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Velloza J, Liu AY, Katz AWK, van der Straten A, Siegler AJ, Scott H, Wilde G, Lockard A, Christie RH, Buchbinder SP. Acceptability of an automated directly observed therapy (DOT) application for PrEP adherence support among young men who have sex with men: a qualitative exploration. AIDS Care 2024:1-15. [PMID: 39222964 DOI: 10.1080/09540121.2024.2397133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
Pre-exposure prophylaxis (PrEP) adherence remains a challenge among young men who have sex with men (MSM). We developed and tested a smartphone application ("app"), "DOT Diary", which combines automated directly observed therapy (DOT) with information about PrEP protection levels, pill-taking reminders, a sexual behavior diary, and a PrEP dosing calendar. To contextualize trial results, we qualitatively explored participants' app experiences. The trial enrolled 100 young MSM in San Francisco and Atlanta. Participants were randomized 2:1 to DOT Diary versus standard-of-care and followed for 24 weeks. Interviews were conducted with 24 intervention participants. Data were analyzed using a memo-writing approach. Most expressed overall satisfaction with the app ("it was good for its purpose"), despite concerns about technical glitches. The most popular app features were the monthly calendar showing days PrEP was taken and information about level of protection based on pills taken. The DOT component helped participants establish PrEP routines. The reminders were "annoying but effective" at motivating dosing. Opinions about the sexual behavior diary varied. Overall, DOT Diary was acceptable; participants were willing to use it daily to record pill-taking. Critical components included the information about PrEP protection levels and calendar, while others may be modified to improve future success.Trial registration: ClinicalTrials.gov identifier: NCT03771638.
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Affiliation(s)
- Jennifer Velloza
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Albert Y Liu
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Ariana W K Katz
- RTI International, Women's Global Health Imperative, Berkeley, CA, USA
| | - Ariane van der Straten
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- ASTRA Consulting, Kensington, CA, USA
| | - Aaron J Siegler
- Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Hyman Scott
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Gretchen Wilde
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | - Annie Lockard
- Department of Epidemiology, Emory University, Atlanta, GA, USA
| | | | - Susan P Buchbinder
- Bridge HIV, San Francisco Department of Public Health, San Francisco, CA, USA
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Liu Y, Xian Y, Liu X, Cheng Z, Wei S, Wang J, Chen J, Li C, Ma J, Yang J, Liu F, Yu M, Chen Z, Cui Z. Significant insights from a National survey in China: PrEP awareness, willingness, uptake, and adherence among YMSM students. BMC Public Health 2024; 24:1009. [PMID: 38605341 PMCID: PMC11010336 DOI: 10.1186/s12889-024-18512-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION Few studies focused on the Pre-Exposure Prophylaxis (PrEP) -related aspects, and the applicability of prior evidence to young men who have sex with men (YMSM) students was unknown. This study aimed to assess the awareness, willingness, uptake, and adherence (AWUA) to PrEP among YMSM students in China and to explore the associated factors with these stages. METHODS A cross-sectional survey with a sizable sample of 1151 was conducted among YMSM students aged 16 and above, who self-identified as men who have sex with men(MSM) and resided in mainland China between October 20 and December 20, 2021. The chi-square test and Fisher's exact test were used for univariate analysis, followed by multivariable logistic regression analysis of influencing factors at all levels. RESULTS According to the cascade analysis approach, 88.71% of the participants were aware of PrEP, among which 66.7% expressed willingness to use it. Among those who were willing to use PrEP, only 13.80% took it, and of those who took it, 44.68% adhered to it. The students taking PrEP were those with higher education (OR = 4.239, 95% CI: 1.334-13.467), residence in pilot cities (OR = 2.791, 95% CI: 1.498-5.198), residence in high-risk areas (OR = 5.082, 95% CI: 2.224-11.612), engagement in multi-person sexual behavior (OR = 2.186, 95% CI: 1.236-3.867), and substance use (OR = 1.908, 95% CI: 1.167-3.118). Furtherly, students with higher adherence to PrEP were likely to have receptive sexual behaviors (OR = 8.702, 95% CI: 2.070-36.592), absence of substance use (OR = 4.468, 95% CI: 1.371-14.561), and uptake of PrEP through daily oral route. (OR = 7.065, 95% CI: 1.699-29.371). CONCLUSION YMSM students exhibit distinct patterns of "high awareness, low willingness, low uptake, and low adherence" to PrEP. Strategies for reduction in the acquisition of HIV prioritizing the current features of utilizing PrEP were urgently warranted.
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Affiliation(s)
- Yuanyuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Yidan Xian
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Xuan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Zhaoyu Cheng
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Siyue Wei
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Jianping Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Jiageng Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Changping Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Jun Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China
| | - Jie Yang
- "Shenlan" Public Health Counseling Service Center, Tianjin, China
| | - Fengli Liu
- "Shenlan" Public Health Counseling Service Center, Tianjin, China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Center for Disease Control and Prevention, Tianjin, China
- Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, China
| | - Zhongdan Chen
- HIV/Hepatitis/STI/TB, World Health Organization Representative Office in China, 401 Dongwai Diplomatic Building 23, DongzhimenwaiDajie, Chaoyang District, Beijing, 100600, China
| | - Zhuang Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, No. 22 Qixiangtai Road, Heping District, Tianjin, 300070, China.
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, China.
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Agarwal H, Erwin M, Lyles S, Esposito M, Ahsan Z. Lower PrEP Retention among Young and Black Clients Accessing PrEP at a Cluster of Safety Net Clinics for Gay and Bisexual Men. J Int Assoc Provid AIDS Care 2024; 23:23259582241275857. [PMID: 39219500 PMCID: PMC11375660 DOI: 10.1177/23259582241275857] [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: 09/04/2024] Open
Abstract
Young men of color who have sex with men are vulnerable to HIV and experience poor PrEP uptake and retention. We conducted a secondary data analysis and calculated adjusted Prevalence Odds Ratios (aPORs) for PrEP retention along with 95% CIs at 90, 180, and 360 days at an organization running safety net clinics in Texas for gay and bisexual men. We found statistically significant association with age, race, in-clinic versus telehealth appointments, and having healthcare insurance. White clients had an aPOR of 1.29 [1.00, 1.67] as compared to Black clients at 90 days. Age group of 18-24 had a lower aPOR than all other age groups except 55 or older at all three time periods. Clients who met providers in person had an aPOR of 2.6 [2.14, 3.19] at 90, 2.6 [2.2, 3.30] at 180 days and 2.84 [2.27, 3.54] at 360 days. Our findings highlight the need for population-specific targeted interventions.
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Affiliation(s)
- Harsh Agarwal
- Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mark Erwin
- Center for Health Empowerment, Austin, TX, USA
| | - Scott Lyles
- Center for Health Empowerment, Austin, TX, USA
| | - Maria Esposito
- Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, North Carolina, USA
| | - Zunaid Ahsan
- Gillings School of Global Public Health, UNC Chapel Hill, Chapel Hill, North Carolina, USA
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Stanford KA, Almirol E, Eller D, Hazra A, Schneider J. Routine, Opt-Out, Emergency Department Syphilis Testing Increases HIV Preexposure Prophylaxis Uptake. Sex Transm Dis 2023; 50:292-297. [PMID: 36689476 PMCID: PMC10116839 DOI: 10.1097/olq.0000000000001774] [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: 01/24/2023]
Abstract
BACKGROUND Many people vulnerable to HIV do not perceive themselves at risk or consider preexposure prophylaxis (PrEP). This study hypothesizes that syphilis diagnosis through universal, emergency department (ED) screening would increase PrEP uptake. METHODS This prospective cohort study enrolled patients tested for syphilis through ED screening between July 2019 and July 2021. Participants completed a survey about behaviors, HIV and PrEP knowledge, and opinions at the time of enrollment. All were offered PrEP if they met Centers for Disease Control and Prevention guidelines for PrEP use. Information about PrEP use and HIV status was collected 6 months later. Bivariate analysis was used to compare outcomes between groups testing positive versus negative for syphilis. RESULTS The study enrolled 97 participants, 49 with syphilis and 48 testing negative. Overall, 11 (11.3%) started PrEP, all in the syphilis group, despite 28 (58.3%) in the negative group having indications for PrEP. Participants with syphilis less frequently reported low perceived HIV risk than syphilis-negative participants who reported HIV transmission behaviors (83.7% vs. 92.9%). Participants reporting moderate to high HIV risk perception were significantly more likely to start PrEP (odds ratio, 10.5; 95% confidence interval, 1.41-78.1; P = 0.02). At 6 months, 3 participants remained on PrEP (follow-up data available for 63.5% of PrEP-eligible participants). CONCLUSIONS Syphilis diagnosis was associated with increased perception of HIV risk and increased PrEP initiation. Individuals who otherwise might not seek testing for syphilis because of perceived low risk may be identified through routine screening, thus providing an important opportunity to link more people to HIV prevention and PrEP services.
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Affiliation(s)
| | - Ellen Almirol
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| | - Dylan Eller
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
| | - John Schneider
- Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, USA
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Arnold T, Gaudiano BA, Barnett AP, Elwy AR, Whiteley L, Giorlando KK, Rogers BG, Ward LM, Leigland A, Brown LK. Development of An Acceptance Based PrEP Intervention ( ACTPrEP) to Engage Young Black MSM in the South Utilizing the Adaptome Model of Intervention Adaptation. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023; 28:60-70. [PMID: 37008800 PMCID: PMC10062414 DOI: 10.1016/j.jcbs.2023.03.009] [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] [Indexed: 03/12/2023]
Abstract
Objectives HIV disproportionately affects young Black men who have sex with men (YBMSM) in the Southern United States. Pre-exposure prophylaxis (PrEP) is an efficacious, biomedical approach to prevent HIV. While Mississippi (MS) has among the highest rates of new HIV infections, it also ranks among the top three states for unmet PrEP need. Thus, increasing engagement in PrEP care for YBMSM in MS is imperative. A potential method to improve psychological flexibility and promote PrEP uptake, explored by this study, is the incorporation of Acceptance and Commitment Therapy (ACT) into PrEP interventions. ACT is an evidence-based intervention used to treat a wide range of mental and physical illnesses. Methods Twenty PrEP-eligible YBMSM and ten clinic staff working with YBMSM in MS were surveyed and interviewed between October 2021 and April 2022. The brief survey covered PrEP structural barriers, PrEP stigma, and psychological flexibility. Interview topics included internal experiences related to PrEP, existing health behaviors, PrEP related personal values, and relevant constructs from the Adaptome Model of Intervention Adaptation (service setting, target audience, mode of delivery, and cultural adaptations). Qualitative data were coded based on ACT and the Adaptome model, organized using NVivo, then thematically analyzed. Results Patients identified side effects, costs, and taking a daily prescription as top barriers to taking PrEP. Staff reported the top barrier to PrEP for clients was concern others would believe they were living with HIV. Levels of psychological flexibility and inflexibility varied widely among participants. The resulting thematic categories derived from the interviews included 1) thoughts, emotions, associations, memories, and sensations (TEAMS) related to PrEP and HIV, 2) general health behaviors (existing coping techniques, views on medication, HIV/PrEP approach and avoidance), 3) values related to PrEP use (relationship values, health values, intimacy values, longevity values), and 4) Adaptome Model adaptations. These results informed the development of a new intervention, ACTPrEP. Conclusions Interview data organized by the Adaptome Model of Intervention Adaptation determined appropriate ACT-informed intervention components, content, intervention adaptations, and implementation strategies. Interventions informed by ACT that help YBMSM endure short-term discomfort related to PrEP by relating it to their values and long-term health goals are promising for increasing individuals' willingness to initiate and maintain PrEP care.
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Affiliation(s)
- Trisha Arnold
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
| | - Brandon A. Gaudiano
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
| | - Andrew P. Barnett
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, 01730, USA
| | - Laura Whiteley
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
| | - Kayla K. Giorlando
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903
| | - Brooke G. Rogers
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02903
| | - Lori M. Ward
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi USA 39217
| | - Avery Leigland
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903
| | - Larry K. Brown
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island, USA 02903
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island USA 02906
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Stansfield SE, Moore M, Boily MC, Hughes JP, Donnell DJ, Dimitrov DT. Estimating benefits of using on-demand oral prep by MSM: A comparative modeling study of the US and Thailand. EClinicalMedicine 2023; 56:101776. [PMID: 36618897 PMCID: PMC9813675 DOI: 10.1016/j.eclinm.2022.101776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Daily and on-demand pre-exposure prophylaxis (PrEP) are effective at preventing HIV acquisition among men who have sex with men (MSM), but only daily PrEP is approved in the US. On-demand PrEP may improve uptake and adherence. We identify sub-groups of MSM who would benefit from on-demand PrEP and determine effectiveness achieved if individuals used their optimal regimens. METHODS Using data from the HPTN 067 study (study period 2012-2014), we created an individual-based stochastic model of HIV risk in two synthetic MSM populations with parameters separately estimated using data from Harlem, US, and Bangkok, Thailand. Agents were assigned daily and on-demand PrEP for six months each. Two personalized PrEP assignments: optimal, based on improved predicted effectiveness and reduced pill burden, and adherence-based, using daily PrEP adherence, were simulated for another six months. FINDINGS Simulated on-demand PrEP was optimal for approximately one-third of MSM. It was assigned mainly to those with low daily PrEP adherence (88% (Harlem), 95% (Bangkok) of MSM with daily PrEP adherence <40%). Mean effectiveness was slightly higher in the full synthetic population with optimal PrEP assignment compared to universal daily PrEP. Among MSM for whom on-demand PrEP was optimal, mean effectiveness improved by 18 (Harlem) and 7 percentage points (Bangkok). Comparable predicted effectiveness was achieved if on-demand PrEP was assigned to the population with daily PrEP adherence <50%. There was no advantage in assigning on-demand PrEP by sex act frequency. INTERPRETATION On-demand PrEP could benefit many MSM by increasing effectiveness or decreasing pill burden with similar effectiveness. On-demand PrEP may be an effective alternative to daily PrEP for individuals with difficulty taking daily PrEP consistently. Results were similar for Harlem and Bangkok, indicating that these conclusions were robust in populations with different overall adherence levels and may inform future public-health policies. FUNDING US NIH grant UM1 AI068617.
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Affiliation(s)
- Sarah E. Stansfield
- Fred Hutchinson Cancer Center, Seattle, WA, United States
- Corresponding author. Vaccine & Infectious Disease Division, Fred Hutchinson Cancer Center, United States.
| | - Mia Moore
- Fred Hutchinson Cancer Center, Seattle, WA, United States
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Hulstein SH, Zimmermann HM, de la Court F, Matser AA, Schim van der Loeff MF, Hoornenborg E, Davidovich U, Prins M, de Vries HJ. Factors Associated With the Intention to Use HIV Preexposure Prophylaxis for Young and Older Men Who Have Sex With Men. Sex Transm Dis 2022; 49:343-352. [PMID: 35001016 PMCID: PMC8994038 DOI: 10.1097/olq.0000000000001599] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The uptake of preexposure prophylaxis (PrEP) against HIV is low among young men who have sex with men (MSM) in the Netherlands. Studying the intention to use PrEP among non-PrEP using young and older MSM can guide health authorities in developing new prevention campaigns to optimize PrEP uptake. METHODS We investigated the sociodemographic, behavioral, and psychosocial factors associated with a high PrEP use intention in the coming 6 months among 93 young MSM (aged ≤25 years), participating in an online survey, and 290 older MSM (aged ≥26 years), participating in an open, prospective cohort in 2019 to 2020. RESULTS Perceiving PrEP as an important prevention tool was associated with a high PrEP use intention among young and older MSM. Among young MSM, a high level of PrEP knowledge and believing that PrEP users take good care of themselves and others were associated with a high PrEP use intention. Among older MSM, 2 or more anal sex partners, chemsex, high HIV risk perception, and believing PrEP increases sexual pleasure were associated with a high PrEP use intention. Believing PrEP leads to adverse effects was associated with a low intention to use PrEP among older MSM. CONCLUSIONS To conclude, we showed that both behavioral and psychosocial factors were associated with a high PrEP use intention among young and older MSM. In addition to focusing on sexual behavior and HIV risk, future prevention campaigns and counseling on PrEP could incorporate education, endorsing positive beliefs, and disarming negative beliefs to improve the uptake of PrEP in young and older MSM.
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Affiliation(s)
| | | | - Feline de la Court
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Amy A. Matser
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam
| | - Maarten F. Schim van der Loeff
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam
| | - Elske Hoornenborg
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Udi Davidovich
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
| | - Maria Prins
- From the Department of Infectious Diseases, Public Health Service of Amsterdam
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam
| | - Henry J.C. de Vries
- Department of Dermatology, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam Institute for Infection and Immunity, Amsterdam, the Netherlands
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Vanbaelen T, Rotsaert A, Jacobs BK, Florence E, Kenyon C, Vuylsteke B, Laga M, Thijs R. Why Do HIV Pre-Exposure Prophylaxis Users Discontinue Pre-Exposure Prophylaxis Care? A Mixed Methods Survey in a Pre-Exposure Prophylaxis Clinic in Belgium. AIDS Patient Care STDS 2022; 36:159-167. [PMID: 35438524 PMCID: PMC9057878 DOI: 10.1089/apc.2021.0197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
It remains unclear why patients discontinue HIV pre-exposure prophylaxis (PrEP) care and to what extent they remain at risk for HIV when they do. We reviewed routinely collected medical records and patient questionnaires and performed an e-mail/telephone survey to assess reasons for discontinuing PrEP care, ongoing risks for HIV infection, and associated factors. Patients with more than two registered PrEP visits from a PrEP clinic in Antwerp, Belgium between June 2017 and February 2020 were included in this study. Patients who did not return for a visit after October 30, 2019 and who were not transferred out were considered as having discontinued PrEP care. A total of 143/1073 patients were considered as having discontinued PrEP care. Patients who discontinued PrEP care were more likely to be younger than those who remained in care (35 vs. 38 years old, p < 0.01). The most common reasons for discontinuation were having stopped using PrEP (62/101, 61.4%) and "COVID-19" (n = 35, 34.7%). The most common reasons for stopping PrEP use was a decreased sexual activity due to coronavirus disease 2019 (COVID-19; 21/62, 33.9%) or not COVID-19 related (10/62, 16.1%), a monogamous relationship (20/62, 32.3%) and consistent condom use (7/62, 11.3%). Among respondents who reported about current HIV risk the majority reported being at low risk either by still taking PrEP (32/91, 35.2%), consistently using condoms, or limiting number of sex acts or partners (58/91, 52.7%). No HIV seroconversion was reported.
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Affiliation(s)
- Thibaut Vanbaelen
- Department of Clinical Sciences and Institute of Tropical Medicine, Antwerp, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Anke Rotsaert
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Bart K.M. Jacobs
- Department of Clinical Sciences and Institute of Tropical Medicine, Antwerp, Belgium
| | - Eric Florence
- Department of Clinical Sciences and Institute of Tropical Medicine, Antwerp, Belgium
| | - Chris Kenyon
- Department of Clinical Sciences and Institute of Tropical Medicine, Antwerp, Belgium
- Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marie Laga
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Reyniers Thijs
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
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Huang ST, Huang JH, Chu JH. Health Beliefs Linked to HIV Pre-Exposure Prophylaxis Use Intention Among Young Men Who Have Sex with Men in Taiwan. AIDS Patient Care STDS 2021; 35:474-480. [PMID: 34748400 DOI: 10.1089/apc.2021.0146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pre-exposure prophylaxis (PrEP) is an effective tool to prevent HIV and has recently been approved in Taiwan. However, more research regarding PrEP acceptability and effective PrEP implementation is needed in Taiwan. Little is known about the intention to use PrEP and salient psychosocial factors among men who have sex with men (MSM). The purpose of this study was to examine health beliefs linked to PrEP use intention among young MSM (YMSM) in Taiwan. Using the Health Belief Model (HBM) as a guiding framework, an anonymous online survey was used to collect data from participants who were recruited using multiple channels to ensure diversity. Multivariate logistic regression was performed to examine the health beliefs linked to high PrEP use intention. Data from 1329 HIV-negative YMSM were analyzed; 488 (36.7%) were classified as having high PrEP use intention, which was found to be associated with having high perceived susceptibility to HIV infection [adjusted odds ratio (AOR) = 2.11], high perceived benefits of PrEP use (AOR = 2.14), high self-efficacy in PrEP use (AOR = 4.19), and many cues to action concerning PrEP use (AOR = 1.49). YMSM with high perceived barriers to PrEP use (AOR = 0.64) had lower PrEP use intention. In addition, the effects of HBM constructs and specific health beliefs on PrEP use intention varied by preferred penile-anal sexual role. The study findings may inform efforts aimed at improving PrEP acceptability and optimizing PrEP implementation programs tailored for YMSM of different sexual roles.
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Affiliation(s)
- Shih-Tse Huang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Jiun-Hau Huang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jen-Hao Chu
- Master of Public Health Degree Program, College of Public Health, National Taiwan University, Taipei, Taiwan
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Meyers K, Wu Y, Shin KY, Hou J, Hu Q, Duan J, Li Y, He X. Salient Constructs for the Development of Shared Decision-Making Tools for HIV Pre-Exposure Prophylaxis Uptake and Regimen Choice: Behaviors, Behavioral Skills, and Beliefs. AIDS Patient Care STDS 2021; 35:195-203. [PMID: 34037427 DOI: 10.1089/apc.2021.0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The availability of multiple pre-exposure prophylaxis (PrEP) regimens creates a preference-sensitive choice for individuals weighing alternative HIV prevention strategies. Investigating factors that are associated with PrEP uptake and regimen choice are key to developing tools to support that decision. A cross-sectional survey was offered to 536 participants in a PrEP demonstration project for gay, bisexual, and other men who have sex with men across 3 cities in China, of which 412 completed surveys and were included in the analysis. We conducted bivariable analyses followed by multi-variable logistic regressions to examine factors associated with overall PrEP uptake and PrEP regimen choice. Among the 412 participants, 36.9% were daily PrEP users, 28.4% were event-driven users, and 34.7% were non-PrEP users. Higher levels of education, lower PrEP use stigma, and higher perceived benefits of PrEP were associated with greater PrEP uptake. More frequent sex, higher PrEP adherence self-efficacy, higher endorsement of the belief in elevated efficacy of daily over on-demand PrEP, and lower endorsement of a desire for a PrEP method that is only taken when needed led to greater odds of choosing the daily PrEP regimen. As multiple HIV prevention modalities become available, there is a greater need for a shared decision-making approach to support this preference-sensitive choice of HIV prevention method. Our findings suggest salient constructs to inform the development of shared decision-making tools to support regimen choice.
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Affiliation(s)
- Kathrine Meyers
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Kee-Young Shin
- Columbia University Mailman School of Public Health, Department of Biostatistics, New York, New York, USA
| | - Jianhua Hou
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Qinghai Hu
- NHC Key Laboratory of AIDS Immunology (China Medical University), Department of Laboratory Medicine, The First Affiliated Hospital of China Medical University, Shenyang, China
| | | | - Yao Li
- Division of Infectious Disease, Chongqing Public Health Medical Center, Chongqing, China
| | - Xiaoqing He
- Division of Infectious Disease, Chongqing Public Health Medical Center, Chongqing, China
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11
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Felner JK, Mittal ML, Hoenigl M, Amico KR, Grelotti DJ, Eanes A, Hess K, Crawford J, Smith LR. Constructions of HIV Risk Among a Diverse Sample of HIV-Negative Young Men Who Have Sex With Men Who Are Repeat Testers. J Acquir Immune Defic Syndr 2021; 86:e126-e133. [PMID: 33394615 PMCID: PMC7933095 DOI: 10.1097/qai.0000000000002614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To end the HIV epidemic, HIV prevention and pre-exposure prophylaxis (PrEP) promotion efforts must reach young men who have sex with men (YMSM) at greatest risk for HIV. This study qualitatively explored whether common metrics used by clinicians, scientists, and public health officials to objectively assess HIV risk align with how YMSM conceptualize their risk for HIV and the factors that shape YMSM's risk perceptions. METHODS Interviews with a racially/ethnically diverse sample of HIV-negative YMSM (ages 19-24 years, 60% Latinx; n = 20) examined conceptualizations of HIV risk within the context of repeat HIV testing. Iterative, applied thematic analysis examined how participants conceptualized and constructed their HIV risk, and compared participants' descriptions of their risk with a validated quantitative assessment of HIV risk that reliably predicts HIV seroconversion in this group. RESULTS Objective quantitative assessments of HIV risk poorly aligned with participants' perceived HIV risk. Participants described their current risk in relative terms (relative to past risk and relative to friends'/peers' risk) and described age/developmental stage and changes in knowledge about HIV prevention as key factors in risk changes over time. Other factors included substance use and trust/mistrust in sexual partners and scientific advances in HIV prevention (eg, U = U and PrEP). Factors that influenced participants' perceived HIV risk were similar regardless of objective risk assessment. CONCLUSIONS Quantitative assessments of risk may poorly align with risk perception among YMSM. Although objective metrics can effectively target YMSM at greatest risk for HIV transmission, interventions to improve prevention behaviors and PrEP uptake may be more effective when tailored to bridge the disconnection between objective HIV risk assessments and YMSM's constructions of risk.
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Affiliation(s)
- Jennifer K. Felner
- San Diego State University, Institute for Behavioral and Community Health and School of Public Health, 9245 Sky Park Court, Suite 224, San Diego, CA 92123
| | - Maria Luisa Mittal
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| | - Martin Hoenigl
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
| | - K. Rivet Amico
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - David J. Grelotti
- HIV Neurobehavioral Research Program, Department of Psychiatry, University of California San Diego School of Medicine, 200 Dickinson St, Suite B, San Diego, CA 92103
| | - Alex Eanes
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
- NASTAD, 444 North Capitol Street NW, Suite 339, Washington, D.C. 20001
| | - Kristen Hess
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
- Clinical Trials Administration, Renown Health, 1155 Mill Street, G14, Reno, NV 89502
| | - Jessica Crawford
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109
| | - Laramie R. Smith
- University of California San Diego, Department of Medicine, Division of Infectious Diseases and Global Public Health, 9500 Gilman Drive MC 0507, La Jolla, CA 92093
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12
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Perlson J, Scholl J, Mayer KH, O'Cleirigh C, Batchelder AW. To Disclose, Not Disclose, or Conceal: A Qualitative Study of HIV-Positive Men with Multiple Concealable Stigmatized Identities. AIDS Patient Care STDS 2021; 35:47-55. [PMID: 33571046 PMCID: PMC7885899 DOI: 10.1089/apc.2020.0205] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
People living with HIV (PLHW) and other concealable stigmatized identities (CSIs) face continual decisions about the degree of openness they are willing to allow for their identities in different social contexts. Disclosing or concealment of CSIs describes potential stigma management strategies that may have distinct psychosocial consequences. This study aimed to examine disclosure processes in a sample of sexual minority men (SMM) with intersecting CSIs, who use substances and were suboptimally engaged in HIV care. Interviews (N = 33) were initially double coded following thematic analysis, which identified disclosure as a theme. Subsequently, content analysis and additional selective double coding were used to iteratively identify and refine subthemes related to disclosure decisions. Illustrative quotes and frequencies of the invoked subthemes and identities were recorded for each participant. The majority of participants discussed experiences of disclosure and nondisclosure (N = 31, 94%). Among these, a spectrum of related behaviors and preferences emerged, including active disclosure, passive disclosure, passive nondisclosure, and concealment. Across disclosure-related content, in addition to HIV status, the majority of participants also described navigating decisions about disclosure of sexual orientation (71%), substance use (61%), and multiple identities at once (55%). Findings from this study highlight the fluid and multi-dimensional nature of identity-related disclosure processes in SMM with multiple CSIs. Participants in this study possessed interlocking stigmatized identities and described being varying degrees of "out" across identities and time. Moreover, these findings challenge common beliefs that disclosure is a binary construct associated with positive gain.
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Affiliation(s)
- Jacob Perlson
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
- Geisel School of Medicine at Dartmouth College, Hanover, New Hampshire, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - James Scholl
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Abigail W. Batchelder
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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13
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Koppe U, Marcus U, Albrecht S, Jansen K, Jessen H, Gunsenheimer-Bartmeyer B, Bremer V. Barriers to using HIV pre-exposure prophylaxis (PrEP) and sexual behaviour after stopping PrEP: a cross-sectional study in Germany. BMC Public Health 2021; 21:159. [PMID: 33468089 PMCID: PMC7816315 DOI: 10.1186/s12889-021-10174-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 01/05/2021] [Indexed: 01/31/2023] Open
Abstract
Background Persistence of individuals at risk of HIV with Pre-Exposure Prophylaxis (PrEP) is critical for its impact on the HIV epidemic. We analysed factors associated with stopping PrEP, barriers that may deter people from continuing PrEP and investigated sexual behaviour after stopping PrEP. Methods Current and former PrEP users in Germany were recruited to complete an anonymous online survey on PrEP use and sexual behaviour. Participants were recruited through dating apps, a PrEP community website, anonymous testing sites and peers. The results were analysed using descriptive methods and logistic regression. Results We recruited 4848 current and 609 former PrEP users in two study waves (July–October 2018, April–June 2019). Former PrEP users were more likely 18–29 years old than current users (adjusted OR = 1.6, 95% confidence interval (CI) 1.1–2.3). Moreover, they were more often unhappy with their sex life, which was more pronounced in former daily PrEP users (aOR = 4.5, 95% CI 2.9–7.1) compared to former on-demand users (aOR = 1.8, 95% CI 1.1–2.9, pinteraction = 0.005). The most common reason for stopping PrEP was a reduced need for PrEP (49.1%). However, 31.4% of former users identified logistic reasons and 17.5% stopped due to side effects. Former PrEP users using PrEP < 3 months were more likely to stop PrEP due to concerns over long-term side effects (32.0% vs. 22.5%, p = 0.015) and not wanting to take a chemical substance (33.2% vs. 24.0%, p = 0.020) compared to former PrEP users who used PrEP for longer. After stopping PrEP, 18.7% of former PrEP users indicated inconsistent condom use while having ≥4 sex partners within the previous 6 months. Former PrEP users with many partners and inconsistent condom use more often indicated logistic reasons for stopping (46.5% vs. 27.9%, p < 0.001) than did other former PrEP users. Conclusions To maximise persistence with PrEP we need to develop strategies for younger PrEP users, reduce logistic barriers to access PrEP, and to develop effective communication on side-effect management. Moreover, prevention strategies for people stopping PrEP are required, since some remain at high risk for HIV. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10174-4.
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Affiliation(s)
- Uwe Koppe
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
| | - Ulrich Marcus
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Stefan Albrecht
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Klaus Jansen
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | | | - Viviane Bremer
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
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14
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Allan-Blitz LT, Mena LA, Mayer KH. The ongoing HIV epidemic in American youth: challenges and opportunities. Mhealth 2021; 7:33. [PMID: 33898602 PMCID: PMC8063015 DOI: 10.21037/mhealth-20-42] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 06/05/2020] [Indexed: 01/05/2023] Open
Abstract
The incidence of human immunodeficiency virus (HIV) infection has been decreasing in the United States overall, except among youth, and in particular among Black and Latinx young men who have sex with men (MSM). In this review we summarize key drivers of the HIV epidemic among youth, as well as novel interventions geared specifically towards combating the epidemic among high-risk populations. Many factors driving the HIV epidemic among youth are related to systemic inequities, including lack of access to healthcare, inadequate education, and internalized and experience homophobia and racism. Developmentally, youth may feel that they are invulnerable and be willing to engage in risks. Moreover, HIV is often invisible for youth given advances in treatment and community stigma, limiting open discussion of risk and new preventive modalities. Outcomes from the HIV treatment cascade suggest that youth are less likely to be aware of their HIV infection status, less likely to link to and be engaged in care, and less likely to be virologically suppressed than older MSM and other populations of people living with HIV. Importantly, pre-exposure prophylaxis (PrEP) has been shown to be an effective tool for prevention of HIV infection that also appears to have disproportionately poor uptake among youth. Barriers to PrEP utilization appear to be quite heterogeneous, and include patient-, provider-, and structural-level barriers. Interventions important in improving HIV prevention will thus have to be multipronged and developed for culturally diverse populations. Cognitive behavioral therapy-based interventions are promising strategies as they are able to address a diverse array of barriers. New formulations of PrEP will also likely be instrumental in improving adherence. Since youth spend considerable amounts of time accessing digital media, the deployment of apps and other mobile phone-based interfaces offer unique opportunities to increase education and to facilitate HIV prevention for at risk youth. Multiple studies are underway to better inform the optimal delivery of treatment and prevention services for this complex and diverse population, and include novel sociobiological interventions and new modes of medication delivery that may lend themselves to overcoming obstacles specific to youth.
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Affiliation(s)
- Lao-Tzu Allan-Blitz
- Department of Medicine, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA, USA
- Department of Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Leandro A. Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kenneth H. Mayer
- Fenway Health, Boston, MA, USA
- Division of Infectious Diseases, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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15
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Resnick D, Morales K, Gross R, Petsis D, Fiore D, Davis-Vogel A, Metzger D, Frank I, Wood S. Prior Sexually Transmitted Infection and Human Immunodeficiency Virus Risk Perception in a Diverse At-Risk Population of Men Who Have Sex with Men and Transgender Individuals. AIDS Patient Care STDS 2021; 35:15-22. [PMID: 33400589 DOI: 10.1089/apc.2020.0179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Prior sexually transmitted infections (STIs) are associated with higher rates of subsequent human immunodeficiency virus (HIV) infection, but the influence of prior STIs on perceived vulnerability to HIV remains unclear. We aimed to assess this relationship, hypothesizing that a prior STI diagnosis is associated with higher self-assessed vulnerability to HIV. We performed a cross-sectional study of men and transgender individuals who have sex with men screening for HIV prevention trials in Philadelphia. An unadjusted regression analysis found no significant association between prior STI and HIV risk perception (p = 0.71) or HIV anxiety (p = 0.32). Multivariate logistic regression models that controlled for predetermined potential cofounders known to impact HIV risk-such as condom use, preexposure prophylaxis use, and demographics-also failed to show statistically significant associations between prior STI and HIV risk perception (p = 0.87) or HIV anxiety (p = 0.10). Furthermore, there was no effect modification by HIV preventive behaviors on the relationship between prior STI and HIV vulnerability. These data suggest that a gap exists between how clinicians may attribute individual HIV risk and how individuals view their own vulnerability at a given moment in time. Future research should focus on the dynamic relationship between perceived HIV vulnerability, STI diagnosis, and adoption of preventive behavior to determine better, individualized targets for HIV prevention interventions.
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Affiliation(s)
- Daniel Resnick
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Knashawn Morales
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Robert Gross
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Danielle Petsis
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Danielle Fiore
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Annet Davis-Vogel
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - David Metzger
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ian Frank
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Sarah Wood
- HIV Research Prevention Division, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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16
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Yumori C, Zucker J, Theodore D, Chang M, Carnevale C, Slowikowski J, LaSota E, Olender S, Gordon P, Cohall A, Sobieszczyk ME. Women Are Less Likely to Be Tested for HIV or Offered Preexposure Prophylaxis at the Time of Sexually Transmitted Infection Diagnosis. Sex Transm Dis 2021; 48:32-36. [PMID: 33315784 PMCID: PMC8543120 DOI: 10.1097/olq.0000000000001265] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Ending the HIV epidemic requires linkage of at-risk individuals from diverse health care settings to comprehensive HIV prevention services. Sexually transmitted infections (STIs) are significant biomarkers of HIV risk and should trigger preexposure prophylaxis (PrEP) discussion. We reviewed STI testing practices outside of sexual health clinics to identify opportunities for improvement in the provision of HIV prevention services. METHODS An electronic sexual health dashboard was used to identify patient encounters with a positive gonorrhea, chlamydia, and/or rapid plasma reagin test result between January 1, 2019, and August 23, 2019, at a large urban academic medical center. A retrospective chart review was performed to assess HIV testing, completeness of STI screening, and HIV prevention discussion; inadequate screening was defined as no HIV test in 12 months before STI diagnosis. RESULTS A total of 815 patients with 856 patient encounters were included. Patients were predominantly female (64.4%); median age was 24 years (range, 18-85 years). The most common test and most common positive test result was the genitourinary gonorrhea/chlamydia nucleic acid amplification test. Multisite testing was rare (7.5% of patient encounters) and performed more frequently in men than in women (20.3% vs. 0.36%). Women were also more likely to be inadequately screened for HIV (15.1% vs. 25.8%).Documentation of PrEP discussion was rare (4.7% of patient encounters) compared with safe sex (44.6%) and condoms (49.8%). Preexposure prophylaxis was discussed almost exclusively with men compared with women (17% vs. 1.1%). CONCLUSIONS In patients diagnosed with bacterial STI outside of sexual health clinics, gaps in HIV prevention exist. HIV screening, multisite STI screening, and discussion of PrEP were particularly infrequent among women.
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Affiliation(s)
- Caitlin Yumori
- Columbia University Vagelos College of Physicians and Surgeons
| | - Jason Zucker
- Department of Internal Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
| | - Deborah Theodore
- Department of Internal Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
| | - Michelle Chang
- Department of Internal Medicine, Columbia University Irving Medical Center
| | | | | | - Elijah LaSota
- Department of Internal Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
| | - Susan Olender
- Department of Internal Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
| | - Peter Gordon
- Department of Internal Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
| | - Alwyn Cohall
- Department of Pediatrics, Columbia University Irving Medical Center
| | - Magdalena E. Sobieszczyk
- Department of Internal Medicine, Division of Infectious Disease, Columbia University Irving Medical Center
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17
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Singleton AL, Marshall BD, Zang X, Nunn AS, Goedel WC. Added Benefits of Pre-Exposure Prophylaxis Use on HIV Incidence with Minimal Changes in Efficiency in the Context of High Treatment Engagement Among Men Who Have Sex with Men. AIDS Patient Care STDS 2020; 34:506-515. [PMID: 33216618 DOI: 10.1089/apc.2020.0151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Although there is ongoing debate over the need for substantial increases in pre-exposure prophylaxis (PrEP) use when antiretroviral treatment confers the dual benefits of reducing HIV-related morbidity and mortality and the risk of HIV transmission, no studies to date have quantified the potential added benefits of PrEP use and changes in its efficiency in the context of high treatment engagement across multiple US subpopulations. We used a previously published agent-based model to simulate HIV transmission in a dynamic network of Black/African American and White men who have sex with men (MSM) in Atlanta, Georgia (2015-2024) to understand how reductions in HIV incidence attributable to varying levels of PrEP use change when United Nations Joint Programme on HIV/AIDS (UNAIDS) "90-90-90" goals for HIV treatment are achieved and maintained. Even at achievement of "90-90-90" goals, 75% PrEP coverage further reduced incidence by 67.9% and 74.2% to 1.53 [simulation interval (SI): 1.39-1.70] and 0.355 (SI: 0.316-0.391) per 100 person-years for Black/African American and White MSM, respectively, compared with the same scenario with no PrEP use. Increasing PrEP coverage from 15% to 75% under "90-90-90" goals only increased the number of person-years of PrEP use per infection averted by 8.1% and 10.5% to 26.7 (SI: 25.6-28.0) and 73.3 (SI: 70.6-75.7) among Black/African American MSM and White MSM, respectively. Even with high treatment engagement, substantial expansion of PrEP use contributes to meaningful decreases in HIV incidence among MSM with minimal changes in efficiency.
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Affiliation(s)
- Alyson L. Singleton
- Department of Biostatistics, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Brandon D.L. Marshall
- Department of Epidemiology, and School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Xiao Zang
- Department of Epidemiology, and School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - William C. Goedel
- Department of Epidemiology, and School of Public Health, Brown University, Providence, Rhode Island, USA
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18
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Kulie P, Castel AD, Zheng Z, Powell NN, Srivastava A, Chandar S, McCarthy ML. Targeted Screening for HIV Pre-Exposure Prophylaxis Eligibility in Two Emergency Departments in Washington, DC. AIDS Patient Care STDS 2020; 34:516-522. [PMID: 33296271 DOI: 10.1089/apc.2020.0228] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is an effective method to prevent HIV acquisition in high-risk individuals. This cross-sectional survey study estimated the proportion of patients who were PrEP eligible among a targeted sample of emergency department (ED) patients with chief complaints indicative of HIV risk. Research assistants screened a convenience sample of adult patients who presented to two hospital EDs in Washington, DC, during a 6-month period with genitourinary, substance use, or intentional injury-related complaints. Patients with these complaints who reported being sexually active within the past 6 months and HIV negative completed a computer-assisted survey that included questions on sexual practices and partners, substance use, and attitudes and knowledge about PrEP. We used the Centers for Disease Control and Prevention (CDC) clinical guidelines to determine whether PrEP use was indicated. We report differences in PrEP eligibility by demographic characteristics, knowledge, and attitudes. Of the 410 participants, the majority were black (85%), and heterosexual females (72%). PrEP use was indicated in 20% (N = 84), most commonly because of condomless sex with a person of unknown HIV status (82%) and/or a sexually transmitted infection (STI) diagnosis (41%). One-third (34%) of participants had heard of PrEP. Overall, 36% of the sample (N = 148) wanted to learn more about PrEP while in the ED. The percentage who wanted to learn more about PrEP was higher among PrEP-eligible patients (52%) compared with PrEP-ineligible patients (32%). Using CDC criteria, targeted screening identified that a substantial proportion of ED patients are PrEP eligible based on their self-reported behaviors.
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Affiliation(s)
- Paige Kulie
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, USA
| | - Amanda D. Castel
- Department of Epidemiology and Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Zhaonian Zheng
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
| | - Natasha N. Powell
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, USA
| | - Aneil Srivastava
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, USA
| | - Sandhya Chandar
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, USA
| | - Melissa L. McCarthy
- Department of Emergency Medicine, The George Washington University, Medical Faculty Associates, Washington, District of Columbia, USA
- Department of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, District of Columbia, USA
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19
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Cui Z, Huang H, Zhang T, Yu Z, Zhang H, Yao T, Song D, Chen Y, Peixoto E, Wang C, Wang X, Yang J, Liu Y, Li C, Ma J. Low awareness of and willingness to use PrEP in the Chinese YMSM: An alert in YMSM HIV prevention. HIV Med 2020; 22:185-193. [PMID: 33197141 DOI: 10.1111/hiv.12990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Despite being a key population in whom to initiate pre-exposure prophylaxis (PrEP), the awareness of and willingness to use PrEP are still unclear in Chinese young men who have sex with men (YMSM). We report factors associated with PrEP awareness and willingness in the population. METHODS From 1 August to 31 December 2018, 495 participants aged 15-24 years were included in a cross-sectional study about awareness of and willingness to use PrEP among YMSM. Logistic regression models were used to identify factors associated with two outcomes: awareness of PrEP; and willingness to use PrEP. RESULTS Among 495 eligible participants, 129 participants (26.1%) knew about PrEP. PrEP awareness among YMSM was associated with higher education level [adjusted odds ratio (aOR) = 1.812, 95% CI: 1.113-2.951] and previous HIV testing (aOR = 3.507, 95% CI: 1.261-9.752). YMSM with shorter local residence time (aOR = 0.317, 95% CI: 0.101-0.992) and internet-based partner-seeking (aOR = 0.171, 95% CI: 0.096-0.305) were less likely to be aware of PrEP. In those with previous knowledge of PrEP, 36 (27.9%) conveyed their willingness to use it. PrEP willingness was associated with internet-based partner-seeking (aOR = 9.593, 95% CI: 1.965-46.844). The main barriers influencing those who knew about PrEP but refused to use it were the high price of PrEP (69.9%), the need to use condoms consistently (52.7%), and concerns about side effects (39.8%) and effectiveness of prevention (22.6%). CONCLUSIONS Chinese YMSM have low awareness of and willingness to use PrEP. Adequate PrEP promotions should be implemented, especially on the Internet and dating software.
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Affiliation(s)
- Zhuang Cui
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Huijie Huang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Tiantian Zhang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Zeyang Yu
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Honglu Zhang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Tingting Yao
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Desheng Song
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yang Chen
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Elissa Peixoto
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Chun Wang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiaomeng Wang
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jie Yang
- Tianjin Shenlan Community-Based Organization, Tianjin, China
| | - Yuanyuan Liu
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Changping Li
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Jun Ma
- Epidemiology and Biostatistics Institute, School of Public Health, Tianjin Medical University, Tianjin, China
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Spinelli MA, Laborde N, Kinley P, Whitacre R, Scott HM, Walker N, Liu AY, Gandhi M, Buchbinder SP. The importance of PrEP persistence in preventing HIV infections on PrEP. J Int AIDS Soc 2020; 23:e25578. [PMID: 32844591 PMCID: PMC7448189 DOI: 10.1002/jia2.25578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 02/01/2023] Open
Affiliation(s)
- Matthew A Spinelli
- Division of HIV, ID, and Global MedicineUniversity of CaliforniaSan FranciscoCAUSA
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Nicole Laborde
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Patrick Kinley
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Ryan Whitacre
- Department of Anthropology and SociologyThe Graduate Institute GenevaGenevaSwitzerland
| | - Hyman M Scott
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Nicole Walker
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Albert Y Liu
- San Francisco Department of Public HealthSan FranciscoCAUSA
| | - Monica Gandhi
- Division of HIV, ID, and Global MedicineUniversity of CaliforniaSan FranciscoCAUSA
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