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Cheung DH, Samoh N, Jonas KJ, Lim SH, Kongjareon Y, Guadamuz TE. Patterns of Chemsex Substance Use and Its Association with HIV Transmission Risk Among Men Who Have Sex with Men in Thailand: A Latent Class Analysis. ARCHIVES OF SEXUAL BEHAVIOR 2024:10.1007/s10508-024-02868-8. [PMID: 39150645 DOI: 10.1007/s10508-024-02868-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 08/17/2024]
Abstract
Sexualized substance use or "chemsex" may contribute to the HIV epidemic among men who have sex with men (MSM) in Thailand. Specific patterns of chemsex use may be associated with different HIV/STI transmission risks. We examined typologies and correlates of sexualized substance use among a sample of high-risk MSM (n = 532) who had attended a private sex party or circuit party in the past three years using latent class analysis. Multinomial regression was used to adjust for variables associated with the 3-class latent class model. We identified a 3-class model as the best fitting model, which included: (1) "negligible sexualized substance users" (36.7%), who had never engaged in chemsex in the past six months; (2) "sexualized substance users" (13.9%), who had a high level of sexualized alcohol use and a wide range of other substances before or during sex in the past six months; and (3) "exclusive chemsex users" (49.4%), who predominantly used crystal methamphetamine, amyl nitrite, and erectile dysfunctional drugs before or during sex in the past six months. Compared to negligible sexualized substance users, exclusive chemsex users were more likely to be HIV-positive, more likely to have six or more sexual partners in the past six months, less likely to have condom use at last anal intercourse, and more likely to have provided sex work. Relative to negligible sexualized substance users, sexualized substance users reported more frequent online sex-seeking behaviors. These subgroups of Thai MSM have unique substance use patterns and HIV-related risk profiles, underscoring the importance of targeted HIV prevention strategies.
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Affiliation(s)
- Doug H Cheung
- Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, 73170, Thailand
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nattharat Samoh
- Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, 73170, Thailand
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Kai J Jonas
- Department of Work and Social Psychology, Maastricht University, Maastricht, The Netherlands
| | - Sin How Lim
- Department of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Yamol Kongjareon
- Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, 73170, Thailand
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Thomas E Guadamuz
- Center of Excellence in Research on Gender, Sexuality and Health, Faculty of Social Sciences and Humanities, Mahidol University, Nakhon Pathom, 73170, Thailand.
- Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.
- John F. Kennedy School of Government, Harvard University, Cambridge, MA, USA.
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Hong C. Intimate Partner Violence and HIV Pre-Exposure Prophylaxis Care Engagement Among Sexual Minority Men: A Systematic Review. AIDS Patient Care STDS 2024. [PMID: 39047006 DOI: 10.1089/apc.2024.0115] [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: 07/27/2024] Open
Abstract
Sexual minority men (SMM) who experience intimate partner violence (IPV) may also be at increased risk for HIV; however, little is known about the relationship between these experiences and the utilization of pre-exposure prophylaxis (PrEP) for HIV prevention. This systematic review aimed to synthesize available literature to examine the complex interplay between IPV experiences and engagement in the PrEP care continuum among SMM. A comprehensive search following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in Embase, PubMed, PsycINFO, Web of Science, Medline, and CINAHL identified only 13 relevant articles, most of which were conducted in the United States (n = 9) and only two in low- and middle-income countries (LMICs). Nearly all studies (n = 12, 92.3%) were quantitative in design and used cross-sectional data. The findings of this review identified critical gaps in measuring IPV and PrEP outcomes and revealed mixed findings regarding the complex interplay between IPV and PrEP care engagement in the context of syndemics experienced by SMM. The results highlight the critical need for future research to understand the impact of IPV on PrEP uptake and adherence and its underlying mechanisms. This includes investigating the effects of different types of IPV (e.g., emotional, physical, sexual) on PrEP utilization and how these experiences influence PrEP preferences, such as daily PrEP versus on-demand PrEP or long-acting injectable PrEP. The implications of this review call for comprehensive public health policies and integrated health care practices that provide tailored interventions for IPV screening in PrEP care settings to deliver IPV services and promote engagement in the PrEP care continuum among SMM, as well as further investigation in LMICs.
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Affiliation(s)
- Chenglin Hong
- School of Social Work, University of Connecticut, Hartford, Connecticut, USA
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3
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Liu Y, Wei S, Cheng Z, Xian Y, Liu X, Yang J, Liu Y, Yu M, Chen Z, Chen J, Ma J, Cui Z, Li C. Correlates of oral pre-exposure prophylaxis cessation among men who have sex with men in China: implications from a nationally quantitative and qualitative study. BMC Public Health 2024; 24:1765. [PMID: 38956521 PMCID: PMC11221119 DOI: 10.1186/s12889-024-19182-6] [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: 12/20/2023] [Accepted: 06/18/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Several studies have demonstrated the population-level effectiveness of oral PrEP in reducing the risk of HIV infection. However, oral PrEP utilization among MSM in China remains below 1%. While existing literature has primarily focused on oral PrEP preference and willingness, there is limited exploration of the underlying factors contributing to oral PrEP cessation in China. This study aims to fill this gap by investigating the factors associated with oral PrEP cessation among MSM in China. METHODS Assisted by MSM community organizations, we collected 6,535 electronic questionnaires from 31 regions across China, excluding Taiwan, Hong Kong, and Macau. The questionnaire focused on investigating MSM's awareness, willingness, usage, and cessation of oral PrEP. Additionally, 40 participants were randomly chosen for key informant interviews. These qualitative interviews aimed to explore the reasons influencing MSM discontinuing oral PrEP. RESULTS We eventually enrolled 6535 participants. Among the 685 participants who had used oral PrEP, 19.70% (135/685) ceased oral PrEP. The results indicated that individuals spending > ¥1000 on a bottle of PrEP (aOR = 2.999, 95% CI: 1.886-4.771) were more likely to cease oral PrEP compared to those spending ≤ ¥1000. Conversely, individuals opting for on-demand PrEP (aOR = 0.307, 95% CI: 0.194-0.485) and those using both daily and on-demand PrEP (aOR = 0.114, 95% CI: 0.058-0.226) were less likely to cease PrEP compared to those using daily PrEP. The qualitative analysis uncovered eight themes influencing oral PrEP cessation: (i) High cost and low adherence; (ii) Sexual inactivity; (iii) Lack of knowledge about PrEP; (iv) Trust in current prevention strategies; (v) Poor quality of medical service and counseling; (vi) PrEP stigma; (vii) Partner and relationship factors; (viii) Access challenges. CONCLUSIONS The cessation of oral PrEP among MSM in China is associated with various factors, including the cost of oral PrEP medication, regimens, individual perception of HIV risk, stigma, and the quality of medical services. It is recommended to provide appropriate regimens for eligible MSM and develop tailored combinations of strategies to enhance PrEP awareness and acceptance among individuals, medical staff, and the MSM community. The findings from this study can support the refinement of HIV interventions among MSM in China, contributing to efforts to reduce the burden of HIV in this population.
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Affiliation(s)
- Yuanyuan Liu
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Siyue Wei
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Zhaoyu Cheng
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Yidan Xian
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Xuan Liu
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Jie Yang
- Shenlan" Public Health Counseling Service Center, Tianjin, China
| | - Yan Liu
- Shenlan" Public Health Counseling Service Center, Tianjin, China
| | - Maohe Yu
- STD & AIDS Control and Prevention Section, Tianjin Center for Disease Control and Prevention, Tianjin, China
- Tianjin Key Laboratory of Pathogenic Microbiology of Infectious Disease, Tianjin Centers for Disease Control and Prevention, Tianjin, 300011, China
| | - Zhongdan Chen
- HIV/Hepatitis, STI/TB, World Health Organization Representative Office in China, 401 Dongwai Diplomatic Building 23, DongzhimenwaiDajie, Chaoyang District, Beijing, 100600, China
| | - Jiageng Chen
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Jun Ma
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
| | - Zhuang Cui
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Changping Li
- Department of Epidemiology and Biostatistics, Tianjin Medical University, Tianjin, China.
- Tianjin Key Laboratory of Environment, Nutrition and Public Health, NO.22, Qixiangtai Street, Tianjin, 300041, China.
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Vega-Ramirez H, Guillen-Diaz-Barriga C, Luz PM, Torres TS. Perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities: a systematic review. BMC Infect Dis 2024; 24:574. [PMID: 38858666 PMCID: PMC11163805 DOI: 10.1186/s12879-024-09456-0] [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] [Received: 12/09/2023] [Accepted: 05/30/2024] [Indexed: 06/12/2024] Open
Abstract
We conducted a systematic review to explore the relationship between perceived risk for HIV acquisition and sexual HIV exposure among sexual and gender minorities. We included 39 studies divided into (i) correlations or associations, (ii) models using sexual HIV exposure as the outcome, and (iii) models using perceived risk for HIV acquisition as the outcome. The sample size range was from 55 to 16,667 participants, primarily cisgender men who have sex with men (73.3%) and White (51.3%). Sexual HIV exposure and perceived risk for HIV acquisition assessments and recall time frames across studies differed markedly. Most of studies (84.6%) found significant correlations, comparisons, or associations between different levels of perceived risk for HIV acquisition and high sexual HIV exposure. In addition, 51.3% of studies reported other variables associated with high sexual HIV exposure (i.e., misuse of substances or alcohol) or with high perceived risk for HIV acquisition (i.e., younger age). In conclusion, the association between perceived risk for HIV acquisition and sexual HIV exposure has shown to be consistent. However, the assessment for perceived risk for HIV acquisition should include more components of perception (i.e., an affective component), or for sexual HIV exposure should consider the different estimated sexual per-acts probability of acquiring HIV.
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Affiliation(s)
- Hamid Vega-Ramirez
- Division of Epidemiology and Psychosocial Research, National Institute of Psychiatry Ramon de la Fuente Muñiz, Mexico City, Mexico.
| | - Centli Guillen-Diaz-Barriga
- Division of Graduate Studies and Research, Faculty of Psychology, National Autonomous University of Mexico, Mexico City, Mexico
| | - Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI- Fiocruz), Rio de Janeiro, Brazil
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (INI- Fiocruz), Rio de Janeiro, Brazil
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Janamnuaysook R, Guo Y, Yu YJ, Phanuphak N, Kawichai S, MacDonell K, Jupimai T, Rongkavilit C, Wang B. Lived experiences with pre-exposure prophylaxis uptake and adherence among transgender women in Thailand: a qualitative study. Sex Health 2024; 21:SH23102. [PMID: 38219741 DOI: 10.1071/sh23102] [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: 06/09/2023] [Accepted: 12/16/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Transgender women (TGW) are disproportionately affected by HIV, and HIV prevalence among TGW in Thailand has been increasing. Although oral daily pre-exposure prophylaxis (PrEP) is effective for HIV prevention, PrEP uptake and persistence among TGW have been low. This study aimed to provide a deeper understanding of TGW's experiences with PrEP uptake and adherence, and to identify major barriers to PrEP use to inform intervention adaptation. METHODS We interviewed 20 young TGW (six non-PrEP users, eight adherent, six non-adherent) and 10 health care providers from two HIV clinics in Bangkok, Thailand, in 2022. We focused on understanding challenges to PrEP use in this population using an interview guide based on a theoretical model of behaviour change and thematic content analysis. RESULTS Thematic analysis identified major barriers to and facilitators of PrEP uptake and adherence. Barriers to PrEP initiation included low self-perceived HIV risk, concern about potential side-effects, patient burdens such as frequent HIV testing for prescription refills and social stigma against PrEP. Barriers to adherence included side-effects, inconvenient access to health services (especially during COVID-19 lockdowns), forgetfulness resulting from busy schedules and low self-perceived HIV risk. TGW also reported health care providers' stigma against PrEP users deterred them from seeking further PrEP services. TGW identified major facilitators of PrEP initiation, including awareness about the benefits of PrEP, concern about risks of HIV and supportive social networks of PrEP users. As to PrEP regimens, most TGW participants reported a clear preference for long-lasting, injectable PrEP over daily oral PrEP. TGW and health care providers largely agreed on barriers and facilitators of PrEP use, but they differed in perceptions of HIV risk. CONCLUSIONS The results highlighted challenges and opportunities to improve the delivery of PrEP, as well as other sexually transmissable infection and mental health services, especially among TGW. Thus, there is an urgent need for developing effective intervention programs that could raise PrEP awareness and knowledge, reduce PrEP stigma, and improve PrEP delivery systems among TGW in Thailand.
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Affiliation(s)
- Rena Janamnuaysook
- Institute of HIV Research and Innovation, Bangkok, Thailand; and Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | - Yan Guo
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Yeon Jung Yu
- Department of Anthropology, Western Washington University, Bellingham, WA, USA
| | - Nittaya Phanuphak
- Institute of HIV Research and Innovation, Bangkok, Thailand; and Center of Excellence in Transgender Health (CETH), Chulalongkorn University, Bangkok, Thailand
| | - Surinda Kawichai
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Karen MacDonell
- Center for Translational Behavioral Research, Florida State University, Tallahassee, FL, USA
| | - Thidarat Jupimai
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok, Thailand
| | - Chokechai Rongkavilit
- Department of Pediatrics, University of California San Francisco-Fresno Branch Campus, Fresno, CA, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA
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Zeballos D, Magno L, Soares F, Filho ME, Amorim L, Pinto JA, Greco D, Grangeiro A, Dourado I. Oral Pre-Exposure Prophylaxis for HIV Discontinuation in a Large Cohort of Adolescent Men Who Have Sex With Men and Transgender Women in Brazil. J Adolesc Health 2023; 73:S43-S49. [PMID: 37953008 DOI: 10.1016/j.jadohealth.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/12/2022] [Accepted: 08/04/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE This study aimed to describe pre-exposure prophylaxis (PrEP) for HIV discontinuation in adolescent men who have sex with men (aMSM) and adolescent transgender women (aTGW) and to identify factors associated with discontinuation. METHODS The PrEP1519 study included a cohort of aMSM and aTGW aged 15-19 years old, and it was conducted in three large Brazilian capital cities. For this analysis, we included adolescents who initiated PrEP. PrEP discontinuation was defined as no possession of PrEP pills for >90 days. Kaplan-Meier curves were used to analyze the probabilities of discontinuation, and survival distributions stratified by covariates were compared using log-rank or Wilcoxon tests. Cox regression models were used to estimate the adjusted hazard ratio (aHR) with a 95% confidence interval (95% CI). RESULTS We included 908 adolescents, 829 (91.30%) aMSM and 79 (8.70%) aTGW, most of whom were 18-19 years (80.29%). The incidence rate of discontinuation was 75.6 per 100 person-years. The probability of discontinuation was 52.61% in the first year. The multivariate analysis demonstrated that the aTGW (aHR = 1.63; 95% CI: 1.02-1.64) and adolescents with a medium (aHR = 1.29; 95% CI: 1.02-1.64) or low (aHR = 1.65; 95% CI: 1.29-2.12) perceived risk of HIV infection had an increased risk of discontinuation, whereas the adolescents with a partner living with HIV had a lower risk of discontinuation (aHR = 0.57; 95% CI: 0.35-0.91). DISCUSSION Adolescents with a high risk for discontinuation may need additional support that emphasizes the value of PrEP as a tool for HIV prevention because PrEP discontinuation was associated with a disconnect between HIV risk perception and HIV prevention.
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Affiliation(s)
- Diana Zeballos
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Fabiane Soares
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Marcos Eustorgio Filho
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Leila Amorim
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Jony Arrais Pinto
- Instituto de Matemática e Estatística, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil
| | - Dirceu Greco
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Alexandre Grangeiro
- Departamento de Medicina Preventiva da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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Soares F, Magno L, Pinto JA, Grangeiro A, Bruxvoort K, Greco D, Dourado I. Same-Day Initiation of Oral Pre-Exposure Prophylaxis is High Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil. J Adolesc Health 2023; 73:S26-S32. [PMID: 37953005 DOI: 10.1016/j.jadohealth.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE This study analyzed the sociodemographic and behavioral characteristics of adolescent men who have sex with men (aMSM) and transgender women (aTGW) initiating oral pre-exposure prophylaxis (PrEP) in human immunodeficiency virus (HIV) prevention clinics. METHODS PrEP1519 is a prospective, multicenter, open-label PrEP demonstration cohort study of aMSM and aTGW aged 15-19 years living in three large Brazilian capital cities. For this analysis, we included adolescents who enrolled in PrEP1519 from February 2019 to August 2021. Adolescents who visited PrEP clinics were classified into four groups based on PrEP eligibility and on their decision to use PrEP: (1) ineligible for same-day PrEP initiation; (2) eligible for same-day PrEP initiation, initiated PrEP at first visit; (3) eligible for PrEP initiation, initiated PrEP after the first visit; and (4) eligible for same-day PrEP initiation but declined. The groups that were eligible for same-day PrEP initiation were compared using the Chi-square and Fisher's exact tests. RESULTS Of the 1,254 adolescents enrolled in the PrEP1519 study, 61 (4.9%) were considered ineligible for same-day PrEP initiation. Of the 1,193 eligible for same-day PrEP initiation, 1,113 (93.3%) initiated PrEP [1,054 initiated PrEP in the first visit (88.3%) and 59 in subsequent visits (4.9%)] and 80 (6.7%) did not. Despite 90% of the PrEP decliners reporting a low risk of HIV infection, most reported condomless anal sex in the past six months (70%). DISCUSSION Same-day PrEP initiation among aMSM and aTGW was high, highlighting that this strategy was important to promote PrEP initiation among adolescents with increased vulnerability to HIV in Brazil.
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Affiliation(s)
- Fabiane Soares
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
| | - Laio Magno
- Departamento de Ciências da Vida, Universidade do Estado da Bahia, Salvador, Bahia, Brazil
| | - Jony Arrais Pinto
- Instituto de Matemática e Estatística, Universidade Federal Fluminense, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Alexandre Grangeiro
- Departamento de Medicina Preventiva, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Katia Bruxvoort
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Dirceu Greco
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Inês Dourado
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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8
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Lorenzetti L, Dinh N, van der Straten A, Fonner V, Ridgeway K, Rodolph M, Schaefer R, Schmidt HA, Baggaley R. Systematic review of the values and preferences regarding the use of injectable pre-exposure prophylaxis to prevent HIV acquisition. J Int AIDS Soc 2023; 26 Suppl 2:e26107. [PMID: 37439057 PMCID: PMC10805120 DOI: 10.1002/jia2.26107] [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: 10/18/2022] [Accepted: 05/04/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is an important HIV prevention option. Two randomized trials have provided efficacy evidence for long-acting injectable cabotegravir (CAB-LA) as PrEP. In considering CAB-LA as an additional PrEP modality for people at substantial risk of HIV, it is important to understand community response to injectable PrEP. We conducted a systematic review of values, preferences and perceptions of acceptability for injectable PrEP to inform global guidance. METHODS We searched nine databases and conference websites for peer-reviewed and grey literature (January 2010-September 2021). There were no restrictions on location. A two-stage review process assessed references against eligibility criteria. Data from included studies were organized by constructs from the Theoretical Framework of Acceptability. RESULTS We included 62 unique references. Most studies were observational, cross-sectional and qualitative. Over half of the studies were conducted in North America. Men who have sex with men were the most researched group. Most studies (57/62) examined injectable PrEP, including hypothetical injectables (55/57) or placebo products (2/57). Six studies examined CAB-LA specifically. There was overall interest in and often a preference for injectable PrEP, though there was variation within and across groups and regions. Many stakeholders indicated that injectable PrEP could help address adherence challenges associated with daily or on-demand dosing for oral PrEP and may be a better lifestyle fit for individuals seeking privacy, discretion and infrequent dosing. End-users reported concerns, including fear of needles, injection site pain and body location, logistical challenges and waning or incomplete protection. DISCUSSION Despite an overall preference for injectable PrEP, heterogeneity across groups and regions highlights the importance of enabling end-users to choose a PrEP modality that supports effective use. Like other products, preference for injectable PrEP may change over time and end-users may switch between prevention options. There will be a greater understanding of enacted preference as more end-users are offered anti-retroviral (ARV)-containing injectables. Future research should focus on equitable implementation, including real-time decision-making and how trained healthcare providers can support choice. CONCLUSIONS Given overall acceptability, injectable PrEP should be included as part of a menu of prevention options, allowing end-users to select the modality that suits their preferences, needs and lifestyle.
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Affiliation(s)
- Lara Lorenzetti
- Global Health and Population ResearchFHI 360DurhamNorth CarolinaUSA
| | - Nhi Dinh
- Global Health and Population ResearchFHI 360DurhamNorth CarolinaUSA
| | - Ariane van der Straten
- ASTRA ConsultingKensingtonCaliforniaUSA
- Center for AIDS Prevention StudiesDepartment of MedicineUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Virginia Fonner
- Global Health and Population ResearchFHI 360DurhamNorth CarolinaUSA
| | | | - Michelle Rodolph
- World Health OrganizationGlobal HIVHepatitis and STI ProgrammesGenevaSwitzerland
| | - Robin Schaefer
- World Health OrganizationGlobal HIVHepatitis and STI ProgrammesGenevaSwitzerland
| | - Heather‐Marie A. Schmidt
- World Health OrganizationGlobal HIVHepatitis and STI ProgrammesGenevaSwitzerland
- UNAIDS Regional Office for Asia and the PacificBangkokThailand
| | - Rachel Baggaley
- World Health OrganizationGlobal HIVHepatitis and STI ProgrammesGenevaSwitzerland
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9
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L C, M C, P N, T D, K T, P T, P S, P P, V P, J S, L D, N T, J N, M M. Providing HIV pre-exposure prophylaxis to men who have sex with men and transgender women in hospitals and community-led clinics in Thailand: acceptance, patterns of use, trends in risk behaviors, and HIV incidence. AIDS Care 2023; 35:524-537. [PMID: 36726288 PMCID: PMC10121879 DOI: 10.1080/09540121.2022.2159312] [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: 01/05/2022] [Accepted: 12/13/2022] [Indexed: 02/03/2023]
Abstract
From May 2015 to June 2018, we conducted a PrEP demonstration project at two hospitals and four community-led clinics in Bangkok and Pattaya. HIV-negative, MSM and TGW aged ≥18 years old, reporting sex without a condom, were offered daily PrEP. Participants received HIV testing and completed a computer-based questionnaire at enrollment, 6 and 12 months. We collected self-reported PrEP adherence at months 1, 3, 6, 9, and 12. We used logistic regression to determine factors associated with the decision to take PrEP and calculated HIV incidence among baseline HIV-negative participants. Of 803 participants enrolled, 349 (43.5%) started PrEP. Participants were more likely to start PrEP if they were sex workers, had moderate or high self-perceived risk of HIV, or a high PrEP-knowledge score. Participants used PrEP for a median of 6.1 months. Reported condom use increased and the number of sex partners decreased during follow-up regardless of PrEP use. Six participants not-taking PrEP acquired HIV (HIV incidence 2.2 per 100 person-years), and five taking PrEP acquired HIV (HIV incidence 2.1 per 100 person-years). All five reported taking <4 pills the weeks before study visits.
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Affiliation(s)
- Cheewanan L
- Division of AIDS and STIs, Ministry of Public Health, Bangkok, Thailand
| | - Chomnad M
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Nittaya P
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Deondara T
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Thana K
- Faculty of Medicine, Thammasat University, Pathumthani, Thailand
| | - Tharee P
- Department of Medical Services, Ministry of Public Health, Lerdsin hospital, Bangkok, Thailand
| | - Supabhorn P
- Institute of HIV Research and Innovation, Bangkok, Thailand
| | - Patcharaporn P
- Division of AIDS and STIs, Ministry of Public Health, Bangkok, Thailand
| | - Prin V
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Surang J
- Service Workers in Group Foundation (SWING), Bangkok, Thailand
| | - Danai L
- Rainbow Sky Association of Thailand, Bangkok, Thailand
| | | | - Nuchapong J
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Nonthaburi, Thailand
| | - Michael M
- Division of Global HIV & Tuberculosis, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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10
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HIV Risk Perception and Pre-Exposure Prophylaxis (PrEP) Awareness Among Transgender Women from Mexico. AIDS Behav 2023; 27:992-1002. [PMID: 36121550 DOI: 10.1007/s10461-022-03836-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/01/2022]
Abstract
This study aimed to identify factors associated with HIV risk perception among Mexican transgender women (TGW). This cross-sectional survey was conducted online and at a public HIV clinic in Mexico City. Participants were ≥ 18 years old, self-identified as TGW, and reported not living with HIV. They answered questions on sexual behavior, HIV risk perception, and pre-exposure prophylaxis (PrEP) awareness. We performed a multivariate logistic regression to accomplish the study's objective. One hundred ninety-one TGW completed the survey. High HIV risk perception was associated with > 5 sexual partners, condomless receptive anal sex, sex with a male partner(s) of unknown HIV status, and PrEP awareness. Although most TGW reported low HIV risk perception, over half had risk sexual behavior, reflecting inaccurate risk assessment. Future interventions to improve accurate risk perception among TGW should promote HIV transmission and prevention knowledge and increase PrEP awareness and uptake.
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11
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Mansergh G, Kota KK, Carnes N, Gelaude D. Brief Report: Refusal of Daily Oral PrEP: Implementation Considerations and Reported Likelihood of Using Various HIV Prophylaxis Products in a Diverse Sample of MSM. J Acquir Immune Defic Syndr 2023; 92:212-216. [PMID: 36442153 PMCID: PMC11283764 DOI: 10.1097/qai.0000000000003134] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND An important subgroup of gay, bisexual, and other men who have sex with men (MSM) with behavioral indications refuse daily oral pre-exposure prophylaxis (PrEP) when recommended by a provider. Emerging HIV prophylaxis products (eg, injectable, event-driven) offer more options to MSM who refuse daily PrEP. In this article, we assess reasons for refusal and likelihood to use various products among MSM who refused PrEP. METHODS MSM who reported anal sex without condoms or PrEP and refused daily oral PrEP in the past 6 months were recruited through clinics, community venues, and online in Atlanta, Chicago, and Raleigh-Durham. Men were asked their main reason for recently refusing daily PrEP and likelihood of using various PrEP options in the future. Bivariate and multivariable regression models were used to estimate associations. RESULTS MSM (n = 93; 70% Black, 48% age 18-29 years) reported their main reason for refusing daily PrEP were potential side effects (35%), a daily pill regimen (22%), and not having enough information (18%). Reported likelihood of using PrEP products was 58% for penile gel, 54% for event-driven oral, 52% for injectable, and 50% for daily PrEP. MSM who reported daily regimen as the main reason for refusing PrEP had greater odds of likelihood to use an injectable [adjusted odds ratio (AOR) = 5.21, 95% confidence interval (CI): 1.32 to 20.52]. Younger men (18-29 vs 30+ years) had greater odds of likelihood to use condoms (AOR = 3.40, 95% CI: 1.15 to 10.04) and daily PrEP (AOR = 2.76, 95% CI: 1.06 to 7.16); there were no product preference differences by race. CONCLUSION Most men who refused daily PrEP indicated likelihood of using some form of PrEP in the future.
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Affiliation(s)
- Gordon Mansergh
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Krishna Kiran Kota
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
- Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Neal Carnes
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deborah Gelaude
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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12
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Savoie SJ, Leonhard C, Smith M, Drake M. Predicting and influencing PrEP use: the role of motivational and attitudinal factors. AIDS Care 2023:1-11. [PMID: 36781301 DOI: 10.1080/09540121.2023.2176427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
This study examined PrEP attitude and HIV risk factors associated with PrEP motivation and evaluated the efficacy of a mock public health video that addresses both motivational and stigma issues for improving PrEP uptake over a standard educational video. Gay, bisexual, and other men who have sex with men (GBMSM; N = 604) were enrolled. One-way between subject analysis of variance (ANOVA) and post-hoc comparisons revealed that GBMSM in later stages of change had significantly higher endorsement of positive PrEP attitudes, PrEP stigma, objective and perceived HIV risk, HIV worry, and valued health benefits of PrEP more. Stepwise multiple regression revealed five significant predictors of PrEP motivation: HIV worry, objective HIV risk, anticipated PrEP stigma, positive PrEP attitudes, and perceived social consequences of PrEP use. Video conditions did not differ in their impact on PrEP attitudes or motivation; however, regardless of video condition, participants experienced a pre- to post-video increase in positive PrEP attitudes and motivation. Findings suggest HIV worry, objective HIV risk, positive PrEP attitudes, and perceived PrEP health benefits are important factors to optimize PrEP motivation, which can inform secondary prevention efforts. Further study is needed on promotional PrEP campaigns that disconfirm stigmatizing PrEP misconceptions.
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Affiliation(s)
- S J Savoie
- Clinical PsyD Program, The Chicago School of Professional Psychology at Xavier University of Louisiana, New Orleans, LA, USA
| | - C Leonhard
- Clinical PsyD Program, The Chicago School of Professional Psychology at Xavier University of Louisiana, New Orleans, LA, USA
| | - M Smith
- Clinical PsyD Program, The Chicago School of Professional Psychology at Xavier University of Louisiana, New Orleans, LA, USA
| | - M Drake
- CrescentCare, New Orleans, LA, USA.,Tulane University School of Social Work, New Orleans, LA, USA
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13
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Soares F, Magno L, da Silva LAV, Guimarães MDC, Leal AF, Knauth D, Veras MA, de Brito AM, Kendall C, Kerr LRFS, Dourado I. Perceived Risk of HIV Infection and Acceptability of PrEP among Men Who Have Sex with Men in Brazil. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:773-782. [PMID: 36169773 PMCID: PMC9517975 DOI: 10.1007/s10508-022-02342-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 06/16/2023]
Abstract
The HIV epidemic affects men who have sex with men (MSM) disproportionally in Brazil, and pre-exposure prophylaxis (PrEP) is effective for preventing HIV in this population. However, low perceived risk of HIV may influence the acceptability and decision to use PrEP. This study estimated the association between self-perception of HIV risk and acceptability of daily oral PrEP among Brazilian MSM. Respondent-driven sampling (RDS) was used for behavioral and biological surveillance to recruit 4,176 MSM 18 years or over in 12 Brazilian cities in 2016. Results were weighted using Gile's estimator in RDS Analyst software. Adjusted odds rations (OR) with 95% confidence intervals were calculated using multivariate logistic regression. Acceptability of daily oral PrEP was high (69.7%) among the 3,544 MSM available for analysis. Most participants self-reported low or moderate risk of HIV infection (67.2%) and a small proportion (9.3%) reported high risk. A dose-response relationship was observed between acceptability of PrEP and self-reported risk: PrEP acceptability was 1.88 times higher (OR 1.8; 95% CI: 1.24-2.85) among MSM whose perceived risk of HIV infection was low or moderate, and 5 times higher (OR 5.68; 95% CI: 2.54-12.73) among those who self-reported high risk compared to MSM reporting no HIV risk. MSM with the highest risk perception of HIV reported higher rates of PrEP acceptability. Given the availability of daily oral PrEP in the public health care system in Brazil, we suggest emphasizing counseling about self-perception of HIV risk as part of routine HIV prevention services.
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Affiliation(s)
- Fabiane Soares
- Institute of Collective Health, Federal University of Bahia, Basílio da Gama, s/n, Campos Universitário Do Canela, Salvador, Bahia, CEP: 4.0110-040, Brazil.
| | - Laio Magno
- Department of Life Sciences, State University of Bahia, Salvador, Bahia, Brazil
| | | | | | - Andrea Fachel Leal
- Sociology Department, Institute of Philosophy and Human Sciences, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Daniela Knauth
- Department of Social Medicine, Faculty of Medicine, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Maria Amélia Veras
- School of Medical Sciences, Santa Casa de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Carl Kendall
- Department of Community Health, Federal University of Ceará, Fortaleza, Ceará, Brazil
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | | | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Basílio da Gama, s/n, Campos Universitário Do Canela, Salvador, Bahia, CEP: 4.0110-040, Brazil
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14
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Abu-Ba’are GR, Shamrock OW, Apreku A, Agbemedu GRK, Zigah EY, Ezechi OC, Nelson LE, Torpey K. Awareness and Willingness to use Condoms and Preexposure Prophylaxis among Gay, Bisexual, and Other Cisgendered Men who Have sex with men in Slum Communities in Ghana. BSGH-004. J Int Assoc Provid AIDS Care 2023; 22:23259582231209649. [PMID: 37933162 PMCID: PMC10631318 DOI: 10.1177/23259582231209649] [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: 08/17/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023] Open
Abstract
Introduction: Research has begun to examine human immunodeficiency virus (HIV) prevention strategies within the Ghanaian context. Still, little is known about specific populations such as gay, bisexual, and other cisgender men who have sex with men (GBMSM) living in slum communities. We studied HIV prevention strategies such as condoms and preexposure prophylaxis (PrEP) in slum communities and the awareness and willingness to use these choices among GBMSM. This qualitative study examines HIV prevention strategies, specifically examining PrEP and condom use behaviors among GBMSM in Ghana. Methods: We conducted in-depth face-to-face interviews among 12 GBMSM from slums in Accra and Kumasi cities in Ghana. Data were analyzed through a summative content analysis with multiple reviewers to develop codes. Data were collected from participants in January 2022. Results: We found the fear and perceived risk of infection were motivators for consistent condom use, especially during anal sex. GBMSM living with HIV receiving antiretroviral therapy were more inclined to use condoms. We found motivations for using PrEP were influenced by the type of sexual activity and a history of negative HIV status. Also, the barriers to PrEP for GBMSM included limited access to healthcare facilities and the distance to these facilities. Conclusions: To improve condom and PrEP access and uptake, we recommend addressing structural barriers by increasing the number of health facilities and implementing targeted interventions to address the lack of information on HIV awareness and prevention. Involving peer educators may also effectively promote HIV prevention strategies, especially in communities with limited access to healthcare such as slums. Overcoming these access constraints could significantly enhance awareness and prevention of HIV, leading to improved health outcomes for GBMSM living in slum communities.
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Affiliation(s)
- Gamji Rabiu Abu-Ba’are
- School of Nursing, University of Rochester, Rochester, USA
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, USA
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, University of Ghana, Accra, Ghana
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Osman Wumpini Shamrock
- School of Nursing, University of Rochester, Rochester, USA
- Behavioral, Sexual and Global Health Lab, School of Nursing, University of Rochester, Rochester, USA
| | - Amos Apreku
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | | | | | - LaRon E. Nelson
- Center for Interdisciplinary Research on AIDS, Yale School of Public Health, University of Ghana, Accra, Ghana
- School of Nursing, Yale University, New Haven, Connecticut, USA
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
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15
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Bangar S, Mohan U, Kumar S, Mahapatra A, Singh SK, Kohli R, Verma A, Katendra TL, Rahane G, Shewale SP, Yenbhar N, Verma V, Saravanamurthy P, George B, Kushwaha BS, Das C, Rajan S, Sahay S. Exploring access to HIV-related services and programmatic gaps for Men having Sex with Men (MSM) in rural India- a qualitative study. PLoS One 2023; 18:e0284901. [PMID: 37141198 PMCID: PMC10159193 DOI: 10.1371/journal.pone.0284901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 04/02/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND Despite the Link Worker Scheme to address the HIV risk and vulnerabilities in rural areas, reaching out to unreached men having sex with men (MSM) remains a challenge in rural India. This study explored issues around health care access and programmatic gaps among MSM in rural settings of India. METHODS We conducted eight Focused Group Discussions (FGDs), 20 Key Informant Interviews (KIIs), and 20 In-Depth Interviews (IDIs) in four rural sites in Maharashtra, Odisha, Madhya Pradesh, and Uttar Pradesh between November 2018 and September 2019. The data in the local language were audio-recorded, transcribed, and translated. Data were analyzed in NVivo version 11.0 software using the grounded theory approach. RESULTS Primary barriers to health care access were lack of knowledge, myths and misconceptions, not having faith in the quality of services, program invisibility in a rural setting, and anticipated stigma at government health facilities. Government-targeted intervention services did not seem to be optimally advertised in rural areas as MSM showed a lack of information about it. Those who knew reported not accessing the available government facilities due to lack of ambient services, fear of the stigma transforming into fear of breach of confidentiality. One MSM from Odisha expressed, "…they get fear to go to the hospital because they know that hospital will not maintain confidentiality because they are local people. If society will know about them, then family life will be disturbed" [OR-R-KI-04]. Participants expressed the desire for services similar to those provided by the Accredited Social Health Activists (ASHA), frontline health workers for MSM. CONCLUSION Programme invisibility emerges as the most critical issue for rural and young MSM. Adolescent and panthis emerged as Hidden MSM and they need focused attention from the programme. The need for village-level workers such as ASHA specifically for the MSM population emerged. MSM-friendly health clinics would help to improve healthcare access in rural MSMs under Sexual and Reproductive Health Care.
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Affiliation(s)
- Sampada Bangar
- Epidemiology Division, ICMR-National AIDS Research Institute, Pune, India
| | - Uday Mohan
- Upgraded Department of Community Medicine and Public Health, King George's Medical University, Lucknow, India
| | - Sanjeev Kumar
- Department of Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, India
| | - Amarendra Mahapatra
- Epidemiology Division, ICMR-Regional Medical Research Center, Bhubaneswar, India
| | - Shivendra Kumar Singh
- Upgraded Department of Community Medicine and Public Health, King George's Medical University, Lucknow, India
| | - Rewa Kohli
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Archana Verma
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Tuman Lal Katendra
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Girish Rahane
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Suhas P Shewale
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Nayana Yenbhar
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
| | - Vinita Verma
- National AIDS Control Organization, New Delhi, India
| | | | | | | | - Chinmoyee Das
- National AIDS Control Organization, New Delhi, India
| | - Shobini Rajan
- National AIDS Control Organization, New Delhi, India
| | - Seema Sahay
- Division of Social and Behavioral Research, ICMR-National AIDS Research Institute, Pune, India
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16
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Thongsak N, Manojai N, Apiputhipan R, Rongram N, Mattawanon N, Bunyatisai W, Plubin B, Nakharutai N, Thumronglaohapun S, Srikummoon P, Wongsawat K, Traisathit P, Homkham N. Risk Factors Associated with Loss to Follow-up Among Transgender Women Receiving HIV Pre-exposure Prophylaxis in Chiang Mai province, Thailand. AIDS Behav 2023; 27:473-483. [PMID: 35930202 PMCID: PMC9362098 DOI: 10.1007/s10461-022-03782-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/25/2022]
Abstract
Although HIV pre-exposure prophylaxis (PrEP) is free in Thailand, many transgender women discontinue taking it after initiation. We determined the loss to follow-up (LTFU) rate of transgender women who initiated PrEP at the Mplus Foundation, Chiang Mai, Thailand, and identified associated risk factors using Cox proportional hazard models. Of 235 participants who initiated PrEP, 59 (55%) out of 108 remaining participants had reactive syphilis. The LTFU rate at 6 months was 38% (95% confidence interval [CI]: 29-48%). Multivariable analysis indicates that LTFU is independently associated with age ≥ 26 years old (adjusted hazard ratio [aHR] = 2.09; 95% CI: 1.06-4.14) and reactive syphilis (aHR = 1.98; 95% CI:1.01-3.88). Delayed appointment scheduling by the PrEP providers and the syphilis clinic was associated with transgender women having reactive syphilis, and the lockdown policy during the COVID-19 pandemic might have influenced them to discontinue PrEP and their subsequent LTFU.
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Affiliation(s)
- Natthapat Thongsak
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | | | | | | | - Natnita Mattawanon
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Walaithip Bunyatisai
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Bandhita Plubin
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Nawapon Nakharutai
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Salinee Thumronglaohapun
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Pimwarat Srikummoon
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Kanokkan Wongsawat
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand
| | - Patrinee Traisathit
- Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Data Science Research Center, Department of Statistics, Faculty of Science, Chiang Mai University, Chiang Mai, Thailand ,Research Center in Bioresources for Agriculture, Industry and Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nontiya Homkham
- Faculty of Public Health, Thammasat University, Pathumthani, Thailand.
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17
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Wray TB, Chan PA, Klausner JD, Ward LM, Ocean EMS. Gay, Bisexual, and Other Men Who Have Sex With Men Who Are Not on Oral PrEP may be Less Interested in Available Injectable Products than in Oral PrEP: Examining Individual-Level Determinants of Interest and Barriers Across Products. AIDS Behav 2022; 26:3794-3805. [PMID: 35583574 PMCID: PMC9912751 DOI: 10.1007/s10461-022-03708-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/24/2022]
Abstract
Approval of the first injectable PrEP product (cabotegravir) provides an exciting addition to oral PrEP that could encourage those not currently on PrEP to use it. However, few studies have explored interest in injectable cabotegravir among those at increased risk who are not currently on PrEP. We conducted an online survey with 327 gay, bisexual, and other men who have sex with men (GBM) with limited PrEP history to explore their interest and intentions to use oral and injectable PrEP (cabotegravir), and examine barriers and individual-level predictors of both product types. Results showed that 17% of participants who reported being uninterested/neutral about oral PrEP expressed interest in injectable PrEP. Slightly more racial/ethnic minority GBM who were uninterested/neutral for oral PrEP expressed interest in injectable PrEP than White GBM (23% vs. 14%). Determinants were similar across PrEP types. Findings can directly inform interventions encouraging use of both PrEP products.
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Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, United States.
| | - Philip A Chan
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Lori M Ward
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, Jackson, MS, United States
| | - Erik M S Ocean
- Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 02912, Providence, RI, United States
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18
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Ndenkeh JJN, Bowring AL, Njindam IM, Folem RD, Fako GCH, Ngueguim FG, Gayou OL, Lepawa K, Minka CM, Batoum CM, Georges S, Temgoua E, Nzima V, Kob DA, Akiy ZZ, Philbrick W, Levitt D, Curry D, Baral S. HIV Pre-exposure Prophylaxis Uptake and Continuation Among Key Populations in Cameroon: Lessons Learned From the CHAMP Program. J Acquir Immune Defic Syndr 2022; 91:39-46. [PMID: 35536113 PMCID: PMC9377496 DOI: 10.1097/qai.0000000000003012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Pre-exposure prophylaxis (PrEP) is proven to be a highly effective HIV prevention method for key populations. However, its scale-up in resource-limited settings remains suboptimal. This paper seeks to describe PrEP initiation and continuation among key populations in Cameroon. METHODOLOGY From June 2019 through October 2020, we collected routine program data on PrEP uptake and continuation among female sex workers (FSWs) and men who have sex with men (MSM) in the Continuum of prevention, care and treatment of HIV/AIDS with Most-at-risk Populations (CHAMP) program in Cameroon. PrEP was offered to clients who tested negative for HIV and were assessed to potentially benefit from PrEP. Using survival analysis, we identified factors associated with PrEP discontinuation over time with significance set at 5%. RESULTS Overall, 27,750 clients were sensitized for PrEP of whom 3,138 persons were eligible to start PrEP and 1,409 (45%; FSW: 691 and MSM: 718) initiated PrEP. The PrEP continuation rate was 37% at 3 months, 28% at 6 months and 19% at 12 months. PrEP discontinuation was significantly higher among FSW than MSM [adjusted hazard ratio (aHR) 1.5 (95% CI: 1.2 to 1.9)] in Yaounde [aHR 1.5 (95% CI: 1.2 to 1.9)] and Bafoussam/Bertoua [aHR 3.1 (2.2-4.5)] relative to Douala. Discontinuation was lower among those with moderate [aHR 0.3 (0.3-0.4)] or good adherence [aHR 0.4 (0.3-0.6)] compared with poor adherence (all P < 0.001). CONCLUSION Differentiated approaches to deliver PrEP, create demand, and provide more intensive support for adherence and continuation may support scale-up of PrEP in Cameroon for equitable and prolonged impact on HIV prevention.
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Affiliation(s)
- Jackson Jr Nforbewing Ndenkeh
- Care International in Cameroon, Yaoundé, Cameroon
- CIH Center for International Health, University Hospital, Ludwig Maximilian University of Munich, Munich, Germany
| | - Anna L. Bowring
- Burnet Institute, Melbourne, Australia
- John Hopkins School of Public Health, Baltimore, USA
| | | | | | | | | | | | - Kelly Lepawa
- Care and Health Program (CHP), Yaoundé, Cameroon
| | | | | | | | - Edith Temgoua
- National AIDS Control Committee (NACC), Yaoundé, Cameroon
| | - Valery Nzima
- United States Agency for International Development (USAID), Yaoundé, Cameroon; and
| | - David Anouar Kob
- United States Agency for International Development (USAID), Yaoundé, Cameroon; and
| | - Zacheus Zeh Akiy
- United States Agency for International Development (USAID), Yaoundé, Cameroon; and
| | | | | | | | - Stefan Baral
- John Hopkins School of Public Health, Baltimore, USA
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19
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Kamire V, Magut F, Khagayi S, Kambona C, Muttai H, Nganga L, Kwaro D, Joseph RH. HIV Risk Factors and Risk Perception Among Adolescent Girls and Young Women: Results From a Population-Based Survey in Western Kenya, 2018. J Acquir Immune Defic Syndr 2022; 91:17-25. [PMID: 35972852 PMCID: PMC9387564 DOI: 10.1097/qai.0000000000003021] [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: 01/06/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In sub-Saharan Africa, HIV prevalence in adolescent girls and young women (AGYW) is 2-fold to 3-fold higher than that in adolescent boys and young men. Understanding AGYW's perception of HIV risk is essential for HIV prevention efforts. METHODS We analyzed data from a HIV biobehavioral survey conducted in western Kenya in 2018. Data from AGYW aged 15-24 years who had a documented HIV status were included. We calculated weighted prevalence and evaluated factors associated with outcomes of interest (HIV infection and high risk perception) using generalized linear models to calculate prevalence ratios. RESULTS A total of 3828 AGYW were included; 63% were aged 15-19 years. HIV prevalence was 4.5% and 14.5% of sexually active AGYW had high risk perception. Over 70% of participants had accessed HIV testing and counseling in the past 12 months. Factors associated with both HIV infection and high risk perception included having an HIV-positive partner or partner with unknown status and having a sexually transmitted infection in the past 12 months. Having an older (by ≥10 years) partner was associated with HIV infection, but not high risk perception. Less than 30% of sexually active AGYW with 3 or more HIV risk factors had high perception of HIV risk. CONCLUSION Gaps in perceived HIV risk persist among AGYW in Kenya. High access to HIV testing and prevention services in this population highlights platforms through which AGYW may be reached with improved risk counseling, and to increase uptake of HIV prevention strategies.
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Affiliation(s)
- Vivienne Kamire
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Faith Magut
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Sammy Khagayi
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Caroline Kambona
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
| | - Hellen Muttai
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
| | - Lucy Nganga
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
| | - Daniel Kwaro
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Rachael H. Joseph
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
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20
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Viamonte M, Ghanooni D, Reynolds JM, Grov C, Carrico AW. Running with Scissors: a Systematic Review of Substance Use and the Pre-exposure Prophylaxis Care Continuum Among Sexual Minority Men. Curr HIV/AIDS Rep 2022; 19:235-250. [PMID: 35701713 PMCID: PMC9279195 DOI: 10.1007/s11904-022-00608-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review Patterns of sexualized drug use, including stimulants (e.g., methamphetamine) and chemsex drugs, are key drivers of HIV incidence among sexual minority men (SMM). Although pre-exposure prophylaxis (PrEP) mitigates HIV risk, there is no consensus regarding the associations of substance use with the PrEP care continuum. Recent Findings SMM who use substances are as likely or more likely to use PrEP. Although SMM who use stimulants experience greater difficulties with daily oral PrEP adherence, some evidence shows that SMM who use stimulants or chemsex drugs may achieve better adherence in the context of recent condomless anal sex. Finally, SMM who use substances may experience greater difficulties with PrEP persistence (including retention in PrEP care). Summary SMM who use stimulants and other substances would benefit from more comprehensive efforts to support PrEP re-uptake, adherence, and persistence, including delivering behavioral interventions, considering event-based dosing, and providing injectable PrEP.
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Affiliation(s)
- Michael Viamonte
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA
| | - Delaram Ghanooni
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA
| | - John M Reynolds
- Calder Memorial Library, University of Miami, FL, Miami, USA
| | - Christian Grov
- City University of New York Graduate School of Public Health and Health Policy, New York, NY, USA
| | - Adam W Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., Office 1010, Miami, FL, 33136, USA.
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21
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Dang M, Scheim AI, Teti M, Quinn KG, Zarwell M, Petroll AE, Horvath KJ, John SA. Barriers and Facilitators to HIV Pre-Exposure Prophylaxis Uptake, Adherence, and Persistence Among Transgender Populations in the United States: A Systematic Review. AIDS Patient Care STDS 2022; 36:236-248. [PMID: 35687813 PMCID: PMC9242706 DOI: 10.1089/apc.2021.0236] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
HIV pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV; however, PrEP use among transgender individuals remains low. We conducted a systematic review to identify barriers and facilitators to PrEP uptake, adherence, and persistence among transgender individuals in the United States. We conducted a literature search in PubMed and CINAHL databases in March 2021 and followed PRISMA guidelines. Studies were eligible if they were published in a peer-reviewed journal and reported interest, uptake, adherence, and/or persistence of PrEP use among transgender individuals. Articles that did not disaggregate results for transgender participants were excluded. Data from included articles were coded using content analysis and narratively synthesized using a framework matrix. We screened 254 unique articles published after US Food and Drug Administration approval of PrEP, and 33 articles were included in the review. Five themes were identified in the literature, including (1) PrEP concentrations were lower among individuals taking feminizing hormones, but the difference did not appear clinically significant; (2) concerns regarding interactions between gender-affirming hormone therapy and PrEP remain a large barrier; (3) PrEP initiation may facilitate increased self-advocacy and self-acceptance; (4) lack of trust in medical institutions impacts PrEP uptake; and (5) social networks have a significant influence on PrEP knowledge, interest, and adherence. Additional research is needed involving transgender men and nonbinary persons, and efforts to improve PrEP persistence among the transgender community are needed. Training health care providers to provide inclusive and affirming care is perhaps one of the strongest areas for intervention to increase PrEP uptake and persistence.
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Affiliation(s)
- Madeline Dang
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ayden I. Scheim
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Michelle Teti
- Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, Missouri, USA
| | - Katherine G. Quinn
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Meagan Zarwell
- Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA
| | - Andrew E. Petroll
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Keith J. Horvath
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Steven A. John
- Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.,Address correspondence to: Steven A. John, PhD, MPH, Center for AIDS Intervention Research, Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, 2071 N. Summit Avenue, Milwaukee, WI 53202, USA
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22
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Pingarilho M, Pimentel V, Miranda MNS, Silva AR, Diniz A, Ascenção BB, Piñeiro C, Koch C, Rodrigues C, Caldas C, Morais C, Faria D, da Silva EG, Teófilo E, Monteiro F, Roxo F, Maltez F, Rodrigues F, Gaião G, Ramos H, Costa I, Germano I, Simões J, Oliveira J, Ferreira J, Poças J, da Cunha JS, Soares J, Henriques J, Mansinho K, Pedro L, Aleixo MJ, Gonçalves MJ, Manata MJ, Mouro M, Serrado M, Caixeiro M, Marques N, Costa O, Pacheco P, Proença P, Rodrigues P, Pinho R, Tavares R, de Abreu RC, Côrte-Real R, Serrão R, Castro RSE, Nunes S, Faria T, Baptista T, Martins MRO, Gomes P, Mendão L, Simões D, Abecasis A. HIV-1-Transmitted Drug Resistance and Transmission Clusters in Newly Diagnosed Patients in Portugal Between 2014 and 2019. Front Microbiol 2022; 13:823208. [PMID: 35558119 PMCID: PMC9090520 DOI: 10.3389/fmicb.2022.823208] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks. Methods Clinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses. Results In Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (p for-trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G. Conclusion Our molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.
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Affiliation(s)
- Marta Pingarilho
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Victor Pimentel
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Mafalda N S Miranda
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Ana Rita Silva
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - António Diniz
- Unidade de Imunodeficiência, Centro Hospitalar Universitário Lisboa Norte - HPV, Lisbon, Portugal
| | | | - Carmela Piñeiro
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Carmo Koch
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Catarina Rodrigues
- Serviço de Medicina, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Cátia Caldas
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Célia Morais
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Domitília Faria
- Serviço de Medicina, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | - Eugénio Teófilo
- Serviço de Medicina, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Fátima Monteiro
- Centro de Biologia Molecular, Serviço de Imunohemoterapia do Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Fausto Roxo
- Hospital de Dia de Doenças Infeciosas, Hospital Distrital de Santarém, Santarém, Portugal
| | - Fernando Maltez
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Fernando Rodrigues
- Serviço de Patologia Clínica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Guilhermina Gaião
- Serviço de Patologia Clínica, Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal
| | - Helena Ramos
- Serviço de Patologia Clínica, Centro Hospitalar do Porto, Porto, Portugal
| | - Inês Costa
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Isabel Germano
- Serviço de Medicina, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joana Simões
- Serviço de Medicina, Hospital de São José, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Joaquim Oliveira
- Serviço de Doenças, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Ferreira
- Serviço de Medicina, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - José Poças
- Serviço de Infeciologia, Centro Hospitalar de Setúbal, Setúbal, Portugal
| | | | - Jorge Soares
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Júlia Henriques
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal
| | - Kamal Mansinho
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Liliana Pedro
- Serviço de Medicina, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | | | | | - Maria José Manata
- Serviço de Doenças Infeciosas, Hospital de Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Margarida Mouro
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Margarida Serrado
- Unidade de Imunodeficiência, Centro Hospitalar Universitário Lisboa Norte - HPV, Lisbon, Portugal
| | - Micaela Caixeiro
- Serviço de Infeciologia, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Nuno Marques
- Serviço de Infeciologia, Hospital Garcia da Orta, Almada, Portugal
| | - Olga Costa
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Patrícia Pacheco
- Serviço de Infeciologia, Hospital Professor Doutor Fernando da Fonseca, Amadora, Portugal
| | - Paula Proença
- Serviço de Infeciologia, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
| | - Paulo Rodrigues
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Raquel Pinho
- Serviço de Medicina, Hospital de Portimão, Centro Hospitalar Universitário do Algarve, Portimão, Portugal
| | - Raquel Tavares
- Serviço de Infeciologia, Hospital Beatriz Ângelo, Loures, Portugal
| | - Ricardo Correia de Abreu
- Serviço de Infeciologia, Unidade de Local de Saúde de Matosinhos, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Rita Côrte-Real
- Serviço de Patologia Clínica, Biologia Molecular, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rosário Serrão
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário de São João, Porto, Portugal
| | | | - Sofia Nunes
- Serviço de Infeciologia, Hospital de Aveiro, Centro Hospitalar Baixo Vouga, Aveiro, Portugal
| | - Telo Faria
- Unidade Local de Saúde do Baixo Alentejo, Hospital José Joaquim Fernandes, Beja, Portugal
| | - Teresa Baptista
- Serviço de Doenças Infeciosas, Hospital de Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Maria Rosário O Martins
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
| | - Perpétua Gomes
- Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), Lisbon, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz, Costa da Caparica, Portugal
| | - Luís Mendão
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - Daniel Simões
- Grupo de Ativistas em Tratamentos (GAT), Lisbon, Portugal
| | - Ana Abecasis
- Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Lisbon, Portugal
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23
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Sullivan PS, Siegler AJ. What will it take to meet UNAIDS targets for preexposure prophylaxis users? Curr Opin Infect Dis 2022; 35:1-8. [PMID: 34879049 DOI: 10.1097/qco.0000000000000809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Preexposure prophylaxis (PrEP) is a critical strategy to curb new HIV infections globally. National and global targets have been set for people starting PrEP. However, global PrEP initiations fell short of UNAIDS 2020 targets, and reflection is needed on how we set and meet targets for PrEP use. RECENT FINDINGS Recent literature documents challenges to meeting ambitious goals for PrEP coverage in multiple phases of PrEP: PrEP initiations are limited by gaps in the identification of those who might benefit from PrEP. Conversely, getting PrEP to those who need it most is threatened by inaccurate risk perception and HIV and PrEP stigma. Once people are on PrEP, a substantial number discontinue PrEP in the first year (the 'PrEP Cliff'), a finding that is robust across groups of PrEP users (e.g., women, men who have sex with men, transwomen) and across global prevention settings. Further, PrEP inequities - by which we refer to utilization of PrEP in a specific group that is not commensurate with their epidemic risk - threaten the overall population benefit of PrEP because those at highest risk of acquiring HIV are not adequately protected. SUMMARY To realize global goals for PrEP utilization and impact, we must address multiple points of PrEP delivery programs that address not just PrEP starts, but also retention in PrEP and measurement and accountability to PrEP equity. We call for new approaches to better identify PrEP candidates, suggest additional research to address the known and consistent reasons for PrEP discontinuations, and advocate for metrics to measure and be accountable to PrEP equity.
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Affiliation(s)
- Patrick Sean Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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24
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Abstract
Supplemental Digital Content is Available in the Text. HIV-1 risk scoring tools could help target provision of prevention modalities such as pre-exposure prophylaxis. Recent research suggests that risk scores for women aged 18–45 may not predict risk well among young women aged 18–24. We evaluated the predictive performance of age-specific risk scores compared with the existing non–age-specific VOICE risk score, developed for women aged 18–45.
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25
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Luz PM, Torres TS, Almeida-Brasil CC, Marins LMS, Veloso VG, Grinsztejn B, Cox J, Moodie EEM. High-Risk Sexual Behavior, Binge Drinking and Use of Stimulants are Key Experiences on the Pathway to High Perceived HIV Risk Among Men Who Have Sex with Men in Brazil. AIDS Behav 2021; 25:748-757. [PMID: 32940826 DOI: 10.1007/s10461-020-03035-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In Brazil, pre-exposure prophylaxis (PrEP) is currently available for gay, bisexual, and other men who have sex with men. As PrEP use depends on an individual's perceived risk, we explored pathways by which potentially modifiable behaviors lead to high perceived HIV risk. Using online surveys (N = 16,667), we conducted a path analysis on the basis of ordered sequences of multivariate logistic regressions. High perceived HIV risk was low (26.3%) compared to condomless receptive anal sex (41.4%). While younger age increased the odds of binge drinking and of condomless receptive anal sex, it was associated with decreased odds of high perceived HIV risk. In contrast, use of stimulants increased the odds of condomless receptive anal sex and of high perceived HIV risk. Our results suggest that binge drinking and use of stimulants are key points in different pathways to high-risk sexual behavior and may lead to different perceptions of HIV risk.
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Affiliation(s)
- Paula M Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil.
| | - Thiago S Torres
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | | | - Luana M S Marins
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Valdilea G Veloso
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365, Manguinhos, Rio de Janeiro, 21040-900, Brazil
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
| | - Erica E M Moodie
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, Canada
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26
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Chakrapani V, Newman PA, Shunmugam M, Rawat S, Baruah D, Nelson R, Roungkraphon S, Tepjan S. PrEP eligibility, HIV risk perception, and willingness to use PrEP among high-risk men who have sex with men in India: A cross-sectional survey. AIDS Care 2021; 34:301-309. [PMID: 33615903 DOI: 10.1080/09540121.2021.1887801] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV pre-exposure prophylaxis (PrEP) is not yet included in India's national AIDS program, with demonstration projects for MSM in planning stages. In order to support PrEP roll-out for MSM, we assessed: (1) associations between guideline-informed PrEP eligibility, HIV risk perception, and perceived PrEP benefits and costs, with willingness to use PrEP (WTUP); and (2) correlates of non-WTUP among PrEP-eligible MSM. Data were collected from MSM (n = 197) sampled from cruising sites in Mumbai and Chennai. More than half (58.4%) reported inconsistent condom use with male partners, 88.3% >1 male partner, and 48.6% engaging in sex work (all past month). Overall, 76.6% reported they would "definitely use" PrEP. Among 92.9% deemed PrEP-eligible, 79.2% reported WTUP. In adjusted analyses, PrEP eligibility (aOR = 5.31, 95% CI 1.11, 25.45), medium (aOR = 2.41, 95% CI 1.03, 5.63) or high (aOR = 13.08, 95% CI 1.29, 132.27) perceived HIV risk, and greater perceived benefits (aOR = 1.13, 95% CI 1.03, 1.24) were associated with higher odds of WTUP. Among PrEP-eligible MSM, non-WTUP was associated with low HIV risk perception and lower perceived benefits. Facilitating accurate risk assessment and promoting awareness of PrEP benefits and eligibility criteria may increase PrEP uptake among MSM in India.
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Affiliation(s)
- Venkatesan Chakrapani
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India.,The Humsafar Trust, Mumbai, India
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Murali Shunmugam
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | | | | | - Ruban Nelson
- Centre for Sexuality and Health Research and Policy (C-SHaRP), Chennai, India
| | - Surachet Roungkraphon
- Faculty of Science and Technology, Rajamangala University of Technology Phra Nakhon, Bangkok, Thailand
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27
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Haldar P, Reza-Paul S, Daniel RA, Lazarus L, Rewari BB, Lorway R, Steen R. A rapid review of pre-exposure prophylaxis for HIV in the Asia-Pacific region: recommendations for scale up and future directions. Sex Health 2021; 18:31-40. [PMID: 33632382 DOI: 10.1071/sh20058] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 01/13/2021] [Indexed: 01/10/2023]
Abstract
Decline in new HIV infections in the Asia-Pacific region (APAC) continues to be slow, emphasising the importance of scaling up new HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). To help inform PrEP rollout in APAC, we conducted a rapid review of published literature on PubMed from 2015 to 2020, to assess feasibility, implementation strategies, cost-effectiveness, and availability of national policies and guidelines; for the latter, we also did an expanded Internet search. This review focussed on nine countries contributing >95% of new infections in this region. A total of 36 PrEP-related studies conducted among men who have sex with men, female sex workers, and transgender women were included, of which 29 were quantitative, six were qualitative and one was a mixed-method study. Most of the studies have addressed the availability and acceptability of PrEP, whereas cost-effectiveness of any approach was assessed by limited studies. Limited published information was available about national PrEP policies and guidelines; of the selected nine countries, five have adopted the recommended World Health Organization PrEP policy of which four have integrated it in their national HIV response. HIV risk perception concerns about safety, side-effects, stigma, and affordability were major challenges to PrEP acceptance. Community-based implementation has the potential to address these. Limited evidence suggested merging PrEP implementation with ongoing targeted intervention and treatment programs could be a cost-effective approach. To stem the epidemic, newer effective prevention strategies, like PrEP, should be urgently adopted within the context of combination HIV prevention approaches.
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Affiliation(s)
- Partha Haldar
- All India Institute of Medical Sciences, Centre for Community Medicine, New Delhi, India
| | - Sushena Reza-Paul
- University of Manitoba, Institute for Global Public Health, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada; and Corresponding author.
| | - Roy Arokiam Daniel
- All India Institute of Medical Sciences, Centre for Community Medicine, New Delhi, India
| | - Lisa Lazarus
- University of Manitoba, Institute for Global Public Health, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - Bharat Bhushan Rewari
- World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Robert Lorway
- University of Manitoba, Institute for Global Public Health, Rady Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - R Steen
- Erasmus Medical Center, Department of Public Health, Rotterdam, Zuid-Holland, Netherlands
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28
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Maksut JL, Eaton LA, Driver R, Knowles CM, Watson. RJ. Factors associated with awareness and use of pre-exposure prophylaxis (PrEP) among Black men who have sex with men with a recent STI diagnosis. Behav Med 2021; 47:161-169. [PMID: 34048328 PMCID: PMC8163996 DOI: 10.1080/08964289.2019.1692776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Black men who have sex with men (BMSM) with a recent STI diagnosis are at particularly high risk for HIV infection and, as such, are a population for whom we must focus our antiretroviral pre-exposure prophylaxis (PrEP) implementation efforts. Understanding the factors that are associated with awareness and use of PrEP among BMSM with a recent STI diagnosis is a critical component of meeting our HIV prevention goals. For the current study, BMSM (N = 209) diagnosed with a STI in the past year residing in the Atlanta, Georgia metropolitan and surrounding areas were assessed on PrEP awareness and use, HIV risk behaviors (e.g., condomless anal intercourse) HIV risk perceptions, HIV treatment optimism, and HIV status communication self-efficacy. BMSM aware of PrEP (n = 152, 72.7%) were younger in age (OR = 0.96, 95% CI: 0.93-0.98, p = 0.030) and had significantly higher educational attainment (OR = 1.96, 95% CI: 1.28-3.02, p = 0.027) than PrEP unaware participants. In addition, participants who were aware of PrEP had significantly higher levels of HIV risk perceptions (OR = 1.27, 95% CI: 1.04-1.56, p = 0.019) than PrEP unaware participants. Finally, participants who had ever used PrEP (n = 15, 7.1%) had significantly higher HIV treatment optimism (OR = 1.55, 95% CI: 1.05-2.96, p = 0.034) than PrEP non-users. The present study showed that, while nearly three-fourths of the sample were PrEP aware, PrEP use among BMSM with STI diagnoses was limited and that PrEP is utilized less often by individuals who have less HIV treatment optimism. These findings call attention to the need to better understand how to effectively target PrEP uptake strategies for key populations.
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Affiliation(s)
- Jessica L. Maksut
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT,Corresponding author. Department of Human Development and Family Studies, University of Connecticut, 348 Mansfield Road, U-1058, Storrs Mansfield, CT 06269-1058. , Fax: (860) 486-3452, Telephone: (207) 590-8207
| | - Lisa A. Eaton
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT,Institute for Collaboration on Health, Intervention, and Policy (InCHIP), University of Connecticut, Storrs Mansfield, CT
| | - Redd Driver
- Department of Psychological Sciences, University of Connecticut, Storrs Mansfield, CT
| | - Cristina M. Knowles
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT
| | - Ryan J. Watson.
- Department of Human Development and Family Studies, University of Connecticut, Storrs Mansfield, CT
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PrEP Use Awareness and Interest Cascade among MSM and Transgender Women Living in Bali, Indonesia. Trop Med Infect Dis 2020; 5:tropicalmed5040158. [PMID: 33050477 PMCID: PMC7709693 DOI: 10.3390/tropicalmed5040158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/06/2020] [Accepted: 10/08/2020] [Indexed: 11/17/2022] Open
Abstract
Indonesia has not implemented HIV pre-exposure prophylaxis (PrEP) despite global calls for its scale-up, and there is limited information about attitudes towards PrEP among its potential users. We aim to present a PrEP cascade among men who have sex with men (MSM) and transgender women (known locally as “waria”) in Denpasar, Bali, from a cross-sectional survey with 220 HIV-negative MSM/waria recruited from one clinic in Denpasar. Only 16.4% of participants had heard of PrEP before. From first-to-last steps included in the cascade, we found 77.3% (170/220) of participants were classified with HIV high risk, 75.9% (129/170) perceived themselves as being at high risk, 81.4% (105/129) expressed interest in using PrEP, 78.1% (82/105) were willing to do PrEP procedures, 48.8% (40/82) were willing to pay 500,000–600,000 IDR, and only two participants had ever been on PrEP before (5.0% of those willing to pay and 0.9% of the total sample). Multivariate logistic regression analysis showed that self-perception of high HIV risk was lower among older age groups (p < 0.001 among 30–39; p = 0.002 among > 40) and higher among participants with multiple sex partners (p = 0.016). Interest in using PrEP was lower among participants with high social engagement as MSM/waria (p = 0.002) and was higher among participants with multiple sex partners (p = 0.020) and inconsistent condom use (p = 0.011). This study has shown a significantly low level of PrEP awareness among its participants and decreases in interest in PrEP use due to procedure and cost. It suggested that an appropriate PrEP campaign is needed if PrEP is going to be introduced in Indonesia.
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Phanuphak N, Ramautarsing R, Chinbunchorn T, Janamnuaysook R, Pengnonyang S, Termvanich K, Chanlearn P, Linjongrat D, Janyam S, Phanuphak P. Implementing a Status-Neutral Approach to HIV in the Asia-Pacific. Curr HIV/AIDS Rep 2020; 17:422-430. [PMID: 32725317 PMCID: PMC7497381 DOI: 10.1007/s11904-020-00516-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Globally, "undetectable equals untransmittable (U=U)" and "pre-exposure prophylaxis (PrEP)" have become crucial elements in HIV treatment and prevention programs. We reviewed the implementation of U=U and PrEP among countries in the Asia-Pacific region. RECENT FINDINGS U=U and PrEP uptakes were limited and slow in the Asia-Pacific. Inadequate knowledge among health care practitioners and pervasive stigma towards individuals living with HIV and their sexual lives are key barriers for the integration of U=U into clinical practice. Paternalistic and hierarchical health care systems are major obstacles in PrEP implementation and scale-up. Countries with the most advanced PrEP implementation all use community-based, nurse-led, and key population-led service delivery models. To advance U=U and PrEP in the Asia-Pacific, strategies targeting changes to practice norm through wide-scale stakeholders' training and education, making use of online health care professional influencers, and utilizing financial mechanism should be further explored through implementation research.
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Affiliation(s)
- Nittaya Phanuphak
- Institute of HIV Research and Innovation, 319 Phayathai Road, Pathumwan, Bangkok, 10330 Thailand
| | - Reshmie Ramautarsing
- Institute of HIV Research and Innovation, 319 Phayathai Road, Pathumwan, Bangkok, 10330 Thailand
| | - Tanat Chinbunchorn
- Institute of HIV Research and Innovation, 319 Phayathai Road, Pathumwan, Bangkok, 10330 Thailand
| | - Rena Janamnuaysook
- Institute of HIV Research and Innovation, 319 Phayathai Road, Pathumwan, Bangkok, 10330 Thailand
| | - Supabhorn Pengnonyang
- Institute of HIV Research and Innovation, 319 Phayathai Road, Pathumwan, Bangkok, 10330 Thailand
| | - Krittaporn Termvanich
- Institute of HIV Research and Innovation, 319 Phayathai Road, Pathumwan, Bangkok, 10330 Thailand
| | - Pongthorn Chanlearn
- Mplus Foundation, 142 Chiang Mai Hod Road, Muang, Chiang Mai, 50200 Thailand
| | - Danai Linjongrat
- Rainbow Sky Association of Thailand, 1 and 3 Ramkhamhaeng Road, Bangkapi, Bangkok, 10240 Thailand
| | - Surang Janyam
- Service Workers in Group Foundation, Surawong Road, Bangrak, Bangkok, 10500 Thailand
| | - Praphan Phanuphak
- Thai Red Cross AIDS Research Centre, 104 Rajdumri Road, Pathumwan, Bangkok, 10330 Thailand
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Lau JYC, Hung C, Lee S. A review of HIV pre-exposure prophylaxis (PrEP) programmes by delivery models in the Asia-Pacific through the healthcare accessibility framework. J Int AIDS Soc 2020; 23:e25531. [PMID: 32603517 PMCID: PMC7326464 DOI: 10.1002/jia2.25531] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/07/2020] [Accepted: 04/27/2020] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION In the Asia-Pacific, pre-exposure prophylaxis (PrEP) is a newly introduced public health intervention for minimizing HIV transmission, the coverage of which has remained limited. The best delivery models and strategies for broadening access of the vulnerable communities are not fully known. This review identified PrEP programmes reported in the Asia-Pacific, which were classified by delivery models and assessed with a healthcare accessibility framework. METHODS We performed a literature search on PubMed and Ovid MEDLINE using relevant search terms, manual searched grey literature by visiting relevant websites, examined reference lists and contacted authors for clarification of included PrEP programmes reported through July 2019. A structured table was used for data extraction and summarizing findings in accordance with the five constructs of approachability, acceptability, availability, affordability and appropriateness grounded in the conceptual framework of Healthcare Accessibility. RESULTS AND DISCUSSION This literature search yielded a total of 1308 publications; 119 full texts and abstracts were screened, and 24 publications were included in the review. We identified 11 programmes implemented in seven cities/countries in the Asia-Pacific. A typology of four PrEP delivery models was delineated: (a) fee-based public service model; (b) fee-based community setting model; (c) free public service model; and (d) free community setting model. Overall, the free community setting model was most commonly adopted in the Asia-Pacific, with the strength to boost the capacity of facility and human resources, which enhanced "approachability", "availability" and "acceptability." The free public service model was characterized by components designed in improving "approachability," "availability" and "appropriateness," with attention on equity in accessing PrEP. Among free-based models, long-term affordability both to the government and PrEP users would need to be maximized to increase accessibility. Alongside the need for raising awareness, supportive environments and ensuring timely access were means for enabling the development of a sustainable PrEP service. CONCLUSION PrEP programmes could be classified by delivery models through the five constructs of healthcare accessibility. While the coverage of PrEP remains limited in the Asia-Pacific, an evaluation of these models could benchmark best practices, which would in turn allow effective models to be designed.
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Affiliation(s)
- Janice YC Lau
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongHong KongPeople’s Republic of China
| | - Chi‐Tim Hung
- JC School of Public Health and Primary CareThe Chinese University of Hong KongHong KongPeople’s Republic of China
| | - Shui‐Shan Lee
- Stanley Ho Centre for Emerging Infectious DiseasesThe Chinese University of Hong KongHong KongPeople’s Republic of China
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Seekaew P, Pengnonyang S, Jantarapakde J, Meksena R, Sungsing T, Lujintanon S, Mingkwanrungruangkit P, Sirisakyot W, Tongmuang S, Panpet P, Sumalu S, Potasin P, Kantasaw S, Patpeerapong P, Mills S, Avery M, Chareonying S, Phanuphak P, Vannaki R, Phanuphak N. Discordance between self-perceived and actual risk of HIV infection among men who have sex with men and transgender women in Thailand: a cross-sectional assessment. J Int AIDS Soc 2019; 22:e25430. [PMID: 31855324 PMCID: PMC6922021 DOI: 10.1002/jia2.25430] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 11/14/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Low uptake of HIV testing and services, including pre-exposure prophylaxis (PrEP), in Thai men who have sex with men (MSM) and transgender women (TGW) may be due to the inaccuracy in self-risk assessment. This study investigated the discordance between self-perceived HIV risk and actual risk. METHODS Data were obtained between May 2015 and October 2016 from MSM and TGW enrolled in key population-led Test and Treat study in six community health centres in Thailand. Eligible participants were at least 18 years old, Thai national, had sex with men, had unprotected sex with a man in the past six months or had at least three male sex partners in the past six months, and were not known to be HIV positive. Baseline demographic behavioural characteristics questionnaires, including self-perceived HIV risk, were self-administered. Participants received HIV/STI (syphilis/gonorrhoea/chlamydia) testing at baseline. Participants who self-perceived to have low risk, but engaged in HIV-susceptible practices were categorized as having risk discordance (RD). Regression was conducted to assess factors associated with RD among MSM and TGW separately. RESULTS Of the 882 MSM and 406 TGW participants who perceived themselves as having low HIV risk, over 80% reported at least one of the following: tested HIV positive, engaged in condomless sex, tested positive for a sexually transmitted infection sexually transmitted infection (STI; or used amphetamine-type stimulants. Logistic regression found that living with a male partner (p = 0.005), having never tested for HIV (p = 0.045), and living in Bangkok (p = 0.01) and Chiang Mai (p < 0.001) were associated with increased risk discordance among MSM. Living with a male partner (p = 0.002), being less than 17 years old at sexual debut (p = 0.001), and having a low knowledge score about HIV transmission (p < 0.001) were associated with increased risk discordance among TGW. However, for TGW, being a sex worker decreased the chance of risk discordance (p = 0.034). CONCLUSIONS Future HIV prevention messages need to fill in the gap between self-perceived risk and actual risk in order to help HIV-vulnerable populations understand their risk better and proactively seek HIV prevention services.
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Affiliation(s)
- Pich Seekaew
- PREVENTIONThai Red Cross AIDS Research CentreBangkokThailand
- Department of EpidemiologyMailman School of Public HealthColumbia UniversityNew YorkNYUSA
| | | | | | | | | | - Sita Lujintanon
- PREVENTIONThai Red Cross AIDS Research CentreBangkokThailand
| | | | | | | | | | - Saman Sumalu
- The Service Workers in Group FoundationBangkokThailand
| | | | | | | | | | | | | | | | - Ravipa Vannaki
- Office of Public HealthU.S. Agency for International Development Regional Development Mission AsiaBangkokThailand
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Tugume L, Muwonge TR, Joloba EN, Isunju JB, Kiweewa FM. Perceived risk versus objectively measured risk of HIV acquisition: a cross-sectional study among HIV-negative individuals in Serodiscordant partnerships with clients attending an Urban Clinic in Uganda. BMC Public Health 2019; 19:1591. [PMID: 31783826 PMCID: PMC6884744 DOI: 10.1186/s12889-019-7929-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 11/08/2019] [Indexed: 01/13/2023] Open
Abstract
Background Acceptability of Pre-exposure Prophylaxis (PrEP) could be hampered by low self-perceived risk for HIV acquisition. Moreover, discordance between risk perception and actual risk of HIV acquisition is likely to occur. We assessed congruence between the level of self- perceived and that of objectively scored risk of HIV acquisition among HIV-negative individuals in discordant relationships. Methods This was a cross-sectional study among a representative sample of HIV-negative adult males and females whose partners were receiving antiretroviral therapy for at least 3 months from the Infectious Diseases Institute Clinic in Kampala, Uganda. Perceived risk was measured based on self-report using a numerical rating scale whereas objective risk was measured using a validated risk score tool. Congruence between perceived risk and objectively scored risk was evaluated using descriptive statistics and validity measures. Incongruence between the two phenomena was further evaluated using univariate and multivariate regression analyses. Results HIV-negative partners evaluated in this study were mostly male (64%) with a median age of 41 years (IQR 35 to 50). Majority (76.3%) of the partners perceived themselves as low risk for HIV acquisition. Similarly, most (93.8%) were objectively scored as low risk. However, nearly three quarters (72.7%) of partners who were objectively scored as high risk perceived themselves as being at low risk and all were men. The sensitivity and specificity of perceived risk for detecting the objectively measured risk was 27.3 and 76.5% respectively; area under ROC curve = 0.52; 95%CI (0.38, 0.66). The proportion of participants at high risk of HIV acquisition who perceived their risk as low was greater among those whose partners had detectable viral load compared to participants whose partners had undetectable viral load (PR = 0.51; 95%CI 0.29 to 0.90). Conclusion Incongruence between perceived and objectively measured risk of HIV acquisition does occur especially among individuals whose partners had a detectable viral load. PrEP counselling for serodiscordant couples should focus on explaining the consequence of detectable viral load in the HIV-positive partner on HIV transmission risk.
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Affiliation(s)
- Lillian Tugume
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda. .,Infectious Diseases Institute, Makerere University, Kampala, Uganda.
| | | | - Edith Nakku Joloba
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - John Bosco Isunju
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Flavia Matovu Kiweewa
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.,Makerere University- John Hopkins University Research Collaboration, Kampala, Uganda
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Patterns and Correlates of Participant Retention in a Multi-City Pre-Exposure Prophylaxis Demonstration Project. J Acquir Immune Defic Syndr 2019; 79:62-69. [PMID: 29771790 DOI: 10.1097/qai.0000000000001724] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Safe and effective use of pre-exposure prophylaxis (PrEP) depends on retention in care after initial engagement. SETTING The United States PrEP Demonstration Project offered daily oral tenofovir/emtricitabine to participants in San Francisco, Miami, and Washington, D.C. for 48 weeks from 2012 to 2014. METHODS The Demo Project participants' patterns of retention were assigned to 1 of 3 categories: early loss to follow-up (ELTF) within the first 12 weeks of the study, retention throughout the study, or intermittent retention in which missed or delayed visits resulted in gaps in medication availability. For each group, baseline characteristics were tabulated. A two-step multivariable analysis was performed. RESULTS Overall, 366/554 (66.1%) of enrolled participants were retained for all study visits, 127/554 (22.9%) had intermittent retention, and 61/554 (11.0%) ELTF. In multivariable analysis, Miami compared with San Francisco site was associated with ELTF rather than full retention [aOR 2.84; confidence interval (CI): 1.24 to 6.47] and also with intermittent rather than full retention (aOR 2.70; CI: 1.43 to 5.11). Younger age was associated with ELTF (aOR 1.80 for each 10-year decrement in age; CI: 1.26 to 2.57) and intermittent retention (aOR 1.47; CI: 1.17 to 1.84) compared with full retention. Factors associated with ELTF (but not intermittent retention) compared with full retention were black compared with white (aOR 3.32; CI: 1.09 to 10.16), reporting sex work (aOR 4.67; CI: 1.49 to 14.58), lack of regular employment (aOR 2.53; CI: 1.27 to 5.05), and lack of previous PrEP awareness (aOR 2.01; CI: 1.01 to 3.96). CONCLUSIONS Tailored interventions addressing causes and risk factors for loss from PrEP care may improve retention and consistency of PrEP use.
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Xie L, Wu Y, Meng S, Hou J, Fu R, Zheng H, He N, Wang M, Meyers K. Risk Behavior Not Associated with Self-Perception of PrEP Candidacy: Implications for Designing PrEP Services. AIDS Behav 2019; 23:2784-2794. [PMID: 31280397 PMCID: PMC7232689 DOI: 10.1007/s10461-019-02587-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In a study of sexually-active HIV-negative men who have sex with men (MSM) in China, we compared behavioral indication for pre-exposure prophylaxis (PrEP) based on risk criteria to self-perception of PrEP candidacy (SPC) and explored factors associated with SPC. Of 708 MSM surveyed, 323 (45.6%) were behaviorally-indicated for PrEP, among whom 42.1% self-perceived as appropriate PrEP candidates. In a multivariable model we found no association between sexual behavior nor HIV risk perception and SPC but found that higher perceived benefits of PrEP, increased frequency of HIV testing, and low condom use self-efficacy were positively-associated with SPC. In a sub-analysis restricted to MSM behaviorally-indicated for PrEP, relationship-factors were also significant. Our findings suggest that PrEP implementers should look beyond risk criteria to consider shared decision-making tools that support individuals to assess whether they are appropriate PrEP candidates based on their existing HIV prevention strategies, sexual health goals, and relationship dynamics.
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Affiliation(s)
- Lu Xie
- Institute of HIV/AIDS, The First Hospital of Changsha, Changsha, Hunan, China
| | - Yumeng Wu
- Aaron Diamond AIDS Research Center, The Rockefeller University, 455 First Avenue, Floor 7, New York, NY, 10016, USA
| | - Siyan Meng
- School of Public Health, Fudan University, Shanghai, China
| | - Jianhua Hou
- Center for Infectious Diseases, Beijing You'an Hospital, Capital Medical University, Beijing, China
| | - Rong Fu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | | | - Na He
- School of Public Health, Fudan University, Shanghai, China
| | - Min Wang
- Institute of HIV/AIDS, The First Hospital of Changsha, Changsha, Hunan, China
| | - Kathrine Meyers
- Aaron Diamond AIDS Research Center, The Rockefeller University, 455 First Avenue, Floor 7, New York, NY, 10016, USA.
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Contreras-Yáñez I, Lavielle P, Clark P, Pascual-Ramos V. Validation of a risk perception questionnaire developed for patients with rheumatoid arthritis. PLoS One 2019; 14:e0219921. [PMID: 31329625 PMCID: PMC6645517 DOI: 10.1371/journal.pone.0219921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/04/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Risk perception is a multidimensional phenomenon that describes the individual's judgment of the likelihood of experiencing something unpleasant. Risk perception helps to understand how rheumatoid arthritis patients perceive disease-related-risks. We developed and validated a risk perception questionnaire for Spanish speaking rheumatoid arthritis patients. METHODS The questionnaire development and validation was performed in 3 steps, using respective convenience samples. Step-1 included the conceptual model construction, 20 patient's interviews to identify components from the conceptual model-dimensions and 11 healthcare provider´s consultations who identified RA related manifestations/complications (network and frequencies analysis). Step-2 consisted of item generation and reduction and questionnaire feasibility (n = 100). Step-3 consisted of the questionnaire psychometric validation (n = 270), which included content, face, construct (exploratory factor analysis) and criterion validity (logistic regression analysis) and consistency and stability (Cronbach's α and test-retest). RESULTS Samples were representative of typical RA outpatients. Initial conceptual model included 7 dimensions, 3 for probability and 1 each, for responsibility, prevention, control and for severity (Step-1). The final version was considered feasible by the patients and included 27 items (Step-2). A five-factor model was most appropriated and resulted in 68.8% of the variance explained: Cronbach's α = 0.90, intraclass-correlation-coefficient = 0.93 (95% CI = 0.90-0.95). A positive relation between number of external criteria from the charts and risk perception was found; all items had ≥80% agreement from experts; patients agreed about item´s semantic clarity (89%) and format adequacy (97%), (Step-3). CONCLUSIONS The risk perception questionnaire was valid and reliable to evaluate risk perception construct in RA outpatients; it can be incorporated to routine care and clinical research, and guide interventions to improve patient's health behaviors.
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Affiliation(s)
- Irazú Contreras-Yáñez
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Pilar Lavielle
- Research Unit in Clinical Epidemiology, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Patricia Clark
- Clinical Epidemiology Unit, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
- Medicine Faculty, Universidad Nacional Autónoma de Mexico, Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Immunology and Rheumatology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Yi S, Plant A, Tuot S, Mun P, Chhim S, Chann N, Chhoun P, Brody C. Factors associated with condom use with non-commercial partners among sexually-active transgender women in Cambodia: findings from a national survey using respondent-driven sampling. BMC Public Health 2019; 19:326. [PMID: 30894165 PMCID: PMC6427883 DOI: 10.1186/s12889-019-6656-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 03/14/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, the prevalence of HIV among transgender women is much higher than that of the general adult population. This can be explained by the persistently low rate of consistent condom use among this population. This study was therefore conducted to explore factors associated with consistent condom use among sexually-active transgender women in Cambodia, specifically with their non-commercial partners. METHODS Data used for this study were collected as part of the National Integrated Biological and Behavioral Survey 2016. Participants were recruited from the capital city of Phnom Penh and 12 other provinces with high burden of HIV using the Respondent-Driven Sampling (RDS) method. Face-to-face interviews were conducted using a structured questionnaire. Weighted multivariate logistic regression analysis was conducted to explore independent factors associated with consistent condom use. RESULTS This study included 1202 transgender women who reported having anal sex with at least one male partner not in exchange for money or gifts in the past three months. The mean age of the participants was 26.0 (SD = 7.0) years. Of the total, 41.5% reported always using condoms with male non-commercial partners in the past three months. After adjustment, the likelihood of consistent condom use was significantly higher among participants who resided in an urban community (AOR = 1.7, 95% CI = 1.1-2.6), had attained at least 10 years of formal education (AOR = 1.8, 95% CI = 1.2-2.7), perceived that they were likely or very likely to be HIV infected (AOR = 2.9, 95% CI = 2.0-4.1), reported drinking alcohol two to three times per week (AOR = 3.1, 95% CI = 1.1-8.3), reported using amphetamine-type stimulants (AOR = 1.9, 95% = 1.1-3.8) or other drugs (AOR = 7.6, 95% CI = 1.5-39.5), and reported inconsistent condom use with male commercial partners in the past three months (AOR = 4.3, 95% CI = 1.8-10.4) compared to that of their respective reference group. CONCLUSIONS This study confirms the low rates of condom use, particularly in non-commercial relationship, among transgender women in Cambodia. To address these concerns, efforts towards education about effects of multiple, concurrent relationships, and inconsistent condom use should be reinforced among transgender women.
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Affiliation(s)
- Siyan Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore. .,KHANA Center for Population Health Research, Phnom Penh, Cambodia. .,Center for Global Health Research, Touro University California, Vallejo, USA.
| | - Amelia Plant
- Reproductive Rights and Programming Consultant, Cairo, Egypt
| | - Sovannary Tuot
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Phalkun Mun
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | | | - Navy Chann
- National Center for HIV/AIDS, Dermatology and STD, Phnom Penh, Cambodia
| | - Pheak Chhoun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Carinne Brody
- Center for Global Health Research, Touro University California, Vallejo, USA
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Chuang DM, Newman PA. Pre-Exposure Prophylaxis (PrEP) Awareness and Acceptability Among Men Who Have Sex With Men in Taiwan. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2018; 30:490-501. [PMID: 30966765 DOI: 10.1521/aeap.2018.30.6.490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Gay and other men who have sex with men (MSM) account for the vast majority of new HIV infections in Taiwan, yet utilization of pre-exposure prophylaxis (PrEP) remains low. We examined correlates of PrEP awareness and acceptability among MSM in Taiwan. A cross-sectional survey was conducted with 176 MSM (mean age = 27.4 years) recruited through community-based organizations in two cities. Less than half of participants (47.2%) were aware of PrEP; however, when it was described to them, the majority (72.2%) indicated PrEP acceptability. In multivariable analyses, condomless anal sex was negatively associated with PrEP awareness, and higher levels of vicarious stigma and anticipated PrEP disclosure to sexual partners were positively associated with PrEP acceptability. Our findings indicate the need for targeted interventions to increase PrEP awareness among MSM engaged in high-risk behaviors and implementation strategies that address sociocultural factors to accelerate PrEP utilization among MSM in Taiwan.
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Affiliation(s)
| | - Peter A Newman
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
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Pintye J, Beima-Sofie KM, Makabong'O PA, Njoroge A, Trinidad SB, Heffron RA, Baeten JM, Celum C, Matemo D, Kinuthia J, Kelley MC, John-Stewart GC. HIV-Uninfected Kenyan Adolescent and Young Women Share Perspectives on Using Pre-Exposure Prophylaxis During Pregnancy. AIDS Patient Care STDS 2018; 32:538-544. [PMID: 30036072 DOI: 10.1089/apc.2018.0058] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
To optimize scale-up of pre-exposure prophylaxis (PrEP) for pregnant women at risk of HIV in high HIV burden settings, implementation strategies must be developed that account for perceptions of PrEP in this unique population. Semistructured focus group discussions were conducted with 68 HIV-uninfected Kenyan pregnant and postpartum women without prior PrEP knowledge or experience. A qualitative descriptive analysis was performed, using a constant comparison approach, to identify key themes related to the values and rationale impacting potential PrEP use in pregnancy. Median age was 19.5 years and participants were either pregnant or had 1-2 children. Almost all (96%) were married or had a steady partner. Women felt pregnancy was a time of high HIV risk because they desired sex less frequently, which may lead their partners to have outside partnerships. This made PrEP an attractive HIV prevention option for themselves and their infants. Although women believed male partner behaviors influenced their HIV risk, many women perceived that male partners would react negatively, including becoming physically violent, if they discovered that women used PrEP. Clinicians were identified as potential facilitators of PrEP use who could explain PrEP to male partners on behalf of pregnant women. Women said that community-level stigma against HIV and potential for conflating PrEP with antiretroviral therapy (ART) would necessitate that PrEP use be discreet. Our results indicate the importance of addressing risk perception of women, concerns of male partners, HIV stigma, and benefits of PrEP for HIV prevention as programs are developed for pregnant women.
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Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Nursing, University of Washington, Seattle, Washington
| | | | | | - Anne Njoroge
- Department of Global Health, University of Washington, Seattle, Washington
| | - Susan Brown Trinidad
- Department of Bioethics and Humanities, University of Washington, Seattle, Washington
| | - Renee A. Heffron
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | | | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, Washington
- Kenyatta National Hospital, Nairobi, Kenya
| | - Maureen C. Kelley
- Nuffield Department of Population Health, The Ethox Center and Wellcome Center for Ethics and Humanities, University of Oxford, Oxford, United Kingdom
| | - Grace C. John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
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40
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Biello KB, Bazzi AR, Mimiaga MJ, Biancarelli DL, Edeza A, Salhaney P, Childs E, Drainoni ML. Perspectives on HIV pre-exposure prophylaxis (PrEP) utilization and related intervention needs among people who inject drugs. Harm Reduct J 2018; 15:55. [PMID: 30419926 PMCID: PMC6233595 DOI: 10.1186/s12954-018-0263-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/30/2018] [Indexed: 12/21/2022] Open
Abstract
Background Antiretroviral pre-exposure prophylaxis (PrEP) is clinically efficacious and recommended for HIV prevention among people who inject drugs (PWID), but uptake remains low and intervention needs are understudied. To inform the development of PrEP interventions for PWID, we conducted a qualitative study in the Northeastern USA, a region where recent clusters of new HIV infections have been attributed to injection drug use. Methods We conducted qualitative interviews with 33 HIV-uninfected PWID (hereafter, “participants”) and 12 clinical and social service providers (professional “key informants”) in Boston, MA, and Providence, RI, in 2017. Trained interviewers used semi-structured interviews to explore PrEP acceptability and perceived barriers to use. Thematic analysis of coded data identified multilevel barriers to PrEP use among PWID and related intervention strategies. Results Among PWID participants (n = 33, 55% male), interest in PrEP was high, but both participants and professional key informants (n = 12) described barriers to PrEP utilization that occurred at one or more socioecological levels. Individual-level barriers included low PrEP knowledge and limited HIV risk perception, concerns about PrEP side effects, and competing health priorities and needs due to drug use and dependence. Interpersonal-level barriers included negative experiences with healthcare providers and HIV-related stigma within social networks. Clinical barriers included poor infrastructure and capacity for PrEP delivery to PWID, and structural barriers related to homelessness, criminal justice system involvement, and lack of money or identification to get prescriptions. Participants and key informants provided some suggestions for strategies to address these multilevel barriers and better facilitate PrEP delivery to PWID. Conclusions In addition to some of the facilitators of PrEP use identified by participants and key informants, we drew on our key findings and behavioral change theory to propose additional intervention targets. In particular, to help address the multilevel barriers to PrEP uptake and adherence, we discuss ways that interventions could target information, self-regulation and self-efficacy, social support, and environmental change. PrEP is clinically efficacious and has been recommended for PWID; thus, development and testing of strategies to improve PrEP delivery to this high-risk and socially marginalized population are needed.
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Affiliation(s)
- K B Biello
- Departments of Behavioral and Social Sciences and Epidemiology, Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA. .,Center for Health Equity Research, Brown University, Providence, RI, USA. .,The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - A R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
| | - M J Mimiaga
- Departments of Behavioral and Social Sciences and Epidemiology, Center for Health Equity Research, Brown University School of Public Health, Box G-S121-8, Providence, RI, 02912, USA.,Center for Health Equity Research, Brown University, Providence, RI, USA.,The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry and Human Behavior, Brown University Alpert Medical School, Providence, RI, USA
| | - D L Biancarelli
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - A Edeza
- Center for Health Equity Research, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - P Salhaney
- Center for Health Equity Research, Brown University, Providence, RI, USA.,Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - E Childs
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA
| | - M L Drainoni
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.,Evans Center for Implementation and Improvement Sciences, Boston University School of Medicine, Boston, MA, USA.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA
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41
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Phanuphak N, Phanuphak P. Time to focus more on condomless anal sex in non-PrEP users. Lancet HIV 2018; 5:e410-e411. [PMID: 29885814 DOI: 10.1016/s2352-3018(18)30100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 05/02/2018] [Indexed: 10/14/2022]
Affiliation(s)
- Nittaya Phanuphak
- PREVENTION, the Thai Red Cross AIDS Research Centre, Bangkok, Thailand.
| | - Praphan Phanuphak
- PREVENTION, the Thai Red Cross AIDS Research Centre, Bangkok, Thailand
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