HIV/STI Service Delivery Within Juvenile Community Supervision Agencies: A National Survey of Practices and Approaches to Moving High-Risk Youth Through the HIV Care Cascade

Provider Comfort with Prescribing HIV Pre-Exposure Prophylaxis to Adolescents

In the United States, Black and Latinx youth remain disproportionately affected by HIV. Oral antiretroviral pre-exposure prophylaxis (PrEP) is a proven effective HIV prevention strategy. PrEP is approved for use in people younger than the age of 18 years, but little is known about provider comfort and preparedness with prescribing it to adolescents. In this study, physicians provide their perspectives on the facilitators and barriers to PrEP access among adolescents. Focus groups (n = 23) were conducted with pediatric and family practitioners practicing in an urban community hospital setting to assess PrEP awareness and receptivity to use among adolescents. Most providers were unfamiliar with clinical guidelines for PrEP use, especially in determining adolescent candidates for PrEP use, including appropriate dosing regimen and follow-up procedures. Overall, providers had low intent on prescribing PrEP, citing concerns about consent, medication adherence, and appropriateness of primary care providers in prescribing and managing adolescent PrEP use. Strategies that will address provider education and comfort in prescribing PrEP to adolescents are required to increase PrEP access and uptake among communities disproportionally affected by HIV.

Lessons Learned from the Pathways to Community Health Study to Evaluate the Transition of Care from Jail to Community for Men with HIV

Time spent in jail can provide opportunities to deliver comprehensive medical care, including screening and treatment for HIV; however, engagement in HIV care postrelease is often fragmented. Identifying ways to improve the transition of care from jail to community for people with HIV (PWH) may help with engagement in HIV care postrelease. We evaluated the current HIV care transition processes of one jail in Massachusetts and identified change ideas to facilitate improving the transition of care from the jail to the community for PWH. We conducted qualitative interviews in 2018–2019 with incarcerated men with HIV (n = 17), jail staff (n = 7), and community providers (n = 6) to understand the processes of HIV care prerelease from the jail and engagement in care on release. Data from these interviews and quality improvement tools were used to identify ways to improve the release process for PWH, such as using a release planning checklist, to help ensure that a 30-day supply of HIV medication and an appointment with a community provider within 30 days of release were provided. We identified communication process inefficiencies related to knowing release dates between the HIV care team and case managers that prevented providing HIV medications on release. We worked with jail administrators to find ways to improve the prerelease planning process, which is vital to the continuity of successful HIV care. The use of quality improvement methods generated a list of testable change ideas to improve the release planning process to better align with the Centers for Disease Control and Prevention guidelines, which has implications for PWH and public health.

Mental Health Service Utilization Among Young Black Gay, Bisexual, and Other Men Who Have Sex with Men in HIV Care: A Retrospective Cohort Study

Young Black gay, bisexual, and other men who have sex with men (YB-GBMSM) face multiple psychosocial stressors, and are disproportionately impacted by HIV. Mental health care engagement is a promising avenue for addressing these disparities. To date, rates of mental health service utilization have not been examined specifically in this population. We conducted a retrospective cohort study among YB-GBMSM receiving care in a Ryan White-funded HIV care center that includes co-located HIV and mental health services. Of 435 unique YB-GBMSM patients, mental health concerns were identified in n = 191 (43.9%). Depressive symptoms were the most common concerns identified, followed by substance use, anxiety, and trauma. Among patients with identified mental health concerns who were not previously in mental health care, 79.1% were referred to mental health care, 56.3% set an appointment with a mental health provider, 40.5% were linked to mental health care (attended an initial visit), and 19.6% remained engaged in mental health care. Younger YB-GBMSM (age 18-24 years), who received care in a more integrated pediatric/adolescent part of the center, were more likely to have an appointment set once a concern was identified (χ² = 7.17; p = 0.007). Even in a setting with co-located HIV and mental health care services, we found significant gaps in engagement at each stage of a newly described mental health care continuum. Implications for intervention at the provider and systems levels are discussed.

A study protocol for a randomized controlled trial of a cross-systems service delivery model to improve identification and care for HIV, STIs and substance use among justice-involved young adults

BACKGROUND

Justice-involved young adults (JIYA) aged 18-24 are at significant risk for HIV and problematic substance use (SU) but are unlikely to know their HIV status or be linked to HIV or SU treatment and care. Intensive efforts to increase screening and improve linkage to HIV and SU services for JIYA are needed that address youth as well as justice and health/behavioral health system-level barriers.

METHODS

MoveUp is a four-session intervention that integrates evidence-based protocols to promote HIV and STI testing, HIV and SU behavioral risk reduction and engagement in treatment for JIYA. MoveUp is delivered onsite at an alternative sentencing program (ASP) by HIV testing outreach workers from a youth-focused medical and HIV treatment program. N = 450 youth are randomized following baseline assessment into two groups: MoveUp or standard of care. Youth are followed for 12 months following the intervention; unprotected sexual behavior, substance use, HIV and STI testing as well as treatment linkage will be assessed at 3, 6, 9 and 12-months.

DISCUSSION

This study is one of the first to systematically test an integrated screen/testing, prevention intervention and linkage-to-care services program (MoveUp), using evidence-based approaches to address the overlapping HIV/STI and substance use epidemics in JIYA by providing on-site services to identify HIV/STI and SU risk and treatment need within justice-settings as well as linkage to services in the community. This approach, capitalizing on health and justice partnerships, represents an innovation that can capitalize on missed opportunities for engaging JIYA in health care.