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Hill-Rorie J, Biello KB, Quint M, Johnson B, Elopre L, Johnson K, Lillis R, Burgan K, Krakower D, Whiteside Y, Mayer KH. Weighing the Options: Which PrEP (Pre-exposure Prophylaxis) Modality Attributes Influence Choice for Young Gay and Bisexual Men in the United States? AIDS Behav 2024:10.1007/s10461-024-04384-1. [PMID: 39126557 DOI: 10.1007/s10461-024-04384-1] [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] [Accepted: 05/15/2024] [Indexed: 08/12/2024]
Abstract
Pre-exposure prophylaxis (PrEP) is effective in preventing HIV transmission, but uptake and adherence among young men who have sex with men (YMSM) remains suboptimal. New PrEP formulations may enhance PrEP use, but little is known about their acceptability. We enrolled 39 cis- and transgender YMSM (age 18-34) from Boston, MA; Jackson, MS; Birmingham, AL; and New Orleans, LA, who participated in video-based focus groups (n = 30) or in-depth interviews (n = 9) to examine how new PrEP products (e.g., injections, monthly pills, implants) are perceived and might be improved for YMSM. Focus groups were transcribed, coded, and analyzed using grounded theory and content analysis. Nearly half (46%) of participants were Black; 11% identified as Hispanic. Seventy-nine percent were PrEP experienced. Product preference was driven by the desire for flexible, safe, effective, and affordable PrEP options. A majority of participants preferred subcutaneous injections every 6 months or monthly pills dispersed in 3 or 4 doses. Subcutaneous injections and batched monthly pills were favored by those with demanding schedules and those who desired fewer provider visits; monthly pills were more appealing for those who feared needles. Despite broad preferences for longer-acting products for convenience, participants raised concerns regarding side effects and waning protection after missed doses. Participants felt that more education about safety and efficacy profiles of new products could influence their attitudes. These findings suggest that it is important to prioritize YMSM's dynamic lifestyles during product development, and that product safety and efficacy information should be accessible in youth-friendly language.
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Affiliation(s)
| | - Katie B Biello
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
| | - Meg Quint
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | | | | | - Kendra Johnson
- University of Mississippi Medical Center, Jackson, MS, USA
| | - Rebecca Lillis
- Louisiana State University School of Medicine, New Orleans, LA, USA
| | - Kaylee Burgan
- University of Alabama, Birmingham, Birmingham, AL, USA
| | - Douglas Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Medical Center/Harvard Medical School, Boston, MA, USA
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Biello KB, Chan PA, Ndoye CD, Nelson L, Nelson E, Silva V, Kwak E, Napoleon S, Cormack Orellana C, Richards OG, Davis E, Mimiaga MJ. Study protocol of a randomized controlled trial to assess the efficacy of the "PrEPare for Work" intervention to enhance PrEP uptake and optimize adherence for HIV prevention among male sex workers in the U.S. BMC Public Health 2024; 24:424. [PMID: 38336731 PMCID: PMC10858584 DOI: 10.1186/s12889-024-17710-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: 11/11/2023] [Accepted: 01/09/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Male sex workers (MSWs), specifically cisgender men who exchange sex for money, goods, drugs, or other items of value with other cisgender men, are at high risk for HIV infection. Compared to men not engaged in sex work, MSWs are more likely to engage in frequent condomless sex with paying and non-paying sexual partners. While MSWs are often included as a subgroup of gay and bisexual men, data show that a large proportion identify as heterosexual; additionally, most MSWs do not identify as "sex workers." This places MSWs in a unique position where they may not engage with traditional HIV prevention programs, and when they do, they may not feel comfortable, leading to poor retention. Thus, HIV prevention interventions that address MSWs' unique life circumstances and provide support in exploring their sexual health options are needed. METHODS In this protocol paper, we describe the design and procedures for a National Institute of Health-funded, randomized controlled trial testing the efficacy of "PrEPare for Work,"- a theory-based, manualized PrEP uptake and adherence intervention for MSW - using a 2-stage randomization design. Stage 1: MSWs are equally randomized to receive either the "PrEPare for Work Stage 1 intervention" (strength-based case management and facilitated PrEP linkage) or Standard of Care (SOC) to evaluate successful PrEP uptake (prescription filled) within two months post-randomization. Stage 2: Those who initiate PrEP are then equally re-randomized to receive either the "PrEPare for Work Stage 2 intervention" (1-on-1 skills training, problem-solving, and motivational interviewing adherence counseling and personalized, daily text message reminders) or SOC to assess adherence (Tenofovir concentrations in hair) over 12 months of follow up. Planned analyses will examine intervention efficacy, specific conceptual mediators, and hypothesized moderators. DISCUSSION Based on our extensive preliminary research, multi-component, theory-informed interventions targeting this subpopulation of MSWs' unique life circumstances are urgently needed. In this study, we are evaluating whether "PrEPare for Work" can improve PrEP uptake and adherence among MSWs. If this intervention is efficacious, it would be readily disseminated to diverse community organizations that serve MSWs and possibly other community or clinic-based settings. TRIAL REGISTRATION ClinicalTrials.gov number NCT05736614, registered February 8, 2023.
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Affiliation(s)
- Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
- Center for Health Promotion and Health Equity Research, Brown University School of Public Health, Providence, USA.
- The Fenway Institute, Fenway Health, Boston, USA.
- Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
| | - Philip A Chan
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
- Department of Medicine, Brown University, Providence, USA
- Open Door Health, Rhode Island Public Health Institute, Providence, USA
| | - Colleen D Ndoye
- Project Weber/RENEW, 121 South Main Street, Providence, RI, 02912, USA
| | - Lance Nelson
- Center for Health Promotion and Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Elizabeth Nelson
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
| | - Vanessa Silva
- Center for Health Promotion and Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Eun Kwak
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
| | - Siena Napoleon
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | | | - Olly G Richards
- Center for Health Promotion and Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Evan Davis
- Center for Health Promotion and Health Equity Research, Brown University School of Public Health, Providence, USA
| | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, USA
- Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA
- Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- UCLA Center for LGBTQ+ Advocacy, Research & Health, Los Angeles, CA, USA
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3
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Whelchel K, Zuckerman AD, DeClercq J, Choi L, Kelly SG. Optimizing HIV PrEP Persistence: Does Your Pharmacy Matter? AIDS Behav 2023; 27:3735-3744. [PMID: 37266824 DOI: 10.1007/s10461-023-04091-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 06/03/2023]
Abstract
Persistence to human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is integral to preventing new HIV infections. Previous studies have shown real-world PrEP persistence is low and insight is needed into PrEP delivery strategies that improve persistence. This single-center, retrospective, cohort study measured persistence in patients filling PrEP through an integrated health-system specialty pharmacy (HSSP) compared to those filling at external pharmacies. The Kaplan-Meier estimates for persistence probability at 6, 12, and 18 months were 0.87 (95% CI 0.79-0.95), 0.75 (95% CI 0.66-0.86), and 0.64 (95% CI 0.53-0.76) for the HSSP cohort compared to 0.65 (95% CI 0.51-0.83), 0.41 (95% CI 0.28-0.62), and 0.32 (95% CI 0.2-0.53), respectively, for the non-HSSP cohort (log-rank p < 0.001, [Formula: see text] = 11.2). Cox PH modeling showed that patients using a non-HSSP were 2.7 times more likely to be non-persistent than HSSP patients (HR 2.7, 95% CI 1.6-4.7, p < 0.001, [Formula: see text] = 12.61), demonstrating patients were better maintained on PrEP therapy when their prescriptions were filled with the HSSP.
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Affiliation(s)
- Kristen Whelchel
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, 726 Melrose Ave, Nashville, TN, 37211, USA.
| | - Autumn D Zuckerman
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, 726 Melrose Ave, Nashville, TN, 37211, USA
| | - Josh DeClercq
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sean G Kelly
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
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Reyniers T, Fiorentino M, Babo SAY, Ouedraogo M, Kanta I, Agbegnigan LE, Rojas D, Anoma C, Dah TTE, Mensah E, Keita BD, Spire B, Vuylsteke B, Laurent C. The Perceived Added Value of Bimonthly Injectable Pre-Exposure Prophylaxis According to West African Men Who Have Sex with Men: A Focus Group Study. AIDS Patient Care STDS 2023; 37:480-488. [PMID: 37862074 DOI: 10.1089/apc.2023.0097] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Bimonthly long-acting injectable pre-exposure prophylaxis (LAI-PrEP) can become an important additional tool for HIV prevention among West African men who have sex with men (MSM). The objective was to explore the perceived added value of LAI-PrEP as an HIV prevention tool among MSM in Burkina Faso, Côte d'Ivoire, Mali, and Togo. We conducted eight focus group discussions among 62 HIV-negative MSM between April and May 2021. Participants were recruited via local community-based clinics. Data collection and analysis were guided by grounded theory and community-based participatory approaches. Participants were generally knowledgeable about HIV, and explained particular barriers for HIV prevention in their communities (e.g., denial of HIV). The added value of LAI-PrEP relative to condoms was similar to oral pre-exposure prophylaxis (PrEP) in terms of perceived advantages (e.g., improved sexual satisfaction) or disadvantages (e.g., no protection against other sexually transmitted infections). Compared with oral PrEP, LAI-PrEP was perceived to provide better protection against HIV and to be more convenient (e.g., no need to be mindful of intake and less risk for stigma). Concerns included fear of needles, doubts about efficacy, potential side effects, and difficulties for ensuring timely injections (e.g., when traveling abroad). The results demonstrate that injectable PrEP can be of particular interest to subgroups of West African MSM, although existing HIV prevention tools such as condoms and oral PrEP will remain valuable alongside of, or instead of, LAI-PrEP. Increasing awareness about HIV and tackling discrimination based on sexual orientation continue to be crucial factors to be addressed for HIV prevention.
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Affiliation(s)
- Thijs Reyniers
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Marion Fiorentino
- INSERM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), ISSPAM, Aix Marseille Université, Marseille, France
| | | | | | | | | | - Daniela Rojas
- INSERM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), ISSPAM, Aix Marseille Université, Marseille, France
- Coalition Plus, Community-Based Research Laboratory, Pantin, France
| | | | - Ter Tiero Elias Dah
- Association African Solidarité, Ouagadougou, Burkina Faso
- UFR Sciences de la Santé, Université de Ouahigouya, Ouahigouya, Burkina Faso
| | | | | | - Bruno Spire
- INSERM, IRD, Sciences Economiques et Sociales de la Santé et Traitement de l'Information Médicale (SESSTIM), ISSPAM, Aix Marseille Université, Marseille, France
| | - Bea Vuylsteke
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Christian Laurent
- TransVIHMI, Université Montpellier, IRD, Inserm, Montpellier, France
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5
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Biello KB, Chan PA, Holcomb R, Ndoye CD, Valente PK, Maynard M, Gandhi M, Mayer KH, Mimiaga MJ. PrEPare for Work: A Pilot Randomized Controlled Trial of an Intervention to Optimize HIV PrEP Outcomes Among Male Sex Workers. AIDS Behav 2023; 27:3294-3305. [PMID: 36976389 PMCID: PMC10753039 DOI: 10.1007/s10461-023-04050-y] [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: 03/14/2023] [Indexed: 03/29/2023]
Abstract
HIV pre-exposure prophylaxis (PrEP) use is limited among male sex workers, who are at exceptionally high-risk for HIV infection. We developed a theory-informed, two-pronged intervention ("PrEPare-for-Work") to optimize PrEP initiation and adherence among male sex workers, which was preliminarily evaluated in a two-stage pilot randomized controlled trial of 110 male sex workers in the US Northeast. Individuals randomized to the Stage 1 PrEPare-for-Work Case Management arm were three times as likely as those in the standard of care (SOC) arm to initiate PrEP (RR = 2.95, 95% CI = 1.57-5.57). Participants who initiated PrEP and were randomized to the Stage 2 PrEPare-for-Work Adherence Counseling arm had higher rates of prevention-effective adherence (measured via tenofovir in hair) compared to those in the SOC arm (RR = 1.7, 95% CI 0.64-4.77; 55.6% vs. 28.6%, respectively); though not statistically significant. Given the need and the promise of this pilot RCT, further efficacy testing is warranted and should be prioritized.
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Affiliation(s)
- Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- , 121 South Main Street, Providence, RI, 02912, USA.
| | - Philip A Chan
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Medicine, Brown University, Providence, RI, USA
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, USA
- Rhode Island Department of Health, Providence, RI, USA
| | | | | | - Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
- Department of Allied Health Sciences, University of Connecticut, Waterbury, CT, USA
| | - Michaela Maynard
- Department of Medicine, Brown University, Providence, RI, USA
- Open Door Health, Rhode Island Public Health Institute, Providence, RI, USA
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco (UCSF), CA, USA
| | | | - Matthew J Mimiaga
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- UCLA Center for LGBTQ Advocacy, Research, and Health (C-LARAH), Los Angeles, CA, USA
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6
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Sharpe JD, Siegler AJ, Sanchez TH, Guest JL, Sullivan PS. Effects of mode of transportation on PrEP persistence among urban men who have sex with men. AIDS Care 2023; 35:1411-1419. [PMID: 37232114 PMCID: PMC11167718 DOI: 10.1080/09540121.2023.2217375] [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: 07/25/2022] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Little is known about the effect of travel-related factors, such as mode of transportation, on retention in PrEP care, or PrEP persistence. We used data from the 2020 American Men's Internet Survey and conducted multilevel logistic regression to estimate the association between mode of transportation used for healthcare access and PrEP persistence among urban gay, bisexual, and other men who have sex with men (MSM) in the U.S. MSM using public transportation were less likely to report PrEP persistence (aOR: 0.51; 95% CI: 0.28-0.95) than MSM using private transportation. There were no significant associations between PrEP persistence and using active transportation (aOR: 0.67; 95% CI: 0.35-1.29) or multimodal transportation (aOR: 0.85; 95% CI: 0.51-1.43) compared to using private transportation. Transportation-related interventions and policies are needed to address structural barriers to accessing PrEP services and to improve PrEP persistence in urban areas.
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Affiliation(s)
| | | | | | - Jodie L. Guest
- Department of Epidemiology, Emory University, Atlanta, GA, USA
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7
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Rogers BG, Murphy M, Zanowick-Marr A, Chambers L, Maynard M, Galipeau D, Toma E, Almonte A, Napoleon S, Chan PA. Characterizing HIV Syndemics and the Role of Incarceration Among Men Who have Sex with Men Presenting for Care at a Sexually Transmitted Infections Clinic. AIDS Behav 2023; 27:2513-2522. [PMID: 36633764 PMCID: PMC10336172 DOI: 10.1007/s10461-023-03978-5] [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: 01/01/2023] [Indexed: 01/13/2023]
Abstract
Men who have sex with men (MSM) with a history of incarceration experience unique risk factors for HIV acquisition. The current study examined unique risk factors for HIV among MSM with a history of incarceration presenting to a sexually transmitted infections (STI) clinic. We analyzed self-reported behavioral data from clinical encounters among patients attending the clinic between January 2012 and April 2021. There were 17,221 unique visits, of which 5988 were MSM. Of these, 4.34% (N = 206) were MSM with a history of incarceration. MSM with a history of incarceration were significantly more likely to report a range of behavioral risk factors for HIV, yet also were significantly less likely to perceive themselves at risk for HIV. Future research and practice should develop culturally tailored biobehavioral HIV prevention services and consider embedding these programs within criminal justice settings to better reach this at-risk group.
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Affiliation(s)
- Brooke G Rogers
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA.
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, 02903, USA.
| | - Matthew Murphy
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
- The Rhode Island Public Health Institute, Providence, RI, USA
| | - Alexandra Zanowick-Marr
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
| | - Laura Chambers
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, 02903, USA
| | - Michaela Maynard
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
| | - Drew Galipeau
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
| | - Emily Toma
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
| | - Alexi Almonte
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
| | - Siena Napoleon
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
| | - Philip A Chan
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School, Brown University, Providence, RI, 02903, USA
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Kim CM, Zhao V, Brito De Mello M, Baggaley R, Johnson CC, Spielman E, Fairley CK, Zhang L, de Vries H, Klausner J, Zhao R, Ong JJ. Determining the screening frequency for sexually transmitted infections for people who use HIV pre-exposure prophylaxis: a systematic review and meta-analysis. Int J Infect Dis 2023; 129:181-187. [PMID: 36690140 DOI: 10.1016/j.ijid.2023.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/04/2023] [Accepted: 01/04/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Although the World Health Organization recommends 'frequent' screening of sexually transmitted infections (STI) for people who use pre-exposure prophylaxis for HIV, there is no evidence for optimal frequency. METHODS We searched five databases and used random-effects meta-analysis to calculate pooled estimates of STI test positivity. We narratively synthesized data on secondary outcomes, including adherence to recommended STI screening frequency and changes in STI epidemiology. RESULTS Of 7477 studies, we included 38 for the meta-analysis and 11 for secondary outcomes. With 2-3 monthly STI screening, the pooled positivity was 0.20 (95% confidence interval [CI]: 0.15-0.25) for chlamydia, 0.17 (95% CI: 0.12-0.22) for gonorrhea, and 0.07 (95% CI: 0.05-0.08) for syphilis. For chlamydia and gonorrhea, the positivity was approximately 50% and 75% lower, respectively, in studies that screened 4-6 monthly vs 2-3 monthly. There was no significant difference in the positivity for syphilis in studies that screened 4-6 monthly compared to 2-3 monthly. Adherence of clients to recommended screening frequency varied significantly (39-94%) depending on population and country. Modeling studies suggest more frequent STI screening could reduce incidence. CONCLUSION Although more frequent STI screening could reduce delayed diagnoses and incidence, there remain significant knowledge gaps regarding the optimal STI screening frequency.
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Affiliation(s)
- Cham-Mill Kim
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Victor Zhao
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
| | - Maeve Brito De Mello
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Rachel Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Erica Spielman
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Christopher K Fairley
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
| | - Lei Zhang
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Henry de Vries
- Amsterdam UMC location University of Amsterdam, Department of Dermatology, Amsterdam, The Netherlands; Amsterdam Institute for Infection and Immunology, Infectious Diseases, Amsterdam, The Netherlands; Center for Sexual Health, Department of Infectious Diseases, Public Health Service Amsterdam, The Netherlands; Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Jeffrey Klausner
- Keck School of Medicine of University of Southern California, Los Angeles, United States
| | - Rui Zhao
- China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jason J Ong
- Central Clinical School, Monash University, Melbourne, Australia; Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia; Clinical Research Department, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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9
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Mbotwa CH, Kazaura MR, Moen K, Lichtwarck HO, Leshabari MT, Metta E, Mmbaga EJ. Effect of an mHealth intervention on retention in HIV pre-exposure prophylaxis services among female sex workers: Preliminary evidence of the use of the Jichunge app in Dar es Salaam, Tanzania. Digit Health 2023; 9:20552076231170507. [PMID: 37113256 PMCID: PMC10126669 DOI: 10.1177/20552076231170507] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/31/2023] [Indexed: 04/29/2023] Open
Abstract
Background Mobile health (mHealth) applications have been reported to be effective in promoting access and adherence to health services. However, knowledge about their effect on retention in HIV preventive services among at-risk populations in sub-Saharan Africa is limited. Objective We aimed to evaluate the effect of the Jichunge mHealth application on retention in HIV pre-exposure prophylaxis (PrEP) services among female sex workers in Dar es Salaam, Tanzania. Methods We used respondent-driven sampling to recruit female sex workers eligible for PrEP and who owned a smartphone. All study participants were provided with a smartphone application (Jichunge app) aiming to promote PrEP use through medication reminders, easy access to PrEP information, online consultations with a doctor and/or peer educator, and online discussions between PrEP users. The effect of optimal use of the Jichunge app on retention in PrEP services at 1-month was modelled using log-binomial regression. Results A total of 470 female sex workers with a median age of 26 (interquartile range: 22-30) years were recruited. Overall, 27.7% of female sex workers were retained in PrEP services at 1 month. Retention was twice as high among optimal users of the app than among sub-optimal users (adjusted risk ratios = 2.00, 95% confidence interval (CI): 1.41-2.83, p < 0.001). Conclusion The optimal use of the Jichunge mHealth application was significantly associated with higher retention in PrEP services among female sex workers in Dar es Salaam.
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Affiliation(s)
- Christopher H Mbotwa
- Department of Epidemiology and
Biostatistics, Muhimbili University of Health and Allied
Sciences, Dar es Salaam, Tanzania
- Mbeya College of Health and Allied
Sciences, University of Dar es Salaam, Mbeya, Tanzania
- Christopher H Mbotwa, Department of
Epidemiology and Biostatistics, Muhimbili University of Health and Allied
Sciences, P.O.Box 65015, Dar es Salaam, Tanzania.
| | - Method R Kazaura
- Department of Epidemiology and
Biostatistics, Muhimbili University of Health and Allied
Sciences, Dar es Salaam, Tanzania
| | - Kåre Moen
- Department of Community Medicine and
Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hanne O Lichtwarck
- Department of Community Medicine and
Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Melkizedeck T Leshabari
- Department of Behavioural Sciences, Muhimbili University of Health and Allied
Sciences, Dar es Salaam, Tanzania
| | - Emmy Metta
- Department of Behavioural Sciences, Muhimbili University of Health and Allied
Sciences, Dar es Salaam, Tanzania
| | - Elia J Mmbaga
- Department of Epidemiology and
Biostatistics, Muhimbili University of Health and Allied
Sciences, Dar es Salaam, Tanzania
- Department of Community Medicine and
Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Ugarte A, de la Mora L, García D, Martínez-Rebollar M, de Lazzari E, Torres B, Inciarte A, Ambrosioni J, Chivite I, Solbes E, de Loredo N, Del Carlo GF, González-Cordón A, Blanco JL, Martínez E, Mallolas J, Laguno M. Evolution of Risk Behaviors, Sexually Transmitted Infections and PrEP Care Continuum in a Hospital-Based PrEP Program in Barcelona, Spain: A Descriptive Study of the First 2 Years' Experience. Infect Dis Ther 2022; 12:425-442. [PMID: 36520330 PMCID: PMC9753893 DOI: 10.1007/s40121-022-00733-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, but the PrEP care continuum also involves improving PrEP awareness, uptake, adherence, and retention in care. Users' awareness is often compromised because of vulnerability factors and risk behaviors, such as chemsex practice or specific substance use, which could lead to risk compensation. Correct adherence and retention in care are essential to achieve the full effectiveness of PrEP. This study describes changes in users' risk behaviors and sexually transmitted infections (STIs), as well also PrEP care continuum details. METHODS This was a descriptive single-center retrospective study including adults at high HIV risk screened between November 2019 and June 2021 in the PrEP program of our hospital. Demographic, behavioral, STI, adherence, and retention in care variables were assessed. Data were collected from medical records and self-report questionnaires. RESULTS A total of 295 people were included, 94% men and 5% transgender women, with a mean age of 34 years (SD 10) and 10% sex workers. At baseline, 55% disclosed chemsex practice and 3% slamming. During follow-up, condom use for anal intercourse decreased from 41% to 13% (p ≤ 0.0001) and one HIV infection was detected; other risk behaviors and STIs remained stable. Chemsex, group sex, fluid exchange, and condomless anal intercourse were related to STI risk. Adherence was correct in 80% of users, and retention in care was 57%. Discontinuations and loss to follow-up were high, mainly affecting transgender women, sex workers, and people practicing fisting. CONCLUSION PrEP program implementation in our hospital was adequate, since it allowed, in a population at high HIV risk, overall users' risk behaviors and STIs to remain stable, with only one HIV diagnosis during the follow-up. We should target specific strategies to improve adherence and retention in care, as vulnerable subgroups at higher risk of loss to follow-up are identified.
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Affiliation(s)
- Ainoa Ugarte
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036, Barcelona, Spain.
| | - Lorena de la Mora
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - David García
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - María Martínez-Rebollar
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Elisa de Lazzari
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Berta Torres
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Alexy Inciarte
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Juan Ambrosioni
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Iván Chivite
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Estela Solbes
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Nicolás de Loredo
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Guillermo Federico Del Carlo
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Ana González-Cordón
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - José Luis Blanco
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Esteban Martínez
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Josep Mallolas
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
| | - Montserrat Laguno
- Infectious Diseases Department, HIV/AIDS Unit, Hospital Clinic of Barcelona, Villarroel Street 170, 08036 Barcelona, Spain
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Kislovskiy Y, Erpenbeck S, Martina J, Judkins C, Miller E, Chang JC. HIV awareness, pre-exposure prophylaxis perceptions and experiences among people who exchange sex: qualitative and community based participatory study. BMC Public Health 2022; 22:1844. [PMID: 36183063 PMCID: PMC9526910 DOI: 10.1186/s12889-022-14235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background People who exchange sex for money, favors, goods or services, combat higher risk of acquiring sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). Understanding barriers to STD and HIV related healthcare from the perspective of this stigmatized and marginalized community may improve access to sexual health services including pre-exposure prophylaxis (PrEP). Methods We used community-partnered participatory and qualitative methods to conduct anonymous one-on-one interviews with people who exchange sex to understand their perspectives and experiences related to pre-exposure prophylaxis (PrEP) to prevent HIV acquisition. We conducted twenty-two interviews and coded them to perform thematic analysis. Results We identified five themes: (1) Appreciation of HIV risk and prevention strategies grew from information accumulated over time. (2) PrEP information came from a variety of sources with mixed messages and uncertain credibility. (3) Decision-making about use of PrEP was relative to other behavioral decisions regarding exchange sex. (4) The multi-step process of obtaining PrEP presented multiple potential barriers. (5) Healthcare providers were seen as powerful facilitators to PrEP utilization. Conclusions Our findings suggest that PrEP education and care needs to be made more relevant and accessible to individuals who exchange sex. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-14235-0.
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Affiliation(s)
- Yasaswi Kislovskiy
- Department of OB/GYN and Women's Institute, Drexel University College of Medicine, Allegheny Health Network, 4800 Friendship Ave, Pittsburgh Pennsylvania, PA, USA. .,Magee-Womens Research Institute (MWRI), Pittsburgh, PA, USA.
| | - Sarah Erpenbeck
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jamie Martina
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Courtney Judkins
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Division of Adolescent and Young Adult Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Judy C Chang
- Magee-Womens Research Institute (MWRI), Pittsburgh, PA, USA.,University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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