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Mars S, Ondocsin J, Koester KA, Mars V, Mars G, Ciccarone D. "I Heard of PrEP-I Didn't Think I Needed it." Understanding the Formation of HIV Risk Perception Among People Who Inject Drugs. Cult Med Psychiatry 2024:10.1007/s11013-024-09870-8. [PMID: 39007986 DOI: 10.1007/s11013-024-09870-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2024] [Indexed: 07/16/2024]
Abstract
Uptake of pre-exposure prophylaxis medication (PrEP) to prevent HIV among people who inject drugs (PWID) remains extremely low in the United States. West Virginia's rising HIV incidence and highest drug overdose rate in the nation makes it an important locus for opioid use and HIV risk interaction. In this pilot study we pioneered the use of Cultural Theory among PWID to understand HIV-related risk perception arising from four contrasting modes of social organization. Carried out during an HIV outbreak, we explored PrEP uptake qualitatively as a window onto risk perception. Of the 26 interviewees, 18 were HIV- and despite the medication's free availability from the health center where recruitment took place, none had taken PrEP, half considering they were not at risk. Intimate couples who showed characteristics of 'enclaves' considered the boundary around themselves protective against HIV, creating a safe space or 'invisible risk group'. Higher HIV risk was perceived among those who were housed compared to those living homeless. Beliefs about the causation of the local HIV outbreak and the validity of scientific research corresponded with characteristics of the contrasting modes of social organization and the approach is promising for informing public health interventions among PWID.
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Affiliation(s)
- Sarah Mars
- Department of Family and Community Medicine, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA.
| | - Jeff Ondocsin
- Department of Family and Community Medicine, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
| | - Kimberly A Koester
- Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St, San Francisco, CA, 94158, USA
| | - Valerie Mars
- Department of Anthropology (Honorary), University College London, Gower St, London, WC1E 6BT, UK
| | - Gerald Mars
- Department of Anthropology (Honorary), University College London, Gower St, London, WC1E 6BT, UK
| | - Daniel Ciccarone
- Department of Family and Community Medicine, University of California, San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA
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Wyatt GE, Norwood-Scott E, Cooley-Strickland M, Zhang M, Smith-Clapham A, Jordan W, Liu H, Hamilton AB. Increasing Urban African American Women's Readiness for Pre-exposure Prophylaxis: A Pilot Study of the Women Prepping for PrEp Plus Program (WP3+). Womens Health Issues 2024; 34:241-249. [PMID: 38267337 DOI: 10.1016/j.whi.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 10/20/2023] [Accepted: 11/03/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND African American women are disproportionately at risk for HIV infection. To increase women's readiness to consider taking pre-exposure prophylaxis (PrEP), we conducted a pilot study of Women Prepping for PrEP Plus (WP3+). Adapted from an evidence-based HIV risk reduction intervention for African American couples who are HIV-serodiscordant, WP3+ is a group-based culturally congruent program designed for African American women without HIV. METHODS Women were screened for eligibility; if eligible, they were invited to participate in the four-session WP3+ group. Participants completed surveys at baseline (n = 47) and post-implementation (n = 28); surveys assessed demographics, HIV and PrEP knowledge, depression and posttraumatic stress (PTS) symptoms, substance use, sexual risk behaviors, health care-related discrimination, and social support. In a process evaluation, a subset of women completed qualitative interviews at baseline (n = 35) and post-implementation (n = 18); the interviews were designed to converge with (e.g., on HIV and PrEP knowledge) and expand upon (e.g., unmeasured perceived impacts of WP3+) quantitative measures. To triangulate with the quantitative data, deductive qualitative analysis concentrated on women's knowledge and awareness of PrEP and HIV, their relationship dynamics and challenges, and their considerations (e.g., barriers, facilitators) related to taking PrEP; inductive analysis focused on women's experiences in the intervention. RESULTS Participants in the WP3+ intervention reported: improved proportion of condom use in the past 90 days (p < .01) and in a typical week (p < .05); reduced PTS symptoms (p < .05); increased HIV knowledge (p < .0001) and awareness of PrEP (p < .001); and greater consideration of using PrEP (p < .001). In interviews, participants expressed not only increased knowledge but also appreciation for learning how to protect themselves against HIV, communicate with their partners, and take charge of their health, and they expressed greater receptiveness to using PrEP as a result of the knowledge and skills they gained. CONCLUSIONS The WP3+ pilot study demonstrated preliminary efficacy and acceptability as an HIV-prevention program for African American women. A controlled trial is needed to confirm its efficacy for increasing PrEP use among African American women.
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Affiliation(s)
- Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California.
| | - Enricka Norwood-Scott
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Michele Cooley-Strickland
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Muyu Zhang
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Amber Smith-Clapham
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California
| | - Wilbert Jordan
- Charles R. Drew University/OASIS Clinic, Los Angeles, California
| | - Honghu Liu
- Section of Public and Population Health, School of Dentistry, University of California Los Angeles, Los Angeles, California; Departments of Biostatistics and Medicine, University of California Los Angeles, Los Angeles, California
| | - Alison B Hamilton
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California; Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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Shankaran S, Friedman EE, Devlin S, Kishen E, Mason JA, Sha BE, Payne D, Sinchek K, Smiley N, York S, Ridgway JP. Assessing Patient Acceptance of an Automated Algorithm to Identify Ciswomen for HIV Pre-Exposure Prophylaxis. J Womens Health (Larchmt) 2024; 33:505-514. [PMID: 38335447 PMCID: PMC11238832 DOI: 10.1089/jwh.2023.0491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2024] Open
Abstract
The use of HIV pre-exposure prophylaxis (PrEP) in cisgender women (ciswomen) lags far behind their need. Data elements from the electronic medical record (EMR), including diagnosis of a sexually transmitted infection (STI), can be incorporated into automated algorithms for identifying clients who are most vulnerable to HIV and would benefit from PrEP. However, it is unknown how women feel about the use of such technology. In this study, we assessed women's attitudes and opinions about an automated EMR-based HIV risk algorithm and determined if their perspectives varied by level of HIV risk. Respondents were identified using best practice alerts or referral to a clinic for STI symptoms from January to December 2021 in Chicago, IL. Participants were asked about HIV risk factors, their self-perceived HIV risk, and their thoughts regarding an algorithm to identify ciswomen who could benefit from PrEP. Most of the 112 women who completed the survey (85%) thought they were at low risk for HIV, despite high rates of STI diagnoses. The majority were comfortable with the use of this algorithm, but their comfort level dropped when asked about the algorithm identifying them specifically. Ciswomen had mixed feelings about the use of an automated HIV risk algorithm, citing it as a potentially helpful and empowering tool for women, yet raising concerns about invasion of privacy and potential racial bias. Clinics must balance the benefits of using an EMR-based algorithm for ciswomen with their concerns about privacy and bias to improve PrEP uptake among particularly vulnerable women.
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Affiliation(s)
- Shivanjali Shankaran
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Eleanor E. Friedman
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Samantha Devlin
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Ekta Kishen
- Rush Research Informatics Core, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph A. Mason
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Beverly E. Sha
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Darjai Payne
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Katherine Sinchek
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Natali Smiley
- Division of Infectious Diseases, Rush University Medical Center, Chicago, Illinois, USA
| | - Sloane York
- Department of Obstetrics and Gynecology, Rush University Medical Center, Chicago, Illinois, USA
| | - Jessica P. Ridgway
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, Chicago, Illinois, USA
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4
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Sheth AN, Dixon Diallo D, Ellison C, Er DL, Ntukogu A, Komro KA, Sales JM. Applying an Evidence-Based Community Organizing Approach to Strengthen HIV Prevention for Cisgender Women in US South: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e56293. [PMID: 38517456 PMCID: PMC10998174 DOI: 10.2196/56293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/19/2024] [Accepted: 02/23/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Most new HIV diagnoses among cisgender women in the United States occur in the South. HIV pre-exposure prophylaxis (PrEP), a cornerstone of the federal Ending the HIV Epidemic (EHE) initiative, remains underused by cisgender women who may benefit. Awareness and access to PrEP remain low among cisgender women. Moreover, improving PrEP reach among cisgender women requires effectively engaging communities in the development of appropriate and acceptable patient-centered PrEP care approaches to support uptake. In a community-clinic-academic collaboration, this protocol applies an evidence-based community organizing approach (COA) to increase PrEP awareness and reach among cisgender women in Atlanta. OBJECTIVE The aim of this study is to use and evaluate a COA for engaging community members across 4 Atlanta counties with high-priority EHE designation, to increase PrEP awareness, interest, and connection to PrEP care among cisgender women. METHODS The COA, consisting of 6 stages, will systematically develop the skills of community members to become leaders and advocates for HIV prevention inclusive of PrEP for cisgender women in their communities. We will use the evidence-based COA to develop and implement a PrEP-specific action plan to create broader community change by raising awareness and interest in PrEP, reducing stigma associated with HIV or PrEP, and connecting women to sexual health clinics providing PrEP services. In the first 4 stages, to prepare for and develop action plans, we will gather data from one-on-one interviews with up to 100 individuals across Atlanta to capture attitudes, motivations, and influences related to women's sexual health with a focus on HIV prevention and PrEP. Informed by the community interviews, we will revise a sexual health curriculum inclusive of PrEP and community-centered engagement. We will then recruit and train community action team members to develop action plans to implement the curriculum during community-located events. In the last 2 stages, we will implement and evaluate COA's effect on PrEP awareness, interest, HIV or PrEP stigma, and connection to PrEP care among cisgender women community members. RESULTS This project was funded by the National Institutes of Health and approved by the Emory University institutional review board in July 2021. Data collection began in December 2021 and is ongoing. COA stage 1 of the study is complete with 70 participants enrolled. Community events commenced in November 2023, and data collection will be completed by November 2025. Stage 1 qualitative data analysis is complete with results to be published in 2024. Full study results are anticipated to be reported in 2026. CONCLUSIONS Through a community-clinic-academic collaboration, this protocol proposes to mount a coordinated approach across diverse Atlanta counties to strengthen HIV prevention for cisgender women and to create a sustainable systems approach to move new sexual health innovations more quickly to cisgender women. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/56293.
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Affiliation(s)
- Anandi N Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Ponce de Leon Center, Grady Health System, Atlanta, GA, United States
| | | | - Celeste Ellison
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Deja L Er
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Kelli A Komro
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - Jessica M Sales
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States
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Clement ME, Perry B, McKenna K, Beckford J, Davenport T, Murray E, Magee V, Bickham JN, Siren J, Smith A, Lillis R, Corneli A. Identifying Implementation Strategies to Enhance HIV Pre-Exposure Prophylaxis Uptake Among Black Cisgender Women in New Orleans, Louisiana. AIDS Patient Care STDS 2024; 38:144-150. [PMID: 38471093 PMCID: PMC10956506 DOI: 10.1089/apc.2023.0300] [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] [Indexed: 03/14/2024] Open
Abstract
There is an unmet need for HIV prevention among Black cisgender women. From January to November 2020, we conducted formative research to develop locally informed implementation strategies to enhance pre-exposure prophylaxis (PrEP) uptake among Black cisgender women in New Orleans, Louisiana. Following an iterative process, we conducted in-depth interviews (IDIs) with Black women who were not taking PrEP and used those findings to inform IDIs with Black women taking PrEP. We asked about PrEP awareness, social support, PrEP-related norms, medical mistrust, motivation to take PrEP, and potential implementation strategies. Data were analyzed using applied thematic analysis. We established the Black Women and PrEP (BWAP) Task Force-a diverse group of 25 Black female community representatives who reviewed the IDI findings and identified strategies to address these determinants of PrEP uptake. We interviewed 12 Black women who were not taking PrEP and 13 Black women who were taking PrEP. Two main PrEP uptake barriers were identified from the IDI findings and Task Force discussions. First, Black women do not know of other Black women taking PrEP. Women perceived PrEP as a drug for gay men. Most said that testimonials from Black women taking PrEP would make its use more relatable. Second, Black women are not frequently offered PrEP by their providers. Many preferred accessing PrEP through women's health providers. The Task Force identified two strategies to address these barriers: a social media campaign for women and an educational initiative to train providers to discuss and prescribe PrEP. These implementation strategies require further study.
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Affiliation(s)
- Meredith E. Clement
- Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Louisiana State University-CrescentCare Sexual Health Center, New Orleans, Louisiana, USA
| | - Brian Perry
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Kevin McKenna
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - Jeremy Beckford
- Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | | | - Erica Murray
- Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
| | | | - Jacquelyn N. Bickham
- STD/HIV/Hepatitis Program, Louisiana Department of Health, New Orleans, Louisiana,, USA
| | | | - Amy Smith
- Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Rebecca Lillis
- Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USA
- Louisiana State University-CrescentCare Sexual Health Center, New Orleans, Louisiana, USA
| | - Amy Corneli
- Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
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6
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Irie WC, Mahone A, Johnson B, Marrazzo J, Mugavero MJ, Van Der Pol B, Elopre L. "Just the Stigma Associated with PrEP Makes You Feel Like It's HIV Itself": Exploring PrEP Stigma, Skepticism, and Medical Mistrust Among Black Cisgender Women in Urban and Rural Counties in the U.S. Deep South. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1187-1195. [PMID: 38195827 DOI: 10.1007/s10508-023-02769-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 11/25/2023] [Accepted: 11/28/2023] [Indexed: 01/11/2024]
Abstract
Despite its effectiveness in HIV prevention, PrEP use among Black women is suboptimal. Notably in the Deep South, Black women have the lowest PrEP uptake rates among all US regions. To increase PrEP engagement, research suggests the implementation of structural and social interventions particular to the needs of Black women. The state of Alabama is of priority to federal HIV prevention initiatives; therefore, this study conducted focus groups among 47 cis-gender Black women in rural and urban Alabama counties, with the highest statewide HIV incidence rates, to understand perceptions of PrEP and decision-making processes. Deductive coding analysis was conducted and themes were finalized based on consensus among the two coders. Four themes were identified. Findings show stigma undergirds Alabaman Black women's decisions to engage in PrEP care. Moreover, women reported stigma stifled community-level education about PrEP. Despite these experiences, education was regarded as a strategy to decrease stigma and PrEP skepticism, the latter of which emerged as a prominent theme. Medical mistrust and healthcare engagement were the other emergent themes influencing participation in PrEP care. To ensure PrEP efforts meet the needs of Black cisgender women in Alabama counties, interventions must address longstanding stigma, increase educational initiatives, and ensure interventions consider women's experiences with medical mistrust and health care engagement.
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Affiliation(s)
- Whitney C Irie
- Boston College School of Social Work, Chestnut Hill, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467-1037, USA.
- The Fenway Institute, Fenway Health, Boston, MA, USA.
| | - Anais Mahone
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Bernadette Johnson
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeanne Marrazzo
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Michael J Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Barbara Van Der Pol
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Latesha Elopre
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Health Behavior, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
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7
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Pitchford K, Shangani S, Dawson C, Masa R, Heron K. Community Health Care Providers' Perspectives on Human Immunodeficiency Virus Pre-Exposure Prophylaxis Use Among Black Women in Eastern Virginia. AIDS Patient Care STDS 2024; 38:123-133. [PMID: 38471092 DOI: 10.1089/apc.2023.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
The most at-risk population among women for human immunodeficiency virus (HIV) diagnosis in the United States are Black women, accounting for 61% of all new HIV cases. Pre-exposure prophylaxis (PrEP) is a safe and effective HIV prevention method for people at risk of HIV acquisition. Although disproportionately affected by HIV, Black women's knowledge, perceived benefits, and uptake of PrEP remain low. The socioecological model (SEM) may be useful for understanding why there is a low uptake of PrEP among Black women. The current study used the SEM to explore provider perspectives on the barriers and facilitators of PrEP uptake among Black women in Eastern Virginia. Semistructured interviews were conducted with a total sample of 15 community health care providers. Barriers of PrEP uptake at the societal (e.g., PrEP advertisements focus on gay men), community/organizational (e.g., time constraints in the workplace), interpersonal (e.g., perceived monogamy), and individual (e.g., unmet basic needs) levels were identified. Providers also identified facilitators of PrEP uptake at the societal (e.g., PrEP advertisements that target women), community/organizational (e.g., PrEP education), interpersonal (e.g., HIV-positive partner), and individual (e.g., PrEP awareness and perceived susceptibility to HIV) levels. These findings highlight unique barriers to accessing and taking PrEP for Black women in the United States, and potential factors that could facilitate PrEP use. Both barriers and facilitators may be important targets for interventions to improve PrEP uptake. Future research focused on improving PrEP uptake among Black women in the United States should consider multi-level interventions that target barriers and facilitators to reduce rates of HIV infections.
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Affiliation(s)
- Kayla Pitchford
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Sylvia Shangani
- Department of Community Health Sciences, School of Public Health, Boston University, Boston, Massachusetts, USA
- Social and Behavioral Sciences Department, Yale School of Public Health, New Haven, Connecticut, USA
| | - Charlotte Dawson
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
| | - Rainier Masa
- School of Social Work, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristin Heron
- The Virginia Consortium Program in Clinical Psychology, Old Dominion University, Norfolk, Virginia, USA
- Department of Psychology, Old Dominion University, Norfolk, Virginia, USA
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Nydegger LA, Kidane H, Benitez S, Yuan M, Claborn KR. A Qualitative Exploration of PrEP Interests, Barriers, and Interventions Among Black and Latina Cisgender Women in the U.S. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:771-783. [PMID: 37796358 PMCID: PMC10844362 DOI: 10.1007/s10508-023-02712-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 08/28/2023] [Accepted: 09/18/2023] [Indexed: 10/06/2023]
Abstract
Black and Latina cisgender women (BLCW) are disproportionally affected by HIV, particularly in the southern U.S. In Austin, Texas, Black women contract HIV 18.4 times more and Latinas 2.6 times more compared to White women. Pre-exposure prophylaxis (PrEP) is a medication that prevents contracting HIV; however, PrEP adoption among women is low. The current qualitative study aimed to explore PrEP awareness, interest, preferred PrEP administration methods, barriers to PrEP adoption, and future programs to increase PrEP adoption and adherence among BLCW. A total of 18 BLCW at high risk for HIV were enrolled. Participants completed 3 semi-structured interviews across 3 months. Interviews were transcribed verbatim, coded, and analyzed using thematic content analysis. Results demonstrated that BLCW had low PrEP awareness, high initial PrEP interest, and were interested in a long-acting injectable form of PrEP. Barriers to PrEP adoption included concerns regarding side effects, concerns about adherence to the currently available daily pill, and difficulty with insurance. Participants proposed different ideas for interventions, including support groups, education, community-level programs, and structural interventions. Future studies should focus on increasing PrEP awareness and HIV risk, consider alternative forms of PrEP, educate providers and medical staff on PrEP, and consider tailored interventions to reduce HIV risk among BLCW.
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Affiliation(s)
- Liesl A Nydegger
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Hampton House, 624 N. Broadway Street, Baltimore, MD, 21205, USA.
| | - Heran Kidane
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX, USA
| | - Sabrina Benitez
- Department of Molecular Biosciences, University of Texas at Austin, Austin, TX, USA
| | - Mandy Yuan
- School of Human Ecology, University of Texas at Austin, Austin, TX, USA
| | - Kasey R Claborn
- School of Social Work, University of Texas at Austin, Austin, USA
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9
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Zack JL, Hull SJ, Coleman ME, Ye PP, Lotke PS, Visconti A, Beverley J, Brant A, Moriarty P, Scott RK. Age-related factors associated with intention to initiate pre-exposure prophylaxis among cisgender women in Washington D.C. Ther Adv Infect Dis 2024; 11:20499361241252351. [PMID: 38751758 PMCID: PMC11095193 DOI: 10.1177/20499361241252351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) utilization among cisgender women (subsequently 'women') is low across age groups, relative to their risk of HIV acquisition. We hypothesize that age-related differences in psychosocial factors also influence women's intention to initiate oral PrEP in Washington, D.C. Methods A secondary analysis of a cross-sectional survey data was performed to evaluate factors influencing intention to initiate oral PrEP among women seen at a family planning and a sexual health clinic. A bivariate analysis was performed to identify differences by age group in demographic characteristics, indications for PrEP, and attitudes toward PrEP; we then performed additional bivariate analysis to assess these variables in relation to PrEP intention. Results Across age groups, perceived risk of HIV acquisition was not significantly different and was not associated with intention to initiate PrEP. Awareness of and attitude toward PrEP, injunctive norms, descriptive norms, and self-efficacy were not different across age, however there were significant age-associated differences in relation to PrEP intention. Specifically, among 18-24-year-olds, intention to start PrEP was associated with support from provider (p = 0.03), main sexual partner (p < 0.01), and peers (p < 0.01). For women 25-34 years old, having multiple sexual partners (p = 0.03) and support from casual sexual partners (p = 0.03) was also important. Among women 35-44 years old, prior awareness of PrEP (p = 0.02) and their children's support of PrEP uptake (p < 0.01) were associated with intention to initiate PrEP. Among 45-55 year-old women intention to initiate PrEP was positively associated with engaging in casual sex (p = 0.03) and negatively associated with stigma (p < 0.01). Conclusion Overall, there were more similarities than differences in factors influencing intention to initiate PrEP across age groups. Observed differences offer an opportunity to tailor PrEP delivery and HIV prevention interventions to increase awareness and uptake for cisgender women.
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Affiliation(s)
- Jennifer L. Zack
- Georgetown University School of Medicine, 3900 Reservoir Rd NW, Washington, DC 20007, USA
| | - Shawnika J. Hull
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Megan E. Coleman
- Whitman-Walker Health, Department of Clinical Investigations, Washington, DC, USA
| | - Peggy Peng Ye
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
| | - Pamela S. Lotke
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
| | - Adam Visconti
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Georgetown University Hospital, Department of Family Medicine, Washington, DC, USA
| | - Jason Beverley
- DC Health, DC Department of Health: HIV/AIDS, Hepatitis, STD & TB Administration (HAHSTA), Washington, DC, USA
| | - Ashley Brant
- Cleveland Clinic Foundation, Women’s Health Institute, Cleveland, OH, USA
| | - Patricia Moriarty
- MedStar Health Research Institute, Clinical Research, Hyattsville, MD, USA
| | - Rachel K. Scott
- Georgetown University School of Medicine, Washington, DC, USA
- MedStar Health, Washington, DC, USA
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10
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Hull SJ, Duan X, Brant AR, Ye PP, Lotke PS, Huang JC, Coleman ME, Nalls P, Scott RK. Understanding Psychosocial Determinants of PrEP Uptake Among Cisgender Women Experiencing Heightened HIV Risk: Implications for Multi-Level Communication Intervention. HEALTH COMMUNICATION 2023; 38:3264-3275. [PMID: 36398676 PMCID: PMC10192462 DOI: 10.1080/10410236.2022.2145781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective daily pill that decreases the likelihood of HIV acquisition by up to 92% among individuals at risk for HIV. PrEP can be discretely used, autonomously controlled, and in place at the time of risk exposure, making it an especially promising method for HIV prevention for cisgender women (CGW). But, PrEP is underutilized by CGW relative to the demonstrable need. We apply the Integrative Model of Behavioral Prediction to identify the critical psychosocial factors that shape CGW's intentions to use PrEP and their relevant underlying beliefs. We surveyed (N = 294) community- and clinic-recruited PrEP eligible CGW to understand the relative importance of attitudes, norms, and efficacy in shaping PrEP intentions. We utilized structural equation modeling to identify the relevant paths. We inspected the summary statistics in relation to three message three selection criteria. We identified beliefs that demonstrated (1) an association with intention, (2) substantial room to move the population, (3) practicality as a target for change through communication intervention. Results show that PrEP awareness was low. When women learned about PrEP, they voiced positive intentions to use it. There were significant and positive direct effects of SE (0.316***), attitudes (0.201**), and subjective norms (0.249***) on intention to initiate PrEP. We illustrate the strategic identification of beliefs within the relevant paths using the 3 belief selection criteria. We also discuss implications for social and structural communication interventions to support women's HIV prevention.
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Affiliation(s)
| | - Xuejing Duan
- Department of Biostatistics and Bioinformatics, The George Washington University
| | | | - Peggy Peng Ye
- Women’s and Infants’ Services Department, MedStar Washington Hospital Center
- Obstetrics & Gynecology, Georgetown University School of Medicine
| | - Pamela S. Lotke
- Women’s and Infants’ Services Department, MedStar Washington Hospital Center
- Obstetrics & Gynecology, Georgetown University School of Medicine
| | - Jim C. Huang
- Department of Business Management, National Sun Yat-sen University
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11
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Arnold T, Whiteley L, Elwy RA, Ward LM, Konkle-Parker DJ, Brock JB, Giorlando KK, Barnett AP, Sims-Gomillia C, Craker LK, Lockwood KR, Leigland A, Brown LK. Mapping Implementation Science with Expert Recommendations for Implementing Change (MIS-ERIC): Strategies to Improve PrEP Use among Black Cisgender Women Living in Mississippi. J Racial Ethn Health Disparities 2023; 10:2744-2761. [PMID: 36396922 PMCID: PMC9672575 DOI: 10.1007/s40615-022-01452-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Black women are disproportionately affected by the HIV epidemic. Strategies to increase Black women's use of pre-exposure prophylaxis (PrEP) are needed. METHODS Interviews were conducted in Mississippi (MS) with Black, cisgender women at risk for HIV, and community healthcare clinic (CHC) staff who work directly with this population. Reflexive thematic analysis was used to identify barriers and select appropriate implementation strategies to increase PrEP care. RESULTS Twenty Black women and twelve CHC staff were interviewed. PrEP use barriers resulted from low HIV risk awareness, lack of PrEP knowledge, and structural and stigma-related barriers. Methods for PrEP education and motivation included normalizing PrEP in public communications, providing education at places where women congregate, and tailoring PrEP content with Black women as educators. The Expert Recommendations for Implementing Change (ERIC) project provides a way for implementation scientists to select strategies that are consistent within research and practice across studies. Strategies from the ERIC project were selected to address implementation barriers. CONCLUSIONS Tailoring PrEP implementation protocols to increase Black women's access, engagement, and adherence to PrEP is needed. This is one of the first implementation studies to incorporate these four implementation concepts into a single study: (1) implementation outcomes, (2) i-PARIHS, (3) ERIC's strategy list, and (4) operationalizing the strategies using the Proctor et al., guidelines. Results provide an in-depth comprehensive list of implementation strategies to increase PrEP uptake for Black women in MS.
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Affiliation(s)
- Trisha Arnold
- Brown University Warren Alpert Medical School, Providence, RI, USA.
- Department of Psychiatry, Rhode Island Hospital, Providence, USA.
| | - Laura Whiteley
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Rani A Elwy
- Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Lori M Ward
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Deborah J Konkle-Parker
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - James B Brock
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | | | - Andrew P Barnett
- Brown University Warren Alpert Medical School, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
| | - Courtney Sims-Gomillia
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Lacey K Craker
- Division of Prevention Science and Community Health, University of Miami, Miami, USA
| | - Khadijra R Lockwood
- Departments of Nursing, Medicine, and Population Health Sciences, University of Mississippi Medical Center, Jackson, USA
| | - Avery Leigland
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
| | - Larry K Brown
- Brown University Warren Alpert Medical School, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, USA
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12
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Devlin SA, Ridgway JP, Dawdani A, Enaholo OE, Liegeon G, Kasal N, Pyra M, Hirschhorn LR, Simon J, Haider S, Ducheny K, Johnson AK. Adapting Provider Training and Pre-Exposure Prophylaxis Advertising to Increase Pre-Exposure Prophylaxis Awareness and Uptake Among Black Cisgender Women. AIDS Patient Care STDS 2023; 37:574-582. [PMID: 38011350 PMCID: PMC10732154 DOI: 10.1089/apc.2023.0188] [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] [Indexed: 11/29/2023] Open
Abstract
Black cisgender women (hereafter referred to as "women") have disproportionately high rates of HIV infection yet low rates of pre-exposure prophylaxis (PrEP) utilization. Barriers to PrEP uptake exist at the system, provider, and individual/client level. To learn how existing training and advertising can be adapted to address race- and sex-based gaps within PrEP service delivery, we conducted focus groups with providers and Black women. Participants were recruited at three health care organizations in the Midwest and South, screened for eligibility, and consented verbally. Focus groups occurred from August 2022 to February 2023. Women were asked about their knowledge and thoughts on PrEP. Providers were asked about factors influencing their decision-making about PrEP. A codebook was developed based on the Consolidated Framework for Implementation Research. Transcripts were coded using the Stanford Lightning Report Method. We completed four focus groups with 10 providers and 9 focus groups with 25 women. Three major themes emerged: (1) low comfort level and limited cultural sensitivity/competency among providers discussing HIV risk and PrEP with Black women, (2) women's concerns about PrEP's side effects and safety during pregnancy, and (3) lack of Black women representation in PrEP advertisement/educational materials. In addition, women in the South reported general medical mistrust and specific misconceptions about PrEP. PrEP trainings for providers need detailed information about the safety of PrEP for women and should include role-playing to enhance cultural competency. Likewise, PrEP advertisements/materials should incorporate information regarding side effects and images/experiences of Black women to increase PrEP awareness and uptake among this population. Clinical Trial Registration Number: NCT05626452.
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Affiliation(s)
| | | | - Alicia Dawdani
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Ososese E. Enaholo
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Geoffroy Liegeon
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Nikki Kasal
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Maria Pyra
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Sadia Haider
- Division of Family Planning, Rush University, Chicago, Illinois, USA
| | | | - Amy K. Johnson
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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13
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Lade C, MacPhail C, Rutherford A. Provider views of pre-exposure prophylaxis (PrEP) for cisgender women - where do women fit in HIV elimination in Australia? Sex Health 2023; 20:558-565. [PMID: 37903431 DOI: 10.1071/sh23163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 10/09/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) in Australia has largely been targeted at gay, bisexual and other men who have sex with men. In the context of HIV elimination, the aim of this qualitative study was to explore PrEP prescribing for Australian cisgender women from the provider's perspective. METHODS Semi-structured interviews were held with Australian prescribers in 2022. Participants were recruited through relevant clinical services, newsletter distribution and snowball sampling. Interviews were audio-recorded, transcribed and analysed thematically. RESULTS Seventeen prescribers participated, of whom 9 were sexual health physicians and 10 worked in New South Wales. All reported limited clinical experience prescribing PrEP for women. Potential enablers to PrEP prescribing to women included education for women and clinicians, easily identifiable risk factors, individualised risk assessment and expansion of existing services. Barriers were limited PrEP awareness among women and prescribers, difficulties with risk assessment and consult and service limitations. The type of service recommended for PrEP provision varied among participants. CONCLUSIONS Clinician experience of PrEP prescribing to Australian cisgender women is limited, with substantial barriers to access perceived by prescribers. Targeted education to PrEP prescribers, updated national PrEP guidelines to include women as a distinct group and further research regarding women's preferred model of PrEP access are required. Clarity of clinical ownership over PrEP implementation for women and, more broadly, women's sexual health, is essential in order to achieve HIV elimination in Australia.
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Affiliation(s)
- Caroline Lade
- Illawarra Shoalhaven Local Health District, Illawarra Shoalhaven Sexual Health Service, Port Kembla Hospital, Cowper Street, Warrawong, NSW, Australia
| | - Catherine MacPhail
- University of Wollongong, School of Health and Society, Building 29, Northfields Avenue, Wollongong, NSW, Australia
| | - Alison Rutherford
- Illawarra Shoalhaven Local Health District, Illawarra Shoalhaven Sexual Health Service, Port Kembla Hospital, Cowper Street, Warrawong, NSW, Australia
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14
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Johnson AK, Devlin S, Haider S, Oehler C, Rivera J, Alvarez I, Ridgway J. Evaluation of multiple data sources for predicting increased need for HIV prevention among cisgender women: understanding missed opportunities for Pre-exposure Prophylaxis (PrEP). BMC Infect Dis 2023; 23:781. [PMID: 37946103 PMCID: PMC10636899 DOI: 10.1186/s12879-023-08719-6] [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: 09/12/2022] [Accepted: 10/17/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Ciswomen constitute a disproportionately low percentage of pre-exposure prophylaxis for HIV prevention (PrEP) users compared to men. Despite PrEP's effectiveness, women are 5.25 times less likely to take PrEP than men. Identifying women who have increased reasons for HIV prevention and educating and offering PrEP to these women is crucial to reducing HIV transmission and overall health equity. However, the best method of identifying women at highest risk of acquiring HIV remains unknown. This study aimed to identify common HIV risk factors and data sources for identifying these common factors (e.g., electronic medical record data, open source neighborhood data), as well as potential intervention points and missed opportunities for PrEP linkage. METHODS We conducted an evaluation of multiple data sources: semi-structured qualitative interviews, electronic medical record (EMR) chart abstraction, and open source data abstraction. We accessed EMRs for enrolled participants and all participants signed a standard release of medical information (ROI) form for all institutions at which they had received medical care for the five-year period preceding their HIV diagnosis. Data were abstracted using a standardized procedure. Both structured and unstructured fields (i.e., narrative text of free notes) within the EMR were examined and included for analysis. Finally, open data sources (e.g., STI cases, HIV prevalence) were examined by community area of Chicago. Open data sources were used to examine several factors contributing to the overall Economic Hardship Index (EHI) score. We used these calculated scores to assess the economic hardship within participants' neighborhoods. RESULTS A total of 18 cisgender women with HIV participated in our study. Participants were mostly Black/African American (55.6%) and young (median age of 34). Our analysis identified two main themes influencing HIV risk among participants: contextual factors and relationship factors. Further, potential pre-diagnosis intervention points and missed opportunities were identified during reproductive health/prenatal visits, behavioral/mental health visits, and routine STI testing. Our evaluation of multiple data sources included investigating the presence or absence of information in the EMR (STI history, HIV testing, substance use, etc.) as well as whether pertinent information could be gathered from open access sources. CONCLUSION Ciswomen recently diagnosed with HIV identified many shared experiences, including syndemic conditions like mental illness and substance abuse, sex with men who have sex with men, and frequent moving in areas with high HIV incidence prior to their diagnosis. It is imperative that providers ask patients about social history, information about partners, and other key variables, in addition to the standardized questions. Findings can be used to better recognize ciswomen most vulnerable to HIV and offer PrEP to them, reducing HIV transmission.
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Affiliation(s)
- Amy K Johnson
- Reasearch Associate Professor Center for Gender, Sexuality, and HIV Prevention, The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Samantha Devlin
- Research Coordinator, University of Chicago, Chicago, IL, USA
| | - Sadia Haider
- Division of Family Planning, Rush University Medical Center (RUMC), Chicago, IL, USA
| | - Cassandra Oehler
- Clinical Assistant Professor Allegheny Health Network, Drexel University School of Medicine, Pennsylvania, USA
| | - Juan Rivera
- Social and Behavioral Research Manager, Howard Brown Health, Chicago, USA
| | - Isa Alvarez
- Clinical Research Coordinator, Division of Family Planning, Rush University Medical Center (RUMC), Chicago, IL, USA
| | - Jessica Ridgway
- Biological Sciences Division, University of Chicago, Chicago, IL, USA
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15
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Weigel G, Theva M, Hardy E, Wagner S, Brown B. Sexual and Reproductive Health Care Visits as a Venue for Preexposure Prophylaxis Service Delivery Among Women in the United States: Results From a Nationally Representative Survey. Sex Transm Dis 2023; 50:726-730. [PMID: 36943788 DOI: 10.1097/olq.0000000000001805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) for HIV is disproportionately underprescribed to women. Centers for Disease Control and Prevention guidelines identify a group of women at risk of HIV acquisition who should be offered PrEP, but opportunities remain to improve patient awareness of and provider counseling about PrEP and to expand service delivery of PrEP. METHODS Using nationally representative data from the 2017-2019 National Survey of Family Growth, we compared women with (n = 689) and without (n = 5,452) Centers for Disease Control and Prevention indications for PrEP on measures of PrEP awareness, counseling by a provider, and interaction with the health care system. RESULTS Women with PrEP indications were no more likely to report awareness of PrEP (odds ratio [OR], 1.03; 95% confidence interval [CI], 0.82-1.29) or PrEP counseling by a provider (OR, 1.32; 95% CI, 0.77-2.27), compared with those without PrEP indications. However, women with PrEP indications were more likely than those without to report a birth control visit (OR, 1.82; 95% CI, 1.39-2.38) or an abortion within the last 12 months (OR, 5.93; 95% CI, 1.48-23.73), and to currently use prescription contraception (OR, 1.45; 95% CI, 1.19-1.78). A majority of both groups reported accessing prenatal care within the last 12 months. CONCLUSIONS There remains a gap in PrEP awareness and counseling among women at highest risk for HIV acquisition. Sexual and reproductive health visits represent a logical and feasible venue for PrEP provision. Obstetrician-gynecologists and other family planning providers may be able to aid in service delivery innovations by providing PrEP alongside other sexual and reproductive health care.
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Affiliation(s)
| | - Meena Theva
- From the Departments of Obstetrics and Gynecology
| | - Erica Hardy
- Medicine, Division of Infectious Disease, Warren Alpert Medical School, Brown University, Providence, RI
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16
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Zhai Y, Isadore KM, Parker L, Sandberg J. Responding to the HIV Health Literacy Needs of Clients in Substance Use Treatment: The Role of Universal PrEP Education in HIV Health and Prevention. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6893. [PMID: 37835163 PMCID: PMC10572580 DOI: 10.3390/ijerph20196893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023]
Abstract
Health literacy, particularly HIV health literacy, is a key social determinant of health and can be significantly improved through targeted health education. This paper explores the often-overlooked potential of pre-exposure prophylaxis (PrEP) education as a powerful tool to enhance HIV health literacy among people with substance use disorders (PWSUD), a population notably susceptible to HIV. Given the syndemic interplay of substance use disorders (SUDs) and HIV, health professionals, especially substance use counselors, are uniquely positioned to bolster HIV health literacy and positively influence health outcomes. This article offers a brief introduction to PrEP, delineates potential barriers and facilitators to its use and education, and proposes strategies for effective PrEP education, implementation, and adherence. By equipping substance use counselors with essential knowledge and skills, we aim to encourage and promote the integration of PrEP education into substance use treatment. The overarching objective is to empower counselors to proactively engage in HIV prevention efforts, thereby fulfilling pressing health literacy needs and contributing to improved health outcomes among PWSUD.
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Affiliation(s)
- Yusen Zhai
- Department of Human Studies, The University of Alabama at Birmingham, Birmingham, AL 35294, USA
| | - Kyesha M. Isadore
- Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison, Madison, WI 53706, USA;
| | - Lauren Parker
- Department of Educational Psychology, Counseling, Special Education, College of Education, The Pennsylvania State University, University Park, PA 16802, USA; (L.P.); (J.S.)
| | - Jeremy Sandberg
- Department of Educational Psychology, Counseling, Special Education, College of Education, The Pennsylvania State University, University Park, PA 16802, USA; (L.P.); (J.S.)
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17
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Desai J, Krakower D, Harris BL, Culp S, Nijhawan AE. HIV/Sexually Transmitted Infection Screening and Eligibility for HIV Preexposure Prophylaxis Among Women Incarcerated in an Urban County Jail. Sex Transm Dis 2023; 50:675-679. [PMID: 37699368 PMCID: PMC10503027 DOI: 10.1097/olq.0000000000001852] [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] [Indexed: 09/14/2023]
Abstract
BACKGROUND Incarcerated women experience high rates of HIV and sexually transmitted infections (STIs); few are offered HIV preexposure prophylaxis (PrEP). We aimed to examine HIV/STI screening rates in this population and identify PrEP eligibility. METHODS Results of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) urine and HIV/syphilis screening in cisgender women in the Dallas County Jail were compiled from January to October 2020. An electronic health record review was conducted for a subgroup in March 2020 to identify PrEP eligibility. RESULTS Overall, 4398 of 13,292 women were screened for CT and 4389 of 13,292 for GC, and among them, 479 (11%) screened for HIV and 562 (13%) for syphilis. Furthermore, 462 of 4398 (11%) were positive for CT, 323 of 4389 (7%) were positive for GC, 10 of 479 (2%) had positive HIV test results, of whom 6 (1.3%) were new diagnoses and 75 (13%) had a reactive rapid plasma reagin test. In March 2020, of 541 women screened, 90 tested positive for CT or GC. Of these 90, 70 (78%) did not receive HIV or syphilis screening, including women with these risk factors: 10 (14%) were homeless, 11 (16%) reported heroin use, and 10 (14%) reported methamphetamine use. Based on the presence of an acute bacterial STI, 17% (96 of 541) were PrEP eligible. CONCLUSIONS Incarcerated women had high STI rates and other risk factors for HIV acquisition, although only 1 in 5 with acute STIs (11% overall) was also screened for HIV or syphilis. HIV prevention efforts should include comprehensive STI/HIV screening, linkage to treatment, and identification of PrEP candidates.
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Affiliation(s)
- Jui Desai
- From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX
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18
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Chandler R, Farinu OTO, Guillaume D, Francis S, Parker AG, Shah K, Hernandez ND. Digital Health App to Address Disparate HIV Outcomes Among Black Women Living in Metro-Atlanta: Protocol for a Multiphase, Mixed Methods Pilot Feasibility Study. JMIR Res Protoc 2023; 12:e42712. [PMID: 37713259 PMCID: PMC10541635 DOI: 10.2196/42712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 02/28/2023] [Accepted: 05/03/2023] [Indexed: 09/16/2023] Open
Abstract
BACKGROUND Cisgender Black women in the southern United States are at heightened risk for HIV and adverse sexual and reproductive health outcomes. Mobile health interventions that target HIV risk while being adapted to the needs and lived experiences of Black women are remarkably limited. OBJECTIVE The study aims to refine SavvyHER, a mobile app for HIV prevention, with Black women residing in high HIV incidence areas of Georgia and evaluate the feasibility, acceptability, and usability of SavvyHER. This paper describes the procedures implemented to conduct this research. METHODS Community-based participatory research tenets guide this multiphase study to finalize the development of what we hypothesize will be an effective, sustainable, and culturally relevant HIV prevention and optimal sexual health and reproductive wellness app for Black women. This multiphased, mixed methods study consists of 3 phases. The first phase entails focus groups with Black women to understand their preferences for the functionality and design of a beta prototype version of SavvyHER. In the second phase, an app usability pretest (N=10) will be used to refine and optimize the SavvyHER app. The final phase will entail a pilot randomized controlled trial (N=60) to evaluate the app's feasibility and usability in preparation for a larger trial. RESULTS Findings from preliminary focus groups revealed educational content, app aesthetics, privacy considerations, and marketing preferred by Black women, thus informing the first functional SavvyHER prototype. As we adapt and test the feasibility of SavvyHER, we hypothesize that the app will be an effective, sustainable, and culturally relevant HIV prevention, sexual health, and reproductive wellness tool for Black women. CONCLUSIONS The findings from this research substantiate the importance of developing health interventions curated for and by Black women to address critical HIV disparities. The knowledge gained from this research can reduce HIV disparities among Black women through a targeted intervention that centers on their health needs and priorities. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/42712.
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Affiliation(s)
- Rasheeta Chandler
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Oluyemi T O Farinu
- Department of Sociology, Georgia State University, Atlanta, GA, United States
| | - Dominique Guillaume
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Sherilyn Francis
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Andrea G Parker
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Kewal Shah
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA, United States
| | - Natalie D Hernandez
- Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, GA, United States
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Scott RK, Hull SJ, Huang JC, Ye PP, Lotke P, Beverley J, Moriarty P, Balaji D, Ward A, Holiday J, Brant AR, Elion R, Visconti AJ, Coleman M. Intention to Initiate HIV Pre-exposure Prophylaxis Among Cisgender Women in a High HIV Prevalence U.S. City. Womens Health Issues 2023; 33:541-550. [PMID: 37479630 PMCID: PMC10552685 DOI: 10.1016/j.whi.2023.05.009] [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: 10/27/2022] [Revised: 05/25/2023] [Accepted: 05/30/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVE Our objective was to identify the individual, interpersonal, community, health-system, and structural factors that influence HIV pre-exposure prophylaxis (PrEP) initiation among cisgender women seeking sexual and reproductive health care in a high HIV prevalence community to inform future clinic-based PrEP interventions. METHODS We collected anonymous, tablet-based questionnaires from a convenience sample of cisgender women in family planning and sexual health clinics in the District of Columbia. The survey used the lens of the socio-ecological model to measure individual, interpersonal, community, institutional, and structural factors surrounding intention to initiate PrEP. The survey queried demographics, behavioral exposure to HIV, perceived risk of HIV acquisition, a priori awareness of PrEP, intention to initiate PrEP, and factors influencing intention to initiate PrEP. RESULTS A total of 1437 cisgender women completed the survey. By socio-ecological level, intention to initiate PrEP was associated with positive attitudes toward PrEP (odds ratio [OR], 1.56; 95% confidence interval [CI], 1.13-2.15) and higher self-efficacy (OR, 1.32; 95% CI, 1.02-1.72) on the individual level, perceived future utilization of PrEP among peers and low fear of shame/stigma (OR, 1.65; 95% CI, 1.33-2.04) on the community level, and having discussed PrEP with a provider (OR. 2.39; 95% CI, 1.20-4.75) on the institutional level. CONCLUSION Our findings highlight the importance of multilevel, clinic-based interventions for cisgender women, which promote sex-positive and preventive PrEP messaging, peer navigation to destigmatize PrEP, and education and support for women's health medical providers in the provision of PrEP services for cisgender women.
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Affiliation(s)
- Rachel K Scott
- MedStar Health Research Institute, Hyattsville, Maryland; MedStar Washington Hospital Center, Washington, District of Columbia.
| | - Shawnika J Hull
- Rutgers University, Department of Communications, New Brunswick, New Jersey
| | - Jim C Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Peggy P Ye
- MedStar Washington Hospital Center, Washington, District of Columbia
| | - Pamela Lotke
- MedStar Washington Hospital Center, Washington, District of Columbia
| | | | | | | | - Allison Ward
- MedStar Health Research Institute, Hyattsville, Maryland; MedStar Washington Hospital Center, Washington, District of Columbia
| | | | - Ashley R Brant
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Rick Elion
- DC Health, Washington, District of Columbia
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20
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Sheth AN, Enders KP, McCumber M, Psioda MA, Ramakrishnan A, Sales JM. State-level clustering in PrEP implementation factors among family planning clinics in the Southern United States. Front Public Health 2023; 11:1214411. [PMID: 37559738 PMCID: PMC10407092 DOI: 10.3389/fpubh.2023.1214411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/12/2023] [Indexed: 08/11/2023] Open
Abstract
Background Availability of PrEP-providing clinics is low in the Southern U.S., a region at the center of the U.S. HIV epidemic with significant HIV disparities among minoritized populations, but little is known about state-level differences in PrEP implementation in the region. We explored state-level clustering of organizational constructs relevant to PrEP implementation in family planning (FP) clinics in the Southern U.S. Methods We surveyed providers and administrators of FP clinics not providing PrEP in 18 Southern states (Feb-Jun 2018, N = 414 respondents from 224 clinics) on these constructs: readiness to implement PrEP, PrEP knowledge/attitudes, implementation climate, leadership engagement, and available resources. We analyzed each construct using linear mixed models. A principal component analysis identified six principal components, which were inputted into a K-means clustering analysis to examine state-level clustering. Results Three clusters (C1-3) were identified with five, three, and four states, respectively. Canonical variable 1 separated C1 and C2 from C3 and was primarily driven by PrEP readiness, HIV-specific implementation climate, PrEP-specific leadership engagement, PrEP attitudes, PrEP knowledge, and general resource availability. Canonical variable 2 distinguished C2 from C1 and was primarily driven by PrEP-specific resource availability, PrEP attitudes, and general implementation climate. All C3 states had expanded Medicaid, compared to 1 C1 state (none in C2). Conclusion Constructs relevant for PrEP implementation exhibited state-level clustering, suggesting that tailored strategies could be used by clustered states to improve PrEP provision in FP clinics. Medicaid expansion was a common feature of states within C3, which could explain the similarity of their implementation constructs. The role of Medicaid expansion and state-level policies on PrEP implementation warrants further exploration.
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Affiliation(s)
- Anandi N. Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States
| | - Kimberly P. Enders
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Micah McCumber
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew A. Psioda
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Aditi Ramakrishnan
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States
| | - Jessica M. Sales
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Piper KN, Anderson KM, Kokubun CW, Sheth AN, Sales J. Using qualitative comparative analysis to understand the conditions that produce successful PrEP implementation in family planning clinics. Implement Sci Commun 2023; 4:64. [PMID: 37296455 DOI: 10.1186/s43058-023-00450-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/03/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Title X-funded family planning clinics have been identified as optimal sites for delivery of pre-exposure prophylaxis (PrEP) for HIV prevention to U.S. women. However, PrEP has not been widely integrated into family planning services, especially in the Southern U.S., and data suggest there may be significant implementation challenges in this setting. METHODS To understand contextual factors that are key to successful PrEP implementation in family planning clinics, we conducted in-depth qualitative interviews with key informants from 38 family planning clinics (11 clinics prescribed PrEP and 27 did not). Interviews were guided by constructs from the Consolidated Framework for Implementation Research (CFIR), and qualitative comparative analysis (QCA) was used to uncover the configurations of CFIR factors that led to PrEP implementation. RESULTS We identified 3 distinct construct configurations, or pathways, that led to successful PrEP implementation: (1) high "Leadership Engagement" AND high "Available Resources"; OR (2) high "Leadership Engagement" AND NOT located in the Southeast region; OR (3) high "Access to Knowledge and Information" AND NOT located in the Southeast region. Additionally, there were 2 solution paths that led to absence of PrEP implementation: (1) low "Access to Knowledge and Information" AND low "Leadership Engagement"; OR (2) low "Available Resources" AND high "External Partnerships". DISCUSSION We identified the most salient combinations of co-occurring organizational barriers or facilitators associated with PrEP implementation across Title X clinics in the Southern U.S. We discuss implementation strategies to promote pathways that led to implementation success, as well as strategies to overcome pathways to implementation failure. Notably, we identified regional differences in the pathways that led to PrEP implementation, with Southeastern clinics facing the most obstacles to implementation, specifically substantial resource constraints. Identifying implementation pathways is an important first step for packaging multiple implementation strategies that could be employed by state-level Title X grantees to help scale up PrEP.
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Affiliation(s)
- Kaitlin N Piper
- Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | | | | | - Anandi N Sheth
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica Sales
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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22
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Nogueira NF, Luisi N, Salazar AS, Cherenack EM, Raccamarich P, Klatt NR, Jones DL, Alcaide ML. PrEP awareness and use among reproductive age women in Miami, Florida. PLoS One 2023; 18:e0286071. [PMID: 37285343 DOI: 10.1371/journal.pone.0286071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Miami, Florida is an epicenter of the HIV epidemic in the US, with 20% of new HIV infections occurring in women. Despite effectiveness of Pre-Exposure Prophylaxis (PrEP) in preventing HIV, only 10% of eligible women benefit from its use. SETTING This study evaluates PrEP awareness and use, and factors associated with PrEP awareness among sexually active women in Miami, Florida. METHODS Results reported in this study included cross-sectional data that were collected as part of a baseline visit from a parent study. Cis-gender, HIV-negative, 18-45-year-old, sexually active women were recruited as part of a study evaluating recurrent bacterial vaginosis and HIV risk. Participants completed questionnaires assessing socio-demographics, HIV risk factors, prior history of HIV testing and reproductive tract infections, PrEP awareness and use. Relationships between variables and PrEP awareness were analyzed and multivariable logistic regression identified variables strongly associated with PrEP awareness. RESULTS Among the 295 women enrolled, median age was 31 (24-38) years, 49% Black, 39% White, and 34% Hispanic. Of 63% who knew about PrEP, only 5% were on PrEP. Women with income below poverty line (OR = 2.00[1.04,3.87];p = 0.04), more male sexual partners in past month (OR = 1.30[1.01,1.68];p = 0.04), lifetime HIV testing (OR = 6.42[2.83,14.52];p<0.01), and current bacterial vaginosis (OR = 2.28[1.18,4.40];p = 0.01) were more likely to be aware of PrEP. Lower odds of PrEP awareness were associated with being Black (OR = 0.38[0.15,0.96];p = 0.04), Hispanic (OR = 0.18[0.08,0.39];p<0.01), heterosexual (OR = 0.29[0.11,0.77];p<0.01), and reporting inconsistent condom use during vaginal sex (OR = 0.21[0.08,0.56];p<0.01). CONCLUSION PrEP awareness is low among reproductive age women in a high-risk setting. Culturally tailored interventions are needed to increase PrEP awareness and uptake, especially among Black and Hispanic women with inconsistent condom use during vaginal sex with male partners.
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Affiliation(s)
- Nicholas Fonseca Nogueira
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Nicole Luisi
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Ana S Salazar
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Jackson Memorial Hospital/University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Emily M Cherenack
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Patricia Raccamarich
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Nichole R Klatt
- Division of Surgical Outcomes and Precision Medicine Research, Department of Surgery, University of Minnesota, Minneapolis, MN, United States of America
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Maria L Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States of America
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23
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Ridgway JP, Devlin SA, Friedman EE, Enaholo OE, Pyra M, Hirschhorn LR, Haider S, Ducheny K, Johnson AK. POWER Up-Improving pre-exposure prophylaxis (PrEP) uptake among Black cisgender women in the Southern United States: Protocol for a stepped-wedge cluster randomized trial (SW-CRT). PLoS One 2023; 18:e0285858. [PMID: 37196008 PMCID: PMC10191268 DOI: 10.1371/journal.pone.0285858] [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: 04/25/2023] [Accepted: 05/02/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND HIV disproportionately affects Black/African American cisgender women (hereafter women) in the United States. Despite its proven effectiveness, pre-exposure prophylaxis (PrEP) for HIV prevention remains vastly under-prescribed to women based on their need. Increasing PrEP uptake and persistence among women is crucial to reducing HIV transmission; however, there have been few studies designed specifically for women. This article describes the study protocol used to assess the feasibility, acceptability, and effectiveness of implementation strategies to improve PrEP uptake and persistence among Black women in the Midwest and South. METHODS PrEP Optimization among Women to Enhance Retention and Uptake (POWER Up) is an evidence-based, woman-focused set of five implementation science strategies that addresses barriers of PrEP utilization at the provider, patient, and clinic levels. POWER Up includes 1) routine PrEP education for patients, 2) standardized provider training, 3) electronic medical record (EMR) optimization, 4) PrEP navigation, and 5) PrEP clinical champions. These strategies will be adapted to specific clinics for implementation, tested via a stepped-wedge trial, and, if effective, packaged for further dissemination. DISCUSSION We will utilize a stepped-wedge cluster randomized trial (SW-CRT) to measure change in PrEP utilization across diverse geographic areas. Preparation for adapting and implementing the bundle of strategies is needed to determine how to tailor them to specific clinics. Implementation challenges will include adapting strategies with the available resources at each site, maintaining stakeholder involvement and staff buy-in, adjusting the study protocol and planned procedures as needed, and ensuring minimal crossover. Additionally, strengths and limitations of each strategy must be examined before, during, and after the adaptation and implementation processes. Finally, the implementation outcomes of the strategies must be evaluated to determine the real-world success of the strategies. This study is an important step toward addressing the inequity in PrEP service delivery and increasing PrEP utilization among Black women in the U.S.
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Affiliation(s)
- Jessica P. Ridgway
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, United States of America
| | - Samantha A. Devlin
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, United States of America
| | - Eleanor E. Friedman
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago, Chicago, IL, United States of America
| | - Ososese E. Enaholo
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, United States of America
| | - Maria Pyra
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Lisa R. Hirschhorn
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States of America
| | - Sadia Haider
- Division of Family Planning, Rush University, Chicago, IL, United States of America
| | - Kelly Ducheny
- Howard Brown Health, Chicago, IL, United States of America
| | - Amy K. Johnson
- The Potocsnak Family Division of Adolescent and Young Adult Medicine, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, United States of America
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24
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Burns JA, Hull SJ, Inuwa A, Moriarty P, Scott RK. Understanding Retention in the HIV Pre-Exposure Prophylaxis Cascade Among Cisgender Women. AIDS Patient Care STDS 2023; 37:205-211. [PMID: 36961388 PMCID: PMC10122259 DOI: 10.1089/apc.2023.0009] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
HIV remains a significant public health concern in the United States, with 34,800 new cases diagnosed in 2019; of those, 18% were among women. Oral pre-exposure prophylaxis (PrEP) with daily tenofovir disoproxil fumarate/emtricitabine is effective and safe, reducing HIV transmission by up to 92% in women. Though studies demonstrate low rates of PrEP adherence among cisgender women prescribed oral PrEP, little is known about the factors that shape PrEP continuation among them. This study focuses on understanding the experiences of cisgender women who have initiated PrEP to gain insight into the factors that shape PrEP continuation. We conducted semi-structured interviews with (N = 20) women who had been prescribed oral PrEP. Interviews were guided by the social-ecological framework to identify multilevel factors affecting PrEP continuation; we specifically examined the experience of engagement and retention in the PrEP cascade. We recruited women who had been prescribed oral PrEP by a government-sponsored sexual health center or a hospital-based family planning clinic in Washington, DC. Factors facilitating PrEP continuation included a positive emotional experience associated with PrEP use, high perceived risk of HIV acquisition, and high-quality communication with health care providers. The most common reason for PrEP discontinuation was low perceived HIV risk (n = 11). Other factors influencing discontinuation were side effects, a negative emotional experience while using PrEP, and negative interactions with the health care system. This study underscores the importance of specific multi-level factors, including the provision of high-quality communication designed to resonate with women and shared decision making between women and their health care providers.
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Affiliation(s)
- Jamie A. Burns
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Shawnika J. Hull
- Department of Communication, Rutgers University-New Brunswick, New Brunswick, New Jersey, USA
| | - Aisha Inuwa
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Patricia Moriarty
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Rachel K. Scott
- MedStar Health Research Institute, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Obstetrics and Gynecology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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25
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Hong Y. Extending the Influence of Presumed Influence Hypothesis: Information Seeking and Prosocial Behaviors for HIV Prevention. HEALTH COMMUNICATION 2023; 38:765-778. [PMID: 34510992 DOI: 10.1080/10410236.2021.1975902] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The influence of presumed influence hypothesis (IPI hypothesis) explains that people have biased perceptions of media influence and they change their behavior based on such perceptions. This study explicated the mechanisms of influence of presumed influence in health communication by integrating the theoretical explanations of the IPI hypothesis with theories of normative influence. The causal chains of the IPI hypothesis were examined using an experimental methodology with a HIV prevention, PrEP (pre-exposure prophylaxis). The results supported the expectations. Presumed exposure to health messages about PrEP shaped presumed influence of the messages on others, which in turn affected one's own intentions for information seeking and prosocial behaviors about PrEP. The findings also show that descriptive norms and injunctive norms interact with presumed influence differently. This study discusses the potential benefits of the IPI hypothesis in health communication.
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Affiliation(s)
- Yangsun Hong
- Department of Communication and Journalism, University of New Mexico
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26
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Hill MJ, Heads AM, Suchting R, Stotts AL. A survey with interventional components delivered on tablet devices versus usual care to increase pre-exposure prophylaxis uptake among cisgender Black women: a pilot randomized controlled trial. BMC Infect Dis 2023; 23:57. [PMID: 36707778 PMCID: PMC9881522 DOI: 10.1186/s12879-023-08019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/19/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Cisgender (cis) Black women in the USA are more likely to become HIV positive during their lifetime than other women. We developed and implemented a behavioral intervention, Increasing PrEP (iPrEP), the first pilot randomized controlled trial (RCT) aimed at motivating cis Black women to be willing to use PrEP for HIV prevention and attend an initial PrEP clinic visit following an emergency department visit. METHODS Eligible participants were Black cisgender women ages 18-55 years who acknowledged recent condomless sex and substance use. Participants were randomized to iPrEP or usual care (UC). iPrEP is a survey-based intervention designed to raise awareness and knowledge about PrEP. Participants completed an assessment of knowledge of and willingness to use PrEP before and after the intervention, then received a warm-hand off with referral to a local PrEP clinic. Enrolled participants were followed for 6 months. RESULTS Forty enrolled participants were ages 18-54 years. Education levels varied evenly between some high school education and graduate education. Most participants were single (n = 25) or married (n = 7). Twenty-two participants were employed full-time. Pre-test results indicated that 21 of 40 participants had heard of PrEP. All participants identified PrEP as a daily HIV prevention medication. For those randomized to iPrEP, the odds of knowing about PrEP at post-test, when controlling for baseline, were higher relative to UC (OR = 5.22, 95%CrI = 0.50, 94.1]. iPrEP did not have any effect on willingness relative to UC. The estimate for iPrEP on willingness is marginally higher (4.16 vs. 4.04; i.e., 0.12 points higher); however, the posterior probability of 67.9% does not suggest a strong degree of evidence in favor of an effect. During the post-test, those receiving iPrEP were less ready to take PrEP than those receiving UC. CONCLUSIONS Findings suggest that iPrEP increased knowledge about the PrEP medication but had a negative impact on readiness to take PrEP relative to UC. It is imperative that future research among cisgender Black women carefully considers the content provided in interventions designed to increase PrEP use, balancing the benefits of PrEP with the side effects and daily pill burden. TRIAL REGISTRATION clinicaltrial.gov Identifier: NCT03930654, 29/04/2019.
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Affiliation(s)
- Mandy J. Hill
- grid.267308.80000 0000 9206 2401University of Texas Health Science Center at Houston, Houston, USA ,grid.267308.80000 0000 9206 2401Department of Emergency Medicine, University of Texas Health Science Center at Houston, Houston, USA
| | - Angela M. Heads
- grid.267308.80000 0000 9206 2401University of Texas Health Science Center at Houston, Houston, USA ,grid.267308.80000 0000 9206 2401Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, USA
| | - Robert Suchting
- grid.267308.80000 0000 9206 2401University of Texas Health Science Center at Houston, Houston, USA ,grid.267308.80000 0000 9206 2401Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, USA
| | - Angela L. Stotts
- grid.267308.80000 0000 9206 2401University of Texas Health Science Center at Houston, Houston, USA ,grid.267308.80000 0000 9206 2401Department of Family Medicine, University of Texas Health Science Center at Houston, Houston, USA
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27
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Experiences of Black Women in the United States Along the PrEP Care Continuum: A Scoping Review. AIDS Behav 2023; 27:2298-2316. [PMID: 36622485 DOI: 10.1007/s10461-022-03960-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 01/10/2023]
Abstract
Black women are disproportionately affected by HIV in the U.S. PrEP could decrease the risk of acquiring HIV. This scoping review seeks to understand the experiences of Black women along the PrEP Care Continuum. We searched PubMed, Embase, PsycInfo, and Google Scholar to identify peer-reviewed studies published between July 16, 2012, and December 15, 2021. Articles were included if they discussed PrEP among Black women in the U.S. Two authors screened titles/abstracts and full-text articles. One author extracted and thematically summarized findings (n = 33). Black women reported low levels of PrEP awareness and knowledge, and negative experiences with providers. Women also experienced negative perceptions of PrEP from their social networks, stigma, and mistrust. Future research should focus on helping Black women to overcome PrEP-related barriers. Additionally, future research should further examine barriers to PrEP initiation, adherence, and retention for Black women, as only three studies discussed these aspects of the Continuum.
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Hollcroft MR, Gipson J, Barnes A, Mena L, Dombrowski JC, Ward LM, Khosropour CM. PrEP Acceptance among Eligible Patients Attending the Largest PrEP Clinic in Jackson, Mississippi. J Int Assoc Provid AIDS Care 2023; 22:23259582231167959. [PMID: 37032460 PMCID: PMC10088405 DOI: 10.1177/23259582231167959] [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: 09/22/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 04/11/2023] Open
Abstract
Compared to other states in the United States, Mississippi has the lowest uptake of PrEP relative to the number of people newly diagnosed with HIV in the state. Open Arms Healthcare Center is the largest provider of PrEP in Mississippi, and has systematically documented PrEP eligibility, offers, and acceptance (ie, agreed to undergo a clinical PrEP evaluation) from 2017 to mid-2020. In encounter-based analyses, we examined factors associated with PrEP acceptance. Among 721 encounters where patients were eligible for PrEP, staff offered PrEP at 680 (94%) of encounters (526 unique individuals); individuals accepted a PrEP offer at 58% of encounters. Accepting a PrEP offer was lowest (15.8%) among transgender/non-binary individuals and highest (93.3%) among individuals who reported having sex partners living with HIV. This clinic's model worked to offer PrEP to a highly impacted population, though there is a need to enhance PrEP acceptance for key groups such as transgender/non-binary individuals.
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Affiliation(s)
| | - June Gipson
- Open Arms Healthcare Center, Jackson, MS, USA
| | | | - Leandro Mena
- Open Arms Healthcare Center, Jackson, MS, USA
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
| | - Julia C. Dombrowski
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Public Health – Seattle & King County, HIV/STD Program, Seattle, WA, USA
| | - Lori M. Ward
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
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Ramakrishnan A, Sales JM, McCumber M, Powell L, Sheth AN. Human Immunodeficiency Virus Pre-Exposure Prophylaxis Knowledge, Attitudes, and Self-Efficacy Among Family Planning Providers in the Southern United States: Bridging the Gap in Provider Training. Open Forum Infect Dis 2022; 9:ofac536. [PMID: 36349276 PMCID: PMC9636854 DOI: 10.1093/ofid/ofac536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background Pre-exposure prophylaxis (PrEP) is an effective human immunodeficiency virus (HIV) prevention intervention, but its access and use are suboptimal, especially for women. Healthcare providers provision of PrEP is a key component of the Ending the HIV Epidemic initiative. Although training gaps are an identified barrier, evidence is lacking regarding how to tailor trainings for successful implementation. Title X family planning clinics deliver safety net care for women and are potential PrEP delivery sites. To inform provider training, we assessed PrEP knowledge, attitudes, and self-efficacy in the steps of PrEP care among Title X providers in the Southern United States. Methods We used data from providers in clinics that did not currently provide PrEP from a web-based survey administered to Title X clinic staff in 18 Southern states from February to June 2018. We developed generalized linear mixed models to evaluate associations between provider-, clinic-, and county-level variables with provider knowledge, attitudes, and self-efficacy in PrEP care, guided by the Consolidated Framework for Implementation Research. Results Among 351 providers from 193 clinics, 194 (55%) were nonprescribing and 157 (45%) were prescribing providers. Provider ability to prescribe medications was significantly associated PrEP knowledge, attitudes, and self-efficacy. Self-efficacy was lowest in the PrEP initiation step of PrEP care and was positively associated with PrEP attitudes, PrEP knowledge, and contraception self-efficacy. Conclusions Our findings suggest that PrEP training gaps for family planning providers may be bridged by addressing unfavorable PrEP attitudes, integrating PrEP and contraception training, tailoring training by prescribing ability, and focusing on the initiation steps of PrEP care.
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Affiliation(s)
- Aditi Ramakrishnan
- Division of Infectious Diseases, Washington University School of Medicine , St. Louis, Missouri , USA
| | - Jessica M Sales
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
| | - Micah McCumber
- Department of Biostatistics, Collaborative Studies Coordinating Center, University of North Carolina at Chapel Hill , Chapel Hill, North Carolina , USA
| | - Leah Powell
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University , Atlanta, Georgia , USA
| | - Anandi N Sheth
- Division of Infectious Diseases, Emory University School of Medicine , Atlanta, Georgia , USA
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Crooks N, Singer R, Smith A, Ott E, Donenberg G, Matthews AK, Patil C, Haider S, Johnson A. Barriers to PrEP Uptake Among Black Female Adolescents and Emerging Adults. Prev Med Rep 2022; 31:102062. [DOI: 10.1016/j.pmedr.2022.102062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/16/2022] [Accepted: 11/19/2022] [Indexed: 11/25/2022] Open
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Johnson LM, Green HD, Lu M, Stockman JK, Felsher M, Roth AM, Wagner KD. Who Can I Ask? Who Would I Tell? An Egocentric Network Analysis Among a Sample of Women At-Risk to Explore Anticipated Advice Seeking and Disclosure Around Pre-exposure Prophylaxis (PrEP). AIDS Behav 2022; 26:2866-2880. [PMID: 35212857 PMCID: PMC9378507 DOI: 10.1007/s10461-022-03621-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/01/2022]
Abstract
Pre-Exposure Prophylaxis (PrEP) health campaigns invite women to talk with their provider, partner, and peers about PrEP, though they do not offer specific guidance about who and how to engage. This study uses egocentric network methods in a sample of women at risk for HIV to understand what characteristics of women (egos), their networks, and network members (alters) were associated with anticipated PrEP advice-seeking and anticipated PrEP disclosure. Multivariable generalized linear mixed models revealed that women often consider close, supportive, and trusted network members as PrEP discussants while ego-level, network-level, and cross-level interactions depict the complexity of anticipated network activation. Findings highlight the importance of considering women at risk for HIV in a broader social context. Anticipated advice-seeking and disclosure related to PrEP were associated but distinct forms of network activation, which highlights the need to develop specific recommendations about who and how women should engage with their networks around PrEP.
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Affiliation(s)
- Laura M Johnson
- University of Nevada Reno, MS 0274, 1664 N Virginia St, Reno, NV, 89557, USA
| | | | - Minggen Lu
- University of Nevada Reno, MS 0274, 1664 N Virginia St, Reno, NV, 89557, USA
| | | | | | | | - Karla D Wagner
- University of Nevada Reno, MS 0274, 1664 N Virginia St, Reno, NV, 89557, USA.
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Randolph SD, Johnson R, Johnson A, Keusch L. Using PrEP and Doing it for Ourselves (UPDOs Protective Styles), a Web-Based Salon Intervention to Improve Uptake of Pre-exposure Prophylaxis Among Black Women: Protocol for a Pilot Feasibility Study. JMIR Res Protoc 2022; 11:e34556. [PMID: 36040785 PMCID: PMC9472057 DOI: 10.2196/34556] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/06/2022] [Accepted: 06/30/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Multilevel interventions are necessary to address the complex social contributors to health that limit pre-exposure prophylaxis use among Black women, including medical distrust, pre-exposure prophylaxis stigma, and access to equitable health care. Strategies to improve knowledge, awareness, and uptake of pre-exposure prophylaxis among Black women will be more successful if information-sharing and implementation take place within trusted environments. Providing women with information through trusted cultural and social channels can effectively support informed decision-making about pre-exposure prophylaxis for themselves and members of their social networks who are eligible for pre-exposure prophylaxis. OBJECTIVE The goal of this project is to improve knowledge, awareness, uptake, and trust of pre-exposure prophylaxis, as well as reduce pre-exposure prophylaxis stigma, among Black women living in the US South. METHODS This multilevel, mixed methods study uses a community-engagement approach to develop and pilot test a salon-based intervention. There are three components of this intervention: (1) stylist training, (2) women-focused entertainment videos and modules, and (3) engagement of a pre-exposure prophylaxis navigator. First, stylist training will be provided through two 2-hour training sessions delivered over 2 consecutive weeks. We will use a pre- and posttest design to examine knowledge and awareness improvement of pre-exposure prophylaxis among the stylists. Upon full completion of training, the stylists will receive a certificate of completion and "Ask Me about PrEP" signage for their beauty salons. Second, together with the community, we have codeveloped a 4-part entertainment series (The Wright Place) that uses culturally and socially relevant stories to highlight key messages about (1) HIV, (2) pre-exposure prophylaxis, and (3) Black women's social contributors to health. Quantitative and qualitative measures will be used in a pre- and posttest design to examine pre-exposure prophylaxis knowledge, awareness, risk, stigma, trust, intentions, and women's perceptions of the usability and acceptability of the overall intervention and its implementation strategies. A video blog will be provided after each video. Third, participants will have access through an email or text message link to a pre-exposure prophylaxis navigator, who will respond to them privately to answer questions or make referrals for pre-exposure prophylaxis as requested. RESULTS This project was funded in October 2020 by Gilead Sciences and was approved by the Duke University School of Nursing institutional review board in April 2021 (Pro00106307). Intervention components were developed in partnership with community partners in the first year. Data collection for phase 1 began in April 2022. Data collection for phase 2 began in May 2022. The study will be complete by October 2022. CONCLUSIONS Multilevel interventions that consider the assets of the community have promise for promoting health among Black women who have influence within their social networks. The findings of this study have the potential to be generalizable to other populations. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/34556.
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Affiliation(s)
- Schenita D Randolph
- Duke University School of Nursing, Duke University, Durham, NC, United States
| | - Ragan Johnson
- Duke University School of Nursing, Duke University, Durham, NC, United States
| | - Allison Johnson
- Duke University School of Nursing, Duke University, Durham, NC, United States
| | - Lana Keusch
- Duke University School of Nursing, Duke University, Durham, NC, United States
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Willie TC, Knight D, Baral SD, Chan PA, Kershaw T, Mayer KH, Stockman JK, Adimora AA, Monger M, Mena LA, Philllips KA, Nunn A. Where's the "Everyday Black Woman"? An intersectional qualitative analysis of Black Women's decision-making regarding HIV pre-exposure prophylaxis (PrEP) in Mississippi. BMC Public Health 2022; 22:1604. [PMID: 35999528 PMCID: PMC9396836 DOI: 10.1186/s12889-022-13999-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 08/11/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Black cisgender women in the U.S. South bear a disproportionate burden of HIV compared to cisgender women in other racial and ethnic groups and in any other part of the US. Critical to decreasing new HIV infections is the improved delivery of pre-exposure prophylaxis (PrEP) for Black cisgender women as it remains underutilized in 2021. Informed by intersectionality, the study sought to characterize the sociostructural influences on Black cisgender women's deliberations about PrEP within the context of interlocking systems of oppression including racism, sexism, and classism. METHODS Six focus groups were conducted with 37 Black women residing in Jackson, Mississippi. This sample was purposively recruited to include Black cisgender women who were eligible for PrEP but had never received a PrEP prescription. RESULTS Six themes were identified as concerns during PrEP deliberation among Black women: 1) limited PrEP awareness, 2) low perceived HIV risk, 3) concerns about side effects, 4) concerns about costs, 5) limited marketing, and 6) distrust in the healthcare system. Three themes were identified as facilitators during PrEP deliberations: 1) women's empowerment and advocacy, 2) need for increased PrEP-specific education, and 3) the positive influence of PrEP-engaged women's testimonials. Black women shared a limited awareness of PrEP exacerbated by the lack of Black women-specific marketing. Opportunities to support Black women-specific social marketing could increase awareness and knowledge regarding PrEP's benefits and costs. Black women also shared their concerns about discrimination in healthcare and distrust, but they felt that these barriers may be addressed by patient testimonials from PrEP-engaged Black women, empowerment strategies, and directly addressing provider biases. CONCLUSIONS An effective response to PrEP implementation among Black women in the South requires developing programs to center the needs of Black women and carry out active strategies that prioritize peer advocacy while reinforcing positive and mitigating negative influences from broader social and historical contexts.
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Affiliation(s)
- Tiara C Willie
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - Deja Knight
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Stefan D Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Philip A Chan
- Department of Medicine, Brown University, 222 Richmond St, Providence, RI, 02903, USA
| | - Trace Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, USA
| | - Kenneth H Mayer
- Harvard Medical School and Harvard T H Chan School of Public Health, Harvard University, 25 Shattuck St, Boston, MA, 02115, USA
| | - Jamila K Stockman
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Adaora A Adimora
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, 170 Rosenau Hall, CB#7400, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA
| | - Mauda Monger
- MLM Center for Health Education and Equity Consulting Services, 123-A Hwy 80 East #258, Clinton, MS, 39056, USA
| | - Leandro A Mena
- Department of Medicine, University of Mississippi Medical Center, 2500 N State St, Jackson, MS, 39216, USA
| | - Karlye A Philllips
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA
| | - Amy Nunn
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, 121 S Main St, Providence, RI, 02903, USA
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Scott RK, Hull SJ, Huang JC, Coleman M, Ye P, Lotke P, Beverley J, Moriarty P, Balaji D, Ward A, Holiday J, Brant AR, Cameron M, Elion R, Visconti A. Factors Associated with Intention to Initiate Pre-exposure Prophylaxis in Cisgender Women at High Behavioral Risk for HIV in Washington, D.C. ARCHIVES OF SEXUAL BEHAVIOR 2022; 51:2613-2624. [PMID: 35622077 PMCID: PMC9308717 DOI: 10.1007/s10508-021-02274-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/15/2023]
Abstract
Pre-exposure prophylaxis (PrEP) for HIV prevention is underutilized by cisgender women at risk for HIV in the USA. Published research on PrEP initiation among cisgender women at risk for HIV focuses on identifying barriers and facilitators associated with intention to initiate, but few apply a behavioral theoretical lens to understand the relative importance of these diverse factors. This study provides a theoretically grounded view of the relative importance of factors associated with intention to initiate PrEP. We conducted an anonymous, cross-sectional survey of 1437 cisgender women seeking care at family planning and sexual health clinics to evaluate hypothesized barriers and facilitators of PrEP initiation. We categorized cisgender women with ≥ 3 behavioral risk-factors as "high-risk" for HIV acquisition; 26.9% (N = 387) met high-risk criterion. Among cisgender women in the high-risk sample, the majority were Black and single. Perceived risk of HIV acquisition was low and 13.7% reported intention to initiate PrEP. Positive attitudes toward PrEP, self-efficacy, perceived support from medical providers and social networks, and prior discussion about PrEP with medical providers were associated with intention to initiate PrEP; stigma was negatively associated. Background characteristics (other than age), risk factors for HIV acquisition, prior awareness of PrEP, and perceived risk of HIV were not associated with uptake intention. These findings support interventions that center on the role of providers in the provision of PrEP and on social networks in destigmatization of PrEP use.
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Affiliation(s)
- Rachel K Scott
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA.
- MedStar Washington Hospital Center, Washington, DC, USA.
| | - Shawnika J Hull
- Department of Communication, Rutgers University, New Brunswick, NJ, USA
| | - Jim C Huang
- Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | | | - Peggy Ye
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Pam Lotke
- MedStar Washington Hospital Center, Washington, DC, USA
| | | | - Patricia Moriarty
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Dhikshitha Balaji
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Allison Ward
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
- MedStar Washington Hospital Center, Washington, DC, USA
| | - Jennifer Holiday
- MedStar Health Research Institute, 6525 Belcrest Road, Hyattsville, MD, 20782, USA
| | - Ashley R Brant
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Martha Cameron
- International Community of Women Living with HIV, Washington, DC, USA
| | | | - Adam Visconti
- MedStar Georgetown University, NW Washington, DC, USA
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Bunting SR, Feinstein BA, Calabrese SK, Hazra A, Sheth NK, Chen AF, Garber SS. Assumptions about patients seeking PrEP: Exploring the effects of patient and sexual partner race and gender identity and the moderating role of implicit racism. PLoS One 2022; 17:e0270861. [PMID: 35776746 PMCID: PMC9249206 DOI: 10.1371/journal.pone.0270861] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 06/09/2022] [Indexed: 01/10/2023] Open
Abstract
Introduction Daily pre-exposure prophylaxis (PrEP) for HIV-prevention is an essential component of national plans to end the HIV epidemic. Despite its well-documented safety and effectiveness, PrEP prescription has not met the public health need. Significant disparities between White and Black people exist with respect to PrEP prescription, as do disparities between men and women. One factor contributing to these disparities is clinicians’ assumptions about patients seeking PrEP. Methods The present study sought to investigate medical students’ assumptions about patients seeking PrEP (anticipated increased condomless sex, extra-relational sex, and adherence to PrEP), and assumed HIV risk when presenting with their sexual partner. We systematically varied the race (Black or White) and gender (man or woman) of a fictional patient and their sexual partner. All were in serodifferent relationships including men who have sex with men (MSM), women (MSW), and women who have sex with men (WSM). Participants also completed an implicit association test measuring implicit racism against Black people. We evaluated the moderation effects of patient and partner race on assumptions as well as the moderated moderation effects of implicit racism. Results A total of 1,472 students participated. For MSM patients, having a Black partner was associated with higher assumed patient non-adherence to PrEP compared to a White partner, however a White partner was associated with higher assumed HIV risk. For MSW patients, a White male patient was viewed as being more likely to engage in more extra-relational sex compared to a Black male patient. For WSM patients, White women were assumed to be more likely to have condomless and extra-relational sex, be nonadherent to PrEP, and were at higher HIV risk. Overall, implicit racism was not related to negative assumptions about Black patients as compared to White patients based on patient/partner race. Discussion Medical education about PrEP for HIV prevention must ensure future health professionals understand the full range of patients who are at risk for HIV, as well as how implicit racial biases may affect assumptions about patients in serodifferent couples seeking PrEP for HIV prevention. As gatekeepers for PrEP prescription, clinicians’ assumptions about patients seeking PrEP represent a barrier to access. Consistent with prior research, we identified minimal effects of race and implicit racism in an experimental setting.
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Affiliation(s)
- Samuel R. Bunting
- Department of Psychiatry and Behavioral Neuroscience, The University of Chicago Medicine, Chicago, Illinois, United States of America
- * E-mail:
| | - Brian A. Feinstein
- Department of Psychology, College of Health Professions, Rosalind Franklin University, North Chicago, Illinois, United States of America
| | - Sarah K. Calabrese
- Department of Psychological and Brain Sciences, The George Washington University, Washington, District of Columbia, United States of America
| | - Aniruddha Hazra
- Section of Infectious Diseases and Global Health, Department of Medicine, The University of Chicago Medicine, Chicago, Illinois, United States of America
| | - Neeral K. Sheth
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, Illinois, United States of America
| | - Alex F. Chen
- Chicago Medical School, Rosalind Franklin University, North Chicago, Illinois, United States of America
| | - Sarah S. Garber
- Department of Pharmaceutical Sciences, College of Pharmacy, Rosalind Franklin University, North Chicago, Illinois, United States of America
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Fay KE, Onwuzurike C, Finley A, Miller E. Integrating anti-violence efforts into sexual and reproductive health: reproductive coercion as a case example. Contraception 2022; 115:75-79. [PMID: 35716807 DOI: 10.1016/j.contraception.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/31/2022] [Accepted: 06/05/2022] [Indexed: 11/03/2022]
Abstract
Integration of anti-oppression approaches into clinical practice, including sexual and reproductive health, is needed. Reproductive coercion is a common form of violence that directly impacts sexual and reproductive health. Person-centered harm reduction strategies for reproductive coercion can be integrated readily into routine care utilizing clinicians' existing skill set. Interventions for reproductive coercion may serve as a proof of concept for the incorporation of anti-violence and healing justice efforts within medical care.
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Affiliation(s)
- Kathryn E Fay
- Harvard Medical School, Department of Obstetrics, Gynecology and Reproductive Biology, Boston, MA, USA.
| | - Chiamaka Onwuzurike
- Harvard Medical School, Department of Obstetrics, Gynecology and Reproductive Biology, Boston, MA, USA
| | | | - Elizabeth Miller
- University of Pittsburgh School of Medicine, Department of Pediatrics, Pittsburgh, PA, USA
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Implementing pre-exposure prophylaxis for HIV prevention in women: the role of the obstetrician-gynecologist. Am J Obstet Gynecol 2022; 226:764-772. [PMID: 34973180 DOI: 10.1016/j.ajog.2021.12.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 12/17/2021] [Accepted: 12/23/2021] [Indexed: 11/21/2022]
Abstract
Pre-exposure prophylaxis is a powerful HIV prevention tool that can reduce the risk of acquiring HIV by >90% from unprotected sex and >70% from injection drug use. The peripartum period is a time of heightened HIV risk, which underscores the need for HIV prevention counseling and the provision of biomedical interventions in all stages of a woman's reproductive life. It is important that women receive nonjudgmental care, have access to discussions of HIV risk, and are provided with pre-exposure prophylaxis counseling from their women's health practitioners. Obstetrician-gynecologists and other women's health providers are uniquely positioned to identify women who would benefit from pre-exposure prophylaxis and provide it in trusted clinical settings.
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Mangum LC, Craddock JB, Whitfield DL. Associations in preventive sexual health service utilization and pre-exposure prophylaxis (PrEP) interest among young Black women in the United States, 2018. AIDS Care 2022; 34:324-330. [PMID: 33975482 PMCID: PMC8581060 DOI: 10.1080/09540121.2021.1925213] [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: 10/19/2020] [Accepted: 04/27/2021] [Indexed: 10/21/2022]
Abstract
Despite declines in HIV prevalence among all U.S. women, HIV remains a serious concern for Black women. PrEP is an effective biomedical intervention and has high acceptability among Black women. Therefore, offering PrEP, in addition to screening and testing for STI/HIV consistently, can reduce HIV risk among this population. We examine the associations of preventive sexual health service utilization (PSHSU) and PrEP interest among young Black women (YBW) (N = 209) in the United States in 2018. YBW, ages 18-25, completed a self-administered questionnaire, assessing sexual risk and prevention behaviors, HIV/STI testing, and PrEP interest. More than half of YBW were aware of PrEP and its benefits. YBW, who received an HIV test within the past three to six months, had higher odds of PrEP interest. The proportion of YBW who reported being interested in PrEP did not differ by PSHSU. Active contraceptive use was associated with PrEP interest. The results suggest YBW engage in preventive sexual health services, including HIV/STI testing, reproductive health, and sexual health behavioral counseling. Additional efforts should be made to normalize PrEP education for heterosexual, cisgender women at student health centers on college and university campuses, and other venues outside of traditional HIV/STI testing facilities.
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Affiliation(s)
- Laurenia C. Mangum
- School of Social Work, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jaih B. Craddock
- School of Social Work, University of Maryland, Baltimore, MD, USA
| | - Darren L. Whitfield
- Department of Psychiatry, School of Social Work, University of Pittsburgh, Pittsburgh, PA, USA
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Teitelman AM, Tieu HV, Flores D, Bannon J, Brawner BM, Davis A, Gugerty P, Koblin B. Individual, social and structural factors influencing PrEP uptake among cisgender women: a theory-informed elicitation study. AIDS Care 2022; 34:273-283. [PMID: 33719816 PMCID: PMC8426410 DOI: 10.1080/09540121.2021.1894319] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The underutilization of pre-exposure prophylaxis (PrEP) among cisgender women in the U.S. limits this population's ability to reduce their risk for HIV infection, especially within the unique individual, social and structural systems they navigate. There is a need to identify the relevant multi-level barriers and facilitators to PrEP use among cisgender women to inform theory-guided efforts that address HIV disparities by race/ethnicity among cisgender women. Guided by the Integrated Behavioral Model and the Behavioral Model of Vulnerble Populations we conducted 41 interviews with PrEP eligible cisgender women in New York City and Philadelphia. Directed content analysis identified 11 modal behavioral beliefs crucial to PrEP uptake, including anticipated negative social consequences, 5 normative beliefs centered on available social supports, and 9 control beliefs such as anticipated barriers such as cost. Awareness and knowledge of PrEP as a biobehavioral HIV prevention method is limited for this sample. Through conventional content analysis we identified interpersonal and structural barriers to PrEP uptake including lack of partner support, transportation, mental health challenges, and challenges in accessing PrEP care. Potential solutions to structural barriers were enumerated along with implications for future intervention work and public health programming.
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Affiliation(s)
- Anne M. Teitelman
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Hong-Van Tieu
- Lab of Infectious Disease Prevention, Lindsley F. Kimball Research Institute, New York Blood Center; Division of Infectious Diseases, Department of Medicine, Columbia University Irving Medical Center
| | - Dalmacio Flores
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Jacqueline Bannon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Bridgette M. Brawner
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Annet Davis
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Paige Gugerty
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Beryl Koblin
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA,Independent Consultant, Metuchen, NJ
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Thorpe S, Hargons CN, Tanner AE, Stevens-Watkins D. Perceived HIV Invulnerability and PrEP Knowledge and Attitudes among Black Sexual Minority Women. AMERICAN JOURNAL OF SEXUALITY EDUCATION 2022; 17:400-413. [PMID: 37346321 PMCID: PMC10284562 DOI: 10.1080/15546128.2022.2035291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Black women have disproportionate rates of HIV compared to women of all other racial groups. The purpose of this analysis was to investigate perceived HIV risk, HIV and STI testing behaviors, and PrEP knowledge and attitudes among Black sexual minority women (SMW) and examine differences based on their history of male sex partners. Secondary data analysis was conducted using data from the Generations Study. This analysis used a sample of N=149 participants who identified as Black cisgender women. Results showed Black SMW with a history of male sex partners reported a higher perceived risk of contracting HIV and significantly more frequent HIV and STI testing than those without a history of male sex partners. Overall, most of the sample was not familiar with PrEP, but one-third had favorable attitudes towards it, and half felt like they did not know enough about PrEP to form an opinion. Implications for culturally relevant public health campaigns and comprehensive sexuality education that integrate PrEP are included.
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Affiliation(s)
- Shemeka Thorpe
- University of Kentucky, Department of Educational, School, and Counseling Psychology
| | - Candice N. Hargons
- University of Kentucky, Department of Educational, School, and Counseling Psychology
| | - Amanda E. Tanner
- University of North Carolina-Greensboro, Department of Public Health Education
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Scott RK, Hull SJ, Richards RC, Klemmer K, Salmoran F, Huang JC. Awareness, acceptability, and intention to initiate HIV pre-exposure prophylaxis among pregnant women. AIDS Care 2022; 34:201-213. [PMID: 33874801 PMCID: PMC8523573 DOI: 10.1080/09540121.2021.1916870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
HIV prevention is critically important during pregnancy, however, pre-exposure prophylaxis (PrEP) is underutilized. We conducted a survey of pregnant and non-pregnant women in a high HIV prevalence community in Washington D.C. to evaluate determinants of PrEP initiation during pregnancy. 201 pregnant women and a reference population of 1103 non-pregnant women completed the survey. Among pregnant women, mean age was 26.9 years; the majority were Black with household-incomes below the federal poverty level. Despite low perceived risk of HIV acquisition and low prior awareness of PrEP, 10.5% of respondents planned to initiate PrEP during pregnancy. Pregnant women identified safety, efficacy, and social network and medical provider support as key factors in PrEP uptake intention. The belief that PrEP will "protect (their) baby from HIV" was associated with PrEP uptake intention during pregnancy. Concerns regarding maternal/fetal side effects, and safety in pregnancy or while breastfeeding were not identified as deterrents to uptake intention. When compared to a nonpregnant sample, there were no significant differences in uptake intention between the two samples. These findings support the need for prenatal educational interventions to promote HIV prevention during pregnancy, as well as interventions that center on the role of providers in the provision of PrEP.
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Affiliation(s)
- Rachel K. Scott
- Women’s Health Research, MedStar Health Research Institute (MHRI), Washington, DC, USA,Women’s & Infants’ Services, MedStar Washington Hospital Center (MWHC), Washington, DC, USA,Obstetrics & Gynecology, Georgetown University School of Medicine (GUSOM), Washington, DC, USA
| | - Shawnika J. Hull
- School of Communication & Information, Rutgers University, New Brunswick, NJ, USA
| | - Robin C. Richards
- Women’s & Infants’ Services, MedStar Washington Hospital Center (MWHC), Washington, DC, USA
| | - Kristen Klemmer
- Obstetrics & Gynecology, Georgetown University School of Medicine (GUSOM), Washington, DC, USA
| | - Frida Salmoran
- Women’s Health Research, MedStar Health Research Institute (MHRI), Washington, DC, USA
| | - Jim C. Huang
- Women’s Health Research, MedStar Health Research Institute (MHRI), Washington, DC, USA,Department of Business Management, National Sun Yat-sen University, Kaohsiung, Taiwan
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Conley C, Johnson R, Bond K, Brem S, Salas J, Randolph S. US Black cisgender women and pre-exposure prophylaxis for human immunodeficiency virus prevention: A scoping review. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221103098. [PMID: 35699104 PMCID: PMC9201306 DOI: 10.1177/17455057221103098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/28/2022] [Accepted: 05/06/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Black cisgender women in the United States experience a disproportionate burden of human immunodeficiency virus acquisition. Pre-exposure prophylaxis is an effective oral daily medication that reduces the risk of human immunodeficiency virus through sex by 99% when taken as prescribed. However, less than 2% of eligible Black cisgender women take pre-exposure prophylaxis. The purpose of this scoping review was to describe the types of research studies done in this area, gaps in knowledge, and potential areas of research needed to increase pre-exposure prophylaxis use among Black cisgender women in the United States. METHODS We conducted our search in MEDLINE (PubMed), Embase (Elsevier), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), and Scopus (Elsevier) using a combination of keywords and database-specific subject headings for the following concepts: pre-exposure prophylaxis, African American/Black or minority, and women. We used the Joanna Briggs Institute's Reviewers' Manual process for Scoping Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews to ensure comprehensive and standardized reporting of each part of the review. RESULTS Fifty-nine studies were included in the final review. Results of the study were classified according to the three phases of the Human Immunodeficiency Virus Prevention Cascade-demand side, supply side, and adherence and retention. The majority of studies (n = 24, 41%) were cross-sectional quantitative surveys and 43 (34%) focused on the demand-side phase of the Human Immunodeficiency Virus Prevention Cascade. Fifty-eight percent of studies either assessed women's pre-exposure prophylaxis knowledge, attitudes, and intentions to use, or assessed perceived barriers and facilitators. Seven studies (12%) tested pre-exposure prophylaxis uptake and adherence among Black cisgender women. CONCLUSION This review found multiple missed opportunities to increase women's demand for pre-exposure prophylaxis and health care provider screening and referral for pre-exposure prophylaxis. Additional studies are needed to effectively assess pre-exposure prophylaxis uptake and adherence among Black cisgender women.
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Affiliation(s)
| | | | - Keosha Bond
- City University of New York School of
Medicine, New York, NY, USA
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Coleman CG, Sales JM, Escoffery C, Piper KN, Powell L, Sheth AN. Primary Care and Pre-exposure Prophylaxis Services in Publicly Funded Family Planning Clinics in the Southern United States. J Gen Intern Med 2021; 36:2958-2965. [PMID: 33443701 PMCID: PMC8481449 DOI: 10.1007/s11606-020-06509-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND HIV pre-exposure prophylaxis (PrEP) is underutilized by US women. Cost and resource concerns are barriers to PrEP delivery in settings that see men. Family planning clinics may be ideal PrEP delivery settings for women, but as they are not uniform in their clinical services, cost and resource concerns may vary. OBJECTIVE We examined factors that influence perceptions of costs and resources related to PrEP delivery in Title X-funded family planning clinics in Southern states, which overlaps with high HIV-burden areas. DESIGN We conducted a web-based survey among a convenience sample of clinicians and administrators of Title X clinics across 18 Southern states (DHHS regions III, IV, VI). We compared cost- and resource-related survey items and other clinic- and county-level variables between clinics by whether their clinics also provided other primary care services. We analyzed interviews for cost and resource themes. PARTICIPANTS Title X clinic staff in the South. KEY RESULTS Among 283 unique clinics, a greater proportion of clinics that also provided primary care currently provided PrEP compared with those that did not provide primary care (27.8% vs. 18.3%, p = 0.06), but this difference was not statistically significant. Among 414 respondents in clinics that were not providing PrEP, those in clinics with primary care services were more likely to respond that they had the necessary financial resources (p < 0.01) and staffing (p < 0.01) for PrEP implementation compared to those without primary care services. In interviews, respondents differed on concerns about costs of labs and staffing based on whether their clinic had concomitant primary care services or not. CONCLUSIONS Among publicly funded Southern family planning clinics, current PrEP provision was higher among clinics with concomitant primary care. Among clinics not providing PrEP, those with concomitant primary care services have lower perceived cost and resource barriers and therefore may be optimal for expanding PrEP among women.
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Affiliation(s)
| | - Jessica M Sales
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kaitlin N Piper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Leah Powell
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anandi N Sheth
- School of Medicine, Emory University, Atlanta, GA, USA. .,Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA. .,Grady Health System, Atlanta, GA, USA.
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Hull SJ, Tessema H, Thuku J, Scott RK. Providers PrEP: Identifying Primary Health care Providers' Biases as Barriers to Provision of Equitable PrEP Services. J Acquir Immune Defic Syndr 2021; 88:165-172. [PMID: 34506359 PMCID: PMC8577287 DOI: 10.1097/qai.0000000000002750] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite their disparately high HIV incidence and voiced willingness to use pre-exposure prophylaxis (PrEP), Black cisgender women's knowledge and uptake of PrEP are low, especially relative to White cisgender women and men who have sex with men. Mounting evidence demonstrates that health care provider recommendations are a critical factor in women's awareness, willingness, and ability to uptake PrEP. Health care providers may make clinical judgments about who is (not) a good candidate for PrEP based on unconscious and conscious stereotypes and prejudice. SETTING We conducted an online experiment among N = 160 health care providers with prescribing privileges in the 48 HIV hotspot counties. METHOD Providers received 1 of 4 vignettes about a PrEP eligible woman. Vignettes varied by patient race and substance use status. Then, providers reported their willingness to discuss PrEP with the patient and willingness to prescribe PrEP to her. RESULTS We tested 2 models predicting providers (1) willingness to discuss and (2) willingness to prescribe PrEP, contingent on their racial attitudes. Providers who scored high on a modern racism measure were less willing to discuss and prescribe PrEP to the Black patient. These effects were mediated by provider perceptions of patients' abilities to adhere to PrEP, but not their expectations of risk compensatory behaviors. CONCLUSIONS Our findings highlight the importance of applying an intersectional lens in documenting the processes that exacerbate inequities in PrEP use. This study provides evidence to support the development of interventions that address the mechanisms that work to thwart optimal care.
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Affiliation(s)
- Shawnika J Hull
- Department of Communication, Rutgers University, New Brunswick, NJ
- Department of Prevention and Community Health, the George Washington University, Washington, DC
| | - Hanna Tessema
- Department of Prevention and Community Health, the George Washington University, Washington, DC
| | - Jeri Thuku
- Department of Prevention and Community Health, the George Washington University, Washington, DC
| | - Rachel K Scott
- Center for AIDS Prevention Studies, Prevention Research Center, Division of Prevention Science, University of California, California, San Francisco
- Women's and Infants' Services Department, MedStar Washington Hospital Center, Washington, DC; and
- Georgetown University School of Medicine, Washington, DC
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Williams MS, Poteat T, Bender M, Ugwu P, Burns PA. Revitalizing HIV Prevention Programs: Recommendations From Those Most Impacted by the HIV in the Deep South. Am J Health Promot 2021; 36:155-164. [PMID: 34409888 DOI: 10.1177/08901171211041097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The incidence of new HIV infections is disproportionately high among Black men who have sex with men (BMSM) in Mississippi. Community-based organizations received funding through the ACCELERATE! initiative to implement interventions aimed at increasing BMSM's access to HIV prevention, treatment and care interventions. APPROACH We conducted a mixed methods evaluation of the ACCELERATE! initiative to assess its impact. We also explored factors that act as barriers to and facilitators of BMSM's engagement in HIV prevention interventions. SETTING Interviews were conducted between July 2018 and February 2020. PARTICIPANTS Thirty-six BMSM and 13 non-grantee key informants who worked in the field of HIV in Mississippi participated. METHOD The qualitative data from the interview transcripts was analyzed using an iterative, inductive coding process. RESULTS We identified 10 key recommendations that were most common across all participants and that were aligned with UNAIDS Global AIDS Strategy strategic priorities. Several recommendations address the reduction of HIV- and LGBT-stigma. Two of the most common recommendations were to increase representation of the target population in health promotion program leadership and to include HIV with other Black health issues in community-based health education programs rather than singling it out. Another recommendation called for programs aimed at addressing underlying factors associated with HIV-risk behaviors, such as mental illness. CONCLUSION Our results indicate that HIV education interventions in the Deep South need to be revitalized to enhance their reach and effectiveness.
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Affiliation(s)
- Michelle S Williams
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Tonia Poteat
- Department of Social Medicine, University of North Carolina Chapel Hill, NC, USA
| | - Melverta Bender
- Office of STD/HIV, Mississippi State Department of Health, Jackson, MS, USA
| | - Precious Ugwu
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Paul A Burns
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
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Tao J, Montgomery MC, Williams R, Patil P, Rogers BG, Sosnowy C, Murphy M, Zanowick-Marr A, Maynard M, Napoleon SC, Chu C, Almonte A, Nunn AS, Chan PA. Loss to Follow-Up and Re-Engagement in HIV Pre-Exposure Prophylaxis Care in the United States, 2013-2019. AIDS Patient Care STDS 2021; 35:271-277. [PMID: 34242092 DOI: 10.1089/apc.2021.0074] [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: 01/14/2023] Open
Abstract
Retention in HIV pre-exposure prophylaxis (PrEP) care is critical for effective PrEP implementation. Few studies have reported long-term lost to follow-up (LTFU) and re-engagement in PrEP care in the United States. Medical record data for all cisgender patients presenting to the major Rhode Island PrEP clinic from 2013 to 2019 were included. LTFU was defined as no PrEP follow-up appointment within 98 days. Re-engagement in care was defined as individuals who were ever LTFU and later attended a follow-up appointment. Recurrent event survival analysis was performed to explore factors associated with PrEP retention over time. Of 654 PrEP patients, the median age was 31 years old [interquartile range (IQR): 25, 43]. The majority were male (96%), White (64%), non-Hispanic (82%), and insured (97%). Overall, 72% patients were ever LTFU and 27% of those ever LTFU re-engaged in care. Female patients were 1.37 times [crude hazard ratio (cHR): 1.37; 95% confidence interval (CI): 0.86-2.18] more likely to be LTFU than male patients, and a 1-year increase in age was associated with a 1% lower hazard of being LTFU (cHR: 0.99; CI: 0.98-0.99). Being either heterosexual (aHR: 2.25, 95% (CI): 1.70-2.99] or bisexual (aHR: 2.35, 95% CI: 1.15-4.82) was associated with a higher hazard of loss to follow-up compared with having same-sex partners only. The majority of PrEP users were LTFU, especially at the first 6 months of PrEP initiation. Although a significant number were re-engaged in care, targeted interventions are needed to improve retention in PrEP care. This study characterized the natural projection of loss to follow-up and re-engagement in HIV PrEP care using a longitudinal clinic cohort data and explored associated factors for guiding future interventions to improve retention in PrEP care.
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Affiliation(s)
- Jun Tao
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Madeline C. Montgomery
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Robert Williams
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Prasad Patil
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Brooke G. Rogers
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Collette Sosnowy
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Matthew Murphy
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alexandra Zanowick-Marr
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Michaela Maynard
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Siena C. Napoleon
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christina Chu
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Alexi Almonte
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Amy S. Nunn
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Philip A. Chan
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, Rhode Island, USA
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Pollock L, Warren M, Levison J. Missed Opportunities for HIV Prevention in Perinatal Care Settings in the United States. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:680046. [PMID: 36304042 PMCID: PMC9580717 DOI: 10.3389/frph.2021.680046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
Universal opt-out HIV screening in pregnancy is an essential intervention toward eliminating perinatal HIV transmission in the US. However, it fails to identify pregnant people who are HIV negative at the time of testing but are at ongoing risk for HIV acquisition. Those of us involved in caring for women living with HIV are acutely aware of the many diagnoses of HIV that might have been prevented if only a partner had been tested for HIV or preexposure prophylaxis (PrEP) had been offered to a patient. This perspective article will review current recommendations and evidence-based interventions to evaluate missed opportunities for HIV prevention in US perinatal care settings. We identified three barriers to implementation of HIV prevention strategies during pregnancy and breastfeeding: (1) HIV risk for women is underestimated and poorly defined in clinical practice; (2) Partner testing is challenging and implementation studies in the US are lacking; and (3) PrEP remains underutilized. In March 2020, the National Perinatal HIV Hotline convened a group of clinicians and researchers specializing in perinatal HIV care to a case-based discussion of missed opportunities in perinatal HIV prevention. From our review of the literature via PubMed search as well as expert opinions gathered in this discussion, we make recommendations for addressing these barriers.
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Affiliation(s)
- Lealah Pollock
- National Clinician Consultation Center, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
- *Correspondence: Lealah Pollock
| | - Marliese Warren
- National Clinician Consultation Center, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Judy Levison
- National Clinician Consultation Center, Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, United States
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, United States
- Judy Levison
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Johnson R, Myers D, McKellar M, Saint-Hillaire L, Randolph SD. Perspectives of Black women in the United States on salon-based intervention to promote the uptake of pre-exposure prophylaxis (PrEP) for HIV. J Clin Nurs 2021; 30:3281-3289. [PMID: 33969573 DOI: 10.1111/jocn.15838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/17/2020] [Accepted: 04/19/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To understand Black women's perspectives on a pre-exposure prophylaxis (PrEP) education intervention in a salon setting. BACKGROUND Black women have a significant lifetime risk of acquiring HIV. Pre-exposure prophylaxis (PrEP) is an effective prevention approach in reducing that risk. Despite this, Black women are least likely to use PrEP. DESIGN This was a qualitative study to identify Black women's perspectives on acceptability of a PrEP education intervention in a salon setting using hair stylists. The paper adhered to the COREQ checklist in reporting. METHODS Seven focus groups among Black women (n = 44) living in north-central North Carolina were conducted. Ethical approval was obtained. The interview guide included questions on knowledge of PrEP and barriers and facilitators to a PrEP promotion programme in a salon setting. RESULTS Conventional content analysis considered content in relation to themes of facilitators, barriers and women's preferences for intervention delivery. Facilitators included the salon characteristics, social culture and relationship with the stylist. Women noted concerns of accuracy of content from stylists and privacy as barriers. CONCLUSIONS Participants' trust with their stylists make a PrEP education salon-based intervention feasible. Salon-based interventions are not one-size-fits-all and researchers interested in this setting should tailor interventions to the individual salon. Interventions for PrEP in a salon setting should be culturally appropriate, confidential and consider the potential reach to the social networks of Black women in the salon. RELEVANCE TO CLINICAL PRACTICE The insights shared by Black women can contribute to developing a PrEP uptake intervention as a way of reducing new cases of HIV.
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Affiliation(s)
- Ragan Johnson
- Duke University School of Nursing, Durham, North Carolina, USA
| | | | - Mehri McKellar
- Duke University School of Medicine, Durham, North Carolina, USA
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Piper KN, Haardörfer R, Escoffery C, Sheth AN, Sales J. Exploring the heterogeneity of factors that may influence implementation of PrEP in family planning clinics: a latent profile analysis. Implement Sci Commun 2021; 2:48. [PMID: 33947472 PMCID: PMC8097793 DOI: 10.1186/s43058-021-00148-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Title X-funded family planning clinics have been identified as optimal sites for delivery of pre-exposure prophylaxis (PrEP) for HIV prevention. However, PrEP has not been widely integrated into family planning services, especially in the Southern US, and data suggest there may be significant implementation challenges in this setting. Because Title X clinics vary greatly in provider-, organizational-, and systems-level characteristics, there is likely variation in capacity to implement PrEP across clinics. METHODS We conducted a survey from February to June 2018 among providers and administrators of non-PrEP-providing Title X-funded clinics across 18 southern states. Survey items were designed using the Consolidated Framework for Implementation Research (CFIR) to assess constructs relevant to PrEP implementation. To explore the heterogeneity of CFIR-related implementation determinants and identify distinct sub-groups of Title X clinics, a latent profile analysis was conducted using nine CFIR constructs: complexity, relative advantage, cost, attitudes, implementation climate, compatibility, leadership engagement, available resources, and cosmopolitanism. We then conducted a multi-level analysis (accounting for nesting of participants within clinics) to test whether group membership was associated with readiness for implementation of PrEP, controlling for key sociodemographic characteristics. RESULTS Four hundred and fourteen healthcare providers/administrators from 227 non-PrEP-providing Title X clinics participated in the study. We identified six sub-groups of clinics that each had distinct patterns of PrEP implementation determinants. Clinic sub-groups included "Highest Capacity for Implementation", "Favorable Conditions for Implementation", "Mixed Implementation Context", "Neutral Implementation Context", "Incompatible Setting for Implementation", and "Resource-Strained Setting". Group membership was related to numerous provider-level (i.e., ability to prescribe medication) and clinic-level (i.e., provision of primary care) characteristics. In comparison to the "Neutral" group (which held neutral perceptions across the implementation determinants), the "Highest Capacity" and "Favorable Conditions" groups had significantly higher levels of implementation readiness, and the "Resource-Strained" group had a significantly lower level of implementation readiness. CONCLUSIONS Latent profile analyses can help researchers understand how implementation readiness varies across healthcare settings, promoting tailoring of implementation strategies to unique contexts.
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Affiliation(s)
- Kaitlin N Piper
- Department of Behavioral, Social, and Health Education Science, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | - Regine Haardörfer
- Department of Behavioral, Social, and Health Education Science, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Cam Escoffery
- Department of Behavioral, Social, and Health Education Science, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Anandi N Sheth
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Jessica Sales
- Department of Behavioral, Social, and Health Education Science, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Dauria EF, Levine A, Hill SV, Tolou-Shams M, Christopoulos K. Multilevel Factors Shaping Awareness of and Attitudes Toward Pre-exposure Prophylaxis for HIV Prevention among Criminal Justice-Involved Women. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:1743-1754. [PMID: 33236275 PMCID: PMC8276158 DOI: 10.1007/s10508-020-01834-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 05/14/2023]
Abstract
Although pre-exposure prophylaxis (PrEP) is a key tool in HIV prevention efforts, little is known about PrEP as a prevention strategy for criminal justice-involved (CJI) women. The purpose of this study was to examine multilevel factors shaping PrEP awareness and acceptability among CJI women. Between January 2017 and December 2017, we conducted 52 interviews with CJI women at high risk for HIV and stakeholders from the criminal justice (CJ) and public health (PH) systems. Interviews explored awareness of PrEP and the multilevel factors shaping PrEP acceptability. Data were analyzed using inductive thematic analysis and executive summaries. Atlas.ti facilitated analyses. The majority of CJI women (n = 27) were, on average, 41.3 years, from racial and ethnic minority groups (56% Black/African-American; 19% Latinx) and reported engaging in recent high-risk behavior (nearly 60% engaged in transactional sex, 22% reported ≥ 4 sexual partners, and 37% reported injection drug use). Of system stakeholders (n = 25), 52% represented the CJ sector. Although CJI women were generally unaware of PrEP, attitudes toward PrEP were enthusiastic. Barriers to PrEP acceptability included medication side effects (individual level); distrust in HIV prevention mechanisms (community level); lack of local HIV prevention efforts among high-risk women (public policy/HIV epidemic stage level). Factors promoting PrEP included perceived HIV risk (individual level); PrEP being an HIV prevention method that women can control without partner negotiation (social and sexual network level); and availability of public health insurance (community level). Despite low awareness of PrEP, CJI women expressed positive attitudes toward PrEP. To improve PrEP access for CJI women, implementation efforts should address barriers and leverage facilitators across multiple levels to be maximally effective.
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Affiliation(s)
- Emily F Dauria
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave., Bldg. 5, San Francisco, CA, 94110, USA.
| | - Andrew Levine
- Department of Sociology, New York University, New York, NY, USA
| | - Samantha V Hill
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave., Bldg. 5, San Francisco, CA, 94110, USA
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