP access for women involved in the CS and have important implications for implementation strategies for all adults involved in the CS. Improving access to PrEP among this population may also support progress toward addressing national disparities in PrEP uptake, where women, black and Latinx populations have substantial unmet need.
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Affiliation(s)
- Emily Dauria
- Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sarah Bauerle Bass
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Katerina Christopoulos
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Baker O, Wellington C, Price CR, Tracey D, Powell L, Loffredo S, Moscariello S, Meyer JP. Experience delivering an integrated service model to people with criminal justice system involvement and housing insecurity. BMC Public Health 2023; 23:222. [PMID: 36732685 PMCID: PMC9892679 DOI: 10.1186/s12889-023-15108-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 01/20/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND People returning to communities from prison or jail face stressors related to securing housing, including discrimination, restrictions based on prior felony convictions, and limited economic and social resources. Existing housing programs can effectively reduce housing instability but often do not fully address the needs of people involved in the criminal justice system experiencing homelessness who often have co-occurring chronic medical issues, and psychiatric and substance use disorders. METHODS Project CHANGE is an ongoing program to deliver person-centered, integrated care and services to individuals involved with the criminal justice system and experiencing homelessness. Applying a Screening, Brief Intervention, (Referral to) Treatment framework, a comprehensive needs assessment is followed by delivery of intensive housing and vocational case management; and psychiatric, substance use, and medical services in a single location by an interdisciplinary team. Participants are followed with study interviews for 12 months. The current analysis was designed to assess the baseline characteristics and needs of the sample population, and the intensity of contact required for integrated service delivery. RESULTS Between November 2019 and September 2021, 86 participants were enrolled, of whom 64% had been released from prison/jail in the past 6 months; the remainder were on parole, probation, or intensive pretrial supervision. Participants were unstably housed (64%) or residing outdoors (26.7%) or in a shelter (24.4%). Most participants had high medical need and frequent healthcare engagement through outpatient and emergency department visits. Most participants were at-risk for clinical depression, and half were diagnosed with anxiety, dissociative, stress-related, somatoform, and other non-psychotic psychiatric disorders. Over 12-month follow-up, the interdisciplinary team made over 500 contact encounters, over half of which resulted in direct services provided, including obtaining vital documents for homelessness verification, housing applications, and employment coaching. CONCLUSION Navigation of services can be particularly challenging for individuals experiencing criminal justice involvement, homelessness, and co-occurring medical, psychiatric, and substance use issues, which can be addressed holistically in an integrated service model. Integrated service delivery was time-, resource-, and staffing-intensive, and challenged by the COVID-19 pandemic, requiring innovative solutions to sustain participant engagement.
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Affiliation(s)
- Olivia Baker
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | | | - Carolina R Price
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - DeShana Tracey
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Lindsay Powell
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
- Yale School of Nursing, New Haven, CT, USA
| | | | | | - Jaimie P Meyer
- Yale School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, USA.
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Lindsay B, Nyirongo N, Mwango L, Toeque MG, Masumba C, Litongola JP, Sikanyika J, Kabombo H, Moyo M, Siachibila S, Mudenda J, Tembo K, Olowski P, Olufunso A, Muchinda E, Musonda B, Okuku J, Mwila A, Moonga CN, Herce ME, Claassen CW. Initial implementation of HIV pre-exposure prophylaxis for people who are incarcerated in Zambia: a cross-sectional observational study. Lancet HIV 2023; 10:e24-e32. [PMID: 36243018 DOI: 10.1016/s2352-3018(22)00220-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND There are over 23 000 incarcerated people in Zambia, a population which has higher HIV prevalence than the general population yet has no access to HIV prevention. To evaluate the feasibility of HIV pre-exposure prophylaxis (PrEP) implementation in Zambian criminal justice facilities, we offered PrEP services to incarcerated people and aimed to describe early implementation outcomes. METHODS In this cross-sectional observational study, we implemented a PrEP programme between Oct 1, 2020, and March 31, 2021, supporting 16 criminal justice facilities in four Zambian provinces. Before implementation, we held stakeholder engagement meetings with Zambia Correctional Service officials to discuss PrEP benefits, and trained Zambia Correctional Service health-care workers in PrEP management using the national PrEP training package. People who were incarcerated and screened positive for substantial HIV risk by use of a standardised HIV risk assessment tool were offered voluntary HIV testing and counselling. Those who tested positive were linked to antiretroviral therapy, and those who tested negative and met national HIV prevention eligibility criteria were offered PrEP. We assessed PrEP uptake and used descriptive statistics to characterise programme beneficiaries and the cascade of PrEP services. FINDINGS During the study period, we reached 12 367 people older than 15 years with HIV risk assessment and counselling, including 11 794 (95·4%) men and 573 (4·6%) women. Of these, 2610 people received HIV testing, with 357 (13·7%) testing HIV positive; positivity was significantly higher in women (20·6%) than men (13·2%, p=0·011). 1276 people were identified as HIV negative and PrEP eligible. Of these, 1190 (93·3%) initiated PrEP. The age group with the highest proportion reached and initiated on PrEP was those aged 25-29 years, representing 19·2% (2377 of 12 367) of all people reached and 24·1% (287 of 1190) of those who initiated PrEP. INTERPRETATION Delivery of PrEP to people who are incarcerated is feasible with adequate resourcing and support to the criminal justice health system, and can result in high uptake among eligible individuals. Further assessment is needed of PrEP persistence and adherence, and the perceptions of people who are incarcerated regarding their HIV risk and preferences for combination HIV prevention services. FUNDING US President's Emergency Plan for AIDS Relief through the US Centers for Disease Control and Prevention.
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Affiliation(s)
- Brianna Lindsay
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Nasho Nyirongo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | - Mona Gekanju Toeque
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | | | | | | | | | - Kalima Tembo
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | - Pawel Olowski
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia
| | | | | | - Bupe Musonda
- Department of Public Health, Ministry of Health, Lusaka, Zambia
| | - Jackson Okuku
- US Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Annie Mwila
- US Centers for Disease Control and Prevention, Lusaka, Zambia
| | - Clement N Moonga
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia; Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
| | - Cassidy W Claassen
- Maryland Global Initiatives Corporation Zambia, Lusaka, Zambia; Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, USA
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Chimoyi L, Charalambous S. The case for pre-exposure prophylaxis in prison settings. Lancet HIV 2023; 10:e3-e4. [PMID: 36243017 DOI: 10.1016/s2352-3018(22)00258-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 09/06/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Lucy Chimoyi
- The Aurum Institute, Parktown, Johannesburg, South Africa 2193; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Salome Charalambous
- The Aurum Institute, Parktown, Johannesburg, South Africa 2193; School of Public Health, University of the Witwatersrand, Johannesburg, South Africa; Yale School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA.
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11
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Knittel AK, Ferguson EG, Jackson JB, Adimora AA. The influence of social relationships on PrEP attitudes among women with incarceration experience in the Southeastern USA. CULTURE, HEALTH & SEXUALITY 2023; 25:110-125. [PMID: 35015606 PMCID: PMC9271531 DOI: 10.1080/13691058.2021.2023760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
Women who have experienced incarceration face a disproportionately high risk of acquiring HIV. Despite efficacy of pre-exposure prophylaxis (PrEP) for HIV, very few women with incarceration histories are using PrEP. Our objective was to learn how sexual, drug-use and social relationships shape decisions about PrEP among women who have experienced incarceration. We used an inductive approach to analyse data from four focus groups undertaken with women who had previously experienced incarceration recruited from three community-based organisations. We identified public policy (medical distrust, lack of prevention in prisons and jails, and cost and coverage of PrEP); community (incarceration stigma, gossip as prevention); social and sexual network (positive peer and parenting relationships, distrust of sexual partners, and networks as a source of risk); and individual-level (active addiction or recovery, change after incarceration, and medical concerns) factors influencing the use of PrEP. Actions and interventions to improve PrEP uptake among women who have experienced incarceration must take account of the multilevel context of HIV prevention decisions.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Ella G. Ferguson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Jamie B. Jackson
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Adaora A. Adimora
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Diagnosis, Treatment, and Prevention of HIV Infection among Detainees: A Review of the Literature. Healthcare (Basel) 2022; 10:healthcare10122380. [PMID: 36553904 PMCID: PMC9777892 DOI: 10.3390/healthcare10122380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
Detainees are one of the most vulnerable populations to human immunodeficiency virus (HIV). This is mostly caused by the lack of knowledge on the topic among the inmates; the lack of prophylaxis; the high percentage of risky behaviors in jail, such as sexual abuse, unprotected sexual intercourses, and injective drug use; and the generally low perception of the risk of transmission. It has also been observed that the problem does not cease to exist at the moment of release, but it also may be aggravated by the weak support system or the total absence of programs for people living with HIV/AIDS (PLWHA) to avoid discontinuation of antiretroviral drugs. Difficulty in providing housing and jobs and, therefore, a form of stability for ex-detainees, also contributes to none adherence to antiretroviral therapy. Among the detainees, there are also categories of people more susceptible to discrimination and violence and, therefore, to risky behaviors, such as black people, Hispanics, transgender people, and men who have sex with men (MSM). We reviewed the literature in order to provide a more complete picture on the situation of PLWHA in jail and to also analyze the difficulties of ex-detainees in adhering to HIV therapy.
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Allen DC, Rabionet SE, Popovici I, Zorrilla CD. Acknowledging and addressing the gender disparity in pre-exposure prophylaxis use for HIV prevention. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2022; 13:168-171. [PMID: 36247367 PMCID: PMC9547494 DOI: 10.1093/jphsr/rmac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/27/2022] [Indexed: 07/20/2023]
Abstract
Objective One in four persons living with HIV in the USA is a woman. While the annual HIV diagnoses for 2019 decreased by approximately 9% when compared with 2015, this decrease was seen in men, while the rates remained stable for women. Pre-exposure prophylaxis (PrEP) is one major biomedical tool that could benefit women at risk of HIV. However, women only account for approximately 5% of PrEP users annually. The objective of this study is to identify and address the gender disparity in PrEP use. Methods This study used epidemiological data from the AIDSVu database to confirm the presence of a gender disparity in PrEP use across the USA. Cross-sectional data from 2019 showed that PrEP use was significantly higher in men, which suggested the existence of a disparity. The PrEP-to-Need ratio was then used to examine the trends in PrEP use relative to the rate of HIV infections, from 2012 to 2019, and to confirm the existence of the gender disparity in PrEP use. Key findings There is a marked gender disparity in PrEP use. This disparity is widening and therefore demands more attention to women at risk of HIV. Some recommendations for addressing the disparity include the following: raising awareness, capacity building for providers, scaling up efforts to better reach women at risk of HIV and additional research to understand the drivers of the disparity. Conclusions Policy makers could therefore prioritize the health outcomes of women by promoting research and education aimed at extending PrEP offerings to effectively reach women.
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Affiliation(s)
- Dion C Allen
- Correspondence: Dion C. Allen, Sociobehavioral and Administrative Pharmacy, Nova Southeastern University College of Pharmacy, 3200 S University Dr, Davie, FL 33328, USA. Tel: 954-262-1095;
| | - Silvia E Rabionet
- Sociobehavioral and Administrative Pharmacy, Nova Southeastern University College of Pharmacy, Davie, FL, USA
| | - Ioana Popovici
- Sociobehavioral and Administrative Pharmacy, Nova Southeastern University College of Pharmacy, Davie, FL, USA
| | - Carmen D Zorrilla
- Obstetrics and Gynecology, Maternal-Infant Studies Center, University of Puerto Rico School of Medicine, Medical Sciences Campus, San Juan, Puerto Rico
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14
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Meyer JP, Price CR, Ye Y, Qin Y, Tracey D, Demidont AC, Melbourne K, Altice FL. A PrEP Demonstration Project Using eHealth and Community Outreach to Justice-Involved Cisgender Women and Their Risk Networks. AIDS Behav 2022; 26:3807-3817. [PMID: 35672552 DOI: 10.1007/s10461-022-03709-2] [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: 05/05/2022] [Indexed: 11/26/2022]
Abstract
Women involved in criminal justice systems (WICJ) are a key population at risk for HIV, and pre-exposure prophylaxis (PrEP) is critical for HIV prevention. This project was designed to evaluate the feasibility and acceptability of delivering PrEP via eHealth to WICJ and members of their risk network (RN). We recruited HIV-negative cisgender WICJ index participants (n = 38) and risk network (RN) members (n = 67) using modified respondent-driven sampling. TDF/FTC was initiated for PrEP in participants meeting clinical criteria and dispensed through eHealth using a community-based, low barrier-to-care outreach model. Key steps in the PrEP care continuum were measured over 12 months. Enrolled participants (n = 105) had high current and lifetime justice-involvement and were predominantly cisgender women and non-Hispanic white with a mean age of 40.9y (SD 9.6). Despite most having primary care providers and medical insurance, PrEP awareness was low, and participants experienced high levels of medical, psychiatric, substance use, social, and economic need. Fifty-two participants (50%) were PrEP-eligible, of whom 24 (46%) initiated PrEP. TDF/FTC was safe and well-tolerated throughout follow-up and 13 individuals chose to remain on PrEP following study conclusion. In this novel PrEP demonstration project for WICJ and RN members, despite high medical, psychiatric, and social comorbidity, PrEP was positively received and effectively delivered using a community outreach model via eHealth.Registered on clinicaltrials.gov under trial registration number NCT03293290.
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Affiliation(s)
- Jaimie P Meyer
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States.
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, United States.
| | - Carolina R Price
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
| | - Yiwen Ye
- Yale School of Public Health, Chronic Disease Epidemiology, New Haven, CT, United States
| | - Yilu Qin
- Primary Care Program, Yale New Haven Health, HIV Training Track, New Haven, CT, United States
| | - DeShana Tracey
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
| | - A C Demidont
- Gilead Sciences, Inc, Foster City, CA, United States
| | | | - Frederick L Altice
- Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, 06510, New Haven, CT, United States
- Yale School of Public Health, Epidemiology of Microbial Diseases, New Haven, CT, United States
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15
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Study protocol of a randomized controlled trial comparing two linkage models for HIV prevention and treatment in justice-involved persons. BMC Infect Dis 2022; 22:380. [PMID: 35428213 PMCID: PMC9013109 DOI: 10.1186/s12879-022-07354-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Persons involved in the justice system are at high risk for HIV and drug overdose upon release to the community. This manuscript describes a randomized controlled trial of two evidence-based linkage interventions for provision of HIV prevention and treatment and substance use disorder (SUD) services in four high risk communities to assess which is more effective at addressing these needs upon reentry to the community from the justice system. Methods This is a 5-year hybrid type 1 effectiveness-implementation randomized controlled trial that compares two models (Patient Navigation [PN] or Mobile Health Unit [MHU] service delivery) of linking justice-involved individuals to the continuum of community-based HIV and SUD prevention and treatment service cascades of care. A total of 864 justice-involved individuals in four US communities with pre-arrest histories of opioid and/or stimulant use who are living with or at-risk of HIV will be randomized to receive either: (a) PN, wherein patient navigators will link study participants to community-based service providers; or (b) services delivered via an MHU, wherein study participants will be provided integrated HIV prevention/ treatment services and SUD services. The six-month post-release intervention will focus on access to pre-exposure prophylaxis (PrEP) for those without HIV and antiretroviral treatment (ART) for people living with HIV (PLH). Secondary outcomes will examine the continuum of PrEP and HIV care, including: HIV viral load, PrEP/ ART adherence; HIV risk behaviors; HCV testing and linkage to treatment; and sexually transmitted infection incidence and treatment. Additionally, opioid and other substance use disorder diagnoses, prescription, receipt, and retention on medication for opioid use disorder; opioid and stimulant use; and overdose will also be assessed. Primary implementation outcomes include feasibility, acceptability, sustainability, and costs required to implement and sustain the approaches as well as to scale-up in additional communities. Discussion Results from this project will help inform future methods of delivery of prevention, testing, and treatment of HIV, HCV, substance use disorders (particularly for opioids and stimulants), and sexually transmitted infections for justice-involved individuals in the community. Trial registration: Clincialtrials.gov NCT05286879 March 18, 2022.
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16
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Preexposure Prophylaxis Acceptability Among Pregnant Individuals and Implications for Human Immunodeficiency Virus Prevention. Obstet Gynecol 2022; 139:537-544. [DOI: 10.1097/aog.0000000000004709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
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17
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Knittel AK, Rudolph JE, Shook-Sa BE, Edmonds A, Ramirez C, Cohen M, Taylor T, Adedimeji A, Michel KG, Milam J, Cohen J, Donohue JD, Foster A, Fischl MA, Long DM, Adimora AA. Self-Reported Sexually Transmitted Infections After Incarceration in Women with or at Risk for HIV in the United States, 2007-2017. J Womens Health (Larchmt) 2022; 31:382-390. [PMID: 34967695 PMCID: PMC8972014 DOI: 10.1089/jwh.2021.0215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background: U.S. women who have been incarcerated report high rates of sexual risk behavior and sexually transmitted infections (STIs). Materials and Methods: We estimated the effect of incarceration on the time to first incident STI in a multicenter cohort of U.S. women with or at risk for HIV. We used marginal structural models to compare time to first self-reported gonorrhea, chlamydia, or trichomonas infection for nonincarcerated women and incarcerated women. Covariates included demographic factors, HIV status, sex exchange, drug/alcohol use, and prior incarceration. Results: Three thousand hundred twenty-four women contributed a median of 4 at-risk years and experienced 213 first incident STI events. The crude incidence of STIs was 3.7 per 100 person-years for incarcerated women and 1.9 per 100 person-years for nonincarcerated women. The weighted hazard ratio for incident STIs was 4.05 (95% confidence interval: 1.61-10.19). Conclusion: Women with or at risk for HIV in the United States who have recently experienced incarceration may be at increased STI risk.
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Affiliation(s)
- Andrea K Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Jacqueline E Rudolph
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Bonnie E Shook-Sa
- Department of Biostatistics, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. USA
| | | | - Tonya Taylor
- Division of Infectious Disease, College of Medicine at SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Katherine G Michel
- Department of Infectious Diseases, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Cohen
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jessica D Donohue
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Antonina Foster
- Division of Infectious Disease, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Margaret A Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Dustin M Long
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Adaora A Adimora
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina. USA
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18
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Thorpe S, Hargons CN, Tanner AE, Stevens-Watkins D. Perceived HIV Invulnerability and PrEP Knowledge and Attitudes among Black Sexual Minority Women. AMERICAN JOURNAL OF SEXUALITY EDUCATION 2022; 17:400-413. [PMID: 37346321 PMCID: PMC10284562 DOI: 10.1080/15546128.2022.2035291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Black women have disproportionate rates of HIV compared to women of all other racial groups. The purpose of this analysis was to investigate perceived HIV risk, HIV and STI testing behaviors, and PrEP knowledge and attitudes among Black sexual minority women (SMW) and examine differences based on their history of male sex partners. Secondary data analysis was conducted using data from the Generations Study. This analysis used a sample of N=149 participants who identified as Black cisgender women. Results showed Black SMW with a history of male sex partners reported a higher perceived risk of contracting HIV and significantly more frequent HIV and STI testing than those without a history of male sex partners. Overall, most of the sample was not familiar with PrEP, but one-third had favorable attitudes towards it, and half felt like they did not know enough about PrEP to form an opinion. Implications for culturally relevant public health campaigns and comprehensive sexuality education that integrate PrEP are included.
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Affiliation(s)
- Shemeka Thorpe
- University of Kentucky, Department of Educational, School, and Counseling Psychology
| | - Candice N. Hargons
- University of Kentucky, Department of Educational, School, and Counseling Psychology
| | - Amanda E. Tanner
- University of North Carolina-Greensboro, Department of Public Health Education
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19
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Hoff E, Rutledge R, Gibson BA, Price CR, Gallagher C, Maurer K, Meyer JP. Preexposure Prophylaxis for Women Across the Criminal Justice System: Implications for Policy and Practice. JOURNAL OF CORRECTIONAL HEALTH CARE 2022; 28:22-31. [PMID: 34762498 PMCID: PMC8825570 DOI: 10.1089/jchc.19.11.0082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Data that inform preexposure prophylaxis (PrEP) implementation for women involved in criminal justice (WICJ) systems are scarce. In a survey of PrEP attitudes, acceptability, and barriers across the criminal justice system, incarcerated women (n = 48) were more likely than WICJ on probation (n = 125) to be eligible for PrEP (29% vs. 15%; p = .04) and willing to take PrEP if offered (94% vs. 78%; p = .01). In multivariate models, PrEP eligibility directly correlated with being incarcerated (adjusted odds ratio [aOR] 4.81, 95% confidence interval [CI] 1.76-13.1) and inversely correlated with Hispanic/Latina ethnicity (aOR 0.31; 95% CI 0.10-0.96). Recent partner violence exposure was associated with PrEP eligibility (aOR 3.29; 95% CI 1.54-7.02) and discordant risk perception (aOR 2.36; 95% CI 1.18-4.70). Findings demonstrate high potential for PrEP for all WICJ, though implementation efforts will need to address partner violence.
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Affiliation(s)
- Emily Hoff
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas, USA
| | - Ronnye Rutledge
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA.,Department of Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Britton A. Gibson
- Frank H. Netter MD School of Medicine, Quinnipiac University, Hamden, Connecticut, USA
| | | | - Colleen Gallagher
- Health and Addiction Services Quality Improvement Program, Connecticut Department of Correction, Wethersfield, Connecticut, USA
| | - Kathleen Maurer
- Health and Addiction Services Quality Improvement Program, Connecticut Department of Correction, Wethersfield, Connecticut, USA
| | - Jaimie P. Meyer
- AIDS Program, Yale School of Medicine, New Haven, Connecticut, USA.,*Address correspondence to: Jaimie P. Meyer, MD, AIDS Program, Yale School of Medicine, 135 College Street, Suite 323 New Haven, CT 06510, USA.
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20
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Wurcel AG, Chen G, Zubiago JA, Reyes J, Nowotny KM. Heterogeneity in Jail Nursing Medical Intake Forms: A Content Analysis. JOURNAL OF CORRECTIONAL HEALTH CARE 2021; 27:265-271. [PMID: 34724807 DOI: 10.1089/jchc.20.04.0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Despite high prevalence of infectious diseases and substance use disorders in jails, there are limited guidelines for the nursing intake process in this setting. We performed a content analysis of nursing intake forms used at each of the 14 Massachusetts county jails, focusing on infectious disease and substance use disorder. Only 85% of jails offered HIV testing during nursing intake and 50% of jails offered hepatitis C testing. Preventive interventions such as vaccines or pre-exposure prophylaxis therapy were infrequently offered during nursing intake. Screening for substance use disorder was present on the majority of intake forms, but only 23% of intake forms inquired about ongoing medication-assisted treatment for opioid use disorder. The results reflect heterogeneity in nursing intake forms, highlighting missed opportunities for public health interventions.
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Affiliation(s)
- Alysse G Wurcel
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA.,Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Gang Chen
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Julia A Zubiago
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
| | - Jessica Reyes
- Department of Medicine, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts, USA
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21
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Miller SJ, Harrison SE, Sanasi-Bhola K. A Scoping Review Investigating Relationships between Depression, Anxiety, and the PrEP Care Continuum in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111431. [PMID: 34769945 PMCID: PMC8583073 DOI: 10.3390/ijerph182111431] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/25/2021] [Accepted: 10/26/2021] [Indexed: 01/04/2023]
Abstract
Men who have sex with men and transgender women in the United States are at increased risk for HIV and may benefit from pre-exposure prophylaxis (PrEP), a once-a-day pill to prevent HIV. Due to stigma and discrimination, sexual and gender minority (SGM) populations are also at risk for depression and anxiety. This scoping review sought to identify literature addressing relationships between the PrEP care continuum, depression, and anxiety among SGM individuals and others at high risk for HIV. We conducted a systematic review of four databases (i.e., PubMed, PsycInfo, Web of Science, Google Scholar) and identified 692 unique articles that were screened for inclusion criteria, with 51 articles meeting the final inclusion criteria. Data were extracted for key study criteria (e.g., geographic location, participant demographics, study design, main findings). Results suggest that while depression and anxiety are not associated with PrEP awareness or willingness to use, they can be barriers to seeking care and to PrEP adherence. However, empirical studies show that taking PrEP is associated with reductions in anxiety. Findings suggest the need to implement mental health screenings in PrEP clinical care. In addition, addressing systemic and structural issues that contribute to mental health disorders, as well as PrEP-related barriers, is critical.
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Affiliation(s)
- Sarah J. Miller
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC 29208, USA;
| | - Sayward E. Harrison
- Department of Psychology, College of Arts and Sciences, University of South Carolina, Columbia, SC 29208, USA;
- South Carolina Smart State Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
- Correspondence:
| | - Kamla Sanasi-Bhola
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC 29203, USA;
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22
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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.
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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
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23
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Dauria EF, Levine A, Hill SV, Tolou-Shams M, Christopoulos K. Multilevel Factors Shaping Awareness of and Attitudes Toward Pre-exposure Prophylaxis for HIV Prevention among Criminal Justice-Involved Women. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1743-1754. [PMID: 33236275 PMCID: PMC8276158 DOI: 10.1007/s10508-020-01834-4] [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] [Received: 03/21/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 05/14/2023]
Abstract
Although pre-exposure prophylaxis (PrEP) is a key tool in HIV prevention efforts, little is known about PrEP as a prevention strategy for criminal justice-involved (CJI) women. The purpose of this study was to examine multilevel factors shaping PrEP awareness and acceptability among CJI women. Between January 2017 and December 2017, we conducted 52 interviews with CJI women at high risk for HIV and stakeholders from the criminal justice (CJ) and public health (PH) systems. Interviews explored awareness of PrEP and the multilevel factors shaping PrEP acceptability. Data were analyzed using inductive thematic analysis and executive summaries. Atlas.ti facilitated analyses. The majority of CJI women (n = 27) were, on average, 41.3 years, from racial and ethnic minority groups (56% Black/African-American; 19% Latinx) and reported engaging in recent high-risk behavior (nearly 60% engaged in transactional sex, 22% reported ≥ 4 sexual partners, and 37% reported injection drug use). Of system stakeholders (n = 25), 52% represented the CJ sector. Although CJI women were generally unaware of PrEP, attitudes toward PrEP were enthusiastic. Barriers to PrEP acceptability included medication side effects (individual level); distrust in HIV prevention mechanisms (community level); lack of local HIV prevention efforts among high-risk women (public policy/HIV epidemic stage level). Factors promoting PrEP included perceived HIV risk (individual level); PrEP being an HIV prevention method that women can control without partner negotiation (social and sexual network level); and availability of public health insurance (community level). Despite low awareness of PrEP, CJI women expressed positive attitudes toward PrEP. To improve PrEP access for CJI women, implementation efforts should address barriers and leverage facilitators across multiple levels to be maximally effective.
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Affiliation(s)
- Emily F Dauria
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave., Bldg. 5, San Francisco, CA, 94110, USA.
| | - Andrew Levine
- Department of Sociology, New York University, New York, NY, USA
| | - Samantha V Hill
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave., Bldg. 5, San Francisco, CA, 94110, USA
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24
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Knittel AK, Shook-Sa BE, Rudolph JE, Edmonds A, Ramirez C, Cohen MH, Adedimeji A, Taylor TN, Michel KG, Milam J, Cohen J, Donohue JD, Foster A, Fischl M, Konkle-Parker D, Adimora AA. Incidence and Prevalence of Incarceration in a Longitudinal Cohort of Women at Risk for Human Immunodeficiency Virus in the United States, 2007-2017. J Womens Health (Larchmt) 2021; 30:694-704. [PMID: 33544023 PMCID: PMC8112715 DOI: 10.1089/jwh.2020.8417] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: To estimate the incidence, prevalence, frequency, and duration of incarceration and to identify risk factors for incarceration among women at risk for human immunodeficiency virus (HIV) in the United States. Methods: During semiannual study visits in a multicenter cohort study, 970 HIV sero-negative participants at risk for HIV were asked about their own incarceration (10/2007-09/2017) and incarceration of sexual partners (10/2013-09/2017). We used descriptive statistics and multivariable log-binomial regression to identify baseline predictors of incident incarceration. Results: Median follow-up time across the 970 participants was 5.5 years (IQR 3.5-9.5). Nearly half (n = 453, 46.7%) of participants were incarcerated during or before the study, and the incarceration rate was 5.5 per 100 person-years. In multivariable models, incident incarceration was associated with prior incarceration (RR 5.20, 95% CI: 3.23-8.41) and noninjection drug use (RR 1.57, 95% CI: 1.10-2.25). Conclusions: Incarceration is common for women at risk for HIV. Prevention interventions that address the complex interplay of drug use, sex exchange, and housing instability for women who have experienced incarceration have the potential to reach an important group of U.S. women at risk of HIV infection.
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Affiliation(s)
- Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Bonnie E. Shook-Sa
- Department of Biostatistics and University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Jacqueline E. Rudolph
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Andrew Edmonds
- Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Catalina Ramirez
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | | | - Adebola Adedimeji
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Brooklyn, New York, USA
| | - Tonya N. Taylor
- Division of Infectious Disease, SUNY Downstate Medical Center, College of Medicine, Brooklyn, New York, USA
| | - Katherine G. Michel
- Department of Infectious Diseases, Georgetown University, Washington, District of Columbia, USA
| | - Joel Milam
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer Cohen
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Jessica D. Donohue
- WIHS Data Management and Analysis Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Antonina Foster
- Division of Infectious Disease, Department of Medicine, Emory University, Atlanta, Georgia, USA
| | - Margaret Fischl
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Adaora A. Adimora
- Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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Meyer JP. Women's Intersectional Risks for HIV and Incarceration and Implications for Interventions. J Womens Health (Larchmt) 2021; 30:630-631. [PMID: 33124955 PMCID: PMC8085140 DOI: 10.1089/jwh.2020.8841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, Connecticut, USA
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26
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Determining the level of sexually transmitted diseases (STDs) awareness in Ota, Nigeria. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Black Cisgender Women's PrEP Knowledge, Attitudes, Preferences, and Experience in Chicago. J Acquir Immune Defic Syndr 2021; 84:497-507. [PMID: 32692108 DOI: 10.1097/qai.0000000000002377] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although black cisgender women in Chicago continue to disproportionally account for new HIV diagnoses, few are on pre-exposure prophylaxis (PrEP). We used concurrent mixed-methods to understand women's PrEP knowledge, attitudes, experience, and preferences in Chicago. SETTING AND METHODS We surveyed 370 HIV(-) cisgender women visiting a sexually transmitted infection clinic (n = 120) or emergency department (n = 250). Two focus groups were conducted with PrEP-naive women, and interviews were conducted with 7 PrEP-experienced women. Quantitative data were analyzed using descriptive statistics and multivariable logistic regression, and qualitative data using thematic analysis. RESULTS Majority of women identified as black (83.0%) and had a regular source of health care (70.0%). In the past 6 months, 84.1% had vaginal or anal sex, most with inconsistent condom use (94.2%). Only 30.3% had heard of PrEP, but once explained, one-quarter considered starting PrEP, with protecting health (76.4%) and reducing HIV worry (58.1%) the most common reasons. Factors associated with considering PrEP included being Latina [adjusted odds ratio (aOR): 3.30, 95% confidence interval (CI): (1.21 to 8.99)], recent sexually transmitted infection [aOR: 2.39, 95% CI: (1.25 to 4.59)], and higher belief in PrEP effectiveness [aOR: 1.85, 95% CI: (1.22 to 2.82)]. Most (81.1%) had concerns about taking PrEP with side effects a common concern. Qualitative themes aligned with survey results, revealing a disconnection from current PrEP marketing, need for community-level PrEP education/outreach, and importance of provider trust. LESSONS LEARNED Despite significant PrEP implementation work in Chicago, less than one-third of women in our study had heard of PrEP. Once informed, PrEP attitudes and interest were positive. Translating these results into interventions reflecting women's preferences and barriers is critical to increase PrEP uptake by cisgender women in Chicago and elsewhere.
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Adams JW, Khan MR, Bessey S, Friedman SR, McMahon JM, Lurie MN, Galea S, Marshall BD. Preexposure prophylaxis strategies for African-American women affected by mass incarceration. AIDS 2021; 35:453-462. [PMID: 33170818 PMCID: PMC7855567 DOI: 10.1097/qad.0000000000002749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/14/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to determine the effectiveness of various preexposure prophylaxis (PrEP) prescription strategies for African-American women impacted by mass incarceration within an urban setting. DESIGN An agent-based model was utilized to evaluate prevention strategies in an efficient, ethical manner. By defining agents, their characteristics and relationships, we assessed population-level effects of PrEP on HIV incidence. METHODS We tested hypothetical PrEP prescription strategies within a simulation representing the African-American population of Philadelphia, Pennsylvania. Four strategies were evaluated: PrEP for women meeting CDC indicators regarding partner characteristics, PrEP for women with a recently incarcerated male partner, PrEP for women with a recently released male partner and couples-based PrEP at time of release. Interventions occurred alongside scale-up of HAART. We evaluated reductions in HIV transmissions, the number of persons on PrEP needed to avert one HIV transmission (NNT) and the resulting proportions of people on PrEP. RESULTS Scenarios prescribing PrEP based on criminal justice system involvement reduced HIV transmissions. The NNT ranged from 147 (couples-based scenario) to 300 (recently released scenario). The percentage of the female population covered by PrEP at any one time ranged from 0.14% (couples-based) to 10.8% (CDC-based). CDC-guideline scenarios were consistently less efficient compared to the justice-involved interventions. CONCLUSION Expanding PrEP for African-American women and their male partners affected by incarceration should be considered in national HIV prevention goals and correctional facilities leveraged as intervention sites. Partner characteristics in the current CDC indications may be more effective and efficient if guidelines considered criminal justice involvement.
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Affiliation(s)
- Joëlla W. Adams
- Brown University School of Public Health, Providence, Rhode Island
| | - Maria R. Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University
| | - S.E. Bessey
- Brown University School of Public Health, Providence, Rhode Island
| | | | | | - Mark N. Lurie
- Brown University School of Public Health, Providence, Rhode Island
| | - Sandro Galea
- Boston University School of Public Health, Boston, Massachusetts, USA
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Uzoeghelu U, Bogart LM, Mahoney T, Ghebremichael MS, Kerr J, Ojikutu BO. HIV Risk-Related Behaviors and Willingness to Use Pre-Exposure Prophylaxis Among Black Americans with an Arrest History. J Racial Ethn Health Disparities 2021; 9:498-504. [PMID: 33544327 DOI: 10.1007/s40615-021-00980-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Black individuals in the USA are arrested and incarcerated at a significantly higher rate than White individuals, and incarceration is associated with increased HIV vulnerability. Pre-exposure prophylaxis (PrEP) reduces the risk for HIV transmission, but little is known about the relationship between HIV risk behavior and willingness to use PrEP among Black individuals with an arrest history. METHOD A total of 868 individuals completed a nationally representative survey and provided baseline data on sexual risk. Participants were grouped as those with a history of arrest (N = 226) and those with no history of arrest (N=619) based on self-reported arrest history. Our study examined HIV risk behaviors associated with willingness to use PrEP between those with arrest history and those without arrest history. RESULTS Participants with an arrest history were more likely to have a lifetime history of anal sex (p<0.0001) and sexually transmitted diseases (p=0.0007). A history of multiple sexual partners in the past 3 months was associated with PrEP willingness in individuals with an arrest history [aPR 2.61 (1.77, 3.85), p<0.0001], adjusting for other covariates in the model. CONCLUSIONS Differences in risk behavior and willingness to use PrEP exist by arrest history. Understanding these risk behaviors are necessary to increase access to PrEP. PrEP uptake and adherence interventions, when recommended and made available for individuals at substantive risk of HIV infection at the time of arrest and during incarceration, are essential to reducing the spread of HIV in correctional facilities and in communities to which they return.
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Affiliation(s)
- Ugochukwu Uzoeghelu
- Department of Postgraduate Education, Harvard Medical School, 25 Shattuck St, Boston, MA, 02215, USA.
| | | | - Taylor Mahoney
- Boston University School of Public Health, Boston, MA, USA
| | | | - Jelani Kerr
- University of Louisville, Louisville, KY, USA
| | - Bisola O Ojikutu
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Meyer J, Price C, Tracey D, Sharpless L, Song Y, Madden L, Elwyn G, Altice F. Preference for and Efficacy of a PrEP Decision Aid for Women with Substance Use Disorders. Patient Prefer Adherence 2021; 15:1913-1927. [PMID: 34511887 PMCID: PMC8420782 DOI: 10.2147/ppa.s315543] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Women with substance use disorders (SUDs) are a key population for HIV prevention with pre-exposure prophylaxis (PrEP), though uptake is limited by awareness of PrEP, misestimation of personal HIV risk, and minimally integrated HIV prevention and addiction treatment services. Patient-centered decision aids (DA) could address these barriers to PrEP, but no extant DA for PrEP has been published, including for women with SUDs. METHODS We developed a patient-centered PrEP DA for women in addiction treatment. In a pilot randomized preference trial, we compared the DA to enhanced standard of care (eSOC) providing standardized information. The primary outcome was opting to receive more information through the DA; we also assessed the impact of the DA on PrEP decisional preference and PrEP uptake over 12 months. RESULTS A total of 164 enrolled participants (DA: 83; eSOC: 81) were similar in terms of HIV risk and demographics, which are representative of women in addiction treatment programs nationally, and most (92%) had opioid use disorder. Half of participants were PrEP eligible, though 37% underestimated their personal HIV risk. Independent correlates of selecting the PrEP DA relative to eSOC included higher alcohol use severity (aOR 4.13, 95% CI 1.05-16.28, p=0.04) and perception of high risk for HIV (aOR 2.95, 95% CI 1.19-7.35, p=0.02). For those selecting the DA, interest in PrEP increased significantly from 25% to 89%. DA participants were also significantly more likely than eSOC participants to see a provider for PrEP during follow-up (15.7% vs 6.2%; p=0.05). CONCLUSION Half of the women selected to use the DA, and those who did significantly increased their engagement in the HIV prevention cascade through increased interest in and initiation of PrEP. Future iterations should accelerate the HIV prevention cascade for women with SUDs by integrating PrEP decision aids into existing addiction treatment services and actively linking women to PrEP.
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Affiliation(s)
- Jaimie Meyer
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
- Correspondence: Jaimie Meyer Yale School of Medicine, AIDS Program, 135 College Street, Suite 323, New Haven, CT, 06510, USATel +203 737 6233Fax +203 737 4051 Email
| | - Carolina Price
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
| | - DeShana Tracey
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
| | | | - Yue Song
- Yale School of Public Health, New Haven, CT, USA
- Oregon Health Sciences University, Portland, OR, USA
| | - Lynn Madden
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, NH, USA
- Scientific Institute for Quality of Healthcare, University Nijmegen Medical Centre, Nijmegen, Netherlands
- Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Frederick Altice
- Yale School of Medicine, AIDS Program, New Haven, CT, USA
- Yale School of Public Health, New Haven, CT, USA
- APT Foundation, Inc., New Haven, CT, USA
- Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia
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Przybyla SM, Cerulli C, Bleasdale J, Wilson K, Hordes M, El-Bassel N, Morse DS. "I think everybody should take it if they're doing drugs, doing heroin, or having sex for money": a qualitative study exploring perceptions of pre-exposure prophylaxis among female participants in an opioid intervention court program. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:89. [PMID: 33228721 PMCID: PMC7684895 DOI: 10.1186/s13011-020-00331-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 11/10/2022]
Abstract
Background Women’s rise in opioid use disorder has increased their presence in the criminal justice system and related risk behaviors for HIV infection. Although pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention treatment, uptake among this high-risk population has been particularly low. Considerably little is known about the interplay between justice-involved women with opioid use disorder and HIV prevention. The aim of this study was to explore PrEP knowledge, attitudes, and perceptions for personal and partner use among women participants in the nation’s first ever opioid intervention court program. Methods The authors conducted semi-structured, in-depth interviews with 31 women recruited from an Opioid Intervention Court, a recent fast-track treatment response to combat overdose deaths. We utilized a consensual qualitative research approach to explore attitudes, perceptions, and preferences about PrEP from women at risk for HIV transmission via sexual and drug-related behavior and used thematic analysis methods to code and interpret the data. Results PrEP interest and motivation were impacted by various factors influencing the decision to consider PrEP initiation or comfort with partner use. Three primary themes emerged: HIV risk perceptions, barriers and facilitators to personal PrEP utilization, and perspectives on PrEP use by sexual partners. Conclusions Findings suggest courts may provide a venue to offer women PrEP education and HIV risk assessments. Study findings inform public health, substance use, and criminal justice research and practice with justice-involved participants experiencing opioid use disorder on the development of gender-specific PrEP interventions with the ultimate goal of reducing HIV incidence.
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Affiliation(s)
- Sarahmona M Przybyla
- Department of Community Health and Health, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, 305 Kimball Tower, Buffalo, NY, 14214, USA.
| | - Catherine Cerulli
- Department of Psychiatry and Medicine, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA.,Susan B. Anthony Center, University of Rochester, PO Box 270435, Rochester, NY, 14627, USA
| | - Jacob Bleasdale
- Department of Community Health and Health, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, 305 Kimball Tower, Buffalo, NY, 14214, USA
| | - Kennethea Wilson
- Department of Community Health and Health, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, 305 Kimball Tower, Buffalo, NY, 14214, USA
| | - Melissa Hordes
- Department of Community Health and Health, School of Public Health and Health Professions, University at Buffalo, 3435 Main Street, 305 Kimball Tower, Buffalo, NY, 14214, USA
| | - Nabila El-Bassel
- School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA
| | - Diane S Morse
- Department of Psychiatry and Medicine, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14642, USA
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32
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Ojikutu BO, Amutah-Onukagha N, Mahoney TF, Tibbitt C, Dale SD, Mayer KH, Bogart LM. HIV-Related Mistrust (or HIV Conspiracy Theories) and Willingness to Use PrEP Among Black Women in the United States. AIDS Behav 2020; 24:2927-2934. [PMID: 32239358 DOI: 10.1007/s10461-020-02843-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Uptake of pre-exposure prophylaxis (PrEP) among Black women living in the US is suboptimal. We sought to determine the association between HIV-related medical mistrust (or belief in HIV conspiracy theories) and willingness to use PrEP among Black women. We analyzed data from the 2016 National Survey on HIV in the Black Community (NSHBC), a nationally representative cross-sectional survey. Among NSHBC participants, 522 were women and 347 (69.0%) reported HIV risk factors. Only 14.1% were aware that PrEP exists; 30.8% reported willingness to use PrEP. HIV-related medical mistrust was reported by 60.4% of women. In multivariable analysis, controlling for income, education, marital status and health care engagement, belief in conspiracy theories was significantly associated with higher willingness to use PrEP. The HIV-Related Medical Mistrust Scale item: "there is a cure for HIV, but the government is withholding it from the poor" was independently associated with higher PrEP willingness. This finding speaks to the need for an improved understanding of the role of HIV-related medical mistrust among Black women to improve uptake of biomedical HIV prevention.
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Affiliation(s)
- B O Ojikutu
- Division of Global Health Equity, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
- Harvard School of Medicine, Boston, MA, USA.
| | | | - T F Mahoney
- School of Public Health, Boston University, Boston, MA, USA
| | - C Tibbitt
- Tufts University School of Medicine, Boston, MA, USA
| | - S D Dale
- University of Miami Medical Center, Miami, FL, USA
| | - K H Mayer
- The Fenway Institute, Boston, MA, USA
- Beth Israel Lahey Medical Center, Boston, MA, USA
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33
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Sewell WC, Patel RR, Blankenship S, Marcus JL, Krakower DS, Chan PA, Parker K. Associations Among HIV Risk Perception, Sexual Health Efficacy, and Intent to Use PrEP Among Women: An Application of the Risk Perception Attitude Framework. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2020; 32:392-402. [PMID: 33112674 PMCID: PMC8049455 DOI: 10.1521/aeap.2020.32.5.392] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
HIV risk perception is a known determinant of HIV prevention behaviors among vulnerable populations. Lesser known is the combined influence of risk perception and efficacy beliefs on PrEP use. We examined the associations between levels of risk perception and strength of efficacy beliefs on intent to use PrEP in a sample of adult Black and Latina women. Guided by the risk perception attitudes (RPA) framework, we used cluster analysis to identify four interpretable groups. We ran analysis of covariance models to determine the relationship between membership in the RPA framework groups and intention to use PrEP. Among the 908 women, the mean age was 29.9 years and participants were Latina (69.4%) and Black (25.6%). Results of the analysis show that women with low perception of HIV risk and strong efficacy beliefs had significantly less intent to use PrEP than women with high risk perception and weak efficacy beliefs.
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Affiliation(s)
- Whitney C Sewell
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Rupa R Patel
- Washington University in St. Louis, St. Louis, Missouri
| | | | - Julia L Marcus
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
| | - Douglas S Krakower
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- The Fenway Institute, Fenway Health, Boston, Massachusetts
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
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34
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Sosnowy C, Tao J, Nunez H, Montgomery MC, Ndoye CD, Biello K, Mimiaga MJ, Raifman J, Murphy M, Nunn A, Maynard M, Chan PA. Awareness and use of HIV pre-exposure prophylaxis among people who engage in sex work presenting to a sexually transmitted infection clinic. Int J STD AIDS 2020; 31:1055-1062. [PMID: 32753003 DOI: 10.1177/0956462420943702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Collette Sosnowy
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | - Jun Tao
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | - Hector Nunez
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | | | | | - Katie Biello
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Matthew J Mimiaga
- Center for Health Equity Research, Brown University School of Public Health, Providence, RI, USA.,Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - Julia Raifman
- Department of Health Law, Policy and Management, Boston University, Boston, MA, USA
| | - Matthew Murphy
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | - Amy Nunn
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA.,Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Michaela Maynard
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA
| | - Philip A Chan
- Department of Medicine, Brown University Alpert Medical School, Providence, RI, USA.,Department of Behavioral and Social Health Sciences, Brown University School of Public Health, Providence, RI, USA
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Mayer KH, Agwu A, Malebranche D. Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review. Adv Ther 2020; 37:1778-1811. [PMID: 32232664 PMCID: PMC7467490 DOI: 10.1007/s12325-020-01295-0] [Citation(s) in RCA: 187] [Impact Index Per Article: 46.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Indexed: 01/01/2023]
Abstract
Antiretroviral pre-exposure prophylaxis (PrEP) to prevent HIV transmission was first approved by the US Food and Drug Administration in 2012. Despite correlations of decreases in new HIV infections being greatest where PrEP has been deployed, the uptake of PrEP is lagging, particularly among populations with disproportionate HIV burden. This narrative review seeks to identify individual and systemic barriers to PrEP usage in the USA. A comprehensive search of recent literature uncovered a complex array of structural, social, clinical, and behavioral barriers, including knowledge/awareness of PrEP, perception of HIV risk, stigma from healthcare providers or family/partners/friends, distrust of healthcare providers/systems, access to PrEP, costs of PrEP, and concerns around PrEP side effects/medication interactions. Importantly, these barriers may have different effects on specific populations at risk. The full potential of PrEP for HIV prevention will not be realized until these issues are addressed. Strategies to achieve this goal should include educational interventions, innovative approaches to delivery of HIV care, financial support, and destigmatization of PrEP and PrEP users. Until then, PrEP uptake will continue to be suboptimal, particularly among those who need it most.
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Affiliation(s)
- Kenneth H Mayer
- The Fenway Institute and Harvard Medical School, Boston, MA, USA.
| | - Allison Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Zaller ND, Neher TL, Presley M, Horton H, Marshall SA, Zielinski MJ, Brinkley-Rubinstein L. Barriers to linking high-risk jail detainees to HIV pre-exposure prophylaxis. PLoS One 2020; 15:e0231951. [PMID: 32302371 PMCID: PMC7164641 DOI: 10.1371/journal.pone.0231951] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 04/03/2020] [Indexed: 12/04/2022] Open
Abstract
Individuals involved in the criminal justice (CJ) system continue to be at disproportionate risk for HIV infection, and often have a greater prevalence of substance use and sexual related risk behaviors relative to their non-CJ involved peers. Pre-exposure prophylaxis (PrEP), a once daily antiretroviral medicine, is an evidence-based approach for reducing the risk of contracting HIV but limited data exist regarding the use of PrEP among CJ populations, especially in the U.S. South. This study was conducted at the Pulaski County Regional Detention Facility (PCRDF) in Little Rock, Arkansas (AR), the largest county jail in the state. We explored knowledge about PrEP and HIV, perceptions about PrEP feasibility in both the jail and community settings and barriers to PrEP program implementation, through in-depth qualitative interviews with 21 jail detainees. We purposively sampled individuals based on specific self-reported risk behavior, including sexual risk (both heterosexual and same-sex) and drug related risk (e.g. IDU), among all eligible individuals. We identified five primary themes from the interviews: 1) accessing healthcare during community reentry was a low priority; 2) perception of risk and interaction with people with HIV was low; 3) there are many barriers to disclosing HIV risk behaviors in jail settings; 4) knowledge of PrEP is low but willingness to use is high; and 5) multiple barriers exist to PrEP uptake post-release. Our findings are contextually unique and therefore have important implications for future implementation of PrEP access either within jail settings or linkage to PrEP post release.
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Affiliation(s)
- Nickolas D. Zaller
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
- * E-mail:
| | - Taylor L. Neher
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Makenzie Presley
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Heather Horton
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - S. Alexandra Marshall
- Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Melissa J. Zielinski
- Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America
| | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
- Center for Health Equity Research, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Brief Report: PrEP Eligibility Among At-Risk Women in the Southern United States: Associated Factors, Awareness, and Acceptability. J Acquir Immune Defic Syndr 2019; 80:527-532. [PMID: 30649036 DOI: 10.1097/qai.0000000000001950] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Among women in the United States, non-Latina black women in the South have disproportionately high rates of new HIV infections but low use of pre-exposure prophylaxis (PrEP). Effective strategies to identify factors associated with PrEP eligibility could facilitate improved screening, offering, and uptake of PrEP among US women at risk of HIV. SETTING AND METHODS We applied 2014 CDC criteria for PrEP use to at-risk HIV-negative women enrolled in the Southern US sites (Atlanta, Chapel Hill, Birmingham/Jackson, Miami) of the Women's Interagency HIV Study from 2014 to 2015 to estimate PrEP eligibility and assess PrEP knowledge and acceptability. Factors associated with PrEP eligibility were assessed using multivariable models. RESULTS Among 225 women, 72 (32%) were PrEP-eligible; the most common PrEP indicator was condomless sex. The majority of PrEP-eligible women (88%) reported willingness to consider PrEP. Only 24 (11%) PrEP-eligible women had previously heard of PrEP, and only 1 reported previous use. Education level less than high school [adjusted odds ratio (aOR) 2.56; 95% confidence interval (CI): 1.22 to 5.37], history of sexual violence (aOR 4.52; 95% CI: 1.52 to 17.76), and medium to high self-perception of HIV risk (aOR 6.76; 95% CI: 3.26 to 14.05) were significantly associated with PrEP eligibility in adjusted models. CONCLUSIONS Extremely low PrEP awareness and use despite a high proportion of eligibility and acceptability signify a critical need to enhance PrEP education and delivery for women in this region. Supplementing CDC eligibility criteria with questions about history of sexual violence and HIV risk self-assessment may enhance PrEP screening and uptake among US women.
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38
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Interest in Pre-exposure Prophylaxis (PrEP) for HIV is Limited Among Women in a General Obstetrics & Gynecology Setting. AIDS Behav 2019; 23:2741-2748. [PMID: 31065923 DOI: 10.1007/s10461-019-02529-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is an important tool for reducing the risk of HIV acquisition, but identifying eligible and interested female patients remains difficult. We collected 144 surveys at urban Obstetrics & Gynecology clinics in Louisiana to assess interest in PrEP. Study participants were predominantly African-American (61.8%) and 45.1% had incomes of less than $20,000 per year. 84.7% of participants estimated their risk of HIV acquisition to be low. Initial interest in PrEP was moderate at 37.5% of the population. Number of partners, condom use, and self-perceived risk of HIV acquisition were associated with initial interest. After receiving more information about side effects and compliance requirements, only four of 144 (7.8% of initially interested, 2.8% of total) women remained interested in using PrEP. Concern about side effects was the major barrier to persistent interest. Further study is needed to determine how best to identify PrEP candidates in Obstetrics & Gynecology settings.
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Ramsey SE, Ames EG, Brinkley-Rubinstein L, Teitelman AM, Clarke J, Kaplan C. Linking women experiencing incarceration to community-based HIV pre-exposure prophylaxis care: protocol of a pilot trial. Addict Sci Clin Pract 2019; 14:8. [PMID: 30832717 PMCID: PMC6398222 DOI: 10.1186/s13722-019-0137-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 02/16/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Women experiencing incarceration (WEI) engage in high rates of sex- and drug-related behavior that places them at risk for HIV. Pre-exposure prophylaxis (PrEP) is an efficacious means of reducing HIV acquisition. There is a general lack of knowledge regarding PrEP among women at elevated risk, and only a small percentage of at-risk women are currently engaged in PrEP care. The period of incarceration represents an opportunity to identify at-risk women, initiate PrEP during incarceration, and establish linkage to community-based PrEP care upon release from incarceration. Further, post-release is a time period that is particularly risky, and there are numerous barriers, including substance use, that may impede linkage to community-based care in the absence of intervention. The current protocol describes plans for the development and pilot randomized controlled trial (RCT) of an intervention to promote PrEP uptake during incarceration and facilitate linkage to community-based PrEP care post-release. METHODS/DESIGN The motivational interviewing-navigation (MI-NAV) study intervention is being developed, refined, and tested over three phases within the framework of the social ecological model. All phases of the study are being conducted at a women's correctional facility and community-based PrEP provider located in the Northeastern region of the United States. Phase 1 consists of individual qualitative interviews to be conducted with key stakeholders (n = 6-10) from the community-based PrEP care site and (n = 6-10) from the women's correctional facility, as well as with (n = 18-30) WEI. Recruitment for Phase 1 was initiated in November 2017. In Phase 2, MI-NAV will be piloted with a small cohort (n = 8-12) of WEI and will be refined based upon participant feedback. During Phase 3, a pilot RCT of MI-NAV and a standard of care condition will be conducted with 80 WEI. RCT participants will complete baseline and follow-up assessments 1, 3, and 6 months post-release. The primary study outcome is linkage to community-based PrEP care, verified via medical records. DISCUSSION This study will develop and evaluate a psychosocial intervention (MI-NAV) to promote PrEP uptake and facilitate linkage to community-based PrEP care among women at-risk for HIV. It is expected that, as a result of this project, the feasibility, acceptability, and preliminary efficacy of MI-NAV will be determined. If found to be efficacious, this intervention has the potential to reduce HIV acquisition in a high-need, underserved community. Clinical trial registration NCT03281343.
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Affiliation(s)
- Susan E. Ramsey
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI USA
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI USA
- Rhode Island Hospital, Providence, RI USA
| | | | - Lauren Brinkley-Rubinstein
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC USA
- Center for Health Equity Research, University of North Carolina, Chapel Hill, NC USA
| | | | - Jennifer Clarke
- Department of Medicine, The Warren Alpert Medical School of Brown University, Providence, RI USA
- Rhode Island Department of Corrections, Cranston, RI USA
- Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Clair Kaplan
- Planned Parenthood of Southern New England, Providence, RI USA
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