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Mantsios A, Murray M, Karver TS, Davis W, Margolis D, Kumar P, Swindells S, Bredeek UF, Deltoro MG, García RR, Antela A, Garris C, Shaefer M, Gomis SC, Bernáldez MP, Kerrigan D. "I feel empowered": women's perspectives on and experiences with long-acting injectable antiretroviral therapy in the USA and Spain. CULTURE, HEALTH & SEXUALITY 2021; 23:1066-1078. [PMID: 32436478 DOI: 10.1080/13691058.2020.1752397] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
Long-acting injectable antiretroviral therapy has been shown to be non-inferior to daily oral antiretroviral therapy in clinical trials and may soon become part of clinical care. While most trial participants to date have been men, approximately one quarter of ongoing Phase 3 trial participants are women offering an important opportunity to understand how long-acting antiretroviral therapy is perceived and experienced by women. We conducted in-depth interviews with 80 people living with HIV participating in Phase 2 and 3 clinical trials of long-acting antiretroviral therapy in the USA and Spain. Fifteen percent (12/80) of trial participants interviewed were women. Interviews were audio-recorded, transcribed and coded using content analysis, focused on gender-specific themes. Women shared many of the positive perceptions expressed by men but also had unique perspectives, including finding that long-acting antiretroviral therapy addressed the challenge of remembering pills amidst busy day-to-day realities including multiple roles and responsibilities, is less time consuming and creates less stress compared to oral antiretroviral therapy, and is emotionally freeing and empowering. The gendered nature of women's lives shaped why and how they were satisfied with long-acting antiretroviral therapy. Findings can inform interventions and support systems to facilitate uptake of and adherence to long-acting antiretroviral therapy in women.
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Affiliation(s)
- Andrea Mantsios
- Department of Sociology, American University, Washington, DC, USA
| | - Miranda Murray
- Department of Sociology, American University, Washington, DC, USA
| | - Tahilin S Karver
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Wendy Davis
- Department of Sociology, American University, Washington, DC, USA
| | - David Margolis
- ViiV Healthcare, Raleigh-Durham, Research Triangle Park, NC, USA
| | - Princy Kumar
- Department of Medicine, Georgetown University, Washington, DC, USA
| | - Susan Swindells
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Miguel García Deltoro
- Infectious Disease Service, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | | | - Antonio Antela
- Infectious Diseases Unit, Complejo Hospitalario Universitario, Santiago de Compostela, Compostela, Spain
| | - Cindy Garris
- ViiV Healthcare, Raleigh-Durham, Research Triangle Park, NC, USA
| | - Mark Shaefer
- ViiV Healthcare, Raleigh-Durham, Research Triangle Park, NC, USA
| | | | | | - Deanna Kerrigan
- Department of Sociology, American University, Washington, DC, USA
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Kerrigan D, Sanchez Karver T, Muraleetharan O, Savage V, Mbwambo J, Donastorg Y, Likindikoki S, Perez M, Gomez H, Mantsios A, Murray M, Beckham SW, Davis W, Galai N, Barrington C. "A dream come true": Perspectives on long-acting injectable antiretroviral therapy among female sex workers living with HIV from the Dominican Republic and Tanzania. PLoS One 2020; 15:e0234666. [PMID: 32530939 PMCID: PMC7292359 DOI: 10.1371/journal.pone.0234666] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/30/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Long-acting injectable antiretroviral therapy (LA ART) was found to be non-inferior to daily oral ART in Phase 3 clinical trials. LA ART may offer an important alternative for people living with HIV with challenges adhering to daily oral ART or preferences for non-pill-based regimens. METHODS Using a mixed methods approach integrating survey, in-depth interview and biological data from female sex workers (FSW) living with HIV in Tanzania (N = 208) and the Dominican Republic (DR) (N = 201), we assessed factors associated with the potential likelihood of LA ART use if it were available. We conducted multivariate logistic regression and thematic content analysis. RESULTS Likelihood of LA ART use was high with 84.92% of FSW from the DR and 92.27% of FSW from Tanzania reporting they would be "likely" or "very likely" to use LA ART if available (p = 0.02). In Tanzania better HIV-related patient-provider communication (AOR 4.58; 95% CI 1.90-11.05) and quality of HIV clinical care (AOR 3.68; 95% CI 1.05-12.86) were positively associated with the high likelihood of LA ART use. In the DR, easier clinic access was associated with a higher likelihood of LA ART use (AOR 3.04; 95% CI 1.41-6.56), as was greater monthly income from sex work (AOR 2.37; 95% CI 1.27-4.41). In both settings, years on ART was significantly associated with a strong likelihood of LA ART use (TZ: AOR 1.16 per year; 95% CI 1.00-1.34/DR: AOR 1.07 per year; 95% CI 1.00-1.14). Qualitative findings underscored enthusiasm for LA ART and reinforced its potential to address sex work-specific barriers to daily oral ART adherence including work-related schedules and substance use. CONCLUSIONS We found a high likelihood of LA ART use if available among FSW in two diverse settings and documented barriers to future uptake. Community-driven approaches which include tailored health education and improved patient-provider communication and quality of care, as well as strategies to facilitate appointment adherence are needed to optimize LA ART use among FSW.
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Affiliation(s)
- Deanna Kerrigan
- Department of Sociology, American University, Washington, DC, United States of America
| | - Tahilin Sanchez Karver
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ohvia Muraleetharan
- Department of Health Policy, Yale University, New Haven, Connecticut, United States of America
| | - Virginia Savage
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Jessie Mbwambo
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Yeycy Donastorg
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Samuel Likindikoki
- Department of Psychiatry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Martha Perez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Hoisex Gomez
- HIV Vaccine Trials Research Unit, Instituto Dermatológico y Cirugía de la Piel, Santo Domingo, Dominican Republic
| | - Andrea Mantsios
- Public Health Innovation and Action, New York, New York, United States of America
| | | | - S. Wilson Beckham
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wendy Davis
- Department of Sociology, American University, Washington, DC, United States of America
| | - Noya Galai
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Department of Statistics, University of Haifa, Mt Carmel, Israel
| | - Clare Barrington
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, United States of America
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