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Cole SW, Glick JL, Campoamor NB, Sanchez TH, Sarkar S, Vannappagari V, Rinehart A, Rawlings K, Sullivan PS, Bridges JFP. Willingness and preferences for long-acting injectable PrEP among US men who have sex with men: a discrete choice experiment. BMJ Open 2024; 14:e083837. [PMID: 38653510 PMCID: PMC11043728 DOI: 10.1136/bmjopen-2023-083837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Cabotegravir long-acting injectable HIV pre-exposure prophylaxis (LA-PrEP) was shown to be safe and effective in multiple clinical trials. Increasing uptake and persistence among populations with elevated risk for HIV acquisition, especially among men who have sex with men (MSM), is critical to HIV prevention. OBJECTIVE This analysis aims to understand potential users' preferences for LA-PrEP, with audience segmentation. DESIGN Willingness to use and preferences for LA-PrEP were measured in HIV-negative, sexually active MSM in the 2020 American Men's Internet Survey. Respondents answered a discrete choice experiment with paired profiles of hypothetical LA-PrEP characteristics with an opt-out option (no LA-PrEP). Conditional and mixed logit models were run; the final model was a dummy-coded mixed logit that interacted with the opt-out. SETTING US national online sample. RESULTS Among 2506 MSM respondents, most (75%) indicated a willingness to use LA-PrEP versus daily oral PrEP versus no PrEP. Respondents were averse to side effects and increasing costs and preferred increasing levels of protection. Respondents preferred a 2-hour time to obtain LA-PrEP vs 1 hour, with a strong aversion to 3 hours. Overall, there was an aversion to opting out of LA-PrEP, with variations: those with only one partner, no/other insurance or who were Black, Indigenous or People of Colour were significantly less likely to prefer LA-PrEP, while those who were Hispanic/Latino, college educated and <40 years significantly preferred LA-PrEP. CONCLUSIONS A large proportion of MSM expressed a preference for LA-PrEP over daily oral pills. Most respondents chose LA-PrEP regardless of cost, clinic time, side effects or protection level; however, preferences varied by sociodemographics. These varied groups likely require tailored intervention strategies to achieve maximum LA-PrEP uptake and persistence.
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Affiliation(s)
- Sam Wilson Cole
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Query Research Consulting, Glen Burnie, Maryland, USA
| | - Jennifer L Glick
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Community Health Science & Policy (CHSP), Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | - Nicola B Campoamor
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Travis H Sanchez
- Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA
| | | | | | | | | | - Patrick S Sullivan
- Epidemiology, Emory University School of Public Health, Atlanta, Georgia, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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McCormick CD, Sullivan PS, Qato DM, Crawford SY, Schumock GT, Lee TA. Adherence and persistence of HIV pre-exposure prophylaxis use in the United States. Pharmacoepidemiol Drug Saf 2024; 33:e5729. [PMID: 37937883 DOI: 10.1002/pds.5729] [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] [Received: 05/05/2023] [Revised: 08/21/2023] [Accepted: 11/06/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE To describe medication adherence and persistence of HIV PrEP overall and compare between sex and age groups of commercially insured individuals in the United States. METHODS We conducted a national retrospective cohort study of the Merative MarketScan Claims Database from 2011 to 2019 to describe adherence and persistence of PrEP overall and compared between sex and age groups. High adherence was defined as ≥80% of proportion of days covered and persistence was measured in days from initiation to the first day of a 60-day treatment gap. RESULTS A total of 29 689 new PrEP users identified. Overall adherence was high (81.9%; 95% confidence interval [CI]: 81.5%-82.3%). Females were more adherent than males (adjusted odds ratio [aOR] 1.87; 95% CI: 1.50-2.34), while those ≥45-years were less adherent than individuals <45-years (aOR 0.87: 95% CI: 0.81-0.93). More than half of individuals discontinued therapy within the first year (median 238.0 days; interquartile range 99.0-507.0 days). Females were less persistent than males (hazard ratio [HR] 1.49; 95% CI: 1.34-1.65), and people ≥45-years old were more persistent (i.e., lower risk of discontinuation) than those <45-years (HR 0.43; 95% CI: 0.33-0.55). CONCLUSIONS These findings show adherence to daily PrEP is high among commercially insured individuals but the majority still discontinue in the first year. Future research should investigate what factors influence PrEP discontinuation among this population and ways to reduce barriers to therapy maintenance to ensure the population-level benefits of PrEP treatment.
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Affiliation(s)
- Carter D McCormick
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois, USA
| | - Patrick S Sullivan
- Department of Epidemiology, Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Dima M Qato
- Program on Medicines and Public Health, Titus Family Department of Clinical Pharmacy, University of Southern California, School of Pharmacy, Los Angeles, California, USA
- USC Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Stephanie Y Crawford
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois, USA
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, College of Pharmacy, Chicago, Illinois, USA
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Jin G, Shi H, Du J, Guo H, Yuan G, Yang H, Zhu Z, Zhang J, Zhang K, Zhang X, Lu X, Xu W, Wang S, Hao J, Sun Y, Su P, Zhang Z. Pre-Exposure Prophylaxis Care Continuum for HIV Risk Populations: An Umbrella Review of Systematic Reviews and Meta-Analyses. AIDS Patient Care STDS 2023; 37:583-615. [PMID: 38011347 DOI: 10.1089/apc.2023.0158] [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: 11/29/2023] Open
Abstract
Pre-exposure prophylaxis (PrEP) is an effective biomedical strategy for HIV prevention. This umbrella review is aimed at providing a comprehensive summary of the current status of each stage of the PrEP care cascade. A systematic literature search was conducted in PubMed, Embase, and Cochrane. Additionally, a Measurement Tool to Assess Systematic Reviews 2 (AMSTAR-2) tool and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) checklist were used to evaluate their methodological and reporting quality, respectively. A total of 30 systematic reviews met the inclusion criteria. According to the results of methodological quality assessment, 3 reviews were rated as low, while 27 as critically low. Furthermore, the results of the reporting quality evaluation revealed a mean score of 23.03 for the included reviews. Across all the reviews, awareness of PrEP was generally moderate in all populations, and the acceptability was even higher compared with awareness. Unfortunately, the PrEP uptake among different groups was even less optimal, although the adherence was almost above moderate, and several barriers that hindered the utilization of PrEP were identified, and the most common are as follows: cost, stigma, lack of knowledge, mistrust, low risk perception, and more. Although PrEP has proven to be an effective prevention method to date, the promotion of PrEP failed to achieve the anticipated outcome. To reinforce the generalization of and use of PrEP, and effectively control HIV transmission, it is urgent to identify the underlying causes of low uptake rates so that efficient interventions can be implemented.
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Affiliation(s)
- Guifang Jin
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Haiyan Shi
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jun Du
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Haiyun Guo
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Guojing Yuan
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Huayu Yang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihui Zhu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jianghui Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Kexin Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Xueqing Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Xiaoyan Lu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Wenzhuo Xu
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Sainan Wang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Jiahu Hao
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Ying Sun
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Puyu Su
- Department of Maternal, Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
| | - Zhihua Zhang
- Department of Epidemiology and Biostatistics and Child, & Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China
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Smith AKJ, Lancaster K, Rhodes T, Holt M. Dosing practices made mundane: Enacting HIV pre-exposure prophylaxis adherence in domestic routines. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:1747-1764. [PMID: 37309108 DOI: 10.1111/1467-9566.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Abstract
Maintaining routines of medication dosing requires effort amidst the variabilities of everyday life. This article offers a sociomaterial analysis of how the oral HIV prevention regimen, pre-exposure prophylaxis (PrEP), is put to use and made to work, including in situations which disrupt or complicate dosing regimes. Other than a daily pill, PrEP can be taken less frequently based on anticipated sexual activity and HIV risk, including 'on-demand' and 'periodic' dosing. Drawing on 40 interviews with PrEP users in Australia in 2022, we explore PrEP and its dosing as features of assemblages in which bodies, routines, desires, material objects and the home environment interact. Dosing emerges as a practice of coordination involving dosette boxes, blister packs, alarms, partners, pets, planning sex, routines and domestic space, and as an effect of experimentations with timing to suit life circumstances and manage side effects. Dosing is materialised in the mundane; a practice that is made to work, as well as domesticated, in its situations. Although there are no 'simple' solutions to adherence, our analysis offers practical insights into how routine, planning and experimentation come together to capacitate PrEP to work in people's lives, in sometimes unexpected ways, including through adaptations of PrEP dosing.
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Affiliation(s)
- Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, New South Wales, Australia
| | - Kari Lancaster
- Centre for Social Research in Health, UNSW Sydney, New South Wales, Australia
| | - Tim Rhodes
- Centre for Social Research in Health, UNSW Sydney, New South Wales, Australia
- London School of Hygiene and Tropical Medicine, London, UK
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, New South Wales, Australia
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MacDonald J, Estcourt CS, Flowers P, Nandwani R, Frankis J, Young I, Clutterbuck D, Dalrymple J, McDaid L, Steedman N, Saunders J. Improving HIV pre-exposure prophylaxis (PrEP) adherence and retention in care: Process evaluation and recommendation development from a nationally implemented PrEP programme. PLoS One 2023; 18:e0292289. [PMID: 37812636 PMCID: PMC10561843 DOI: 10.1371/journal.pone.0292289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/15/2023] [Indexed: 10/11/2023] Open
Abstract
INTRODUCTION HIV pre-exposure prophylaxis (PrEP), in which people take HIV medication to prevent HIV acquisition, underpins global HIV transmission elimination strategies. Effective prevention needs people to adhere to PrEP and remain in care during periods of risk, but this is difficult to achieve. We undertook a process evaluation of Scotland's PrEP programme to explore barriers and facilitators to PrEP adherence and retention in care and to systematically develop evidence-based, theoretically-informed recommendations to address them. METHODS We conducted semi-structured interviews and focus groups (09/2018-07/2019) with patients who identified as gay or bisexual men and were either using PrEP, had declined the offer of PrEP, had stopped PrEP, or had been assessed as ineligible for PrEP (n = 39 of whom n = 5 (13%) identified as trans, median age 31 years and interquartile range 14 years), healthcare professionals involved in PrEP provision (n = 54 including specialist sexual health doctors and nurses of various grades, PrEP prescribing general practitioners, health promotion officers, midwifes, and a PrEP clinical secretary), and clients (n = 9) and staff (n = 15) of non-governmental organisations with an HIV prevention remit across Scotland. We used thematic analysis to map key barriers and facilitators to priority areas that could enhance adherence and retention in care. We used implementation science analytic tools (Theoretical Domains Framework, Intervention Functions, Behaviour Change Technique Taxonomy, APEASE criteria) and expert opinion to systematically generate recommendations. RESULTS Barriers included perceived complexity of on-demand dosing, tendency for users to stop PrEP before seeking professional support, troublesome side-effects, limited flexibility in the settings/timings/nature of review appointments, PrEP-related stigma and emerging stigmas around not using PrEP. Facilitators included flexible appointment scheduling, reminders, and processes to follow up non-attenders. Examples of the 25 recommendations include: emphasising benefits of PrEP reviews and providing appointments flexibly within individualised PrEP care; using clinic systems to remind/recall PrEP users; supporting PrEP conversations among sexual partners; clear on-demand dosing guidance; encouraging good PrEP citizenship; detailed discussion on managing side-effects and care/coping planning activities. CONCLUSIONS PrEP adherence and retention in care is challenging, reducing the effectiveness of PrEP at individual and population levels. We identify and provide solutions to where and how collaborative interventions across public health, clinical, and community practice could address these challenges.
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Affiliation(s)
- Jennifer MacDonald
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Claudia S. Estcourt
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
- Sandyford Sexual Health Services, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, Scotland, United Kingdom
| | - Rak Nandwani
- Sandyford Sexual Health Services, NHS Greater Glasgow and Clyde, Glasgow, Scotland, United Kingdom
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Jamie Frankis
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Ingrid Young
- Centre for Biomedicine, Self & Society, University of Edinburgh, Edinburgh, Scotland, United Kingdom
| | - Dan Clutterbuck
- Chalmers Sexual Health Centre, NHS Lothian, Edinburgh, Scotland, United Kingdom
| | - Jenny Dalrymple
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, Scotland, United Kingdom
| | - Lisa McDaid
- Institute for Social Science Research, The University of Queensland, Brisbane, Australia
| | - Nicola Steedman
- Chief Medical Officer Directorate, Scottish Government, Edinburgh, Scotland, United Kingdom
| | - John Saunders
- Institute for Global Health, University College London, London, England, United Kingdom
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Gebru NM, Canidate SS, Liu Y, Schaefer SE, Pavila E, Cook RL, Leeman RF. Substance Use and Adherence to HIV Pre-Exposure Prophylaxis in Studies Enrolling Men Who Have Sex with Men and Transgender Women: A Systematic Review. AIDS Behav 2023; 27:2131-2162. [PMID: 36538138 PMCID: PMC10869193 DOI: 10.1007/s10461-022-03948-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
Optimal adherence to pre-exposure prophylaxis (PrEP) is critical, but challenging. Men who have sex with men and transgender women have high rates of HIV incidence and substance use. Substance use is associated with reduced adherence to other medications, but associations between substance use and adherence to PrEP are less clear. Thus, the current review 1) systematically evaluates the measurement of substance use and PrEP adherence in studies examining both and 2) summarizes reported findings. Peer-reviewed articles published between 2010 - April 2021 examining associations between substance use and PrEP adherence were reviewed. Fifty studies met inclusion criteria. Assessment of substance use (i.e., mostly via self-reports at baseline) and PrEP adherence (i.e., often via tenofovir diphosphate [TFV-DP] concentration levels at follow-up) varied considerably across studies. Many studies used categorical variables (e.g., substance use: yes/no). Studies using TFV-DP levels defined adherence consistently (i.e., TFV-DP ≥ 700 fmol/punch), with slight variations. Qualitative studies (n = 10) indicated that substance use (mainly alcohol) is related to poorer PrEP adherence. While quantitative findings to date are equivocal for alcohol, there is a pattern of findings linking stimulant use with poorer PrEP adherence. This review reveals four methodological gaps, which can be addressed in future research by: 1) use of uniform benchmarks for substance use measures, 2) prospective assessment for substance use, 3) use of continuous outcome variables wherever possible, and 4) more extensive consideration of potential confounders. Addressing these methodological gaps may help us reach more definitive conclusions regarding associations between substance use and PrEP adherence.
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Affiliation(s)
- Nioud Mulugeta Gebru
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St, Box G-S121-3, 02912, Providence, RI, USA.
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA.
| | - Shantrel S Canidate
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA
- Southern HIV and Alcohol Research Consortium (SHARC), University of Florida, Gainesville, FL, USA
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Yiyang Liu
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA
- Southern HIV and Alcohol Research Consortium (SHARC), University of Florida, Gainesville, FL, USA
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Sage E Schaefer
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St, Box G-S121-3, 02912, Providence, RI, USA
| | - Emmely Pavila
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St, Box G-S121-3, 02912, Providence, RI, USA
| | - Robert L Cook
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA
- Southern HIV and Alcohol Research Consortium (SHARC), University of Florida, Gainesville, FL, USA
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
| | - Robert F Leeman
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main St, Box G-S121-3, 02912, Providence, RI, USA
- Department of Health Education & Behavior, University of Florida, Gainesville, FL, USA
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McKetchnie SM, White B, Fontenot H, Dormitzer J, Psaros C, Fitch C, O'Cleirigh C, Mayer KH, Krakower DS. Perspectives of Young Men Who Have Sex with Men on PrEP Adherence and Peer Navigation: A Qualitative Study. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:2037-2049. [PMID: 36940046 PMCID: PMC10330054 DOI: 10.1007/s10508-023-02579-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
HIV incidence is disproportionately high among young cisgender men who have sex with men (YMSM), but YMSM are less likely than adults to use HIV pre-exposure prophylaxis (PrEP). Among YMSM living with HIV, peer navigation programs have been effective in linkage to care and increasing medication adherence; such programs may aid HIV-uninfected YMSM in overcoming barriers to engagement in PrEP care. We conducted 32 semi-structured qualitative interviews at a community health center in Massachusetts, USA, specializing in sexual and gender minority health with four sub-groups of YMSM who: (1) had never discussed PrEP with a medical provider, (2) had discussed PrEP with a medical provider but declined a prescription, (3) were prescribed PrEP and have sub-optimal adherence (taking fewer than 4 pills per week), and (4) were prescribed PrEP and were optimally adherent. Domains addressed in the interviews included knowledge of PrEP and HIV prevention, barriers and facilitators to PrEP adherence, and attitudes toward peer navigation for PrEP. Interviews were transcribed and coded using thematic analysis methodology. Multiple themes emerged from the interviews, including finding that perceived costs, anticipated stigma, sexual activity, and relationship status influence PrEP uptake and adherence; establishing pill-taking routines is an important adherence facilitator; and peer navigators could offer benefits for PrEP adherence.
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Affiliation(s)
- Samantha M McKetchnie
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA.
- School of Social Work, Boston College, Newton, MA, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Bradley White
- Department of Nursing, MGH Institute of Health Professionals, Boston, MA, USA
| | - Holly Fontenot
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Nancy Atmospera-Walch School of Nursing, University of Hawaii at Manoa, Honolulu, HI, USA
| | | | - Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Calvin Fitch
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Conall O'Cleirigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Boston, MA, 02214, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Douglas S Krakower
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Harvard University, Boston, MA, USA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA, USA
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8
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Gyamerah AO, Kinzer E, Aidoo-Frimpong G, Sorensen G, Mensah MD, Taylor KD, Vanderpuye NA, Lippman SA. PrEP knowledge, acceptability, and implementation in Ghana: Perspectives of HIV service providers and MSM, trans women, and gender diverse individuals living with HIV. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001956. [PMID: 37285336 DOI: 10.1371/journal.pgph.0001956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/29/2023] [Indexed: 06/09/2023]
Abstract
Pre-exposure prophylaxis (PrEP) could help reduce HIV incidence among cis men, trans women, and gender diverse individuals assigned male at birth who have sex with men (MSM, trans women, and GDSM) in Ghana, a group that bears a high HIV burden. Our study examined PrEP knowledge and acceptability, and barriers and facilitators to its uptake and implementation through qualitative interviews with 32 MSM, trans women, and GDSM clients living with HIV, 14 service providers (SPs), and four key informants (KIs) in Accra, Ghana. We interviewed participants about their PrEP knowledge, whether MSM would take PrEP, and what factors would make it easy/difficult to uptake or implement PrEP. Interview transcripts were analyzed using thematic analysis. There was high acceptability of PrEP use and implementation among MSM, trans women, GDSM, and SPs/KIs in Ghana. MSM, trans women, and GDSM interest in, access to, and use of PrEP were shaped by intersectional HIV and anti-gay stigma; PrEP affordability, acceptability, and ease of use (e.g., consumption and side effects); sexual preferences (e.g., condomless sex vs. condom use), and HIV risk perception. Concerns raised about barriers and facilitators of PrEP use and implementation ranged from medical concerns (e.g., STIs; drug resistance); social behavioral concerns (e.g., stigma, risk compensation, adherence issues); and structural barriers (e.g., cost/affordability, govern commitment, monitoring systems, policy guidance). Targeted education on PrEP and proper use of it is needed to generate demand and dispel worries of side effects among MSM, trans women, and GDSM. Free, confidential, and easy access to PrEP must be supported by health systems strengthening, clear prescription guidelines, and anti-stigma training for providers.
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Affiliation(s)
- Akua O Gyamerah
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Ezra Kinzer
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Gloria Aidoo-Frimpong
- Department of Community Health and Health Behavior, The State University of New York at Buffalo, Buffalo, New York, United States of America
| | | | | | - Kelly D Taylor
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, California, United States of America
| | | | - Sheri A Lippman
- Center for AIDS Prevention Studies, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
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Sallabank G, Stephenson R, Gandhi M, Merrill L, Sharma A. Lessons Learned From the Implementation of a Pilot Study on Self-collected Specimen Return by Sexual Minority Men (Project Caboodle!): Qualitative Exploration. JMIR Form Res 2023; 7:e43539. [PMID: 37023442 PMCID: PMC10131702 DOI: 10.2196/43539] [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: 10/14/2022] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Self-collection of specimens at home and their return by mail might help reduce some of the barriers to HIV and bacterial sexually transmitted infection (STI) screening encountered by gay, bisexual, and other men who have sex with men (GBMSM). To evaluate the benefits and challenges of bringing this approach to scale, researchers are increasingly requesting GBMSM to return self-collected specimens as part of web-based sexual health studies. Testing self-collected hair samples for preexposure prophylaxis drug levels may also be a viable option to identify GBMSM who face adherence difficulties and offer them support. OBJECTIVE Project Caboodle! sought to evaluate the acceptability and feasibility of self-collecting at home and returning by mail 5 specimens (a finger-stick blood sample, a pharyngeal swab, a rectal swab, a urine specimen, and a hair sample) among 100 sexually active GBMSM in the United States aged between 18 and 34 years. In this manuscript, we aimed to describe the key lessons learned from our study's implementation and to present recommendations offered by participants to maximize the rates of self-collected specimen return. METHODS Following the specimen self-collection phase, a subset of 25 participants (11 who returned all 5 specimens, 4 who returned between 1 and 4 specimens, and 10 who did not return any specimens) was selected for in-depth interviews conducted via a videoconferencing platform. During the session, a semistructured interview guide was used to discuss the factors influencing decisions regarding returning self-collected specimens for laboratory processing. The transcripts were analyzed using template analysis. RESULTS University branding of web-based and physical materials instilled a sense of trust in participants and increased their confidence in the test results. Shipping the specimen self-collection box in plain unmarked packaging promoted discretion during transit and on its receipt. Using different colored bags with matching color-coded instructions to self-collect each type of specimen minimized the potential for confusion. Participants recommended including prerecorded instructional videos to supplement the written instructions, providing information on the importance of triple-site bacterial STI testing, and adding a reminder of the types of testing that would and would not be conducted on hair samples. Participants also suggested tailoring the specimen self-collection box to include only the tests that they might be interested in completing at that time, adding real-time videoconferencing to the beginning of the study to introduce the research team, and sending personalized reminders following the delivery of the specimen self-collection box. CONCLUSIONS Our results offer valuable insights into aspects that facilitated participant engagement in self-collected specimen return, as well as areas for potential improvement to maximize return rates. Our findings can help guide the design of future large-scale studies and public health programs for home-based HIV, bacterial STI, and preexposure prophylaxis adherence testing. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/13647.
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Affiliation(s)
- Gregory Sallabank
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI, United States
| | - Monica Gandhi
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Leland Merrill
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
| | - Akshay Sharma
- Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, United States
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, United States
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10
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Sharma A, Gandhi M, Sallabank G, Merrill L, Stephenson R. Perceptions and Experiences of Returning Self-collected Specimens for HIV, Bacterial STI and Potential PrEP Adherence Testing among Sexual Minority Men in the United States. AIDS Behav 2023; 27:1091-1105. [PMID: 36094639 PMCID: PMC9466335 DOI: 10.1007/s10461-022-03846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 11/04/2022]
Abstract
Few studies among gay, bisexual and other men who have sex with men (GBMSM) have examined facilitators and barriers to self-collecting specimens for extragenital STI screening, and none have evaluated attitudes towards self-collecting hair samples that can be utilized for PrEP drug level testing to assess adherence. To address this gap, we interviewed 25 sexually active GBMSM who were offered a choice to self-collect and return finger-stick blood samples (for actual HIV testing), pharyngeal swabs, rectal swabs and urine specimens (for actual gonorrhea and chlamydia testing), and hair samples (to visually determine their adequacy for PrEP drug level testing): 11 who returned all, 4 who returned some, and 10 who did not return any. Participants found self-collecting finger-stick blood samples and rectal swabs more challenging than other specimens. Frequently discussed facilitators of return included an opportunity to confirm one's HIV or STI status, limited access to a healthcare provider and a desire to advance research focusing on home-based testing. Commonly cited barriers to return included low self-efficacy pertaining to self-collection and apprehension around the possibility of delay or loss of specimens during transit. Offering additional support such as real-time video conferencing may prove helpful in future field-based research with GBMSM.
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Affiliation(s)
- Akshay Sharma
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA.
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA.
| | - Monica Gandhi
- Division of HIV, Infectious Disease, and Global Medicine, Department of Medicine, University of California San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, USA
| | - Gregory Sallabank
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
| | - Leland Merrill
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
| | - Rob Stephenson
- Center for Sexuality and Health Disparities, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI, 48109, USA
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11
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Savoie SJ, Leonhard C, Smith M, Drake M. Predicting and influencing PrEP use: the role of motivational and attitudinal factors. AIDS Care 2023:1-11. [PMID: 36781301 DOI: 10.1080/09540121.2023.2176427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This study examined PrEP attitude and HIV risk factors associated with PrEP motivation and evaluated the efficacy of a mock public health video that addresses both motivational and stigma issues for improving PrEP uptake over a standard educational video. Gay, bisexual, and other men who have sex with men (GBMSM; N = 604) were enrolled. One-way between subject analysis of variance (ANOVA) and post-hoc comparisons revealed that GBMSM in later stages of change had significantly higher endorsement of positive PrEP attitudes, PrEP stigma, objective and perceived HIV risk, HIV worry, and valued health benefits of PrEP more. Stepwise multiple regression revealed five significant predictors of PrEP motivation: HIV worry, objective HIV risk, anticipated PrEP stigma, positive PrEP attitudes, and perceived social consequences of PrEP use. Video conditions did not differ in their impact on PrEP attitudes or motivation; however, regardless of video condition, participants experienced a pre- to post-video increase in positive PrEP attitudes and motivation. Findings suggest HIV worry, objective HIV risk, positive PrEP attitudes, and perceived PrEP health benefits are important factors to optimize PrEP motivation, which can inform secondary prevention efforts. Further study is needed on promotional PrEP campaigns that disconfirm stigmatizing PrEP misconceptions.
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Affiliation(s)
- S J Savoie
- Clinical PsyD Program, The Chicago School of Professional Psychology at Xavier University of Louisiana, New Orleans, LA, USA
| | - C Leonhard
- Clinical PsyD Program, The Chicago School of Professional Psychology at Xavier University of Louisiana, New Orleans, LA, USA
| | - M Smith
- Clinical PsyD Program, The Chicago School of Professional Psychology at Xavier University of Louisiana, New Orleans, LA, USA
| | - M Drake
- CrescentCare, New Orleans, LA, USA.,Tulane University School of Social Work, New Orleans, LA, USA
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12
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Xavier Hall CD, Bundy C, Foran JE, Newcomb ME, Carrillo H, Watkins-Hayes C, Mustanski B. Identifying Strategies for Improving Pre-exposure Prophylaxis Adherence: Perspectives from a Sample of Highly Adherent Young Men Who have Sex with Men. AIDS Behav 2023; 27:506-517. [PMID: 35906443 PMCID: PMC9884315 DOI: 10.1007/s10461-022-03785-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 02/04/2023]
Abstract
Most research on pre-exposure prophylaxis (PrEP) adherence and persistence uses a deficit-based approach to identify negative influences on PrEP adherence; however, an alternative set of approaches (such as resilience, asset-based, and positive variation) may identify equally important positive influences on PrEP adherence. Thus, the current study presents qualitative perspectives of PrEP adherence strategies from a sample of adherent YMSM. PrEP-using YMSM living in the Chicago area from a larger cohort study were recruited into a 90-day diary study that measured sexual health behaviors including PrEP use. A subset (n = 28) were then recruited for in-depth interviews between April and September 2020 covering topics of PrEP use and adherence. Thematic analysis was used to interpret patterns within the data. The analytic sample (n = 19) consistently reported high levels of adherence. Adherence strategies were organized into three broader categories: psychological (e.g. mindfulness, pill auditing), technical/instrumental (e.g. automated reminders, pill organizers), and social strategies (e.g. checking in with friends, or getting suggestions from friends). The majority of participants described using multiple strategies and changing strategies to respond to barriers to adherence. Other themes that were related to adherence included having a daily medication history and a generally positive outlook toward the PrEP regimen. Those who had medication histories were able to draw from experience to develop strategies for PrEP adherence. Findings suggest the need for pre-emptive counseling for PrEP-initiators on the use of multiple strategies, how to prepare for PrEP adherence, to adapt to challenges, and to adopt a range of potential strategies for adherence.
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Affiliation(s)
- Casey D. Xavier Hall
- grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL USA
| | - Camille Bundy
- grid.16753.360000 0001 2299 3507Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL USA
| | - James E. Foran
- grid.16753.360000 0001 2299 3507Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL USA
| | - Michael E. Newcomb
- grid.16753.360000 0001 2299 3507Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL USA ,grid.16753.360000 0001 2299 3507Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL USA
| | - Héctor Carrillo
- grid.16753.360000 0001 2299 3507Department of Sociology, Northwestern University, Evanston, IL USA
| | - Celeste Watkins-Hayes
- grid.214458.e0000000086837370Ford School of Public Policy, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Sociology, University of Michigan, Ann Arbor, MI USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. .,Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA.
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13
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Gillespie D, de Bruin M, Hughes DA, Ma R, Williams A, Wood F, Couzens Z, Jones A, Hood K. Between- and Within-Individual Sociodemographic and Psychological Determinants of PrEP Adherence Among Men Who have Sex with Men Prescribed a Daily PrEP Regimen in Wales. AIDS Behav 2022; 27:1564-1572. [PMID: 36322216 PMCID: PMC9628468 DOI: 10.1007/s10461-022-03890-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/30/2022]
Abstract
We investigated the determinants of daily PrEP use and coverage of condomless anal sex (CAS) by PrEP among men who have sex with men in Wales, UK. We measured PrEP use by electronic monitors and CAS by secure online surveys. We defined PrEP use based on daily medication cap openings and coverage as CAS episodes preceded by ≥ 3 days of PrEP use and followed by ≥ 2 days of PrEP use. We included 57 participants (5463 observations). An STI diagnosis was associated with lower PrEP use but also lower PrEP coverage. Older adults had higher PrEP use. A belief that other PrEP users took PrEP as prescribed was associated with lower PrEP coverage. An STI diagnosis is an important cue for an intervention, reflecting episodes of high-risk sexual behaviour and low PrEP coverage. Other results provide a basis for the development of an evidence-informed intervention for promoting coverage of PrEP.
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Affiliation(s)
- David Gillespie
- Centre for Trials Research, College of Biomedical & Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK.
| | - Marijn de Bruin
- Radboud University Medical Center, Institute of Health Sciences, IQ Healthcare, Nijmegen, Netherlands
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, Wales, UK
| | - Richard Ma
- Imperial College London, London, England, UK
| | - Adam Williams
- Centre for Trials Research, College of Biomedical & Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Fiona Wood
- Division of Population Medicine and PRIME Centre Wales, College of Biomedical & Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
| | - Zoë Couzens
- Public Health Wales NHS Trust, Cardiff, Wales, UK
| | - Adam Jones
- Policy, Research and International Development, Public Health Wales, Cardiff, Wales, UK
| | - Kerenza Hood
- Centre for Trials Research, College of Biomedical & Life Sciences, School of Medicine, Cardiff University, Cardiff, Wales, UK
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14
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Sang JM, McAllister K, Wang L, Barath J, Lal A, Parlette A, Noor SW, Apelian H, Skakoon‐Sparling S, Hull M, Moore DM, Cox J, Hart TA, Lambert G, Grace D, Jollimore J, Hogg RS, Lachowsky NJ. Examining provincial PrEP coverage and characterizing PrEP awareness and use among gay, bisexual and other men who have sex with men in Vancouver, Toronto and Montreal, 2017-2020. J Int AIDS Soc 2022; 25:e26017. [PMID: 36306245 PMCID: PMC9616170 DOI: 10.1002/jia2.26017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Accessibility of pre-exposure prophylaxis (PrEP) in Canada remains complex as publicly funded coverage and delivery differs by province. In January 2018, PrEP became publicly funded and free of charge in British Columbia (BC), whereas PrEP coverage in Ontario and Montreal is more limited and may require out-of-pocket costs. We examined differences over time in PrEP uptake and assessed factors associated with PrEP awareness and use. METHODS Gay, bisexual and other men who have sex with men (GBM) were recruited through respondent-driven sampling (RDS) in Toronto, Vancouver and Montreal, Canada, in a prospective biobehavioural cohort study. We applied generalized estimating equations with hierarchical data (RDS chain, participant, visit) to examine temporal trends of PrEP use and correlates of PrEP awareness and use from 2017 to 2020 among self-reported HIV-negative/unknown GBM. RESULTS Of 2008 self-identified HIV-negative/unknown GBM at baseline, 5093 study visits were completed from February 2017 to March 2020. At baseline, overall PrEP awareness was 88% and overall PrEP use was 22.5%. During our study period, we found PrEP use increased in all cities (all p<0.001): Montreal 14.2% during the first time period to 39.3% during the last time period (p<0.001), Toronto 21.4-31.4% (p<0.001) and Vancouver 21.7-59.5% (p<0.001). Across the study period, more Vancouver GBM used PrEP than Montreal GBM (aOR = 2.05, 95% CI = 1.60-2.63), with no significant difference between Toronto and Montreal GBM (aOR = 0.90, 95% CI = 0.68-1.18). CONCLUSIONS Full free-of-charge public funding for PrEP in BC likely contributed to differences in PrEP awareness and use. Increasing public funding for PrEP will improve accessibility and uptake among GBM most at risk of HIV.
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Affiliation(s)
- Jordan M. Sang
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Kate McAllister
- School of Public Health and Social PolicyUniversity of VictoriaVictoriaBritish ColumbiaCanada
| | - Lu Wang
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Justin Barath
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | - Allan Lal
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada
| | | | - Syed W. Noor
- Ryerson UniversityTorontoOntarioCanada,School of Human SciencesLouisiana State University ShreveportShreveportLouisianaUSA
| | - Herak Apelian
- McGill UniversityMontréalQuebecCanada,Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada
| | | | - Mark Hull
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,University of British ColumbiaVancouverBritish ColumbiaCanada
| | - David M. Moore
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Joseph Cox
- McGill UniversityMontréalQuebecCanada,Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada
| | - Trevor A. Hart
- Ryerson UniversityTorontoOntarioCanada,University of TorontoTorontoOntarioCanada
| | - Gilles Lambert
- Direction régionale de santé publique ‐MontréalCIUSSS Centre‐Sud‐de‐l'Ile‐de‐MontréalMontréalQuebecCanada,Institut national de santé publique du QuébecMontréalQuebecCanada
| | | | - Jody Jollimore
- Community Based Research CentreVancouverBritish ColumbiaCanada
| | - Robert S. Hogg
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,Simon Fraser UniversityBurnabyBritish ColumbiaCanada
| | - Nathan J. Lachowsky
- British Columbia Centre for Excellence in HIV/AIDSVancouverBritish ColumbiaCanada,School of Public Health and Social PolicyUniversity of VictoriaVictoriaBritish ColumbiaCanada,Community Based Research CentreVancouverBritish ColumbiaCanada
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15
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Valente PK, Bauermeister JA, Lin WY, Operario D, Rusley J, Hightow-Weidman L, Mayer KH, Biello KB. Next Generation Pre-Exposure Prophylaxis for Young Men who have Sex with Men: Lessons from System and Provider-level barriers to oral PrEP. AIDS Behav 2022; 26:3422-3435. [PMID: 35445994 PMCID: PMC9474568 DOI: 10.1007/s10461-022-03665-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 02/04/2023]
Abstract
Next generation pre-exposure prophylaxis (PrEP) modalities that do not require daily regimens may address some of the barriers to daily oral PrEP among young men who have sex with men (YMSM). We conducted online semi-structured interviews with 30 YMSM to examine experiences and preferences related to HIV prevention care that may inform implementation of next generation PrEP. Barriers to PrEP care included initiating conversations about sexuality with providers; confidentiality concerns regarding disclosure of sexual practices and PrEP use to family; gaps in access to healthcare; and limited availability of affordable health services. Future implementation of next generation PrEP may benefit from providers addressing confidentiality concerns when discussing PrEP with YMSM; PrEP programs accounting for discontinuities in healthcare access among YMSM while strengthening access to affordable services; and collaborations between generalist providers and specialized clinics and providers to address providers' education needs, which may increase as next generation PrEP becomes available. We have linked affiliation 9 to author name "Katie B. Biello". Please check and confirm. Okay!
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Affiliation(s)
- Pablo K Valente
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, U.S
| | - Jose A Bauermeister
- Program for Sexuality, Technology, and Action Research, University of Pennsylvania, Philadelphia, PA, U.S
- Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, U.S
| | - Willey Y Lin
- Program for Sexuality, Technology, and Action Research, University of Pennsylvania, Philadelphia, PA, U.S
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, U.S
| | - Jack Rusley
- Division of Adolescent Medicine, Department of Pediatrics, Alpert Medical School of Brown University, Providence, RI, U.S
- Department of Health Services, Policy, and Practice, Brown University School of Public, Providence, RI, U.S
| | - Lisa Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, U.S
| | | | - Katie B Biello
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, U.S..
- The Fenway Institute, Fenway Health, Boston, MA, U.S..
- Center for Health Promotion and Health Equity, Brown University School of Public Health, Providence, RI, U.S..
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, U.S..
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16
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Sharpe JD, Sanchez TH, Siegler AJ, Guest JL, Sullivan PS. Association between the geographic accessibility of PrEP and PrEP use among MSM in nonurban areas. J Rural Health 2022; 38:948-959. [PMID: 34997634 PMCID: PMC9259757 DOI: 10.1111/jrh.12645] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The US HIV epidemic has become a public health issue that increasingly affects men who have sex with men (MSM), including those residing in nonurban areas. Increasing access to pre-exposure prophylaxis (PrEP) in nonurban areas will prevent HIV acquisition and could address the growing HIV epidemic. No studies have quantified the associations between PrEP access and PrEP use among nonurban MSM. METHODS Using 2020 PrEP Locator data and American Men's Internet Survey data, we conducted multilevel log-binomial regression to examine the association between area-level geographic accessibility of PrEP-providing clinics and individual-level PrEP use among MSM residing in nonurban areas in the United States. FINDINGS Of 4,792 PrEP-eligible nonurban MSM, 20.1% resided in a PrEP desert (defined as more than a 30-minute drive to access PrEP), and 15.2% used PrEP in the past 12 months. In adjusted models, suburban MSM residing in PrEP deserts were less likely to use PrEP in the past year (adjusted prevalence ratio [aPR] = 0.35; 95% confidence interval [CI] = 0.15, 0.80) than suburban MSM not residing in PrEP deserts, and other nonurban MSM residing in PrEP deserts were less likely to use PrEP in the past year (aPR = 0.75; 95% CI = 0.60, 0.95) than other nonurban MSM not residing in PrEP deserts. CONCLUSIONS Structural interventions designed to decrease barriers to PrEP access that are unique to nonurban areas in the United States are needed to address the growing HIV epidemic in these communities.
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Affiliation(s)
- J. Danielle Sharpe
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Travis H. Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Aaron J. Siegler
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jodie L. Guest
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Patrick S. Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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17
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Maxwell S, Shahmanesh M, Gafos M. Pre-exposure prophylaxis (PrEP) uptake and adherence experiences of gay and bisexual men who engage in chemsex: A qualitative study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 103:103630. [DOI: 10.1016/j.drugpo.2022.103630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
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18
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Salinas-Rodríguez A, Sosa-Rubí SG, Chivardi C, Rodríguez-Franco R, Gandhi M, Mayer KH, Operario D, Gras-Allain N, Vargas-Guadarrama G, Galárraga O. Preferences for Conditional Economic Incentives to Improve Pre-exposure Prophylaxis Adherence: A Discrete Choice Experiment Among Male Sex Workers in Mexico. AIDS Behav 2022; 26:833-842. [PMID: 34453239 PMCID: PMC8840956 DOI: 10.1007/s10461-021-03443-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 12/29/2022]
Abstract
Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV but requires sustained adherence. Conditional economic incentives (CEIs) can improve medication-taking behaviors, yet preferences for programs that employ CEIs to increase PrEP use among male sex workers (MSWs) have not been investigated. We conducted a discrete choice experiment in Mexico City to elicit stated preferences for a CEI-based PrEP adherence program among MSWs. Respondents expressed their preferences for different program characteristics: incentive amount; incentive format; incentive type; and adherence-verification method. We used a random utility logit model to estimate the relative importance of each attribute and estimated willingness-to-pay. MSWs preferred a higher, fixed incentive, with PrEP adherence measured via hair sampling. MSWs were willing to forego up to 21% of their potential maximum CEI amount to ensure receipt of a fixed payment. MSWs are highly willing to accept a CEI-based intervention for PrEP adherence, if offered along with fixed payments.
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Affiliation(s)
- Aarón Salinas-Rodríguez
- Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca , Morelos, Mexico
| | - Sandra G Sosa-Rubí
- Division of Health Economics, Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Carlos Chivardi
- Division of Health Economics, Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico.
| | - Roxana Rodríguez-Franco
- Division of Health Economics, Center for Health Systems Research, National Institute of Public Health (INSP), Cuernavaca, Morelos, Mexico
| | - Monica Gandhi
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, and Harvard University, Boston, MA, USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | | | | | - Omar Galárraga
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, USA
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19
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Arnold-Forster D, Horne R, Nutland W, Wayal S, Rayment M, Rae C, Desai M, Clarke A, Sullivan A, McCormack S, Gafos M. Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England. AIDS Behav 2022; 26:2768-2782. [PMID: 35182281 PMCID: PMC9252952 DOI: 10.1007/s10461-022-03624-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/27/2022]
Abstract
PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes.
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Affiliation(s)
- Dora Arnold-Forster
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | | | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Monica Desai
- National Institute for Health and Care Excellence, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sheena McCormack
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK.
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
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20
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Saxton PJW, Azariah S, Cavadino A, Forster RF, Jenkins R, Werder SF, Southey K, Rich JG. Adherence, Sexual Behavior and Sexually Transmitted Infections in a New Zealand Prospective PrEP Cohort: 12 Months Follow-up and Ethnic Disparities. AIDS Behav 2022; 26:2723-2737. [PMID: 35167038 PMCID: PMC8853116 DOI: 10.1007/s10461-022-03617-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 11/29/2022]
Abstract
Inequities in pre-exposure prophylaxis (PrEP) experiences will impede HIV epidemic elimination among gay and bisexual men (GBM). Ethnicity is a strong marker of inequity in the United States, but evidence from other countries is lacking. We investigated experiences on-PrEP to 12 months follow-up in a prospective cohort of 150 GBM in Auckland, New Zealand with an equity quota of 50% non-Europeans. Retention at 12 months was 85.9%, lower among Māori/Pacific (75.6%) than non-Māori/Pacific participants (90.1%). Missed pills increased over time and were higher among Māori/Pacific. PrEP breaks increased, by 12 months 35.7% of Māori/Pacific and 15.7% of non-Māori/Pacific participants had done so. Condomless receptive anal intercourse partners were stable over time. STIs were common but chlamydia declined; 12-month incidence was 8.7% for syphilis, 36.0% gonorrhoea, 46.0% chlamydia, 44.7% rectal STI, 64.0% any STI. Structural interventions and delivery innovations are needed to ensure ethnic minority GBM gain equal benefit from PrEP. Clinical trial number ACTRN12616001387415.
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Affiliation(s)
- Peter J W Saxton
- School of Population Health, University of Auckland, 28 Park Ave, Auckland, 1023, New Zealand.
| | - Sunita Azariah
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
| | - Alana Cavadino
- School of Population Health, University of Auckland, 28 Park Ave, Auckland, 1023, New Zealand
| | - Rose F Forster
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Renee Jenkins
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
| | - Suzanne F Werder
- Auckland Sexual Health Regional Service, Auckland District Health Board, Auckland, New Zealand
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21
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Hempel S, Ferguson L, Bolshakova M, Yagyu S, Fu N, Motala A, Gruskin S. Frameworks, measures, and interventions for HIV-related internalised stigma and stigma in healthcare and laws and policies: systematic review protocol. BMJ Open 2021; 11:e053608. [PMID: 34887280 PMCID: PMC8663079 DOI: 10.1136/bmjopen-2021-053608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION There is strong global commitment to eliminate HIV-related stigma. Wide variation exists in frameworks and measures, and many strategies to prevent, reduce or mitigate stigma have been proposed but critical factors determining success or failure remain elusive. METHODS AND ANALYSIS Building on existing knowledge syntheses, we designed a systematic review to identify frameworks, measures and intervention evaluations aiming to address internalised stigma, stigma and discrimination in healthcare, and stigma and discrimination at the legal or policy level. The review addresses four key questions (KQ): KQ1: Which conceptual frameworks have been proposed to assess internal stigma, stigma and discrimination experienced in healthcare settings, and stigma and discrimination entrenched in national laws and policies? KQ2: Which measures of stigma have been proposed and what are their descriptive properties? KQ3: Which interventions have been evaluated that aimed to reduce these types of stigma and discrimination or mitigate their adverse effects and what are the effectiveness and unintended consequences? KQ4: What common 'critical factors for success or failure' can be identified across interventions that have been evaluated? We will search PubMed, PsycINFO, Web of Science, Universal Human Rights Index, HeinOnline, PAIS, HIV Legal Network, CDSR, Campbell Collaboration, PROSPERO and Open Science Framework. Critical appraisal will assess the source, processes and consensus finding for frameworks; COnsensus-based Standards for the selection of health Measurement Instruments criteria for measures; and risk of bias for interventions. Quality of evidence grading will apply . A gap analysis will provide targeted recommendations for future research. We will establish a compendium of frameworks, a comprehensive catalogue of available measures, and a synthesis of intervention characteristics to advance the science of HIV-related stigma. PROSPERO REGISTRATION NUMBER CRD42021249348.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Laura Ferguson
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sachi Yagyu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Ning Fu
- Department of Economics, Shanghai University of Finance and Economics, Shanghai, China
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Sofia Gruskin
- Institute on Inequalities in Global Health, University of Southern California, Los Angeles, California, USA
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22
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Goodreau SM, Maloney KM, Sanchez TH, Morris M, Janulis P, Jenness SM. A Behavioral Cascade of HIV Seroadaptation Among US Men Who Have Sex with Men in the Era of PrEP and U = U. AIDS Behav 2021; 25:3933-3943. [PMID: 33884510 PMCID: PMC8528882 DOI: 10.1007/s10461-021-03266-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 10/25/2022]
Abstract
Seroadaptive behaviors help reduce HIV risk for some men who have sex with men (MSM), and have been well documented across MSM populations. Advancements in biomedical prevention have changed the contexts in which seroadaptive behaviors occur. We thus sought to estimate and compare the prevalence of four stages of the "seroadaptive cascade" by PrEP use in the recent era: knowledge of own serostatus, knowledge of partner serostatus; serosorting (matching by status), and condomless anal intercourse. Serosorting overall appeared to remain common, especially with casual and one-time partners. Although PrEP use did not impact status discussion, it did impact serosorting and the likelihood of having condomless anal intercourse. For respondents not diagnosed with HIV and not on PrEP, condomless anal intercourse occurred in just over half of relationships with HIV-positive partners who were not on treatment. Biomedical prevention has intertwined with rather than supplanted seroadaptive behaviors, while contexts involving neither persist.
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Affiliation(s)
- Steven M Goodreau
- Department of Anthropology and Center for Studies in Demography and Ecology, University of Washington, Campus Box 353100, Seattle, WA, 91895, USA.
| | - Kevin M Maloney
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Travis H Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Martina Morris
- Departments of Statistics and Sociology, University of Washington, Seattle, WA, USA
| | - Patrick Janulis
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Samuel M Jenness
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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23
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Colyer S, Lachowsky NJ, Schmidt AJ, Adam BD, Paquette D, Hart TA, Brennan DJ, Blais M, Kroch AE. Measures of HIV Pre-exposure Prophylaxis Uptake Among Gay, Bisexual, and Other Men Who Have Sex with Men in Canada and Demographic Disparities Among Those at Elevated Likelihood for HIV Acquisition. AIDS Behav 2021; 25:3638-3650. [PMID: 34114164 DOI: 10.1007/s10461-021-03336-3] [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] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool being scaled up in Canada. We describe PrEP uptake and identify demographic correlates of uptake among gay, bisexual, and other men who have sex with men (gbMSM) at elevated HIV risk using data from an online survey of gbMSM residing in Canada between Oct 2017 and Jan 2018. Among the 969 participants at elevated HIV risk who had recently tested for HIV, 96.0%, 83.3%, 72.6%, and 39.7% reported awareness, knowledge, acceptability, and pursuit of PrEP, respectively; 27.1% had ever and 24.6% were currently taking PrEP. The strongest correlate of PrEP uptake was living in a city of ≥ 500,000 inhabitants; others included being out to all or almost all family, friends, and colleagues regarding sexual attraction to men, greater financial coping, and being 30-49 years of age. Improved upscaling of PrEP in Canada may be accomplished through consideration of these disparities.
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24
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Lanham M, Ridgeway K, Mireku M, Nhamo D, Pillay D, Murire M, Stankevitz K, Kyongo J, Mullick S. Health care providers' attitudes toward and experiences delivering oral PrEP to adolescent girls and young women in Kenya, South Africa, and Zimbabwe. BMC Health Serv Res 2021; 21:1112. [PMID: 34663320 PMCID: PMC8522219 DOI: 10.1186/s12913-021-06978-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 09/01/2021] [Indexed: 12/02/2022] Open
Abstract
Background In Kenya, South Africa, and Zimbabwe, oral pre-exposure prophylaxis (PrEP) is recommended for adolescent girls and young women (AGYW) at high risk of HIV. Health providers play a critical role in the uptake and effective use of sexual and reproductive health services; however, few published studies have explored providers’ attitudes toward and experiences delivering PrEP to AGYW. Methods We conducted a cross-sectional qualitative study, interviewing 113 providers at 36 public, private, and nongovernmental health facilities in Kenya, South Africa, and Zimbabwe that were offering PrEP during the research period or were likely to offer PrEP in the future. Data were coded in NVivo 11, and an applied thematic analysis was conducted. Results Most providers preferred that adolescent girls wait until age 18 to have sex but acknowledged that many girls younger than 18 could benefit from oral PrEP. Their primary concern was whether adolescent girls would be able to take PrEP daily, especially if they do not tell their parents or partners they are using it. Providers reported that it was more challenging to deliver PrEP and other HIV services to girls younger than 18. Those with experience providing PrEP pointed to stigma and lack of PrEP awareness in communities as two primary barriers to PrEP uptake and use. Conclusions Providers were generally accepting of oral PrEP as an HIV prevention option for AGYW; however, many had negative attitudes about adolescent girls being sexually active and concerns about whether they could take PrEP daily. Results were used to update national PrEP training materials to address negative provider attitudes about PrEP use by AGYW. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06978-0.
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Affiliation(s)
- Michele Lanham
- FHI 360, 359 Blackwell Street, Suite 201, NC, 27707, Durham, USA.
| | | | - Maryline Mireku
- LVCT Health, P.O. Box 19835-00202 KNH, Argwings Kodhek Road, Nairobi, Kenya
| | - Definate Nhamo
- Pangaea Zimbabwe AIDS Trust, 27 Rowland Square, Milton Park, Harare, Zimbabwe
| | - Diantha Pillay
- Wits Reproductive Health and HIV Institute, 31 Princess of Wales Terrace, 2193, Parktown, Johannesburg, South Africa
| | - Mercy Murire
- Wits Reproductive Health and HIV Institute, 31 Princess of Wales Terrace, 2193, Parktown, Johannesburg, South Africa
| | - Kayla Stankevitz
- FHI 360, 359 Blackwell Street, Suite 201, NC, 27707, Durham, USA
| | - Jordan Kyongo
- LVCT Health, P.O. Box 19835-00202 KNH, Argwings Kodhek Road, Nairobi, Kenya
| | - Saiqa Mullick
- Wits Reproductive Health and HIV Institute, 31 Princess of Wales Terrace, 2193, Parktown, Johannesburg, South Africa
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25
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Sharma A, Paredes-Vincent A, Kahle EM. Awareness, Utilization, and Preferences for Traditional and Contemporary HIV Prevention Strategies Among Facebook and Instagram-Using MSM in the United States. J Int Assoc Provid AIDS Care 2021; 20:23259582211024770. [PMID: 34132144 PMCID: PMC8212379 DOI: 10.1177/23259582211024770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
HIV prevention research among men who have sex with men (MSM) has traditionally
focused on individual risk reduction strategies. Our study evaluated awareness,
utilization, and preferences for 10 complementary HIV prevention strategies
among 1,286 MSM recruited via Facebook and Instagram from June-August 2018. Ages
ranged from 18-85 years, and the majority were non-Hispanic white (n = 1,019,
79.24%), college-educated (n = 819, 63.69%), gay-identifying (n = 1,074,
83.51%), and partnered (n = 808, 62.83%). Post-exposure prophylaxis was the
least familiar option, and engaging in sexual activities other than anal sex was
the most utilized option. Progressively older and bisexual-identifying MSM were
less likely, but those with higher educational levels and easy access to local
HIV resources were more likely to be aware of and to be utilizing a greater
number of strategies. Additionally, Hispanic MSM were less likely to be aware
of, and those in a “closed” relationship were less likely to be utilizing a
greater number of strategies. In a subset of 775 multiple strategy users,
pre-exposure prophylaxis, regularly testing for HIV, and limiting the number of
sex partners emerged as the most preferred options. Combination intervention
packages for MSM should be tailored to personal circumstances, including sexual
orientation, relationship characteristics and access to local HIV resources.
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Affiliation(s)
- Akshay Sharma
- Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA.,Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Ariana Paredes-Vincent
- Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Erin M Kahle
- Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA.,Center for Sexuality and Health Disparities, University of Michigan School of Nursing, Ann Arbor, MI, USA
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26
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High Levels of Prevention-Effective Adherence to HIV PrEP: An Analysis of Substudy Data From the EPIC-NSW Trial. J Acquir Immune Defic Syndr 2021; 87:1040-1047. [PMID: 33852503 DOI: 10.1097/qai.0000000000002691] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) prevents HIV infection but relies on good adherence at times of risk, termed "prevention-effective adherence." Most studies assess adherence without reference to sexual behaviur, making it challenging to determine if poor adherence coincides with HIV risk. SETTING We examined data from a behavioral substudy of a large-scale PrEP implementation trial in New South Wales, Australia. METHODS Trial participants completed optional brief quarterly surveys, reporting the number of pills taken and sexual behavior with male partners for each day of the "last full week" before each survey. Condomless sex (CLS) was defined as "higher risk" for HIV when with HIV-positive men with detectable/unknown viral loads or unknown HIV status men. Adequate PrEP protection was defined as ≥4 pills for participants assigned male sex at birth and ≥6 pills for participants assigned female sex at birth (including transgender men). RESULTS Of 9596 participants dispensed PrEP, 4401 completed baseline and ≥1 follow-up survey. Participants reported on 12,399 "last full weeks": 7485 weeks (60.4%) involved CLS and 2521 weeks (33.7% of CLS-weeks) involved higher risk CLS. There were 103 weeks in which participants did not have adequate PrEP protection and had higher risk CLS: 4.1% of higher-risk CLS weeks (n = 103/2521), 1.4% of all CLS weeks (n = 103/7485), and 0.8% of all observed weeks (n = 103/12,399). CONCLUSIONS In a large PrEP trial, prevention-effective adherence to PrEP was very high at 99%. Our findings illustrate the importance of measuring pill-taking and sexual behavior in the same period so that prevention-effective adherence can be better estimated.
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27
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Kota KK, Mansergh G, Stephenson R, Hirshfield S, Sullivan P. Sociodemographic Characteristics of HIV Pre-Exposure Prophylaxis Use and Reasons for Nonuse Among Gay, Bisexual, and Other Men Who Have Sex with Men from Three US Cities. AIDS Patient Care STDS 2021; 35:158-166. [PMID: 33901403 DOI: 10.1089/apc.2020.0261] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
HIV pre-exposure prophylaxis (PrEP) is a preventive medication that could reduce new infections among men who have sex with men (MSM). There are limited data on differing reasons for PrEP nonuse by condomless anal sex (CAS). We examined demographic and behavioral variables associated with PrEP use and reasons for PrEP nonuse by CAS. Data are from the M-cubed Study, collected in a 2018 baseline assessment of MSM (n = 798) in Atlanta, Detroit, and New York City. Participants reported current PrEP use (31%), previous use (8%), and never use (61%). MSM reporting CAS [adjusted odds ratio (aOR) = 2.60, confidence interval (95% CI) = 1.73-3.91], age 18-29 (aOR = 2.11, 95% CI = 1.26-3.52), 30-39 (aOR = 2.12, 95% CI = 1.25-3.59), with a college degree (aOR = 1.96, 95% CI = 1.20-3.21), or postgraduate education (aOR = 2.58, 95% CI = 1.51-4.40) had greater odds of current (vs. never) use; uninsured (aOR = 0.30, 95% CI = 0.16-0.57) men had lower odds of current (vs. never) use. For never use, more MSM who reported CAS (vs. did not) endorsed the following reasons (p's < 0.05): Insurance wouldn't cover PrEP (20% vs. 12%), Didn't know where to get it (33% vs. 24%) and fewer reported Didn't need PrEP (23% vs. 39%) and Started a committed relationship (7% vs. 25%). For discontinuation, more MSM who reported CAS (vs. did not) endorsed Worry about the safety of PrEP (19% vs. 3%). Efforts are needed to enhance PrEP as an option among older, less educated, and uninsured MSM. These findings may inform how providers can facilitate PrEP use by messaging on access and safety for MSM who reported CAS.
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Affiliation(s)
- Krishna Kiran Kota
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Gordon Mansergh
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Rob Stephenson
- School of Nursing and The Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, Michigan, USA
| | - Sabina Hirshfield
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Patrick Sullivan
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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28
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Voglino G, Gualano MR, Rousset S, Forghieri P, Fraire I, Bert F, Siliquini R. Knowledge, Attitudes and Practices Regarding Pre-Exposure Prophylaxis (PrEP) in a Sample of Italian Men Who Have SEX with MEN (MSM). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4772. [PMID: 33947130 PMCID: PMC8124277 DOI: 10.3390/ijerph18094772] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pre-exposure prophylaxis (PrEP) is suitable for high human immunodeficiency virus (HIV)-infection risk people, foremost among whom are males who have sex with other males (MSM). This study evaluated knowledge, attitudes and practices regarding PrEP in a sample of Italian MSM, in order to hypothesize strategies to implement PrEP awareness and use. No previous study has assessed this issue; Methods: An online survey was given to an opportunistic sample of Italian MSM. The questionnaire investigated sexual behaviour and habits, HIV/acquired immune deficiency syndrome (AIDS) knowledge and PrEP awareness, attitudes and practices. Univariable and multivariable logistic regressions were conducted to identify factors associated with PrEP knowledge; Results: A total of 196 MSM participated in this survey. Overall data showed that 87.2% of participants knew what PrEP is, but only 7.5% have ever used it. The main reason for not using PrEP was the cost of the therapy (26.9%). The principal source of PrEP information was the Internet (68.4%). Being regularly tested for HIV was significantly associated with PrEP knowledge (adjusted odds ratio (AdjOR) = 3.16; confidence interval (CI) = 1.06-9.29); Conclusions: Knowledge regarding PrEP was well established, but PrEP use was not equally widespread. It is necessary to improve research on PrEP usage in order to PrEP access to be granted.
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Affiliation(s)
- Gianluca Voglino
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
| | - Maria Rosaria Gualano
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
| | - Stefano Rousset
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
| | - Pietro Forghieri
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
| | - Isabella Fraire
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
| | - Fabrizio Bert
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
- AOU City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences and Paediatrics, University of Turin, 10126 Turin, Italy; (G.V.); (S.R.); (P.F.); (I.F.); (F.B.); (R.S.)
- AOU City of Health and Science of Turin, Corso Bramante 88, 10126 Turin, Italy
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29
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Cox J, Apelian H, Moodie EEM, Messier-Peet M, Hart TA, Grace D, Moore DM, Lachowsky NJ, Armstrong HL, Jollimore J, Skakoon-Sparling S, Rodrigues R, Tan DHS, Maheu-Giroux M, Noor SW, Lebouché B, Tremblay C, Olarewaju G, Lambert G. Use of HIV pre-exposure prophylaxis among urban Canadian gay, bisexual and other men who have sex with men: a cross-sectional analysis of the Engage cohort study. CMAJ Open 2021; 9:E529-E538. [PMID: 34021010 PMCID: PMC8177951 DOI: 10.9778/cmajo.20200198] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In Canada, gay, bisexual and other men who have sex with men (GBM) are disproportionately affected by HIV. Our objective was to describe access to HIV pre-exposure prophylaxis (PrEP) and identify factors associated with not using PrEP among self-reported HIV-negative or HIV-unknown GBM. METHODS This was a cross-sectional analysis of the Engage study cohort. Between 2017 and 2019, sexually active GBM aged 16 years or more in Montréal, Toronto and Vancouver were recruited via respondent-driven sampling (RDS). Participation included testing for HIV and sexually transmitted and blood-borne infections, and completion of a questionnaire. We examined PrEP access using a health care services model and fit RDS-adjusted logistic regressions to determine correlates of not using PrEP among those for whom PrEP was clinically recommended and who were aware of the intervention. RESULTS A total of 2449 GBM were recruited, of whom 2008 were HIV-negative or HIV-unknown; 1159 (511 in Montréal, 247 in Toronto and 401 in Vancouver) met clinical recommendations for PrEP. Of the 1159, 1100 were aware of PrEP (RDS-adjusted proportion: Montréal 84.6%, Toronto 94.2%, Vancouver 92.7%), 678 had felt the need for PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 39.2%, Toronto 56.1%, Vancouver 49.0%), 406 had tried to access PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 20.6%, Toronto 33.2%, Vancouver 29.6%) and 319 had used PrEP in the previous 6 months (RDS-adjusted proportion: Montréal 14.5%, Toronto 21.6%, Vancouver 21.8%). Not using PrEP was associated with several factors, including not feeling at high enough risk, viewing PrEP as not completely effective, not having a primary care provider and lacking medication insurance. INTERPRETATION Although half of GBM met clinical recommendations for PrEP, less than a quarter of them reported use. Despite high levels of awareness, a programmatic response that addresses PrEP-related perceptions and health care system barriers is needed to scale up PrEP access among GBM in Canada.
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Affiliation(s)
- Joseph Cox
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que.
| | - Herak Apelian
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Marc Messier-Peet
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Trevor A Hart
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Daniel Grace
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - David M Moore
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Nathan J Lachowsky
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Heather L Armstrong
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Jody Jollimore
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Shayna Skakoon-Sparling
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Ricky Rodrigues
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Darrell H S Tan
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Syed W Noor
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Bertrand Lebouché
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Cecile Tremblay
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Gbolahan Olarewaju
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
| | - Gilles Lambert
- Department of Epidemiology, Biostatistics & Occupational Health (Cox, Moodie, Maheu-Giroux), McGill University; Direction régionale de santé publique, Centre intégré universitaire de santé et de services sociaux Centre-Sud-de-l'Ile-de-Montréal (Cox, Apelian, Messier-Peet, Lambert); Research Institute of the McGill University Health Centre (Apelian, Messier-Peet), Montréal, Que.; Department of Psychology (Hart, Skakoon-Sparling, Rodrigues, Noor), Ryerson University; Dalla Lana School of Public Health (Grace), University of Toronto, Toronto, Ont.; British Columbia Centre for Excellence in HIV/AIDS (Moore, Armstrong, Olarewaju); Faculty of Medicine (Moore), University of British Columbia, Vancouver, BC; School of Public Health & Social Policy (Lachowsky), Faculty of Human & Social Development, University of Victoria, Victoria, BC; Department of Psychology (Armstrong), University of Southampton, Southampton, UK; Community-Based Research Centre (Jollimore), Vancouver, BC; Division of Infectious Diseases (Tan), St. Michael's Hospital; Department of Medicine (Tan), University of Toronto, Toronto, Ont.; Department of Family Medicine (Lebouché), Faculty of Medicine, McGill University; Centre for Outcomes Research and Evaluation (Lebouché), Research Institute of the McGill University Health Centre; Centre de recherche du centre hospitalier de l'Université de Montréal (Tremblay); Institut national de santé publique du Québec (Lambert), Montréal, Que
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Bardon AR, Simoni JM, Layman LM, Stekler JD, Drain PK. Perspectives on the utility and interest in a point-of-care urine tenofovir test for adherence to HIV pre-exposure prophylaxis and antiretroviral therapy: an exploratory qualitative assessment among U.S. clients and providers. AIDS Res Ther 2020; 17:50. [PMID: 32762713 PMCID: PMC7412814 DOI: 10.1186/s12981-020-00308-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 07/29/2020] [Indexed: 12/02/2022] Open
Abstract
Background Real-time, objective measures of adherence to antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) are needed to better assess adherence levels and to expedite clinical response for those with suboptimal adherence. Point-of-care tenofovir (POC-TFV) testing has been proposed as a solution to facilitate real-time antiretroviral adherence monitoring, but little is known about how health care providers, people living with HIV (PLWH) receiving ART, and people receiving PrEP will perceive POC-TFV testing. Methods We conducted an exploratory qualitative study to assess perspectives on the utility and interest in POC-TFV testing from potential end users. We conducted three focus group discussions (FGDs) among 17 PLWH receiving ART and four individuals receiving PrEP, as well as eight in-depth interviews (IDIs) with health care providers in the Seattle area and presented participants with a hypothetical urine-based POC-TFV test. FGDs and IDIs were audio recorded, transcribed, coded, and analyzed to describe emerging themes. Results Overall, study participants demonstrated divergent opinions about the POC-TFV test. Among study participants, PLWH were most ambivalent about POC-TFV testing, first demonstrating reluctance to TFV-level monitoring and shifting positions during the FGDs. However, all PLWH participants were receptive to POC-TFV testing if requested by their provider. PrEP participants were generally supportive of POC-TFV testing for routine adherence monitoring and emphasized potential value in self-administered testing. Providers’ perceptions were equally divided – half suggested POC-TFV testing would be valuable, particularly for people receiving PrEP, while half indicated the test would have little benefit for most individuals receiving ART or PrEP in the U.S. All providers agreed that POC-TFV test results could be beneficial for assessing discrepancies in viral load results and self-reported adherence among PLWH. The study also revealed that a low-cost, non-urine-based POC-TFV test with a long-term limit of detection would be preferred over the hypothetical urine-based test. Conclusions Our findings indicate POC-TFV testing may be beneficial for routine, clinic-based adherence monitoring, particularly for individuals receiving PrEP or for PLWH with persistent viremia or following recent ART initiation. These findings should also be used to formulate a target product profile for a POC-TFV test and to guide further developments in tools for objective antiretroviral adherence monitoring.
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Owens C, Hubach RD, Williams D, Voorheis E, Lester J, Reece M, Dodge B. Facilitators and Barriers of Pre-exposure Prophylaxis (PrEP) Uptake Among Rural Men who have Sex with Men Living in the Midwestern U.S. ARCHIVES OF SEXUAL BEHAVIOR 2020; 49:2179-2191. [PMID: 32219687 DOI: 10.1007/s10508-020-01654-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 05/24/2023]
Abstract
Facilitators and barriers of Pre-exposure Prophylaxis (PrEP) uptake have been established in prior studies; however, most of these studies comprise samples of MSM from metropolitan cities and hypothetical PrEP use. There is a dearth of literature on the uptake factors among rural U.S. MSM who are prescribed PrEP. Thirty-four rural Midwestern MSM who currently take PrEP participated in semi-structured telephone interviews about their barriers and facilitators to their PrEP use. Interviews were analyzed using an inductive thematic analysis approach. There were four barriers: (1) lack of rural dissemination of PrEP information, (2) concern about side and adverse effects of using PrEP, (3) cost of PrEP uptake and engagement, and (4) lack of access to PrEP care and PrEP care quality. Individual and social facilitators that participants utilized to overcome these barriers are discussed. Findings elevate the importance of multilevel interventions that address PrEP adoption from a patient, provider, and healthcare system perspective.
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Affiliation(s)
- Christopher Owens
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Room 116, 1025 E 7th St., Bloomington, IN, 47403, USA.
| | - Randolph D Hubach
- Center for Rural Health, Center for Health Sciences, Oklahoma State University, Tulsa, OK, USA
| | - Deana Williams
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Eva Voorheis
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
| | - Jessica Lester
- Department of Counseling and Educational Psychology, School of Education, Indiana University, Bloomington, IN, USA
| | - Michael Reece
- Department of Social and Public Health, College of Health Sciences and Professions, Ohio University, Athens, OH, USA
| | - Brian Dodge
- Center for Sexual Health Promotion, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA
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Edeza A, Karina Santamaria E, Valente PK, Gomez A, Ogunbajo A, Biello K. Experienced barriers to adherence to pre-exposure prophylaxis for HIV prevention among MSM: a systematic review and meta-ethnography of qualitative studies. AIDS Care 2020; 33:697-705. [PMID: 32530302 DOI: 10.1080/09540121.2020.1778628] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Men who have sex with men (MSM) in the United States are at disproportionate risk for HIV. Once-daily pre-exposure prophylaxis (PrEP) for HIV prevention is a highly effective method of preventing HIV infection; however, optimal adherence is necessary to maintain effectiveness. Many studies have profiled perceived barriers to adherence among at-risk MSM; however, nearly a decade after FDA approval, there has been little work examining experienced barriers to adherence among MSM who have previously used the medication. To assess the current state of this literature and its implications for behavioral interventions, we conducted a meta-ethnography (i.e., A systematic review and synthesis of qualitative studies) of experiences with PrEP use among cis-gender MSM in the United States. We found that structural-level interventions, such as telehealth and pharmacist-prescribed approaches to PrEP distribution, may circumvent barriers to uptake and adherence for some MSM, but may not be enough for already underserved communities, such as MSM of color. Furthermore, interpersonal-level factors, such as enacted PrEP stigma by providers and peers, highlight the necessary consideration of social identity in the branding of PrEP for HIV prevention. Tailored interventions should consider experienced barriers to PrEP adherence across socioecological levels to be most effective.
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Affiliation(s)
- Alberto Edeza
- Department of Social and Behavioral Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - E Karina Santamaria
- Department of Social and Behavioral Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Pablo Kokay Valente
- Department of Social and Behavioral Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Ashley Gomez
- Department of Social and Behavioral Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Adedotun Ogunbajo
- Department of Social and Behavioral Health Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Katie Biello
- Department of Social and Behavioral Health 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.,Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA.,Fenway Health, The Fenway Institute, Boston, MA, USA
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33
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Wang Z, Mo PKH, Ip M, Fang Y, Lau JTF. Uptake and willingness to use PrEP among Chinese gay, bisexual and other men who have sex with men with experience of sexualized drug use in the past year. BMC Infect Dis 2020; 20:299. [PMID: 32321442 PMCID: PMC7178573 DOI: 10.1186/s12879-020-05024-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/12/2020] [Indexed: 01/03/2023] Open
Abstract
Background Sexualized drug use (SDU) refers to use of any psychoactive substance before/during sexual intercourse. Chemsex is a subset of SDU, which is defined as the use of some specific psychoactive substances (methamphetamine, mephedrone, γ-hydroxybutyrate, ketamine and cocaine) before/during sexual intercourse. SDU and chemsex are prevalent among gay, bisexual and other men who have sex with men (GBMSM). This study investigated uptake and willingness to use pre-exposure prophylaxis (PrEP) among a sample of GBMSM in Hong Kong with experience of SDU in the past year. Methods A total of 600 GBMSM were recruited by convenient sampling through outreaching in gay venues, online recruitment and peer referral. Participants completed a cross-sectional anonymous telephone interview. This study was based on a subsample of 580 GBMSM self-reported as HIV negative/unknown sero-status. Results Of the participants, 82 (14.1%) and 37 (6.4%) had experience of SDU and chemsex in the past year. The prevalence of PrEP uptake was 4.0% among all participants and 14.6% among those with experience of SDU in the past year. Among GBMSM with experience of SDU in the past year who were not on PrEP (n = 70), 67.1% were willing to use daily oral PrEP in the next 6 months. Multivariate logistic regression models showed that positive attitudes toward PrEP (AOR: 2.37, 95%CI: 1.47, 3.82), perceived support from significant others to use PrEP (AOR: 9.67, 95%CI: 2.95, 31.71), and perceived behavioral control of using PrEP (AOR: 19.68, 95%CI: 5.44, 71.26) were significantly associated with higher willingness to use PrEP. Conclusion GBMSM with experience of recent SDU are potentially good candidates of PrEP implementation. This group of GBMSM reported high prevalence of uptake and willingness to use PrEP. Perceptions related to PrEP based on the Theory of Planned Behavior were significantly associated with willingness to use PrEP.
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Affiliation(s)
- Zixin Wang
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China.
| | - Phoenix K H Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mary Ip
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yuan Fang
- Department of Early Childhood Education, Faculty of Education and Human Development, The Education University of Hong Kong, Hong Kong SAR, China
| | - Joseph T F Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
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34
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Maxwell S, Gafos M, Moncrieff M, Shahmanesh M, Stirrup O. Pre-exposure prophylaxis use among men who have sex with men who have experienced problematic chemsex. Int J STD AIDS 2020; 31:474-480. [PMID: 32075538 PMCID: PMC7814093 DOI: 10.1177/0956462420906927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 01/12/2020] [Indexed: 11/17/2022]
Abstract
Men who have sex with men (MSM) who experience problematic chemsex are at high risk of acquiring HIV due to combined drug use and sexual behaviours. Pre-exposure prophylaxis (PrEP) could substantially reduce the risk of HIV transmission in this group of men. The aim of this study was to examine the biopsychosocial characteristics associated with PrEP use among HIV-negative MSM who have experienced problematic chemsex. This was a cross-sectional analysis of secondary data collected during client assessments at a specialist alcohol and drug service based within the United Kingdom. We compared the socio-demographics, substance use, sexual behaviours and mental health of MSM who reported ever using PrEP to those who reported never using PrEP. Statistical analysis was conducted using the Mann–Whitney U-test for continuous variables and Fisher’s exact test for categorical variables. Between August 2016 and July 2018, 165 HIV-negative MSM who engaged in chemsex had an assessment completed. Thirty-four per cent (n = 50/145) had ever used PrEP. The median age was 36 years (IQR: 30–42), 92% identified as gay (n = 152/165) and 79% were of white ethnicity (n = 130/164). The use of crystal methamphetamine was associated with higher levels of men ever using PrEP (40% versus 21%) (p= 0.047). Men who had ever used PrEP had a higher median number of sexual partners in the previous three months (20 versus 10) (p= 0.004) and had lower level of condom use in their sex lives (median reported 5% versus 50%) (p= 0.010) in comparison to men who had never used PrEP. It is encouraging that men having higher-risk sex had been accessing PrEP. However, further research is required to explore PrEP uptake, retention and adherence in this high-risk group.
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Affiliation(s)
- Steven Maxwell
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Mitzy Gafos
- London School of Hygiene and Tropical Medicine, London, UK
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