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Campbell CK, Kielhold K, Reynolds HE, Vincent W, Siconolfi DE, Ramos SD, Ogunbajo A, Kegeles SM, Storholm ED. LAI-ART Awareness, Willingness, Barriers and Facilitators among Black Sexual Minority Men Living with HIV in the US South. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:602. [PMID: 38791816 PMCID: PMC11121555 DOI: 10.3390/ijerph21050602] [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] [Received: 03/02/2024] [Revised: 05/02/2024] [Accepted: 05/04/2024] [Indexed: 05/26/2024]
Abstract
Black sexual minority men (BSMM) continue to bear a disproportionate burden of HIV in the United States, with the highest incidence and prevalence in the southern region of the country. In Texas, BSMM living with HIV (BSMM+) have the lowest rates of viral suppression of all SMM and have lower antiretroviral treatment (ART) adherence than white and Hispanic SMM. Long-acting injectable ART (LAI-ART) can potentially overcome several barriers to daily oral ART adherence (e.g., stigma, forgetfulness, pill fatigue). However, little is known about the knowledge, willingness, barriers, and facilitators regarding LAI-ART among BSMM+. From July 2022 to September 2023, we conducted in-depth, semi-structured interviews with 27 BSMM+ from the Houston and Dallas Metropolitan Areas, Texas. Data were analyzed using a thematic analysis approach. Most men knew about LAI-ART, but their understanding varied based on their existing sources of information. Some men were enthusiastic, some were cautious, and some reported no interest in LAI-ART. Barriers to LAI-ART included a lack of public insurance coverage of LAI-ART; fear of needles and side effects; the frequency of injection visits; the requirement of viral suppression before switching from oral ART to LAI-ART; and satisfaction with oral daily ART. Motivators of LAI-ART uptake included the eliminated burden of daily pills and reduced anxiety about possibly missing doses. BSMM+ may be among those who could most benefit from LAI-ART, though more research is needed to understand which factors influence their willingness and how the barriers to LAI-ART might be addressed, particularly among diverse communities of SMM of color.
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Affiliation(s)
- Chadwick K. Campbell
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA; (K.K.); (S.D.R.)
| | - Kirstin Kielhold
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA; (K.K.); (S.D.R.)
- School of Public Health, San Diego State University, San Diego, CA 92182, USA; (H.E.R.); (E.D.S.)
| | - Hannah E. Reynolds
- School of Public Health, San Diego State University, San Diego, CA 92182, USA; (H.E.R.); (E.D.S.)
| | - Wilson Vincent
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA 19122, USA;
| | | | - Stephen D. Ramos
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA; (K.K.); (S.D.R.)
- School of Public Health, San Diego State University, San Diego, CA 92182, USA; (H.E.R.); (E.D.S.)
| | | | - Susan M. Kegeles
- Department of Medicine, University of California San Francisco, San Francisco, CA 94158, USA;
| | - Erik D. Storholm
- School of Public Health, San Diego State University, San Diego, CA 92182, USA; (H.E.R.); (E.D.S.)
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Ahmed M, Nijhawan AE, Gao A, Ahn C, Chow JY. Association Between Substance Abuse and Mental Illness Symptoms Screener (SAMISS) Scores and HIV Care Continuum Outcomes in People Newly Diagnosed with HIV in the US South. AIDS Behav 2024; 28:1731-1740. [PMID: 38361170 DOI: 10.1007/s10461-024-04287-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
Mental illness (MI) and substance use (SU) are highly prevalent among people with HIV (PWH) and impact care outcomes. The Substance Abuse and Mental Illness Symptoms Screener (SAMISS) is a validated screener for MI and SU, but it is unknown how screening results at entry to care correlate with subsequent HIV outcomes. This is a retrospective chart review of individuals newly diagnosed with HIV between 2016 and 2019 in a Southern US, safety-net clinic. Baseline demographics, HIV risk factors, socioeconomic variables, and SAMISS screening scores were collected. Outcomes included retention in care, achieving virologic suppression (VS), and continuous VS. Data analyses included stepwise Cox and logistic multivariate regression modeling. Among the 544 newly diagnosed PWH, mean age was 35, 76% were male, 46% non-Hispanic Black, 40% Hispanic/other. Overall, 35% screened positive for SU and 41% for MI. A positive SU (odds ratio (OR) 0.66, p = 0.04) or MI (OR 0.65, p = 0.03) SAMISS screening was associated with lower retention in care in univariate analysis, but was not statistically significant after adjusting for other variables. Positive SAMISS screening for SU and MI were both associated with reduced continuous VS in univariate and multivariate analyses (SU: adjusted OR (aOR) 0.67, p = 0.05; MI: aOR 0.66, p = 0.03). SAMISS is a useful tool for prospectively identifying individuals at risk for low retention in care and for not achieving sustained VS. Future interventions guided by SAMISS may improve HIV care continuum outcomes.
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Affiliation(s)
- Manal Ahmed
- University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Ank E Nijhawan
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ang Gao
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Chul Ahn
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jeremy Y Chow
- Department of Internal Medicine, Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA.
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Dove-Medows E, Knox J, Valentine-Graves M, Sullivan P. I Can't Afford it Right Now, So it Doesn't Matter" Structural Drivers of Viral Suppression Among Men Who Have Sex With Men: A Longitudinal Qualitative Approach. RESEARCH SQUARE 2024:rs.3.rs-4001004. [PMID: 38585772 PMCID: PMC10996790 DOI: 10.21203/rs.3.rs-4001004/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Racial disparities in outcomes across the HIV care continuum, including in viral suppression, have been observed among sexual minority men (SMM) living with HIV. Structural factors are drivers of these disparities, yet data is lacking at the individual level on how day-to-day experiences of these structural factors contribute to losing viral suppression, and what happens to SMM after loss of viral suppression, including whether they achieve viral suppression again over time. Method We conducted longitudinal semi-structured interviews with a subsample of men living with HIV drawn from a larger cohort study. Three Black and 2 White SMM participated in a series of three interviews after they lost viral suppression, and then again at 6- and 12-months follow-up. The focus of the interviews was on experiences with structural issues (e.g., housing, transportation, employment, insurance) and their impact on HIV care. Results Content analysis showed that multiple structural issues disrupted HIV care, particularly insurance, housing stability, transportation, and employment. Black SMM described experiencing multiple compounding structural barriers, and they struggled to achieve viral suppression again. Conclusions These data show how SMM living with HIV are impacted by structural barriers to HIV care over time. Black SMM experienced multiple, compounding barriers, and these negatively impacted HIV care outcomes over time. Efforts to address long-standing HIV care-related disparities need to address the mechanisms of structural racism.
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Knox JR, Dolotina B, Moline T, Matthews I, Durrell M, Hanson H, Almirol E, Hotton A, Pagkas-Bather J, Chen YT, English D, Manuzak J, Rower JE, Miles C, Millar B, Jean-Louis G, Rendina HJ, Martins SS, Grov C, Hasin DS, Carrico AW, Shoptaw S, Schneider JA, Duncan DT. HIV Prevention and Care Among Black Cisgender Sexual Minority Men and Transgender Women: Protocol for an HIV Status-Neutral Cohort Study Using an Observational-Implementation Hybrid Approach. JMIR Res Protoc 2023; 12:e48548. [PMID: 38039075 PMCID: PMC10724817 DOI: 10.2196/48548] [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: 05/01/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Black cisgender gay, bisexual, and other sexual minority men (SMM) and transgender women (TW) continue to be heavily affected by HIV. Further research is needed to better understand HIV prevention and care outcomes in this population. In particular, there is a need for research examining the impact of substance use and sleep health on HIV prevention and treatment outcomes among Black SMM and TW. OBJECTIVE This paper outlines the study methods being used in the recently launched follow-up study to the Neighborhoods and Networks (N2) study, which we refer to as N2 Part 2 (N2P2). N2P2 aims to address this gap in the literature, build off the findings of the original N2 study, and identify socioenvironmental determinants of health, including whether neighborhood and network factors mediate and moderate these relationships. METHODS Building on the N2 cohort study in Chicago from 2018 to 2022, N2P2 used a prospective longitudinal cohort design and an observational-implementation hybrid approach. With sustained high levels of community engagement, we aim to recruit a new sample of 600 Black SMM and TW participants residing in the Chicago metropolitan statistical area. Participants are asked to participate in 3 study visits across an 18-month study period (1 visit every 9 months). Four different forms of data are collected per wave: (1) an in-person survey, (2) biological specimen collection, (3) a daily remote ecological momentary assessment for 14 days after each study visit, and (4) data from electronic health records. These forms of data collection continue to assess neighborhood and network factors and specifically explore substance use, sleep, immune function, obesity, and the implementation of potential interventions that address relevant constructs (eg, alcohol use and pre-exposure prophylaxis adherence). RESULTS The N2P2 study was funded in August 2021 by the National Institute of Drug Abuse (R01DA054553 and R21DA053156) and National Heart, Lung, and Blood Institute (R01HL160325). This study was launched in November 2022. Recruitment and enrollment for the first wave of data collection are currently ongoing. CONCLUSIONS The N2P2 study is applying innovative methods to comprehensively explore the impacts of substance use and sleep health on HIV-related outcomes among an HIV status-neutral cohort of Black SMM and TW in Chicago. This study is applying an observational-implementation hybrid design to help us achieve findings that support rapid translation, a critical priority among populations such as Black SMM and TW that experience long-standing inequities with regard to HIV and other health-related outcomes. N2P2 will directly build off the findings that have resulted from the original N2 study among Black SMM and TW in Chicago. These findings provide a better understanding of multilevel (eg, individual, network, and neighborhood) factors that contribute to HIV-related outcomes and viral suppression among Black SMM and TW. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/48548.
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Affiliation(s)
- Justin R Knox
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Dolotina
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Tyrone Moline
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Isabella Matthews
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Mainza Durrell
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Hillary Hanson
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Ellen Almirol
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Anna Hotton
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Jade Pagkas-Bather
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Yen-Tyng Chen
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Devin English
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Jennifer Manuzak
- Division of Immunology, School of Medicine, Tulane University, New Orleans, LA, United States
| | - Joseph E Rower
- Center for Human Toxicology, University of Utah, Salt Lake City, UT, United States
| | - Caleb Miles
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Brett Millar
- Department of Psychiatry, Rutgers University, New Brunswick, NJ, United States
| | - Girardin Jean-Louis
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - H Jonathon Rendina
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| | - Silvia S Martins
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Christian Grov
- Einstein-CUNY-Rockefeller Center for AIDS Research, School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Deborah S Hasin
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Adam W Carrico
- Department of Psychiatry and Behavioral Sciences, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
| | - Steve Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - John A Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, United States
| | - Dustin T Duncan
- Mailman School of Public Health, Columbia University, New York, NY, United States
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Chahine EB, Nunez-Medina RM, Williams K, Kuretski J, Maarsingh H. Comparing Safety and Effectiveness of Antiretroviral Therapy in a Diverse Population of Older People With HIV. Sr Care Pharm 2023; 38:472-485. [PMID: 37885097 DOI: 10.4140/tcp.n.2023.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background Advances in antiretroviral therapy (ART) enable people with HIV to live longer, healthier lives. However, older people with HIV (OPWH) are more susceptible to long-term toxicity and drug interactions associated with ART. Racial and ethnic minorities have specific social determinants of health, which increase their risks of negative outcomes. Objective To determine if there were differences in the safety and effectiveness of ART in White, Black, and Hispanic OPWH. Methods A retrospective observational study was conducted on patients receiving care between January 1, 2017, and December 31, 2022, at two affiliated HIV clinics in South Florida. The primary effectiveness endpoint was the percentage of OPWH with undetectable viral load (< 50 copies/mL) throughout the study. Secondary safety endpoints were changes in median metabolic, hepatic, and renal parameters. A two-way analysis of variance or the Chi-square test was used to determine differences between groups. Results A total of 116 White, 42 Black, and 40 Hispanic OPWH were included. Upon enrollment, most patients (90.7%) were receiving ART. Of these, the percentage with undetectable viral load was lower among Black (61.8%) compared with White (85.8%; P < 0.01) or Hispanic (83.3%; P < 0.05) patients. Similarly, throughout the study after the first visit, the percentage with undetectable viral load was lower among Black (61.6%) compared with White (84.7%; P < 0.05) or Hispanic (83.3%; P = 0.12) patients. However, there were no significant differences in the percentage of virally suppressed (< 200 copies/mL) participants throughout the study after the first visit between Black (88.5%), White (94.9%), and Hispanic (96.7%) patients. Additionally, no significant changes in safety endpoints were observed among the groups throughout the study. Conclusion Fewer Black OPWH had undetectable viral load upon enrollment and throughout the study compared with White or Hispanic OPWH, suggesting the need to provide more targeted interventions for Black patients.
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Affiliation(s)
- Elias B Chahine
- 1Palm Beach Atlantic University Gregory School of Pharmacy, West Palm Beach, Florida
| | | | - Kiara Williams
- 1Palm Beach Atlantic University Gregory School of Pharmacy, West Palm Beach, Florida
| | - Jennifer Kuretski
- 2Palm Beach Atlantic University School of Nursing, West Palm Beach, Florida
| | - Harm Maarsingh
- 1Palm Beach Atlantic University Gregory School of Pharmacy, West Palm Beach, Florida
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6
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Coleman JL, Jones M, Washington D, Almirol E, Forberg P, Dyer TV, Spieldenner A, Martinez O, Rodriguez-Diaz CE, Parker SD, Schneider JA, Brewer R. Using the Meaningful Involvement of People Living with HIV/AIDS (MIPA) Framework to Assess the Engagement of Sexual Minority Men of Color in the US HIV Response: a Literature Review. J Racial Ethn Health Disparities 2023; 10:2374-2396. [PMID: 36171496 PMCID: PMC10098811 DOI: 10.1007/s40615-022-01417-0] [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: 07/28/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/29/2022]
Abstract
Black and Latino sexual minority men (SMM) continue to be disproportionately impacted by HIV. We utilized eight components of the Meaningful Involvement of People Living with HIV/AIDS (MIPA) framework to assess the engagement of Black and Latino SMM. Thirty-six (36) studies were included in the literature review. Forty-two percent of studies were Black SMM-specific, followed by Latino SMM-specific (31%) studies. Twenty-eight percent of studies were conducted among both groups. Most studies (72%) were intervention-related and focused on HIV prevention. The top five most common methods of community engagement were focus groups (39%), followed by interviews (36%), community-based participatory research (14%), the utilization of community advisory boards or peer mentorship (11%), and the establishment of multi-stakeholder coalitions, observations, or surveys (8%). We documented at least 7 MIPA components in 47% of the included studies. Community-based participatory research was more commonly utilized to engage Latino SMM. Researchers were more likely to initiate the engagement across all included studies. Few studies documented how Black and Latino SMM perceived the engagement. Engagement responsiveness was a well-documented MIPA component. In terms of engagement power dynamics, there were several examples of power imbalances, especially among Black SMM-specific studies. The inclusion of Black and Latino SMM had robust impacts on HIV research and interventions. There were limited examples of engagement capacity and maintenance. This is one of the first studies focused on utilizing MIPA to document the engagement of SMM of color. MIPA served as a useful framework for understanding the engagement of SMM of color in the US HIV response. The engagement of SMM of color is critical to reducing health inequities.
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Affiliation(s)
| | - Mickaya Jones
- Ann & Robert H. Lurie Children's Hospital, Chicago, IL, USA
| | | | - Ellen Almirol
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
| | | | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, University of Maryland, College Park, MD, USA
| | - Andrew Spieldenner
- MPact Global, Oakland, CA, USA
- California State University-San Marcos, San Marcos, CA, USA
| | - Omar Martinez
- College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Carlos E Rodriguez-Diaz
- Department of Prevention and Community Health, George Washington University - Milken Institute School of Public Health, Washington, DC, USA
| | - Sharon D Parker
- North Carolina Agricultural and Technical State University, Greensboro, NC, USA
| | - John A Schneider
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA
| | - Russell Brewer
- Department of Medicine, University of Chicago, 5837 S. Maryland Avenue, MC 5065, Chicago, IL, 60637, USA.
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7
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Wien S, Guest JL, Luisi N, Taussig J, Kramer MR, Stephenson R, Millett G, del Rio C, Sullivan PS. Racial differences in the association of undetectable HIV viral load and transportation to an HIV provider among men who have sex with men in Atlanta, Georgia: a health equity perspective. AIDS Care 2023; 35:1154-1163. [PMID: 36878481 PMCID: PMC10426396 DOI: 10.1080/09540121.2023.2182871] [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: 09/23/2022] [Accepted: 02/14/2023] [Indexed: 03/08/2023]
Abstract
There are inequities in HIV outcomes among Black gay, bisexual, and other sexual minority men who have sex with men (GBMSM) compared to GBMSM overall, including access to transportation to HIV care. It is unclear if the relationship between transportation and clinical outcomes extends to viral load. We assessed the relationship between transportation dependence to an HIV provider and undetectable viral load among Black and White GBMSM in Atlanta. We collected transportation and viral load information from GBMSM with HIV from 2016-2017 (n = 345). More Black than White GBMSM had a detectable viral load (25% vs. 15%) and took dependent (e.g. public) transportation (37% vs. 18%). Independent (e.g. car) transportation was associated with undetectable viral load for White GBMSM (cOR 3.61, 95% CI 1.45, 8.97) but was attenuated by income (aOR. 2.29, 95% CI 0.78, 6.71), and not associated for Black GBMSM (cOR 1.18, 95% CI 0.58, 2.24). One possible explanation for no association for Black GBMSM is that there are more competing barriers to HIV care for Black GBMSM than White GBMSM. Further investigation is needed to confirm whether 1) transportation is unimportant for Black GBMSM or 2) transportation interacts with additional factors not considered in this analysis.
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Affiliation(s)
- Simone Wien
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jodie L. Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jennifer Taussig
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Michael R. Kramer
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rob Stephenson
- Department of Systems, Populations, and Leadership, School of Nursing, and the Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Greg Millett
- American Foundation for AIDS Research, Washington DC, USA
| | - Carlos del Rio
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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8
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Evans KN, Martinez O, King H, van den Berg JJ, Fields EL, Lanier Y, Hussen SA, Malavé-Rivera SM, Duncan DT, Gaul Z, Buchacz K. Utilizing Community Based Participatory Research Methods in Black/African American and Hispanic/Latinx Communities in the US: The CDC Minority HIV Research Initiative (MARI-Round 4). J Community Health 2023; 48:698-710. [PMID: 36943607 PMCID: PMC10028312 DOI: 10.1007/s10900-023-01209-5] [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: 03/02/2023] [Indexed: 03/23/2023]
Abstract
The Centers for Disease Control and Prevention Minority HIV Research Initiative (MARI) funded 8 investigators in 2016 to develop HIV prevention and treatment interventions in highly affected communities. We describe MARI studies who used community-based participatory research methods to inform the development of interventions in Black/African American and Hispanic/Latinx communities focused on sexual minority men (SMM) or heterosexual populations. Each study implemented best practice strategies for engaging with communities, informing recruitment strategies, navigating through the impacts of COVID-19, and disseminating findings. Best practice strategies common to all MARI studies included establishing community advisory boards, engaging community members in all stages of HIV research, and integrating technology to sustain interventions during the COVID-19 pandemic. Implementing community-informed approaches is crucial to intervention uptake and long-term sustainability in communities of color. MARI investigators' research studies provide a framework for developing effective programs tailored to reducing HIV-related racial/ethnic disparities.
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Affiliation(s)
- Kimberly N Evans
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Omar Martinez
- Department of Population Health Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Hope King
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Errol L Fields
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Yzette Lanier
- Rory Meyers College of Nursing, New York University, New York, NY, USA
| | - Sophia A Hussen
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Souhail M Malavé-Rivera
- School of Public Health, University of Puerto Rico-Medical Sciences Campus, San Juan, PR, USA
| | - Dustin T Duncan
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Zaneta Gaul
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Social & Scientific Systems affiliate of DLH, Atlanta, GA, USA
| | - Kate Buchacz
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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9
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Tilchin C, Wagner J, Schumacher CM, Ghanem KG, Hamill MM, Rompalo A, Fields E, Latkin CA, Greenbaum A, Jennings JM. HIV Transmission Potential and Sex Partner Concurrency: Evidence for Racial Disparities in HIV Risk Among Gay and Bisexual Men (MSM). AIDS Behav 2022; 26:709-718. [PMID: 34405302 PMCID: PMC8840903 DOI: 10.1007/s10461-021-03430-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/25/2022]
Abstract
We determined whether racial disparities in HIV infection among gay and bisexual men (MSM) may be partially explained by racial differences in the HIV transmission potential (i.e. mixing of people living with HIV and people not living with HIV or of unknown HIV serostatus) and density (i.e. sex partner concurrency) of sexual networks. Data included a behavioral survey, testing for HIV, and an egocentric sexual network survey. Mixed effects logistic regressions were used for hypothesis testing. Black (vs. non-Black) MSM were more likely to not know their partner's HIV serostatus (21.8% vs. 9.6%). Similar proportions reported sex partner concurrency (67.1% vs. 68.0%). In adjusted analyses, among Black MSM, sex partner concurrency significantly increased the odds of an HIV transmission potential partnership (TPP), and this association was not significant among non-Black indexes. The association between an HIV TPP and sex partner concurrency may help explain persistent racial disparities in HIV prevalence.
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Affiliation(s)
- Carla Tilchin
- Department of Pediatrics, Center for Child and Community Health Research (CCHR), Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F. Lord Bldg-Center Towers, Suite 4200, Baltimore, MD, 21224, USA
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica Wagner
- Department of Pediatrics, Center for Child and Community Health Research (CCHR), Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F. Lord Bldg-Center Towers, Suite 4200, Baltimore, MD, 21224, USA
| | - Christina M Schumacher
- Department of Pediatrics, Center for Child and Community Health Research (CCHR), Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F. Lord Bldg-Center Towers, Suite 4200, Baltimore, MD, 21224, USA
| | - Khalil G Ghanem
- Department of Infectious Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Matthew M Hamill
- Department of Infectious Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Baltimore City Health Department, Baltimore, MD, USA
| | - Anne Rompalo
- Department of Infectious Disease, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Errol Fields
- Department of Pediatrics, Center for Child and Community Health Research (CCHR), Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F. Lord Bldg-Center Towers, Suite 4200, Baltimore, MD, 21224, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Jacky M Jennings
- Department of Pediatrics, Center for Child and Community Health Research (CCHR), Johns Hopkins School of Medicine, 5200 Eastern Avenue, Mason F. Lord Bldg-Center Towers, Suite 4200, Baltimore, MD, 21224, USA.
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10
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Harkness A, Weinstein ER, Atuluru P, Mayo D, Vidal R, Rodríguez-Díaz CE, Safren SA. Latinx Sexual Minority Men's Access to HIV and Behavioral Health Services in South Florida During COVID-19: A Qualitative Study of Barriers, Facilitators, and Innovations. J Assoc Nurses AIDS Care 2022; 33:9-21. [PMID: 34939984 PMCID: PMC8981513 DOI: 10.1097/jnc.0000000000000280] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Despite the availability of HIV prevention and treatment tools, HIV disparities continue to affect Latinx sexual minority men (LSMM). Behavioral health concerns further exacerbate HIV disparities among LSMM. This study used rapid qualitative analysis to understand factors influencing LSMM's access to HIV and behavioral health services during coronavirus disease 2019 (COVID-19). Participants included LSMM with (n = 10) and without HIV (n = 10). The analysis identified 15 themes. Themes revealed that LSMM's access was disrupted by new and worsening barriers resulting from COVID-19, such as anxiety about COVID-19 exposure, confusion and disruptions to services, and new structural challenges. Other themes highlight positive changes, such as telehealth and relaxed clinic protocols, which enhanced LSMM's access to services during COVID-19. The findings suggest the need for HIV and behavioral health clinics to innovate and ensure LSMM's continued access to services during and beyond COVID-19.
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Affiliation(s)
- Audrey Harkness
- Research Assistant Professor of Prevention Science and Community Health, Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Elliott R. Weinstein
- Predoctoral Psychology Trainee, Department of Psychology, University of Miami, Miami, Florida, USA
| | - Pranusha Atuluru
- medical student, Department of Medicine, University of Miami, Miller School of Medicine, Miami, Florida, USA
| | - Daniel Mayo
- Research Associate, Department of Psychology, University of Miami, Miami, Florida, USA
| | - Ronald Vidal
- graduate student, Department of Public Health Sciences, University of Miami, Miami, Florida, USA
| | - Carlos E. Rodríguez-Díaz
- Associate Professor, The George Washington University, Washington, D.C., USA, and Associate Professor, University of Puerto Rico-Medical Sciences Campus, School of Public Health, San Juan, Puerto Rico
| | - Steven A. Safren
- Professor, Department of Psychology, University of Miami, Miami, Florida
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11
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Dangerfield DT, Ober AJ, Li MJ, Allen S, Bluthenthal RN. HIV Treatment Adherence Strategies Among Virally Suppressed Black Sexual Minority Men in Baltimore, Maryland, and Los Angeles, California: A Theory-Based Qualitative Study. J Assoc Nurses AIDS Care 2022; 33:54-62. [PMID: 34939988 PMCID: PMC8718261 DOI: 10.1097/jnc.0000000000000304] [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: 01/12/2021] [Indexed: 01/03/2023]
Abstract
ABSTRACT The goals and strategies of Black sexual minority men living with HIV (BSMMLWH) who achieve viral suppression require further investigation. This study explored treatment adherence strategies among BSMMLWH with sustained viral suppression. We conducted 27 in-depth qualitative interviews with BSMMLWH in Baltimore, Maryland, and Los Angeles, California, between December 2018 and May 2019. Interviews included questions guided by Positive Deviance and Life Course theoretical frameworks regarding multilevel factors and explicit strategies for antiretroviral therapy adherence. Themes regarding intentional, age group-specific strategies such as using technology (among younger men) and taking HIV medications with other daily pills (among older men) were identified. Participants also reported symbiotic goals and values that encouraged adherence, such as having a desire to live, strong familial relationships with clinicians, and support networks. Identifying personal goals and having supportive clinical and social relationships could be key to improving treatment adherence and viral suppression among BSMMLWH.
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Affiliation(s)
| | | | - Michael J. Li
- Department of Family Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Sophia Allen
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ricky N. Bluthenthal
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
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12
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Chen YT, Duncan DT, Del Vecchio N, Timmins L, Pagkas-Bather J, Lacap S, Hotton A, Knox J, Hanson H, Koli K, Durrell M, Dehlin J, Schneider JA. COVID-19-Related Stressors, Sex Behaviors, and HIV Status Neutral Care Among Black Men Who Have Sex With Men and Transgender Women in Chicago, USA. J Acquir Immune Defic Syndr 2021; 88:261-271. [PMID: 34310447 PMCID: PMC8518204 DOI: 10.1097/qai.0000000000002770] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/01/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND COVID-19 has disproportionately impacted vulnerable populations, including Black men who have sex with men (BMSM) and transgender women (BTW). We investigated associations of COVID-19 stressors and sex behaviors with pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) among BMSM and BTW. METHODS As part of the Neighborhoods and Networks (N2) study, we conducted virtual interviews during peak COVID-19 infectivity in Chicago among BMSM and BTW (April-July 2020). Survey questions included multilevel COVID-19 stressors, sex behaviors, and current PrEP/ART use and access. Poisson regressions were used to examining relationships between COVID-19 stressors, sex behaviors, and PrEP/ART use/access. RESULTS Among 222 participants, 31.8% of participants not living with HIV reported current PrEP use and 91.8% of participants living with HIV reported ART use during the pandemic. Most (83.3% and 78.2%, respectively) reported similar or easier PrEP and ART access during the pandemic. Physical stress reaction to COVID-19 [adjusted prevalence ratio [aPR] = 2.1; confidence interval (CI): 1.3 to 3.5] and being in close proximity with someone diagnosed with COVID-19 (aPR = 1.7; CI: 1.1 to 2.8) were associated with current PrEP use. Intimate partner violence (aPR = 2.7; CI: 1.0 to 7.2) and losing health insurance (aPR = 3.5; CI: 1.1 to 10.7) were associated with harder ART access. Travel-related financial burden was associated with harder access in PrEP (aPR = 3.2; CI: 1.0 to 10.1) and ART (aPR = 6.2; CI: 1.6 to 24.3). CONCLUSIONS Multiple COVID-19 stressors were found to interfere with PrEP and ART use and access among BMSM and BTW. Contextually relevant strategies (eg, promoting telehealth and decreasing transportation burden) to address COVID-19 stressors and their sequelae should be considered to minimize disruption in HIV biomedical interventions.
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Affiliation(s)
- Yen-Tyng Chen
- Department of Public Health, William Paterson University of New Jersey, Wayne, NJ
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Dustin T. Duncan
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Natascha Del Vecchio
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Liadh Timmins
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Jade Pagkas-Bather
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Shaina Lacap
- Department of Public Health, William Paterson University of New Jersey, Wayne, NJ
| | - Anna Hotton
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Justin Knox
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | | | | | - Mainza Durrell
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - Jessica Dehlin
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
| | - John A. Schneider
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL
- Department of Medicine, University of Chicago, Chicago, IL
- Department of Public Health Sciences, University of Chicago, Chicago, IL; and
- Crown School of Social Work, University of Chicago, Chicago, IL
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13
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Sullivan PS, Knox J, Jones J, Taussig J, Valentine Graves M, Millett G, Luisi N, Hall E, Sanchez TH, Del Rio C, Kelley C, Rosenberg ES, Guest JL. Understanding disparities in viral suppression among Black MSM living with HIV in Atlanta Georgia. J Int AIDS Soc 2021; 24:e25689. [PMID: 33821554 PMCID: PMC8022103 DOI: 10.1002/jia2.25689] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/01/2020] [Accepted: 12/23/2020] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Due to factors associated with structural racism, Black men who have sex with men (MSM) living with HIV are less likely to be virally suppressed compared to white MSM. Most of these data come from clinical cohorts and modifiable reasons for these racial disparities need to be defined in order to intervene on these inequities. Therefore, we examined factors associated with racial disparities in baseline viral suppression in a community-based cohort of Black and white MSM living with HIV in Atlanta, GA. METHODS We conducted an observational cohort of Black and white MSM living with HIV infection in Atlanta. Enrolment occurred from June 2016 to June 2017 and men were followed for 24 months; laboratory and behavioural survey data were collected at 12 and 24 months after enrolment. Explanatory factors for racial disparities in viral suppression included sociodemographics and psychosocial variables. Poisson regression models with robust error variance were used to estimate prevalence ratios (PR) for Black/white differences in viral suppression. Factors that diminished the PR for race by ≥5% were considered to meaningfully attenuate the racial disparity and were included in a multivariable model. RESULTS Overall, 26% (104/398) of participants were not virally suppressed at baseline. Lack of viral suppression was significantly more prevalent among Black MSM (33%; 69/206) than white MSM (19%; 36/192) (crude Prevalence Ratio (PR) = 1.6; 95% CI: 1.1 to 2.5). The age-adjusted Black/white PR was diminished by controlling for: ART coverage (12% decrease), housing stability (7%), higher income (6%) and marijuana use (6%). In a multivariable model, these factors cumulatively mitigated the PR for race by 21% (adjusted PR = 1.1 [95% CI: 0.8 to 1.6]). CONCLUSIONS Relative to white MSM, Black MSM living with HIV in Atlanta were less likely to be virally suppressed. This disparity was explained by several factors, many of which should be targeted for structural, policy and individual-level interventions to reduce racial disparities.
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Affiliation(s)
- Patrick S Sullivan
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Justin Knox
- Department of PsychiatryColumbia UniversityNew YorkNYUSA
| | - Jeb Jones
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Jennifer Taussig
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | | | - Greg Millett
- American Foundation for AIDS ResearchWashingtonDCUSA
| | - Nicole Luisi
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Eric Hall
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Travis H Sanchez
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
| | - Carlos Del Rio
- Department of MedicineSchool of MedicineEmory UniversityAtlantaGAUSA
| | - Colleen Kelley
- Department of MedicineSchool of MedicineEmory UniversityAtlantaGAUSA
| | | | - Jodie L Guest
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGAUSA
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14
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Sullivan PS, Taussig J, Valentine-Graves M, Luisi N, Del Rio C, Guest JL, Jones J, Millett G, Rosenberg ES, Stephenson R, Kelley C. Disparities in Care Outcomes in Atlanta Between Black and White Men Who Have Sex With Men Living With HIV: Protocol for a Prospective Cohort Study (Engage[men]t). JMIR Res Protoc 2021; 10:e21985. [PMID: 33320821 PMCID: PMC7943338 DOI: 10.2196/21985] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 12/14/2020] [Accepted: 12/15/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The US HIV epidemic is driven by infections in men who have sex with men and characterized by profound disparities in HIV prevalence and outcomes for Black Americans. Black men who have sex with men living with HIV are reported to have worse care outcomes than other men who have sex with men, but the reasons for these health inequities are not clear. We planned a prospective observational cohort study to help understand the reasons for worse HIV care outcomes for Black versus White men who have sex with men in Atlanta. OBJECTIVE The aim of this study is to identify individual, dyadic, network, neighborhood, and structural factors that explain disparities in HIV viral suppression between Black and White men who have sex with men living with HIV in Atlanta. METHODS Black and White men who have sex with men living with HIV were enrolled in a prospective cohort study with in-person visits and viral suppression assessments at baseline, 12 months, and 24 months; additional surveys of care and risk behaviors at 3, 6, and 18 months; analysis of care received outside the study through public health reporting; and qualitative interviews for participants who experienced sentinel health events (eg, loss of viral suppression) during the study. The study is based on the Bronfenbrenner socioecological theoretical model. RESULTS Men who have sex with men (n=400) were enrolled between June 2016 and June 2017 in Atlanta. Follow-up was completed in June 2019; final study retention was 80% at 24 months. CONCLUSIONS Health disparities for Black men who have sex with men are hypothesized to be driven by structural racism and barriers to care. Observational studies are important to document and quantify the specific factors within the socioecological framework that account for disparities in viral suppression. In the meantime, it is also critical to push for steps to improve access to care, including Medicaid expansion in Southern states, such as Georgia, which have not yet moved to expand Medicaid. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/21985.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Jennifer Taussig
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Mariah Valentine-Graves
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Carlos Del Rio
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, United States
| | - Jodie L Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Jeb Jones
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Greg Millett
- amFAR, the Foundation for AIDS Research, Washington, DC, United States
| | - Eli S Rosenberg
- Department of Epidemiology, School of Public Health, University at Albany, State University of New York, Albany, NY, United States
| | - Rob Stephenson
- Department of Systems, Population, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, United States.,The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Colleen Kelley
- Division of Infectious Diseases, Department of Medicine, Emory University, Atlanta, GA, United States
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15
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Alonzo J, Mann-Jackson L, Garcia M, Tanner AE, Rhodes SD. Meeting the needs of young Latino gay, bisexual, and other men who have sex with men (MSM) and transgender women living with HIV through the weCare intervention in the United States (US). EHQUIDAD 2021; 15:209-232. [PMID: 33681870 PMCID: PMC7935230 DOI: 10.15257/ehquidad.2021.0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Young gay, bisexual, and other MSM (men who have sex with men) and transgender women in the United States (US) who are living with HIV, and particularly those who are Latino, have low rates of viral suppression. The weCare intervention uses social media to increase HIV care engagement. METHOD We used community-based participatory research to develop the intervention as well as theory-based social media messages tailored to each participant's unique context. We analyzed elements and characteristics of weCare, messages sent by the Cyber Health Educator (CHE), and lessons learned to meet the needs of Latino participants living with HIV. RESULTS We identified 6 core elements, 5 key characteristics, effective social media messages used in implementation, and 8 important lessons regarding relationships between the CHE and HIV clinics, the CHE and participants, and participants and the health system. CONCLUSIONS Social media offers a promising platform to retain young Latino gay bisexual and other MSM and transgender women living with HIV in care and achieve viral suppression.
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Affiliation(s)
- Jorge Alonzo
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
- CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
| | - Lilli Mann-Jackson
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
- CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
| | - Manuel Garcia
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
| | - Amanda E. Tanner
- University of North Carolina Greensboro, Department of Public Health Education, 1400 Spring Garden St., Greensboro, NC USA 27412
| | - Scott D. Rhodes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
- CTSI Program in Community-Engaged Research, Wake Forest School of Medicine, Medical Center Blvd., Winston-Salem, NC USA 27157
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16
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Quinn KG, Voisin DR. ART Adherence Among Men Who Have Sex with Men Living with HIV: Key Challenges and Opportunities. Curr HIV/AIDS Rep 2020; 17:290-300. [PMID: 32557117 DOI: 10.1007/s11904-020-00510-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW In the USA, gay, bisexual, and other men who have sex with men (MSM) are disproportionately affected by HIV. High levels of adherence to antiretroviral therapy (ART) can dramatically improve outcomes for persons living with HIV and reduce the risk of HIV transmission to others. Yet, there are numerous individual, social, and structural barriers to optimal ART adherence. Many of these factors disproportionately impact Black MSM and may contribute to their poorer rates of ART adherence. This review synthesizes the key challenges and intervention opportunities to improve ART adherence among MSM in the USA. RECENT FINDINGS Key challenges to ART adherence include stigma, violence, depression, and substance use. Black MSM are significantly disadvantaged by several of these factors. There are several promising interventions to improve ART adherence among MSM, and there remains an opportunity to culturally tailor these to the needs of Black MSM populations to enhance adherence. Despite high rates of HIV among MSM, there continues to be a paucity of research on the various contributors to poor ART adherence among this population. Similarly, few interventions have been tested that lead to increased and sustained ART adherence among Black MSM.
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Affiliation(s)
- Katherine G Quinn
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit, Milwaukee, WI, 53202, USA.
| | - Dexter R Voisin
- Factor-Intwentash School of Social Work, University of Toronto, Toronto, Canada
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17
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Buchacz K, Armon C, Palella FJ, Novak RM, Fuhrer J, Tedaldi E, Ward D, Mayer C, Battalora L, Carlson K, Purinton S, Durham M, Li J. The HIV Outpatient Study-25 Years of HIV Patient Care and Epidemiologic Research. Open Forum Infect Dis 2020; 7:ofaa123. [PMID: 32455145 PMCID: PMC7235508 DOI: 10.1093/ofid/ofaa123] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 04/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background The clinical epidemiology of treated HIV infection in the United States has dramatically changed in the past 25 years. Few sources of longitudinal data exist for people with HIV (PWH) spanning that period. Cohort data enable investigating new exposure and disease associations and monitoring progress along the HIV care continuum. Methods We synthesized key published findings and conducted primary data analyses in the HIV Outpatient Study (HOPS), an open cohort of PWH seen at public and private HIV clinics since 1993. We assessed temporal trends in health outcomes (1993-2017) and mortality (1994-2017) for 10 566 HOPS participants. Results The HOPS contributed to characterizing new conditions (eg, lipodystrophy), demonstrated reduced mortality with earlier HIV treatment, uncovered associations between select antiretroviral agents and cardiovascular disease, and documented remarkable shifts in morbidity from AIDS opportunistic infections to chronic noncommunicable diseases. The median CD4 cell count of participants increased from 244 cells/mm3 to 640 cells/mm3 from 1993 to 2017. Mortality fell from 121 to 16 per 1000 person-years from 1994 to 2017 (P < .001). In 2010, 83.7% of HOPS participants had a most recent HIV viral load <200 copies/mL, compared with 92.2% in 2017. Conclusions Since 1993, the HOPS has been detecting emerging issues and challenges in HIV disease management. HOPS data can also be used for monitoring trends in infectious and chronic diseases, immunologic and viral suppression status, retention in care, and survival, thereby informing progress toward the Ending the HIV Epidemic initiative.
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Affiliation(s)
- Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Carl Armon
- Cerner Corporation, Kansas City, Missouri, USA
| | - Frank J Palella
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Richard M Novak
- University of Illinois College of Medicine, Chicago, Illinois, USA
| | - Jack Fuhrer
- Renaissance School of Medicine at Stony Brook University, Stony Brook, New York, USA
| | - Ellen Tedaldi
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA
| | - Douglas Ward
- Dupont Circle Physicians Group, Washington, DC, USA
| | - Cynthia Mayer
- St. Joseph’s Hospital Comprehensive Research Institute, Tampa Florida, USA
| | - Linda Battalora
- Cerner Corporation, Kansas City, Missouri, USA
- Colorado School of Mines, Golden, Colorado, USA
| | | | | | - Marcus Durham
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jun Li
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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18
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Step MM, McMillen Smith J, Kratz J, Briggs J, Avery A. "Positive Peers": Function and Content Development of a Mobile App for Engaging and Retaining Young Adults in HIV Care. JMIR Form Res 2020; 4:e13495. [PMID: 32012035 PMCID: PMC7055772 DOI: 10.2196/13495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 07/23/2019] [Accepted: 09/26/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although treatment for HIV infection is widely available and well tolerated, less than 30% of adolescents and young adults living with HIV infection achieve stable viral suppression. Mobile technology affords increased opportunities for young people living with HIV to engage with information, health management tools, and social connections that can support adherence to treatment recommendations and medication. Although mobile apps are increasingly prevalent, few are informed by the target population. OBJECTIVE The objective of this study was to describe the "Positive Peers" app, a mobile app currently being evaluated in a public hospital in the Midwestern United States. Formative development, key development strategies, user recruitment, and lessons learned are discussed in this paper. METHODS "Positive Peers" was developed in collaboration with a community advisory board (CAB) comprising in-care young adults living with HIV and a multidisciplinary project team. Mobile app functions and features were developed over iterative collaborative sessions that were tailored to the CAB members. In turn, the CAB built rapport with the project team and revealed unique information that was used in app development. RESULTS The study was funded on September 1, 2015; approved by the MetroHealth Institutional Review Board on August 31, 2016; and implemented from October 11, 2016, to May 31, 2019. The "Positive Peers" mobile app study has enrolled 128 users who reflect priority disparity population subgroups. The app administrator had frequent contact with users across app administration and study-related activities. Key lessons learned from the study include changing privacy concerns, data tracking reliability, and user barriers. Intermediate and outcome variable evaluation is expected in October 2019. CONCLUSIONS Successful development of the "Positive Peers" mobile app was supported by multidisciplinary expertise, an enthusiastic CAB, and a multifaceted, proactive administrator.
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Affiliation(s)
- Mary M Step
- College of Public Health, Kent State University, Kent, OH, United States
| | | | | | | | - Ann Avery
- Metrohealth Medical Center, Cleveland, OH, United States.,Case Western Reserve University, School of Medicine, Cleveland, OH, United States
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19
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Fields EL, Thornton N, Long A, Morgan A, Uzzi M, Sanders RA, Jennings JM. Young black MSM's exposures to and discussions about PrEP while navigating geosocial networking apps. JOURNAL OF LGBT YOUTH 2019; 18:23-39. [PMID: 34109014 PMCID: PMC8186480 DOI: 10.1080/19361653.2019.1700205] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 06/12/2023]
Abstract
Young Black gay, bisexual and other men who have sex with men (YBMSM) carry a disproportionate HIV burden perpetuated by exposure to sexual networks with higher untreated HIV prevalence and incidence. In Baltimore, these sexual networks include high utilization of geosocial networking apps (GSN-apps). Our prior work suggests these apps can be important access points for targeted interventions like PrEP. To inform online PrEP outreach we explored YBMSM GSN-app users' exposure to and discussions about PrEP while navigating apps. We actively recruited YBMSM (n=17) age 18-24 from the GSN-app most frequently reported by newly diagnosed HIV-infected MSM in Baltimore. Participants were recruited through direct messaging within the GSN-app while logged-on in high HIV transmission areas. Participants completed 60-90 minute semi-structured interviews, which were analyzed using a 3-stage analytic coding strategy. While some participants had not heard of PrEP, the majority described mentions or conversations about PrEP on GSN-apps. Three themes emerged: (1) Mistrust of PrEP, (2) Association with sexual promiscuity, and (3) Concerns about lack of protection from other STIs. Proper messaging, accurate information, and education are needed to account for the negative perceptions that surround PrEP; otherwise, continued underuse among YBMSM will expand rather than reduce HIV disparities.
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Affiliation(s)
- Errol L. Fields
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nicole Thornton
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amanda Long
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anthony Morgan
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mudia Uzzi
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Renata Arrington Sanders
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacky M. Jennings
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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