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Zapata JP, Zamantakis A, Queiroz AAFLN. Identification of Determinants and Implementation Strategies to Increase Long-Acting Injectable PrEP for HIV Prevention Among Latino Men Who Have Sex with Men (MSM). J Racial Ethn Health Disparities 2024; 11:2093-2102. [PMID: 37347407 DOI: 10.1007/s40615-023-01678-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Latino men who have sex with men (LMSM) are disproportionally affected by HIV infections in the USA. The uptake rate of pre-exposure prophylaxis (PrEP) for HIV prevention has remained low among LMSM. Long-acting injectable PrEP (LAI-PrEP) may have the potential to improve structural, behavioral, and cognitive barriers to adherence. Given the potential benefits of LAI-PrEP and the limited data with this population, the aim of our study was to explore experiences and attitudes of LAI-PrEP among LMSM and identify implementation barriers compared to the standard oral presentation, align proposed implementation strategies, and propose outcomes to monitor and assess impact. METHODS In this qualitative study, guided by the Consolidated Framework for Implementation Research, we explored health care providers perspectives on facilitators and barriers to LAI-PrEP implementation strategies for LMSM. Interviews were recorded, transcribed, and analyzed using thematic content analysis. RESULTS Fear of immigration policies, ability to conceal PrEP medication, health insurance coverage, health information fatigue, lack of culturally adapted information, and provider's lack of knowledge were among the main barriers to LAI-PrEP. Most providers discussed the need for adapted and/or tailored training materials for and suggested designing marketing materials and specific clinical recommendations for LAI-PrEP. CONCLUSION In order to ensure an effective adaptation process that encompasses local and national goals of HIV prevention, future interventions should be designed in a way that incorporates culturally relevant information for LMSM. This study provides an implementation research logic model to guide future studies.
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Affiliation(s)
- Juan Pablo Zapata
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave. 14th Floor, Chicago, IL, 60611, USA.
| | - Alithia Zamantakis
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave. 14th Floor, Chicago, IL, 60611, USA
| | - Artur Acelino Francisco Luz Nunes Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave. 14th Floor, Chicago, IL, 60611, USA
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McCauley PS, Morgan E, Caba AE, Renley BM, Eaton LA, Watson RJ. Perceptions of bias in HIV prevention services, happiness with social support, and anticipated PrEP stigma among Black and Latine/x sexual and gender diverse individuals. AIDS Care 2024; 36:682-691. [PMID: 38451740 DOI: 10.1080/09540121.2024.2326126] [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: 08/14/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024]
Abstract
Although pre-exposure prophylaxis (PrEP) is a highly effective preventive treatment for HIV, anticipated PrEP stigma can hinder uptake. Perceptions of bias in HIV prevention and evaluations (e.g., happiness) tied to social support among Black and Latine/x sexual and gender diverse (SGD) individuals could be important correlates of anticipated PrEP stigma. To further this line of inquiry, a national sample of 872 Black and Latine/x SGD individuals who had and had never taken PrEP (Mage = 25.1, SD = 2.8) reported how they perceived HIV prevention and how happy they were with their social support. Multivariable linear regressions revealed that greater perceptions of bias in HIV prevention services were associated with higher anticipated PrEP stigma among Black and Latine/x SGD individuals who have never taken PrEP. Greater happiness with friend support was associated with lower PrEP stigma, whereas greater happiness with family support was associated with higher PrEP stigma among individuals who have taken PrEP. Findings highlight the need for PrEP and HIV interventions to address the intersectional stigma attached to prevention and for researchers to understand how evaluations of social support may contribute to stigma among Black and Latine/x SGD individuals.
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Affiliation(s)
- Peter S McCauley
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CA, US
| | - Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, OH, US
- Infectious Disease Institute, The Ohio State University, Columbus, OH, US
| | - Antonia E Caba
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CA, US
| | - Benton M Renley
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CA, US
| | - Lisa A Eaton
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CA, US
| | - Ryan J Watson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CA, US
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Schnarrs PW, Zuñiga J, Benitez G, Fliedner P, Norwood A, Croll M, Oviedo LDS, Buchorn J, Oeffinger J, Lane R, Schelling E, Pham G, Pate T, Arnold EM. Intention to Use Different Formulations of Longer Acting HIV Pre-Exposure Prophylaxis Among Transgender and Gender Expansive Individuals: The Roles of Social Vulnerability and Medical Mistrust. AIDS Patient Care STDS 2024; 38:51-60. [PMID: 38381948 DOI: 10.1089/apc.2023.0211] [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] [Indexed: 02/23/2024] Open
Abstract
In 2012, the Federal Drug Administration approved daily oral pre-exposure prophylaxis (PrEP) for HIV prevention in adults. Longer acting injectable PrEP (LA PrEP) has been approved and other formulations are in development. A successful LA PrEP rollout requires examining potential facilitators and barriers to PrEP uptake. Given that transgender and gender expansive (TGE) individuals experience more social vulnerability and higher levels of medical mistrust compared to other populations, examining the role of these two factors in LA PrEP uptake is important. This study, PrEP for ALL, is a community-based participatory research project in Texas that engaged TGE community members and organizational partners through a community advisory board. In total, 482 TGE individuals were recruited and responded to all relevant questions in an online survey, including their intentions to use three formulations: a monthly oral pill, a bimonthly intramuscular injection, and an annual subdermal implant. Multiple regression analysis was used to examine the influence of social vulnerability and medical mistrust on intention to use each LA PrEP formulation adjusting for other relevant factors. Findings suggest that individuals with higher levels of social vulnerability had greater intentions to use the monthly oral pill (β = 0.12, p = 0.009), the bimonthly intramuscular injection (β = 0.18, p < 0.001), and annual subdermal implant (β = 0.17, p < 0.001), whereas medical mistrust reduced intentions to use the bimonthly intramuscular injection (β = -0.18, p < 0.001) and annual subdermal implant (β = -0.11, p = 0.021). Improvements in gender-affirming clinical care are needed along with LA PrEP formulations that allow for greater autonomy and reduced clinical contact. Clinical Trial Registration number: NCT05044286.
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Affiliation(s)
- Phillip W Schnarrs
- Department of Population Health, The University of Texas at Austin, Austin, Texas, USA
| | - Julie Zuñiga
- School of Nursing, The University of Texas at Austin, Austin, Texas, USA
| | - Gabrielle Benitez
- Department of Population Health, The University of Texas at Austin, Austin, Texas, USA
| | - Paul Fliedner
- Department of Population Health, The University of Texas at Austin, Austin, Texas, USA
| | - Aliza Norwood
- Department of Population Health, The University of Texas at Austin, Austin, Texas, USA
- Department of Internal Medicine, The University of Texas at Austin, Austin, Texas, USA
| | - Madeleine Croll
- Department of Sociology, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | | | - Jacey Buchorn
- Department of Sociology, The University of Texas at Austin, Austin, Texas, USA
| | | | - Rocky Lane
- Transgender Education Network of Texas, Austin, Texas, USA
| | | | - Gin Pham
- Transgender Education Network of Texas, Austin, Texas, USA
| | - TreShaun Pate
- Transgender Education Network of Texas, Austin, Texas, USA
| | - Elizabeth M Arnold
- Department of Psychiatry, The University of Kentucky, Lexington, Kentucky, USA
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Watson DL, Listerud L, Drab RA, Lin WY, Momplaisir FM, Bauermeister JA. HIV pre-exposure prophylaxis programme preferences among sexually active HIV-negative transgender and gender diverse adults in the United States: a conjoint analysis. J Int AIDS Soc 2024; 27:e26211. [PMID: 38332521 PMCID: PMC10853582 DOI: 10.1002/jia2.26211] [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: 08/18/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Current implementation efforts have failed to achieve equitable HIV pre-exposure prophylaxis (PrEP) provision for transgender and gender-diverse (trans) populations. We conducted a choice-based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States. METHODS Between April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out-of-pocket cost; dispensing venue; frequency of visits for PrEP-related care; travel time to PrEP provider; and ability to bundle PrEP-related care with gender-affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt-out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part-worth utility scores for the total sample and by respondents' PrEP status. RESULTS The median age was 24 years (range 18-56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out-of-pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender-affirming hormone therapy services (18.7%). Minimal cost-sharing ($0 out-of-pocket cost) most positively influenced the attribute importance of cost (average conjoint part-worth utility coefficient of 2.5 [95% CI 2.4-2.6]). PrEP-experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP-naïve respondents preferred pharmacies (relative utility score 5.1). CONCLUSIONS Participants preferred programmes that offered PrEP services without cost-sharing and bundled with gender-affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low-barrier PrEP provision are critical to achieving equitable PrEP provision. Community-engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient-centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients.
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Affiliation(s)
- Dovie L. Watson
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Louis Listerud
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ryan A. Drab
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Willey Y. Lin
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Florence Marie Momplaisir
- Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - José A. Bauermeister
- Department of Family and Community HealthUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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5
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Janamnuaysook R, Guo Y, Yu YJ, Phanuphak N, Kawichai S, MacDonell K, Jupimai T, Rongkavilit C, Wang B. Lived experiences with pre-exposure prophylaxis uptake and adherence among transgender women in Thailand: a qualitative study. Sex Health 2024; 21:SH23102. [PMID: 38219741 DOI: 10.1071/sh23102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Transgender women (TGW) are disproportionately affected by HIV, and HIV prevalence among TGW in Thailand has been increasing. Although oral daily pre-exposure prophylaxis (PrEP) is effective for HIV prevention, PrEP uptake and persistence among TGW have been low. This study aimed to provide a deeper understanding of TGW's experiences with PrEP uptake and adherence, and to identify major barriers to PrEP use to inform intervention adaptation. METHODS We interviewed 20 young TGW (six non-PrEP users, eight adherent, six non-adherent) and 10 health care providers from two HIV clinics in Bangkok, Thailand, in 2022. We focused on understanding challenges to PrEP use in this population using an interview guide based on a theoretical model of behaviour change and thematic content analysis. RESULTS Thematic analysis identified major barriers to and facilitators of PrEP uptake and adherence. Barriers to PrEP initiation included low self-perceived HIV risk, concern about potential side-effects, patient burdens such as frequent HIV testing for prescription refills and social stigma against PrEP. Barriers to adherence included side-effects, inconvenient access to health services (especially during COVID-19 lockdowns), forgetfulness resulting from busy schedules and low self-perceived HIV risk. TGW also reported health care providers' stigma against PrEP users deterred them from seeking further PrEP services. TGW identified major facilitators of PrEP initiation, including awareness about the benefits of PrEP, concern about risks of HIV and supportive social networks of PrEP users. As to PrEP regimens, most TGW participants reported a clear preference for long-lasting, injectable PrEP over daily oral PrEP. TGW and health care providers largely agreed on barriers and facilitators of PrEP use, but they differed in perceptions of HIV risk. CONCLUSIONS The results highlighted challenges and opportunities to improve the delivery of PrEP, as well as other sexually transmissable infection and mental health services, especially among TGW. Thus, there is an urgent need for developing effective intervention programs that could raise PrEP awareness and knowledge, reduce PrEP stigma, and improve PrEP delivery systems among TGW in Thailand.
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Affiliation(s)
- Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand; and Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | - Yan Guo
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Yeon Jung Yu
- Department of Anthropology, Western Washington University, Bellingham, WA, USA
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand; and Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | - Surinda Kawichai
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Karen MacDonell
- Center for Translational Behavioral Research, Florida State University, Tallahassee, FL, USA
| | - Thidarat Jupimai
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Chokechai Rongkavilit
- Department of Pediatrics, University of California San Francisco-Fresno Branch Campus, Fresno, CA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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6
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Zamudio-Haas S, Koester K, Venegas L, Salinas A, Herrera C, Gutierrez-Mock L, Welborn L, Deutsch MB, Sevelius J. "Entre Nosotras:" a qualitative study of a peer-led PrEP project for transgender latinas. BMC Health Serv Res 2023; 23:1013. [PMID: 37730598 PMCID: PMC10510224 DOI: 10.1186/s12913-023-09707-x] [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: 12/16/2022] [Accepted: 06/15/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Uptake of HIV pre-exposure prophylaxis (PrEP) remains low among transgender people as compared to other subgroups, despite high rates of HIV acquisition. In California, Latinx people comprise 40% of the population and Latina transgender women experience some of the highest burden of HIV of any subgroup, indicating a critical need for appropriate services. With funding from the California HIV/AIDS Research Programs, this academic-community partnership developed, implemented, and evaluated a PrEP project that co-located HIV services with gender affirming care in a Federally Qualified Heath Center (FQHC). Trans and Latinx staff led intervention adaptation and activities. METHODS This paper engages qualitative methods to describe how a PrEP demonstration project- Triunfo- successfully engaged Spanish-speaking transgender Latinas in services. We conducted 13 in-depth interviews with project participants and five interviews with providers and clinic staff. Interviews were conducted in Spanish or English. We conducted six months of ethnographic observation of intervention activities and recorded field notes. We conducted thematic analysis. RESULTS Beneficial elements of the intervention centered around three intertwined themes: creating trusted space, providing comprehensive patient navigation, and offering social support "entre nosotras" ("between us women/girls"). The combination of these factors contributed to the intervention's success supporting participants to initiate and persist on PrEP, many of whom had previously never received healthcare. Participants shared past experiences with transphobia and concerns around discrimination in a healthcare setting. Developing trust proved foundational to making participants feel welcome and "en casa/ at home" in the healthcare setting, which began from the moment participants entered the clinic and continued throughout their interactions with staff and providers. A gender affirming, bilingual clinician and peer health educators (PHE) played a critical part in intervention development, participant recruitment, and patient navigation. CONCLUSIONS Our research adds nuance to the existing literature on peer support services and navigation by profiling the multifaced roles that PHE served for participants. PHE proved instrumental to empowering participants to overcome structural and other barriers to healthcare, successfully engaging a group who previously avoided healthcare in clinical settings.
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Affiliation(s)
- Sophia Zamudio-Haas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA.
| | - Kim Koester
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luz Venegas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Ariana Salinas
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Cinthya Herrera
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Luis Gutierrez-Mock
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Layla Welborn
- La Clinica de La Raza, 3451 East 12th Street, CA, 94601, Oakland, USA
| | - Madeline B Deutsch
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
| | - Jae Sevelius
- Department of Medicine, University of California, 550 16th Street, 3rd Floor, CA, 94158, San Francisco, USA
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McKetchnie SM, White B, Fontenot H, Dormitzer J, Psaros C, Fitch C, O'Cleirigh C, Mayer KH, Krakower DS. Perspectives of Young Men Who Have Sex with Men on PrEP Adherence and Peer Navigation: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2037-2049. [PMID: 36940046 PMCID: PMC10330054 DOI: 10.1007/s10508-023-02579-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
HIV incidence is disproportionately high among young cisgender men who have sex with men (YMSM), but YMSM are less likely than adults to use HIV pre-exposure prophylaxis (PrEP). Among YMSM living with HIV, peer navigation programs have been effective in linkage to care and increasing medication adherence; such programs may aid HIV-uninfected YMSM in overcoming barriers to engagement in PrEP care. We conducted 32 semi-structured qualitative interviews at a community health center in Massachusetts, USA, specializing in sexual and gender minority health with four sub-groups of YMSM who: (1) had never discussed PrEP with a medical provider, (2) had discussed PrEP with a medical provider but declined a prescription, (3) were prescribed PrEP and have sub-optimal adherence (taking fewer than 4 pills per week), and (4) were prescribed PrEP and were optimally adherent. Domains addressed in the interviews included knowledge of PrEP and HIV prevention, barriers and facilitators to PrEP adherence, and attitudes toward peer navigation for PrEP. Interviews were transcribed and coded using thematic analysis methodology. Multiple themes emerged from the interviews, including finding that perceived costs, anticipated stigma, sexual activity, and relationship status influence PrEP uptake and adherence; establishing pill-taking routines is an important adherence facilitator; and peer navigators could offer benefits for PrEP adherence.
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Affiliation(s)
- Samantha M McKetchnie
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA.
- School of Social Work, Boston College, Newton, MA, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Bradley White
- Department of Nursing, MGH Institute of Health Professionals, Boston, MA, USA
| | - Holly Fontenot
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, HI, USA
| | | | - Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Calvin Fitch
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Conall O'Cleirigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
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8
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Antonini M, Silva IED, Elias HC, Gerin L, Oliveira AC, Reis RK. Barriers to Pre-Exposure Prophylaxis (PrEP) use for HIV: an integrative review. Rev Bras Enferm 2023; 76:e20210963. [PMID: 37377313 DOI: 10.1590/0034-7167-2021-0963] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/07/2022] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES to identify and synthesize scientific evidence on the barriers and difficulties for Pre-exposure Prophylaxis (PrEP) use and compliance for HIV. METHODS an integrative literature review, using the MEDLINE/PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Premier and Scopus (Elsevier) databases. RESULTS all (100%) the articles included identified that PrEP users experience some type of structural barrier related to health services such as long distance from the units, suboptimal logistics for taking pills and professional resistance to prescribing PrEP. Furthermore, 63.21% identified social barriers, such as stigma about sexuality and HIV, in addition to individual barriers such as alcohol use, adverse effects, and concerns about long-term toxicity. CONCLUSIONS the barriers to PrEP use are multifactorial. Effective interventions are needed to support PrEP users in accessing, complying with, and retaining health services.
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Affiliation(s)
| | | | | | - Larissa Gerin
- Universidade de São Paulo. Ribeirão Preto, São Paulo, Brasil
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9
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Rivera AV, Lopez JM, Braunstein SL. Exploring the Association Between Gender Affirmation and PrEP use Among Transgender Women in New York City. AIDS Behav 2023; 27:1523-1530. [PMID: 36574185 PMCID: PMC10191875 DOI: 10.1007/s10461-022-03944-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2022] [Indexed: 12/28/2022]
Abstract
Black and Hispanic/Latina transgender women are inequitably impacted by HIV; yet gaps in PrEP use exist. Among a sample of mostly Black and Hispanic/Latina transgender women in New York City, we aim to examine whether PrEP use was associated with gender affirmation and the use of gender-affirming health services. We found that PrEP use was more prevalent among those who used hormone therapy and those who had a provider they were comfortable speaking to about gender-related issues. In separate models, these associations were attenuated when adjusting for race/ethnicity, with those who use hormones being marginally more likely to report PrEP use and with Hispanic/Latina transgender women being more likely to have used PrEP, compared to Black transgender women. We found evidence of a potential association between medical gender affirmation and PrEP use. More research is needed to explore the social and structural contexts that are influenced by race/ethnicity that may serve to prevent PrEP uptake.
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Affiliation(s)
- Alexis V Rivera
- Bureau of Hepatitis, HIV, and STI, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN-44, 11101, Queens, NY, USA.
| | - Jasmine M Lopez
- Bureau of Division Management and Systems Coordination, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Sarah L Braunstein
- Bureau of Hepatitis, HIV, and STI, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN-44, 11101, Queens, NY, 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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11
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Nabunya R, Karis VMS, Nakanwagi LJ, Mukisa P, Muwanguzi PA. Barriers and facilitators to oral PrEP uptake among high-risk men after HIV testing at workplaces in Uganda: a qualitative study. BMC Public Health 2023; 23:365. [PMID: 36805698 PMCID: PMC9940677 DOI: 10.1186/s12889-023-15260-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 02/10/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Men in Uganda contribute significantly to new HIV infections annually yet PrEP uptake among them is low and those initiated are likely to discontinue usage. We explored the barriers and facilitators to PrEP uptake among high-risk men employed in private security services with negative HIV results after testing at workplaces in Uganda. METHODS An explorative qualitative study comprising in-depth participant interviews. Data were collected via telephone calls and manually analyzed by inductive content analysis. RESULTS Fifty-six (56) men participated, 27(48.21%) had heard about PrEP, and 29(51.79%) were willing to initiate it. Four categories emerged for the facilitators of PrEP uptake including the perceived need for HIV prevention, awareness creation, availability, and sexual freedom. Six categories emerged for the barriers to PrEP uptake. These were: Inaccessibility of PrEP services, Misinformation, Knowledge deficit, Medication-related barriers, Potential for increased risky sexual behavior, and Perceptions about PrEP use. CONCLUSION The findings suggest the need for healthcare providers to offer information regarding PrEP and HIV prevention services and mass sensitization campaigns to facilitate uptake. Participants recommend mass roll-out of PrEP to lower-level facilities and accessible pick-up points for men such as workplaces. The men also suggested the use of longer-acting PrEP modalities such as an injectable option or an option that is utilized specifically by the female partner. Finally, the stigma surrounding PrEP use could be reduced by the separation of PrEP and ART services at health facilities, or special pick-up days to reduce waiting times.
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Affiliation(s)
- Racheal Nabunya
- Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda.
| | - Victoria M. S. Karis
- grid.11194.3c0000 0004 0620 0548Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Lydia Joslyline Nakanwagi
- grid.11194.3c0000 0004 0620 0548Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Pius Mukisa
- grid.11194.3c0000 0004 0620 0548Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
| | - Patience A. Muwanguzi
- grid.11194.3c0000 0004 0620 0548Department of Nursing, School of Health Sciences, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, Uganda
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12
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Hollcroft MR, Gipson J, Barnes A, Mena L, Dombrowski JC, Ward LM, Khosropour CM. PrEP Acceptance among Eligible Patients Attending the Largest PrEP Clinic in Jackson, Mississippi. J Int Assoc Provid AIDS Care 2023; 22:23259582231167959. [PMID: 37032460 PMCID: PMC10088405 DOI: 10.1177/23259582231167959] [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: 09/22/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 04/11/2023] Open
Abstract
Compared to other states in the United States, Mississippi has the lowest uptake of PrEP relative to the number of people newly diagnosed with HIV in the state. Open Arms Healthcare Center is the largest provider of PrEP in Mississippi, and has systematically documented PrEP eligibility, offers, and acceptance (ie, agreed to undergo a clinical PrEP evaluation) from 2017 to mid-2020. In encounter-based analyses, we examined factors associated with PrEP acceptance. Among 721 encounters where patients were eligible for PrEP, staff offered PrEP at 680 (94%) of encounters (526 unique individuals); individuals accepted a PrEP offer at 58% of encounters. Accepting a PrEP offer was lowest (15.8%) among transgender/non-binary individuals and highest (93.3%) among individuals who reported having sex partners living with HIV. This clinic's model worked to offer PrEP to a highly impacted population, though there is a need to enhance PrEP acceptance for key groups such as transgender/non-binary individuals.
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Affiliation(s)
| | - June Gipson
- Open Arms Healthcare Center, Jackson, MS, USA
| | | | - Leandro Mena
- Open Arms Healthcare Center, Jackson, MS, USA
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Lori M. Ward
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
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13
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Dang M, Scheim AI, Teti M, Quinn KG, Zarwell M, Petroll AE, Horvath KJ, John SA. Barriers and Facilitators to HIV Pre-Exposure Prophylaxis Uptake, Adherence, and Persistence Among Transgender Populations in the United States: A Systematic Review. AIDS Patient Care STDS 2022; 36:236-248. [PMID: 35687813 PMCID: PMC9242706 DOI: 10.1089/apc.2021.0236] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
HIV pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV; however, PrEP use among transgender individuals remains low. We conducted a systematic review to identify barriers and facilitators to PrEP uptake, adherence, and persistence among transgender individuals in the United States. We conducted a literature search in PubMed and CINAHL databases in March 2021 and followed PRISMA guidelines. Studies were eligible if they were published in a peer-reviewed journal and reported interest, uptake, adherence, and/or persistence of PrEP use among transgender individuals. Articles that did not disaggregate results for transgender participants were excluded. Data from included articles were coded using content analysis and narratively synthesized using a framework matrix. We screened 254 unique articles published after US Food and Drug Administration approval of PrEP, and 33 articles were included in the review. Five themes were identified in the literature, including (1) PrEP concentrations were lower among individuals taking feminizing hormones, but the difference did not appear clinically significant; (2) concerns regarding interactions between gender-affirming hormone therapy and PrEP remain a large barrier; (3) PrEP initiation may facilitate increased self-advocacy and self-acceptance; (4) lack of trust in medical institutions impacts PrEP uptake; and (5) social networks have a significant influence on PrEP knowledge, interest, and adherence. Additional research is needed involving transgender men and nonbinary persons, and efforts to improve PrEP persistence among the transgender community are needed. Training health care providers to provide inclusive and affirming care is perhaps one of the strongest areas for intervention to increase PrEP uptake and persistence.
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Affiliation(s)
- Madeline Dang
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michelle Teti
- Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, Missouri, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Address correspondence to: Steven A. John, PhD, MPH, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI 53202, USA
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14
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Starbuck L, Golub SA, Klein A, Harris AB, Guerra A, Rincon C, Radix AE. Brief Report: Transgender Women and Preexposure Prophylaxis Care: High Preexposure Prophylaxis Adherence in a Real-World Health Care Setting in New York City. J Acquir Immune Defic Syndr 2022; 90:15-19. [PMID: 35013087 PMCID: PMC8986585 DOI: 10.1097/qai.0000000000002915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transgender women and trans feminine individuals (TGW/TFI) are a high priority population for the provision of HIV preexposure prophylaxis (PrEP) care within the United States, but there is limited research that focuses specifically on PrEP adherence within this population. SETTING Observational study of patients prescribed PrEP at a community-based health center. METHODS We enrolled 100 TGW/TFI PrEP patients at a community health center during clinic visits. Adherence data were collected at 3 time points, using self-report surveys, patient interviews, and urine assays measuring tenofovir. Data were summarized descriptively. RESULTS The sample was diverse in age, race/ethnicity, and socioeconomic characteristics. Participants demonstrated strong PrEP adherence; at least 80% of the sample reported 90% or greater adherence at each time point. Concordance between self-report and urine assay was high. Among patients who reported taking PrEP within the past 48 hours, 82%-92% had detectable urine tenofovir. However, many patients reported PrEP stop periods of 4 or more days (28%-39% per time point). CONCLUSIONS Our data highlight TGW/TFI's capacity to adhere to daily PrEP and sustain PrEP use over time. The concordance between patient self-report and urine TFV levels suggest that providers can trust patient reports of PrEP adherence behavior and support the use of adherence conversations in clinical settings, without the need for point of care biological monitoring. Findings also underscore the importance of continued attention to drivers of PrEP stops at the patient, clinic, and systems levels and the development of strategies that support sustained PrEP use.
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Affiliation(s)
- Lila Starbuck
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Sarit A. Golub
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
- Basic and Applied Social Psychology (BASP) PhD Program, Department of Psychology, Graduate Center of the City University of New York, New York, NY USA
| | - Augustus Klein
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | | | - Amiyah Guerra
- Callen-Lorde Community Health Center, New York, NY, USA
| | - Christopher Rincon
- Department of Psychology, Hunter College of the City University of New York, 695 Park Avenue, New York, NY, 10065, USA
| | - Asa E. Radix
- Callen-Lorde Community Health Center, New York, NY, USA
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15
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Starbuck L, Golub SA, Klein A, Harris AB, Guerra A, Rincon C, Radix AE. Brief Report: Transgender Women and Preexposure Prophylaxis Care: High Preexposure Prophylaxis Adherence in a Real-World Health Care Setting in New York City. J Acquir Immune Defic Syndr 2022. [PMID: 35013087 DOI: 10.1097/qai.0000000000002915]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
BACKGROUND Transgender women and trans feminine individuals (TGW/TFI) are a high priority population for the provision of HIV preexposure prophylaxis (PrEP) care within the United States, but there is limited research that focuses specifically on PrEP adherence within this population. SETTING Observational study of patients prescribed PrEP at a community-based health center. METHODS We enrolled 100 TGW/TFI PrEP patients at a community health center during clinic visits. Adherence data were collected at 3 time points, using self-report surveys, patient interviews, and urine assays measuring tenofovir. Data were summarized descriptively. RESULTS The sample was diverse in age, race/ethnicity, and socioeconomic characteristics. Participants demonstrated strong PrEP adherence; at least 80% of the sample reported 90% or greater adherence at each time point. Concordance between self-report and urine assay was high. Among patients who reported taking PrEP within the past 48 hours, 82%-92% had detectable urine tenofovir. However, many patients reported PrEP stop periods of 4 or more days (28%-39% per time point). CONCLUSIONS Our data highlight TGW/TFI's capacity to adhere to daily PrEP and sustain PrEP use over time. The concordance between patient self-report and urine TFV levels suggest that providers can trust patient reports of PrEP adherence behavior and support the use of adherence conversations in clinical settings, without the need for point of care biological monitoring. Findings also underscore the importance of continued attention to drivers of PrEP stops at the patient, clinic, and systems levels and the development of strategies that support sustained PrEP use.
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Affiliation(s)
- Lila Starbuck
- Department of Psychology, Hunter College of the City University of New York, New York, NY
| | - Sarit A Golub
- Department of Psychology, Hunter College of the City University of New York, New York, NY
- Department of Psychology, Graduate Center of the City University of New York, New York, NY; and
| | - Augustus Klein
- Department of Psychology, Hunter College of the City University of New York, New York, NY
| | - Alexander B Harris
- Department of Medicine, Callen-Lorde Community Health Center, New York, NY
| | - Amiyah Guerra
- Department of Medicine, Callen-Lorde Community Health Center, New York, NY
| | - Christopher Rincon
- Department of Psychology, Hunter College of the City University of New York, New York, NY
| | - Asa E Radix
- Department of Medicine, Callen-Lorde Community Health Center, New York, NY
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16
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Hojilla JC, Hurley LB, Marcus JL, Satre DD, Silverberg MJ, Zaritsky EF, Getahun D, Goodman M, Volk JE. HIV Pre-exposure Prophylaxis Continuum of Care Among Transgender Individuals in an Integrated Health care System. J Acquir Immune Defic Syndr 2022; 89:e30. [PMID: 34723924 PMCID: PMC8837673 DOI: 10.1097/qai.0000000000002853] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- J. Carlo Hojilla
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, CA, USA
| | - Leo B. Hurley
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
| | - Julia L. Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Derek D. Satre
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, USA
- Weill Institute for Neurosciences, Department of Psychiatry, University of California, San Francisco, CA, USA
| | | | - Eve F. Zaritsky
- Department of Obstetrics and Gynecology, Kaiser Permanente Oakland Medical Centre, Oakland, CA, USA
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jonathan E. Volk
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco Medical Centre, San Francisco, CA, USA
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17
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Exploring barriers and facilitators to PrEP use among transgender women in two urban areas: implications for messaging and communication. BMC Public Health 2022; 22:17. [PMID: 34991548 PMCID: PMC8740429 DOI: 10.1186/s12889-021-12425-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trans women are at increased risk for HIV infection yet are less likely to use pre-exposure prophylaxis (PrEP) medication as a preventive measure. PrEP messaging and marketing has focused on men who have sex with men (MSM) or included trans women as a subset of MSM, ignoring the potential barriers to PrEP use unique to trans women. Little is known about how this group conceptualizes PrEP, what knowledge gaps still exist, and how trans women believe PrEP should be communicated to increase use. METHODS This qualitative study conducted focus groups (n = 5) in Philadelphia and Sacramento with trans women to assess these issues. RESULTS Twelve sub-themes were found related to five main domains, including PrEP knowledge, benefits, barriers, community-related considerations, and messaging/marketing. Findings indicate that knowledge of PrEP is still low and beliefs about PrEP's effects on hormone use persist. Most importantly, participants voiced a demand for culturally appropriate trans-specific messages in HIV prevention interventions and communication. CONCLUSIONS Without acknowledging specific barriers to PrEP uptake among transgender women separate from those of MSM and incorporating gender affirmation into PrEP education, simply knowing PrEP is available may not motivate trans women to use PrEP. This has important implications for future efforts to communicate about PrEP with trans women.
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18
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Summers NA, Huynh TT, Dunn RC, Cross SL, Fuchs CJ. Effects of Gender-Affirming Hormone Therapy on Progression Along the HIV Care Continuum in Transgender Women. Open Forum Infect Dis 2021; 8:ofab404. [PMID: 34514019 PMCID: PMC8415531 DOI: 10.1093/ofid/ofab404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/27/2021] [Indexed: 01/03/2023] Open
Abstract
Background Progression along the HIV care continuum has been a key focus for improving outcomes for people with HIV (PWH). Transgender women with HIV (TGWWH) have not made the same progress as their cisgender counterparts. Methods All PWH identifying as transgender women receiving care at our clinic from 1/1/2015 to 12/31/2019 were identified from the electronic health records (EHRs) using International Classification of Diseases (ICD) codes. Demographics, laboratory data, prescription of gender-affirming hormone therapy (GAHT), and visit history were abstracted from the EHR. Retention in care and viral suppression were defined using Centers for Disease Control and Prevention definitions. The proportions of TGWWH who were consistently retained in care or virally suppressed over time were calculated using a binary response generalized mixed model including random effects and correlated errors. Results Of the 76 PWH identified by ICD codes, 2 were excluded for identifying as cisgender and 15 for insufficient records, leaving 59 TGWWH included for analysis. Patients were on average 35 years old and Black (86%), with a median CD4 count of 464 cells/µL. There were 13 patients on GAHT at study entry and 31 receiving GAHT at any point during the study period. Fifty-five percent were virally suppressed at study entry and 86% at GAHT initiation. The proportion of TGWWH who were consistently virally suppressed over time was greater among those receiving GAHT compared with those who were not (P = .04). Conclusions Rates of viral suppression were significantly greater among TGWWH receiving GAHT when compared with those who were not. More research to evaluate the reasons behind this effect is needed.
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Affiliation(s)
- Nathan A Summers
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA.,Adult Special Care Center, Regional One Health, Memphis, Tennessee, USA
| | - Trang T Huynh
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
| | - Ruth C Dunn
- Department of Medicine, University of Tennessee Health Science Center College of Medicine, Memphis, Tennessee, USA
| | - Sara L Cross
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Christian J Fuchs
- Division of Infectious Diseases, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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19
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Klasko-Foster L, Wilson K, Bleasdale J, Gabriel SJ, Przybyla S. "Shades of risk": Understanding current PrEP users' sexually transmitted infection perceptions. AIDS Care 2021; 34:353-358. [PMID: 34308702 DOI: 10.1080/09540121.2021.1957762] [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: 10/20/2022]
Abstract
ABSTRACTPre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention strategy. Given the possibility of increased sexual risk-taking and acquisition of other sexually transmitted infections (STIs) following PrEP initiation, it is important to explore STI risk perceptions both before and after PrEP initiation to understand the extent to which these perceptions inform decisions to engage in condomless sex. Semi-structured qualitative interviews were conducted with men who have sex with men currently using PrEP (n = 30). Prior to analysis, PrEP users were categorized into four subgroups based on condom use behavior post-PrEP initiation: (1) condom continuers (2) condomless sex continuers, (3) condomless sex increasers, and (4) condomless sex decreasers. Thematic analysis revealed two major themes that elucidated differences in (1) the appraisal of HIV risk relative to other STIs and (2) the importance of partner communication in determining STI risk perceptions by subgroup. Most PrEP users demonstrated no behavioral change after PrEP initiation. Those engaging in condomless sex prior to PrEP initiation also continued that behavior while taking PrEP. Results of this study support a tailored approach to PrEP counseling based on individual STI risk appraisal and motivations to initiate and continue PrEP.
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Affiliation(s)
| | - Kennethea Wilson
- School of Public Health and Health Professions, University at Buffalo, SUNY
| | - Jacob Bleasdale
- School of Public Health and Health Professions, University at Buffalo, SUNY
| | - Steven J Gabriel
- School of Public Health and Health Professions, University at Buffalo, SUNY
| | - Sarahmona Przybyla
- School of Public Health and Health Professions, University at Buffalo, SUNY
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20
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Fehrenbacher AE, Fletcher JB, Clark K, Kisler KA, Reback CJ. Social Networks and Exchange Sex among Transgender Women. JOURNAL OF SEX RESEARCH 2021; 58:743-753. [PMID: 33779427 PMCID: PMC8273090 DOI: 10.1080/00224499.2021.1892575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Transgender women are more likely to exchange sex than cisgender individuals. This study investigated how social networks were associated with exchange sex among transgender women in Los Angeles County. From July 2015 to September 2016, transgender women (N = 271; "egos") reported their sexual and substance use behaviors and perceptions of the same behaviors among their peers (N = 2,619; "alters"). Clustered logistic and negative binomial regressions were used to model odds of exchange sex and number of exchange sex partners in the past 6 months, respectively. Transgender women who perceived that any of their peers were engaged in exchange sex were approximately four times more likely to exchange sex themselves and reported three times as many exchange sex partners as those who did not perceive any peers engaged in exchange sex. Perceived ecstasy use among peers was associated with higher odds of exchange sex and more exchange sex partners, whereas perceived marijuana use among peers was associated with lower odds of exchange sex and fewer exchange sex partners. Peer behaviors were strongly associated with both transgender women's likelihood and rate of engagement in exchange sex. Risk reduction interventions with transgender women should attend to network dynamics that are often overlooked in existing programs.
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Affiliation(s)
- Anne E. Fehrenbacher
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
| | | | - Kirsty Clark
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Kimberly A. Kisler
- Friends Research Institute, Inc., Los Angeles, CA, USA
- Department of Public Health, Rongxiang Xu College of Health and Human Services, California State University, Los Angeles, CA, USA
| | - Cathy J. Reback
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
- UCLA Center for HIV Identification, Prevention, and Treatment Services, Los Angeles, CA, USA
- Friends Research Institute, Inc., Los Angeles, CA, USA
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21
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Wharton MJ, Harris OO, Chapman Lambert C, LeGrand S. "The More Things Change, the More Things Remain the Same": It's Time to Dismantle Structural Inequalities of Racism, Discrimination, and Health Disparities. J Assoc Nurses AIDS Care 2021; 32:413-417. [PMID: 34115721 DOI: 10.1097/jnc.0000000000000283] [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: 10/21/2022]
Affiliation(s)
- Mitchell J Wharton
- Mitchell J. Wharton, PhD, RN, FNP-BC, CNS, is an Associate Dean for Equity and Inclusion and Associate Professor of Clinical Nursing, School of Nursing, University of Rochester, Rochester, New York, USA. Orlando O. Harris, PhD, RN, MPH, FNP, is an Assistant Professor, Department of Community Health Systems, School of Nursing, University of California, San Francisco, San Francisco, California, USA. Crystal Chapman Lambert, PhD, CRNP,FNP-BC, ACRN, is an Associate Professor, School of Nursing, The University of Alabama at Birmingham, Birmingham, Alabama, USA. Sara LeGrand, PhD, is an Associate Research Professor, Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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22
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Farvid P, Vance TA, Klein SL, Nikiforova Y, Rubin LR, Lopez FG. The health and wellbeing of transgender and gender
non‐conforming
people of colour in the United States: A systematic literature search and review. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2555] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Panteá Farvid
- Psychology, Schools of Public Engagement The New School New York New York USA
| | - Thomas A. Vance
- Psychology, Schools of Public Engagement The New School New York New York USA
- Boys and Girls Clubs of America Atlanta Georgia USA
| | - Samantha L. Klein
- Psychology, School for Social Research The New School New York New York USA
| | | | - Lisa R. Rubin
- Psychology, School for Social Research The New School New York New York USA
| | - Felix G. Lopez
- Psychology, School for Social Research The New School New York New York USA
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