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Dunn Navarra AM, Gormley M, Liang E, Loughran C, Vorderstrasse A, Garcia DR, Rosenberg MG, Fletcher J, Goldsamt LA. Developing and testing a web-based platform for antiretroviral therapy (ART) adherence support among adolescents and young adults (AYA) living with HIV. PEC INNOVATION 2024; 4:100263. [PMID: 38463238 PMCID: PMC10920727 DOI: 10.1016/j.pecinn.2024.100263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
Objective Describe the development and testing of a web-based platform for antiretroviral treatment (ART) adherence support among HIV+ adolescents and young adults (AYA) in a randomized controlled trial (RCT). Methods A seven-member multi-disciplinary team operationalized the flat, password protected, web-based platform. Manualized protocols guided the objectives and content for each of the eight web-based sessions. Team members evaluated usability and content validity. Client satisfaction and perceived ease of use was evaluated with the first ten HIV+ AYA participants. Results The web-based platform was developed, evaluated, refined, implemented and pilot tested between September 2020 to April 2022. Usability was rated as high; the evaluation of content validity showed an excellent fit between session content and objectives. HIV+ AYA participants (mean age = 24.2 years) were satisfied with the quality, type, and amount of support/education received, and found the platform easy to use, operate, and navigate. Average time spent per session was 6.5 min. Conclusion Findings support the usability, validity, acceptability, and feasibility of this web-based platform for ART adherence support among HIV+ AYA. Innovation Our research and findings are responsive to research gaps and the need for transparency in the methodological development and testing of web-based control arms for ART adherence support among HIV+ AYA.
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Affiliation(s)
- Ann-Margaret Dunn Navarra
- StonyBrook University, School of Nursing, 101 Nicolls Road, Health Sciences Center, Level 2, StonyBrook, NY 11794, USA
| | - Maurade Gormley
- University of Connecticut, School of Nursing, 231 Glenbrook Road, Storrs, CT 06269, USA
| | - Eva Liang
- New York University, Rory Meyers College of Nursing, 380 Second Avenue, New York, NY 10010, USA
| | - Claire Loughran
- New York University, Rory Meyers College of Nursing, 380 Second Avenue, New York, NY 10010, USA
| | - Allison Vorderstrasse
- University of Massachusetts Amherst, Elaine Marieb College of Nursing, 651 N Pleasant St., Amherst, MA 01003, USA
| | - David R. Garcia
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
| | - Michael G. Rosenberg
- Division of Infectious Diseases, Department of Pediatrics, Jacobi Medical Center, Bronx, NY, 10461, USA
| | - Jason Fletcher
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
| | - Lloyd A. Goldsamt
- New York University, Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010, USA
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Aldhouse NVJ, Chan EKH, Al-Zubeidi T, McKee S, Oriol Mathieu V, El Khoury AC, Kitchen H. Perceptions and Acceptance of a Prophylactic Vaccine for Human Immunodeficiency Virus (HIV): A Qualitative Study. THE PATIENT 2024; 17:457-469. [PMID: 38581599 PMCID: PMC11189960 DOI: 10.1007/s40271-024-00686-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Despite advances in human immunodeficiency virus (HIV) prevention methods, such as the advent of pre-exposure prophylaxis (PrEP), the number of people with newly acquired HIV remains high, particularly in at-risk groups. A prophylactic HIV vaccine could contribute to reduced disease prevalence and future transmission and address limitations of existing options, such as suboptimal long-term adherence to PrEPs. METHODS This qualitative study aimed to capture perceptions towards and acceptance of prophylactic HIV vaccination in three adult populations in the United States: the general population, 'at-risk' individuals (e.g. men who have sex with men, transgender individuals, gender-nonconforming individuals, and individuals in a sexual relationship with a person living with HIV), and parents/caregivers of children aged 9-17 years. Interviews were conducted with 55 participants to explore key drivers and barriers to HIV vaccine uptake, and a conceptual model was developed. RESULTS The sample was diverse; participants were 51% female, aged 20-57 years (mean 37 years), 33% with high school diploma as highest education level, and identified as White (42%), Black or African American (35%), of Hispanic, Latino, or Spanish origin (22%), or other races/ethnicities (8%) [groupings are not mutually exclusive]. Perceptions were influenced by individual, interpersonal, community, institutional, and structural factors. Overall, 98% of participants thought vaccination would be beneficial in preventing HIV. Key considerations/barriers included perceived susceptibility, i.e. whether participants felt there was a risk of contracting HIV (discussed by 90%); the clinical profile of the vaccine (e.g. the adverse effect profile [98%], and vaccine efficacy [85%], cost [73%] and administration schedule [88%]); and concerns around potential vaccine-induced seropositivity (VISP; 62%). Stigma was not found to be an important barrier, with a general view that vaccination status was personal. Participants in the 'at-risk' group were the most likely to accept an HIV vaccine (70%). Unique concerns in the subgroups included how a potential vaccine's clinical profile compared with PrEP, voiced by those receiving/considering PrEP, and considerations of children's views on the topic, voiced by parents/caregivers. CONCLUSIONS Understanding these factors could help develop HIV vaccine research strategies and contribute toward public health messaging to support future HIV vaccination programs.
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Erguera XA, Koester KA, Diaz Tsuzuki M, Dance KV, Flores R, Kerman J, McNulty MC, Colasanti JA, Collins LF, Montgomery ET, Johnson MO, Sauceda JA, Christopoulos KA. Acceptability of Long-Acting Injectable Antiretroviral Therapy Among People with HIV Receiving Care at Three Ryan White Funded Clinics in the United States. AIDS Behav 2024; 28:2226-2238. [PMID: 38598026 PMCID: PMC11199206 DOI: 10.1007/s10461-024-04315-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/11/2024]
Abstract
Understanding the acceptability of long-acting injectable antiretroviral therapy (LAI-ART) among people with HIV (PWH), especially priority populations, is essential for effective implementation. We conducted semi-structured interviews with patients in three Ryan White-funded HIV clinics in San Francisco, Chicago, and Atlanta. We employed maximal variation sampling across age, gender, race, ethnicity, and time living with HIV and oversampled for individuals with suboptimal clinical engagement. An 8-step hybrid deductive and inductive thematic analysis approach guided data analysis. Between August 2020 and July 2021, we conducted 72 interviews. Median age was 46 years; 28% were ciswomen, 7% transwomen, 44% Black/African-American and 35% Latinx, 43% endorsed a psychiatric diagnosis, 35% were experiencing homelessness/unstable housing, and 10% had recent substance use. Approximately 24% were sub-optimally engaged in care. We observed a spectrum of LAI-ART acceptability, ranging from enthusiasm to hesitancy to rejection. We also characterized four emergent orientations towards LAI-ART: innovator, pragmatist, deliberator, and skeptic. Overall, the majority of participants expressed favorable initial reactions towards LAI-ART. Most approached LAI-ART pragmatically, but acceptability was not static, often increasing over the course of the interview. Participants considered their HIV providers as essential for affirming personal relevance. HIV stigma, privacy concerns, and medical mistrust had varied impacts, sometimes facilitating and other times hindering personal relevance. These findings held across priority populations, specifically young adults, cis/trans women, racial/ethnic minorities, and individuals with suboptimal clinical engagement. Further research is needed to explore the transition from hypothetical acceptance to uptake and to confirm the actual benefits and drawbacks of this treatment.
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Affiliation(s)
- Xavier A Erguera
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Department of Public Health, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Kimberly A Koester
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Manami Diaz Tsuzuki
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kaylin V Dance
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Ponce de Leon Center, Grady Health System, Atlanta, GA, USA
| | - Rey Flores
- Department of Family and Community Medicine, College of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Jared Kerman
- Cancer Treatment Centers of America, Comprehensive Care and Research Center, City of Hope Chicago, Chicago, IL, USA
| | - Moira C McNulty
- Chicago Center for HIV Elimination, University of Chicago, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Jonathan A Colasanti
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Ponce de Leon Center, Grady Health System, Atlanta, GA, USA
| | - Lauren F Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
- Ponce de Leon Center, Grady Health System, Atlanta, GA, USA
| | - Elizabeth T Montgomery
- Women's Global Health Imperative, RTI International, Berkeley, CA, USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mallory O Johnson
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - John A Sauceda
- Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA
| | - Katerina A Christopoulos
- Division of HIV, ID and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
- Department of Public Health, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
- Division of HIV, Infectious Disease, and Global Medicine, San Francisco General Hospital, 1001 Potrero Avenue, Building 80, Room 424, San Francisco, CA, 94110, USA.
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Denison JA, Willis K, DeLong SM, Sievwright KM, Agwu AL, Arrington-Sanders R, Kaufman MR, Prabhu S, Williams AM, Fields EL, Alexander KA, Lee L, Yang C. Advancing Adolescent and Young Adult HIV Prevention and Care and Treatment Through Use of Multi-level Theories and Frameworks: A Scoping Review and Adapted HIV Ecological Framework. AIDS Behav 2024; 28:1694-1707. [PMID: 38351279 PMCID: PMC11069483 DOI: 10.1007/s10461-023-04255-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 05/05/2024]
Abstract
While multi-level theories and frameworks have become a cornerstone in broader efforts to address HIV inequities, little is known regarding their application in adolescent and young adult (AYA) HIV research. To address this gap, we conducted a scoping review to assess the use and application of multi-level theories and frameworks in AYA HIV prevention and care and treatment empirical research. We systematically searched five databases for articles published between 2010 and May 2020, screened abstracts, and reviewed eligible full-text articles for inclusion. Of the 5890 citations identified, 1706 underwent full-text review and 88 met the inclusion criteria: 70 focused on HIV prevention, with only 14 on care and treatment, 2 on both HIV prevention and care and treatment, and 2 on HIV-affected AYA. Most authors described the theory-based multi-level framework as informing their data analysis, with only 12 describing it as informing/guiding an intervention. More than seventy different multi-level theories were described, with 38% utilizing socio-ecological models or the eco-developmental theory. Findings were used to inform the adaptation of an AYA World Health Organization multi-level framework specifically to guide AYA HIV research.
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Affiliation(s)
- Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA.
| | - Kalai Willis
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Stephanie M DeLong
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kirsty M Sievwright
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, US
| | - Allison L Agwu
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Michelle R Kaufman
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sandeep Prabhu
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
| | - Ashlie M Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street. Room E5546, Baltimore, MD, 21205, USA
| | - Errol L Fields
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Lana Lee
- Adult Clinical Branch, Office of HIV/AIDS, United States Agency for International Development, Washington, DC, USA
| | - Cui Yang
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Mantula F, Toefy Y, Sewram V. Barriers to cervical cancer screening in Africa: a systematic review. BMC Public Health 2024; 24:525. [PMID: 38378542 PMCID: PMC10877795 DOI: 10.1186/s12889-024-17842-1] [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: 09/14/2023] [Accepted: 01/22/2024] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Africa has one of the highest burdens of cervical cancer in the world. The unacceptably high incidence and mortality rates could be reduced through implementing a comprehensive approach to its prevention and control that includes screening, which however, is low in most low-and-middle-income countries. Hence, this systematic review aims at exploring factors that prevent women from utilising cervical cancer screening services in the region. METHODS A mixed method systematic review was conducted. A search was performed on PubMed (Medline), EMBASE, CINAHL (EBSCOHOST) and Scopus databases for articles published until May 2019 without time, language or study design limits. Two reviewers critically appraised the included studies independently using the standard quality assessment criteria for evaluating primary research papers. Results of the quantitative and mixed methods studies were transformed into qualitative data and synthesised using thematic analysis. RESULTS From a potential 2 365 studies, 24 from 11 countries met the eligibility criteria and were selected; eight qualitative, 13 quantitative, and three that used the mixed-method approach. The primary barriers were identified as poor access to screening services, lack of awareness and knowledge on cervical cancer and screening, and socio-cultural influences. Service providers perceived lack of skills, screening equipment and supplies, and staff shortages as the major barriers to the provision of screening services. CONCLUSION Barriers to cervical cancer screening in Africa are multifaceted and require a holistic approach that will address them concurrently at the health system, individual, interpersonal, community and structural levels. Political will complimented by stakeholder involvement is required in the development and implementation of strategies that will ensure acceptability, availability, accessibility, and affordability of screening to minimise barriers in accessing the service.
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Affiliation(s)
- Fennie Mantula
- African Cancer Institute, Stellenbosch University, P.O Box 241, Cape Town, 8000, South Africa.
- Department of Nursing and Midwifery, Faculty of Medicine, National University of Science and Technology, P.O. Box A.C. 939, Ascot, Bulawayo, Zimbabwe.
| | - Yoesrie Toefy
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O Box 241, Cape Town, 8000, South Africa
| | - Vikash Sewram
- African Cancer Institute, Stellenbosch University, P.O Box 241, Cape Town, 8000, South Africa.
- Division of Health Systems and Public Health, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, P.O Box 241, Cape Town, 8000, South Africa.
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Kimaru LJ, Habila MA, Mantina NM, Madhivanan P, Connick E, Ernst K, Ehiri J. Neighborhood characteristics and HIV treatment outcomes: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002870. [PMID: 38349915 PMCID: PMC10863897 DOI: 10.1371/journal.pgph.0002870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 12/21/2023] [Indexed: 02/15/2024]
Abstract
Recognizing challenges faced by people living with HIV is vital for improving their HIV treatment outcomes. While individual-level interventions play a crucial role, community factors can shape the impact of individual interventions on treatment outcomes. Understanding neighborhood characteristics' association with HIV treatment outcomes is crucial for optimizing effectiveness. This review aims to summarize the research scope on the association between neighborhood characteristics and HIV treatment outcomes. The databases PubMed, CINAHL (EBSCOhost), Embase (Elsevier), and PsychINFO (EBSCOhost) were searched from the start of each database to Nov 21, 2022. Screening was performed by three independent reviewers. Full-text publications of all study design meeting inclusion criteria were included in the review. There were no language or geographical limitations. Conference proceedings, abstract only, and opinion reports were excluded from the review. The search yielded 7,822 publications, 35 of which met the criteria for inclusion in the review. Studies assessed the relationship between neighborhood-level disadvantage (n = 24), composition and interaction (n = 17), social-economic status (n = 18), deprivation (n = 16), disorder (n = 8), and rural-urban status (n = 7) and HIV treatment outcomes. The relationship between all neighborhood characteristics and HIV treatment outcomes was not consistent across studies. Only 7 studies found deprivation had a negative association with HIV treatment outcomes; 6 found that areas with specific racial/ethnic densities were associated with poor HIV treatment outcomes, and 5 showed that disorder was associated with poor HIV treatment outcomes. Three studies showed that rural residence was associated with improved HIV treatment outcomes. There were inconsistent findings regarding the association between neighborhood characteristics and HIV treatment outcomes. While the impact of neighborhood characteristics on disease outcomes is highly recognized, there is a paucity of standardized definitions and metrics for community characteristics to support a robust assessment of this hypothesis. Comparative studies that define and assess how specific neighborhood indicators independently or jointly affect HIV treatment outcomes are highly needed.
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Affiliation(s)
- Linda Jepkoech Kimaru
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Magdiel A. Habila
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, United States of America
| | - Namoonga M. Mantina
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
| | - Elizabeth Connick
- Department of Medicine, The University of Arizona, Tucson, Arizona, United States of America
| | - Kacey Ernst
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, United States of America
| | - John Ehiri
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, United States of America
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Clarke R, Heath G, Ross J, Farrow C. Interventions supporting engagement with sexual healthcare among people of Black ethnicity: a systematic review of behaviour change techniques. Sex Health 2024; 21:NULL. [PMID: 38163758 DOI: 10.1071/sh23074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Black ethnic groups are disproportionately affected by sexually transmitted infections (STIs). This review aimed to identify interventions designed to increase engagement with sexual healthcare among people of Black ethnicity as determined by rates of STI testing, adherence to sexual health treatment, and attendance at sexual healthcare consultations. The behaviour change techniques (BCTs) used within identified interventions were evaluated. METHOD Four electronic databases (Web of science; ProQuest; Scopus; PubMed) were systematically searched to identify eligible articles published between 2000 and 2022. Studies were critically appraised using the Mixed Methods Appraisal Tool. Findings were narratively synthesised. RESULTS Twenty one studies across two countries were included. Studies included randomised controlled trials and non-randomised designs. Behavioural interventions had the potential to increase STI/HIV testing, sexual healthcare consultation attendance and adherence to sexual health treatment. Behavioural theory underpinned 16 interventions which addressed barriers to engaging with sexual healthcare. Intervention facilitators' demographics and lived experience were frequently matched to those of recipients. The most frequently identified novel BCTs in effective interventions included information about health consequences, instruction on how to perform behaviour, information about social and environmental consequences, framing/reframing, problem solving, and review behavioural goal(s). DISCUSSION Our findings highlight the importance of considering sociocultural, structural and socio-economic barriers to increasing engagement with sexual healthcare. Matching the intervention facilitators' demographics and lived experience to intervention recipients may further increase engagement. Examination of different BCT combinations would benefit future sexual health interventions in Black ethnic groups.
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Affiliation(s)
- Rebecca Clarke
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Gemma Heath
- School of Psychology, Aston University, Birmingham, UK
| | - Jonathan Ross
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Claire Farrow
- School of Psychology, Aston University, Birmingham, UK
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Ramos SD, Woodward H, Kannout L, Du Bois S. Dimensional Reduction in Barriers and Facilitators to Pre-exposure Prophylaxis (PrEP) Uptake Willingness for Full-Service Sex Workers. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:799-810. [PMID: 37962828 DOI: 10.1007/s10508-023-02742-z] [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: 03/01/2023] [Revised: 10/31/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023]
Abstract
Full-Service Sex Workers (FSSWs) face heightened risk of acquiring HIV, yet exhibit relatively low adoption of pre-exposure prophylaxis (PrEP)-an antiviral that substantially reduces HIV acquisition risk. Little work examines barriers and facilitators to PrEP uptake willingness among FSSWs. This study aimed to identify the distinct components of barriers and facilitators to PrEP uptake willingness for FSSWs. Here, we subjected 19 PrEP barriers and facilitators identified in the literature to a principal component analysis (PCA) among a sample of 83 FSSWs. Preliminary statistics supported factorability of data. PCA revealed three distinct components of barriers and facilitators that explained 62.80% of the total variance in survey responses. We labeled these components Behavioral and Social Concerns (α = 0.93), Access and Affordability (α = 0.67), and Biologically Based Health Concerns (α = 0.79). This study shows promise for future clinical and research utility of these factors and provides a basis for future psychometric studies of barriers and facilitators to PrEP uptake willingness among FSSWs.
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Affiliation(s)
- Stephen D Ramos
- Department of Medicine, University of California San Diego, La Jolla, CA, 92093, USA.
- SDSU Research Foundation, San Diego State University, San Diego, CA, USA.
| | - Honor Woodward
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Lynn Kannout
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
| | - Steff Du Bois
- Department of Psychology, Illinois Institute of Technology, Chicago, IL, USA
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Lichtwarck HO, Mbotwa CH, Kazaura MR, Moen K, Mmbaga EJ. Early disengagement from HIV pre-exposure prophylaxis services and associated factors among female sex workers in Dar es Salaam, Tanzania: a socioecological approach. BMJ Glob Health 2023; 8:e013662. [PMID: 38154811 PMCID: PMC10759139 DOI: 10.1136/bmjgh-2023-013662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 11/25/2023] [Indexed: 12/30/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is an effective HIV prevention tool when taken as prescribed. However, suboptimal use may challenge its real-life impact. To support female sex workers in their efforts to prevent themselves from HIV, it is essential to identify factors that contribute to early disengagement from PrEP care. In this study, we aimed to estimate the risk of early disengagement from PrEP services among female sex workers in Tanzania and associated factors using a socioecological model as a guiding framework. METHODS The study was conducted as part of a pragmatic mHealth trial for PrEP roll-out in Dar es Salaam in 2021. We estimated the risk of early disengagement, defined as not presenting for the first follow-up visit (within 56 days of enrolment), and its associations with individual, social, behavioural and structural factors (age, self-perceived HIV risk, mental distress, harmful alcohol use, condom use, number of sex work clients, female sex worker stigma and mobility) using multivariable logistic regression models, with marginal standardisation to obtain adjusted relative risks (aRR). RESULTS Of the 470 female sex workers enrolled in the study, 340 (74.6%) did not attend the first follow-up visit (disengaged). Mental distress (aRR=1.14; 95% CI 1.01 to 1.27) was associated with increased risk of disengagement. Participants who reported a higher number of clients per month (10-29 partners: aRR=0.87; 95% CI 0.76 to 0.98 and ≥30 partners: aRR=0.80; 95% CI 0.68 to 0.91) and older participants (≥35 years) (RR=0.75; 95% CI 0.56 to 0.95) had a lower risk of disengagement. CONCLUSIONS AND RECOMMENDATIONS Early disengagement with the PrEP programme was high. Mental distress, younger age and having fewer clients were risk factors for disengagement. We argue that PrEP programmes could benefit from including mental health screening and treatment, as well as directing attention to younger sex workers and those reporting fewer clients.
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Affiliation(s)
- Hanne Ochieng Lichtwarck
- Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Christopher Hariri Mbotwa
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | | | - Kåre Moen
- Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Elia John Mmbaga
- Department of Community Medicine and Global Health, University of Oslo, Faculty of Medicine, Oslo, Norway
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Ichite A, Jean-Gilles M, Rosenberg R, Abbamonte J, Dévieux JG. Assessing the Preliminary Efficacy of a Nonrandomized, Clinic-Based HIV Risk Reduction Pilot Intervention for PrEP-Initiated, Alcohol- and Other Drug-Using Women of Color in Miami, FL. J Racial Ethn Health Disparities 2023; 10:3077-3094. [PMID: 36648620 PMCID: PMC10645637 DOI: 10.1007/s40615-022-01482-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 01/18/2023]
Abstract
In this paper, we assessed the preliminary efficacy and acceptability of a quasi-experimental, clinic-based sexual risk reduction pilot intervention for pre-exposure prophylaxis (PrEP)-initiated, alcohol- and other drug-using women of color and explored their self-reported barriers to, and facilitators of, PrEP use. Using a mixed methods design, analyses incorporated pre- and post-intervention study assessment data from 38 women and semi-structured process evaluations using a subsample of 25. The intervention administered over an 8-week period consisted of 4 one-on-one in person educational sessions, a process evaluation, and study assessments conducted at baseline and 3 and 6 months. Post intervention, statistically significant changes in sexual risk scores were not observed; however, we found significant decreases in alcohol use (Z = - 3.02, p = .003, η2 = .41). Process evaluation data revealed interpersonal relationships as a key motivator for PrEP initiation as well as a prominent barrier to PrEP use; these relationships rarely facilitated adherence. Overall, women found the intervention to be acceptable and reported a wide range of benefits of participation-most notably its therapeutic benefits. Findings from this study provide preliminary evidence of the potential for the Talking PrEP with Women of Color intervention to improve risky behaviors, knowledge, and attitudes related to sexual risk taking. Furthermore, findings suggest that interventions to increase PrEP uptake and adherence in at-risk women may benefit from supporting them in accurately estimating their risk for HIV and increasing their sense of social support.
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Affiliation(s)
- Amanda Ichite
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA.
| | - Michèle Jean-Gilles
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
| | - Rhonda Rosenberg
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
| | - John Abbamonte
- Department of Educational and Psychological Studies, Counseling Psychology Area, University of Miami, Coral Gables, FL, 33146, USA
| | - Jessy G Dévieux
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public, Health and Social Work, Florida International University, Miami, FL, 33199, USA
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11
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Yakubu K, Bowen P, Govender R. The influence of type of sexual partnership on male condom use: empirical evidence from the South African construction industry. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:185-200. [PMID: 37909699 DOI: 10.2989/16085906.2023.2265902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/01/2023] [Indexed: 11/03/2023]
Abstract
There are indications that gender has an effect on individual risk factors and pathways to HIV diagnoses and treatment. Furthermore, there is growing recognition that to improve HIV-related health outcomes for men, it is important to understand their experiences and perspectives. Perhaps because of the physical nature of construction work, the South African construction industry is dominated by men. Given that employed men are a hard-to-reach community population group, the construction workplace offers an ideal environment for data collection and delivery of non-health-facility-based HIV prevention and treatment interventions. Furthermore, workers in the construction industry have been identified as being at a heightened risk of acquiring HIV and AIDS because of work-related travel, the ubiquity of transactional sex around worker hostels and having an increased likelihood of multiple and concurrent sex partnerships. As a consequence, this study examines the association between condom use and sexual partnerships among men working in the construction industry. A purposive cross-sectional survey was used to collect data from 450 workers across 18 construction sites in the Western Cape province of South Africa. The types of sexual partnership had three categories: regular sex partnerships, casual sex partnerships and sex worker partnerships. Frequency of condom use was determined to be highest with casual sex partners (51.2%), followed by sex workers (40.6%) and regular sex partners (25.6%). Hierarchical multiple linear regression analysis was used to examine the demographic, experiential, behavioural and cognitive predictors of condom use across the three categories of sexual partnership. The results indicate that an individual's perception of control over condom use, and the perceived threat posed by HIV and AIDS are significantly associated with consistent condom use, even after accounting for differences in partner type. Implications of the findings are discussed, and directions for future research on the association between sexual partnerships and condom use are offered.
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Affiliation(s)
- Kamal Yakubu
- Nelson Mandela School of Public Governance, University of Cape Town, South Africa
| | - Paul Bowen
- Construction Economics and Management, University of Cape Town, South Africa
| | - Rajen Govender
- Nelson Mandela School of Public Governance, University of Cape Town, South Africa
- Medical Research Council of South Africa, Cape Town, South Africa
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12
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Troutman J, Robillard A, Ingram LA, Qiao S, Gaddist B, Segosebe K. Individual, Social, and Structural Vulnerability for Black Women in the South: Implications for PrEP. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2023; 35:290-308. [PMID: 37535327 DOI: 10.1521/aeap.2023.35.4.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention option, yet adoption among Black women, who are disproportionately impacted by HIV, is low. A nuanced understanding of the multi-level factors that contribute to elevated risk is necessary to better contextualize PrEP uptake. Qualitative data from Black women residing in the Southern U.S. who self-screened as HIV-negative, were collected via four focus groups (N = 27) to understand influences on HIV vulnerability and the potential role of PrEP in mitigating risk. Content analysis of transcribed data yielded multiple themes addressing: the pervasiveness of sexual partner sharing; lack of transparency regarding HIV status, disclosure, and testing; and social/cultural influences on HIV risk. Experiences with the health care system and providers were of particular concern. Findings demonstrate support for PrEP in this population and contribute to our understanding of individual, social, and structural factors to better inform PrEP promotion.
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Affiliation(s)
- Jamie Troutman
- Quality Comprehensive Health Center, Charlotte, North Carolina
| | - Alyssa Robillard
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Lucy Annang Ingram
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Shan Qiao
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | | | - Kebafe Segosebe
- Edson College of Nursing and Health Innovation, Arizona State University
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13
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Elbur AI, Ghebremichael M, Konkle-Parker D, Jones DL, Collins S, Adimora AA, Schneider MF, Cohen MH, Tamraz B, Plankey M, Wilson T, Adedimeji A, Haberer J, Jacobson DL. Trajectories of Antiretroviral Therapy Adherence and Virologic Failure in Women With HIV in the United States. J Acquir Immune Defic Syndr 2023; 93:162-170. [PMID: 36804871 PMCID: PMC10180014 DOI: 10.1097/qai.0000000000003174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/28/2022] [Indexed: 02/22/2023]
Abstract
BACKGROUND Women with HIV (WHIV) in the United States face many challenges with adherence to antiretroviral therapy (ART), and suboptimal adherence often leads to virologic failure. This study aimed to determine the association between ART adherence trajectories and the risk of virologic failure. METHODS We included WHIV (aged 18 years or older) enrolled in the Women's Interagency HIV Study in the United States from April 2014 to September 2019 who had at least 2 consecutive measurements of HIV RNA and ≥3 measurements of self-reported adherence. Group-based trajectory modeling was used to identify adherence trajectories. Cox proportional hazard ratios were used to measure the association. MAIN OUTCOME MEASURE Virologic failure was defined as HIV RNA ≥200 copies/mL at 2 consecutive visits. RESULTS We included 1437 WHIV (median age 49 years). Of all women, 173 (12.0%) experienced virologic failure. Four adherence trajectories were identified, namely "consistently high" (26.3%), "moderate increasing" (9.5%), "moderate decreasing" (30.6%), and "consistently low" (33.5%). Women in the consistently low adherence group consumed alcohol and experienced depression more than other groups. Compared with the "consistently high" trajectory, the risk of virologic failure was higher among women with "consistently low" [adjusted hazard ratio (aHR) 2.8; 95% confidence interval (CI): 1.6 to 4.9; P < 0.001] and "moderate decreasing" adherence trajectories (aHR 1.8; 95% CI: 1.0 to 3.2; P = 0.04), but it was similar to those with "moderate increasing" adherence trajectory (aHR 1.0; 95% CI: 0.4 to 2.5; P = 0.94). CONCLUSIONS Adherence to ART remains a challenge among WHIV. Multilevel behavioral interventions to address poor adherence, alcohol consumption, and depression are needed.
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Affiliation(s)
| | | | - Deborah Konkle-Parker
- Schools of Nursing, Medicine and Population Health, University of Mississippi Medical Center, Jackson, MS
| | - Deborah L. Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Shelby Collins
- Emory University School of Medicine, Division of Infectious Disease, Atlanta, GA
| | - Adaora A. Adimora
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Michael F. Schneider
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Mardge H. Cohen
- Department of Medicine, Stroger Hospital of Cook County, Chicago IL
| | - Bani Tamraz
- University of California, San Francisco, School of Pharmacy, San Francisco, CA, MA
| | - Michael Plankey
- Georgetown University Medical Center, Department of Medicine, Division of General Internal Medicine, Washington DC
| | - Tracey Wilson
- School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Adebola Adedimeji
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Jessica Haberer
- Center for Global Health, Massachusetts General Hospital, Boston, MA; and
| | - Denise L. Jacobson
- Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, MA
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14
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Navarra AMD, Rosenberg MG, Gormley M, Bakken S, Fletcher J, Whittemore R, Gwadz M, Cleland C, Melkus GD. Feasibility and Acceptability of the Adherence Connection Counseling, Education, and Support (ACCESS) Proof of Concept: A Peer-Led, Mobile Health (mHealth) Cognitive Behavioral Antiretroviral Therapy (ART) Adherence Intervention for HIV-Infected (HIV+) Adolescents and Young Adults (AYA). AIDS Behav 2023; 27:1807-1823. [PMID: 36574184 PMCID: PMC9792943 DOI: 10.1007/s10461-022-03913-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2022] [Indexed: 12/28/2022]
Abstract
Effective antiretroviral therapy (ART) adherence strategies for HIV+ adolescents and young adults (AYA) are needed to prevent HIV-related morbidity, mortality, and onward transmission. In the Adherence Connection for Counseling, Education, and Support (ACCESS) pilot, an exploratory sequential mixed-methods design was used to develop and test a peer-led, mobile health (mHealth) cognitive behavioral ART adherence intervention. HIV+ AYA (ages 16-29 years) with unsuppressed plasma HIV RNA (HIV viral load) were eligible for this five-session intervention directed to improving ART adherence and HIV viral load. A total of 78 peer-led remote videoconferencing sessions (via WebEx) were delivered to 16 participants. High completion rates (97.5%) and client satisfaction scores (mean = 29.13 of 32; SD = 2.45) were observed. Self-reported ART adherence improved (32% increase in doses taken; 95th CI 11.2-53.3) with an annualized average rate of 47.5% (0.28 log10) reduction in HIV viral load. We established proof of concept for the ACCESS peer-led, mHealth cognitive behavioral ART adherence intervention, with promising adherence and virologic outcome data.
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Affiliation(s)
| | - Michael G Rosenberg
- Division of Infectious Diseases, Department of Pediatrics, Jacobi Medical Center, Bronx, NY, USA
| | - Maurade Gormley
- University of Connecticut, School of Nursing, Storrs, CT, USA
| | - Suzanne Bakken
- Columbia University School of Nursing, Columbia University, New York, NY, USA
| | - Jason Fletcher
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
| | | | - Marya Gwadz
- Silver School of Social Work, New York University, New York, NY, USA
| | - Charles Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Gail D'Eramo Melkus
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY, 10010, USA
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15
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Monroe AK, Kulie PE, Byrne ME, Wilbourn BC, Barth SK, Resnik JB, Huebner DM, Horberg MA, Castel AD, Greenberg AE. Psychosocial impacts of the COVID-19 pandemic from a cross-sectional Survey of people living with HIV in Washington, DC. AIDS Res Ther 2023; 20:27. [PMID: 37161481 PMCID: PMC10169119 DOI: 10.1186/s12981-023-00517-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 04/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND COVID-19 has not only taken a staggering toll in terms of cases and lives lost, but also in its psychosocial effects. We assessed the psychosocial impacts of the COVID-19 pandemic in a large cohort of people with HIV (PWH) in Washington DC and evaluated the association of various demographic and clinical characteristics with psychosocial impacts. METHODS From October 2020 to December 2021, DC Cohort participants were invited to complete a survey capturing psychosocial outcomes influenced by the COVID-19 pandemic. Some demographic variables were also collected in the survey, and survey results were matched to additional demographic data and laboratory data from the DC Cohort database. Data analyses included descriptive statistics and multivariable logistic regression models to evaluate the association between demographic and clinical characteristics and psychosocial impacts, assessed individually and in overarching categories (financial/employment, mental health, decreased social connection, and substance use). RESULTS Of 891 participants, the median age was 46 years old, 65% were male, and 76% were of non-Hispanic Black race/ethnicity. The most commonly reported psychosocial impact categories were mental health (78% of sample) and financial/employment (56% of sample). In our sample, older age was protective against all adverse psychosocial impacts. Additionally, those who were more educated reported fewer financial impacts but more mental health impacts, decreased social connection, and increased substance use. Males reported increased substance use compared with females. CONCLUSIONS The COVID-19 pandemic has had substantial psychosocial impacts on PWH, and resiliency may have helped shield older adults from some of these effects. As the pandemic continues, measures to aid groups vulnerable to these psychosocial impacts are critical to help ensure continued success towards healthy living with HIV.
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Affiliation(s)
- Anne K. Monroe
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Paige E. Kulie
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Morgan E. Byrne
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Brittany C. Wilbourn
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Shannon K. Barth
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Jenna B. Resnik
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - David M. Huebner
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Amanda D. Castel
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - Alan E. Greenberg
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
| | - the DC Cohort Executive Committee
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue, Washington, DC, NW 20052 USA
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
- Kaiser Permanente Mid Atlantic States, Rockville, MD, USA
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16
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Hong C, Queiroz A, Hoskin J. The impact of the COVID-19 pandemic on mental health, associated factors and coping strategies in people living with HIV: a scoping review. J Int AIDS Soc 2023; 26:e26060. [PMID: 36912238 PMCID: PMC10009802 DOI: 10.1002/jia2.26060] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/19/2023] [Indexed: 03/14/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic and associated measures implemented by authorities have created additional stressors and increased the risk of psychological illnesses among people living with HIV (PLWH). Yet, there is no collective evidence on the mental health status of this population during the global pandemic and associated factors. This scoping review aimed to synthesize the evidence in the current literature related to the mental health outcomes and challenges faced by PLWH during the COVID-19 pandemic, identify the associated factors with psychological distress and summarize various coping strategies to ease these psychological distresses used by this population. METHODS We conducted a scoping review following the PRISMA-ScR guideline and a literature search in four electronic databases in August 2022. Three reviewers independently screened all the search records and extracted the data from studies that met the inclusion criteria. Factors associated with worsened mental health outcomes were synthesized according to the socio-ecological framework. RESULTS Among 1100 research records, 45 articles met the eligibility criteria and were included in the final review and data extraction, most of which were quantitative analyses. PLWH reported high rates of mental health problems during the pandemic. Multi-level factors were associated with increased psychological distress, including substance use, antiretroviral adherence, social support, financial hardship and economic vulnerability during the pandemic. PLWH used social media as a coping strategy to foster social support to deal with growing mental distress. Increased mental health illnesses were associated with increased substance use, it was also found associated with suboptimal medication adherence and antiretroviral therapy (ART) care engagement. DISCUSSION PLWH experienced high rates of mental health illnesses, such as depression during the global COVID-19 pandemic. There is an urgent need to provide comprehensive HIV treatment and mental health services as the pandemic continues to evolve. CONCLUSIONS The review summarized how the mental health of PLWH was affected during the COVID-19 pandemic. Future work in the implementation of effective interventions to promote mental health in this population is needed, not only to ensure their quality of life but also to help them maintain ART adherence and healthcare during more unprecedented times.
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Affiliation(s)
- Chenglin Hong
- Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, USA
| | - Artur Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, Illinois, USA
| | - Jordan Hoskin
- State of California Department of Rehabilitation, Los Angeles, California, USA
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17
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Torres-Cortés B, Leiva L, Canenguez K, Olhaberry M, Méndez E. Shared Components of Worldwide Successful Sexuality Education Interventions for Adolescents: A Systematic Review of Randomized Trials. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4170. [PMID: 36901181 PMCID: PMC10002383 DOI: 10.3390/ijerph20054170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/17/2023] [Accepted: 02/21/2023] [Indexed: 06/18/2023]
Abstract
A crucial aspect of human development is sexuality which has implications for health, particularly in adolescence, since unfavorable sexual experiences may result in physical and mental problems. Sexuality education interventions (SEI) are one of the most used actions to promote sexual health in adolescents. Nevertheless, there is variability across their components; therefore, key elements for an effective SEI targeted at adolescents (A-SEI) are not well known. Based on this background, this study aims to identify the shared components of successful A-SEI through a systematic review of randomized controlled trials (RCT). This study followed the preferred reporting items for systematic reviews and meta-analyses statement. A search was conducted in CINAHL, PsycInfo, PubMed, and Web of Science between November and December 2021. A total of 21 studies passed the inclusion test after the review of 8318 reports. A total of 18 A-SEIs were identified in these studies. The components analyzed were the intervention's approach, dose, type of intervention, theoretical framework, facilitators' training, and intervention methodology. The results established that components that should be present in the design of an effective A-SEI are behavior change theoretical models, the use of participatory methodology, be targeted at mixed-sex groups, facilitators' training, and at least ten hours of weekly intervention.
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Affiliation(s)
- Betzabé Torres-Cortés
- Department of Psychology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul 7820436, Chile
- Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Avenida Capitán Ignacio Carrera Pinto 1045, Ñuñoa 7800284, Chile
- Millennium Institute for Research on Depression and Personality (MIDAP), Av. Vicuña Mackenna 4860, Macul 7820436, Chile
| | - Loreto Leiva
- Department of Psychology, Faculty of Social Sciences, Universidad de Chile, Avenida Capitán Ignacio Carrera Pinto 1045, Ñuñoa 7800284, Chile
| | - Katia Canenguez
- Department of Psychiatry, Massachusetts General Hospital, Yawkey 6A, 55 Fruit Street, Boston, MA 02114, USA
- Department of Psychiatry, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
| | - Marcia Olhaberry
- Department of Psychology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul 7820436, Chile
- Millennium Institute for Research on Depression and Personality (MIDAP), Av. Vicuña Mackenna 4860, Macul 7820436, Chile
| | - Emmanuel Méndez
- Department of Psychology, Faculty of Social Sciences, Pontificia Universidad Católica de Chile, Av. Vicuña Mackenna 4860, Macul 7820436, Chile
- Department of Psychiatry, Faculty of Medicine, Universidad de Chile, Gran Av. José Miguel Carrera 3100, San Miguel 8900085, Chile
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18
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Beauchamp G, Hosek S, Donnell DJ, Chan KCG, Flaherty BP, Anderson PL, Dye BJ, Mgodi N, Bekker LG, Delany-Moretlwe S, Celum C. Development of a tool to assess HIV prevention readiness of adolescent girls and young women in HPTN 082 study. PLoS One 2023; 18:e0281728. [PMID: 36827440 PMCID: PMC9956790 DOI: 10.1371/journal.pone.0281728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 01/25/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND African adolescent girls and young women (AGYW) represent a large proportion of new HIV infections, a priority population for pre-exposure prophylaxis (PrEP), but adherence remains a challenge. A reliable, valid readiness tool would help identify AGYW motivated to take PrEP who need adherence support. METHODS In the HPTN 082 open-label PrEP study (2016-2019), South African and Zimbabwean women ages 16-25 were administered an HIV prevention readiness measure (HPRM). The 25 items in the HPRM included medication beliefs, connection with care, disclosure of PrEP use, social support, and housing stability using a 5-point Likert scale. Exploratory factor analysis (EFA) using polychoric correlations, scale reliability, and predictive validity were performed on data from 315 participants who responded to all items. We assessed the predictive value of HPRM scores with PrEP adherence, defined as tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots, as a continuous measure and dichotomized as high PrEP adherence (≥700 fmol/punch). RESULTS EFA yielded 23 items with three subscales: self-efficacy (16 items), PrEP disclosure (4 items), and social support (3 items). Cronbach's α ranged from 0.71 to 0.92 for the overall scale and the subscales. The average overall scale and the subscales were predictive of 3-month PrEP adherence for TFV-DP concentrations: for each unit increase of the HPRM score, TFV-DP concentration increased by 103 fmol/punch (95% CI: 16, 189, p = 0.02); the highest HPRM score equated with 608 fmol/punch on average. For the self-efficacy subscale, TFV-DP increased by 90 fmol/punch (95% CI: 7, 172, p = 0.03); PrEP disclosure, 68 fmol/punch (95% CI: 19, 117 p = 0.01); and social support, 58fmol/punch (95% CI: 2, 113, p = 0.04). Higher PrEP disclosure suggests high adherence (OR 1.36, 95% CI: 1.00, 1.86, p = 0.05) and predicted persistent high adherence at both months three and six (OR: 1.50, 95% CI: 1.03, 2.21, p = 0.04). CONCLUSIONS The HPRM scale overall and the subscales individually demonstrated good internal consistency among African young women. PrEP disclosure subscale exhibiting significant association with persistent high PrEP adherence is an important finding for PrEP adherence support programs. Future work will assess replicability and expand self-efficacy and social-support subscales after item revision. TRIAL REGISTRATION ClinicalTrials.gov NCT02732730.
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Affiliation(s)
- Geetha Beauchamp
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois, United States of America
| | - Deborah J. Donnell
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
| | - Kwun C. G. Chan
- Department of Health Systems and Population Health, University of Washington, Seattle, Washington, United States of America
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | - Brian P. Flaherty
- Department of Psychology, University of Washington, Seattle, Washington, United States of America
| | - Peter L. Anderson
- Department of Pharmaceutical Sciences, University of Colorado-Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Bonnie J. Dye
- FHI 360, Durham, North Carolina, United States of America
| | - Nyaradzo Mgodi
- University of Zimbabwe Clinical Trials Research Centre, Harare, Zimbabwe
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Connie Celum
- Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, Washington, United States of America
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19
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Mabire-Yon R, Di Ciaccio M, Picard H, Palich R, Supervie V, Préau M. Psychosocial factors involved in the very rare use of HIV testing among French MSM: a cross-sectional study. Int J STD AIDS 2023:9564624231155762. [PMID: 36798044 DOI: 10.1177/09564624231155762] [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: 02/18/2023]
Abstract
BACKGROUND Among men who have sex with men (MSM) in France, the average time between infection and testing is too long, leading to late diagnosis. A better understanding of very infrequent HIV testing (VIT; i.e. have not tested for at least 6 years) could help reach unknowingly long-infected MSM. Thus, we aim to identify psychosocial factors associated with VIT among MSM in France. METHODS We conducted a multivariate regression on the data collected via a cross-sectional survey among 315 MSM. RESULTS 11.1% (n = 35) had VIT. Being over 50, not knowing about the existence of HIV self-testing, having predominantly heterosexual friends, and the level of belief in the effectiveness of treatment as prevention were significantly associated with VIT. CONCLUSION We call for the development, at the same time, of programs that operate at the individual, institutional and societal levels. In particular, we recommend diversifying the modes of promotion and access to prevention tools, especially for MSM over 50 years old or with little or no connection to the gay community.
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Affiliation(s)
- Renaud Mabire-Yon
- UMR1296 (Radiations, Défense, Santé, Environnement), 27028INSERM, Université Lyon 2, Bron, France
| | - Marion Di Ciaccio
- UMR1296 (Radiations, Défense, Santé, Environnement), 27028INSERM, Université Lyon 2, Bron, France.,Laboratoire de Recherche Communautaire, 594243Coalition PLUS, Patin, France
| | - Hervé Picard
- Service de Recherche Clinique, 55659Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Romain Palich
- Département des Maladies Infectieuses et Tropicales, 26933Hôpital de La Pitié-Salpêtrière, Paris, France.,Sorbonne Université, INSERM, 243485Institut Pierre Louis D'Épidémiologie et de Santé Publique, Paris, France
| | - Virginie Supervie
- Sorbonne Université, INSERM, 243485Institut Pierre Louis D'Épidémiologie et de Santé Publique, Paris, France
| | - Marie Préau
- UMR1296 (Radiations, Défense, Santé, Environnement), 27028INSERM, Université Lyon 2, Bron, France
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20
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Duberstein PR, Hoerger M, Norton SA, Mohile S, Dahlberg B, Hyatt EG, Epstein RM, Wittink MN. The TRIBE model: How socioemotional processes fuel end-of-life treatment in the United States. Soc Sci Med 2023; 317:115546. [PMID: 36509614 DOI: 10.1016/j.socscimed.2022.115546] [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: 11/18/2021] [Revised: 03/21/2022] [Accepted: 11/13/2022] [Indexed: 11/25/2022]
Abstract
Prior interventions have repeatedly failed to decrease the prescription and receipt of treatments and procedures that confer more harm than benefit at the End-of-Life (EoL); new approaches to intervention are needed. Ideally, future interventions would be informed by a social-ecological conceptual model that explains EoL healthcare utilization patterns, but current models ignore two facts: (1) healthcare is an inherently social activity, involving clinical teams and patients' social networks, and (2) emotions influence social activity. To address these omissions, we scaffolded Terror Management Theory and Socioemotional Selectivity Theory to create the Transtheoretical Model of Irrational Biomedical Exuberance (TRIBE). Based on Terror Management Theory, TRIBE suggests that the prospect of patient death motivates healthcare teams to conform to a biomedical norm of care, even when clinicians believe that biomedical interventions will likely be unhelpful. Based on Socioemotional Selectivity Theory, TRIBE suggests that the prospect of dwindling time motivates families to prioritize emotional goals, and leads patients to consent to disease-directed treatments they know will likely be unhelpful, as moral emotions motivate deference to the perceived emotional needs of their loved ones. TRIBE is unique among models of healthcare utilization in its acknowledgement that moral emotions and processes (e.g., shame, compassion, regret-avoidance) influence healthcare delivery, patients' interactions with family members, and patients' outcomes. TRIBE is especially relevant to potentially harmful EoL care in the United States, and it also offers insights into the epidemics of overtreatment in healthcare settings worldwide. By outlining the role of socioemotional processes in the care of persons with serious conditions, TRIBE underscores the critical need for psychological innovation in interventions, health policy and research on healthcare utilization.
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Affiliation(s)
- Paul R Duberstein
- Department of Health Behavior, Society, and Policy, Rutgers University School of Public Heath, 683 Hoes Lane West, Piscataway, NJ, 08854, United States.
| | - Michael Hoerger
- Department of Psychology, Psychiatry, and Medicine, Tulane University, 131 S. Robertson Building, 131 S Robertson St, New Orleans, LA, 70112, United States; Tulane Cancer Center, Tulane University, 1415 Tulane Ave, New Orleans, LA, 70112, United States.
| | - Sally A Norton
- School of Nursing, University of Rochester, 255 Crittenden Blvd, Rochester, NY, 14642, United States; Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, United States.
| | - Supriya Mohile
- Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, United States; James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, 90 Crittenden Blvd, Rochester, NY, 14642, United States.
| | - Britt Dahlberg
- Center for Humanism, Cooper Medical School of Rowan University, 401 South Broadway, Camden, NJ, 08103, United States.
| | - Erica Goldblatt Hyatt
- Rutgers School of Social Work, 536 George St, New Brunswick, NJ, 08901, United States.
| | - Ronald M Epstein
- Department of Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, United States; James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, 90 Crittenden Blvd, Rochester, NY, 14642, United States; Department of Family Medicine, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, United States.
| | - Marsha N Wittink
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave, Rochester, NY, 14642, United States.
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21
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Brothers S, DiDomizio E, Nichols L, Brooks R, Villanueva M. Perceptions Towards HCV Treatment with Direct Acting Antivirals (DAAs): A Qualitative Analysis with Persons with HIV/HCV Co-infection Who Delay or Refuse Treatment. AIDS Behav 2023; 27:119-133. [PMID: 35776253 PMCID: PMC9663279 DOI: 10.1007/s10461-022-03749-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 01/24/2023]
Abstract
In the United States, approximately 25% of people with HIV (PWH) are co-infected with hepatitis C (HCV). Since 2014, highly effective and well-tolerated direct-acting antivirals (DAAs) have revolutionized HCV treatment. Uptake of DAAs by people with HIV/HCV co-infection has improved but remains suboptimal due to system, provider, and patient-level barriers. To explore patient-level issues by better understanding their attitudes towards DAA treatment, we conducted qualitative interviews with 21 persons with HIV/HCV co-infection who did not consent to DAA treatment or delayed treatment for at least 1 year after diagnosis. We found PWH perceived DAA treatment barriers and facilitators on multiple levels of the social-ecological environment: the individual (HCV disease and treatment literacy), interpersonal (peer influence), institutional (media and healthcare provider relationship), and structural levels (treatment cost and adherence support). Recommendations to improve DAA treatment uptake include HCV-treatment adherence support, HCV disease and treatment literacy training (particularly for substance use and DAA treatment interactions), and encouraging PWH who have successfully completed DAA treatment to speak with their peers.
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Affiliation(s)
- Sarah Brothers
- Department of Sociology, Pennsylvania State University, 316 Oswald Tower, University Park, PA, 16802, USA.
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
| | - Elizabeth DiDomizio
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Lisa Nichols
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Ralph Brooks
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
| | - Merceditas Villanueva
- HIV/AIDS Program, Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA
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22
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Lichtwarck HO, Kazaura MR, Moen K, Mmbaga EJ. Harmful Alcohol Use and Associated Socio-Structural Factors among Female Sex Workers Initiating HIV Pre-Exposure Prophylaxis in Dar es Salaam, Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:698. [PMID: 36613018 PMCID: PMC9819768 DOI: 10.3390/ijerph20010698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/21/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
Harmful alcohol use is an important risk factor for premature mortality and morbidity and associated with increased HIV risk and lower uptake of and adherence to HIV interventions. This study aimed to assess the extent of harmful alcohol use and associated socio-structural vulnerability factors among female sex workers in Dar es Salaam, Tanzania, a key population in the HIV epidemic. Data from a study of female sex workers initiating pre-exposure prophylaxis (PrEP) recruited through respondent driven sampling were used. We assessed harmful alcohol use with the Alcohol Use Disorders Identification Test (AUDIT) defined as having an AUDIT score ≥ 16. Associations between harmful alcohol use and socio-structural factors were assessed using logistic regression with marginal standardization. Of the 470 women recruited, more than one third (37.3%) had a drinking pattern suggestive of harmful alcohol use. Such use was independently associated with sex work-related mobility (aPR: 1.36, 95% CI: 1.11-1.61), arrest/incarceration (aPR: 1.55, 95% CI: 1.27-1.84) and gender-based violence (aPR: 1.31, 95% CI: 1.06-1.56). The high prevalence of harmful alcohol use and the interconnectedness with socio-structural factors indicate a need for a holistic programmatic approach to health for female sex workers. Programming should not solely direct attention to individual behavior but also include strategies aiming to address socio-structural vulnerabilities.
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Affiliation(s)
- Hanne Ochieng Lichtwarck
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Method Rwelengera Kazaura
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania
| | - Kåre Moen
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
| | - Elia John Mmbaga
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, 0450 Oslo, Norway
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam 11103, Tanzania
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23
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Yeboah I, Okyere J, Dey NEY, Mensah RO, Agbadi P, Essiaw MN. Multiple sexual partnership among adolescent boys and young men in Ghana: analysis of the 2003-2014 Ghana Demographic and Health Survey. Trop Med Health 2022; 50:88. [PMID: 36443834 PMCID: PMC9703711 DOI: 10.1186/s41182-022-00484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 11/18/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Multiple sexual partnership (MSP) is a major cause of HIV/AIDS epidemic and unplanned pregnancies in sub-Saharan Africa. We investigate how individual, household, interpersonal, community and structural factors correlate with multiple sexual partnership of adolescent boys and young men in Ghana. METHODS We pooled secondary data from the 2003, 2008 and 2014 Ghana Demographic and Health Surveys (GDHS). Analytic sample of 1422 males aged 15-24 years who are sexually active and never married were used for the study. The outcome variable for the study was two or more sexual partners in the last 12 months preceding the survey. Five models were fitted using multilevel mixed effects logistic regression to identify predictors of multiple sexual partners. Results were presented using adjusted odds ratios (ORadj) with its corresponding 95% confidence interval. RESULTS The pooled data prevalence of multiple sexual partnership was 28.1%, with 18.7%, 30.0% and 33.3% of adolescent boys and young men involved in multiple sexual partnerships in 2003, 2008 and 2014, respectively. Results of the study showed that young men aged 20-24 years [ORadj = 1.39, 95% CI = 1.01-1.91], being from household with richest wealth index [ORadj = 1.76, 95% CI = 1.01-3.06] and those with secondary/higher education [ORadj = 2.94, 95% CI = 1.44-6.06] were more likely to have multiple sexual partners. On the other hand, those who delayed their first sex [ORadj = 0.45, 95% CI = 0.29-0.70] and those currently using modern contraceptive methods [ORadj = 0.37, 95% CI = 0.28-0.50] were less likely to have multiple sexual partners. CONCLUSION The findings provide support for the social ecological argument that sexual health behaviours are influenced by individual, interpersonal, community and contextual characteristics. Future policies and interventions seeking to address the increasing prevalence of multiple sexual partnerships among adolescent boys and young men should take into consideration family planning programmes and sexual education in affluent communities, secondary and higher institutions.
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Affiliation(s)
- Isaac Yeboah
- Institute of Work, Employment and Society, University of Professional Studies, Accra, Ghana.
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Ronald Osei Mensah
- Centre for Languages and Liberal Studies, Takoradi Technical University, Takoradi, Ghana
| | - Pascal Agbadi
- Department of Sociology and Social Policy, Lingnan University, SAR, Hong Kong, China
| | - Mary Naana Essiaw
- Institute of Work, Employment and Society, University of Professional Studies, Accra, Ghana
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24
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Kayesu I, Mayanja Y, Nakirijja C, Machira YW, Price M, Seeley J, Siu G. Uptake of and adherence to oral pre-exposure prophylaxis among adolescent girls and young women at high risk of HIV-infection in Kampala, Uganda: A qualitative study of experiences, facilitators and barriers. BMC Womens Health 2022; 22:440. [PMCID: PMC9648457 DOI: 10.1186/s12905-022-02018-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 10/20/2022] [Indexed: 11/12/2022] Open
Abstract
Background There is limited information on factors that influence oral pre-exposure prophylaxis (PrEP) uptake and adherence among adolescent girls and young women (AGYW). We conducted a qualitative methods study to explore experiences, facilitators and barriers of PrEP uptake and adherence to PrEP among AGYW at risk of Human Immunodeficiency Virus (HIV) infection in Kampala, Uganda. Methods This study was nested in a prospective cohort study that offered daily oral PrEP to AGYW. Between April 2019 and October 2020 we conducted in-depth interviews with 26 AGYW aged 14–24 years who had been offered or had been using PrEP for at least 6 months, including PrEP adherers (8), non-adherers (8) and those who had declined PrEP (10). After 12 months, follow-up interviews were conducted with 12 AGYW who had adhered to PrEP and those who had dropped it. Thematic analysis was conducted and data were further examined and categorized into the 5 constructs of the Socio-Ecological Model (SEM). Results PrEP uptake and adherence were facilitated by factors including: perceptions that one’s own or partner’s sexual behaviour was high risk, a negative attitude towards condoms, social support and wanting to maintain a negative HIV status after receiving a negative HIV test result. Good adherence to PrEP was enabled by effective counselling, support tools such as alarms and phone reminders and incentives like free treatment for STIs and other illnesses during study visits. Barriers to uptake included: anxiety about the pill burden, perceptions of being too young for PrEP and fear of being labelled `prostitute’ or `HIV positive’. Poor adherence was attributed to doubt over the efficacy of PrEP as a result of beliefs that because HIV was incurable, no medicine could prevent it. Alcohol use, side effects experienced, and mobility all had a negative impact on adherence. The majority of PrEP users reported feeling safe as a result of using PrEP which had both good and negative implications on their sexual behaviour, specifically the number of sexual partners and condom use. Conclusion Addressing community misconceptions to maximize uptake of PrEP among AGYW is important. Targeted education messages, and counselling to address misconceptions in ways that capture the attention of AGYW in communities are required.
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Affiliation(s)
- Ivy Kayesu
- grid.415861.f0000 0004 1790 6116Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Yunia Mayanja
- grid.415861.f0000 0004 1790 6116Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Catherine Nakirijja
- grid.415861.f0000 0004 1790 6116Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda
| | - Yvonne Wangũi Machira
- grid.420368.b0000 0000 9939 9066International AIDS Vaccine Initiative (IAVI), 125 Broad Street, 9th Floor, 10004 New York, NY USA
| | - Matt Price
- grid.420368.b0000 0000 9939 9066International AIDS Vaccine Initiative (IAVI), 125 Broad Street, 9th Floor, 10004 New York, NY USA ,grid.266102.10000 0001 2297 6811Department of Epidemiology and Biostatistics, University of California, San Francisco (UCSF), 550 16th St, 94158 San Francisco, CA USA
| | - Janet Seeley
- grid.415861.f0000 0004 1790 6116Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda ,grid.8991.90000 0004 0425 469XGlobal Health and Development Department, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH London, UK
| | - Godfrey Siu
- grid.415861.f0000 0004 1790 6116Medical Research Council, Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. Box 49, Entebbe, Uganda ,grid.11194.3c0000 0004 0620 0548Child Health and Development Centre, Makerere University, Mulago Hill Road, Kampala, Uganda
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25
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Hossain F, Hasan M, Begum N, Mohan D, Verghis S, Jahan NK. Exploring the barriers to the antiretroviral therapy adherence among people living with HIV in Bangladesh: A qualitative approach. PLoS One 2022; 17:e0276575. [PMID: 36269716 PMCID: PMC9586390 DOI: 10.1371/journal.pone.0276575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 10/10/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Since the evolution of highly active antiretroviral therapy (ART), a near-perfect ART adherence level (>95%) is needed to control viral suppression. Non-adherence to treatment may lead to acquired immunodeficiency syndrome (AIDS) and drug resistance. Though the Bangladesh government provides free treatment and counselling services to people living with human immunodeficiency virus (PLHIV), only 22% of the identified PLHIV continue treatment. Therefore, this study aims to explore the barriers that obstruct the Bangladeshi PLHIV to ensure ART adherence. METHODS We conducted a qualitative study in Dhaka, Bangladesh, and recruited the sensitive study population following non-probability, mainly purposive sampling from a community-based registered organization for PLHIV. We conducted the in-depth interview using a semi-structured guideline with 15 consented respondents. We transcribed the audio-recorded interviews in the local language (Bangla) and then translated those into English for data analysis. During the data extraction process, the lead and corresponding authors independently extracted raw data to generate different themes and sub-themes and invited other authors to contribute when they could not solve any discrepancies. RESULTS The study identified three significant categories of barriers at the individual, community, and institutional levels that negatively interfered with ART adherence. The most dominant barriers were discrimination and rejection related to stigma, as almost all participants mentioned these barriers. Stigmatizing attitudes and the discriminatory act of the community people and healthcare providers critically affected their treatment adherence. Other leading barriers were improper inventory management of ART-related medicines and CD4 tests and lack of proper counselling. In addition, we found that a positive approach toward life and family support motivated some respondents to overcome the barriers. CONCLUSIONS We recommended strengthening Bangladesh's HIV/AIDS prevention, treatment, and management program with a special focus on the improvement of the supply chain of ART-related medicines and CD4 tests and ensuring proper counselling. In addition, we recommended strengthening the behaviour change communication and IEC activities at a large scale to destigmatize health facilities and community levels.
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Affiliation(s)
- Fariha Hossain
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | | | | | - Devi Mohan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | - Sharuna Verghis
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
| | - Nowrozy Kamar Jahan
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor Darul Ehsan, Malaysia
- * E-mail:
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26
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Medina-Marino A, Bezuidenhout D, Ngcelwane N, Cornell M, Wainberg M, Beyrer C, Bekker LG, Daniels J. Qualitative Identification of Intervention Preferences to Support Men's Engagement and Retention in TB Care in South Africa. Am J Mens Health 2022; 16:15579883221129349. [PMID: 36218175 PMCID: PMC9558889 DOI: 10.1177/15579883221129349] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Globally and in South African specifically, men account for 56% and 62% of all tuberculosis (TB) cases, respectively. Men are at increased risk of not accessing TB testing or treatment, and having poor treatment outcomes. Unfortunately, no interventions exist to address these issues. Toward the development of targeted, patient-centered TB care and support interventions, we used semistructured interviews to explored men's social network composition, TB testing behaviors, disclosure and treatment support, clinical experiences, and TB's influence on daily living. Data were analyzed using a thematic approach guided by the Network Individual Resource Model to identify mental and tangible resources influential and preferred during engagement in TB treatment. Men emphasized the desire for peer-to-peer support to navigate TB-related stigma and unhealthy masculinity norms. Men advocated for awareness events to educate communities about their challenges with TB. Men strongly suggested that interventions be delivered in familiar locations where men congregate. Since 2022, no TB treatment support interventions have included the preferred components or delivery modes described by men in our study. To improve men's TB-related health outcomes, the global TB community must identify and address men's unique challenges when designing interventions.
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Affiliation(s)
- Andrew Medina-Marino
- Division of Men’s Health, Desmond Tutu
HIV Centre, University of Cape Town, Cape Town, South Africa,Perelman School of Medicine, University
of Pennsylvania, Philadelphia, PA, USA,Research Unit, Foundation for
Professional Development, East London, South Africa,Andrew Medina-Marino, Division of Men’s
Health, Desmond Tutu HIV Centre, University of Cape Town, Cape Town, 7915, South
Africa.
| | - Dana Bezuidenhout
- Research Unit, Foundation for
Professional Development, East London, South Africa,Department of Epidemiology, Mailman
School of Public Health, Columbia University, New York City, NY, USA
| | - Nondumiso Ngcelwane
- Buffalo City Health District, Eastern
Cape Provincial Department of Health, Bisho, South Africa
| | - Morna Cornell
- School of Public Health & Family
Medicine, University of Cape Town, Cape Town, South Africa
| | - Milton Wainberg
- Department of Psychiatry, Columbia
University Vagelos College of Physicians and Surgeons, New York City, NY, USA,New York State Psychiatric Institute,
New York City, NY, USA
| | - Chris Beyrer
- Duke Global Health Institute, Duke
University, Durham, NC, USA,Desmond Tutu HIV Centre, University
of Cape Town, Cape Town, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University
of Cape Town, Cape Town, South Africa
| | - Joseph Daniels
- Edson College of Nursing and Health
Innovation, Arizona State University, Phoenix, AZ, USA
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27
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Mbengo F, Adama E, Towell-Barnard A, Bhana A, Zgambo M. Barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide: a systematic review. BMC Infect Dis 2022; 22:679. [PMID: 35941562 PMCID: PMC9361597 DOI: 10.1186/s12879-022-07649-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Interventions aimed at reducing risky sexual behavior are considered an important strategy for averting Human Immunodeficiency Virus (HIV) infection among youth (15-24 years) who continue to be at risk of the disease. Enhancing intervention success requires a comprehensive understanding of the barriers and facilitators to interventions targeting youth. However, there is lack of a systematic review of both quantitative and qualitative studies to comprehensively identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide. This review aimed to identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth globally based on original peer-reviewed studies published in the last decade. METHODS The Joanna Briggs Institute approach for mixed methods systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to guide this review. Nine electronic databases, Joint United Nations Programme on HIV/AIDS and World Health Organization websites, and reference lists of included studies and systematic reviews on barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth were searched for eligible articles. Studies that met the inclusion criteria underwent quality appraisal and data extraction. Findings were analyzed using thematic synthesis and underpinned by Nilsen, 2015's Determinant Framework. RESULTS Overall 13 studies comprising of eight qualitative studies, four quantitative studies and one mixed methods study were included in the review. Several barriers and facilitators across the five Determinant Framework domains were identified. Most of the barriers fell under the characteristics of the context domain (e.g., gender-biased norms). The next important group of barriers emerged within the characteristics of the end users domain (e.g., fear of relationship breakdown). In terms of facilitators, the majority fell under the characteristics of the strategy of facilitating implementation domain (e.g., implementation of intervention with fidelity) and characteristics of the end users domain (e.g., fear of pregnancy or sexually transmitted infections). The next common set of facilitators appeared within the characteristics of the context domain (e.g., family support). CONCLUSION This review identified several multi-level barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth. Multi-level and combination approaches are needed to address these factors and enhance intervention success.
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Affiliation(s)
- Fungai Mbengo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia.
| | - Esther Adama
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
| | - Arvin Bhana
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, 7505, South Africa.,Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4041, South Africa
| | - Maggie Zgambo
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, 6027, Australia
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28
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Sianturi EI, Latifah E, Soltief SN, Sihombing RB, Simaremare ES, Effendy C, Probandari A, Suryawati S, Taxis K. Understanding reasons for lack of acceptance of HIV programs among indigenous Papuans: a qualitative study in Indonesia. Sex Health 2022; 19:367-375. [PMID: 35732462 DOI: 10.1071/sh21206] [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: 10/15/2021] [Accepted: 05/04/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Melanesians are indigenous Papuans racially and culturally different from most Indonesians. The Melanesia region is characterised by high poverty and inequalities, even though it has the highest revenue. Furthermore, Papua has the highest HIV prevalence rate, 24-fold higher than that of other regions. Therefore, this study aimed to examine the resistance of indigenous people residing in eastern Indonesia towards HIV programs. METHODS This is a qualitative study analysed using grounded theory. Data were collected from July to September 2018 through semi-structured face-to-face interviews involving 23 Papuans. The interviews were conducted in Bahasa Indonesia, audio-recorded, summarised and transcribed for analysis. RESULTS The results showed that being a good Papuan emerges from four interconnected categories, including culture and religion, dealing with modernisation, integrated HIV program and stigma reduction. As a substantive theory underpinning the indigenous people's experiences with HIV programs, 'Keep being a good Papuan' was a way of overcoming problems and dealing with modernism to eliminate HIV. This largely focuses on the local culture, implying any adjustment should keep their tradition and welcome modernism. CONCLUSIONS The future of the HIV programs should be agreed upon, funded, implemented, measured and achieved by stakeholders. This could be achieved by elaborating a supportive culture and community-based interventions. Furthermore, the implementation should be prioritised to integrate and improve the programs' quality to take into account community needs and the available resources.
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Affiliation(s)
- Elfride Irawati Sianturi
- Faculty of Mathematics and Natural Sciences Universitas Cenderawasih, Jayapura, Papua, Indonesia
| | - Elmiawati Latifah
- Department of Pharmacy, Faculty of Health Science, Universitas Muhammadiyah Magelang, Magelang, Indonesia
| | - Sitti N Soltief
- Voluntary and Counselling, and Testing Clinic (VCT), Jayapura Public Hospital, Indonesia; and Perhimpunan Konselor VCT-HIV (PKVHI), Jayapura, Indonesia
| | | | - Eva S Simaremare
- Faculty of Mathematics and Natural Sciences Universitas Cenderawasih, Jayapura, Papua, Indonesia
| | - Christiantie Effendy
- Department of Medical Surgical Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Indonesia
| | - Sri Suryawati
- Department of Pharmacology and Therapeutics, Faculty of Medicine Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Katja Taxis
- Pharmaco-Therapy, Epidemiology and Economics (PTEE) Department of Pharmacy, University of Groningen, Groningen, the Netherlands
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Triulzi I, Ciccacci F, Palla I, Mthiko B, Thole D, Marazzi MC, Palombi L, Turchetti G, Orlando S. Improving Male Partner Involvement in HIV-Positive Women's Care Through Behavioral Change Interventions in Malawi (WeMen Study): A Prospective, Controlled Before-and-After Study. Front Public Health 2022; 10:864489. [PMID: 35875033 PMCID: PMC9305193 DOI: 10.3389/fpubh.2022.864489] [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] [Received: 01/28/2022] [Accepted: 06/14/2022] [Indexed: 11/26/2022] Open
Abstract
Several strategies and interventions have been implemented to improve male partner involvement (MI) in Sub-Saharan Africa, but evidence on successful interventions is scarce. This controlled before-and-after intervention study aims to evaluate the impact of three interventions on male partners' involvement in HIV+ women's care in Malawi. We piloted these three interventions: the organization of a special day for men, the deployment of male champions in communities to increase awareness on MI, and the delivery of an incentive (food package) for couples attending the facility. We observed a significant increase in the number of women accompanied by their partners (from 48.5 to 81.4%) and the number of women feeling safe at home (from 63.5 to 95.2%) after the special day intervention. This outcome increased after the deployment of male champions in communities (from 44.0 to 75.0%). No significant improvement was observed in the site where we delivered the incentive to couples. Our findings showed that the special day for men and the use of male champions might effectively increase the male involvement in the health of their female partners.
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Affiliation(s)
- Isotta Triulzi
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Fausto Ciccacci
- Unicamillus, Saint Camillus International University of Health Sciences, Rome, Italy
| | - Ilaria Palla
- Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Bryan Mthiko
- DREAM Programme, Community of Sant'Egidio, Balaka, Malawi
| | | | | | - Leonardo Palombi
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
| | | | - Stefano Orlando
- Department of Biomedicine, University of Tor Vergata, Rome, Italy
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Gómez-Lugo M, Morales A, Saavedra-Roa A, Niebles-Charris J, Abello-Luque D, Marchal-Bertrand L, García-Roncallo P, García-Montaño E, Pérez-Pedraza D, Espada JP, Vallejo-Medina P. Effects of a Sexual Risk-Reduction Intervention for Teenagers: A Cluster-Randomized Control Trial. AIDS Behav 2022; 26:2446-2458. [PMID: 35084613 PMCID: PMC9162964 DOI: 10.1007/s10461-022-03574-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 12/03/2022]
Abstract
This study evaluated the efficacy of the COMPAS program in the short term and 6 months after its application. For the initial sample, 2047 teenagers aged 14–19 years from 14 schools in 11 Colombian cities participated; eight schools were randomly assigned to the experimental condition and six to the control group. The participants completed self-report assessments that evaluated several variables theoretically associated with protective sexual behaviors. In the short term, the experimental group showed increased knowledge about HIV and other STIs, sexual assertiveness, self-efficacy, greater behavioral intention toward condom use, and more favorable attitudes toward HIV and condom use than the control group. After 6 months, most psychological and health variables also showed a significant positive change. In conclusion, the COMPAS program is the first school-based sexuality education program that has been shown to be effective in reducing mediating and behavioral variables associated with sexual risk reduction in Colombia.
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Affiliation(s)
| | - Alexandra Morales
- AITANA Research Group, Department of Health Psychology, Universidad Miguel Hernández, Avda. de la Universidad, s/n., 03202, Elche, Alicante, Spain.
| | | | | | | | | | | | | | | | - Jose P Espada
- AITANA Research Group, Department of Health Psychology, Universidad Miguel Hernández, Avda. de la Universidad, s/n., 03202, Elche, Alicante, Spain
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Chan C, Bavinton BR, Prestage GE, Broady TR, Mao L, Rule J, Wilcock B, Holt M. Changing Levels of Social Engagement with Gay Men Is Associated with HIV Related Outcomes and Behaviors: Trends in Australian Behavioral Surveillance 1998-2020. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2509-2521. [PMID: 35672592 PMCID: PMC9293873 DOI: 10.1007/s10508-022-02310-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 05/30/2023]
Abstract
Changes to how gay, bisexual, and other men who have sex with men (GBM) connect with each other and with their communities have implications for HIV prevention. Social engagement with gay men (defined as having friends who are gay men and spending time with them) has been associated with HIV related outcomes over time among Australian GBM. Using data collected in national, repeated, cross-sectional surveys of GBM between 1998 and 2020 (N = 161,117), analyses of trends in the prevalence of gay social engagement (GSE) in Australia were conducted using linear regression. To assess changing associations with GSE at different time points in the HIV epidemic, three cross-sectional analyses were conducted on factors associated with high and low GSE in 1999/2000, 2009/2010, and 2019/2020 using bivariate and multivariable logistic regression. GSE (scored from 0 to 7) declined among all participants from 4.76 in 1998 to 4.04 in 2020 (p < 0.001) with a steeper decline among GBM aged under 25 years from 4.63 in 1998 to 3.40 in 2020 (p < 0.001). In all timepoints, high GSE was associated with older age, being university educated, full time employment, identifying as gay, recent HIV testing, and PrEP uptake. While mostly associated with protective behaviors, high GSE was also associated with some practices that may put GBM at risk of HIV infection such as drug-enhanced sex and group sex in the most recent timepoint. Changing levels of GSE have implications for health promotion among GBM, particularly how to engage GBM less connected to gay social networks.
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Affiliation(s)
- Curtis Chan
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia.
| | - Benjamin R Bavinton
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Garrett E Prestage
- Kirby Institute, UNSW Sydney, Level 6 Wallace Wurth Building High Street, Kensington, Sydney, NSW, 2052, Australia
| | - Timothy R Broady
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Limin Mao
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - John Rule
- National Association of People with HIV Australia, Sydney, Australia
| | - Ben Wilcock
- Australia Federation of AIDS Organisations, Sydney, Australia
| | - Martin Holt
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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32
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Adams C, Kiruki M, Karuga R, Otiso L, Graham SM, Beima-Sofie KM. "Your status cannot hinder you": the importance of resilience among adolescents engaged in HIV care in Kenya. BMC Public Health 2022; 22:1272. [PMID: 35773690 PMCID: PMC9245269 DOI: 10.1186/s12889-022-13677-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Approximately 40% of the 110,000 adolescents living with HIV (ALHIV) in Kenya have not achieved viral suppression. Despite the increasing availability of adolescent-friendly services, adolescents face barriers that impact ART adherence. This study aimed to identify key stigma-related barriers to ART adherence and strategies used by adolescents in overcoming these barriers. METHODS Data were collected by LVCT Health, a Kenyan organization with a programmatic focus on HIV testing, prevention, and care. 122 participants were recruited from 3 clinical sites affiliated with LVCT Health in Nairobi, Kisumu, and Mombasa. In-depth interviews were conducted with ALHIV (n = 12). Focus group discussions were conducted with ALHIV (n = 5), peer leaders (n = 3), and adolescents receiving HIV services in community settings (AIC) irrespective of HIV status (n = 3). Interviews and focus groups were audio recorded, translated, and transcribed. Data were analyzed thematically, with a focus on stigma and resilience. RESULTS While AIC primarily focused on adherence barriers and stigma, ALHIV and, to some extent, peer leaders, also identified resilience factors that helped overcome stigma. Four major themes emerged: 1) knowledge and future-oriented goals can drive motivation for ALHIV to remain healthy; 2) disclosure to others strengthens support systems for ALHIV; 3) medication-taking strategies and strategic disclosure can overcome adherence challenges in school; and 4) a supportive clinic environment promotes continuous adolescent engagement in HIV care. These concepts were used to develop a conceptual stigma/resilience model depicting how resilience moderates negative effects of stigma among ALHIV. CONCLUSIONS This study demonstrates the positive effects of ALHIV resilience on ART adherence and illuminates how stigma impacts ALHIV differently depending on their resilience. Strengths-based interventions, focused on increasing resilience among ALHIV in Kenya, and more formal involvement of adolescent peers to bolster adolescent support, have the potential to improve ART adherence among ALHIV.
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Affiliation(s)
- Casey Adams
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Social Work, University of Washington, Seattle, WA USA
| | - Millicent Kiruki
- grid.463443.20000 0004 0372 7280Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Robinson Karuga
- grid.463443.20000 0004 0372 7280Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Lilian Otiso
- grid.463443.20000 0004 0372 7280Department of Research and Strategic Information, LVCT Health, Nairobi, Kenya
| | - Susan M. Graham
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Medicine, University of Washington, Seattle, WA USA ,grid.34477.330000000122986657Department of Epidemiology, University of Washington, Seattle, WA USA
| | - Kristin M. Beima-Sofie
- grid.34477.330000000122986657Department of Global Health, University of Washington, Seattle, WA USA
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de Wit JBF, Adam PCG, den Daas C, Jonas K. Sexually transmitted infection prevention behaviours: health impact, prevalence, correlates, and interventions. Psychol Health 2022; 38:675-700. [PMID: 35748408 DOI: 10.1080/08870446.2022.2090560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Sexually transmitted infections (STIs) remain a major public health threat, disproportionately affecting young people, and men who have sex with men. In this narrative review of the current state of behavioural science research on STI prevention, we consider the definition, health impacts, correlates and determinants, and interventions to promote STI prevention behaviour. Research on STI prevention behaviour has extended from a focus on abstinence, partner reduction and condom use, to also include novel preventive behaviours, notably treatment-as-prevention, pre-exposure prophylaxis (i.e., the preventive use of medicines by uninfected people), and vaccination for some STIs. Social-cognitive factors specified by, for instance the theory of planned behaviour, are critical proximal determinants of STI prevention behaviours, and related interventions can effectively promote STI prevention behaviours. Social-ecological perspectives highlight that individual-level determinants are embedded in more distal environmental influences, with social stigma especially affecting STI prevention behaviours and requiring effective intervention. Further to providing a major domain of application, STI prevention also poses critical challenges and opportunities for health psychology theory and research. We identify a need for health behaviour theory that addresses the processes linking multiple levels of influence on behaviour and provides practical guidance for multi-level behaviour change interventions adapted to specific contexts.
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Affiliation(s)
- John B. F. de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
| | - Philippe C. G. Adam
- Centre for Social Research in Health, UNSW Sydney, Kensington, Australia
- Institute for Prevention and Social Research, Bangkok, Thailand
| | - Chantal den Daas
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland
| | - Kai Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
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Wiginton JM, Mathur S, Gottert A, Pilgrim N, Pulerwitz J. Hearing From Men Living With HIV: Experiences With HIV Testing, Treatment, and Viral Load Suppression in Four High-Prevalence Countries in Sub-Saharan Africa. Front Public Health 2022; 10:861431. [PMID: 35651865 PMCID: PMC9149263 DOI: 10.3389/fpubh.2022.861431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/21/2022] [Indexed: 12/02/2022] Open
Abstract
Engaging men in HIV services remains a challenge across sub-Saharan Africa. There is a critical need to better understand facilitators of men's successful engagement with HIV services and assess if there are similarities across contexts. We conducted in-depth interviews and focus group discussions with 92 men living with HIV (MLHIV) across Malawi, Uganda, South Africa, and Eswatini, most of whom had been diagnosed with HIV within the last 5 years. We coded interviews for themes using a constant-comparative approach. We contextualized our findings within a socioecological framework. HIV testing was primarily motivated by illness (individual level), though illness was sometimes accompanied by prompting and support from healthcare providers and/or intimate partners. Once diagnosed, nearly all participants reported immediate linkage to care, initiation of antiretroviral therapy (ART), and subsequent ART adherence. ART initiation and adherence were facilitated by men's sense of agency and ownership over their health (individual level), social support from intimate partners, friends, and family (interpersonal/network level), supportive-directive counseling from healthcare providers (institutional/health systems level), and male-friendly services, i.e., rapid, respectful, private (institutional/health systems level). Health literacy regarding viral suppression (individual level), strengthened by patient-provider communication (institutional/health systems level), was highest in Uganda, where most men could discuss viral load testing experiences, report their viral load status (most reported suppressed), and demonstrate an understanding of treatment as prevention. Elsewhere, few participants understood what viral load suppression was and even fewer knew their viral load status. Our findings reveal socioecological-level facilitators of men's progress across the HIV-care continuum. Programs may want to leverage facilitators of ART initiation and adherence that span socioecological levels—e.g., healthcare ownership and agency, social support, supportive-directive counseling—and apply them to each end of the continuum to encourage early HIV testing/diagnosis and improve health literacy to help men understand and achieve viral load suppression.
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Affiliation(s)
- John Mark Wiginton
- Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD, United States
| | | | - Ann Gottert
- Population Council, Washington, DC, United States
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Hecht J, Zlotorzynska M, Sanchez TH, Wohlfeiler D. Gay Dating App Users Support and Utilize Sexual Health Features on Apps. AIDS Behav 2022; 26:2081-2090. [PMID: 35018547 PMCID: PMC9046136 DOI: 10.1007/s10461-021-03554-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 12/21/2022]
Abstract
Men who have sex with men (MSM) frequently meet sex partners through dating apps. Research has demonstrated an association between app use and greater number of sex partners and STIs, but dating apps also pose an opportunity for intervention. By advocating for sexual health features on dating apps, Building Healthy Online Communities (BHOC) aims to increase communication about sexual health among app users. In partnership with Emory University, BHOC added questions to an annual survey of MSM. The questions assessed awareness and uptake of profile fields and sexual health features on the dating apps. Among survey participants, 67% (6737/10,129) reported using dating apps to meet a partner in the past year. Among this group, 77% (4993/6525) reported awareness of sexual health features. 61% of app users (2866/4721) who were aware of them reported using one or more sexual health features. BHOC continues to advocate for increased uptake of these features.
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Affiliation(s)
- Jennifer Hecht
- Building Healthy Online Communities, Springboard HealthLab, 5601 Van Fleet Ave, Richmond, CA, 94804, USA.
| | - Maria Zlotorzynska
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Travis H Sanchez
- Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, USA
| | - Dan Wohlfeiler
- Building Healthy Online Communities, Springboard HealthLab, 5601 Van Fleet Ave, Richmond, CA, 94804, USA
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Inferring the effective start dates of non-pharmaceutical interventions during COVID-19 outbreaks. Int J Infect Dis 2022; 117:361-368. [PMID: 34986406 PMCID: PMC8720386 DOI: 10.1016/j.ijid.2021.12.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/19/2021] [Accepted: 12/26/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND During Feb-Apr. 2020, many countries implemented non-pharmaceutical interventions (NPIs), such as school closures and lockdowns, to control the COVID-19 pandemic caused by the SARS-CoV-2 virus. Overall, these interventions seem to have reduced the spread of the pandemic. We hypothesized that the official and effective start dates of NPIs can be noticeably different, for example, due to slow adoption by the population, and that these differences can lead to errors in the estimation of the impact of NPIs. METHODS SEIR models were fitted to case data from 12 regions to infer the effective start dates of interventions and compare these with the official dates. The impact of NPIs was estimated from the inferred model parameters. RESULTS We infer mostly late effective start dates of interventions. For example, Italy implemented a lockdown on Mar 11, but we infer the effective start date on Mar 17 (+3.05-2.01 days 95% CI). Moreover, we find that the impact of NPIs can be underestimated if it is assumed they start on their official date. CONCLUSIONS Differences between the official and effective start of NPIs are likely. Neglecting such differences can lead to underestimation of the impact of NPIs, which could cause decision-makers to escalate interventions and guidelines.
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Gamarel KE, King WM, Operario D. Behavioral and social interventions to promote optimal HIV prevention and care continua outcomes in the United States. Curr Opin HIV AIDS 2022; 17:65-71. [PMID: 35067595 PMCID: PMC8885930 DOI: 10.1097/coh.0000000000000717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW This review reports on trends in behavioral and social intervention research in the United States published over the past year (2020-2021) investigating HIV prevention and care outcomes, organized by the level of intervention focus - individual, dyadic, and organizational. RECENT FINDINGS Researchers have continued to develop and evaluate behavioral and social interventions to reduce HIV acquisition risk and disease progression. With few exceptions, social and behavioral interventions have primarily focused on individuals as the unit of behavior change. Interventions operating at the individual-, dyadic-, and organizational-level have made strides to reduce HIV transmission risk and disease progressing by addressing mental health, substance use, stigma, peer and romantic relationships, and, to some extent, structural vulnerabilities. SUMMARY Social and behavioral interventions continue to be critical in addressing HIV inequities in the United States. An important gap in the literature is the need for multilevel interventions designed and implemented within existing community-based organizations and local healthcare settings. We call on researchers to continue to attend to the structural, environmental, and economic vulnerabilities that shape HIV inequities in the development of multilevel approaches necessary to realize the full potential of existing and emerging HIV prevention and care strategies.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Wesley M. King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI USA
| | - Don Operario
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI USA
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Factors Associated with Linkage to Care following Community-Level Identification of HIV-Positive Clients in Lira District. ADVANCES IN PUBLIC HEALTH 2022. [DOI: 10.1155/2022/4731006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Community HIV testing helps to increase access to high-risk groups who are less likely to visit a clinic for a test. A large proportion of people identified with HIV following community-based testing are not easily linked to care compared to facility-based identified cases. There is a paucity of literature on linkage to HIV care and its predictors particularly following community-based testing in a rural setting. We assessed the level of linkage to the care of HIV-positive individuals and associated factors following community-level identification in Lira district. Method. A cross-sectional survey was conducted in Lira district employing mixed methods among HIV-positive adults identified in the communities. Quantitative data were collected from 329 randomly selected study participants using interviewer-administered questionnaires. Key informant interview guide was used to collect qualitative data. The data were double entered, cleaned, and analyzed using SPSS version 23. Odds ratios and confidence intervals were used to assess the association between predictors of linkage with HIV care. Qualitative data were analyzed using thematic content analysis. Results. The respondents were aged between 18 and 85 years with a mean age of 42.9 (SD = 11.6). The level of linkage to HIV care following community-level identification of HIV testing in Lira district was 98% (95% CI 96.07–99.33). Clients who self-initiated the HIV testing were more likely to link to HIV care than their counterparts (AOR = 9.03; 95% CI 1.271–64.218,
). Key informants identified factors influencing linkage to care as health education, counseling, follow-up, and family support. Fear of stigma, disclosure, denial, and distance to facility were reported as barriers to linkage. Conclusion/Recommendation. The level of linkage to HIV care following community identification was found to be excellent (98%). Predictors to linkage to care included self-initiated testing, positive perception of distance, and waiting time at health facilities. We recommend health education, counseling, follow-up, and family support as interventions to strengthen successfully linking to care.
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Greene GJ, Reidy E, Felt D, Marro R, Johnson AK, Phillips G, Green E, Stonehouse P. Implementation and evaluation of patient navigation in Chicago: Insights on addressing the social determinants of health and integrating HIV prevention and care services. EVALUATION AND PROGRAM PLANNING 2022; 90:101977. [PMID: 34373116 DOI: 10.1016/j.evalprogplan.2021.101977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 02/12/2021] [Accepted: 06/17/2021] [Indexed: 06/13/2023]
Abstract
Patient navigation is a primary element in linkage to HIV pre-exposure prophylaxis (PrEP) care and linkage to or re-engagement in HIV care, depending on the HIV status of the individual. However, there is a dearth of literature describing navigation services in these areas. In the context of Chicago Project PrIDE, this project conducted process and implementation evaluations with eight agencies leading demonstration projects to address these gaps. The evaluation team conducted semi-structured, individual interviews with agency staff (N = 20) assessing navigation implementation and fit, as well as project successes and challenges. Additionally, agency staff collected patient surveys (N = 300) assessing services provided, service quality, and satisfaction. The interview transcripts were coded and analyzed thematically and descriptive analyses were performed on the survey data. Analyses indicated that screening for social determinants of health, providing healthcare engagement guidance, and providing service referrals were frequently cited navigation activities. Most staff members indicated that navigation fits well within their agencies, and that limited staff and clinic capacity were often barriers to navigation. Patient navigation to support engagement in HIV prevention and care services is critical due to the extensive support provided by navigators to address social determinants of health impacting HIV disparity populations.
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Affiliation(s)
- George J Greene
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA.
| | - Emma Reidy
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Dylan Felt
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Rachel Marro
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Amy K Johnson
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA; Ann & Robert H. Lurie Children's Hospital of Chicago, The Potocsnak Family Division of Adolescent and Young Adult Medicine, 225 E. Chicago Ave., Box 161, Chicago, IL, 60611, USA
| | - Gregory Phillips
- Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave., Chicago, IL, 60611, USA
| | - Evelyn Green
- Chicago Department of Public Health, 333 S. State St., Suite 200, Chicago, IL, 60604, USA
| | - Patrick Stonehouse
- Chicago Department of Public Health, 333 S. State St., Suite 200, Chicago, IL, 60604, USA
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Njau B, Mhando G, Jeremiah D, Mushi D. Correlates of Sexual Risky Behaviours, HIV Testing, and HIV Testing Intention among Sexually Active Youths in Northern Tanzania. East Afr Health Res J 2022; 5:151-158. [PMID: 35036841 PMCID: PMC8751422 DOI: 10.24248/eahrj.v5i2.666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/05/2021] [Indexed: 11/27/2022] Open
Abstract
Background: HIV testing services are important entry-point into the HIV cascade to care and treatment in order to slow down the spread of HIV infection. Over half of all new HIV infections in Sub-Saharan Africa occur among young people under the age of 25, particularly women. The study aimed to determine factors influencing young people's decision to undergo HIV testing services in Northern Tanzania. Methods: A total of 536 sexually active participants aged 15 to 24 years old completed a semi-structured questionnaire based on the Health Belief Model (HBM) and the Theory of Planned Behaviour (TPB). Results: Males compared to femaleparticipants were significantly younger at first age of sexual intercourse (15.4 vs. 16.7 years; p = .001). Out of 536 participants, 418(78%) reported inconsistent condom use, and 203/303(67%) were those practicing casual sex. Only, 189/536(35.3%) of the participants reported to have had an HIV-test. Age, socioeconomic status, perceived HIV severity, attitudes and social approval regarding testing and beliefs about testing procedures and perceived barriers to testing were significant predictors of HIV testing (R2 =.22). Age, unsafe casual sex, perceived severity, HIV-testing attitudes, self-efficacy, social approval, cues for actions and perceived quality of testing procedures were significant and positively related to HIV-testing intentions, while perceived barriers to testing were negatively related (R2 = .36). Conclusion: The integrated constructs of HBM and TPB provides a framework for identifying correlates of HIV testing behaviours and HIV testing intentions among sexually active youths. Future behaviour change interventions should focus on reduction of sexually risky behaviours, increasing perceived HIV severity, enhance positive attitudes and social approvals on testing, reduce misconceptions about testing procedures, alleviation of perceived barriers to testing and improve testing self-efficacy among sexually active youths in this setting.
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Affiliation(s)
- Bernard Njau
- Amana Regional Referral Hospital, Dar-es-Salaam, Tanzania.,Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - Grace Mhando
- Amana Regional Referral Hospital, Dar-es-Salaam, Tanzania
| | - Damian Jeremiah
- Kilimanjaro Christian University College, Kilimanjaro, Tanzania
| | - Declare Mushi
- Kilimanjaro Christian University College, Kilimanjaro, Tanzania
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Villa-Rueda AA, Onofre-Rodríguez DJ, Colina JADDL, Churchill S, Mendoza-Catalán G. “¿Por qué pasa esto? Porque vivimos en una sociedad que constantemente te dice que no eres mujer”: género y riesgo del VIH en mujeres trans del noreste mexicano. CAD SAUDE PUBLICA 2022. [DOI: 10.1590/0102-311x00266920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Las mujeres trans enfrentan un riesgo desproporcionado de adquirir el VIH. Este estudio analiza cualitativamente el riesgo del VIH en mujeres trans mexicanas desde el género como estructura social. Se trata de un estudio cualitativo realizado en el noreste de México. Se hicieron 15 entrevistas a mujeres trans de entre 22 y 69 años y se realizó un análisis temático. El análisis de las entrevistas reveló tres categorías temáticas: construcciones sociales del VIH y estigma, el género y el VIH en las relaciones interpersonales, y el género y el VIH en las instituciones y la política. Los resultados muestran que las construcciones sociales del VIH se tejen en el colectivo, a partir de la interacción con otras mujeres trans. El VIH es un fenómeno atravesado por la temporalidad sociohistórica y, en ese sentido, se generan las percepciones de riesgo frente a él. El género como estructura de opresión se vincula con las experiencias de estigma y discriminación, así como la búsqueda de la legitimación del género a través de las relaciones con parejas sexuales. Las instituciones y la política pública se relacionan con el acceso a los servicios de salud, además se identifican y analizan las barreras institucionales, personales y colectivas a partir de la identidad de género. La política sostiene y refuerza la marginalización de las mujeres trans impactando en el riesgo del VIH. Los resultados muestran que el riesgo del VIH es un fenómeno multicausal basado en el género como estructura de opresión con implicaciones sistémicas.
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Berner-Rodoreda A, Ngwira E, Alhassan Y, Chione B, Dambe R, Bärnighausen T, Phiri S, Taegtmeyer M, Neuhann F. "Deadly", "fierce", "shameful": notions of antiretroviral therapy, stigma and masculinities intersecting men's life-course in Blantyre, Malawi. BMC Public Health 2021; 21:2247. [PMID: 34893060 PMCID: PMC8665632 DOI: 10.1186/s12889-021-12314-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stigma and masculinity represent persistent barriers in delivering successful HIV interventions to men. Our study examined community perceptions of HIV and anti-retroviral therapy (ART) and their implications for men on ART across the life course in Blantyre, Malawi. METHODS Our qualitative study is based on 72 face-to-face semi-structured interviews. Participants were selected purposively and included men on ART (with suppressed and unsuppressed viral loads), adult male community members irrespective of HIV status and other HIV stakeholders such as health personnel and program implementers. Interviews were conducted in Chichewa and English, transcribed verbatim and analyzed thematically in NVivo 12. We applied the socio-ecological model as our theoretical framework as well as a "life-course" perspective. RESULTS Our findings highlight lingering negative perceptions towards ART in general and towards PLHIV irrespective of viral load suppression. With intersecting notions of masculinity and stigma, men's descriptions of anticipated stigma in their relationships and when visiting health facilities dominated. Stigma was experienced at the personal, interpersonal, facility and community level. Yet, men living with HIV were perceived differently throughout the life-course, with young sexually active men seen as the most stigmatized group and older men seen as drawing resilience from a greater range of masculine norms. Some men of all ages displayed "transformative" masculinities independent of stigma and community expectations. CONCLUSIONS We propose the "life-course" as a useful concept for studies on masculinity, HIV and stigma. Considering gendered constructions of "respectable" midlife-older age vis-à-vis younger age, and how they influence stigma as well as uptake and adherence to ART might lead to more targeted services for men that build on "transformative masculinities".
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Affiliation(s)
| | - Esther Ngwira
- Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
| | - Yussif Alhassan
- Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | | | - Till Bärnighausen
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | - Sam Phiri
- The Lighthouse Trust, Blantyre, Malawi
| | - Miriam Taegtmeyer
- Community Health Systems Group, Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Florian Neuhann
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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Palfai TP, Luehring-Jones P. How Alcohol Influences Mechanisms of Sexual Risk Behavior Change: Contributions of Alcohol Challenge Research to the Development of HIV Prevention Interventions. AIDS Behav 2021; 25:314-332. [PMID: 34148189 DOI: 10.1007/s10461-021-03346-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 10/21/2022]
Abstract
This paper examines the contributions of laboratory-based alcohol challenge research (ACR) to the development of HIV prevention interventions. Following a brief overview of HIV prevention interventions and related health behavior change models, we discuss how alcohol may influence mechanisms of behavior change. The paper highlights the value of ACR for: (1) elucidating mechanisms of action through which alcohol affects sexual risk behavior, (2) testing how alcohol may influence mechanisms thought to underlie HIV prevention interventions, (3) clarifying moderators of the causal influences of alcohol, (4) identifying novel intervention targets, and (5) developing strategies to reduce sexual risk among those who consume alcohol. We conclude with a discussion of the importance of using experimental research to identify mechanisms of behavior change that are specific to populations at high risk for HIV and outline some key implications for developing HIV prevention interventions that integrate the role of alcohol.
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Ameli V, Taj L, Barlow J, Sabin L, Meinck F, Haberer J, Mohraz M. 'You just prefer to die early!': how socioecological context impedes treatment for people living with HIV in Iran. BMJ Glob Health 2021; 6:bmjgh-2021-006088. [PMID: 34794955 PMCID: PMC8603297 DOI: 10.1136/bmjgh-2021-006088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 10/25/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Despite the low prevalence of HIV and broad provision of antiretroviral therapy, the Middle East and North Africa (MENA) remains the only region where new HIV infections and AIDS-related deaths are not declining. There is a dearth of evidence from MENA on antiretroviral therapy engagement. In this qualitative study, we sought to identify the ways in which successful treatment is hindered in Iran, which is home to 24% of HIV infections in MENA. Methods From August 2018 to January 2019, we used purposive sampling and conducted 12 individual interviews and 8 focus group discussions with 27 female and 31 male patients, in addition to 5 individual interviews with HIV care providers and 1 focus group discussion with 8 care providers. Social constructivism augmented with realist-informed thematic analysis was used to understand how the socioecological context triggers cognitive and affective mechanisms that disrupt antiretroviral therapy. Results The use of Thematic Network Analysis resulted in the identification of three key cognitive and affective mechanisms that appear to shape treatment experience and are triggered via HIV’s socioecological context and changing economic conditions in Iran: denial in response to societal negative perceptions of HIV; fear in response to societal lack of awareness regarding HIV and misinformation; and despair in response to HIV-related stigma and enacted discrimination, economic insecurity and social support. Conclusions To our knowledge, this is the first study within MENA to identify pathways through which successful treatment is hindered. It appears that lack of societal awareness regarding HIV is specific to low prevalence settings, such as MENA countries, where negative perceptions, stigma, discrimination and misinformation regarding HIV and its treatment produce denial, fear and despair, acting as mechanisms that disrupt antiretroviral therapy. The experience of despair, in response to changing economic conditions and social support, further impacts treatment experience.
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Affiliation(s)
- Vira Ameli
- Social Policy and Intervention, Oxford University, Oxford, UK .,Iranian Research Center for HIV / AIDS, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Leila Taj
- Iranian Research Center for HIV / AIDS, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Jane Barlow
- Social Policy and Intervention, Oxford University, Oxford, UK
| | - Lora Sabin
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Franziska Meinck
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK.,School of Public Health, North-West University, Potchefstroom, South Africa
| | - Jessica Haberer
- Center for Global Health at Massachusetts General Hospital, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Minoo Mohraz
- Iranian Research Center for HIV / AIDS, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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45
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Yakubu K, Bowen P, Govender R. Determinants of HIV testing behaviour among male South African construction workers. AIDS Care 2021; 34:847-855. [PMID: 34581654 DOI: 10.1080/09540121.2021.1981222] [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: 10/20/2022]
Abstract
The global trend of poorer outcomes across the HIV treatment cascade for men has drawn attention to the importance of engaging men in prevention and treatment services. The South African construction industry is one of the economic sectors most adversely affected by HIV/AIDS. Previous research on HIV testing behaviour among workers in the industry has revealed that male workers are less likely to be tested than female workers. Given this gender differential, this study employed a field-administered survey to gather data from 450 site-based, male construction workers in Western Cape, South Africa. An integrated model comprising demographic, cognitive, and behavioural factors was then hypothesised to explain HIV testing behaviour. Bivariate analysis and structural equation modelling were then used to test the model. Findings indicate that HIV knowledge, having previously had an STI, and possessing a positive attitude towards HIV testing are terminal predictors of testing behaviour. As a strategy for positively influencing testing behaviour, employers should ensure that effective communication about HIV testing is established with workers across all levels of education and ethnic groups. Interventions relating to risky sexual behaviour need particular attention, and where possible HIV testing should be coupled with general STI screening.
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Affiliation(s)
- Kamal Yakubu
- Nelson Mandela School of Public Governance, University of Cape Town, Cape Town, South Africa
| | - Paul Bowen
- Department of Construction Economics and Management, University of Cape Town, Cape Town, South Africa
| | - Rajen Govender
- Nelson Mandela School of Public Governance, University of Cape Town, Cape Town, South Africa.,Institute for Social and Health Sciences, University of South Africa, Lenasia, South Africa.,Violence, Injury and Peace Research Unit, South African Medical Research Council, Tygerberg, South Africa
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46
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Nagelkerke N, Seedat S, Abu-Raddad LJ. Sexual Behavior Surveys Should Ask More: Covering the Diversity of Sexual Behaviors That May Contribute to the Transmission of Pathogens. Sex Transm Dis 2021; 48:e119-e121. [PMID: 33346590 PMCID: PMC8360661 DOI: 10.1097/olq.0000000000001347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 12/09/2020] [Indexed: 11/26/2022]
Abstract
Supplemental digital content is available in the text.
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Affiliation(s)
- Nico Nagelkerke
- From the Infectious Disease Epidemiology Group, Weill Cornell Medicine—Qatar, Cornell University
| | - Shaheen Seedat
- From the Infectious Disease Epidemiology Group, Weill Cornell Medicine—Qatar, Cornell University
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine—Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY
| | - Laith J. Abu-Raddad
- From the Infectious Disease Epidemiology Group, Weill Cornell Medicine—Qatar, Cornell University
- World Health Organization Collaborating Centre for Disease Epidemiology Analytics on HIV/AIDS, Sexually Transmitted Infections, and Viral Hepatitis, Weill Cornell Medicine—Qatar, Cornell University, Qatar Foundation—Education City, Doha, Qatar
- Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, NY
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47
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Emotion Efficacy Improves Prediction of HIV/AIDS Risky Behaviors: A Modified Information-Motivation-Behavioral Skills Model. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2021. [DOI: 10.1007/s10942-021-00410-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Myburgh H, Reynolds L, Hoddinott G, van Aswegen D, Grobbelaar N, Gunst C, Jennings K, Kruger J, Louis F, Mubekapi-Musadaidzwa C, Viljoen L, Wademan D, Bock P. Implementing 'universal' access to antiretroviral treatment in South Africa: a scoping review on research priorities. Health Policy Plan 2021; 36:923-938. [PMID: 33963393 PMCID: PMC8227479 DOI: 10.1093/heapol/czaa094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2020] [Indexed: 01/15/2023] Open
Abstract
‘Universal’ access to antiretroviral treatment (ART) has become the global standard for treating people living with HIV and achieving epidemic control; yet, findings from numerous ‘test and treat’ trials and implementation studies in sub-Saharan Africa suggest that bringing ‘universal' access to ART to scale is more complex than anticipated. Using South Africa as a case example, we describe the research priorities and foci in the literature on expanded ART access. To do so, we adapted Arksey and O’Malley’s six-stage scoping review framework to describe the peer-reviewed literature and opinion pieces on expanding access to ART in South Africa between 2000 and 2017. Data collection included systematic searches of two databases and hand-searching of a sub-sample of reference lists. We used an adapted socio-ecological thematic framework to categorize data according to where it located the challenges and opportunities of expanded ART eligibility: individual/client, health worker–client relationship, clinic/community context, health systems infrastructure and/or policy context. We included 194 research articles and 23 opinion pieces, of 1512 identified, addressing expanded ART access in South Africa. The peer-reviewed literature focused on the individual and health systems infrastructure; opinion pieces focused on changing roles of individuals, communities and health services implementers. We contextualized our findings through a consultative process with a group of researchers, HIV clinicians and programme managers to consider critical knowledge gaps. Unlike the published literature, the consultative process offered particular insights into the importance of researching and intervening in the relational aspects of HIV service delivery as South Africa’s HIV programme expands. An overwhelming focus on individual and health systems infrastructure factors in the published literature on expanded ART access in South Africa may skew understanding of HIV programme shortfalls away from the relational aspects of HIV services delivery and delay progress with finding ways to leverage non-medical modalities for achieving HIV epidemic control.
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Affiliation(s)
- Hanlie Myburgh
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.,Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Nieuwe Achtergracht 166, WV, Amsterdam, the Netherlands
| | - Lindsey Reynolds
- Department of Sociology and Social Anthropology, Faculty of Arts and Social Sciences, Stellenbosch University, c/o Merriman and Ryneveld Avenue, Stellenbosch, 7600, South Africa
| | - Graeme Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Dianne van Aswegen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Nelis Grobbelaar
- The Anova Health Institute, Willie Van Schoor Avenue, Bellville, Cape Town, 7530, South Africa
| | - Colette Gunst
- Division of Family Medicine and Primary Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa.,Western Cape Department of Health, Cape Winelands District, 7 Haarlem Street, Worcester, 6850, South Africa
| | - Karen Jennings
- City of Cape Town Health Department, Cape Town Municipality, 12 Hertzog Boulevard, Cape Town, 8001, South Africa
| | - James Kruger
- Western Cape Department of Health, HIV Treatment and PMTCT Programme, 4 Dorp Street, Cape Town, 8000, South Africa
| | - Francoise Louis
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Constance Mubekapi-Musadaidzwa
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Lario Viljoen
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Dillon Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
| | - Peter Bock
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa
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Ongolly FK, Dolla A, Ngure K, Irungu EM, Odoyo J, Wamoni E, Peebles K, Mugwanya K, Mugo NR, Bukusi EA, Morton J, Baeten JM, O’Malley G. "I Just Decided to Stop:" Understanding PrEP Discontinuation Among Individuals Initiating PrEP in HIV Care Centers in Kenya. J Acquir Immune Defic Syndr 2021; 87:e150-e158. [PMID: 33492024 PMCID: PMC8026512 DOI: 10.1097/qai.0000000000002625] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) discontinuation rates in clinical trials and demonstration projects have been well characterized; however, little is known about discontinuation in routine public health settings in sub-Saharan Africa. Understanding discontinuation in nonstudy settings is important for establishing expectations for PrEP continuation in national programs and for facilitating effective PrEP scale-up. METHODS We conducted in-depth interviews with 46 individuals who had initiated PrEP at 25 HIV comprehensive care clinics (CCCs) in central and western Kenya and whose clinic records indicated they had discontinued. RESULTS Many of our study participants discontinued PrEP when their perceived risk decreased (eg, hiatus or end of a sexual relationship or partner known to be living with HIV became virally suppressed). Others reported discontinuation due to side effects, daily pill burden, preference for condoms, or their partner's insistence. Participant narratives frequently described facility level factors such as stigma-related discomforts with accessing PrEP at CCCs, inconvenient clinic location or operating hours, long wait times, and short refill dates as discouraging factors, suggesting actionable areas for improving PrEP access and continuation. CONCLUSION Clients frequently make intentional decisions to discontinue PrEP as they weigh different prevention options within the context of complex lives. Many clients will decide to discontinue PrEP when perceiving themselves to be at reduced risk and PrEP counseling must include provisions for addressing seasons of risk. PrEP will not be the right prevention method for everyone, or forever. Expanding PrEP access points and increasing sex-positive messaging may facilitate PrEP being a better option for many.
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Affiliation(s)
| | - Annabel Dolla
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Kenneth Ngure
- Department of Global Health, Seattle, Washington, USA
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya
| | - Elizabeth M. Irungu
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Josephine Odoyo
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Elizabeth Wamoni
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Kathryn Peebles
- Department of Epidemiology, Medicine, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Kenneth Mugwanya
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Nelly R. Mugo
- Center for Clinical Research, Kenya Medical Research Institute; Nairobi, Kenya
- Department of Global Health, Seattle, Washington, USA
| | - Elizabeth A. Bukusi
- Department of Global Health, Seattle, Washington, USA
- Department of Obstetrics and Gynecology, Seattle, Washington, USA
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Jennifer Morton
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - Jared M. Baeten
- Department of Global Health, Seattle, Washington, USA
- Department of Epidemiology, Medicine, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
- Center for Microbiology Research, Kenya Medical Research Institute; Nairobi, Kenya
| | - Gabrielle O’Malley
- Department of Global Health, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
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50
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Merrill KG, Campbell JC, Decker MR, McGready J, Burke VM, Mwansa JK, Miti S, Frimpong C, Kennedy CE, Denison JA. Past-Year Violence Victimization is Associated with Viral Load Failure Among HIV-Positive Adolescents and Young Adults. AIDS Behav 2021; 25:1373-1383. [PMID: 32761474 PMCID: PMC8052241 DOI: 10.1007/s10461-020-02958-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We examined the relationship between past-year violence victimization and viral load (VL) failure among consecutively-sampled male and female adolescents and young adults, aged 15-24, in four HIV clinics in Ndola, Zambia. Measures of past-year physical violence, psychological abuse, and forced sex were adapted from the ICAST-C and WHO Multi-Country Study. Using logistic regression, we derived associations between VL failure (≥ 1000 copies/mL) and: any victimization; cumulative victimization; and types and perpetrators of violence. Among 272 youth (59.2% female, 72.8% perinatally infected), 73.5% (n = 200) experienced past-year violence and 36.8% (n = 100) had VL failure. Higher odds of VL failure were observed for participants who reported high frequency of any violence versus no violence victimization (adjusted OR, aOR: 3.58; 95% CI 1.14-11.27), high frequency of psychological abuse versus no psychological abuse (aOR: 3.32; 95% CI 1.26-8.70), any versus no violence from a family member other than a parent/caregiver for physical violence (aOR: 2.18, 95% CI 1.05-4.54) and psychological abuse (aOR: 2.50; 95% CI 1.37-4.54), and any versus no physical violence from a friend/peer (aOR: 2.14, 95% CI 1.05-4.36). Past-year violence victimization was associated with VL failure when considering the frequency, type, and perpetrator of violence. Programs addressing violence among youth living with HIV may be critical to improving viral suppression and preventing onward transmission.
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Affiliation(s)
- Katherine G Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | - Jacquelyn C Campbell
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Michele R Decker
- Department of Population, Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John McGready
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Virginia M Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | - Sam Miti
- Arthur Davison Children's Hospital, Ndola, Zambia
| | | | - Caitlin E Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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